WHETHERTHE STROKE is your own or that of a friend, parent,

child, spouse or loved one, your life is affected. Today there are
treatments that can reduce the risk of death or disability from stroke,
that`s why it`s so important to know the warning signs and to call
9-1-1 immediately if you or someone else experiences them.
4(%2% !2% -!.9 &!#%3 /& 342/+%

SUDDEN NUMBNESS OR WEAKNESS OF THE

FACE, ARM OR LEG, ESPECIALLY ON ONE SIDE
OF THE BODY

SUDDEN CONFUSION, TROUBLE SPEAKING OR

UNDERSTANDING

SUDDEN TROUBLE SEEING IN ONE OR BOTH EYES

SUDDEN TROUBLE WALKING, DIZZINESS, LOSS

OF BALANCE OR COORDINATION

SUDDEN, SEVERE HEADACHE WITH NO KNOWN CAUSE

THlS lS THE
FACE OF
A PERSON
AFFECTED BY
STROKE.
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Visit strokeassociation.org CaII 1-SSS-4STROKE
2005, American Heart Association 05/05 50-1562
whatdoctorsknow.com
On Call with Dr. Porter
Steve Porter, MD
Publisher and Chairman
Care and Commitment.
Need is the mother of invention. This is perhaps no more accurate than when, a little more
than 90 years ago, a polio epidemic was sweeping our country. Children were being afflicted
in frightening numbers and not only was care difficult to find, the disease left families
with no means to provide the necessary long-term care for their polio stricken children.
It was this need that prompted Shriners of North America, looking for
a cause, to establish a hospital in Shreveport, Louisiana to provide care
for these stricken children regardless of the ability to pay.
Being a parent is difficult enough. We all want our children to be perfect and when they sneeze
or cough, we oftentimes lament over the inconvenience of having to administer medicines for
a day or two or worse yet, deal with a child forced to stay home because of a cold or fever.
What happens when our childs illness turns out to be long term or debilitating? What
happens when dealing with a medical problem becomes a way of life? Worse yet, what
happens when you are faced with the inability to pay for your childs medical care?
Parents all over the world face such issues everyday and feel helpless during a time when their
children need them the most. It is in times like these that Shriners Hospitals step in to ease the
burden. Shriners offers medical care, hope and a helping hand and dont charge for their service.
When you read the Shriners story this month, you will marvel at the many services and
the many children the organization has helped over the years. We didnt know and when
we heard how caring Shriners has been over the years, we had to share their story.
Shriners is proud of their Care and Commitment. On behalf of the many families that
have been helped by the Care and Commitment of Shriners, we want to say thanks.
Enjoy the Shriners story in this months What Doctors Know
whatdoctorsknow.com
WHAT DOCTORS KNOW
And you should, too!
Health Hints
41 Take A Mental Health Day
44 Q&A About CF (Cystic Fibrosis)
46 Myth 4: Cancer is My Fate
48 Fatigue and Lupus
53 Itchy, Runny Nose
P16
Taking Control
10 Lets Talk Menopause
16 One Breath at a Time
26 Your Microbes and You
28 Get the Facts about Cystic Fibrosis
P48
whatdoctorsknow.com
Vol. 2 Issue 5
01 On Call With Dr. Porter
04 Medicine in the News
21 CDC Vital Signs:
Asthma in the US
42 HealthWatchMD: Gotta Go?
56 Know Your Specialist
Optician. Optometrist.
Ophthalmologist.
In Every Issue
Contents
32 Shriners Hospitals for
Children: Bringing Love
to the Rescue Since 1922
38 Online: Are My
Medicines Safe?
64 Are New Moms OCD?
On The Cover
P60
Inquiring Minds
54 More Mothers Are Breastfeeding
58 Basal Cell Skin Cancer
60 A Link Between Atherosclerosis
and Macular Degeneration?
62 Zit Face?
66 Excessive Spit Up Doesnt Mean Reflux
whatdoctorsknow.com
The Nebraska Medical Center celebrate 30 years
of cancer transplant program milestones
OMAHA, Neb. Since performing its first bone marrow
transplant on April 1, 1983, the University of Nebraska
Medical Center and its hospital partner, The Nebraska
Medical Center, have evolved into one of the leading bone
marrow/stem cell transplantation centers in the world.
The program has performed 4,460 transplants in
patients from all 50 states and more than a dozen
countries -- 4,043 transplants in
adults and 417 in children. Most
adults have sought the treatment for
cancers of the blood, in particular,
lymphoma, leukemia and multiple
myeloma. Pediatric transplants
normally are performed for patients
with more aggressive disease such as
for acute lymphoblastic leukemia.
We have an extraordinary team
dedicated to improving cancer treatment
and care. Their work has increased
survival substantially in patients, said
Julie Vose, M.D., chief of the UNMC
Division of Hematology/Oncology
and the Neumann M. and Mildred E.
Harris Professor. Through the efforts
of many, people now have access to
some of the best cancer treatment in
the world right here in Omaha.
The adult transplant program, which was founded by
Kearney, Neb., native, James Armitage, M.D., performed
its first bone marrow transplant on April 1, 1983,
while the pediatric transplant program was launched
in 1987 by Peter Coccia, M.D. Anne Kessinger, M.D.,
of Scribner, Neb., pioneered stem cell transplantation.
The therapy is now standard practice around the world.
We learn through our encounters
with patients and our clinical trials.
Our experience not only helps our
current patients but also will help
future patients five or 10 years down
the road. In oncology, everything
we do is based on research, Dr.
Vose said. Were excited to take
the next step to advance our
work for better treatments and
improve the quality of life for
those with cancer, Dr. Vose said.
Its reassuring to be able to see
patients over the years and help
them through their illness. Theres
nothing better than seeing them
return to a normal, healthy lifestyle
and have time with their families.
For more information visit:
www.unmc.edu/transplant.
whatdoctorsknow.com
Researchers find a way to
predict the date of a woman's
final menstrual period
Stem cell injections may relieve arthritis pain
ATLANTA, Ga. Emory Orthopaedics
& Spine Center is offering a
cutting edge stem cell treatment
for Osteoarthritis (OA).
The procedure involves extracting stem cell
blood from the bone marrow in a patient's
hip, removing the plasma, concentrating
the remaining fluid in a centrifuge, and
then injecting the concoction directly
into the damaged joint. Because the
material is a patient's own, there is
little chance the body will reject it.
Kenneth Mautner, an assistant professor
in the Department of Orthopaedics at
Emory University School of Medicine,
is excited by the stem cell therapy.
"There are only so many non-surgical
options that are available," says Mautner.
"In the past we've done cortical steroid
injections, which can give short-
term relief for pain, but oftentimes
the pain comes back, and it actually
can worsen the problem over time."
Stem cells have the ability to develop
into many different kinds of cells the
body uses, such as new cartilage.
"We hope that by placing an abundance
of those cells directly in the area that's
deficient, healthier cells will grow."
Osteoarthritis is one of the oldest
and most common forms of arthritis,
and is characterized by an erosion of
the protective cartilage in joints. As
cartilage wears down, bones can rub
against one another causing pain,
stiffness and a loss of mobility. Load-
bearing joints such as the knees and
hips are often the first to feel the
ravages of the disease. While the exact
cause of OA is not known, factors such
as age, obesity, injury and genetics
all play a role in its progression.
LOS ANGELES, Calif. A new UCLA-
led study suggests a way to predict
when a woman will have her final
menstrual period. The findings,
published in the April issue of the
peer-reviewed Journal of Clinical
Endocrinology and Metabolism,
could help women and physicians
gauge the onset of menopause-related
bone loss, which generally begins
a year prior to the last period.
The researchers used women's ages,
menstrual bleeding patterns and
measurements of hormone levels to
estimate the amount of time until they
were likely to reach menopause, said the
study's lead author, Dr. Gail Greendale,
professor of medicine in the division
of geriatrics at the David Geffen
School of Medicine at UCLA.
Greendale said women who are
approaching menopause often ask
their health care providers when
they will be done with their periods,
but the information is sometimes
more telling than women realize.
"Being able to estimate when the
final menstrual period will take
place has taken on importance
beyond just helping women
gauge when they will stop having
periods," she said. "We know that
potentially deleterious physiological
developments, such as the onset
of bone loss and an increase in
cardiovascular risk factors, precede
the final menses by at least a year."
The study found that the levels of
the two hormones could be used
to estimate whether women were
within two years of beginning their
final menstrual period, within one
year or beyond their final period.
whatdoctorsknow.com
Study Shows Children at Risk for
Schizophrenia have Different Brain Functions
CHAPEL HILL, N.C. Research from the University
of North Carolina has shown that children at
risk of developing schizophrenia have brains that
function differently than those not at risk.
Brain scans of children who have parents or siblings
with the illness reveal a neural circuitry that is
hyperactivated or stressed by tasks that peers with no
family history of the illness seem to handle with ease.
Because these differences in brain functioning appear
before neuropsychiatric symptoms such as trouble
focusing, paranoid beliefs, or hallucinations, the scientists
believe that the finding could point to early warning
signs or vulnerability markers for schizophrenia.
Individuals who have a first-degree family member
with schizophrenia have an 8-fold to 12-fold increased
risk of developing the disease. However, there is no
way of knowing for certain who will become
schizophrenic until symptoms arise and a
diagnosis is reached. Some of the earliest signs
of schizophrenia are a decline in verbal memory,
IQ, and other mental functions, which
researchers believe stem from an inefficiency
in cortical processing the brains
waning ability to tackle complex tasks.
The study found circuitry involved in
emotion and higher order decision-
making was hyperactivated in
individuals with a family history of
schizophrenia, suggesting that the
task was stressing out these areas of
the brain in the study subjects.
This finding shows that
these regions are not
activating normally, said
senior study author Aysenil
Belger, PhD, associate
professor of psychiatry at the
UNC School of Medicine. We
think that this hyperactivation
eventually damages these
specific areas in the brain to
the point that they become
hypoactivated in patients, meaning that when the
brain is asked to go into high gear it no longer can.
Belger is currently exploring what kind of role stress
plays in the changing mental capacity of adolescents
at high risk of developing schizophrenia. Though
only a fraction of these individuals will be diagnosed
with schizophrenia, Belger thinks it is important to
pinpoint the most vulnerable people early to explore
interventions that may stave off the mental illness.
The U.S. remains on track to have the most
reported pertussis cases since 1959, with more
than 32,000 cases already reported along with 16
deaths, the majority of which are in infants.
whatdoctorsknow.com
Lactate may protect diabetics
against complications
of hypoglycemia
Study finds saliva testing predicts aggression in boys
The Yale team investigated alternates
to glucose as fuel sources for the
brain to find out if they can help
diabetics achieve the necessary tight
glycemic control. They infused rodents
with lactate and measured levels of
indicative chemicals in their brains.
Their results show that lactate helped
the animals maintain normal levels of
glucose during bouts of hypoglycemia,
and helped reverse symptoms associated
with acute hypoglycemic attacks.
There may be implications in this study
for human diabetics. Our findings
help us understand how brain energy
NEW HAVEN, Conn. Providing the
brain with lactate and potentially
other fuels may protect diabetics
against life-threatening bouts of
hypoglycemia, a Yale study has found.
Both type 1 and type 2 diabetics must
tightly control their blood glucose levels
to prevent long-term complications
of the disease. But the intensive daily
regimen of insulin that is required
may often result in severe episodes
of hypoglycemia, or dangerously low
blood sugar levels. Such episodes may
occur without warning or during
sleep, and can lead to brain damage,
cognitive impairment, or even death.
metabolism is altered in the context of
hypoglycemia, explained first author
Raimund Herzog, assistant professor
of endocrinology at Yale School of
Medicine. This study will now guide us
in the design of therapies that protect the
brain from hypoglycemic injury, thereby
permitting tighter control of glucose
levels via intensive insulin treatment.
CINCINATTI, Ohio A new study
indicates that a simple saliva
test could be an effective tool in
predicting violent behavior.
The pilot study, led by Cincinnati
Childrens Hospital Medical
Center, suggests a link between
salivary concentrations of certain
hormones and aggression.
Researchers, led by Drew Barzman,
MD, a child and adolescent forensic
psychiatrist at Cincinnati
Childrens, collected saliva
samples from 17 boys ages 7
9 admitted to the hospital for
psychiatric care to identify which
children were most likely to
show aggression and violence.
The samples, collected three
times in one day shortly after
admission, were tested for levels
of three hormones: testosterone,
dehydroepiandrosterone (DHEA)
and cortisol. The severity and
frequency of aggression correlated
with the levels of these hormones.
Barzmans team focused on rapid, real-
time assessment of violence among
child and adolescent inpatients, a
common problem in psychiatric
units. But he believes a fast and
accurate saliva test could eventually
have several other applications.
We believe salivary hormone testing
has the potential to help doctors
monitor which treatments are
working best for their patients, said
Barzman. And because mental health
professionals are far more likely to be
assaulted on the job than the average
worker, it could offer a quick way to
anticipate violent behavior in child
psychiatric units. Eventually, we hope
this testing might also provide a tool
to help improve safety in schools.
For this study, the saliva test was used
in combination with other aggressive
behavior tools, including the Brief
Rating of Aggression by Children and
Adolescents (BRACHA) questionnaire,
an assessment tool also
developed by Barzmans
team to predict aggression
and violence in the hospital.
This study sample, while
small, gives us the data we
need to move forward,
added Barzman. We have
more studies planned before
we can reach a definitive
conclusion, but developing
a new tool to help us
anticipate violent behavior
is our ultimate goal.
whatdoctorsknow.com
Ten Presidents Have Suffered Strokes
ECG Screening Can Help Identify
Cardiovascular Risks in Adolescents
MIAMI, Fla. A combination of
screening methods, including
electrocardiography (ECG), blood
pressure and body mass index
(BMI), can identify adolescents at
risk for heart disease, according to a
groundbreaking University of Miami
Miller School of Medicine study
led by Steven E. Lipshultz, M.D.,
professor of pediatrics, the George
Batchelor Endowed Chair in Pediatric
Cardiology, and Director of the
Batchelor Childrens Research Institute.
After screening 600 students in
grades 9-12 in seven metropolitan
Tampa high schools, Lipshultz and his
research team found 14 percent of the
adolescents had borderline or abnormal
ECGs including two students
whose ECG screenings indicated
a heart problem that could lead to
sudden cardiac death. In addition,
nearly 40 percent of the students
screened met the criteria for either
systolic or diastolic prehypertension
or hypertension, and 25 percent were
classified as overweight or obese.
The risk of premature cardiovascular
disease during the teenage years, as
indicated by an abnormal ECG, is
much higher than anticipated, said
Lipshultz. This shows the importance
of large-scale screening to identify
adolescents who appear healthy, but
whose hearts may have already been
adversely affected by obesity, high
blood pressure and other problems.
It is far more cost-effective to reduce
cardiovascular risk factors in an
adolescent than to wait 20 years and
provide expensive emergency care
to an adult after a heart attack.
In reviewing the screening factors, the
Miller School researchers found that 31
percent of all teens had one risk factor
for cardiovascular disease an abnormal
ECG, an elevated blood pressure or an
elevated body mass index. In addition,
15 percent had two risk factors, and
4 percent had three risk factors.
For teens with three risk factors, the
prevalence of borderline or abnormal ECGs
consistent with possible early heart disease
was very concerning at 26.9 percent,
said Lipshultz. This study suggests that
there are a high number of teens with
cardiovascular abnormalities who could
benefit from counseling and interventions
to reduce the risk of future heart problems.
Overall, 50 percent of the screened
students had one or more abnormal risk
factors for premature cardiovascular
disease. However, when BMI and
blood pressure results were both
normal, there was a low chance that
the heart was adversely affected with an
abnormal ECG, according to Lipshultz.
MAYWOOD, Ill. Ten of the nation's
44 presidents likely suffered strokes
during their presidencies or after
leaving office, according to Dr.
Jos Biller, a Loyola University
Medical Center neurologist.
Woodrow Wilson was so incapacitated
by a series of strokes that his wife,
Edith, became the virtual acting
president. Franklin Roosevelt died of
a massive stroke on April 12, 1945,
leaving the presidency to an unprepared
Harry Truman just as World War II
was ending. And in 2000, former
President Gerald Ford began slurring
his words during a TV interview.
"Strokes affect the brain. And
everything we do - from simple motor
functions to more complex behaviors
such as planning, reasoning and
judgment - is brain-related," Biller said.
"When a stroke affects a president, it
can have a major impact not only on
the individual, but on the world."
Biller said the afflicted presidents had
several stroke risk factors in common.
Being men, they were more likely than
women to suffer strokes. Seven of the 10
presidents were older than 65 when they
suffered strokes. And, of course, the
presidency is an extremely stressful job.
Plus, some of the presidents who
suffered strokes had unhealthy
lifestyles. Chester Arthur was obese and
got little exercise. Franklin Roosevelt
was a heavy smoker. Andrew Johnson
may have abused alcohol. Wilson and
Dwight Eisenhower suffered nonfatal
strokes while in office. (Unlike Wilson,
Ike did not suffer serious disabilities).
Seven presidents - John Tyler, Millard
Fillmore, John Quincy Adams,
Andrew Johnson, Chester Arthur,
Richard Nixon and Gerald Ford -
suffered strokes after leaving office.
What happens if a president suffers
a debilitating stroke while in office?
The 25th Amendment to the
Constitution provides a mechanism
for the vice president to become acting
president should the president be
unable to perform his or her duties.
