Archive For: Medical Conditions

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

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: Not Gender-Neutral

The Female Factor: Alcohol is Not Gender-aNeutral

Given the growing popularity of the cocktail culture and wine time, it’s important to know that alcohol affects women very 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, as 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.

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.

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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Kidney Stones: Treatment & Prevention

This Too Shall Pass: Treating and Preventing Kidney Stones

More common, frequently less painful and far more preventable than reputed, kidney stones have, thankfully, entered a new era of highly effective, noninvasive procedures. We bring you up to date on this eminently treatable condition.

Q: Why do kidney stones happen?

A: They form when substances such as calcium, oxalate, cystine or uric acid are present at high levels in urine, becoming crystals that gradually increase in size to a stone.

Q: How likely am I to experience kidney stones?

A: One in 10 people deal with kidney stones in their lifetime, more frequently men, but in recent years, women are rapidly closing the gap. Genetic factors also play a role: if kidney stones are prevalent among your family members, you are at higher risk of developing them.

Q: Are kidney stones very painful?

A: Over the years, the pain associated with kidney stones has taken on an almost mystical aura, sometimes described as “worse than childbirth.” However, the truth is that not every kidney stone causes intense pain. Some are small enough to pass unnoticed, and many are asymptomatic and only discovered when blood is found in the urine during routine testing. Others are large but can stay in the kidney forever without incident. It is only the stones that become “stuck” on their way out of the body that cause renal colic, or waves of severe pain, which can be promptly treated with pain medication.

Q: Does back pain mean I have kidney stones?

A: This is frequently asked by patients concerned about pain felt in the flank area near the kidney. A careful history will be taken to help determine the location of the pain, but a fairly simple way to distinguish the cause is to change positions. If the pain worsens, it is more likely to be a musculoskeletal type of strain. Kidney stone pain is less likely to be positional.

Q: How do you determine if treatment is needed?

A: A noninvasive, less expensive ultrasound is used for screening, but a spiral computed tomography (CT) scan provides superior imagery used to more accurately pinpoint the stone’s location. If only a partial obstruction is seen and not much pain is involved, time is on your side and we can wait to see if the stone passes naturally. At that point, many patients can rest comfortably at home and may be given antispasmodics (such as Flomax) to relax the ureter, pain medications to manage pain and instructed to drink plenty of water to aid the stone’s passage.

Q: What if it doesn’t pass on its own?

A: It’s reassuring to realize there is no urgency to remove the stone unless the kidney is obstructed or infected or the patient is experiencing intractable pain. And when removal is indicated, urologists (specialists in diseases of the urinary tract) have a number of options available, many of them noninvasive or minimally invasive. Open surgical procedures are a rare event. Instead, an outpatient ureteroscopy can be done, using an endoscope to break up or remove the stone. Even less invasive is lithotripsy, good for small stones, which directs high-energy shock waves toward the stone and breaks it into fragments to more easily pass out of the body. For extremely large or resistant stones, a minimally invasive percutaneous nephrolithotomy is conducted to remove the stone via an endoscope inserted through a small incision in the skin.

Q: What is the best way to prevent kidney stones from forming again?

A: We can take the time to develop an individualized approach, based on your stone’s composition. First, your stone will be tested and categorized as calcium oxalate (the most common type), calcium phosphate, a mix or a non-calcium type. Also recommended is a 24-hour urine collection to form a clear picture of how the crystals form in your body, as well as blood tests for further analysis. While those who have formed stones before are at higher risk for forming a subsequent one, we know that dietary modifications tailored to stone type and – if needed – drug therapy can substantially reduce that risk. If you form calcium oxalate stones, we’ll work on a plan to avoid foods high in oxalate, such as spinach, beets and rhubarb, and keep sodium consumption at a minimum. Also important to know is that despite its role in the stone’s composition, there is no need to restrict calcium. In fact, increasing your calcium intake with higher-calcium foods such as milk, yogurt and cheese can help lower oxalate levels in the urine. Finally, keep in mind that the single best preventive measure is to simply fill a bottle with water and drink often.

The post Kidney Stones: Treatment & Prevention appeared first on Specialdocs Consultants.

