Archive For: Medical Conditions

COVID-19 and The Road Ahead

From Boosters & Breakthroughs to Vaccines & Variants: Where Do We Go From Here?

The following reflects an 8/24/2021 discussion; please check the CDC website for real-time updates as the situation continues to evolve.

Their answers may not land lightly, but epidemiologist Jodie Guest, PhD, and drug development expert Michael Kinch, PhD, have been immersed in examining COVID-19 since its first stirrings in early 2020. They share an informed look at the road ahead for us all.

State of Concern

Noting more than 39 million COVID-19 cases nationwide, (as of 9/2/21) Guest projects this will continue to rise rapidly and eclipse one million a week. While “hot spots” for outbreaks clearly correspond to the country’s most lightly vaccinated locales, the impact of the delta variant is being felt in virtually every state. “There’s almost nowhere you can go in the U.S. that you don’t need to be masked indoors, even if vaccinated,” she says. The progressive increase in vaccinated patients with COVID-19 in European hospitals is also troubling, says Kinch, a potential harbinger of what is to come for the U.S.

However, what’s driving the surge is not cases among the vaccinated, known as “breakthroughs.” It’s a term Guest would like to eliminate permanently, given its negative connotation regarding vaccine efficacy. “These type of infections are still rare. More than 90% of those hospitalized with COVID-19 are unvaccinated.” She points out that while viral loads in patients with COVID-19 are the same for vaccinated and unvaccinated patients in the first few days of illness, they drop much faster and further in the vaccinated.

The vaccine, contends Kinch, was never intended to eliminate all possibility of getting COVID-19. “It’s not a suit of armor,” he says, “because no vaccine ever provides 100% protection. But we know they work incredibly well to prevent you from getting very sick or dying.”

The FDA’s recent approval of the Pfizer mRNA vaccine, with Moderna approval expected to follow soon, is pivotal, says Guest, in helping launch vaccination requirements at businesses, schools and other locations. “Don’t underestimate the importance of this approval in providing support for mandates that will protect all of us,” she says. “Recognize that in the entire history of vaccines, there has never been a set more studied than the ones we have now.”
Adds Kinch, “With the enormous amount of data gathered on the vaccines’ efficacy and safety, those who think of themselves as vaccine hesitant may more accurately be described as vaccine resistant.”

Third Doses and Boosters

The recent approval of a third dose of Pfizer or Moderna for immunosuppressed patients who didn’t build sufficient immunity from the first two doses applies to just 3% of the adult population. For everyone else (with the exception of pregnant women), a booster shot six to eight months after the initial series is being considered for approval.

“Right now, that’s how long we believe we can go without significantly diminished immunity,” says Guest. Antibody tests are not proven to be an accurate measure of protection from COVID-19, says Kinch, because the antibody levels vary by individual.

If you received Pfizer or Moderna initially, choose the same for a booster. Notes Kinch: “There’s no difference between these two vaccines—one is not better than the other.” In fact, some studies show no impact on efficacy from switching brands, he says; Johnson & Johnson data is yet to come.

And where does the flu shot fit in this fall? Absolutely essential, both agree, with the only caution that a two-week separation between the two vaccines may be recommended by some healthcare providers to avoid triggering a hyperactive immune response.

Protecting our Children

The best way to keep youngsters under 12 safe is ensuring that everyone around them is vaccinated, says Guest.
“Teachers, caregivers, babysitters and others should be vaccinated, or fully masked whenever they’re with children,” she advises. A different dose is being tested for 5- to 12-year-olds, with approval possible later this year.

The Next Wave of Variants?

While not identified by the Centers for Disease Control (CDC) as a “high concern,” Kinch admits that the lambda variant worries him primarily because not enough is known about its ability to resist vaccines. “One view is that the COVID-19 spike protein can only mutate to a certain point, and if that’s true, lambda could be the end of the virus. The other view is that we don’t know if it stopped mutating,” he says.
“We’re not defenseless, though,” counters Guest, “because we can keep it from getting here by having COVID-19 not circulating in communities. Greater numbers of vaccinated people will prevent us from getting whatever variant might follow delta.”

Stay Safe and Well

One of last year’s most popular signoff lines takes on new resonance as our experts advise on what that now means for the vaccinated in fall 2021.

Mask Up, Indoors and Out.

Masks are increasingly needed outside in crowded areas. Indoors, remember that while a soft, comfortable cloth mask protects others from you, if you need extra protection in certain settings, use a KN95 or N95 mask.

Pass on Indoor Dining, Movies, Concerts and Sporting Events.

Also reconsider full-capacity outdoor events with no masking/distancing/vaccine requirements. (As an alternative, order take-out and support virtual events offered by local venues). And avoid getting together in person with those who are not vaccinated.

Reach out to Every Unvaccinated Person you Know.

“The best action we can take is to keep encouraging every unvaccinated person we know to get the shot, now,” advises Guest. “We’re all in the race against variants and need to work together to defeat them as quickly as possible.” Adds Kinch, “It’s unfortunate that the motivations behind much of the messaging has messed up the message itself. Be completely honest about what is known and not known about the vaccine.”

The Swiss Cheese Respiratory Pandemic Defense.