Stroke treatments have significantly
improved in recent years. And the
sooner a patient arrives at the hospital,
the better the outcome, Biller said.
whatdoctorsknow.com
WHAT DOCTORS KNOW
And you should, too!
Published by
What Doctors Know, LLC
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Steve Porter, MD
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Let's Talk
Menopause
What is menopause?
Menopause is the point in time when a woman's menstrual
periods stop. Some people call the years leading up
to a woman's last period "menopause," but that time
actually is perimenopause (PER-ee-MEN-oh-pawz).
Periods can stop for a while and then start again, so a woman is
considered to have been through menopause only after a full year
without periods. (There also cant be some other reason for the
periods stopping like being sick or pregnant.) After menopause,
a woman no longer can get pregnant. It is common to experience
symptoms such as hot flashes in the time around menopause.
The average age of menopause is 51, but for some women it
happens in their 40s or later in their 50s. Sometimes called
the change of life, menopause is a normal part of life.
Visit http://www.womenshealth.gov/
menopause to get more information
and a chart for tracking your symptoms
in our special section on menopause.
Practice Safe Sex
After a year without a period, you cannot get
pregnant. But unsafe sex could still put you at
risk for sexually transmitted infections (STIs).
What is perimenopause?
Perimenopause (PER-ee-MEN-oh-
pawz), which is sometimes called "the
menopausal transition," is the time
leading up to a woman's last period.
During this time a woman will have
changes in her levels of the hormones
estrogen (ES-truh-jin) and progesterone
(proh-JES-tuh-RONE). These changes
may cause symptoms like hot flashes. Some
symptoms can last for months or years after a
womans period stops. After menopause, a woman
is in postmenopause, which lasts the rest of her life.
whatdoctorsknow.com
What symptoms might I have before
and after menopause?
The hormone changes that happen around
menopause affect every woman differently.
Also, symptoms sometimes are not caused by
menopause but by other aspects of aging instead.
Some changes that might start in the
years around menopause include:
Irregular periods. Your periods may:
o Come more often or less often
o Last more days or fewer
o Be lighter or heavier
Hot flashes (or flushes). These can cause:
o Sudden feelings of heat all over or in
the upper part of your body
o Flushing of your face and neck
o Red blotches on your chest, back, and arms
o Heavy sweating and cold shivering after the flash
Trouble sleeping. You may have:
o Trouble sleeping through the night
o Night sweats (hot flashes that make
you sweat while you sleep)
Vaginal and urinary problems. Changing
hormone levels can lead to:
o Drier and thinner vaginal tissue, which
can make sex uncomfortable
o More infections in the vagina
o More urinary tract infections
o Not being able to hold your urine long enough
to get to the bathroom (urinary incontinence)
Mood changes. You might:
o Have mood swings (which are not
the same as depression)
o Cry more often
o Feel crabby
Changing feelings about sex. You might:
o Feel less interested in sex
o Feel more comfortable with your sexuality
Other changes. Some other possible changes at
this time (either from lower levels of hormones
or just from getting older) include:
o Forgetfulness or trouble focusing
o Losing muscle, gaining fat, and having a larger waist
o Feeling stiff or achy
How will I know when I am nearing menopause?
Symptoms, a physical exam, and your medical history can
provide clues that you are in perimenopause. Your doctor
also could test the amount of hormones in your blood.
But hormones go up and down during your menstrual
cycle, so these tests alone cant tell for sure that you have
gone through menopause or are getting close to it.
How can I manage symptoms of menopause?
It is not necessary to get treatment for your symptoms
unless they are bothering you. You can learn
about simple lifestyle changes that may help with
symptoms, and some symptoms will go away on
their own. If youre interested in medical treatments
like menopausal hormone therapy (MHT), ask
your doctor about the possible risks and benefits.
Here are some ways to deal with symptoms:
Hot flashes
Try to avoid things that may trigger hot flashes, like spicy
foods, alcohol, caffeine, stress, or being in a hot place.
Dress in layers, and remove some
when you feel a flash starting.
Use a fan in your home or workplace.
Try taking slow, deep breaths when a hot flash starts.
If you still get periods, ask your doctor about low-dose
oral contraceptives (birth control pills), which may help.
Some women can take menopausal hormone
therapy (MHT), which can be very effective
in treating hot flashes and night sweats.
If MHT is not an option, your doctor may prescribe
medications that usually are used for other conditions,
like epilepsy, depression, and high blood pressure,
but that have been shown to help with hot flashes.
Vaginal dryness
A water-based, over-the-counter vaginal lubricant
like K-Y Jelly can help make sex more comfortable.
An over-the-counter vaginal moisturizer like Replens
can help keep needed moisture in your vagina.
The most effective treatment may be MHT if the
dryness is severe. But if dryness is the only reason for
considering MHT, vaginal estrogen products like
creams generally are a better choice.
Problems sleeping
Be physically active (but not too
close to bedtime, since exercise
might make you more awake).
Avoid large meals,
smoking, and working
right before bed.
Avoid caffeine
after noon.
Keep your
bedroom dark,
quiet, and
cool. Use your
bedroom
only for sleep
and sex.
When to see a doctor
Do not assume that if you miss a couple of periods
the cause is menopause. See your doctor to find
out if pregnancy or a health problem could be the
cause. Also see your doctor if you have not had
a period for a year and then start "spotting."
whatdoctorsknow.com
Avoid napping during the day.
Try to go to bed and get up at the same times every day.
If you can't get to sleep, get up and read until youre tired.
If hot flashes are the cause of sleep problems,
treating the hot flashes usually will help.
Mood swings
Try getting enough sleep and staying
physically active to feel your best.
Talk to your doctor to see if you may have
depression, which is a serious illness.
Consider seeing a therapist or joining a support group.
If you are using MHT for hot flashes or
another menopause symptom, your
mood swings may get better too.
Memory problems
Getting enough sleep and keeping
physically active may help.
If forgetfulness or other mental problems are
affecting your daily life, see your doctor.
Urinary incontinence
Ask your doctor about treatments, including medicines,
behavioral changes, certain devices, and surgery.
Does menopause cause bone loss?
Lower estrogen around the time of menopause leads
to bone loss in women. Bone loss can cause bones
to weaken, which can cause bones to break more
easily. When bones weaken a lot, the condition is
called osteoporosis (OSS-tee-oh-puh-ROH-suhss).
To keep your bones strong, women need weight-
bearing exercise, such as walking, climbing stairs,
or using weights. You can also protect bone health
by eating foods rich in calcium and vitamin D, or if
needed, taking calcium and vitamin D supplements.
Not smoking also helps protect your bones.
Ask your doctor if you need a bone density
test. Your doctor can also suggest ways
to prevent or treat osteoporosis.
Does menopause raise my chances of
getting cardiovascular disease?
Yes. After menopause, women are more likely to have
cardiovascular (kar-dee-oh-VAS-kuh-lur) problems,
like heart attacks and strokes. Changes in estrogen
levels may be part of the cause, but so is getting
older. That's because as you get older, you may gain
weight and develop other health problems that
increase your risk of cardiovascular disease (CVD).
Ask your doctor about important tests like
those for cholesterol and high blood pressure.
Discuss ways to prevent CVD. The following
lifestyle changes also can help prevent CVD:
Not smoking and avoiding secondhand smoke
Exercising
Following a healthy diet
Can menopausal hormone therapy
(MHT) help treat my symptoms?
MHT, which used to be called hormone replacement
therapy (HRT), involves taking the hormones
estrogen and progesterone. (Women who dont have
a uterus anymore take just estrogen). MHT can be
very good at relieving moderate to severe menopausal
symptoms and preventing bone loss. But MHT also
has some risks, especially if used for a long time.
MHT can help with menopause by:
Reducing hot flashes and night sweats, and related
problems such as poor sleep and irritability
Treating vaginal symptoms, such as
dryness and discomfort, and related
problems, such as pain during sex
Slowing bone loss
Possibly easing mood swings and mild depressive mood
For some women, MHT may increase their chance of:
Blood clots
Heart attack
Stroke
Breast cancer
Gall bladder disease
Research into the risks and benefits of MHT continues.
For example, a recent study suggests that the low-dose
patch form of MHT may not have the possible risk of
stroke that other forms can have. Talk with your doctor
about the positives and negatives of MHT based on your
medical history and age. Keep in mind, too, that you
may have symptoms when you stop MHT. You can also
MHT is not an antidepressant.
If you are having signs of
depression, ask your doctor about
other treatments that can help.
whatdoctorsknow.com
ask about other treatment options. Lower-dose estrogen
products (vaginal creams, rings, and tablets) are a good
choice if you are bothered only by vaginal symptoms,
for example. And other drugs may help with bone loss.
If you choose MHT, experts recommend that you:
Use it at the lowest dose that helps
Use it for the shortest time needed
If you take MHT, call your doctor if you
develop any of the following side effects:
Vaginal bleeding
Bloating
Breast tenderness or swelling
Headaches
Mood changes
Nausea
Who should not take MHT for menopause?
Women who:
Think they are pregnant
Have problems with undiagnosed vaginal bleeding
Have had certain kinds of cancers (such
as breast or uterine cancer)
Have had a stroke or heart attack
Have had blood clots
Have liver disease
Have heart disease
Can MHT prevent heart disease
or Alzheimer's disease?
A major study called the Womens Health Initiative
(WHI) has looked at the effects of MHT on
heart disease and other health concerns. It has
explored many questions relating to MHT,
including whether MHTs effects are different
depending on when a woman starts it.
Future research may tell experts even more about
MHT. For now, MHT should not be used to
prevent heart disease, memory loss, dementia, or
Alzheimers disease. MHT sometimes is used to
treat bone loss and menopausal symptoms.
Are there natural treatments for my symptoms?
Some women try herbs or other products that come
from plants to help relieve hot flashes. These include:
Soy. Soy contains phytoestrogens (FEYE-toh-ESS-truh-
juhns). These are substances from a plant that may act
like the estrogen your body makes. There is no clear
proof that soy or other sources of phytoestrogens
make hot flashes better. And the risks of taking soy
products like pills and powders are not known. If
you are going to try soy, the best sources are foods
such as tofu, tempeh, soymilk, and soy nuts.
Other sources of phytoestrogens. These include
herbs such as black cohosh, wild yam, dong quai,
and valerian root. There is not enough evidence that
these herbs or pills or creams containing these
herbs help with hot flashes. Also, not enough is
known about the risks of using these products.
Make sure to discuss any natural or herbal products
with your doctor before taking them. Its also
important to tell your doctor about all medicines
you are taking. Some plant products or foods can be
harmful when combined with certain medications.
What is "bioidentical" hormone therapy?
Bioidentical hormone therapy (BHT) means manmade
hormones that are the same as the hormones the
body makes. There are several prescription BHT
products that are well-tested and approved by the
U.S. Food and Drug Administration (FDA).
Often, people use the term BHT to mean medications
that are custom-made by a pharmacist for a specific
patient based on a doctors order. These custom-
made products are also sometimes called bioidentical
hormone replacement therapy (BHRT). Despite claims,
there is no proof that these products are better or
safer than drugs approved by the FDA. Also, many
insurance and prescription programs do not pay for
these drugs because they are viewed as experimental.
How much physical activity do I need
as I approach menopause?
Physical activity helps many areas of your life,
including mood, sleep, and heart health. Aim for:
At least 2 hours and 30 minutes a week of
moderate aerobic physical activity or 1 hour
and 15 minutes of vigorous aerobic activity
or some combination of the two
Exercises that build muscle strength
on two days each week
If you are not able to follow these guidelines,
be as physically active as you can. Your doctor
can help you decide whats right for you.
Visit http://www.womenshealth.gov/
FitnessNutrition for related information
on staying active and eating healthy.
whatdoctorsknow.com
Do I need a special diet as I approach menopause?
A balanced diet will give you most of what
your body needs to stay healthy. Here
are a few special points to consider:
Older people need just as many nutrients but
tend to need fewer calories for energy.
Women over 50 need 2.4 micrograms
(mcg) of vitamin B12 and 1.5 milligrams
of vitamin B6 each day. Ask your doctor
if you need a vitamin supplement.
After menopause, a woman's calcium needs go
up to maintain bone health. Women 51 and older
should get 1,200 milligrams (mg) of calcium each
day. Vitamin D also is important to bone health.
Women 51 to 70 should get 600 international
units (IU) of vitamin D each day. Women ages 71
and older need 800 IU of vitamin D each day.
Women past menopause who are
still having vaginal bleeding because
they are using menopausal hormone
therapy might need extra iron.
I'm having a hysterectomy soon.
Will this cause menopause?
A woman who has a hysterectomy (his-tur-EK-
tuh-mee) but keeps her ovaries does not have
menopause right away. Because your uterus is
removed, you no longer have periods and cannot
get pregnant. But your ovaries might still make
hormones, so you might not have other signs of
menopause. You may have hot flashes because the
surgery may affect the blood supply to the ovaries.
Later on, you might have natural menopause
a year or two earlier than usually expected.
A woman who has both ovaries removed at the same
time that the hysterectomy is done has menopause
right away. Having both ovaries removed is called a
bilateral oophorectomy (OH-uh-fuh-REK-tuh-mee).
Women who have this operation no longer have
periods and may have menopausal
symptoms right away. Because
your hormones drop quickly, your
symptoms may be stronger than with
natural menopause. If you are having
this surgery, ask your doctor about
how to manage your symptoms.
Menopause that is caused by surgery
also puts you at risk for certain
conditions, such as bone loss and
heart disease. Ask your doctor about
possible steps, including MHT,
to help prevent these problems.
What if I have symptoms of
menopause before age 40?
Some women have symptoms of
menopause and stop having their
periods much earlier than expected. This can
happen for no clear reason, or it can be caused by:
Medical treatments, such as surgery
to remove the ovaries
Cancer treatments that damage the ovaries such
as chemotherapy or radiation to the pelvic area
although menopause does not always occur
An immune system problem in which a
womans own body cells attack her ovaries
When menopause comes early on its own,
it sometimes has been called premature
menopause or premature ovarian failure. A
better term is primary ovarian insufficiency,
which describes the decreased activity in the
ovaries. In some cases, women have ovaries that
still make hormones from time to time, and
their menstrual periods return. Some women
can even become pregnant after the diagnosis.
For women who want to have children and
cant, early menopause can be a source of great
distress. Women who want to become mothers
can talk with their doctors about other options,
such as donor egg programs or adoption.
Early menopause raises your risk of certain health
problems, such as heart disease and osteoporosis.
Talk to your doctor about ways to protect your
health. You might ask about menopausal hormone
therapy (MHT). Some researchers think the risks
of MHT for younger women might be smaller and
the benefits greater than for women who begin
MHT at or after the typical age of menopause.
Let your doctor know if you are younger than 40 and
have symptoms of menopause. -This information
provided courtesy of U.S. Department of Health
and Human Services, Office on Women's Health
More information on menopause and menopause treatments
For more information about menopause and menopause
treatments, call womenshealth.gov at 800-994-9662 (TDD:
888-220-5446) or contact the following organizations:
Food and Drug Administration, HHS
Phone: 888-463-6332
National Center for Complementary and Alternative Medicine
Phone: 888-644-6226 (TDD: 866-464-3615)
National Institute on Aging, NIH, HHS
Phone: 301-496-1752 (TDD: 800-222-2225)
The Hormone Foundation
Phone: 800-467-6663
The North American Menopause Society
Phone: 440-442-7550
A liver transplant gave
Sonia
her life back.
In the fall of 1996, Sonia was
diagnosed with end stage liver
disease. The most difficult thing
for her to accept was that she was
no longer able to drive herself.
Now she is driving again and has
taken up a new hobby, making
rosary beads which are distributed
to people around the world.
You have the power to Donate Life.
Be an organ, eye and tissue donor.
To find out how, go today to www.donatelife.net
or call 1-800-485-7427.
One
Breath At
A Time
A
s a young NFL quarterback, Boomer
Esiason became involved in the cystic
fibrosis cause. He had been at a banquet
and heard a grieving father talk
about the disease and was moved.
In 1991, not long after Boomer had
attended that banquet, his wife Cheryl gave birth
to the couples son Gunnar. As fate would have
it, Gunnar was diagnosed with cystic fibrosis.
For someone making a living trying to avoid being
knocked on your back by savage defenders every Sunday
and having to get back up quicklythis news knocked
Esiason down harder and hurt a lot more. It had crossed
his mind to quit football altogether and dedicate more
time to his son and to fighting the disease. Thankfully,
he realized he could use Super Star status to help Gunnar
and the thousands of others afflicted by the disease.
The Numbers
About 30,000 people in the United States are affected
by cystic fibrosis (CF), and about 1,000 babies are
diagnosed with it each year. It occurs mainly in
Caucasians, who have a northern European heredity,
although it does occur in African-Americans,
Asian Americans, and Native Americans.
CF causes the body to produce unusually thick,
sticky mucus that clogs the lungs and obstructs the
pancreas and stops enzymes from helping the body
break down and absorb food. Patients are prone to
infections and progressively lose the ability to breathe.
Approximately one in 31 people in the US are carriers
