What’s Behind those Hepatitis C Ads on TV?
Baby Boomers and others at risk should get the simple test.
If you watch TV or surf the web you’ve probably seen ads about hepatitis C (Hep C) and new drugs used to treat it. The older adults in the ads represent a group of people in the U.S.—Baby Boomers—identified by the Centers for Disease Control and Prevention (CDC) as at-risk for chronic Hep C.
But what exactly is Hep C? How do you get it? What tests and treatments are available?
Types of Hepatitis
The term hepatitis simply refers to liver inflammation. Viral hepatitis refers to a group of infectious diseases caused by distinct viruses and known as hepatitis A, B, C, D and E. While all types affect the liver, each type spreads in a different way, affects different groups of people, and results in different outcomes.
Hepatitis A is spread through contaminated food or water and causes only acute disease. Hepatitis B is spread through contact with blood and other body fluids and can be both acute and chronic. Hepatitis D is passed through contact with infected blood but only occurs in people already infected with hepatitis B virus. Hepatitis E is mainly spread through contaminated drinking water and causes acute disease. There are vaccines available in the U.S. but they prevent only hepatitis A and B.
About Hep C
Hep C is spread primarily through contact with the blood of an infected person. It can cause acute and chronic infection. Some people clear the virus from their system on their own, but most (about 80 percent) develop chronic infection.
In the U.S., three in four people with chronic Hep C are Baby Boomers and about half the people who have it don’t know it. That’s why the CDC recommends that everyone born from 1945 to 1965 gets tested for Hep C.
Why Baby Boomers? There are several reasons this group may have been exposed: infection caused by medical equipment or procedures in the 1960s though 1980s before standard infection control practices were in place; contaminated blood and blood products received before 1992 when screening eliminated the virus from the nation’s blood supply; and sharing needles or drug paraphernalia in the past—even just one time.
Tragically, our country’s current opioid epidemic is creating a whole new group of non-Boomers who are chronically infected with Hep C through injection drug use.
Regardless of age, testing for hepatitis C is crucial because many people live for years with few or no symptoms of the disease. Over time though, Hep C can cause serious liver disease including cirrhosis. It’s also the leading cause of liver cancer and the number-one cause of liver transplants in the U.S.
Testing for hepatitis C is a simple blood test, called a hepatitis C antibody test. This screening test looks for chemicals (antibodies) that the body’s immune system releases into the bloodstream in response to infection with hepatitis C virus. If this screening test is negative or non-reactive, the person does not have hepatitis C and no further testing is needed.
If the antibody test is positive or reactive, it may simply mean that at some point the person was exposed to the virus and developed antibodies. An additional viral load test, checking for viral RNA (HCV RNA test), is needed to diagnose chronic infection. If the preliminary test is positive, both tests are essential to determine Hep C status.
Now the Good News
Treatment is available that can cure over 90 percent of chronic hepatitis C infections. Today’s medications, called direct-acting antivirals (DAAs), target specific steps in the Hep C virus life cycle to ultimately clear the body of the virus. So if you’re a Baby Boomer or otherwise at risk of having Hep C, ask your doctor about testing the next time you see one of those ads about Hep C.
For more information about Hep C, testing and treatment, contact your primary care provider, or visit CDC’s website at CDC.gov/Hepatitis.
Peggy McCall, RN BSN, has been a public health nurse with the Chester County Health Department for four years, specializing in infectious diseases including hepatitis, tuberculosis, sexually transmitted infections and HIV. After completing her nursing education at Albert Einstein Medical Center in Philadelphia and West Chester University, she practiced for many years in critical care and emergency nursing.
Enjoy productive aging with some simple lifestyle changes
Myths about the fountain of youth date as far back as the 5th century B.C., demonstrating our deep desire for easy aging. And although life expectancy is now much longer than it was for our grandparents, we still haven’t found the secret to eternal life.
The good news is that we do have control over lifestyle choices that can help us stay fit and youthful as we grow older. A few key building blocks to healthy aging revolve around maintaining strong bones, good balance, healthy brains and hearts, and getting regular check-ups.
Let’s break that down further.
As we age our bones become thinner and more brittle. This is especially true for post-menopausal women.
To combat this problem we need an adequate supply of vitamin D, calcium and phosphorus in our diet. In addition to the nutrients in a healthy diet, most people benefit from supplemental vitamin D3, which helps our bones absorb calcium.
We can get vitamin D from sunlight and can include it in our diet by eating seafood, eggs, shitake mushrooms and enriched foods. Calcium is found in green leafy vegetables, almonds, beans and fish as well as dairy and fortified foods. And we can get phosphorus from nuts, seeds, wheat germ, edamame and cheese.
In addition to a healthy diet rich in key nutrients, weight-bearing exercise is also essential to maintaining strong bones. This type of exercise includes walking, running, yoga, weight lifting (even light weights), push-ups, tennis and golf. You can have fun and build bone at the same time!
And, as you likely know, smoking and excessive alcohol consumption are both detrimental to bone health.
Balance is an undervalued skill and one that becomes increasingly important as we age. One in four Americans 65 and older falls every year, and falling is a leading cause of disability for seniors. Improving balance helps protect us from falling.