“Layering prevention messages is crucial because the delta variant has made the holes in the Swiss cheese slice of the vaccine just a bit bigger,” says Guest. “Now masks are more crucial than ever before.”

Dr. Jodie Guest is professor and vice chair of the Department of Epidemiology, Emory University, Atlanta, and award-winning leader of Emory’s Outbreak Response Team for COVID-19.

Dr. Michael Kinch is associate vice chancellor and founder/director of the Center for Research Innovation in Biotechnology and the Center for Drug Discovery at Washington University, St. Louis.

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New Lung Cancer Screening Recommendations

Illustration of a toxic smoke in Lung

Spotlighting Both Challenges and Progress

This winter the U.S. Preventive Services Task Force (USPSTF) released its new Lung Cancer screening recommendations, lowering both the starting age and pack-per-year criteria. Previously, low-dose computed tomography screening was advised for adults age 55 to 80 years with a 30-pack-per-year history of smoking who are current smokers or have quit within the past 15 years; now the USPSTF recommends extending the screening to adults starting at age 50 who have a 20-pack-per-year smoking history.

For most, the announcement may have gone under the radar due to the intense focus on the COVID-19 vaccine rollout in early 2021. But as the first change in lung cancer screening eligibility criteria since 2013, its significance was quickly recognized and is still being broadly debated across the medical community.

Notably, previous recommendations missed female patients who tended to be lighter smokers than men, and despite Black smokers’ higher risk of developing lung cancer, included only 17% of Black people who smoke compared to 31% of White smokers. The question is, by doubling the number of people eligible for screening, do the guidelines indicate a significant shift that will improve gender and racial disparities in testing and outcomes, or are they simply a small, overdue step in the right direction?

“It’s excellent news because expanded screening eligibility can reduce lung cancer mortality and may reduce all-cause mortality,” acknowledges Ella Kazerooni, MD, professor of radiology and internal medicine at the University of Michigan Medical School, who’s devoted much of her career to creating lung cancer survivors through her work as chair of the National Lung Cancer Roundtable.

The downside: “This may also cause false-positive results, leading to unnecessary tests and invasive procedures, because we’re still not incorporating other known risk factors. These encompass more than just smoking, but include air pollution, exposure to radon and other carcinogens, family history and social determinants of health,” says Dr. Kazerooni.

In March 2021, the American Academy of Family Physicians (AAFP) weighed in with support for the measure while also noting the need for additional research to determine potential harms from annual screening.

“More studies are needed to achieve our goal of increasing survivorship and lowering mortality without enhancing risk along the way,” agrees Dr. Kazerooni. “Compared to cardiac disease, research for lung cancer screening and risk assessment is relatively new and evolving. Tools, like an individualized lung cancer risk calculator, will take time to develop because of the complexity of the disease.”

Lung cancer survivor Jill Feldman views the new recommendations with the same unflinching honesty that’s fueled her remarkable 20-year crusade for others with the disease. She is the former president of LUNGevity and a founding member of the EGFR Resisters, both leading nonprofit patient support and advocacy organizations.

“We took too long to get here,” she says, “and it’s still not being viewed with a nearly wide enough lens. By focusing solely on age and smoking habits, we’re not considering the critical intersection of environmental factors and personal and family history that impact an individual’s risk of lung cancer.”
Having lost two grandparents, an aunt and both her parents to lung cancer before being diagnosed in 2009 with non-small cell lung cancer at age 39, Jill is painfully aware of the barriers that still surround screening and treatment.

“Despite its prevalence, lung cancer carries a real stigma,” says Jill. “The unintended consequence of successfully educating the public about the heightened risk of lung cancer among people who smoke, is that it’s considered preventable, making people reluctant to seek screening, and if diagnosed, ashamed to admit they have it.”

“It’s a significant problem that impacts people along the entire cancer care continuum,” says Dr. Kazerooni. “And it affects funding and research dollars as well. Although lung cancer is the leading cause of cancer death in the U.S., only 6% of federal dollars dedicated to cancer research are allocated to lung cancer.”

The stigma issue is particularly harmful for the rising numbers of younger women in their 20s to 40s with no smoking history who are diagnosed with lung cancer. “When someone is forced to
emphasize that they never smoked, the message being sent to the 85% of patients with lung cancer who have a smoking history is ‘you are the ones who deserve this.’ No one deserves lung cancer,” says Jill.

Epidemiology studies centered on nonsmokers with lung cancer have begun, but actionable findings may not be reported for at least another decade or two, according to Dr. Kazerooni. The GO2 Foundation for Lung Cancer is currently studying genomic, environmental and behavioral risk factors to identify the common link among nonsmokers in order to run trials.

“We know the disease seems to be increasing among nonsmokers, especially younger women, but we don’t know enough to effectively screen for it now,” says Dr. Kazerooni.

While screening challenges remain, advances in treatment show incredible promise, especially targeted biomarker therapy, which is allowing Jill to treat her incurable lung cancer as a chronic condition.

“I never used to use the word ‘hope’ in the same sentence with lung cancer. But there is real hope now,” she says.

The following are traditional signs of non-small cell and small cell lung cancer, which can also be present as a result of many other conditions. Keep in mind, however, that the hope of expanded lung cancer screening is to find the disease before these symptoms appear.