of the cystic fibrosis gene. Fortunately, the disease
does not affect these people and most of those in this
group dont know they are carriers of the gene.
One Breath At A Time
According to a 2008 study, the median survival
age for someone with cystic fibrosis has gone up
from six months in 1959 to a median age of 37.8
in 2008. While this is remarkable, its not enough
for those afflicted with the disease. They dont
want to face a time clock. They want a cure.
Living with Cystic Fibrosis
whatdoctorsknow.com
The First Step
In 1993, Esiason launched the Boomer Esiason
Foundation. Knowing he was in for a battle, Boomer
realized he couldnt fight this one alone. He needed
to pick a team and he needed each member to
be as passionate and dedicated to the cause as a
man with a son fighting to breathe another day.
His first round pick was his former center with
the Bengals, Dave Rimington, who was working
for an import-export business in Hong Kong.
Esiason simply told Rimington, "I could use a hand,
buddy." Rimington returned to the states and helped
launch the foundation. Football had now taken a back
seat to Esiasons new goal: being outlived by his son.
According to the foundation, the organization is a dynamic
partnership of leaders in the medical and business
communities joining with a committed core of volunteers
to heighten awareness, education and quality of life for
those affected by CF, while providing financial support to
research aimed at finding a cure. Since its inception, the
Boomer Esiason Foundation has raised more than $100
million to support research toward a cure for CF, as well
as programs directly benefiting the CF community.
Esiason continues to attack the disease head-
on and helps bring CF to the forefront of policy
discussions throughout the country. He has traveled
to Capitol Hill on multiple occasions and to various
states to speak on behalf of the CF community.
whatdoctorsknow.com
whatdoctorsknow.com
The Accidental Poster Child for Cystic Fibrosis
In 1993, Boomer Esiason and son Gunnar graced
the cover of Sports Illustrated. While Boomer merely
intended to go public with his crusade to fight CF, the
heart stealing photo of a smiling cherub on his dads
shoulders made Gunnar the unofficial poster child for
the disease. Twenty years later, Gunnar has embraced
that role with the style and a matter of fact attitude.
I guess I am the unofficial poster child for the disease
and I dont mind, he says. I enjoy helping people
understand the disease and help them get the most out
of life. I find that too often people are scared to
share the disease and sometimes they
use it as a crutch. Thats
unfortunate.
I try to be as normal as possible and show others
you can live with the disease and succeed in life.
Dont let the disease take control of your life.
Part of living with the disease sometimes means
educating others who arent affected about what
it means to live with CF. An English major in his
senior year, he plans to take a year off to work
for the foundation, doing some public speaking
and educating others about the disease. Then he
plans to head back to college for a law degree.
When Gunnar decided he wanted to
leave home for college, his mother
Cheryl wasnt happy. Living with CF
means a clean environment and the
typical college dorm is far from the
good housekeeping seal of approval.
Consider that with the lifestyle
of a typical male college student
and it was a recipe for disaster.
It took some convincing.
Going away to college was a
big step for Gunnar as well.
His choices were limited to a
college that had to be located
close to medical facilities
experienced in dealing
with CF. He chose Boston
college because of Boston
Childrens Hospital and
the Dana Farber Hospital
being minutes away. That
made his mother a little
more comfortable, but
she also liked the idea
that he was only a little
more than three hour
drive from home. Of
course, the choice
of Boston was easy
for Gunnar since it
is a huge hockey
school, one of his
favorite sports.
I understood
my moms
concerns,
Gunnar
noted. But I
have always
known the
steps I have
to take
and the
whatdoctorsknow.com
precautions necessary to live as normal as possible
with the disease. And Im used to educating people
about the disease. I sat down with my roommates and
laid out the rules. We have bottles of hand sanitizer
all over our dorm, they all got flu shots, we keep the
apartment clean and when one of my roommates get
sick, they automatically quarantine themselves.
Now in his senior year at Boston College, Gunnars
roommates are used to his daily routines of a
nebulizer, vibrating vests and medication.
Gunnars outlook on the disease is a reflection of todays
approach to living with CF. In the beginnings, those
affected were told to avoid activity. Modern day medicine
says the key to enjoying life with CF, is to be active and
strengthen the lungs. A stronger body can fight harder.
Being active and loving sports has always been
a part of his life. Not because of his fathers
legendary status, he has just loved sports.
In high school I played organized sports football,
lacrosse, and hockey. Hockey was my favorite, he
points out. I try to reassure everyone who is affected
by this disease that CF isnt the end of the world if
you dont want it to be. That has been my main goal.
It may surprise many that Gunnar has been so
active athletically. Given contemporary treatments
and the success in the battle against CF, he merely
is demonstrating how understanding the disease
and knowing your limitations can go a long way.
He knows the signs of being in trouble and calls
his doctors. Knows when to head to a hospital for
treatments and he keeps educated on medications and
advancements in the fight against CF. Most importantly,
he says being compliant with your treatment plan
is a necessary part of life. Being told you or a loved
one has a serious disease can be difficult and life
changing. But it doesnt have to stop your life.
Changing the Outlook
The median age of survival for CF patients has increased
to more than 37 years far more encouraging than
the six-month life expectancy in the 50s. Along with
this good news, comes the need to focus on CF
patients who are living well into their adult years.
With Gunnar growing into adulthood, the Esiasons
have added the focus of bridging the gap between
pediatric and adult CF care. With the life expectancy
expanding, the research efforts have to adjust as well.
Part of bridging that gap and addressing this new
milestone for the disease, The Boomer Esiason
Foundation granted Columbia University Medical
Center $6 million to establish the Gunnar Esiason
Adult Cystic Fibrosis and Lung Program in 2009.
The Gunnar Esiason Adult Cystic Fibrosis and
Lung Program offers a comprehensive approach
to diagnosis and treatment of CF in adults, with
specific attention to transition of patients from the
pediatric to adult health care system. The program
pursues innovative clinical and basic research, trains
future experts in the care and study of adult CF, and
provides patient education and outreach programs.
Another support program the Foundation funds is
the Lung Transplant Grant Program that financially
assists families with travel, relocation, and rehabilitation
costs that are not incurred by insurance companies.
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whatdoctorsknow.com 0
Last year, the Foundation provided more than
$100,000 to families in transplant grants alone.
In plain terms, Esiason and the Foundation have
instituted several educational, awareness and compliance
programs aimed at the growing adult CF population.
The Adult Version of the Cystic Fibrosis Poster Child
Meet Jerry Cahill
Jerry Cahill is the senior version of Gunnar Esiason.
He has volunteered at the Foundation since 2004
and he plays an integral role in all Boomer Esiason
Foundation efforts in the CF community.
Jerry, 56 years old and living with CF, heads up
the Boomer Esiason Foundation scholarship and
transplant grant programs, and he hosts a podcast
series and the CF Wind Sprint video series. Under
his leadership, the Foundation launched the
Exercise For Life Scholarship and Team Boomer-
Fighting Cystic Fibrosis athletic program.
Cahill is another example of how being compliant
allows you to live life with CF. Prior to joining
the foundation, he spent 27 years working in sales
and management in the apparel industry until
the need for a double lung transplant ended his
apparel career, but it didnt stop him from living.
A lifelong athlete, Cahill competed in the pole vault
for the University of Connecticut and New York
Athletic Club, including a personal of best 16 feet,
10 3/4 inches. He is living, breathing proof that
people living with CF can have a fulfilling life.
On April 18, 2012, Jerry received a life-saving double
lung transplant and ran in Boomer's CF Run to
Breathe only three months later. Cahill coaches pole
vaulting for a New York high school, runs and bikes
and hosts a series of podcasts for those with CF.
In the athletic world, it is said: Those who can,
do. Those who cant, teach. Jerry Cahill, much like
Gunnar Esiason breaks the mold. They both do. They
both teach, and they both raise the bar on living with
CF. Maybe it would be better said that they eliminate
the bar because the individual sets the standards.
In spite of having a double lung transplant, Cahill
continues living and teaching. Gunnar sets his life goals
and lives. Dealing with medications, treatments, etc., to
be compliant are just part of life. As Gunnar says, you
have to get into a routine. Its just a part of the day.
Team Boomer, created by Cahill, encourages people
with CF and those who support the CF community
to exercise, a proven medical protocol that extends
the lives of CF patients. Team Boomer not only
encourages exercise but also provides an avenue by
which individual athletes can raise money to support
the CF community. The program sponsors and
participates in numerous athletic events, including
Boomers Cystic Fibrosis Run to Breathe 10K,
which is held in Central Park in New York City.
You Cannot Fail, the newest program at the
Foundation, which was also created by Jerry Cahill,
is a multi-platform initiative designed to motivate,
inspire, and aid those with CF and any others
facing seemingly insurmountable difficulties.
Progress
The Boomer Esiason Foundation is driven. Driven
to find a cure and determined to help those with
CF understand you can live with the disease and
succeed. Most importantly, the foundation
from Boomer, to Gunnar to Cahill to every
member of the staffwants those with CF know
they arent alone. Progress is being made.
Advancements are being made, new drugs are being
developed and the life expectancy rises everyday.
While the medical community works toward a cure,
foundations continue to raise awareness and funding for
research and develop education programs. The Boomer
Esiason Foundation takes it one step further teaching
those with the disease how to live one breath at a time.
You Cannot Fail
The Boomer Esiason Foundation recently launched
the You Cannot Fail campaign, a program that
supports not only the cystic fibrosis community,
but also anyone facing dire illness or circumstances.
At some point, every person faces some sort of
difficultly from an unusually difficult day to a life-
changing decision to a formidable situation. The You
Cannot Fail initiative aims to encourage people to
face lifes challenges with dignity and grace and to
motivate every person to discover the hero inside.
The You Cannot Fail campaign uses multiple platforms
to collect, organize, and share individuals heroic stories,
to accept donations that fund a scholarship, and to
spread the motivational message that you cannot fail
if you try to be the hero of your own story every day.
The You Cannot Fail scholarship, awarded annually
on April 18 the anniversary of Jerrys double
lung transplant, was created to honor exceptional
student-athletes who have cystic fibrosis and do not
let the disease prevent them from living their lives
with purpose, passion, optimism, and courage.
For more information contact the Boomer
Esiason Foundation at http://esiason.org. You
Cannot Fail Program: www.youcannotfail.
com -Larry Myers, What Doctors Know
1
www http://www.cdc.gov/vitalsigns
Asthma in the US
Asthma is a lifelong disease that causes wheezing,
breathlessness, chest tightness, and coughing. It can
limit a persons quality of life. While we dont know
why asthma rates are rising, we do know that most
people with asthma can control their symptoms and
prevent asthma attacks by avoiding asthma triggers and
correctly using prescribed medicines, such as inhaled
corticosteroids.
The number of people diagnosed with asthma grew by
4.3 million from 2001 to 2009. From 2001 through
2009 asthma rates rose the most among black children,
almost a 50% increase. Asthma was linked to 3,447
deaths (about 9 per day) in 2007. Asthma costs in the
US grew from about $53 billion in 2002 to about $56
billion in 2007, about a 6% increase. Greater access
to medical care is needed for the growing number of
people with asthma.
Learn what you can do to reduce asthma.
Want to learn more? Visit
About 1 in 2 people (about 12
million) with asthma had an
asthma attack in 2008, but
many asthma attacks could
have been prevented.
Asthma cost the US about
$56 billion in medical costs,
lost school and work days,
and early deaths in 2007.
1 in 12
About 1 in 12 people
(about 25 million) have
asthma, and the numbers
are increasing every year.
12M
Growing every year
Billion
National Center for Environmental Health
Division of Environmental Hazards and Health Effects
Problem
More than half (59%) of children and one-
third (33%) of adults who had an asthma
attack missed school or work because of
asthma in 2008. On average, in 2008 children
missed 4 days of school and adults missed 5
days of work because of asthma.
3. Better asthma education is needed.
People with asthma can prevent asthma
attacks if they are taught to use inhaled
corticosteroids and other prescribed daily
long-term control medicines correctly and to
avoid asthma triggers. Triggers can include
tobacco smoke, mold, outdoor air pollution,
DQGFROGVDQGX
In 2008 less than half of people with asthma
reported being taught how to avoid triggers.
Almost half (48%) of adults who were taught
how to avoid triggers did not follow most of
this advice.
Doctors and patients can better manage
asthma by creating a personal asthma action
plan that the patient follows.
1. Too many people have asthma.
The number of people with asthma continues
to grow. One in 12 people (about 25 million,
or 8% of the population) had asthma in 2009,
compared with 1 in 14 (about 20 million, or 7%)
in 2001.
More than half (53%) of people with asthma had
an asthma attack in 2008. More children (57%)
than adults (51%) had an attack.
185 children and 3,262 adults died from asthma
in 2007.
About 1 in 10 children (10%) had asthma
and 1 in 12 adults (8%) had asthma in 2009.
Women were more likely than men and boys
more likely than girls to have asthma.
About 1 in 9 (11%) non-Hispanic blacks of all
ages and about 1 in 6 (17%) of non-Hispanic
black children had asthma in 2009, the
highest rate among racial/ethnic groups.
The greatest rise in asthma rates was among
black children (almost a 50% increase) from
2001 through 2009.
2. Asthma has a high cost for individuals
and the nation.
Asthma cost the US about $3,300 per person
with asthma each year from 2002 to 2007 in
medical expenses.
Medical expenses associated with asthma
increased from $48.6 billion in 2002 to $50.1
billion in 2007. About 2 in 5 (40%) uninsured
people with asthma could not afford their
prescription medicines and about 1 in 9 (11%)
insured people with asthma could not afford
their prescription medicines.
Green Zone: Doing Well
No cough, wheeze, chest tightness, or shortness of
breath; can do all usual activities. Take prescribed long-
term control medicine such as inhaled corticosteroids.
Red Zone: Medical Alert!
Very short of breath; quick-relief medicines dont help;
cannot do usual activities; symptoms no better after 24
hours in Yellow Zone. Get medical help NOW.
Yellow Zone: Getting Worse
Cough, wheeze, chest tightness, or shortness of
breath; waking at night; can do some, but not all, usual
activities. Add quick-relief medicine.
Asthma Action Plan
Source: http://www.cdc.gov/asthma/actionplan.html
Asthma is increasing every
year in the US.
Problem
More than half (59%) of children and one-
third (33%) of adults who had an asthma
attack missed school or work because of
asthma in 2008. On average, in 2008 children
missed 4 days of school and adults missed 5
days of work because of asthma.
3. Better asthma education is needed.
People with asthma can prevent asthma
attacks if they are taught to use inhaled
corticosteroids and other prescribed daily
long-term control medicines correctly and to
avoid asthma triggers. Triggers can include
tobacco smoke, mold, outdoor air pollution,
DQGFROGVDQGX
In 2008 less than half of people with asthma
reported being taught how to avoid triggers.
Almost half (48%) of adults who were taught
how to avoid triggers did not follow most of
this advice.
Doctors and patients can better manage
asthma by creating a personal asthma action
plan that the patient follows.
1. Too many people have asthma.
The number of people with asthma continues
to grow. One in 12 people (about 25 million,
or 8% of the population) had asthma in 2009,
compared with 1 in 14 (about 20 million, or 7%)
in 2001.
More than half (53%) of people with asthma had
an asthma attack in 2008. More children (57%)
than adults (51%) had an attack.
185 children and 3,262 adults died from asthma
in 2007.
About 1 in 10 children (10%) had asthma
and 1 in 12 adults (8%) had asthma in 2009.
Women were more likely than men and boys
more likely than girls to have asthma.
About 1 in 9 (11%) non-Hispanic blacks of all
ages and about 1 in 6 (17%) of non-Hispanic
black children had asthma in 2009, the
highest rate among racial/ethnic groups.
The greatest rise in asthma rates was among
black children (almost a 50% increase) from
2001 through 2009.
2. Asthma has a high cost for individuals
and the nation.
Asthma cost the US about $3,300 per person
with asthma each year from 2002 to 2007 in
medical expenses.
Medical expenses associated with asthma
increased from $48.6 billion in 2002 to $50.1
billion in 2007. About 2 in 5 (40%) uninsured
people with asthma could not afford their
prescription medicines and about 1 in 9 (11%)
insured people with asthma could not afford
their prescription medicines.
Green Zone: Doing Well
No cough, wheeze, chest tightness, or shortness of
breath; can do all usual activities. Take prescribed long-
term control medicine such as inhaled corticosteroids.
Red Zone: Medical Alert!
Very short of breath; quick-relief medicines dont help;
cannot do usual activities; symptoms no better after 24
hours in Yellow Zone. Get medical help NOW.
Yellow Zone: Getting Worse
Cough, wheeze, chest tightness, or shortness of
breath; waking at night; can do some, but not all, usual
activities. Add quick-relief medicine.
Asthma Action Plan
Source: http://www.cdc.gov/asthma/actionplan.html
Asthma is increasing every
year in the US.
Whos at Risk?
AL
AZ
AR
CA CO
NM
CT
DE
DC
FL
GA
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE NV
NH
NJ
AK
HI
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
Adults with asthma, US, 2009
SOURCE: Behavioral Risk Factor Surveillance System, 2009
5%<7%
8%-<9%
7%<8%
9%
% of all adults
10
9
8
7
6
5
Asthma by age and sex US, 2001-2009
%