We can improve our balance by building core strength and working on flexibility. Yoga and Pilates are wonderful for helping with this goal, but there are simple exercises that most people can do anytime to improve balance.
For example, stand on one leg at a time while brushing teeth or washing dishes. Practice sitting down and standing up from a chair without using your arms for support. Or, walk across a room heel to toe as if you’re on a balance beam.
It’s also important to check your environment. Remove things that can throw you off balance or are tripping hazards, such as throw rugs and carpets with curled up edges. Install handrails and grab bars as needed in your home. Keep your environment well lit, and you may want to keep a flashlight near your bed in case you get up during the night.
Unfortunately, there’s no cure for Alzheimer’s disease, which is more common in women, or for most other causes of dementia. But, although we don’t know how to prevent all types of dementia, there are ways to control age-related memory loss and maximize brain health.
Exercise is important for brain health—both physical and mental exercise. You can incorporate mental exercise into your life with enjoyable pastimes such as reading, doing puzzles and playing card games. Staying socially engaged, working and volunteering are more activities to help you stay mentally sharp.
A healthy brain also requires you to keep blood pressure and cholesterol under control to protect the arteries in the brain and prevent strokes. If healthy diet and exercise are not enough, your doctor will prescribe medications to help maintain safe blood pressure and cholesterol levels.
Excessive alcohol consumption is a known cause of dementia. Drinking can also lead to falls and accidents that may cause brain trauma. And smoking damages the arteries in our brains.
Chronic conditions associated with aging such as high cholesterol, elevated blood pressure, elevated glucose levels (diabetes) and obesity are all controllable risk factors for heart disease. The first lines of defense are proper diet and exercise.
A healthy diet is high in good fats (avocado, fish oil, nuts, olive oil) and vegetables, includes adequate lean protein and is low in simple carbohydrates (bread, cake, cookies, chips, pasta, crackers, pretzels, French fries, etc.). Minimize your use of salt if you have high blood pressure. If you’re on medication for high blood pressure, high cholesterol or diabetes, be sure to take all prescribed medication regularly and follow up with your physician.
In addition, stress elevates cortisol levels and raises blood pressure. Although stress can’t be eliminated, it can be managed with exercise, meditation, adequate sleep and maintaining social connections. Meditation can be as simple as stepping outside or closing your eyes and taking five deep breaths before returning to what you were doing.
If you feel overwhelmed, give yourself the gift of talking to friends, family or seeking professional counseling. It’s good for your heart!
In addition to eating a healthy diet and getting adequate exercise, have regular checkups with your doctor. Make sure you’re up to date with tests (mammogram, pap smear, colonoscopy, bone density scan) and vaccines (flu, shingles, pneumonia and others your doctor recommends).
A few final pieces of advice: wear a seatbelt—even if you’re only going to the grocery store. Practice safe sex. And don’t smoke—yes, it’s important enough to say that again.
Here’s to feeling young and living long!
Elana Kripke, M.D., practices internal medicine in Paoli. She’s a graduate of The University of Pennsylvania’s school of medicine and completed her residency at The New York Hospital, Cornell Medical Center. Her affiliation with the MDVIP network allows her to give each of her patients the time, attention and quality care that they deserve.
About 60 million Americans have active acne, including 85 percent of those between 12 and 24
Acne (or acne vulgaris, the even more unattractive medical term) is such a common skin disease that it’s often considered a natural part of life. At some point in their lives, most people have dealt with occasional blemishes, while others have suffered with severe acne that results in deep-seated cysts or even scars. Though hard to quantify, it’s easy to see the impact on the quality of life and the psychological distress that acne can cause, especially, though not limited to, teens.
First Line Treatments
Fortunately, there’s an ever-growing arsenal of treatments to combat this inflammatory skin disease and its consequences.
A good place to start for treating mild acne is over the counter products—such as cleansers or pads containing benzoyl peroxide or salicylic acids. If OTC medications don’t help, then a visit to your dermatologist may be next. Your dermatologist may prescribe topical antibiotics—such as clindamycin combined with benzoyl peroxide—which may help reduce the severity of acne.
Another important treatment is vitamin A-derived products called retinoids, which unclog pores and exfoliate skin cells. Although most retinoid creams are by prescription, differin gel (adapalene 0.1% gel) was approved by the FDA for over the counter treatment of acne.
If topical treatments don’t help, then systemic treatments—oral antibiotics such as doxycycline and minocycline—are the next step. Cysts and pimples can be dramatically reduced with oral antibiotics, but long-term use can cause complications including antibiotic resistance and changes in gut flora.
For the most severe acne cases, isotretinoin (Accutane) is an excellent option, but with some significant potential complications, including depression and severe birth defects if taken while a woman is pregnant.
Some teens and women suffer from hormonal acne, or acne that typically gets worse around menses and typically affects the jawline and chin. These patients have increased sensitivity to circulating hormones, like testosterone, that cause oil glands to go into hyper-drive.
While oral contraceptives can be helpful for hormonal acne, another option that’s gaining popularity is the high blood pressure medication spironolactone. Spironolactone blocks the effects of circulating hormones on oil glands and has been a game-changer for many women who haven’t responded to other treatments.