Kidney Stones: Treatment & Prevention

This Too Shall Pass: Treating and Preventing Kidney Stones

More common, frequently less painful and far more preventable than reputed, kidney stones have, thankfully, entered a new era of highly effective, noninvasive procedures. We bring you up to date on this eminently treatable condition.

Q: Why do kidney stones happen?

A: They form when substances such as calcium, oxalate, cystine or uric acid are present at high levels in urine, becoming crystals that gradually increase in size to a stone.

Q: How likely am I to experience kidney stones?

A: One in 10 people deal with kidney stones in their lifetime, more frequently men, but in recent years, women are rapidly closing the gap. Genetic factors also play a role: if kidney stones are prevalent among your family members, you are at higher risk of developing them.

Q: Are kidney stones very painful?

A: Over the years, the pain associated with kidney stones has taken on an almost mystical aura, sometimes described as “worse than childbirth.” However, the truth is that not every kidney stone causes intense pain. Some are small enough to pass unnoticed, and many are asymptomatic and only discovered when blood is found in the urine during routine testing. Others are large but can stay in the kidney forever without incident. It is only the stones that become “stuck” on their way out of the body that cause renal colic, or waves of severe pain, which can be promptly treated with pain medication.

Q: Does back pain mean I have kidney stones?

A: This is frequently asked by patients concerned about pain felt in the flank area near the kidney. A careful history will be taken to help determine the location of the pain, but a fairly simple way to distinguish the cause is to change positions. If the pain worsens, it is more likely to be a musculoskeletal type of strain. Kidney stone pain is less likely to be positional.

Q: How do you determine if treatment is needed?

A: A noninvasive, less expensive ultrasound is used for screening, but a spiral computed tomography (CT) scan provides superior imagery used to more accurately pinpoint the stone’s location. If only a partial obstruction is seen and not much pain is involved, time is on your side and we can wait to see if the stone passes naturally. At that point, many patients can rest comfortably at home and may be given antispasmodics (such as Flomax) to relax the ureter, pain medications to manage pain and instructed to drink plenty of water to aid the stone’s passage.

Q: What if it doesn’t pass on its own?

A: It’s reassuring to realize there is no urgency to remove the stone unless the kidney is obstructed or infected or the patient is experiencing intractable pain. And when removal is indicated, urologists (specialists in diseases of the urinary tract) have a number of options available, many of them noninvasive or minimally invasive. Open surgical procedures are a rare event. Instead, an outpatient ureteroscopy can be done, using an endoscope to break up or remove the stone. Even less invasive is lithotripsy, good for small stones, which directs high-energy shock waves toward the stone and breaks it into fragments to more easily pass out of the body. For extremely large or resistant stones, a minimally invasive percutaneous nephrolithotomy is conducted to remove the stone via an endoscope inserted through a small incision in the skin.

Q: What is the best way to prevent kidney stones from forming again?

A: We can take the time to develop an individualized approach, based on your stone’s composition. First, your stone will be tested and categorized as calcium oxalate (the most common type), calcium phosphate, a mix or a non-calcium type. Also recommended is a 24-hour urine collection to form a clear picture of how the crystals form in your body, as well as blood tests for further analysis. While those who have formed stones before are at higher risk for forming a subsequent one, we know that dietary modifications tailored to stone type and – if needed – drug therapy can substantially reduce that risk. If you form calcium oxalate stones, we’ll work on a plan to avoid foods high in oxalate, such as spinach, beets and rhubarb, and keep sodium consumption at a minimum. Also important to know is that despite its role in the stone’s composition, there is no need to restrict calcium. In fact, increasing your calcium intake with higher-calcium foods such as milk, yogurt and cheese can help lower oxalate levels in the urine. Finally, keep in mind that the single best preventive measure is to simply fill a bottle with water and drink often.

The post Kidney Stones: Treatment & Prevention appeared first on Specialdocs Consultants.

An Update on the Measles Outbreak in the US

What are the newest guidelines for measles vaccinations?