w
i
t
h

a
s
t
h
m
a
Children
All Females
Adults
All Males
Total
Source: National Health Interview Survey, 2001-2009
Percentages are age-adjusted.
Asthma self-management education by age, US, 2008
SOURCE: National Health Interview Survey, 2008, asthma supplement.
Adults
Children
Taught to
respond to
an asthma
attack
Taught to
recognize early
signs and
symptoms of
an asthma attack
Taught to recognize
early signs and
symptoms of an
asthma attack
Given a written
asthma management
action plan
78%
64%
72%
55% 51%
49%
44%
30%
www http://www.cdc.gov/vitalsigns
www http://www.cdc.gov/mmwr
For more information, please contact
Telephone: 1-800-CDC-INFO (232-4636)
TTY: 1-888-232-6348
E-mail: cdcinfo@cdc.gov
Web: www.cdc.gov
Centers for Disease Control and Prevention
1600 Clifton Road NE, Atlanta, GA 30333
Publication date: 05/03/2011
What Can Be Done
Federal, state, and local health
offcials can
Track asthma rates and the effectiveness of
control measures so continuous improvements
can be made in prevention efforts.
3URPRWHLQXHQ]DDQGSQHXPRQLDYDFFLQDWLRQ
for people with asthma.
Promote improvements in indoor air quality
for people with asthma through measures
such as smoke-free air laws and policies,
healthy schools and workplaces, and
improvements in outdoor air quality.
Health care providers can
Determine the severity of asthma and monitor
how much control the patient has over it.
Make an asthma action plan for patients.
Use this to teach them how to use inhaled
corticosteroids and other prescribed medicines
correctly and how to avoid asthma triggers
such as tobacco smoke, mold, pet dander, and
outdoor air pollution.
Prescribe inhaled corticosteroids for all
patients with persistent asthma.
People with asthma and parents of
children with asthma can
Receive ongoing appropriate medical care.
Be empowered through education to manage
their asthma and asthma attacks.
Avoid asthma triggers at school, work, home,
and outdoors. Parents of children with asthma
should not smoke, or if they do, smoke only
outdoors and not in their cars.
Use inhaled corticosteroids and other
prescribed medicines correctly.
Schools and school nurses can
Use student asthma action plans to guide
use of inhaled corticosteroids and other
prescribed asthma medicines correctly and
to avoid asthma triggers.
Make students quick-relief inhalers readily
available for them to use at school as
needed.
Take steps to fix indoor air quality problems
like mold and outdoor air quality problems
such as idling school buses.
Employers and insurers can
Promote healthy workplaces by reducing or
eliminating known asthma triggers.
Promote measures that prevent asthma attacks
such as eliminating co-payments for inhaled
corticosteroids and other prescribed medicines.
Provide reimbursement for home
environmental assessments and educational
sessions conducted by clinicians, health
educators, and other health professionals both
within and outside of the clinical setting.
Provide reimbursement for long-term control
medicines, education, and services to reduce
asthma triggers that are often not covered by
health insurers.
C221812-B
Dont let diabetes destroy your life ... choose to live.
People with diabetes are two to four times more likely to suffer a stroke
than people without diabetes. And many who survive are severely
disabled.
You can reduce your risk of stroke by lowering your blood sugar, blood
pressure and cholesterol. You should also talk to your health care provider
about taking aspirin and, if you smoke, get help to quit.
To learn more about reducing your risk of stroke, call 1-800-DIABETES for
your free "Diabetes Survival Guide".
www.diabetes.org
Diabetes is a killer.
After I was diagnosed,
I had no pain, I didnt
feel sick, so I didnt
listen to my doctor.
Then it STRUCK.
I had a stroke at 49,
and now Im disabled.
If only Id known
if only Id listened.
ADA Choose 2 Eng 7x10 COL 2/15/06 10:48 PM Page 1
whatdoctorsknow.com
Your Microbes
and You
M
icroscopic creaturesincluding
bacteria, fungi and virusescan
make you ill. But what you may not
realize is that trillions of microbes
are living in and on your body
right now. Most dont harm you at
all. In fact, they help you digest food, protect against
infection and even maintain your reproductive health.
We tend to focus on destroying bad microbes. But
taking care of good ones may be even more important.
You might be surprised to learn that your microbes
actually outnumber your own cells by 10 to
1. The current estimate is that humans have
10 trillion human cells and about 100 trillion
bacterial cells, says Dr. Martin J. Blaser at the
New York University School of Medicine.
New techniques allow scientists to study
these rich microbial communities and their
genesthe microbiome. In 2007, NIH
launched the Human Microbiome Project
to study microbes in and on the body.
Earlier this year, researchers from almost 80 institutions
published a landmark series of reports. They found that
more than 10,000 different species occupy the human
body. The microbiome actually provides more genes
that contribute to human survival than the human
genome itself (8 million vs. 22,000). Humans need
bacteria and their genes more than most of us thought.
One of the most important things microbes do for
us is to help with digestion. The mix of microbes
in your gut can affect how well you use and store
energy from food. In laboratory experiments,
transferring bacteria from certain obese mice to
normal ones led to increased fat in the normal mice.
Blaser and his colleagues are concerned that changes
in our microbiome early in life may contribute to
weight problems later. Were in the middle of an
epidemic of obesity that is very severe, Blaser says.
Its relatively recent, its widespread across the United
States and across the world, and increased calories and
decreased exercise seem insufficient to explain this.
We might be changing our microbiome for the worse,
he says, by using antibiotics too often. In a recent
NIH-funded study, Blasers team found that low-
dose antibiotic therapy affected the gut microbiomes
of young mice. Antibiotics also altered how the mice
used sugars and fats. After 7 weeks, treated mice
had up to 15% more fat than untreated mice. This
and other studies suggest that gut bacteria can affect
both appetite and how you use energy in food.
In related work, Dr. Leonardo Trasande, Blaser and
colleagues analyzed data from more than 11,000
children. Although the results werent conclusive,
they suggest that infants given antibiotics might
be at increased risk of becoming overweight. More
work will be needed to confirm this connection.
Microbes in our intestines may play critical roles in
how we absorb calories, Trasande says. Exposure to
antibiotics, especially early in life, may kill off healthy
bacteria that influence how we absorb nutrients into
our bodies, and would otherwise keep us lean.
Microbes are also important for your skin, one of the
bodys first lines of defense against illness and injury.
Skin health depends on the delicate balance between
your own cells and the microbes that live on its surface.
The Good, Bad and Ugly
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Basically, the healthy bacteria are filling all those little
niches so that the more dangerous bacteria cant get a
foothold onto the skin, says Dr. Julie Segre of NIH.
Segre and other NIH researchers looked at skin
microbes collected from different body regions on
healthy volunteers. They found that body location
has a huge effect on which types of bacteria live.
For example, bacteria living under your arms likely
are more similar to those under another persons
arm than to the bacteria on your own forearm.
Microbes are also important to the bodys infection-
fighting immune system. In one recent study, NIH
scientists examined special mice that were born and
raised to be germ-free. These mice seemed to have
weak immune function. In contrast, normal mice
have vibrant bacterial communities and a rich variety
of immune cells and molecules on their skin.
The germ-free mice were exposed to Staphylococcus
epidermidis, one of the most common bacteria on
human skin. Adding this one species of bacteria
boosted immune function in the mouse skin. The
mice with S. epidermidis were able to defend against
a parasite, whereas the bacteria-free mice werent.
We often have a sense that the bacteria that
live on our skin are harmful, Segre says. But
in this study we show that these bacteria can
play an important role in promoting health by
preventing skin infections from becoming more
prolonged, pronounced and more serious.
Theres strong evidence that the microbes in the female
reproductive tract affect reproductive health and help
protect against disease. A recent study also found a diverse
community of microbes in the male urinary tract and
on the penis. NIH-funded researchers are investigating
other positive roles for microbes. One major area of
research concerns allergy-related conditions, including
childhood asthma, skin allergies, hay fever and eczema.
So what can you do to protect against microbes that
cause infection but take care of the ones that help
you? We know that washing our hands is important
for removing harmful microbesfor example,
before eating or after using the bathroom.
Other less obvious things can affect your skin microbes,
Segre says. The lotions and creams you use can provide
a barrier to protect your skins moisture, Segre points
out, but in fact youre also putting a fertilizer onto the
microbial garden. Youre really changing the food source
for the bacteria that live on your skin. Theres not one right
answer about which skin products are best for you, she
says. Experiment to see how different ones affect your skin.
Many researchers worry that some people are trying
to get too clean. Blaser thinks that people are using
sanitizers and antibiotic products too often these days.
Obviously, there are many bad germs, but I think weve
gone overboard and it looks like trying to get rid of the
bad guys has had a collateral effect on the good guys.
Youre never alone when it comes to your microbes. But
dont get squeamish about it. Just remember how much
you need them. -Source: NIH News in Health, November
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
Protect Your Microbes
Dont be scared of microbes. Most actually help you.
Dont pressure your doctor to give you antibiotics.
They may cause more harm than good.
Know when to wash your handsfor example, when preparing food
and before eating. To learn more, visit www.cdc.gov/handwashing.
Dont use antibacterial products you dont need. Antibacterial
soaps have little or no health benefit. And antibacterial
versions of household products (like phones and staplers)
have not been shown to reduce your risk of infection.
Dont go overboard with hand sanitizers. Theyre useful in health
care settings, but hand washing is a better option in most situations.
Experiment with different skin moisturizers
to see which work best for you.
Theres no conclusive evidence that so-called
probiotic products have health benefits.
whatdoctorsknow.com
Get the Facts about
Cystic Fibrosis
C
ystic fibrosis (CF) is an inherited
disease characterized by an abnormality
in the glands that produce sweat and
mucus. It is chronic, progressive,
and is usually fatal. Due to improved
treatments, people with CF, on
average, live into their mid to late 30s.
Cystic fibrosis affects various systems in children
and young adults, including the following:
Respiratory system
Digestive system
Reproductive system
There are about 30,000 people in the US who are
affected with the disease, and about 1,000 babies
are diagnosed with it each year. It occurs mainly in
Caucasians, who have a northern European heredity,
although it also occurs in African-Americans,
Asian Americans, and Native Americans.
Approximately one in 31 people in the US
are carriers of the cystic fibrosis gene. These
people are not affected by the disease and
usually do not know that they are carriers.
How does CF affect the respiratory system?
The basis for the problem with CF lies in an abnormal
gene. The result of this gene defect is an atypical
electrolyte transport system within the cells of the
body. The abnormal transport system causes the cells
in the respiratory system, especially the lungs, to
absorb too much sodium and water. This causes the
normal thin secretions in our lungs to become very
thick and hard to remove. These thick secretions put
the child with CF at risk for constant infection.
The high risk of infection in the respiratory system
leads to damage in the lungs, lungs that do not work
properly, and eventually death of the cells in the
lungs. The most common causes for infection in the
lungs of the CF patient are the following bacteria:
Staphylococcus aureus
Haemophilus influenzae
Pseudomonas aeruginosa (PA)
Over a period of time, PA becomes the most
common bacteria that causes infection and becomes
difficult to fight. A large percentage of respiratory
infections in the CF patient are due to PA.
whatdoctorsknow.com
As a result of the high rate of infection in the lower respiratory
tract, people with CF may develop a chronic cough, blood in
the sputum, and sometimes can even have a collapsed lung.
The cough is usually worse in the morning or after activity.
People with CF also have involvement of the upper
respiratory tract. Some patients have nasal polyps that
need surgical removal. Nasal polyps are small protrusions
of tissue from the lining of the nose that go into the nasal
cavity. Children also have a high rate of sinus infections.
How does CF affect the gastrointestinal (GI) system?
The organ primarily affected is the pancreas, which secretes
substances that aid digestion and help control blood-glucose levels.
As a result of the abnormal electrolyte transport system in the
cells, the secretions from the pancreas become thick and lead to
an obstruction of the ducts of the pancreas. This obstruction
then causes a decrease in the secretion of enzymes from the
pancreas that normally help to digest food. A person with CF has
difficulty absorbing proteins, fats, and vitamins A, D, E, and K.
The problems with the pancreas can become so severe that some
of the cells in the pancreas can become destroyed. This may
lead to glucose intolerance and insulin-dependent diabetes.
About 35 percent of CF patients develop this type of diabetes in
their 20s and 43 percent develop the disease after 30 years of age.
The symptoms that may be present due to the
involvement with the GI tract include the following:
Bulky, greasy stools
Rectal prolapse--a condition in which the end
part of the bowels comes out of the anus.
Delayed puberty
Fat in the stools
Stomach pain
Bloody diarrhea
The liver may also be affected. A small number
of patients may actually develop liver disease.
Symptoms of liver disease may include:
Enlarged liver
Swollen abdomen
Yellow color to the skin
Vomiting of blood
How does CF affect the reproductive system?
Most males with CF have obstruction of the sperm canal
known as congenital bilateral absence of the vas deferens
(CBAVD). This results from the abnormal electrolyte transport
system in the cells, causing the secretions to become thick
and lead to an obstruction and infertility. Women also have
an increase in thick cervical mucus that may lead to a decrease
in fertility, although many women with CF have children.
What are the symptoms of cystic fibrosis?
Symptoms for cystic fibrosis may include:
Abnormalities in the glands that
produce sweat and mucus
This may cause a loss of salt. A loss of salt may cause
an upset in the balance of minerals in the blood,
abnormal heart rhythms, and, possibly, shock.
Thick mucus that accumulates in the lungs and intestines
This may cause malnutrition, poor growth,
frequent respiratory infections, breathing
difficulties, and/or lung disease.
Other medical problems, such as:
Sinusitis
Nasal polyps
Clubbing of fingers and toes--a condition marked
by the ends of the fingers and toes become
enlarged; more prevalent in the fingers.
Pneumothorax--the presence of air or gas in the
pleural cavity causing the lung to collapse.
Hemoptysis--coughing blood.
Cor pulmonale--enlargement of right side of heart.
Abdominal pain
Gas in the intestines
Rectal prolapse
Liver disease
Diabetes
Pancreatitis
Gallstones
Congenital bilateral absence of the
vas deferens (CBAVD) in males
The symptoms of CF differ for each person. Infants
born with CF usually show symptoms by age two.
Some children may not show symptoms until later
in life. When infants have the following suspicious
signs of CF, they should be tested for the disease:
Diarrhea that does not go away
Foul-smelling stools
Greasy stools
Frequent episodes of wheezing
Frequent episodes of pneumonia
or other lung infections
Persistent cough
Skin tastes like salt
Poor growth despite a good appetite
The symptoms of cystic fibrosis may
resemble other conditions or medical
problems. Therefore its always best to
consult a physician for a diagnosis to be sure.
whatdoctorsknow.com 0
How is cystic fibrosis diagnosed?
Most cases of cystic fibrosis are now
identified with newborn screening. In
addition to a complete medical history and
physical examination, diagnostic procedures
for cystic fibrosis include a sweat test to
measure the amount of sodium chloride (salt)
present. Higher than normal amounts of
sodium and chloride suggest cystic fibrosis.
Other diagnostic procedures include:
Chemical tests
Chest X-rays
Lung function tests
Sputum cultures
Stool evaluations
For babies, who do not produce enough
sweat, blood tests may be used.
Treatment for cystic fibrosis
Specific treatment for cystic fibrosis will be
determined by the physician based on:
Age, overall health, and medical history
Extent of the disease
Expectations for the course of the disease
Tolerance for specific medications,
procedures, or therapies
The patient opinion or preference
There is no cure for CF. A cure would call for gene
therapy at an early age and this has not been developed
yet, although research is being done in this direction.
The gene that causes CF has been identified and
there are hopes that this will lead to an increased
understanding of the disease. Also being researched
are different drug regimens to help stop CF. Goals of
treatment are to ease severity of symptoms and slow
the progress of the disease. Treatment may include:
Management of problems that cause lung
obstruction, which may involve:
Physical therapy
Exercise to loosen mucus, stimulate coughing,
and improve overall physical condition
Medications to reduce mucus and help breathing
Antibiotics to treat infections
Anti-inflammatories
Management of digestive problems,
which may involve:
Appropriate diet
Pancreatic enzymes to aid digestion
Vitamin supplements
Treatments for intestinal obstructions
Newer therapies include lung transplantation for
patients with end-stage lung disease. The type of
transplant done is usually a heart-lung transplant, or a
double lung transplant. Not everyone is a candidate for
a lung transplant. Discuss this with your physician.
whatdoctorsknow.com
Ethnic Background
Caucasian
Hispanic
African-American
Asian
Risk of Child with CF
1 in 2,500-3,500
1 in 4,000-10,000
1 in 15,000-20,000
1 in 100,000
Risk of CF Mutation
1 in 29
1 in 46
1 in 65
1 in 90
The genetics of cystic fibrosis
Cystic fibrosis (CF) is a genetic disease which means CF is
inherited. A person will be born with CF only if two CF
genes are inherited - one from the mother and one from
the father. A person who has only one CF gene is healthy
and said to be a "carrier" of the disease. A carrier has an
increased chance of having a child with CF. This type of
inheritance is called "autosomal recessive." "Autosomal" means
that the gene is on one of the first 22 pairs of chromosomes
which do not determine gender, so that the disease equally
affects males and females. "Recessive" means that two
copies of the gene, one inherited from each parent, are
necessary to have the condition. Once parents have had a
child with CF, there is a one in four, or 25 percent chance
with each subsequent pregnancy, for another child to be
born with CF. This means that there is a three out of four,
or 75 percent chance, for another child to not have CF.
The birth of a child with CF is often a total surprise
to a family, since most of the time (in eight out of 10
families) there is no previous family history of CF.
Many autosomal recessive conditions occur this way.
Since both parents are healthy, they had no prior
knowledge that they carried the gene, nor that they
passed the gene to the pregnancy at the same time.
Genes are founds on structures in the cells of our body
called chromosomes. There are normally 46 total, or
23 pairs of chromosomes in each cell of our body. The
seventh pair of chromosomes contains a gene called the
CFTR (cystic fibrosis transmembrane regulator) gene.
Mutations or errors in this gene are what cause CF. This
gene is quite large and complex. Over 1,000 different
mutations in this gene have been found which cause CF.
Testing for the CF gene can be done from a small blood sample or from a cheek
swab, which is a brush rubbed against the inside of your cheek to obtain cells
for testing. Laboratories generally test for the most common mutations.
There are many people with CF whose mutations have not been identified.
In other words, all of the genetic errors that cause the disease have not
been discovered. Because not all mutations are detectable, a person can still
be a CF carrier even if no mutations were found by carrier testing.
Testing for the CF gene is recommended for anyone who has a family member
with the disease, or whose partner is a known carrier of CF or affected with CF.
-This information provided courtesy of The Ohio State Wexner Medical Center
The risk for having a mutation in the gene for CF depends on your ethnic
background (for persons without a family history of CF):
whatdoctorsknow.com
Shriners
Hospitals for
Children
Bringing Love to the Rescue Since 1922
A
Health Care System Built on Compassion and Commitment
In the early 1920s, a polio epidemic was sweeping across the country, causing countless
children to suffer, and their families to be suddenly faced with finding long-term medical
care. At the same time, a fraternal organization, Shriners of North America (now known
as Shriners International) was searching for a philanthropic effort to call its own.
These two events led to the establishment
of the first Shriners Hospital in 1922
in Shreveport, La. The hospitals
mission was to provide medical care for
children with orthopaedic conditions,
such as polio, regardless of the families
ability to pay for these services.
From the beginning, the Shriners realized
the need was greater than one facility
could meet. In 1923, hospitals were
established in Honolulu, Minneapolis and
San Francisco (relocated to Sacramento,
Calif., in 1997). The following year the
developing health care system expanded
to Portland, Ore., St. Louis, and Spokane,
Wash. By the end of the decade, there
were 14 Shriners Hospitals for Children

.
What began as a single hospital built in
whatdoctorsknow.com
Orthopaedics
Since the founding of our first hospital in 1922, treating
orthopaedic conditions has been the foundation of
Shriners Hospitals for Children. The diseases and
disorders we treat are wide-ranging and diverse.
Whether we are treating bone deformities such as
clubfoot, neuromuscular conditions such as cerebral
palsy or genetic anomalies such as achondroplasia, our
goal is to help each child become as functional and
healthy as possible. Care for orthopaedic conditions
is available at 20 of our facilities; with a large full-
time staff of pediatric orthopaedic surgeons, as well
as a comprehensive team of physical, occupational,
speech and other therapists, we are able provide
each patient with a customized care plan based
on their overall health and medical conditions.
While the methods of our medical staff and researchers
are distinctly different, their goals are same to
improve the lives of children. For example, led by
Francis Glorieux, M.D., Ph.D., the research team
at our Canada hospital was able to develop a more
effective treatment for osteogenesis imperfecta
(OI), also known as brittle bone disease, which has
improved the quality of life for many children.
A more common orthopaedic condition affecting
children is clubfoot, which occurs in approximately
one out of 1,000 births in the United States.
Clubfoot refers to a variety of foot abnormalities
in which the foot is twisted inward. In addition to
offering treatment options, including serial casting,
our physicians are among those seeking the cause
for this potentially debilitating abnormality.
Gianna, 5, has been a
patient of Shriners Hospitals
for Children Los Angeles
since she was 3 months old.
Below are all of Giannas
prosthetics which were
specially customized for her
by the Los Angeles Hospital.
response to a single medical issue is now a 22-facility
health care system with locations in three countries
that provides care and treatment for a multitude
of conditions. Since the first hospital opened in
Shreveport, more than 1 million children have benefited
from the Shriners compassion and commitment.
Today, in addition to expert care and treatment,
the mission of Shriners Hospitals for Children
includes conducting research to expand medical
knowledge and improve treatments, and offering
educational opportunities to medical professionals.
Providing Excellent, Expert Pediatric Care in a
Compassionate, Family-Centered Environment
Now, Shriners Hospitals for Children provides care
for orthopaedic conditions, burns, spinal cord injuries
and cleft lip and palate. Within these broad service
lines, many types of care are provided. For example,
some facilities offer reconstructive plastic surgery,
treatment for craniofacial abnormalities or care for
sports injuries. While we are pleased to be able to
offer this expert care regardless of our families ability
to pay, we are equally proud to offer it in a setting
that emphasizes a multidisciplinary approach and
the well-being of the whole child, and their family.
Many of the conditions treated at Shriners Hospitals
for Children have long-term or even life-time effects
or repercussions, and our staff, including physicians,
therapists and counselors, is acutely aware of the need
to encourage and increase confidence, self-esteem and
even independent living skills in our young patients, as
well as work to heal the medical problem. The phrase
Love to the rescue

aptly describes our philosophy.