Alternative Treatments, Diet and Self Help
Conventional acne treatments don’t work for everyone. And because alternative treatments don’t need to be tested before being sold in the U.S., be sure to discuss them with your doctor before trying any.
One alternative treatment that’s recently gained attention is tea tree oil. This pleasant-smelling essential oil comes from the leaves of a tree native to Australia and has been shown to have antibacterial and cosmetic properties. The ingredient that’s largely responsible for acne benefits is terpinen 4-op, a potent antioxidant. Tea tree oil can be a short-term solution for mild acne and has similar efficacy to benzoyl peroxide.
For years, dermatologists dismissed the idea that diet is linked to acne. But several studies suggest that foods high in glycemic index—carbohydrate-rich foods like white bread, chips, white potatoes—can actually trigger acne. Dairy has also been weakly associated with acne, with the strongest association being skim milk. Because high glycemic carbs, along with dairy, saturated fats and trans fats are common in Western diets, a change to low glycemic carbs, high antioxidants, limited dairy, and omega-3 supplements may help improve acne.
And finally, it’s best to avoid scrubbing the face and exfoliating frequently. This can lead to excessive dryness and increased oil production. Instead, wash your face twice a day with a gentle cleanser and lightly exfoliate once or twice a week. And always choose moisturizers and make-up that are non-comedogenic (won’t clog pores).
Similar to the range of medications, procedures available from your dermatologist continue to evolve. From special acne facials to lasers, new treatments offer help.
A variety of chemical peels can treat acne and acne scarring, including the most common options—alpha-hydroxy acids (glycolic acid), beta-hydroxy acids (salicylic acid) and retinoid (tretinonin). Chemical peels work by reducing inflammation, exfoliating the skin, and reducing bacteria on the skin and do so with very little downtime.
Microdermabrasion is a non-chemical, non-invasive procedure that removes the outermost, dead layer of skin. It typically helps with mild acne resulting from clogged pores.
Photodynamic Therapy (PDT) is an especially effective in-office, “power-level” treatment. PDT controls resistant, hard-to-treat active acne by combining light and a special light-activated solution that targets and destroys acne. PDT, which also diminishes older acne scars and leaves your skin smoother, is thought to work by shrinking the skin’s oil glands and killing bacteria that cause breakouts. These treatments show great promise in treating acne, especially pimples and cysts.
The newest drugstore solution to acne uses light-based therapy. Neutrogena Light Therapy Acne Mask emits a fluoro pink glow—a combination of red light (to reduce inflammation) and blue light (to reduce bacteria on the skin’s surface) for a two-pronged attack on acne. Although not as strong as the lights used in dermatologist offices, it allows patients to use light-based therapy at home to help with mild and moderate acne.
Isolaz is a breakthrough technology that safely treats and prevents acne by extracting pores, killing bacteria, and purifying the skin from the inside out. First, a vacuum device is used to loosen and extract dirt, blackheads, dead cells and excess oil from deep within pores. Next, a broadband laser, or intense pulsed light, kills acne-causing bacteria from within and heals the surface layer of the skin. Isolaz laser is ideal for women in their 40s and older with acne who are also looking for a wrinkle-reducing and skin-smoothing treatment.
Treating Acne Scars
A primary goal of acne treatment is to prevent scarring. Unfortunately, acne scars can be stubborn, and no single treatment is best for everyone. The good news is that several methods may help improve your complexion and minimize the scars’ appearance.
One of the best ways to treat acne scars is with the fractionated CO2 laser and the fraxel laser. These resurfacing lasers stimulate the body’s own collagen to reduce signs of acne scars.
A new and promising treatment for acne scars uses a technology called MFR or micro needling fractional radiofrequency. This technique uses tiny gold-plated microneedles to deliver radiofrequency energy and heat to targeted layers within the skin and break down the scars deep under the skin. Once the layers of the skin have been heated, collagen stimulation and tightening begins. After a series of treatments, the skin should look smoother, tighter and more youthful.
Dermatologists have a wide array of treatment options available. Just as acne is not one-size-fits-all, acne treatment is not either. A dermatologist can tell you about different treatment options and devise a customized plan to get rid of acne and help with acne scars.
Here’s to better skin!
Noushin Heidary, M.D., specializes in medical dermatology, dermatologic surgery and cosmetic procedures. She’s a graduate of Harriton High School, Princeton University and New York University School of Medicine. A fellow of the American Academy of Dermatology, Dr. Heidary is known for her compassion and warm bedside manner and was named a “Top Doc in NJ” and won a Patients’ Choice Award.
Health Professionals Share Their Advice
For this closer look at women’s health issues, we asked local experts to remind us of best practices, latest developments and their advice to patients on four issues.
Dr. Baohuong Tran of Chester County Hospital urges healthy pregnant women to exercise—after checking with their doctors—and recommends some safe activities and identifies possible risky choices. From the Bryn Mawr Skin & Cancer Institute, Dr. Noushin Heidary has advice about acne—first-line treatments, alternative approaches and in-office procedures—and notes that this concern is not limited to teens.
Managing menopause is the topic by Dr. Beverly Vaughn of Lankenau Medical Center, covering what to expect and how to find relief from this natural stage in life. And finally, MDVIP’s Dr. Elana Kripke shares advice about the building blocks of healthy aging and how to enjoy productive aging with some simple lifestyle changes.