  • A cough that gets worse or does not go away
  • Coughing up blood
  • Breathing trouble, such as shortness of breath
  • New wheezing when you breathe
  • Ache or pain in your chest, upper back or shoulder that doesn’t go away and may get worse with deep breathing
  • Hoarseness
  • Frequent respiratory tract infections, such as pneumonia or bronchitis
  • Feeling unusually tired all the time
  • Weight loss with no known cause
  • Trouble swallowing
  • Swelling in the face and/or veins in the neck

Source: LUNGevity Foundation

The post New Lung Cancer Screening Recommendations appeared first on Specialdocs Consultants.

A Quick Guide to Seasonal Allergies

Mature Couple Gardening

Pollen, Grass, Ragweed and Mold spores

For more than 24 million Americans, the flowering trees and mild weather of spring and summer, signals another allergy season in full bloom. The cause: substances such as pollen, grass, ragweed and mold spores enter the body and are mistakenly identified as a threat by the immune system, triggering a variety of symptoms. We hope you find some comfort in this quick guide to seasonal allergies.

Reduce the effects of seasonal allergies

  • Pollen and spores can be carried into the home on your clothes or enter through windows during allergy season.
  • Know which pollens you are sensitive to and then check pollen counts. Weather reports often include this information during allergy seasons. In spring and summer, during tree and grass pollen season, levels are highest in the evening. In late summer and early fall, during ragweed pollen season, levels are highest in the morning. For an interactive map to view allergy levels and pollen count forecasts, visit pollen.com.
  • If your allergy symptoms are very bothersome:
    • Take a shower, wash your hair and change your clothes after you’ve been working or playing outdoors, and keep windows and doors shut at home and in your car.
    • Wear sunglasses and a hat outside to keep pollen out of eyes and hair. Your COVID-19 mask could provide a protective barrier against pollen.
    • Indoors, get an air purifier with a HEPA filter, and vacuum regularly.

Treatment

Seasonal allergies are often treated with over-the-counter or prescription antihistamines (non-drowsy types are available), nasal steroid sprays, decongestants and immunotherapy (allergy shots that expose you over time to gradual increments of the allergen), as well as alternative methods. Please check with your healthcare provider to discuss what’s right for you.

Symptom Checker: Is It Allergies, a Cold or COVID-19?

Allergies Colds Covid-19
Duration of symptoms Allergy season 4-10 days Varies
Mucus Thin, watery and clear Thick and yellow/green
New loss of taste or smell Uncommon Uncommon Often (early)
Itchy or watery eyes Usually Rarely Rarely
Sneezing Usually Sometimes Rarely
Cough Frequent Usually Usually
Shortness of breath Sometimes allergens can exacerbate a respiratory condition Sometimes Usually
Sore throat Frequent Usually Usually
Fever Never Sometimes Usually
Diarrhea Never Uncommon Sometimes
Contagious Never Yes Yes
Body aches Never Sometimes Usually
Fatigue Sometimes Sometimes Usually

Not Your Imagination: Pollen Season May Be Getting Worse

According to the American College of Allergy, Asthma and Immunology (ACAAI), climate change has made pollen season longer and more severe throughout North America. A recent study showed that pollen seasons for plants like trees, grasses, and weeds showed a 20-day increase in length and a 21% increase in pollen concentration from 1990 to 2018. Notably the researchers also found that the pollen produced is more allergenic – more likely to trigger an allergic reaction with fewer grains of pollen in the air.
Sources: Mayo Clinic, ACAAI

The post A Quick Guide to Seasonal Allergies appeared first on Specialdocs Consultants.

Pandemic Stress Likely Compounded by Seasonal Affective Disorder

Experts Expect Record Numbers of Seasonal Affective Disorder Diagnoses in 2021

As we continue to weather the storm of COVID-19, seasonal affective disorder, or SAD, is also on our radar. More subtle than an arctic blast, SAD is just as real, with just as much potential to have a chilling effect on our mood, productivity and wellness. Unfortunately, the emotional stress and fear that come with a global pandemic create an ideal climate for SAD this winter. Not surprisingly, mental health experts are expecting to diagnose and treat more cases of SAD in 2021 than ever before.

First discovered in the 1840s, SAD was not officially recognized as a disorder until the early 1980s, when Dr. Norman Rosenthal coined the term and categorized it as a form of clinical depression. We now know that SAD affects at least 5% of Americans; is more likely to affect women than men, those with other forms of depression or family members with the condition; and is far more common in northern regions, due to reduced natural sunlight. New research has advanced several theories as to why some people develop SAD, including: sluggish transmission of serotonin (which helps regulate mood and the body’s circadian rhythms; reduced sensitivity of the eyes to environmental light; a combination of these factors; or other reasons yet to be uncovered).

Increased understanding of what triggers SAD and its impact on mental health has inspired a growing number of clinical treatments that can effectively neutralize its effects.

Chief among them:

Healing light.

Sitting in front of a bright light box for 30 to 45 minutes daily has been a treatment of choice for more than three decades, helping SAD patients with either 10,000 lux of white fluorescent or full spectrum light that shines 20 times brighter than ordinary indoor illumination. Dawn simulation, another form of light therapy, begins in early morning before patients awake by emitting a low level of light that gradually increases over 30 to 90 minutes to recommended room light level (approximately 250 lux). Enhancing indoor lighting with regular lamps and fixtures is also recommended).