whatdoctorsknow.com
in the walkway measure how the ground is pushing
on the patient. A pressure platform might also be used
to tell how the ground force is spread over the bottom
of the patients foot, and what support and assistance
the patients foot is providing to the leg and body. All
of these pieces of data about the patients walking and
other movement patterns are combined with information
gathered during a detailed interview with the family
and in a careful physical examination of the patient. An
experienced, multidisciplinary team typically comprised of
physicians, engineers, physical therapists and kinesiologists
meets with the patients physician to review this
information and to recommend treatments, including
bracing, physical therapy, medications, or surgery.
Burn Care
In the 1960s, Shriners Hospitals for Children expanded
its care disciplines to include pediatric burn care, and
built three hospitals specifically for that purpose.
Today, burn care is also offered at a fourth facility. Our
patients receive advanced care for burn injuries and
related scarring, along with physical rehabilitation and
emotional support to help them successfully return
to their school or community after their injury.
Along those lines, patients often have the opportunity
to attend special camps and participate in activities that
focus on self-esteem and confidence. Because returning to
school after a severe burn injury can be stressful, our burn
hospitals offer school re-entry programs that help prepare
everyone for the childs return, including classmates and
teachers. One hospitals program goes a step further
and sends a stuffed animal to sit in the place of the child
at school, serving as a silent reminder to the students
that the child is being taken care of and will return.
Dan Caro was burned in a gasoline explosion when
2 years old and sustained third degree burns over 70
percent of his body. As a result of the burn injuries, Caro
lost his right hand, and most of his left, and was severely
scarred. He underwent many surgeries and treatments
at both our Boston and Galveston facilities, including
reconstructive surgery to give Caro the use of a moveable
thumb on his left hand. This allowed him to pursue a
lifelong dream of playing the drums. Today, Caro is a
successful musician, author and motivational speaker.
The staff was endlessly supportive, and instrumental
in me finding my own way, and my independence
both physically and emotionally, Caro said. I never
saw myself as different because of the support of
Shriners Hospitals for Children and the Shriners.
In addition to providing exceptional patient care,
the Shriners Hospitals specializing in burns are
committed to burn research. Some of the medical
advances made through these efforts include improved
survival rates from severe burns and shorter hospital
stays; an understanding of the value of immediate
Matthew Dobbs, M.D., pediatric foot deformity specialist
for Shriners Hospitals for Children St. Louis and
associate professor of orthopaedic surgery at Washington
University School of Medicine, recently published
significant research findings regarding genetic links to
clubfoot in the American Journal of Human Genetics.
In what was considered a discovery of the most common
genetic cause of isolated clubfoot found to date, Dr. Dobbs
research was able to identify the specific cause in nearly
10 percent of familial, or inherited, clubfoot cases tested.
Shriners Hospitals for Children also treat the orthopaedic
effects of cerebral palsy (CP), a neuromuscular condition
affecting muscle tone, movement and coordination.
There may be other complications, as well. CP is the
most common disability that occurs before, during or
immediately after birth. Although statistics vary, there
are more than 500,000 people in the U.S. with some
degree of CP, and 3,000 to 10,000 infants are diagnosed
annually as having the condition. Shriners Hospitals
provided care for more than 10,000 children with this
condition in the time frame of 2011 through August 2012.
Using Movement Analysis
One method used to determine the best course of
treatment is movement analysis. Twelve of our facilities
have movement analysis laboratories, which are used
to carefully observe and measure the way our patients
move, to understand how and why they move differently
from children without mobility problems, such as
cerebral palsy, to recommend treatments, and to evaluate
how well those treatments improve their function.
The sophisticated technology of the movement
laboratories is similar to the process Hollywood uses
to animate characters for films and video games,
and, in fact, the explosion of that field over the past
several years has helped to increase the capabilities
of the movement laboratories in the medical field.
In the movement analysis laboratory, specialized cameras
measure the movement of highly reflective balls placed
on the patients feet, legs, arms, and torso. Other sensors
on their skin tell which muscles are pulling. Force plates
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wound closure; creation of pressure garments to
prevent scarring; improvements in metabolic and
nutritional care; and development of engineered skin
substitutes and better wound-healing techniques.
It is important to our physicians and researchers to
share our knowledge with the medical community. Our
physicians have served as President of the American
Burn Society, and, our burn hospitals have co-hosted
the Phoenix Societys World Burn Congress, an annual
gathering of thousands of individuals concerned with
caring for those with burn injuries, and burn survivors.
In addition to providing excellent care for burn injuries,
Shriners Hospitals for Children is also committed to
preventing burn injuries. To that end, the health care system
has an ongoing educational effort that kicks off every year
in the first week of February, known as Burn Awareness
Week. The effort provides free materials appropriate for
both children and adults that promote burn prevention
and awareness, to help ensure the safety of all children.
Spinal Cord Injury (SCI)
Sustaining a spinal cord injury can be a
frightening, overwhelming experience. From the
point of injury down to the toes, a spinal cord
injury can affect every function of the body.
In the mid-1980s, Shriners Hospitals for Children
established the nations first spinal cord injury
rehabilitation programs specifically designed for
children and teenagers. At our three facilities that
provide SCI care located in Chicago, Philadelphia
and Sacramento, Calif. (a designated Rehabilitation
Facility) our young patients are offered a wide
range of services designed to help them recover to the
maximum extent possible, and return to their homes
and communities as active participants. The implications
of SCI will last a lifetime; our programs address the
full range of issues, including the developmental, social
and educational needs of our patients with SCI.
Dan Caro
whatdoctorsknow.com
From physical and occupational therapy, to training
and fitting of adaptive devices, and support for
transitioning back to the school or community,
Shriners Hospitals for Children provides comprehensive
care that helps the children lead a full, active and
healthy life. In some hospitals, physical therapy
options include automated body-weight-supported
treadmill systems, such as the Lokomat, TheraStride
and ZeroG. In general, these systems facilitate
the therapists work of retraining the patients
neurosystem to develop new movement patterns,
through repetitive motion and sensory stimulation.
Another issue of great concern is improving the quality of
life for people with SCI. Lawrence Vogel, M.D., assistant
chief of staff, chief of pediatrics and medical director for
spinal cord injury, Shriners Hospitals for Children
Chicago, has been involved in several research studies
involving long-term outcomes. While much progress has
been made in the areas of removing architectural and
attitudinal barriers, ensuring educational opportunities
and providing access to transportation, plenty remains
to be done, particularly in the area of employment.
Our former (SCI) patients are well-educated, nearly 40
percent have college degrees, yet they are significantly less
employed than the general public, having an employment
rate of only 40-50 percent, said Dr. Vogel. Everyone
involved the kids, their families and their health care
providers have to have the expectation that the child
with an SCI will become independent and live a full and
satisfying life, and work toward that goal every day.
Bill Bogdan is an example of what can be achieved. Born
with a neuroblastoma that left him with a spinal cord
injury (SCI), Bogdan first came to Shriners Hospitals
for Children Chicago at age 3. The hospital helped
me become the person I am today, said Bogdan.
Today, Bill is the disability liaison to the Illinois
Secretary of State, as well as a husband and father
Another concern is, of course, finding
better treatments for the injury
itself. Researchers at our facilities
in Philadelphia and Sacramento,
Calif., are studying the regrowth and
regeneration of nerves in the spinal
cord, in hopes of one day developing
and offering improved solutions.
Still another effort is preventing
SCI from occurring. Motor vehicle
crashes are the leading cause of spinal
cord injuries. To address this issue,
we have participated in distracted
driving summits, which bring together
lawmakers, patients and families,
medical professionals and other industry
leaders, in Illinois, Texas and Florida.
Cleft Lip and Palate
Facial clefts are one of the most common birth defects in
the U.S., and were officially added to the hospitals care
disciplines in 2005. At Shriners Hospitals for Children
patients with a cleft lip and/or palate are treated by a
multidisciplinary group of experts who work together to
improve the childs ability to eat, communicate, breathe
and even feel good about their looks. Each patients
unique treatment plan may include surgery, orthodontics,
and hearing, speech and psychological therapies to
restore them to optimal function and appearance.
Mollie Carlson of Scandia, Kan., is just one of many
children with cleft lip and palate who have benefited
from the expert care available at Shriners Hospitals
for Children Chicago. Mollie was born with a
complete unilateral cleft lip and palate, a birth defect
that causes the tissues of the mouth or lip not to
form properly. Along with serious cosmetic issues,
children with cleft lip and palate can also experience
hearing loss, problems eating and difficulty breathing
and speaking. Mollie became our patient when only
1 year old and underwent several reconstructive
and cosmetic surgeries, including closure of her
palate, rhinoplasty and orthodontic procedures.
Mollie Carlson
Bill Bogdan
on NFL rosters, more than 60 are members of the NFL
Hall of Fame, and nearly 200 former players are in the
College Hall of Fame. The 2014 Game will be played
on January 18 at Tropicana Field in St. Petersburg, Fla.
The second event, the Shriners Hospitals for Children
Open, is held in October. The 2013 event will be part of
the FedEx Cup in Las Vegas. Both events are televised
nationally, bringing tremendous media exposure to our
health care system. To learn more about these events,
visit shrinegame.com and shrinershospitalsopen.com.
Shriners Hospitals for Children would like to thank
the Shriners fraternity for having the vision to create
this unique health care system, and for their continued
support. We would also like to acknowledge all
our donors, staff and volunteers for their efforts to
fulfill our mission of bringing Love to the rescue
of children. To learn more about Shriners Hospitals
for Children, or this great fraternity, please visit
Now in her 20s, Mollie is a confident and accomplished
young lady. She graduated from high school in 2009
as one of four valedictorians. Inspired by her speech
pathologist at Shriners Hospitals for Children
Chicago, she studied communication disorders and
graduated cum laude in May 2012. She is now pursuing
a masters degree in speech-language pathology
at Fort Hays State University in Hays, Kan.
Researchers at Shriners Hospitals for Children
continue to both develop new treatment techniques,
including a non-surgical method available for some
cases of the condition, and scientific work that may
lead to greater understanding of the genetic causes.
Depending on the Shriners and the Public
While all of the care and services at Shriners Hospitals
for Children are provided regardless of the ability
to pay, a 22-facility health care system obviously is
costly to operate. We depend on the generosity of our
donors, including the Shriners, the general public
and corporations. And we respect
their generosity approximately
90 percent of the health care
systems annual operating budget
is spent in direct support of the
organizations three-part mission of
treatment, research and teaching.
The generosity of donors enables
Shriners Hospitals for Children
to deliver life-changing medical
care without placing a burden on
the families of our patients, and
continue the mission the fraternity
started many years ago. Every
gift and volunteer hour makes a
difference in the life of a child; and
for that, we will be forever grateful.
In addition to raising funds, raising
awareness is also critical. At the
national level, we present two
signature events annually to help
raise awareness of our mission to
improve the lives of children: the
East-West Shrine Game

and the
Shriners Hospitals for Children Open.
The East-West Shrine Game is
the longest-running college all-
star game in U.S. history, and in
addition to assisting the health care
system, it serves as a prime scouting
opportunity for current college all-
stars to land spots on NFL teams.
Since its inception, hundreds of East-
West Shrine Game alumni have been
shrinershospitalsforchildren.org or shrinersinternational.org.
whatdoctorsknow.com
Online: Are My
Medicines Safe?
W
hen it comes to
buying prescription
medicines online,
it's better to be
safe than sorry.
BeSafeRx: Know
Your Online Pharmacy, a new public
education campaign by the U.S. Food
and Drug Administration (FDA),
is aimed at helping consumers
understand and minimize the risks
of buying medicines online.
In a recent FDA survey of Internet
users, 29 percent of participants reported
they are unsure how to safely buy medicines online.
Still, more than 20 percent of respondents reported
using the Internet to buy prescription medicines.
The Internet makes it easier for fraudulent and illegal
online pharmacies to sell medicines to American consumers
outside the system of federal and state safeguards that
protect patients from inappropriate or unsafe medicines.
Medicines you purchase from fraudulent online pharmacies
may put your health, or the health of your family, at risk.
"Many online consumers may not realize that they're
buying from a fraudulent, illegal online pharmacy
and that the medicines they may receive could
be counterfeit, contaminated, contain the wrong
active ingredient, or not approved by FDA," says
FDA pharmacist, Connie Jung, RPh., Ph.D.
Medicines purchased from fraudulent online pharmacies
may contain no active ingredient. (The active ingredients
in medicines are responsible for their effects.) It's also
possible that they'll have too much or too little of the
active ingredient or the wrong ingredient entirely.
These medicines may also be contaminated with
harmful substances, or be past their expiration dates.
As a result, says Jung, you may not receive the
therapy you need. And, you may experience
unexpected side effects and possibly get worse.
Some Red Flags
According to the National Association of Boards of
Pharmacy (NABP), the professional organization that
represents the state boards of pharmacy (or equivalent
state agencies) that are responsible for licensing
pharmacies, only 3 percent of online websites reviewed
appear to meet state and federal pharmacy laws.
It's sometimes hard to tell that a website isn't trustworthy,
says Jung. Many fraudulent online sellers use convincing
marketing efforts and develop websites that look legitimate.
Even careful consumers may be fooled. FDA is providing
information through its BeSafeRx campaign to help
consumers identify and avoid fraudulent pharmacy websites.
FDA Commissioner Margaret Hamburg, M.D., says,
"Fraudulent online pharmacies often offer deep discounts.
If the low prices seem too good to be true, they probably
are. BeSafeRx is designed to help patients learn how
to avoid these risks and safely buy medicine online."
Jung also warns consumers not to be tempted by the
much lower prices than those charged for prescription
drugs by a legitimate pharmacy. "They are a sure
sign of a fraudulent, illegal online pharmacy, and the
medicines you are getting could be harmful," Jung says.
whatdoctorsknow.com

Why are consumers increasingly turning to
online pharmacies for their medicines?
The Internet provides consumers with instant access to information
and services, including online pharmacies for prescription
medicines. Health insurance plans are encouraging home delivery
of maintenance medications and use of pharmacy services
online. As the cost of prescription medicine continues to increase,
consumers may look for cost savings from online pharmacies to
afford their medicines. In addition, many consumers value the
convenience and privacy of purchasing their medicines online.
For those consumers that may be considering purchasing from
online sources that are not associated with health insurance
plans or local pharmacy, these consumers need to know
the risks of buying from fraudulent online pharmacies.
-This information provided courtesy of the
U.S. Food and Drug Administration
A survey of more than
6,000
adults who have made online
purchases revealed these patterns:

23%
say they've purchased prescription medicine
online. Of those, almost 1 in 5 chose sites not
associated with a local pharmacy or health insurance plan.
21%
of those who reported buying
from an online pharmacy reported
using one based outside the U.S.
15%
of all respondents would consider
purchasing from an online
pharmacy based outside the U.S.
47%
of those who reported buying from an
online pharmacy not associated with a local
pharmacy or health insurance plan searched online for
comments and ratings before making the purchase.

What are the risks of purchasing
from a fake online pharmacy?
Buying prescription medicine from fraudulent online
pharmacies can be dangerous, or even deadly. At best,
counterfeit medicines are fakes of approved drugs and should
be considered unsafe and ineffective. These medicines
may be less effective or have unexpected side effects.
In addition to health risks, most fraudulent online pharmacies
may put your personal and financial information at risk. Some
intentionally misuse the information you provide. These sites
may infect your computer with viruses, and they may sell your
information to other illegal websites and Internet scams.

What are some of the warning signs
of a fake online pharmacy?
Avoid online pharmacies that:
1. Allow you to buy drugs without a prescription
or by completing an online questionnaire
2. Offer discounts or cheap prices that seem too good to be true
3. Send unsolicited email or other spam
offering cheap medicine
4. Ship prescription drugs worldwide
5. State that the drugs will be shipped from a foreign country
6. Are located outside of the United States
7. Are not licensed by a state board of pharmacy in the
United States (or equivalent state health authority)

What are some tips to identify
safe online pharmacies?
To identify a safe online pharmacy, make
sure that the online pharmacy:
1. Requires a valid prescription
2. Provides a physical address in the United States
3. Is licensed by the state board of pharmacy in your
state and the state where the pharmacy is operating
4. Has a state-licensed pharmacist to answer your question

Is it okay to buy prescription medicine
online from other countries?
FDA does not have jurisdiction of prescription medication from
other countries; therefore, FDA cannot guarantee the safety or
effectiveness of those medication. Medicines approved in other
countries may have slight variations, or different ingredients,
that could cause you to develop a resistance to your medicine
or result in a misdiagnosis by your doctor. If you take more than
one medicine, these differences could also cancel out the effects
of your medicines or cause harmful interactions. Additionally,
many of these illegal pharmacies use fake storefronts to make
consumers think they come from countries with high safety
standards, but the medicines could have been made anywhere.

Arent most online pharmacies safe and legal?
No. Only 3 percent of online pharmacies reviewed
by the National Association of Boards of Pharmacy are in
compliance with U.S. pharmacy laws and practice standards.