We hope you find something helpful in these pages. And here’s to your health!
Exercise for a Healthy Pregnancy
Dr. Baohuong Tran, Penn Ob/Gyn Chester County
Acne: It's Not Just for Teens
Dr. Beverly Vaughn, Lankenau Medical Center
Building Blocks of Healthy Aging
Local Medical Experts Share Their Advice
Interested in a late winter health check-up? Who isn’t?
We asked local medical experts to share the latest thinking on four health topics that span the ages. We start with a better understanding of the common occurrence of miscarriage in early pregnancy, then move on to the growing problem of children’s food allergies and new advances in treatments, including advice on early exposure to peanuts. Next we tackle the challenge of diagnosing and treating adult ADHD and end with advice on preserving healthy hips and a look at some less invasive surgical options available.
Here’s to your health at every age!
A common occurrence in early pregnancy.
Lindsay Odell, M.D., Penn Ob/Gyn Chester County
Childhood Food Allergies
One in 13 children in the United States have a food allergy
Dr. Laura M. Gober, Children’s Hospital of Philadelphia
Tackling the Challenges of Adult ADHD
Dr. Kevin Caputo, Crozer-Keystone Health Network
Know the new blood pressure guidelines and what else you can do.
Dr. John P. Salvo, Jr., Thomas Jefferson University Hospital
Hip Preservation Has Come a Long Way
Hip and groin pain are a common problem for many patients. For those 50–55 or older, the most likely cause of this type of pain is arthritis or degenerative joint disease—a gradual breakdown of the cartilage of this weight-bearing joint.
For those younger than 50–55 and for athletes, the causes of hip and groin pain are much different. In younger patients the pain may be due to a tear in the lining of the hip combined with a problem with the shape of the hip.
No matter the cause, some patients require surgery for their hip problems. But fortunately there are several less invasive options to try first, regardless of age or injury.
For those in the 50–55 age range or older, prevention is the key to having healthy hips for life. Losing weight, eating well and regular exercise are three of the best things you can do to keep your hips healthy and pain free.
When pain does strike, here are some options to explore as first steps:
- Losing excess weight is the number one thing you can do to avoid or reduce hip discomfort. Less weight equals less stress on your joints—it’s that simple.
- Stretching and strengthening exercises maintain your range of motion, build muscle and promote flexibility. Consider walking (walking your furry friend regularly is great exercise), bicycling, swimming or using low impact exercise machines (like the elliptical) at your local gym. Talk with your doctor about which exercises are right for you.
- Keep moving. When possible, stand up and walk around. You’d be surprised how much those short walks or sets of stairs can benefit your hip health. Try to move around every 30 minutes.
- Warm up and cool down every time you exercise to prevent injury and promote flexibility. Stretching is key both before and after any activity.
- Stay motivated. To help with this you may want to add music to your routine or exercise with a friend or in a group. Many gyms offer low-impact group exercise classes, and these classes will help you stay motivated, make new friends and build self-esteem.
If these techniques aren’t sufficient to manage your pain, the next steps are to:
- Modify your activities. Stop doing what hurts. Back off your activities for a while to see if that relieves your pain.
- Take oral medications. Simple over-the-counter medicines—nonsteroidal anti-inflammatory drugs such as ibuprofen (Advil, Motirn IB) and naprozen (Aleve)—may relieve hip pain. If you have any questions, consult your doctor first.
When your lack of mobility or pain becomes intolerable, it may be time to consider surgery—including a hip replacement—but not until then. Examples of serious issues that may suggest it’s time to take additional steps include experiencing hip pain that persists despite pain medication, worsens with walking, affects your ability to use stairs, or interferes with your sleep.
Your doctor will generally leave it up to you to decide when it’s the right time to consider surgery as an option.
Even for younger hips, the steps outlined above may help decrease hip and groin pain. And as with older patients, these approaches are generally tried before considering surgery.
Hip and groin pain in young patients and athletes often begins with intermittent symptoms but can soon progress to consistent and sometime debilitating pain. The most common causes of pain in these non-arthritic hips are femoroacetabular impingement (FAI, when the ball and the socket of the hip don’t fit together properly), labral tear (tear in the cartilage of the hip socket), and dysplasia (abnormal growth or misalignment of the hip joint).
Patients with FAI have a problem most often with the shape of the ball and neck of the femur, but can also have the pelvis cover too much of the ball. In these patients, there’s an over-constraint to the joint. Over time this leads to increased pressure in the joint that can damage the labrum (cartilage).
When these issues of FAI and labral tear become painful, surgery may be required.
Fortunately, hip arthroscopy may be successful in many cases. But unfortunately, patients with arthritis, dysplasia, instability or related medical conditions usually are not good candidates for hip arthroscopy.
Less Than Hip Replacement
Hip arthroscopy and hip preservation procedures have advanced tremendously in the last few decades.
The goal of hip arthroscopy is to fix the hip through a minimally invasive approach. Through very small incisions, a fiber-optic camera is used to enter the hip joint and specialized instruments are used to fix the injury.
The labrum is usually repaired or anchored back to the pelvis so it can do the job it was designed to do. During the same procedure, the FAI can be attended to by decompressing the bone with a burr (a small surgical tool for cutting bone) to ensure the original cause of the problem won’t be an issue in the future.