Talk therapy.

Newer studies from the University of Vermont suggest that cognitive behavioral therapy (CBT), a psychological treatment aimed at providing patients with tools to change negative thoughts and behaviors, may be as effective as light therapy for treating SAD. According to the National Institute for Mental Health (NIMH), CBT adapted for SAD focuses on behavioral activation, helping SAD sufferers identify and engage in enjoyable seasonal activities to combat the ennui and fatigue they typically experience in winter.

Sleep hygiene.

Creating a consistent light-dark, sleep-wake cycle is important for SAD patients, who often experience hypersomnia (excessive daytime sleepiness) and insomnia (trouble falling or staying asleep).
Antidepressant medications. Because SAD is associated with disturbances in serotonin activity, antidepressant medications have been effectively used to treat symptoms.
Active days. Keep moving with daily walks outside, even on cloudy days, and aerobic exercise. Both can help alleviate symptoms of SAD.

Winterize your mental health

Be proactive in safeguarding your mental wellness over the coming months. Most importantly, know the symptoms of SAD and call our office for help if you’re experiencing:

  • Diminished interest in things that were once enjoyable
  • Low energy or overwhelming fatigue
  • Difficulty with concentration or focus
  • Worthless or helpless feeling
  • Sleep issues: too much sleep, or not enough
  • Changes in appetite or weight; increases in carbohydrate and sugar cravings
  • Agitation

Experts advise those who’ve previously experienced episodes of seasonal depression to try to get in front of it this year. Call our office for guidance regarding medications or CBT sessions. For many, reprogramming their mindset can help restore proper circadian rhythms and eliminate the psychological dread of winter. Try enrolling in an online class, taking up a new hobby or creating a new routine to optimize daylight exposure. Or keep it even simpler. As Dr. Rosenthal recently told the New York Times, “A 20-minute early morning walk in the sun can be as good as commercial light therapy.”

 
 

The post Pandemic Stress Likely Compounded by Seasonal Affective Disorder appeared first on Specialdocs Consultants.

Pandemic Stress Likely Compounded by Seasonal Affective Disorder

Experts Expect Record Numbers of Seasonal Affective Disorder Diagnoses in 2021

As we continue to weather the storm of COVID-19, seasonal affective disorder, or SAD, is also on our radar. More subtle than an arctic blast, SAD is just as real, with just as much potential to have a chilling effect on our mood, productivity and wellness. Unfortunately, the emotional stress and fear that come with a global pandemic create an ideal climate for SAD this winter. Not surprisingly, mental health experts are expecting to diagnose and treat more cases of SAD in 2021 than ever before.

First discovered in the 1840s, SAD was not officially recognized as a disorder until the early 1980s, when Dr. Norman Rosenthal coined the term and categorized it as a form of clinical depression. We now know that SAD affects at least 5% of Americans; is more likely to affect women than men, those with other forms of depression or family members with the condition; and is far more common in northern regions, due to reduced natural sunlight. New research has advanced several theories as to why some people develop SAD, including: sluggish transmission of serotonin (which helps regulate mood and the body’s circadian rhythms; reduced sensitivity of the eyes to environmental light; a combination of these factors; or other reasons yet to be uncovered).

Increased understanding of what triggers SAD and its impact on mental health has inspired a growing number of clinical treatments that can effectively neutralize its effects.

Chief among them:

Healing light.

Sitting in front of a bright light box for 30 to 45 minutes daily has been a treatment of choice for more than three decades, helping SAD patients with either 10,000 lux of white fluorescent or full spectrum light that shines 20 times brighter than ordinary indoor illumination. Dawn simulation, another form of light therapy, begins in early morning before patients awake by emitting a low level of light that gradually increases over 30 to 90 minutes to recommended room light level (approximately 250 lux). Enhancing indoor lighting with regular lamps and fixtures is also recommended).

Talk therapy.

Newer studies from the University of Vermont suggest that cognitive behavioral therapy (CBT), a psychological treatment aimed at providing patients with tools to change negative thoughts and behaviors, may be as effective as light therapy for treating SAD. According to the National Institute for Mental Health (NIMH), CBT adapted for SAD focuses on behavioral activation, helping SAD sufferers identify and engage in enjoyable seasonal activities to combat the ennui and fatigue they typically experience in winter.

Sleep hygiene.

Creating a consistent light-dark, sleep-wake cycle is important for SAD patients, who often experience hypersomnia (excessive daytime sleepiness) and insomnia (trouble falling or staying asleep).
Antidepressant medications. Because SAD is associated with disturbances in serotonin activity, antidepressant medications have been effectively used to treat symptoms.
Active days. Keep moving with daily walks outside, even on cloudy days, and aerobic exercise. Both can help alleviate symptoms of SAD.