Isnt it obvious which online pharmacies
are fake and which are legitimate?
No, it may not be obvious that an online pharmacy is fake. Many
illegal online pharmacies use fake storefronts to make you
think they are real pharmacies. Fraudulent sellers run fake online
pharmacy scams to exploit American consumers by pretending
to be legitimate pharmacies offering prescription medicines
for sale. However, the products they provide may be fake,
expired and otherwise unsafe. In fact, many online pharmacy
scams are so sophisticated that even health care professionals
can have a hard time detecting illegal sites at first glance
I want to know my
online pharmacy.
Do You?
There are thousands of fraudulent pharmacies on the Internet.
According to the National Association of Boards of Pharmacy, only
3 percent of more than 10,000 online pharmacies reviewed comply with U.S.
pharmacy laws. This means that if you search for an online pharmacy, most
of the results are likely to be fraudulent pharmacies. Furthermore, these
websites can be so convincing that anyone can become a victim to online
pharmacy scams.
Buying from a fraudulent pharmacy can put your health at risk.
Medicines from fraudulent online pharmacies may look safe, but they could
be contaminated, contain the wrong ingredients, or be missing the active
ingredient. These drugs could make you sick or keep you from getting better.
Visit www.FDA.gov/BeSafeRx for more information.
Before buying your medicine online, check to make sure you are using
a safe, legal online pharmacy. Visit www.FDA.gov/BeSafeRx or call
1-888-463-6332 for more information.
GET A
PRESCRIPTION
KNOW YOUR ONLINE
PHARMACY
ONLY BUY FROM A SAFE,
LEGAL PHARMACY
TAKE MEDICINE AS
DIRECTED
whatdoctorsknow.com
Take a
M
ental
Health D
ay
E
veryone needs a mental
health day once in a while
maybe to catch up on a few
more Zs or just to indulge
in some me time. A mental
health day is a day you take
off work to relax, refresh and rejuvenate.
As part of Mental Health Month,
we talked with psychiatrist Dave
Davis, M.D., a psychiatrist on staff
at Piedmont Hospital and Piedmont
Psychiatric Clinic, about the benefits
of taking a day for yourself.
Mental health days are great, he says.
Everyone can benefit from them.
Dr. Davis says there are some signs
you may notice when you need to
take a mental health day boredom,
poor sleep habits, more stress and
worry than normal, and taking
yourself too seriously. When this
happens, a day off of work may be
just what the doctor ordered. What
you do on your day off depends
largely on what relaxes you.
Mental days are for fun, says
Dr. Davis. Try a new experience,
something you havent done before.
Invite a friend you havent seen in
a while to the Georgia Aquarium,
Zoo Atlanta or the Atlanta History
Center. Delve into your fantasy
life and find a new adventure.
You might argue you dont have time
to take off work because youre too
busy, and a day off would only add to
your workload when you return. But
Dr. Davis says you are only fooling
yourself if you really believe that.
Anyone can take a day off! he says.
We are all replaceable. Saying we are
too busy is only a way of trying to
pump up our self-esteem. Dr. Davis
warns that those who ignore the
tell tale signs and neglect their own
needs may suffer the consequences.
If someone refuses to play, they may
pay the price with depression, anxiety,
hypochondria or even drugs, he says.
Remember, the goal of a mental health
day is to feel less stressed or anxious.
If youre extremely stressed out, one
day may not be enough. Try to plan
your mental health day on a Friday so
you can have one day to decompress
and the rest of the weekend to enjoy
the positive effects of it. In the end,
it can even make you a happier, more
efficient employee. -This information
provided courtesy of Piedmont Hospital
whatdoctorsknow.com
HealthWatchMD
with Dr. Randy Martin
Provided courtesy of Piedmont Healthcare
Dr. Randy Martin: Millions of women
have urinary incontinence, especially as they
get older, but the good news is there are
multiple ways to treat it. I met with Dr. Anne
Wiskind, a urogynecologist at Piedmont
Hospital, to learn more about this condition.
Gotta Go?
Millions of women
do, but no one wants
to talk about it
whatdoctorsknow.com
Dr. Randy Martin: Dr. Wiskind has given
great information for women who suffer
from urinary incontinence. She has outlined
many options, so talk to your doctor about
which method would work best for you.
A
nne Wiskind, M.D., has a unique job
title: she is a urogynecologist, which she
describes as a blend between urology
and gynecology. In her practice, she
works with many women who suffer
from urinary incontinence and says the
condition is more common than you may think.
About 20 million people in our country have urinary
incontinence, at a cost of billions annually, she says.
This condition affects women more than men, which
Dr. Wiskind attributes to the fact that women give birth.
Most incontinence tends to come from
childbirth injury, she explains. The
main two types of incontinence are stress
incontinence and urge incontinence.
Stress incontinence is when leakage occurs while
coughing, laughing and sneezing. It results
from loss of support in the bladder neck, which
can be caused by childbirth injury.
Urge incontinence means that leakage occurs
when a person has an urge to urinate, but
cannot get to the bathroom fast enough.
For the millions of women who suffer from this
condition, there are several ways to treat it.
I tell everyone who says, I leak a little bit, to
try to empty their bladder by the clock instead of
waiting for the urge to go, do pelvic floor exercises,
and [avoid] certain foods that are considered
bladder irritants, such as caffeine, alcohol, artificial
sweeteners and spicy food, says Dr. Wiskind.
Incontinence medications
There are medications for urge incontinence,
but not really for stress incontinence, she says.
What these medications do is relax the bladder
muscle so its not spasming. This allows the
patient to hold more and have better control.
Stress incontinence is typically treated with surgery,
but if you are not ready for that, Dr. Wiskind says
the next step is pelvic floor or supporting devices.
So when should you see a specialist for urinary
incontinence? Its simple, says Dr. Wiskind: When
it becomes bothersome in your everyday life.
Q & A
whatdoctorsknow.com
whatdoctorsknow.com
What is CF?
Cystic Fibrosis (CF) is a genetic disorder caused
by a defect in a gene called the Cystic Fibrosis
Transmembrane Conductance Regulator
(CFTR) gene. This gene normally makes a
protein channel that controls the movement of
salt and water in and out of the cells in your
body. In people with CF, the channel does not
work effectively, causing unusually thick, sticky
mucus in the lungs, pancreas and other organs.
Another feature includes very salty tasting skin.
What is a CF mutation?
Genes are essentially a set of instructions within
the body. They lie in long strands of DNA called
chromosomes. A gene mutation is a permanent
change in the DNA sequence. CF is a genetically
recessive condition, meaning a person must inherit
a gene mutation from both parents. If a person has
only one gene mutation, he/she will be a carrier,
who can possibly pass the gene mutation to his/her
children, but will not have CF as a medical condition.
How is CF diagnosed?
Most people are diagnosed with CF at birth through
newborn screening or before the age of 2. Two
tests can be used to diagnose CF. First, is a sweat
chloride test. Second, a blood sample to test for
more than 1,000 genetic mutations that cause CF.
How many people have
cystic fibrosis and what is
their average lifespan?
There are approximately 30,000 people in the
United States who have cystic fibrosis. In 2011, the
median predicted age of survival rose to 36.8 years.
This was up from 2004s figure of 35.1 years.
Is CF contagious?
No. CF is not a contagious condition.
Individuals with CF, however, can more easily
get respiratory infections from others colds.
Is it inevitable that a person
with CF will need a lung
transplant in the future?
CF is a progressive disease that primarily affects
the lung. Over time, lung damage develops. Lung
transplant, in selected cases, improves quality of life.
Lung transplant will not cure CF. Lung transplant
is a difficult and personal decision. It is crucial that
you communicate with your health-care provider
about your thoughts on lung transplantation.
What is 65 Roses?
65 Roses is another phrase for cystic fibrosis.
It came into being when a young boy with
cystic fibrosis overheard his mother saying 65
roses when she was saying cystic fibrosis.
Can men with CF produce children?
90 percent of men with CF are infertile, but not sterile.
It is recommended that men with CF first have a
sperm analysis to determine their fertility status. If the
analysis is normal, intracytoplasmic sperm injection
(in vitro fertilization) can be performed allowing
men with CF and their partners to have children.
Can women with CF produce children?
Some women with CF have fertility difficulties.
Vaginal mucous is often thicker, making it more
difficult for the sperm to travel and for fertilization
to take place. It may take longer for women with
CF to become pregnant, although this in no way
affects the pregnancy itself or the fetus. It is crucial
that women with CF who want to become pregnant
communicate with their health-care provider
because it involves modifications to treatments
and closer monitoring of overall symptoms.
For more information about the Center for
Cystic Fibrosis at Keck Hospital of USC,
please call (323) 442-8522 or visit http://bit.ly/
CFatUSC. -Kamyar Afshar, DO, Keck Hospital
of the University of Southern California
About CF
(Cystic Fibrosis)
MYTH 4:
CANCER
IS MY
FATE
CANCER PREVENTION
Prevention is the most cost-effective and sustainable way of reducing
the global cancer burden in the long-term.
EVIDENCE
Clobal, regiohal ahd haIiohal policies ahd programmes IhaI promoIe
healIhy li!esIyles cah subsIahIially reduce cahcers IhaI are caused by risk
!acIors such as alcohol, uhhealIhy dieI ahd physical ihacIiviIy. Improvihg
dieI, physical acIiviIy ahd maihIaihihg a healIhy body weighI could prevehI
arouhd a Ihird o! Ihe mosI commoh cahcers.
8ased oh currehI Irehds, Iobacco use is esIimaIed Io kill ohe billioh people
ih Ihe 21sI cehIury. Addressihg Iobacco use, which is lihked Io 71% o! all
luhg cahcer deaIhs, ahd accouhIs !or aI leasI 22% o! all cahcer deaIhs is
Ihere!ore criIical.
For developihg couhIries, Ihe siIuaIioh o!Ieh goes beyohd addressihg
behavioural chahge, wiIh mahy couhIries !acihg a 'double burdeh' o!
exposures, Ihe mosI commoh o! which is cahcer-causihg ih!ecIiohs. Chrohic
ih!ecIiohs are esIimaIed Io cause approximaIely 16% o! all cahcers globally,
wiIh Ihis !gure risihg Io almosI 23% ih developihg couhIries. Several o! Ihe
mosI commoh cahcers ih developihg couhIries such as liver, cervical ahd
sIomach cahcers are associaIed wiIh ih!ecIiohs wiIh hepaIiIis 8 virus (H8V),
Ihe humah papillomavirus (HPV), ahd Ihe bacIerium HelicobacIer pylori (H.
pylori), respecIively. As a cohsequehce, Ihe ihIroducIioh o! sa!e, e!!ecIive
ahd a!!ordable vaccihes should be implemehIed as parI o! haIiohal cahcer
cohIrol plahs.
Lxposure Io a wide rahge o! ehvirohmehIal causes o! cahcer ih our persohal
ahd pro!essiohal lives, ihcludihg exposure Io ihdoor air polluIioh, radiaIioh
ahd excessive suhlighI are also ma|or prevehIable causes o! cahcer
GLOBAL ADVOCACY
MESSAGE
Effective cancer prevention
aI Ihe haIiohal level begins
with a national cancer
control plan (NCCP) IhaI
respohds Io a couhIry's
cahcer burdeh ahd cahcer
risk !acIor prevalehce, ahd
is desighed Io implemehI
evidehce-based resource-
appropriaIe policies ahd
programmes IhaI reduce
the level of exposure to
risk factors !or cahcer ahd
sIrehgIheh Ihe capaciIy
o! ihdividuals Io adopI
healthy lifestyle choices.
TRUTH:
With the right strategies,
A THIRD OF
THE MOST
COMMON
CANCERS CAN
BE PREVENTED.
C
I
A
N

A
g
e
h
c
y

F
r
a
h

o
i
s

S
I
r
u
z
i
k

-

s
i
m
p
l
y

h
u
m
a
h
CANCER KNOWLEDGE
Lack of information and awareness about cancer is a critical obstacle
to effective cancer control and care in developing countries, especially
for the detection of cancers at earlier and more treatable stages.
EVIDENCE
Ih mahy developihg couhIries, miscohcepIiohs abouI diaghosis ahd IreaImehI
ahd sIigma associaIed wiIh cahcer cah lead ihdividuals Io seek alIerhaIive care
ih place o! sIahdard IreaImehI or Io avoid care alIogeIher. UhdersIahdihg
ahd respohdihg Io culIural belie!s ahd pracIices is essehIial.
AlIhough geheral cahcer awarehess ih developihg couhIries remaihs low,
eveh amohg healIh pro!essiohals, levels o! cohcerh abouI cahcer are high,
ahd Ihe public pays aIIehIioh Io messagihg abouI Ihe disease.
Ihdividuals, policy makers ahd healIhcare pro!essiohals heed Io uhdersIahd
IhaI mahy cahcers cah be prevehIed Ihrough appropriaIe li!esIyle chahge,
IhaI cahcer cah o!Ieh be cured, ahd IhaI e!!ecIive IreaImehIs are available,
regardless o! Ihe resource seIIihg.
RecehI experiehce wiIh screehihg ahd vaccihaIioh programmes ih developihg
couhIries suggesIs IhaI ohce people uhdersIahd basic ih!ormaIioh abouI
cahcer ahd khow how Io access services Ihey Iehd Io come !or Ihe services.
Lqually imporIahI is Ihe developmehI o! sIraIegies Io ehcourage help seekihg
behaviour, ihcludihg awarehess ahd educaIioh o! ways Io recoghise Ihe sighs
ahd sympIoms, ahd uhdersIahdihg IhaI Iimely evaluaIioh will ihcrease Ihe
opporIuhiIies !or cure.
CANCER OUTCOMES
Disparities in cancer outcomes exist between the developed and
developing world for most cancers.
EVIDENCE
PaIiehIs whose cahcers are curable ih Ihe developed world uhhecessarily
su!!er ahd die due Io a lack o! awarehess, resources ahd access Io a!!ordable,
e!!ecIive ahd qualiIy cahcer services IhaI ehable early diaghosis ahd
appropriaIe IreaImehI ahd care.
1he realiIy o! cahcer cure raIes ih childreh is re!ecIive o! Ihe ihexcusable
ihequiIies ih global access Io IreaImehI ahd care. 1here are ah esIimaIed
160,000 hewly diaghosed cases o! childhood cahcer worldwide each year
wiIh more Ihah 70% o! Ihe world's childreh wiIh cahcer lackihg access Io
e!!ecIive IreaImehI. 1he resulI is ah uhaccepIably low survival raIe o! ~10%
ih developihg couhIries compared Io ~90% ih high-ihcome couhIries.
Ih mahy cases Ihe largesI ahd mosI uhaccepIable gap ih cahcer care is Ihe
lack o! adequaIe palliaIive care ahd access Io paih relie! !or much o! Ihe
world's populaIioh. A shorI lisI o! medicaIiohs cah cohIrol paih !or almosI
90% o! all people wiIh cahcer paih ihcludihg childreh, yeI milliohs o! cahcer
paIiehIs have liIIle Io ho access Io adequaIe paih IreaImehI.
GLOBAL ADVOCACY MESSAGE
Effcacious and cost-effective
interventions musI be made available
ih ah equitable mahher Ihrough
cahcer prevehIioh, early deIecIioh ahd
IreaImehI delivered as parI o! haIiohal
cahcer cohIrol plahs (NCCPs) IhaI
respohd Io Ihe haIiohal cahcer burdeh.
Access to effective, quality and
affordable cancer services is a right
o! all ihdividuals ahd should hoI be
deIermihed by where you live.
GLOBAL ADVOCACY MESSAGE
1he approach ahd scope o! ah effective
cancer prevention programme Iakes
ihIo accouhI hoI ohly ecohomic
!acIors buI also social and cultural
factors. Comprehehsive prevehIioh
programmes IhaI ihclude sIraIegies Io
improve khowledge o! cahcer amohg
commuhiIies, healIh pro!essiohals
ahd policy makers, expahd access Io
services ahd promoIe healIhy !oods
ahd !aciliIaIe physical acIiviIy have, Ihe
greaIesI chahce o! success.
worldcancerday.org
UNION FOR INTERNATIONAL CANCER CONTROL
UNION INTERNATIONALE CONTRE LE CANCER
62 route de Frontenex t 1207 Geneva t Switzerland
Tel. +41 (0)22 809 1811 t Fax +41 (0)22 809 1810 t info@uicc.org tuicc.org
MYTH 4:
CANCER
IS MY
FATE
CANCER PREVENTION
Prevention is the most cost-effective and sustainable way of reducing
the global cancer burden in the long-term.
EVIDENCE
Clobal, regiohal ahd haIiohal policies ahd programmes IhaI promoIe
healIhy li!esIyles cah subsIahIially reduce cahcers IhaI are caused by risk
!acIors such as alcohol, uhhealIhy dieI ahd physical ihacIiviIy. Improvihg
dieI, physical acIiviIy ahd maihIaihihg a healIhy body weighI could prevehI
arouhd a Ihird o! Ihe mosI commoh cahcers.
8ased oh currehI Irehds, Iobacco use is esIimaIed Io kill ohe billioh people
ih Ihe 21sI cehIury. Addressihg Iobacco use, which is lihked Io 71% o! all
luhg cahcer deaIhs, ahd accouhIs !or aI leasI 22% o! all cahcer deaIhs is
Ihere!ore criIical.
For developihg couhIries, Ihe siIuaIioh o!Ieh goes beyohd addressihg
behavioural chahge, wiIh mahy couhIries !acihg a 'double burdeh' o!
exposures, Ihe mosI commoh o! which is cahcer-causihg ih!ecIiohs. Chrohic
ih!ecIiohs are esIimaIed Io cause approximaIely 16% o! all cahcers globally,
wiIh Ihis !gure risihg Io almosI 23% ih developihg couhIries. Several o! Ihe
mosI commoh cahcers ih developihg couhIries such as liver, cervical ahd
sIomach cahcers are associaIed wiIh ih!ecIiohs wiIh hepaIiIis 8 virus (H8V),
Ihe humah papillomavirus (HPV), ahd Ihe bacIerium HelicobacIer pylori (H.
pylori), respecIively. As a cohsequehce, Ihe ihIroducIioh o! sa!e, e!!ecIive
ahd a!!ordable vaccihes should be implemehIed as parI o! haIiohal cahcer
cohIrol plahs.
Lxposure Io a wide rahge o! ehvirohmehIal causes o! cahcer ih our persohal
ahd pro!essiohal lives, ihcludihg exposure Io ihdoor air polluIioh, radiaIioh
ahd excessive suhlighI are also ma|or prevehIable causes o! cahcer
GLOBAL ADVOCACY
MESSAGE
Effective cancer prevention
aI Ihe haIiohal level begins
with a national cancer
control plan (NCCP) IhaI
respohds Io a couhIry's
cahcer burdeh ahd cahcer
risk !acIor prevalehce, ahd
is desighed Io implemehI
evidehce-based resource-
appropriaIe policies ahd
programmes IhaI reduce
the level of exposure to
risk factors !or cahcer ahd
sIrehgIheh Ihe capaciIy
o! ihdividuals Io adopI
healthy lifestyle choices.
TRUTH:
With the right strategies,
A THIRD OF
THE MOST
COMMON
CANCERS CAN
BE PREVENTED.
C
I
A
N