These procedures are done on an outpatient basis, although it does take some time to recover. Patients need to do physical therapy for a few months and full recovery typically takes 4 to 6 months after surgery.
Causes of hip pain can vary greatly depending on age, and treatment options to relieve the pain and restore mobility can vary greatly as well.
Because the treatment for every patient is different, if you suffer from hip pain at any age, the best first step is to consult your doctor.
Dr. Salvo is double board certified in orthopaedic surgery and sports medicine by the American Board of Orthopaedic Surgeons. He’s a clinical associate professor of orthopaedic surgery at Thomas Jefferson University Hospital and specializes in knee ligament (ACL) reconstructions, shoulder instability and rotator cuff repairs, as well as hip arthroscopy. He’s an active member of several subspecialty societies. RothmanInstitute.com.
Tackling the Challenges of Adult ADHD
When I’m assessing teenagers for Attention-Deficit/Hyperactivity Disorder (ADHD), I’ll often hear a parent say, “I was just like that when I was a kid.” Sometimes, that leads to an “aha moment” when they find out that ADHD runs in families.
Now, the parents and other relatives have a name for the disruptive symptoms that started in their own childhood and carried over into adulthood—disorganization, inability to focus or concentrate to finish a task, repeated loss of keys and wallets, or having so much energy they couldn’t sit still, to name a few.
Today, ADHD affects about three million children and adults in the U.S. Patterns of inattention and hyperactivity become classified as a disorder when they significantly affect a person’s ability to function in a variety of settings and relationships. While the overall percentage of sufferers in the population is small (about 1 percent), the good news is that ADHD is highly treatable and people can be helped through a combination of medication, psychotherapy, counseling and learning strategies.
It’s never too late to get effective treatment for the disorder and, as a result, have a greatly improved life.
What Is ADHD?
ADHD is a neurobiological disorder that affects the brain’s prefrontal cortex starting in childhood. This region of the brain is responsible for controlling cognitive functions related to maintaining attention and controlling impulsivity.
While 60 percent of children go on to have ADHD as adults, all adults who have ADHD had the condition when they were children. Sometimes they don’t know it because it didn’t greatly interfere with schoolwork or show other significant signs. The condition is more common in men and boys than in women and girls, at about a 3-to-2 ratio.
People who have significant problems with attention but don’t have hyperactivity or impulsivity are classified as having Attention-Deficit Disorder (ADD).
What Are the Symptoms?
The National Institute of Mental Health (NIMH) says an ADHD diagnosis for an adult means the person had inattention/hyperactivity symptoms before age 12 and, as an adult, has at least five symptoms that interfere with functioning in at least two settings (e.g., home, work, school, social situations, etc.)
Classic adult symptoms of inattention listed by the NIMH are:
- Failing to pay attention to details
- Making careless mistakes
- Having difficulty sustaining attention during presentations, lectures, lengthy reading tasks, etc.
- Failing to follow through on instructions or finish chores or workplace duties
- Having difficulty organizing tasks and activities (e.g., is messy or has poor time management)
- Seeming not to listen when spoken to directly
- Avoiding tasks that require sustained mental effort
- Frequently losing items like keys, wallets, and phones
- Being easily distracted by unrelated thoughts, activities or sounds
- Forgetting daily responsibilities, such as paying bills, keeping appointments
Hyperactivity and impulsivity symptoms include:
- Feeling restless or unable to be still for extended periods
- Fidgeting, tapping hands or feet, squirming in seat
- Leaving one’s seat in situations when remaining seated is expected
- Being unable to engage in leisure activities quietly
- Talking excessively
- Having difficulty waiting for one’s turn, such as when waiting in line
- Interrupting or intruding on others
Because ADHD is known to be a developmental disorder, it’s minimally affected by diet or by parenting, contrary to popular belief.
How Is ADHD Diagnosed?
It may be tempting to take an Internet quiz for ADHD, but it’s best to have a professional assessment done if you think you or a loved one may have the disorder. That’s because many conditions mimic ADHD symptoms, such as anxiety or an over-active thyroid. As I tell my patients, if I talk fast and interrupt people a lot, it could be because I’m from New York and drink a lot of caffeine.
Psychiatrists begin the diagnostic process by taking a thorough medical and behavioral history from the patient and family. Sometimes, conversations with spouses, parents or even siblings can help bring to light longtime patterns of disruptive or distracted behaviors. Blood samples are tested for biological causes of symptoms.
About a week later, the doctor and patient meet to review the test results and discuss treatment approaches.
How Is ADHD Treated?
Because ADHD is rooted in brain chemistry, medication can provide the balance needed to let the brain do its job of maintaining attention and controlling impulses. Treatments commonly include Methylphenidate (Ritalin, Metadate, Concerta, Methylin), Dextroamphetamine (Dexedrine, Dextrostat), a mixture of amphetamine salts (Adderall), Atomoxetine (Strattera) and Lisdexamfetamine (Vyvanse).
ADHD patients may also benefit from counseling to help them develop coping strategies to improve organizational skills. Patients may also learn relaxation techniques—from controlled breathing to meditation to self-care—since ADHD symptoms get worse when patients are anxious.