Winterize your mental health

Be proactive in safeguarding your mental wellness over the coming months. Most importantly, know the symptoms of SAD and call our office for help if you’re experiencing:

  • Diminished interest in things that were once enjoyable
  • Low energy or overwhelming fatigue
  • Difficulty with concentration or focus
  • Worthless or helpless feeling
  • Sleep issues: too much sleep, or not enough
  • Changes in appetite or weight; increases in carbohydrate and sugar cravings
  • Agitation

Experts advise those who’ve previously experienced episodes of seasonal depression to try to get in front of it this year. Call our office for guidance regarding medications or CBT sessions. For many, reprogramming their mindset can help restore proper circadian rhythms and eliminate the psychological dread of winter. Try enrolling in an online class, taking up a new hobby or creating a new routine to optimize daylight exposure. Or keep it even simpler. As Dr. Rosenthal recently told the New York Times, “A 20-minute early morning walk in the sun can be as good as commercial light therapy.”

 
 

The post Pandemic Stress Likely Compounded by Seasonal Affective Disorder appeared first on Specialdocs Consultants.

Can We Co-Exist with COVID-19?

An Epidemiologist Separates Fact from Fiction and Offers Hope for the Future

Epidemiologists seek to learn why, how and when some people contract diseases when others don’t. Their findings are used to help monitor public health status, develop new medical treatments and disease prevention efforts, and provide an evidence base to healthcare and policy leaders.

Whether you feel the coronavirus is receding or set to surge, that testing is plentiful or inadequate, or that cases are reported as too high or too low may vary considerably based on where you live and your political leanings.

For an objective, no-spin perspective, we checked in with Jodie Guest, PhD, an epidemiologist at Emory University in Atlanta. Dr. Guest’s life’s work is studying the distribution, causes, prevention and control of diseases in populations.

Her answers to some of today’s most important questions about COVID-19 are below. Please note these reflect the situation mid-September…check our website for further updates.

Q: Are we seeing a slowdown in the number of new COVID-19 cases in the U.S.?

Dr. Guest: The number of new cases has, fortunately, plateaued or slowed down, but in many places the plateaus reflect substantially higher numbers than were reported in April, when everyone was still staying home. My concern is with schools and businesses reopening and less willingness to follow safety guidelines, the numbers may creep back up.

Q: What sites do you trust for accurate reporting on COVID-19?

Dr. Guest: I compare numbers from Johns Hopkins, Centers for Disease Control (CDC) and Worldometer to see if they match.

Q: What is the significance of the latest report from the CDC that just 6% of coronavirus deaths to date have COVID-19 as the only cause of death?

Dr. Guest: It’s not at all surprising for two reasons. One is that more than 60% of Americans have an underlying condition, such as obesity or diabetes. The risk of complications and hospitalization for people with two to three underlying conditions who contracted the virus is up to five times greater than for people with no [underlying] conditions. Second, death certificates list everything that may have contributed to mortality, including comorbid conditions and conditions caused by COVID-19 such as pneumonia. This does NOT mean that any of the more than 200,000 people who had heart disease or diabetes as an underlying condition didn’t actually die of COVID-19.

Q: Why are people of color and Latinos at greater risk of death from COVID-19?

 

Dr. Guest: This is not about a genetic risk of death. It’s driven by multiple factors, including a higher incidence of underlying conditions, less access to proper healthcare, greater risk of infection at the workplace and crowded living conditions that preclude social distancing.

Q: What is your take on the revised CDC guidelines that say testing for people who have been exposed to COVID-19 should be limited to those with symptoms?

Dr. Guest: Many of us in the public health community feel very strongly that we need to be testing asymptomatic people. From a public health perspective, more testing of asymptomatic people, not less, must be done to control the virus. NOTE: As of 9.18.20, CDC guidelines were revised again to state: “if you have been in close contact, such as within 6 feet of a person with documented SARS-CoV-2 infection for at least 15 minutes, and do not have symptoms, you need a test.”

Q: What are the relative risks of activity as we move forward?

Dr. Guest: There’s so much variation based on how carefully an activity is done, but there are four good rules that apply to all: Outside is safer than inside, shorter time is safer than longer, small groups are safer than bigger, and distance is safer than closeness.

Q: How might COVID-19 affect the epidemic of flu we see annually?

Dr. Guest: If we take COVID-19 prevention measures seriously – masking, social distancing, handwashing – we could have a light flu season. If we don’t, COVID-19 will make it worse. The good news is that this has already spurred many people to get their flu shots.

Q: Any other silver linings you’re seeing?

Dr. Guest: For the first time, we are having a national conversation around health disparities and inequalities. We might actually come to a reckoning and take corrective action, and that would be spectacular.

Q: What is most important for people to know about getting back to normal?

Dr. Guest: Eventually we’ll have a vaccine but we’re not going to eliminate COVID-19 completely. However, there needn’t be this level of impact on our society. I can’t emphasize enough that we have control over how this virus spreads. We need strict guidelines and most importantly, a social contract with everyone in your community. This may be the first time many of us are asking “What are we willing to do for each other?” I hope we can all rise to the challenge.


When considering whether it is safe to resume an activity, there is much variation based on how carefully an activity is done. Additional details are provided in the infographic below, courtesy of www.covid19reopen.com

The post Can We Co-Exist with COVID-19? appeared first on Specialdocs Consultants.

Can We Co-Exist with COVID-19?

An Epidemiologist Separates Fact from Fiction and Offers Hope for the Future

Epidemiologists seek to learn why, how and when some people contract diseases when others don’t. Their findings are used to help monitor public health status, develop new medical treatments and disease prevention efforts, and provide an evidence base to healthcare and policy leaders.