  • Adults with no evidence of immunity should get 1 dose of MMR. Immunity is defined as documented receipt of 1 dose, or 2 doses, 4 weeks apart if high risk, of live measles virus-containing vaccine, laboratory evidence of immunity or laboratory confirmation of disease, or birthdate before 1957.
  • High-risk people, including healthcare personnel, international travelers and students at post-high school educational institutions, should receive 2 doses.
  • Persons who previously received a dose of MMR vaccine in 1963–1967 and are unsure which type of vaccine it was, or if it was an inactivated measles vaccine, should be revaccinated with either 1 (if low-risk) or 2 (if high-risk) doses of MMR vaccine. At the discretion of the state public health department, anyone exposed to measles in an outbreak setting can receive an additional dose of MMR vaccine even if they are considered complete for their age or risk status.

Why does a birthdate prior to 1957 confer immunity to measles?

People born before 1957 lived through several years of epidemic measles before the first measles vaccine was licensed in 1963. As a result, these people are very likely to have had measles disease. Surveys suggest that 95% to 98% of those born before 1957 are immune to measles. Persons born before 1957 can be presumed to be immune. However, if serologic testing indicates that the person is not immune, at least 1 dose of MMR should be administered.

Why is a second dose of MMR necessary?

Between 2% and 5% of people do not develop measles immunity after the first dose of vaccine for a variety of reasons. The second dose is to provide another chance to develop measles immunity for people who did not respond to the first dose.

Are there any situations in which more than 2 doses of MMR are recommended?

There are two circumstances when a third dose of MMR is recommended, according to ACIP.

  1. Women of childbearing age who have received 2 doses of rubella-containing vaccine and have rubella serum IgG levels that are not clearly positive should receive 1 additional dose of MMR vaccine (maximum of 3 doses). Further testing for serologic evidence of rubella immunity is not recommended. NOTE: MMR should not be administered to a pregnant woman.
  2. Persons previously vaccinated with 2 doses of a mumps virus–containing vaccine who are identified by public health authorities as being part of a group or population at increased risk for acquiring mumps because of an outbreak should receive a third dose of a mumps virus–containing vaccine (MMR or MMRV) to improve protection. More information is available at www.cdc.gov/mmwr/volumes/67/wr/pdfs/mm6701a7-H.pdf

Many people age 60 years and older do not have records indicating what type of measles vaccine they received as children in the early 1960s. What measles vaccine was most frequently given in that time period? That guidance would assist many older people who would prefer not to be revaccinated.

Both killed and live attenuated measles vaccines became available in 1963. Live attenuated vaccine was used more often than killed vaccine. Without a written record, it is not possible to know what type of vaccine an individual may have received.

  • The killed vaccine was found to be not effective and people who received it should be revaccinated with live vaccine.
  • Persons born during or after 1957 who received killed measles vaccine or measles vaccine of unknown type, or who cannot document having been vaccinated or having laboratory-confirmed measles disease, should receive at least 1 dose of MMR.
  • Some people at increased risk of exposure to measles (such as healthcare professionals and international travelers) should receive 2 doses of MMR separated by at least 4 weeks.

Do people who received MMR in the 1960s need to have their dose repeated?

Not necessarily.

  • People who have documentation of receiving live measles vaccine in the 1960s do not need to be revaccinated.
  • People who were vaccinated prior to 1968 with either inactivated (killed) measles vaccine or measles vaccine of unknown type should be revaccinated with at least one dose of live attenuated measles vaccine. This recommendation is intended to protect people who may have received killed measles vaccine which was available in the United States in 1963 through 1967 and was not effective (see above).
  • Persons vaccinated before 1979 with either killed mumps vaccine or mumps vaccine of unknown type who are at high risk for mumps infection (such as persons who work in a healthcare facility) should be considered for revaccination with 2 doses of MMR vaccine.

Please explain the Advisory Committee on Immunization Practices (ACIP)’s revised definition of evidence of immunity to measles, rubella, and mumps.

In the 2013 revision of its MMR vaccine recommendations, ACIP includes laboratory confirmation of disease as evidence of immunity for measles, mumps, and rubella. ACIP removed physician diagnosis of disease as evidence of immunity for measles and mumps. Physician diagnosis was previously not accepted as evidence of immunity for rubella. The decrease in measles and mumps cases over the last 30 years has made the validity of physician-diagnosed disease questionable. In addition, documenting history from physician records is not a practical option for most adults. The 2013 MMR ACIP recommendations are available at www.cdc.gov/mmwr/pdf/rr/rr6204.pdf

What can be done for unvaccinated people who have already been exposed to measles, mumps, or rubella?