Talk therapy can also help with feelings of low self-esteem, which may arise after years of difficulties with attention, focus, organization and other ADHD symptoms that inhibit success.
If the full mental health assessment identifies additional problems such as anxiety, depression and conduct disorders, which are common in ADHD patients, these can also be addressed through medication and psychotherapy or counseling. Appropriate support for learning disorders, if present, may also be recommended.
If you recognize your younger self in your children or other family members and your inability to concentrate, pay attention and organize your life is affecting your happiness, consider getting a formal evaluation.
There is help for ADHD, and it’s never too late.
Kevin Caputo, M.D., is chairman and vice president of psychiatry and behavioral health for Crozer-Keystone Health and lead administrator for Specialty Practices for the Crozer-Keystone Health Network. A fellow with the American Psychiatric Association, he specializes in psychotherapy, psychopharmacology and geriatric behavioral health and focuses on a wide variety of conditions, including attention deficit disorder, anxiety, depression, postpartum depression, post-traumatic stress disorder, personality disorders and medication management.
One in 13 children in the United States have a food allergy, a 50% increase overall and a 300% increase in peanut allergies during the 14 years from 1997 to 2011. This growing epidemic costs our health care system $24.8 billion each year. For families, food allergies affect everyday activities—meal planning, grocery shopping, attending social functions—in addition to creating significant financial burdens and stress.
The top eight food allergens are milk, egg, soy, wheat, peanut, tree nuts, fish and shellfish, accounting for 90% of all food allergies. And one-third of children have allergies to more than one food.
Some good news is that about 85% of allergies to milk, soy, egg and wheat will be outgrown by the time a child turns 3. But the bad news is that allergies to peanut, tree nuts, seeds and seafood are more likely to persist into adulthood. Luckily recent research is promising.
Diagnosing and Symptoms
Diagnosing a food allergy requires taking a complete medical history and doing a physical exam. It’s noteworthy that a child of a parent with an allergic disease (asthma, eczema, food allergies, hay fever) is more likely to have food allergies.
Next, if a food allergy is suspected, it’s on to an allergist for testing. Some children may also need to see a nutritionist for possible nutritional deficiencies, such as lack of calcium with a milk allergy.
A specialist may recommend skin prick testing for suspected food allergies, plus blood tests. However, these tests alone are not definitive without a medical history, given the tests’ high false positive rates.
The most common symptom of a food allergy is a rash, such as hives. Gastrointestinal symptoms, such as vomiting or abdominal pain, and shortness of breath are also common symptoms.
More severe symptoms, such as anaphylaxis, may also occur. Anaphylaxis is a life-threatening allergic reaction that can send the body into shock. Unfortunately, 40% of people with food allergies experience it at some time.
A common myth is that prior symptoms and reactions predict the severity of future reactions. But since reactions can vary widely, children with food allergies and their parents must always be prepared for the possibility of anaphylaxis.
Factors contributing to the severity of reactions are—in addition to sensitivity to a particular food—the amount of allergen that’s ingested, any current illness (like a cold), a history of asthma, and exercise near the time of ingestion.
While minor reactions, such as an isolated skin rash, can be treated with an antihistamine, severe reactions require the use of epinephrine—also known as adrenaline. Since delay in administering epinephrine increases the risk of a fatal reaction, those with food allergies must carry epinephrine auto-injectors at all times. In addition, all caregivers should be instructed on using these devices and have an Anaphylaxis Emergency Action Plan from a doctor.
And if food allergies weren’t stressful enough for families, the food allergy community was hit recently by huge price increases for epinephrine auto-injectors. The price of an EpiPen twin pack (manufactured by Mylan) rose to $600 in 2016 compared with its $100 price in 2009.
Although generic epinephrine auto-injectors are available (from Lineage and Mylan), they can still cost above $100 for two auto-injectors. Another option, Auvi-Q, is available once again, after its 2015 recall.
Imagine the cost to a family for a child who needs two twin-packs—one for home and one for school. Then add the cost each year, since injectors expire after about a year.
Managing Food Allergies Away From Home
The mainstay of treatment for food allergies has been strict avoidance of known food allergens. And a key step in avoiding those allergens is understanding the information on food labels.
A visit to an allergist can help educate parents on how to read food labels to keep their children safe. And although the top eight allergens are stated clearly and in common language on food labels, other allergens, such as sesame seeds, are not as easy to spot in prepared food.
The majority of accidental exposures to food allergens occur away from home—in places such as camps and schools, where each classroom has an average of two children with food allergies. As a result, schools have to be food allergy-savvy.
Some families develop a written plan for school that discusses necessary accommodations including what to do on field trips and how to manage food in the classroom.
Two important tips for kids with food allergies are never share food (because they don’t know for sure what’s in their friends’ food) and always wash hands before eating.
The Future of Food Allergies is Bright
In the U.S., clinical trials are seeking ways to desensitize those with food allergies. One of the most promising techniques, oral immunotherapy (OIT), involves gradually feeding someone their food allergen in increasing quantities until they’re desensitized or no longer react to the food.
With this technique, reactions to the food allergen can occur, so dosing needs to be supervised. It’s important to know that desensitizing a child to a food does not lead to tolerance—tolerance is long-lasting immunity without an allergic reaction to a food even if it’s not consumed daily. Those trying OIT must continue to eat the food every day to maintain their desensitization.