Whether you feel the coronavirus is receding or set to surge, that testing is plentiful or inadequate, or that cases are reported as too high or too low may vary considerably based on where you live and your political leanings.

For an objective, no-spin perspective, we checked in with Jodie Guest, PhD, an epidemiologist at Emory University in Atlanta. Dr. Guest’s life’s work is studying the distribution, causes, prevention and control of diseases in populations.

Her answers to some of today’s most important questions about COVID-19 are below. Please note these reflect the situation mid-September…check our website for further updates.

Q: Are we seeing a slowdown in the number of new COVID-19 cases in the U.S.?

Dr. Guest: The number of new cases has, fortunately, plateaued or slowed down, but in many places the plateaus reflect substantially higher numbers than were reported in April, when everyone was still staying home. My concern is with schools and businesses reopening and less willingness to follow safety guidelines, the numbers may creep back up.

Q: What sites do you trust for accurate reporting on COVID-19?

Dr. Guest: I compare numbers from Johns Hopkins, Centers for Disease Control (CDC) and Worldometer to see if they match.

Q: What is the significance of the latest report from the CDC that just 6% of coronavirus deaths to date have COVID-19 as the only cause of death?

Dr. Guest: It’s not at all surprising for two reasons. One is that more than 60% of Americans have an underlying condition, such as obesity or diabetes. The risk of complications and hospitalization for people with two to three underlying conditions who contracted the virus is up to five times greater than for people with no [underlying] conditions. Second, death certificates list everything that may have contributed to mortality, including comorbid conditions and conditions caused by COVID-19 such as pneumonia. This does NOT mean that any of the more than 200,000 people who had heart disease or diabetes as an underlying condition didn’t actually die of COVID-19.

Q: Why are people of color and Latinos at greater risk of death from COVID-19?

 

Dr. Guest: This is not about a genetic risk of death. It’s driven by multiple factors, including a higher incidence of underlying conditions, less access to proper healthcare, greater risk of infection at the workplace and crowded living conditions that preclude social distancing.

Q: What is your take on the revised CDC guidelines that say testing for people who have been exposed to COVID-19 should be limited to those with symptoms?

Dr. Guest: Many of us in the public health community feel very strongly that we need to be testing asymptomatic people. From a public health perspective, more testing of asymptomatic people, not less, must be done to control the virus. NOTE: As of 9.18.20, CDC guidelines were revised again to state: “if you have been in close contact, such as within 6 feet of a person with documented SARS-CoV-2 infection for at least 15 minutes, and do not have symptoms, you need a test.”

Q: What are the relative risks of activity as we move forward?

Dr. Guest: There’s so much variation based on how carefully an activity is done, but there are four good rules that apply to all: Outside is safer than inside, shorter time is safer than longer, small groups are safer than bigger, and distance is safer than closeness.

Q: How might COVID-19 affect the epidemic of flu we see annually?

Dr. Guest: If we take COVID-19 prevention measures seriously – masking, social distancing, handwashing – we could have a light flu season. If we don’t, COVID-19 will make it worse. The good news is that this has already spurred many people to get their flu shots.

Q: Any other silver linings you’re seeing?

Dr. Guest: For the first time, we are having a national conversation around health disparities and inequalities. We might actually come to a reckoning and take corrective action, and that would be spectacular.

Q: What is most important for people to know about getting back to normal?

Dr. Guest: Eventually we’ll have a vaccine but we’re not going to eliminate COVID-19 completely. However, there needn’t be this level of impact on our society. I can’t emphasize enough that we have control over how this virus spreads. We need strict guidelines and most importantly, a social contract with everyone in your community. This may be the first time many of us are asking “What are we willing to do for each other?” I hope we can all rise to the challenge.


When considering whether it is safe to resume an activity, there is much variation based on how carefully an activity is done. Additional details are provided in the infographic below, courtesy of www.covid19reopen.com

The post Can We Co-Exist with COVID-19? appeared first on Specialdocs Consultants.

Headaches – Types and Remedies

Headache Types and Remedies

Oh, My Aching Head

A dull pressure, a sharp pain, an uncomfortable pounding, a vise-like sensation – all can signal the start of a headache. A painful part of the human condition since the beginning of time, more than 150 different types of headaches have been identified, categorized and treated in increasingly effective ways. We take a look at how to cope with the most common headaches, as well as when your symptoms indicate immediate attention is needed in this great reference guide to headache types and remedies.

Headache Types and RemediesTension Headache

It’s the rare person who hasn’t experienced the tight feeling or band-like grip around the head that characterizes a tension headache. Stress is frequently the trigger, so staving them off with recognized stress management strategies such as deep breathing exercises, yoga, meditation, and progressive muscle relaxation may help. For immediate relief, gentle massage and use of warmth or heat to ease tense neck and shoulder muscles often work well. Over-the-counter medicine such as aspirin, ibuprofen or acetaminophen may also be used judiciously.

Cluster Headache

Seen more often in men, these headaches cause intense pain on one side of the head or around one eye; are often accompanied by nasal discharge or teary eyes; and occur in bouts of frequent attacks over weeks or months, followed by long periods of remission. Treatments include inhaling pure oxygen through a face mask, which often relieves pain within 15 minutes, and injectable triptan medications used to treat migraines.