The measles vaccine, given as MMR, may be effective if given within the first 3 days (72 hours) after exposure to measles. Immune globulin may be effective for as long as 6 days after exposure. Post-exposure prophylaxis with MMR vaccine does not prevent or alter the clinical severity of mumps or rubella. However, if the exposed person does not have evidence of mumps or rubella immunity they should be vaccinated since not all exposures result in infection.

Adult ADD

Attention Please: ADD/ADHD is Not Just a Childhood Condition

In the 21stcentury, it’s standard procedure to test unfocused, impulsive and restless children who struggle to achieve in school for Attention Deficit Disorder (ADD) and Attention Deficit Hyperactivity Disorder (ADHD), and provide support and treatment well into adulthood. But for those who came of age prior to the 1970s, that diagnosis was rarely made, leading to a lifetime of challenges. Only now, as ADHD and ADD are recognized as conditions that often do not disappear with maturity, are some seniors finally finding the answer to problems that have haunted them for years.

ADD is a condition of varying degrees, and in cases of milder severity, whether in the young or older patient, can be difficult to diagnose; especially in older adults, because the symptoms are different than in children.  Hyperactivity is rarely the primary indicator, although remnants are felt such as restlessness and talking too much. Most frequently experienced by adults is a tendency to be easily distracted, a decline in working memory and a lack of focused attention. As we get older, the challenge may lie in distinguishing these issues from the normal aging process, mild cognitive impairment or early dementia.  Forgetting names, misplacing things, or having problems with organization and planning can be hallmark traits of ADD or an aging brain. The key to identifying the difference is longevity of symptoms. ADD doesn’t suddenly appear full-blown in an adult, but leaves a years-long trail of distraction in its wake.

Experts advise that symptoms can shift with age, but these are found fairly consistently in older adults with ADD*:

  • “Swiss cheese memory,” characterized by things that slip through the cracks
  • Issues with working memory, such as being easily thrown off course mid-task
  • Misplacing items
  • Forgetting words or names, brain going ‘blank’ periodically
  • Difficulty learning new things
  • Talking excessively, often without realizing it
  • Interrupting others
  • Trouble following conversations
  • Difficulty maintaining relationships and keeping in touch

According to the organization ADDitude, a leading source of information, support and advocacy for people living with ADHD, asking this simple question – “Would you have been talking about these symptoms 20 years ago?” – can be one of the most accurate of all indicators. Patients who answer in the affirmative, remembering constantly being chided for a messy room, branded as a daydreamer or underachiever, and finding it difficult to keep organized and on time at a first job, are more likely to have previously undiagnosed ADHD. In fact, the majority would say “I can’t remember a time that I wasn’t this way.”

Gratifyingly, adults who are diagnosed with ADHD or ADD in their older years find it can be revelatory to finally identify the cause of their ongoing challenges, and receive the support they need at a particularly vulnerable life stage. Coping with ADD as a senior actually parallels the issues faced by young people with ADHD when they leave home. The loss of structure for both groups can strain their ability to adequately care for themselves, and poor sleeping or eating habits can result, which exacerbate ADHD symptoms. However, treatment which may include appropriate doses of stimulant medication and cognitive behavioral therapy, has been shown to work as well for adults as children, and provide a newfound satisfaction with life.

As Dr. David W. Goodman, assistant professor of psychiatry and behavioral sciences at the Johns Hopkins University School of Medicine and director of the Adult Attention Deficit Disorder Center of Maryland, explains: “People may ask, ‘if you’ve had this problem for so long, why bother treating it now?’ Imagine you believed yourself to be as others labeled you throughout your life – careless, irrational, a daydreamer, dumb or just plain odd. Then, you realize a treatable disorder caused these symptoms, and they aren’t a reflection of who you are. It’s liberating to understand the difference between what you have – a disorder – and who you are – a person.”

*Source: Kathleen Nadeau, Ph.D. presentation at the 2018 Annual Meeting of the American Professional Society of ADHD and Related Disorders

Did You Know?

Although ADHD and ADD is a commonly seen psychiatric condition in the US, second only to generalized depression, adults in their 50s, 60s and 70s often go undiagnosed and untreated.

Fewer than half of adults with ADHD ages 45+ have ever sought any kind of treatment and only 25% have tried medication.