A variation of OIT currently in clinic trials is sublingual immunotherapy (SLIT), which involves giving patients small doses of an allergen under the tongue to boost tolerance and reduce symptoms.
Another approach, epicutaneous immunotherapy (EPIT), involves wearing a patch on the skin containing a food protein. A peanut patch shows promise for treating children and young adults with peanut allergy, with the Viaskin Peanut patch in phase III FDA trials. Clinical trials are also underway for a milk patch, with an egg patch on the horizon. See sidebar for most recent peanut allergy news.
Living with food allergies can be daunting and scary, but remember you’re not alone. Your local allergist can help with diagnosing and managing food allergies, and the American Academy of Allergy, Asthma and Immunology can help you locate a specialist.
Support groups and food allergy websites, such as the Food Allergy and Anaphylaxis Network and Kids with Food Allergies, can also be great resources, providing safety information, social support and updates on new developments.
Laura M. Gober, M.D., is an attending physician in the Division of Allergy and Clinical Immunology at The Children’s Hospital of Philadelphia. Dr. Gober also sees patients at the CHOP Care Network Brandywine Valley Specialty Care and Ambulatory Surgery Center. She completed a pediatric residency at the University of Maryland in Baltimore and finished her allergy fellowship at CHOP.
A common occurrence in early pregnancy.
Although it’s not often spoken about, miscarriage is the most common complication of early pregnancy. Miscarriages usually occur within the first trimester, by week 12.
Several medical conditions are typically included under the term miscarriage, including abnormally growing pregnancies, pregnancies that previously had a heartbeat but no longer show cardiac activity, and otherwise normally developing pregnancies that somehow become disrupted before week 20. Stillbirth is the term used for pregnancies that end after week 20 but before delivery.
While studies have shown that the rate of first trimester miscarriage is between 10 and 20 percent of all pregnancies, it’s thought that the true rate is closer to 25 to 30 percent, if the rates included pregnancies not yet clinically detected.
It’s important to remember that despite suffering a miscarriage, most women will find they can have a full-term pregnancy.
Symptoms: The typical symptoms of miscarriage are cramping and vaginal bleeding, although some miscarriages don’t show any symptoms. These signs can sometimes be difficult to interpret because many women with mild cramping or light bleeding in their first trimester go on to have normal pregnancies.
To help clarify the underlying cause of these symptoms, your obstetrician may order blood tests to monitor pregnancy hormone levels along with an ultrasound scan. Even though light spotting or mild cramping can be normal, any severe abdominal or pelvic pain and heavy vaginal bleeding should always be evaluated by a physician. These symptoms may indicate a more serious condition called ectopic pregnancy, which can be life-threatening to the mother if untreated.
Causes: Many women experiencing a miscarriage are concerned whether something they did or consumed may have contributed to this outcome. Was it that glass of wine? That big cup of coffee? That heavy box she lifted before she found out she was pregnant?
There are many misconceptions about what can cause a miscarriage. For example, some people believe stress, exercise, working, intercourse or a history of prior birth control use caused the miscarriage. But none of these are associated with increased risk of miscarriage.
The truth is that about 50 percent of miscarriages are thought to be caused by genetic abnormalities that happen at the time of fertilization. These are usually genetic problems that are considered lethal, or in other words, would prevent the fetus from surviving the pregnancy. Genetic abnormalities are more likely to be the cause of a miscarriage in early pregnancies and with mothers who conceive at an older age.
Other factors that have been shown to be associated with the risk of miscarriage are smoking, moderate-to-high alcohol consumption, and illicit drug use. Age, having prior miscarriages, and certain invasive prenatal tests (amniocentesis and chorionic villus sampling, (CVS)) are also associated with increased risk of miscarriage. Caffeine, although sometimes associated with miscarriage, has been found to be safe in low doses—meaning about one eight-ounce cup of coffee a day.
Things that can alter the shape of the uterine cavity also may cause an increase in miscarriage risk, such as uterine abnormalities (like a uterine septum or bicornuate uterus), scar tissue from previous uterine surgery, or uterine fibroids.
Some maternal medical problems—such as poorly controlled thyroid disease, diabetes or adrenal disease—may also be related to miscarriage. And some infections may have the potential to lead to a miscarriage—for example, Fifth disease, rubella and toxoplasmosis. For this reason, pregnant women with a fever greater than 100.3°F should see their doctor immediately.
Treatment: Because a miscarriage often happens in women who want to be pregnant, treatment is usually reserved for those who are medically unstable or have a serious condition, or those women who clearly have an abnormal pregnancy. For women with desired pregnancies who have no symptoms or very mild symptoms, some doctors will wait until the miscarriage or abnormal pregnancy is confirmed with certainty by either blood tests or ultrasound.
Treatment typically depends on the patient’s symptoms, preference and how far along the pregnancy is. Options for treatment include waiting for the pregnancy tissue to pass on its own (called expectant management), medication that causes the uterus to push out any remaining pregnancy tissue, or a surgical procedure called a dilation and curettage (or D&C) to remove this tissue.