Exertional Headache

Headaches experienced after strenuous exercise may result from being dehydrated or overheated or simply from overexertion, and are usually resolved quickly with rest and adequate hydration.

Sinus Headache

The pain, pressure and fullness in cheeks, brow or forehead, often accompanied by stuffy nose, fatigue and an upper toothache, can indicate a headache from sinusitis or seasonal allergies, but be aware that in many cases it is actually a migraine. Rest, fluids, decongestants and over-the-counter pain medications help alleviate headaches caused by sinusitis; those caused by an allergy will usually be treated with a nasal spray.

Each headache has its own “flavor,” but if they occur more frequently or more severely, seem to worsen with the use of over-the-counter drugs, and interfere with your normal activities, please contact us…and consider starting a headache journal that you can bring to your appointment. Track if they are occurring at certain times of day, or after specific activities or foods; e.g., after a workout, a sleepless night or a change in diet. Also note the duration of each headache; where the pain is located; the intensity and type of pain; other accompanying symptoms, such as gastrointestinal distress; and medications you used. Pre-formatted trackers can be accessed online at sites such as headaches.org.

When to seek help promptly: If your headache can be described as one of the worst you’ve ever experienced and is accompanied by trouble seeing, speaking or walking; fainting; high fever; numbness, weakness or paralysis on one side of your body; stiff neck; or nausea or vomiting.

Inside the ‘Migraine Brain’

Despite the prevalence of migraine headaches, which affect 39 million people in the U.S. alone, their complex and multifactorial causes have made it difficult to pinpoint the most effective management of often debilitating symptoms that can include severe, pulsating pain; nausea; and visual auras. But years of research into the “migraine brain” are revealing a deeper understanding and new treatments, discussed in our Q&A with a headache expert, below.

Q: What is a migraine brain?

A: We have found it’s wired somewhat differently than the average brain, highly sensitive to light, sound and movement.

Q: Does genetics play a role?

A: Absolutely, as more than 70% of migraine sufferers have at least one close relative with the problem.

Q: What triggers a migraine?

A: Among the multiple factors are stress, hormonal shifts, time and travel changes, certain foods, inadequate nutrition, alcohol, and too much or too little caffeine. Anyone of these, or more likely, a combination, can trigger an episode. But the number one cause is the overuse of migraine medications, which triggers rebound headaches and starts a cycle of needing increasing quantities for relief.

Q: What medications are used to manage or prevent symptoms?

A: In addition to over-the-counter medications such as acetaminophen, a class of drugs called triptans that block pain signals in the brain have been used effectively for years. There are many other options, such as new biologic drugs to prevent or minimize the pain of migraines, including calcitonin gene-related peptide (CGRP) inhibitors and serotonin-receptor agonists.

Q: Will lifestyle adjustments make a difference?

A: There is no question that migraine patients benefit most from a set routine of healthy eating (avoiding alcohol and foods with nitrites or preservatives) and regular exercise; getting adequate sleep each night; and learning to manage stress with techniques such as biofeedback training, relaxation training and cognitive-behavioral therapy.

 

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Headaches – Types and Remedies

Picture of woman having a headache

Oh, My Aching Head

A dull pressure, a sharp pain, an uncomfortable pounding, a vise-like sensation – all can signal the start of a headache. A painful part of the human condition since the beginning of time, more than 150 different types of headaches have been identified, categorized and treated in increasingly effective ways. Following is a look at how to cope with the most common headaches, as well as when your symptoms indicate immediate attention is needed.

Tension. It’s the rare person who hasn’t experienced the tight feeling or band-like grip around the head that characterizes a tension headache. Stress is frequently the trigger, so staving them off with recognized stress management strategies such as deep breathing exercises, yoga, meditation, and progressive muscle relaxation may help. For immediate relief, gentle massage and use of warmth or heat to ease tense neck and shoulder muscles often work well. Over-the-counter medicine such as aspirin, ibuprofen or acetaminophen may also be used judiciously.

Cluster. Seen more often in men, these headaches cause intense pain on one side of the head or around one eye; are often accompanied by nasal discharge or teary eyes; and occur in bouts of frequent attacks over weeks or months, followed by long periods of remission. Treatments include inhaling pure oxygen through a face mask, which often relieves pain within 15 minutes, and injectable triptan medications used to treat migraines.

Exertional. Headaches experienced after strenuous exercise may result from being dehydrated or overheated or simply from overexertion, and are usually resolved quickly with rest and adequate hydration.

Sinus. The pain, pressure and fullness in cheeks, brow or forehead, often accompanied by stuffy nose, fatigue and an upper toothache, can indicate a headache from sinusitis or seasonal allergies, but be aware that in many cases it is actually a migraine. Rest, fluids, decongestants and over-the-counter pain medications help alleviate headaches caused by sinusitis; those caused by an allergy will usually be treated with a nasal spray.