A
g
e
h
c
y

F
r
a
h

o
i
s

S
I
r
u
z
i
k

-

s
i
m
p
l
y

h
u
m
a
h
CANCER KNOWLEDGE
Lack of information and awareness about cancer is a critical obstacle
to effective cancer control and care in developing countries, especially
for the detection of cancers at earlier and more treatable stages.
EVIDENCE
Ih mahy developihg couhIries, miscohcepIiohs abouI diaghosis ahd IreaImehI
ahd sIigma associaIed wiIh cahcer cah lead ihdividuals Io seek alIerhaIive care
ih place o! sIahdard IreaImehI or Io avoid care alIogeIher. UhdersIahdihg
ahd respohdihg Io culIural belie!s ahd pracIices is essehIial.
AlIhough geheral cahcer awarehess ih developihg couhIries remaihs low,
eveh amohg healIh pro!essiohals, levels o! cohcerh abouI cahcer are high,
ahd Ihe public pays aIIehIioh Io messagihg abouI Ihe disease.
Ihdividuals, policy makers ahd healIhcare pro!essiohals heed Io uhdersIahd
IhaI mahy cahcers cah be prevehIed Ihrough appropriaIe li!esIyle chahge,
IhaI cahcer cah o!Ieh be cured, ahd IhaI e!!ecIive IreaImehIs are available,
regardless o! Ihe resource seIIihg.
RecehI experiehce wiIh screehihg ahd vaccihaIioh programmes ih developihg
couhIries suggesIs IhaI ohce people uhdersIahd basic ih!ormaIioh abouI
cahcer ahd khow how Io access services Ihey Iehd Io come !or Ihe services.
Lqually imporIahI is Ihe developmehI o! sIraIegies Io ehcourage help seekihg
behaviour, ihcludihg awarehess ahd educaIioh o! ways Io recoghise Ihe sighs
ahd sympIoms, ahd uhdersIahdihg IhaI Iimely evaluaIioh will ihcrease Ihe
opporIuhiIies !or cure.
CANCER OUTCOMES
Disparities in cancer outcomes exist between the developed and
developing world for most cancers.
EVIDENCE
PaIiehIs whose cahcers are curable ih Ihe developed world uhhecessarily
su!!er ahd die due Io a lack o! awarehess, resources ahd access Io a!!ordable,
e!!ecIive ahd qualiIy cahcer services IhaI ehable early diaghosis ahd
appropriaIe IreaImehI ahd care.
1he realiIy o! cahcer cure raIes ih childreh is re!ecIive o! Ihe ihexcusable
ihequiIies ih global access Io IreaImehI ahd care. 1here are ah esIimaIed
160,000 hewly diaghosed cases o! childhood cahcer worldwide each year
wiIh more Ihah 70% o! Ihe world's childreh wiIh cahcer lackihg access Io
e!!ecIive IreaImehI. 1he resulI is ah uhaccepIably low survival raIe o! ~10%
ih developihg couhIries compared Io ~90% ih high-ihcome couhIries.
Ih mahy cases Ihe largesI ahd mosI uhaccepIable gap ih cahcer care is Ihe
lack o! adequaIe palliaIive care ahd access Io paih relie! !or much o! Ihe
world's populaIioh. A shorI lisI o! medicaIiohs cah cohIrol paih !or almosI
90% o! all people wiIh cahcer paih ihcludihg childreh, yeI milliohs o! cahcer
paIiehIs have liIIle Io ho access Io adequaIe paih IreaImehI.
GLOBAL ADVOCACY MESSAGE
Effcacious and cost-effective
interventions musI be made available
ih ah equitable mahher Ihrough
cahcer prevehIioh, early deIecIioh ahd
IreaImehI delivered as parI o! haIiohal
cahcer cohIrol plahs (NCCPs) IhaI
respohd Io Ihe haIiohal cahcer burdeh.
Access to effective, quality and
affordable cancer services is a right
o! all ihdividuals ahd should hoI be
deIermihed by where you live.
GLOBAL ADVOCACY MESSAGE
1he approach ahd scope o! ah effective
cancer prevention programme Iakes
ihIo accouhI hoI ohly ecohomic
!acIors buI also social and cultural
factors. Comprehehsive prevehIioh
programmes IhaI ihclude sIraIegies Io
improve khowledge o! cahcer amohg
commuhiIies, healIh pro!essiohals
ahd policy makers, expahd access Io
services ahd promoIe healIhy !oods
ahd !aciliIaIe physical acIiviIy have, Ihe
greaIesI chahce o! success.
worldcancerday.org
UNION FOR INTERNATIONAL CANCER CONTROL
UNION INTERNATIONALE CONTRE LE CANCER
62 route de Frontenex t 1207 Geneva t Switzerland
Tel. +41 (0)22 809 1811 t Fax +41 (0)22 809 1810 t info@uicc.org tuicc.org
whatdoctorsknow.com
Fatigue and
Lupus
A
s many as 80 percent of
people with lupus experience
fatigue. For some people
with lupus, fatigue is
their main symptom and
can be debilitating. It is
unclear why extreme fatigue occurs
in so many people with lupus, but a
variety of factors appear to play a role.
15 Questions with
Dr. Diane Kamen,
courtesy of the Lupus
Foundation of America
1
Have lupus researchers discovered
any more information about the
causes of the extreme lupus fatigue
so many of us experience?
A majority of patients with lupus
identify fatigue as one of their
primary symptoms, yet the causes of
fatigue vary from person to person.
Although research is still ongoing,
several important factors have been
found to be associated with fatigue
such as poor sleep quality, depression,
anxiety, anemia, vitamin D deficiency,
and reduced physical activity with
deconditioning. Conditions that
sometimes co-exist with lupus such as
obesity, diabetes, thyroid disease and
fibromyalgia can also be associated
with fatigue. Lupus itself can also be
associated with fatigue, but so can the
medications used to treat lupus, creating
a challenging balance for many patients.
whatdoctorsknow.com
2
3 5
4
My fatigue is not constant but seems
to come in bouts, it this something
you hear frequently? New Canaan, CT
Yes, just like other symptoms of lupus
commonly wax and wane over time,
so can the fatigue. And similar to what
we know about triggers of lupus flares,
what triggers the onset of severe fatigue
can vary from person to person and can
sometimes be unpredictable. Research
is ongoing to find better biomarkers
(lab tests that detect early indications
of a problem) which will help reduce
this unpredictability but the studies
so far have not found an ideal test.
Is it possible to have debilitating
fatigue and have normal labs and other
symptoms are minimal? Cumming, MA
Yes, we definitely see this occur where
fatigue is the main, or only, active
symptom of a persons otherwise-well-
controlled lupus. It is a reminder that
labs do not always tell the whole picture
and there is much about lupus we still
need to understand better. Up to 80%
of patients with lupus identify fatigue
as one of their primary symptoms
and the fatigue can be quite severe.
Despite fatigue being recognized by the medical community as a sometimes debilitating
symptom of Lupus, it is extremely hard to have that fact recognized by disability
insurance companies. What are some ways patients and doctors can work together to
provide objective evidence of disabling fatigue cause by Lupus? North Fort Myers, FL
Insurance companies and other organizations involved with disability do sometimes put
less weight on what we call subjective problems symptoms that are felt and experienced
by patients but not easily validated with an objective finding such as with a lab value or
physical exam finding. Often, this requires a statement from the treating physician explaining
the condition and how fatigue is related. Educating insurance companies more about lupus
and related fatigue would certainly be a good place to start. Lupus awareness is growing
everyday (thanks to awareness campaigns like those the LFA has initiated) and hopefully
will lead to more understanding of this illness by organizations like insurance companies.
I have been a lupus patient
for seven years. One major
struggle is dealing with
fatigue. What activities/
habits might exacerbate
being fatigued? Chicago, IL
As with most chronic illnesses,
leading a healthy lifestyle will
help lessen the impact of your
symptoms. We know that even
small lifestyle changes can help
with many symptoms of lupus
including fatigue. Lifestyle
factors that influence fatigue and
energy levels include exercising
regularly, avoiding tobacco and
drug use, limiting or avoiding
alcohol, eating healthy (limiting
fast food and high sugar foods,
eating more lean meats, fruits and
vegetables for example). Several
studies in which patients with
lupus with low levels of physical
activity participated in supervised
exercise programs have shown
that exercise tolerance, fatigue,
and quality of life improve
slowly over time. Injury from
the exercises is rare despite it
being a common fear of patients
prior to starting a program.
whatdoctorsknow.com 0
7
Do people with lupus actually NEED a lot
of sleep or do we just FEEL like we always
need more sleep. Should I be sleeping the
normal 8 hours instead of 11? Will it make a
difference in my fatigue? Oceanside, CA
While getting an adequate amount of sleep is
important, everyone has a different amount
of sleep they require to function normally
during the day. For adults 8-9 hours is
usually adequate (10-11 hours for children)
and sleeping longer does not usually help
with fatigue, even in patients with lupus. It
is important that your doctor check you for
other common causes of fatigue such as sleep
apnea, diabetes, anemia and thyroid disease. It
is also important that your sleep at night is not
disrupted i.e. do you awaken frequently at
night, get up to go to the bathroom at night,
have problems falling asleep? If so, these may
indicate another problem causing your fatigue.
I am 39 years old and was diagnosed with
Lupus a year ago. I am fatigued all the time,
even after 12 or more hours of hard sleep. What
does research show to be the most helpful
for true lupus fatigue? Are there any new
medications on the horizon that may help with
this symptom? Reidsville, NC Berryton, KS
Earlier this year there was an excellent review
published by Drs. Grace Ahn and Rosalind
Ramsey-Goldman describing the findings from
research trials of treatments for fatigue among
patients with lupus. Non-drug interventions
which were found to be helpful in reducing
fatigue include behavioral therapy sessions,
acupuncture, and home-based exercise 3 days a
week using the Wii-Fit system. Medication trials
of intravenous belimumab, a biologic therapy
for active systemic lupus, found that fatigue was
significantly reduced compared to placebo. A trial
of dehydroepiandrosterone (DHEA), an adrenal
hormone, taken 200 mg daily improved fatigue
among patients but so did the placebo pills.
Clearly, more research studies need to be done
so we can make more specific recommendations
to help patients with their fatigue.
6
I teach 4th grade and feel totally worn out by
day's end. Are there any specific foods/diet,
vitamins, exercise, etc. that can re-energize to
get through a full day? Does your overall diet
have any impact on lupus fatigue? La Mirada, CA
Regular exercise is one of the single most
important things you can do to help combat
fatigue. A diet lower in carbohydrates and higher
in protein, vegetables and fruits has been shown
to help with fatigue (see #5 above). I often
recommend patients visit the LFA website for
tips on meal planning and food choices. There
are no specific vitamins that have been shown to
help with fatigue unless you are deficient, which
is uncommon except for vitamin D deficiency (see
#12 below). Your doctor can check for vitamin
deficiencies with a physical exam and simple
blood tests to see if supplementation is needed.
8
whatdoctorsknow.com
Is it possible that being deficient in Vitamin D has anything to do
with increased disease activity and extreme fatigue? Media, PA
Good question and one which our group has been researching for several
years, since finding that a majority of patients with lupus have low blood
levels of vitamin D. These low levels are likely due to several causes, one of
which is sun-avoidance since direct sunlight is a trigger of lupus flares but
it is also our main source of vitamin D. We know that adequate vitamin
D is important for bone health as well as balance/stability and we are still
learning about the ways vitamin D influences immune system health. Dr.
Guillermo Ruiz-Irastorza and his group in Spain studied the relationship
between fatigue measurements in patients with lupus and their blood
25-hydroxyvitamin D levels and concluded that very low vitamin D
levels predicted higher fatigue scores. When vitamin D levels were
increased by oral vitamin D3 supplements, fatigue among the patients
improved. This is promising news that vitamin D supplementation for
those patients who are vitamin D deficient may help with fatigue and
several research studies of vitamin D are underway for us to learn more.
9
10
How do we distinguish between the overwhelming fatigue
of our lupus and depression? Oklahoma City, OK
This can be difficult sometimes to distinguish. Often depression will have other
symptoms such as crying spells, persistent feeling of sadness, loss of interest
in doing things you usually enjoy, or isolating yourself from others. With the
fatigue from lupus, you may still enjoy doing things but feel like you dont have
the energy to do them. With depression, you may lose the interest in doing
these things, regardless of your energy level. It is very important to discuss
your symptoms with a healthcare provider since depression can be a serious
illness requiring treatment such as medication or psychological counseling.
11
How can Lupus Fatigue be differentiated from other
causes of fatigue such as Chronic Fatigue Syndrome? I've
been told I have both and I don't understand how my
fatigue can be a separate diagnosis. Hatboro, PA
Usually there is not a way to clearly distinguish these causes of fatigue,
especially since (as described in #3 above) fatigue may be the only
active symptoms of otherwise-well-control lupus. It is very important to
make sure lupus activity is adequately and appropriately treated and that
other causes (mentioned in #1 above) are ruled out. With that in mind,
the treatments and things to avoid or reduce to help your symptoms
of fatigue would be the same as mentioned in other answers here.
12
Is there anything I can do to
prepare myself for fatigue I
know is coming after a stressful
day? I was preparing for a
parade I was participating in and
literally collapsed after it was
over. A few hours later I was able
to get up but still wiped out for
the next 16 hours. San Dimas, CA
Many people, even without lupus,
identify stress as a trigger of
fatigue. So if you know a stressful
situation is coming, it makes
getting good quality sleep, eating
healthy and drinking plenty of
water to stay hydrated even more
important. Doing those beneficial
things, as well as avoiding fatigue
triggers (direct sun exposure is
a common one for patients, as
well as others such as smoking
or alcohol/sedatives), can help
you get through a stressful day.
whatdoctorsknow.com
14
13
Ive had lupus for 32 years. During
this time I've had extreme fatigue and
insomnia. I'd like to find something
natural to help me sleep. I'm so
tired of taking drugs and I refuse
to take sleeping pills. Can you
suggest anything? Pahrump, NV
Insomnia can have a number of causes and
can be difficult to treat. Exercising during
the day with only light exercise in the
evening, avoiding a heavy dinner or eating
late at night, reducing caffeine, choosing
a comfortable mattress, and a relaxing
bedtime routine such as listening to music
or pleasure reading have all been shown to
help with sleep at night. To increase your
chances of a good nights sleep, you should
also try not to nap during the day and
avoid late night TV watching or working
in bed. It is a good idea to establish a wind
down routine in the evening to relax your
mind and body before getting into bed.
I was diagnosed last March w/ SLE Lupus. I went
from not being able to walk, to doing well on
CellCept. I still have this incredible fatigue.
After work I have to go to bed sometimes at 6
pm. My husband says I snore at night. I wonder
if I may have sleep apnea. Does that happen
often with Lupus patients and could this
contribute to my fatigue? Would a sleep study
be appropriate to rule that out? Springfield, MO
It is certainly possible that you do have sleep
apnea, which could certainly contribute to your
fatigue and be diagnosed with an overnight sleep
study. Studies of sleep patterns among patients
with lupus have found high rates of unrestorative
(poor quality) sleep and sleep disorders, including
sleep apnea and abnormal limb movements during
sleep. Factors that were found to be associated with
poor sleep quality include lupus disease activity,
prednisone use, depressed mood and lower levels
of exercise. Other factors that increase the risk
of sleep apnea in the general population include
smoking, alcohol or sedative use, being overweight,
and having a family history of sleep apnea.
I have extreme fatigue about a week before
my menstrual cycle. Is this due to my lupus or
the hormone changes during menses? Do you
have any other suggestions to help alleviate
the pre-menstrual fatigue? Madison, WI
Hormonal changes, especially shifts in estrogen
and progesterone around the time of menses, are a
common trigger of fatigue in women both with and
without lupus. Be sure you get checked for other
causes such as thyroid disease and anemia if you
have not already. Keeping a monthly symptom diary
may help you predict the timing and severity of your
premenstrual symptoms. There is some evidence
that certain anti-depressant medications may help
with premenstrual symptoms such as fatigue.
Hormonal birth control, such as birth control pills,
are often prescribed to treat premenstrual syndrome,
including fatigue, however estrogen-containing
formulations should be avoided in patients at
risk for blood clots, so the decision should be
discussed with your lupus doctor before starting.
15
whatdoctorsknow.com
Itchy,
Runny
Nose...
...what's to blame,
allergy or the weather?
A
s the weather takes the country on a
temperature roller coaster ridefrom
seasonal bone-chilling cold to spring-
like warmth and then back again
many people find themselves reaching
for pain relievers or other remedies
to deal with runny noses and other symptoms
associated with sinus and allergy problems.
John Fahrenholz, M.D., assistant professor of
Medicine who practices at the Vanderbilt Asthma,
Sinus and Allergy Program, says that such whipsawing
temperatures can be a real challenge for people
with allergiesand with the rest of us, too.
People who know they have allergies should make sure to take
their allergy medications daily during such times, he said.
But even those of us who dont suffer from allergies can
develop a runny nose when the temperature and humidity
are changing rapidly. Rhinitisa swollen, itchy nose
can occur in the midst of rapidly changing weather that
many parts of the U.S. continue to experience this year.
Since simply experiencing the weather can cause an
itchy, runny nose, it can be a challenge to figure out
who is experiencing allergy symptoms and who is not.
Here are a few guidelines from Fahrenholz to help you
and your nosethrough crazy changeable weather:
If temperature changes bring on an itchy, runny
nose, try using an over-the-counter salt water
nose spray or nasal sinus rinses. These can also be
helpful in dealing with cold, dry air in winter.
If symptoms persist even when the temperatures
level out, you may have allergies.
Dont blame changing weather for your
cold or flutheres no evidence that cycles
of cold and warm days make your immune
system any more likely to pick up a virus.
People with a tendency toward ongoing allergy
symptoms during the winter months should make
sure to take their regular allergy medications. Colder
air is dry which can cause irritation to the nasal tissues
leading to increased nasal allergy symptoms.
If regular use of over-the-counter antihistamines or
other allergy products are not controlling symptoms,
the allergy sufferer should make an appointment to
see a health care professional to see if prescription
medications, such as nasal steroids, may help.
-This information provided courtesy of
Vanderbilt University Medical Center
More Mothers Are
Breastfeeding
A
cross all groups, the
percentage of mothers
who start and continue
breastfeeding is rising,
according to a report
released in February 2013
by the Centers for Disease Control and
Prevention (CDC). From 2000 to 2008,
mothers who started breastfeeding
increased more than 4 percentage
points. During that same time, the
number of mothers still breastfeeding
at six months jumped nearly 10
percentage points, from 35 percent in
2000 to nearly 45 percent in 2008.
In addition to increases among all
groups, gaps in breastfeeding rates
between African American and white
mothers are narrowing. The gap
narrowed from 24 percentage points in
2000 to 16 percentage points in 2008.
Breastfeeding is good for the mother
and for the infant and the striking news
here is, hundreds of thousands more
babies are being breastfed than in past
years, and this increase has been seen
across most racial and ethnic groups,
said CDC Director Tom Frieden, M.D.,
M.P.H. Despite these increases, many
mothers who want to breastfeed are
still not getting the support they need
from hospitals, doctors, or employers.
We must redouble our efforts to support
mothers who want to breastfeed.
While gaps continue to narrow among
groups, more targeted strategies to
increase breastfeeding support for
African American mothers are still
needed. To address this, CDC is
currently funding Best-Fed Beginnings,
a project that provides support to 89
hospitals, many serving minority and low
income populations, to improve hospital
practices that support breastfeeding
mothers. CDC has also recently awarded
funds to six state health departments
to develop community breastfeeding
support systems in communities of color.
To better understand breastfeeding
trends and differences among African
American, white and Hispanic infants
born from 2000 to 2008, CDC
analyzed National Immunization
Survey data from 20022011. Other
key findings of the report include:
From 2000 to 2008, breastfeeding
at six and twelve months increased
significantly among African American,
white and Hispanic infants.
While numbers are rising across all
groups, all mothers need more support
to continue breastfeeding since less
than half of mothers are breastfeeding
at six months (45 percent) and less
than a quarter of mothers (23 percent)
are breastfeeding at twelve months.
Although rates of breastfeeding
at six months increased by more
than 13 percent among African
American mothers, this group still
had the lowest rates of breastfeeding
duration, indicating that they still
need more, targeted support.
For more information about CDC
efforts to improve support for
breastfeeding mothers, specifically
hospital practices to support
breastfeeding, visit www.cdc.gov/
breastfeeding/promotion. For broadcast
quality clips of the MMWR report on
progress in increasing breastfeeding
and reducing racial/ethnic differences,
please visit http://www.cdc.gov/media/
subtopic/mmwr-audioVideo.htm#.
-This information provided courtesy
of the Centers for Disease Control
whatdoctorsknow.com
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.
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Definition: Often called a dispensing optician, this individual designs, fits and
dispenses lenses to correct vision. An optician can fill the prescriptions written by an
optometrist or ophthalmologist. They are not trained to conduct eye exams or to treat
patients. They analyze and interpret the prescriptions written by ophthalmologists or
optometrists to determine which eyeglasses or contact lenses are best suited to the
patient's lifestyle and visual needs. Some opticians have received specialized training and
may manufacture (grind) lenses from raw materials and cut them to fit into the frame.
Education/Licensing: While opticians are not required to be licensed in most states,
there are several national programs that offer training and certification. They certify
those individuals who have received the necessary knowledge and skills to safely
dispense eyewear. There are also associate opticianry degrees or an optician may have
apprenticed for a required number of hours. An optician is not a medical doctor.
KNOW YOUR SPECIALIST
Optician. Optometrist. Ophthalmologist.
W
hen it comes to eye care, most people dont know the difference
between Optician, Optometrist or Ophthalmologist. All three are typically
lumped into the category of eye doctor. But there is a difference.
Optician
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Optometrist
Definition: An ophthalmologist is a doctor who that specializes
in the anatomy, function and diseases of the eye. These doctors
provide a full spectrum of care including routine eye exams,
diagnosis and medical treatment of eye disorders and diseases,
prescriptions for eyeglasses, surgery, and management of eye
problems caused by systemic illnesses. An ophthalmologist is a
surgeon trained to perform complex and delicate eye surgery.
Education/Licensing: Ophthalmologists can be either
medical doctors (M.D.) or doctors of osteopathy (D.O.). An
ophthalmologist is a fully licensed medical doctor qualified
to practice surgery. Licensed by the state after completing
4 years of undergraduate study at a college or university,
ophthalmologists attend 4 years of medical school to obtain
an M.D. or D.O. degree. After graduating from medical school,
they complete a one-year internship and three years of training
in ophthalmology in a residency program approved by the
Accreditation Council for Graduate Medical Education (ACGME).
Following residency, ophthalmologists may enroll in a 1- to
2-year fellowship program for training in a subspecialty such
as glaucoma or ophthalmic plastic surgery. Ophthalmologists
receive their licensing from a state regulatory board to
practice medicine and surgery after they are board certified.
Definition: An optometrist is considered the primary care physician
for the eye. They are trained and licensed to examine, diagnose and
treat diseases, injuries, and disorders of the eye and visual system.
An optometrist can prescribe medications and different forms of
vision therapy such as low vision rehabilitation as treatment for the
disorders such as nearsightedness, farsightedness, astigmatism and
presbyopia. They can perform certain minor surgical procedures.
Education/Licensing: An optometrist is a doctor of optometry (O.D.),
and is held to the same legal standards as a physician. After completing
at least three years of higher education at an accredited university or
college, an individual is eligible to attend an accredited four-year school in
optometry. After graduating, passing state board examinations, both written
and clinical are required. The optometrist has the option to complete an
additional one-year residency to specialize in any number of areas including
family practice, ocular disease, pediatric optometry and vision therapy.
Ophthalmologist
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B
a
s
a
l
C
e
l
l