After Effects: Most women will experience some bleeding and cramping for several days after their miscarriage. Cramping usually improves over two to three days, while bleeding may continue to be irregular until the woman’s next period. And the next period may also be heavier with more cramping than normal and may be delayed up to eight weeks after the miscarriage. Pelvic rest—avoiding use of tampons, douches or having intercourse—is usually recommended for one to two weeks after a miscarriage.
Many women are eager to try to conceive again after a miscarriage. Some physicians recommend waiting several menstrual cycles to allow some time to recover both physically and emotionally. While there’s no medical reason to wait beyond the initial recovery period, it’s helpful to verify that the current pregnancy has resolved completely, either by ultrasound or a negative pregnancy test.
Regardless of when a woman has physically recovered from her pregnancy and miscarriage, it’s important to wait until she has emotionally recovered before trying again. Many women grieve over their lost pregnancy, even if they were unaware they were pregnant prior to miscarrying.
Conclusion: As devastating as miscarriage can be, it’s important to remember that miscarriage is common and the majority have nothing to do with the actions of the mother. Most women will then go on to have normal, healthy pregnancies in the future.
Hopefully, by continuing to discuss miscarriage openly and accurately, women can feel less isolated about their experience and more hopeful about their chances of a normal pregnancy in the future, if and when they so desire.
Dr. Lindsay Odell is a physician at Penn Ob/Gyn Chester County, a practice of Chester County Hospital with offices in Exton, West Chester and Southern Chester County. Dr. Odell received her medical degree from Chicago Medical School-Rosalind Franklin University and completed her internship and residency at Thomas Jefferson University Hospital. She’s board eligible in obstetrics and gynecology and has a special interest in family planning and patient education.
Flu season peaks in February and can last into May.
There are several months left in the flu season. Here’s some advice about how not to join the millions who get sick, hundreds of thousands who are hospitalized and thousands who die from flu every year.
Prevention is the Best Medicine. The best way to avoid the flu is to get immunized. It’s that simple—and it’s recommended that everyone six months or older do that. Getting a shot at your doctor’s office from a nurse you know in familiar surroundings can lessen any shot anxiety. For people on the go, most area pharmacies offer flu shots as early as September.
People sensitive to the vaccine’s preservative can get a preservative-free shot. Those allergic to eggs can be tested to see if they’re allergic to egg white (the most allergic part) or the yolk (usually non-allergenic), from which the flu shot is derived. So, no excuses. In fact, insurance usually covers the cost of the shot.
The immunity from a flu shot lasts about six months, so getting the shot in late October to November gives peak immunity for February’s onset of flu season. Prevention obviously saves time, money and inconvenience.
Avoiding the Flu. As you may remember, flu virus is spread through contact with contaminated surfaces and droplets in the air. The virus’s point of entry is the mucous membranes of your eyes, nose and mouth. And the usual way of contracting the flu is by inhaling these droplets or touching contaminated surfaces—common areas like door knobs, public restrooms—with your fingers and then touching your eyes, nose or mouth.
For prevention, clean surfaces and objects frequently and wash hands, especially before eating.
Also avoid contact with people who have the flu. If you’re sick, it’s best to stay home to avoid spreading it to others. In Asian countries it’s considered proper to wear a surgical facemask during flu season to prevent breathing droplets and to avoid spreading the illness. Though it would be helpful if this were more widely accepted in the U.S., that’s unlikely. You’ll have to use other preventive steps.
Staying healthy also helps avoid the flu. Get enough rest and exercise to keep your immune system strong. And eat a healthy diet.
Foods for Fighting the Flu. One of the best immune system helpers is garlic, which has anti-viral and anti-bacterial qualities. Green tea has polyphenol compounds that may kill the flu virus, and blueberries are particularly high in antioxidants. Drinking plenty of fluid will help flush viral particles out of your body.
Raw honey has been shown to be effective in treating cold and flu symptoms, especially as a cough medicine. Note: children under a year and immune-compromised people should avoid raw honey because it may contain botulism toxin. But most healthy adults are immune.
Vitamins and Supplements. Vitamin C plays a major role in fighting off infections and is thought to stimulate the body’s production of interferon, which fights viral disease. Vitamin D is also important for strengthening the immune system. In winter, it’s best obtained in oil-based gel caps, rather than pressed powder pills.
Echinacea, derived from the coneflower, may shorten duration and severity of cold and flu symptoms. Some people take it for the entire flu season. In traditional Chinese medicine, astragalus root, a plant in the legume family, is used to lower stress cortisol and fight disease.
Antiviral Medications. A powerful way to combat the flu is to start the medication oseltamivir (Tamiflu) within 48 hours of the onset of symptoms. This drug, which is not an antibiotic but must be prescribed by your doctor, can dramatically shorten the course of the disease and lessen the intensity of the symptoms. It can also reduce the risk of complications, including ear inflections and pneumonia, thereby reducing the need for antibiotics.
Best Advice. Getting a flu shot is still the best way to stay healthy during flu season.
Mary-Anne Ost, M.D., is board certified in family and geriatric medicine. Part of the MDVIP personalized wellness program, her practice is located in Kennett Square and West Grove, where she provides personal, preventive health care and comprehensive medical care. Learn more about her practice at MDVIP.com/MaryAnneOstMD.