Each headache has its own “flavor,” but if they occur more frequently or more severely, seem to worsen with the use of over-the-counter drugs, and interfere with your normal activities, please contact us…and consider starting a headache journal that you can bring to your appointment. Track if they are occurring at certain times of day, or after specific activities or foods; e.g., after a workout, a sleepless night or a change in diet. Also note the duration of each headache; where the pain is located; the intensity and type of pain; other accompanying symptoms, such as gastrointestinal distress; and medications you used. Preformatted trackers can be accessed online at sites such as headaches.org.

When to seek help promptly: If your headache can be described as one of the worst you’ve ever experienced and is accompanied by trouble seeing, speaking or walking; fainting; high fever; numbness, weakness or paralysis on one side of your body; stiff neck; or nausea or vomiting.

Inside the ‘Migraine Brain’

Despite the prevalence of migraine headaches, which affect 39 million people in the U.S. alone, their complex and multifactorial causes have made it difficult to pinpoint the most effective management of often debilitating symptoms that can include severe, pulsating pain; nausea; and visual auras. But years of research into the “migraine brain” are revealing a deeper understanding and new treatments, discussed in our Q&A with a headache expert, below.

Q: What is a migraine brain?

A: We have found it’s wired somewhat differently than the average brain, highly sensitive to light, sound and movement.

Q: Does genetics play a role?

A: Absolutely, as more than 70% of migraine sufferers have at least one close relative with the problem.

Q: What triggers a migraine?

A: Among the multiple factors are stress, hormonal shifts, time and travel changes, certain foods, inadequate nutrition, alcohol, and too much or too little caffeine. Anyone of these, or more likely, a combination, can trigger an episode. But the number one cause is the overuse of migraine medications, which triggers rebound headaches and starts a cycle of needing increasing quantities for relief.

Q: What medications are used to manage or prevent symptoms?

A: In addition to over-the-counter medications such as acetaminophen, a class of drugs called triptans that block pain signals in the brain have been used effectively for years. There are many other options, such as new biologic drugs to prevent or minimize the pain of migraines, including calcitonin gene-related peptide (CGRP) inhibitors and serotonin-receptor agonists.

Q: Will lifestyle adjustments make a difference?

A: There is no question that migraine patients benefit most from a set routine of healthy eating (avoiding alcohol and foods with nitrites or preservatives) and regular exercise; getting adequate sleep each night; and learning to manage stress with techniques such as biofeedback training, relaxation training and cognitive-behavioral therapy.

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Alcohol Affects Women Differently than Men

The Female Factor: Alcohol is Not Gender-Neutral

Given the growing popularity of the cocktail culture and wine time, it’s important to know that alcohol affects women differently than men – physiologically, psychologically and socially. It’s worth asking: For women, is the wine glass half full or half empty when considering the risk-versus-benefit ratio?

First, there is the difference in women’s body composition. Women have more total body fat and less total body water than men. As a result, alcohol is less dispersed, resulting in a higher blood alcohol level, drink for drink, than in men.

Metabolism also plays a role

Women produce less of the alcohol dehydrogenase (ADH) enzyme that controls the rate at which alcohol is broken down in the body. This means a blood alcohol level that rises more quickly in women and stays elevated longer. Women are more vulnerable than men to alcohol’s effects on other levels too: more likely to black out from drinking, to suffer from mood and behavioral changes and to more rapidly develop an addiction. Women may also experience higher rates of depression and anxiety, often drinking in response to negative emotions and problems with loved ones versus men’s tendency to drink for positive reinforcement and pleasure.

High Drinking Rates in Women: A Cause for Concern

All these factors make the record high drinking rates for women a real cause for concern. Problem drinking rose by 83% among women from 2002 to 2013, rapidly closing – in a most unfortunate way – a gender gap that has existed for decades. Current statistics show that 5.4 million women over 18 may be considered as having alcohol use disorder (AUD) and need treatment. However, gender plays a role here too, as women who consistently seek treatment for almost every other physical and mental health problem at higher rates than men are far less likely to do so for alcohol-related problems. Less than 1 in 10 women get formal help, hindered by the stigma of addiction and feelings of guilt or shame in not being able to function as caregiver for their family.

Alcohol’s impact on other disease is mixed. There is evidence that one drink a day may reduce women’s risk of heart attack, cardiovascular disease and the most common type of stroke. The risk of breast cancer, however, increases by 5 – 9% and rises with each additional drink per day. It’s worth noting that taking a multivitamin fortified with 400 mcg of folic acid daily may lower some of women’s elevated risk from alcohol, according to recent studies.

Alcohol in Moderation is Key

The best advice, as with most of life’s issues, is moderation. Avoid alcohol if pregnant or if you have a personal or family history of breast cancer, liver disease or alcohol abuse. Otherwise, consuming one drink a day is generally healthy, so be knowledgeable about how to measure that (see below) and enjoy a glass with friends or at special events. Don’t try to match the pace of male celebrants, especially if they’re over-imbibing. In fact, gently steering them away from the bar and onto the dance floor may be the healthiest move for all.

Heavy drinking for women = more than one drink per day or seven-plus drinks per week

Did You Know?

Alcohol use disorder is characterized by symptoms such as:
· excessive time spent drinking
· needing to drink more to get the same effect
· wanting a drink so badly you can’t think of anything else
· inability to stop drinking despite the impact on work and family
*Source: National Institute on Alcohol Abuse and Alcoholism

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