Source: www.additudemag.com

The post Adult ADD appeared first on Specialdocs Consultants.

Adult ADD

Attention Please: ADD/ADHD is Not Just a Childhood Condition

In the 21stcentury, it’s standard procedure to test unfocused, impulsive and restless children who struggle to achieve in school for Attention Deficit Disorder (ADD) and Attention Deficit Hyperactivity Disorder (ADHD), and provide support and treatment well into adulthood. But for those who came of age prior to the 1970s, that diagnosis was rarely made, leading to a lifetime of challenges. Only now, as ADHD and ADD are recognized as conditions that often do not disappear with maturity, are some seniors finally finding the answer to problems that have haunted them for years.

ADD is a condition of varying degrees, and in cases of milder severity, whether in the young or older patient, can be difficult to diagnose; especially in older adults, because the symptoms are different than in children.  Hyperactivity is rarely the primary indicator, although remnants are felt such as restlessness and talking too much. Most frequently experienced by adults is a tendency to be easily distracted, a decline in working memory and a lack of focused attention. As we get older, the challenge may lie in distinguishing these issues from the normal aging process, mild cognitive impairment or early dementia.  Forgetting names, misplacing things, or having problems with organization and planning can be hallmark traits of ADD or an aging brain. The key to identifying the difference is longevity of symptoms. ADD doesn’t suddenly appear full-blown in an adult, but leaves a years-long trail of distraction in its wake.

Experts advise that symptoms can shift with age, but these are found fairly consistently in older adults with ADD*:

  • “Swiss cheese memory,” characterized by things that slip through the cracks
  • Issues with working memory, such as being easily thrown off course mid-task
  • Misplacing items
  • Forgetting words or names, brain going ‘blank’ periodically
  • Difficulty learning new things
  • Talking excessively, often without realizing it
  • Interrupting others
  • Trouble following conversations
  • Difficulty maintaining relationships and keeping in touch

According to the organization ADDitude, a leading source of information, support and advocacy for people living with ADHD, asking this simple question – “Would you have been talking about these symptoms 20 years ago?” – can be one of the most accurate of all indicators. Patients who answer in the affirmative, remembering constantly being chided for a messy room, branded as a daydreamer or underachiever, and finding it difficult to keep organized and on time at a first job, are more likely to have previously undiagnosed ADHD. In fact, the majority would say “I can’t remember a time that I wasn’t this way.”

Gratifyingly, adults who are diagnosed with ADHD or ADD in their older years find it can be revelatory to finally identify the cause of their ongoing challenges, and receive the support they need at a particularly vulnerable life stage. Coping with ADD as a senior actually parallels the issues faced by young people with ADHD when they leave home. The loss of structure for both groups can strain their ability to adequately care for themselves, and poor sleeping or eating habits can result, which exacerbate ADHD symptoms. However, treatment which may include appropriate doses of stimulant medication and cognitive behavioral therapy, has been shown to work as well for adults as children, and provide a newfound satisfaction with life.

As Dr. David W. Goodman, assistant professor of psychiatry and behavioral sciences at the Johns Hopkins University School of Medicine and director of the Adult Attention Deficit Disorder Center of Maryland, explains: “People may ask, ‘if you’ve had this problem for so long, why bother treating it now?’ Imagine you believed yourself to be as others labeled you throughout your life – careless, irrational, a daydreamer, dumb or just plain odd. Then, you realize a treatable disorder caused these symptoms, and they aren’t a reflection of who you are. It’s liberating to understand the difference between what you have – a disorder – and who you are – a person.”

*Source: Kathleen Nadeau, Ph.D. presentation at the 2018 Annual Meeting of the American Professional Society of ADHD and Related Disorders

Did You Know?

Although ADHD and ADD is a commonly seen psychiatric condition in the US, second only to generalized depression, adults in their 50s, 60s and 70s often go undiagnosed and untreated.

Fewer than half of adults with ADHD ages 45+ have ever sought any kind of treatment and only 25% have tried medication.

Source: www.additudemag.com

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The Age of Anxiety

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

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

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

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

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

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

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

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

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

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

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

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

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

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


Did You Know?

40 million

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

37%

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

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The Enemy Within: Autoimmune Disease is on the Rise

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

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

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

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

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

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

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

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