S
k
i
n
C
a
n
c
e
r
A
n
alternative to surgical rem
oval
A clinical study has demonstrated that a new drug, a
targeted molecular therapy called vismodegib (trade
name Erivedge), can dramatically shrink basal cell
skin cancers and prevent the formation of new ones,
in patients with basal cell nevus syndrome (BCNS). This
rare genetic condition causes dozens, and sometimes
hundreds or thousands, of skin cancers on each patients
body. The primary treatment option is surgical removal.
These study results are significant as they indicate
the possibility of an alternative treatment with oral
medication; although side effects remain a consideration.
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T
he phase II clinical study, led by researchers
at NewYork-Presbyterian Hospital/Columbia
University Medical Center (NYPH/CUMC)
and Childrens Hospital of Oakland Research
Institute (CHORI), was published June
6, 2012 in the online edition of the New
England Journal of Medicine, Inhibiting the Hedgehog
Pathway in Basal-Cell Nevus Syndrome Patients.
In its current formulation, vismodegib is appropriate
only for BCNS patients with very large numbers of
basal cell skin cancers. Still, this is a huge step forward,
pointing to the day when we can offer every one of
these patients an alternative to repeated surgery, which
can be disfiguring and burdensome, said study co-
leader David R. Bickers, MD, the Carl Truman Nelson
Professor and chairman of dermatology at CUMC
and director of dermatology at NewYork-Presbyterian
Hospital/CUMC. The study was co-led by Ervin H.
Epstein, Jr., MD, a senior scientist at CHORI.
The study is the first to evaluate vismodegib in
patients with BCNS. Forty-two patients were
randomized to receive either vismodegib (taken
orally) or a placebo, for a maximum of 18 months.
Overall, the study tracked more than 2,000 existing
surgically eligible basal cell skin cancers (SEBs) and
documented 694 new SEBs, on the 42 patients.
Patients taking vismodegib experienced an average
of 2.3 new SEBs, compared with 29 for patients in
the placebo group. Among patients taking the drug,
the diameter of clinically significant skin cancers
decreased an average of 65 percent, compared
with 11 percent among controls. In light of these
findings, the independent data and safety monitoring
board appointed to oversee this trial recommended
switching all patients into the treatment group.
In many patients, we observed a dramatic
reduction in the size of the lesions within
one to two months, said Dr. Bickers.
BCNS, also called Gorlin syndrome, encompasses
multiple defects that involve the skin, nervous system,
eyes, endocrine glands, and bones. The hallmark of
BCNS is the appearance of basal cell carcinomas, a slow-
growing form of skin cancer, at or around puberty.
BCNS has been linked to mutations in a gene
called PTCH1. PTCH1 is the primary inhibitor of
a signaling pathway called sonic hedgehog, which
helps ensure proper segmentation of the developing
embryo. At birth, PTCH1 activity causes most
sonic hedgehog signaling to cease. When PTCH1 is
mutated, however, sonic hedgehog signaling continues
postnatally. The result can be abnormal cell growth and
proliferation, setting the stage for tumor formation.
Vismodegib was designed specifically to achieve
targeted inhibition of the sonic hedgehog
pathway, which is implicated in many types of
cancer. The drug is manufactured by Genentech,
Inc., of South San Francisco, CA.
Earlier clinical trials found vismodegib to be an
effective treatment for metastatic and recurrent locally
advanced basal cell skin cancer. On January 30,
2012, the Food and Drug Administration approved
vismodegib for use in adults with these conditions
who cannot be treated with surgery or radiation.
Vismodegib is a new treatment option for those with
extensive disease, particularly those whose lives may
be devastated by the disease and the need for repeated
treatment, Dr. Bickers said. However he would not
recommend vismodegib for all BCNS patients. The
side effects, which include loss of taste and appetite,
weight loss, muscle cramps and hair loss, occur in nearly
half of patients. Though not life threatening, they
can be debilitating. Since patients would have to take
vismodegib indefinitely, it is not a suitable alternative
to surgery for patients with sporadic basal cell cancers.
The purpose of the study was to see whether, by
using this targeted molecular therapy, we could match
the performance of a surgeon, and in many ways, we
could, Dr. Bickers added. The challenge now is to
see if we can lessen the adverse effects while achieving
the same therapeutic benefits by modifying the
dosing schedule or perhaps by alternating drug
treatment with other modalities such as photodynamic
therapy, which can be effective for smaller lesions.
This is one of the first human cancer therapies based
on determining the genetic mutations in a particular
tumor pathway (in this case, sonic hedgehog) and
inhibiting the pathway directly. The findings may
have broader relevance to treating other types of basal
cell skin cancer (the most common form of cancer in
adults), which are caused by similar dysregulation of the
sonic hedgehog pathway. -This information provided
courtesy of Columbia University Medical Center
whatdoctorsknow.com 0
A Link Between
Atherosclerosis
and Macular
Degeneration?
A

new study raises the intriguing possibility that drugs prescribed to lower cholesterol
may be effective against macular degeneration, a blinding eye disease. Researchers
at Washington University School of Medicine in St. Louis have found that age-
related macular degeneration, the leading cause of vision loss in Americans over
50, shares a common link with atherosclerosis. Both problems have the same
underlying defect: the inability to remove a buildup of fat and cholesterol.
Beneath the retina of a patient with macular degeneration, the small light dots against the
orange background are cholesterol deposits, and as cholesterol builds up, the area becomes
inflamed, spurring the development of abnormal blood vessels that can lead to loss of vision.
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Working in mice and in human cells, the researchers
shed new light on how deposits of cholesterol
contribute to macular degeneration and atherosclerosis
and even blood vessel growth in some types of cancer.
Patients who have atherosclerosis often are
prescribed medications to lower cholesterol and
keep arteries clear. This study suggests that
some of those same drugs could be evaluated
in patients with macular degeneration.
Based on our findings, we need to investigate
whether vision loss caused by macular degeneration
could be prevented with cholesterol-lowering eye
drops or other medications that might prevent the
buildup of lipids beneath the retina, says senior
investigator Rajendra S. Apte, MD, PhD.
The new research centers on macrophages, key
immune cells that remove cholesterol and fats from
tissues. In macular degeneration, the excessive
buildup of cholesterol begins to occur as we age,
and our macrophages begin to malfunction.
In the dry form of age-related macular degeneration,
doctors examining the eye can see lipid deposits
beneath the retina. As those deposits become
larger and more numerous, they slowly begin to
destroy the central part of the eye, interfering with
the vision needed to read a book or drive a car.
As aging macrophages clear fewer fat deposits beneath
the retina, the macrophage cells themselves can become
bloated with cholesterol, creating an inflammatory
process that leads to the formation of new blood
vessels that can cause further damage. Those vessels
characterize the later wet form of the disease.
Ultimately, that inflammation creates a toxic mix of
things that leads to new blood vessel growth, Apte
explains. Most of the vision loss from wet macular
degeneration is the result of bleeding and scar-tissue
formation related to abnormal vessel growth.
As part of their research, the scientists identified
a protein that macrophages need to clear fats and
cholesterol. As mice and humans age, they make less
of the protein, and macrophages become less effective
at engulfing and removing fat and cholesterol.
Apte and his team found that macrophages, from old
mice and in patients with macular degeneration, have
inadequate levels of the protein, called ABCA1, which
transports cholesterol out of cells. As a result, the old
macrophages accumulated high levels of cholesterol
and couldnt inhibit the growth of the damaging blood
vessels that characterize the wet form of the disorder.
But when the researchers treated the macrophages
with a substance that helped restore levels of ABCA1,
the cells could remove cholesterol more effectively, and
the development of new blood vessels was slowed.
We were able to deliver the drug, called an LXR
agonist, in eye drops, says first author Abdoulaye
Sene, PhD, a post-doctoral fellow in the Apte lab.
And we found that we could reverse the macular
degeneration in the eye of an old mouse. Thats
exciting because if we could use eye drops to deliver
drugs that fight macular degeneration, we could
focus therapy only on the eyes, and we likely could
limit the side effects of drugs taken orally.
Sene and Apte also say that since macrophages are
important in atherosclerosis and in the formation of
new blood vessels around certain types of cancerous
tumors, the same pathway also might provide a target
for more effective therapies for those diseases.
We have shown that we can reverse the disease
cascade in mice by improving macrophage function,
either with eye drops or with systemic treatments,
Apte says. Some of the therapies already being used
to treat atherosclerosis target this same pathway,
so we may be able to modify drugs that already
are available and use them to deliver treatment to
the eye. -This information provided courtesy of
Washington University School of Medicine in St. Louis
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Zit-Face?
Why some people get
zits and others don't
T
he bacteria that cause acne live on everyone's
skin, yet one in five people is lucky enough
to develop only an occasional pimple
over a lifetime. What's their secret?
In a boon for teenagers everywhere, a
UCLA study conducted with researchers
at Washington University in St. Louis and the Los
Angeles Biomedical Research Institute has discovered
that acne bacteria contain "bad" strains associated with
pimples and "good" strains that may protect the skin.
The findings, published in the Feb. 28 edition of
the Journal of Investigative Dermatology, could
lead to a myriad of new therapies to prevent
and treat the disfiguring skin disorder.
"We learned that not all acne bacteria trigger pimples
one strain actually may help keep skin healthy," explained
lead author Huiying Li, an assistant professor of molecular
and medical pharmacology at the David Geffen School
of Medicine at UCLA. "We hope to apply our findings
to develop new strategies that stop blemishes before they
start, and enable dermatologists to customize treatment
to each patient's unique cocktail of skin bacteria."
The scientists looked at a tiny microbe with a
big name: Propionibacterium acnes, bacteria that
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thrive in the oily depths of our pores. When the
bacteria aggravate the immune system, they cause
the swollen, red bumps associated with acne.
Using over-the-counter pore-cleansing strips, LA
BioMed and UCLA researchers lifted P. acnes bacteria
from the noses of 49 pimply and 52 clear-skinned
volunteers. After extracting the microbial DNA from
the strips, Li's laboratory tracked a genetic marker to
identify the bacterial strains in each volunteer's pores
and recorded whether the person suffered from acne.
Next, Li's lab cultured the bacteria from the strips to
isolate more than 1,000 strains. Washington University
scientists sequenced the genomes of 66 of the P.
acnes strains, enabling UCLA co-first author Shuta
Tomida to zero in on genes unique to each strain.
"We were interested to learn that the bacterial strains
looked very different when taken from diseased skin,
compared to healthy skin," said co-author Dr. Noah
Craft, a dermatologist and director of the Center
for Immunotherapeutics Research at LA BioMed at
HarborUCLA Medical Center. "Two unique strains
of P. acnes appeared in one out of five volunteers with
acne but rarely occurred in clear-skinned people."
The biggest discovery was still to come.
"We were extremely excited to uncover a third strain of
P. acnes that's common in healthy skin yet rarely found
when acne is present," said Li, who is also a member
of UCLA's Crump Institute for Molecular Imaging.
"We suspect that this strain contains a natural defense
mechanism that enables it to recognize attackers and
destroy them before they infect the bacterial cell."
Offering new hope to acne sufferers, the researchers
believe that increasing the body's friendly strain
of P. acnes through the use of a simple cream or
lotion may help calm spotty complexions.
"This P. acnes strain may protect the skin, much like
yogurt's live bacteria help defend the gut from harmful
bugs," Li said. "Our next step will be to investigate
whether a probiotic cream can block bad bacteria from
invading the skin and prevent pimples before they start."
Additional studies will focus on exploring new drugs
that kill bad strains of P. acnes while preserving the
good ones; the use of viruses to kill acne-related
bacteria; and a simple skin test to predict whether a
person will develop aggressive acne in the future.
"Our research underscores the importance of strain-level
analysis of the world of human microbes to define the role
of bacteria in health and disease," said co-author George
Weinstock, associate director of the Genome Institute
and professor of genetics at Washington University in St.
Louis. "This type of analysis has a much higher resolution
than prior studies that relied on bacterial cultures or
only made distinctions between bacterial species."
Acne affects 80 percent of Americans at some point
in their lives, yet scientists know little about what
causes the disorder and have made limited progress in
developing new strategies for treating it. Dermatologists'
arsenal of anti-acne tools benzoyl peroxide, antibiotics
and Accutane (isotretinoin) hasn't expanded in
decades. Most severe cases of acne don't respond to
antibiotics, and Accutane can produce serious side
effects. -This information provided courtesy of UCLA
Health Systems and Washington University in St. Louis.
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Are New
Moms
OCD?
A

new mother may constantly worry and
check to see if her baby is still breathing.
Or she may fret about germs, obsessing
whether shes properly sterilized the
bottles, then wash and rewash them.
A new Northwestern Medicine study
found that women who have recently given birth
have a much higher rate of obsessive-compulsive
symptoms than the general population.
The study found 11 percent of women at two weeks
and six months postpartum experience significant
obsessive-compulsive symptoms compared to 2
to 3 percent in the general population. This is the
first large-scale longitudinal study of obsessive-
compulsive symptoms in the postpartum period.
These symptoms, including fear of injuring the baby
and worry about germs, are usually temporary and
could result from hormonal changes or be an adaptive
response to caring for a new baby, researchers said.
But if the compulsions interfere with a mothers
functioning, they may indicate a psychological disorder.
It may be that certain kinds of obsessions and
compulsions are adaptive and appropriate for a new
parent, for example those about cleanliness and
hygiene, said study senior author Dana Gossett,
M.D., chief and assistant professor of obstetrics and
About 50 percent of the women reported an
improvement in their symptoms by six months, but
at that time point new women developed symptoms
whom had not experienced them at two weeks.
If those symptoms are developing much later after
delivery, they are less likely to be hormonal or adaptive,
Gossett said. The risk for psychological disorders
persists for up to a year after delivery, she noted.
About 70 percent of the women who screened positive
for obsessive-compulsive symptoms also screened
positive for depression. That overlap and the unique
subset of obsessions and compulsions could indicate
postpartum OCD represents a distinct postpartum
mental illness that is not well classified, Miller said.
There is some debate as to whether postpartum
depression is simply a major depressive episode that
happens after birth or its own disease with its own
features, Miller said. Our study supports the idea that
it may be its own disease with more of the anxiety and
obsessive-compulsive symptoms than would be typical
for a major depressive episode. -This information
provided courtesy of Northwestern Medicine
gynecology at Northwestern University Feinberg School
of Medicine and a physician at Northwestern Memorial
Hospital. But when it interferes with normal day-
to-day functioning and appropriate care for the baby
and parent, it becomes maladaptive and pathologic.
Gossett and colleagues recollections of their own
obsessive and upsetting thoughts after giving birth led
them to investigate if the experience was universal.
Obsessions are unwanted and repeated
thoughts or images that create anxiety.
A compulsion is a response to those obsessive thoughts,
a ritualistic behavior that temporary allays the anxiety but
cant rationally prevent the obsession from occurring,
explained Emily Miller, M.D., lead study author and a
clinical fellow in maternal fetal medicine at Feinberg.
Obsessive-compulsive disorder (OCD) may be triggered
by stress, research shows. Thus, stressful situations,
such as pregnancy and the postpartum period, may
exacerbate or predispose women to OCD.
The most prevalent thoughts women reported
in the study were concern about dirt or germs
followed by compulsions to check that they
did not make a mistake, Miller said. New
mothers may check and recheck baby monitors are
working, the baby's crib side is properly latched
or bottles are properly sterilized, for example.
Some women in the study reported intrusive
thoughts that they would harm the baby.
That can be emotionally painful, Miller
said. You dont intend to harm the baby,
but youre fearful that you will.
For postpartum women with obsessive-
compulsive symptoms who otherwise are
functioning normally, Gossett said, It would
be reassuring to hear that their thoughts and
behaviors are very common and should pass.
Gossett recalled that after she gave birth to her first child,
she routinely worried about falling down the stairs with
her baby or the baby would fall out of bed. It comes
into your mind unbidden and its frightening, she said.
Researchers now need to determine what behavior
is normal and whats pathologic, Gossett said.
The women in the study were recruited during their
delivery hospitalization at Northwestern Memorial and
completed screening tests for anxiety, depression and
OCD two weeks and six months after going home. A
total of 461 women completed the surveys at two weeks
and 329 of the original group completed them at six
months. The womens symptoms were self-reported and
they did not receive a clinical diagnosis by a psychologist.
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Excessive Spit Up
Doesn't Mean
Reflux
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M
edications used to treat
gastroesophageal reflux disease,
or GERD, are some of the most
widely used medications in
children less than one year old.
In a new study, researchers from
the University of Michigan and the University
of Missouri concluded that physicians often label
common symptoms in infants, such as crying
and spitting up, as disease. Frequent use of the
GERD label can lead to overuse of medication.
The study found that doctors use of the GERD label
prompted parents to request medication for their baby
even when they had been advised that the medication
would probably be ineffective, says senior author Beth
Tarini, M.D., assistant professor of pediatrics at the
University of Michigans C.S. Mott Childrens Hospital.
"As doctors we need to appreciate that the words we
use when talking with patients and parents have
power the power to make a normal process seem
like a disease. As pediatricians, our job is to make
sick children healthy, not to make healthy children
sick," says Tarini, who also is an investigator in U-Ms
Child Health Evaluation and Research Unit.
In the study, researchers surveyed parents coming
into a pediatric clinic in Michigan about how they
would respond to a hypothetical clinical scenario
describing an infant who cries and spits up excessively
but is otherwise healthy. Parents were randomly
assigned to receive one of multiple vignettes. In some
vignettes, the doctor gave a diagnosis of GERD; in
others the doctor did not provide a disease label.
Half the parents were told that existing medications
are probably ineffective; the rest were not given
information about medication effectiveness. Parents
who received a GERD diagnosis were interested in
medicating their infant, even when told that medications
were ineffective. Parents not given a disease label were
interested in a prescription only when the doctor did
not discuss whether the medication was effective.
Over-diagnosis of GERD can make a medical condition
out of a normal behavior, says lead author Laura Scherer,
assistant professor of psychological science in the College
of Arts and Science at the University of Missouri.
The growing digestive systems of an infant can be
finicky and cause the child to regurgitate. The discomfort
can cause the infant to cry, but it is not necessarily a
disease, says Scherer. Parents can learn from this study
that a disease label can make them want medication for
their child, regardless of whether the drugs are effective
or not. Parents should follow doctors advice, which
sometimes means accepting a doctors explanation of
why an infants crying and vomiting may be normal.
Unnecessary use of medication is costly, says Scherer.
Especially for families without insurance, the over-
use of medications can be a needless expense. In
addition, the long-term side effects of the medication
frequently prescribed to children diagnosed with
GERD have not been fully studied, although the
medication has been correlated to slightly higher rates
of pneumonia. -This information provided courtesy
of the University of Michigan Medical School
For Robbie, a
lung transplant
could
save an entire family.
I just want to be a regular mom:
to be there for my daughter as
she grows up, goes to the prom,
gets married, has kids of her own.
I want to live to be there for her.
Robbie is among the tens of
thousands of people waiting
right now for an organ, eye or
tissue transplant.
You have the power to Donate Life.
Be an organ, eye and tissue donor.
To find out how, go today to www.donatelife.net
or call 1-800-355-7427.