Staying Healthy is not always possible

For over thirty years, the U. S. Centers for Disease Control and Prevention (CDC) has been collecting and examining the causes of death in the U. S. Not surprisingly over the past decade heart disease and cancer have accounted for well over half of all deaths. But that only tells part of the story; there are other diseases that warrant our attention for prevention and treatment. Accordingly, we want to provide you with a brief summary of some of the major illnesses (cardiac, cancer, respiratory, kidney, diabetes, dementia/Alzheimer's, mental illness/behavioral health, addiction and substance abuse, the flu, Parkinson's and thyroid/endocrine conditions) that may face us and some resources that may be of use in living with and avoiding serious disease.

Heart Disease, Stroke and Cerebrovascular Diseases

Heart disease is a term used to describe several conditions that affect your heart and blood vessels. Many of these diseases are related to the buildup of plaque in the walls of the arteries making it more difficult for blood to flow and creates the risk of stroke or heart attack. Other types of cardiac problems include angina, arrhythmias and heart failure. Heart attack is the number one killer of both men and women in the United States. While approximately 735,000 Americans suffer a heart attack each year, most deaths occur before the patient reaches the hospital. Those who reach the emergency room have an excellent prognosis with survival rates exceeding 90%.

The most important thing to do if you think you are having heart attack symptoms is call 911 immediately. Do not hesitate to make this call. Minutes matter. Unless there are no other options, do not drive yourself to the hospital or go with a family member or friend. When you call 911, they will send first responder and an ambulance so that Emergency Medical Service (EMS) personnel can begin treatment as soon as they arrive. Chances are you will also receive faster treatment at the hospital if you arrive by ambulance (versus in a car!) t should be noted that women generally wait longer than men before calling 911 and tend to more easily dismiss their symptoms. Even if you are not sure you are heaving a heart attack, it is critical to be checked.

Sometimes the 911 emergency medical personnel recommend taking aspirin during a heart attack as it can reduce heart damage by keeping your blood from clotting. However, aspirin can interact with other medications. (If they don’t mention aspirin ask them about it). If recommended, the usual dose is to crush or chew a full-strength aspirin and swallow it with a glass of water.

If you encounter someone who is unconscious or having a heart attack, call 911 for emergency medical help. If the person is unconscious, you may be asked to begin CPR on the person to keep the blood flowing. They will instruct you to push hard and fast on the person's chest in a fairly rapid rhythm -- about 100 to 120 compressions a minute. t should be noted that women generally wait longer than men before calling 911 and tend to more easily dismiss their symptoms.

Presentations of cardiac anomalies may be different for women than for men, especially in the area of heart attack. Heart attack symptoms can vary from person to person and even from one episode to another in the same person. Heart attacks do not always “feel” the same in women as they do in men. Women may not get what people often regard as the classic symptom  -- chest pain or pain that radiates down their arm. Women often experience more vague or silent symptoms that are easy to miss. Women report that they feel a fullness or squeezing around their chest area and women are more likely than men to experience lightheadedness, nausea, fainting/dizziness, and/or pressure and pain in the jaw, upper back and neck. The most common symptom for both men and women is chest pain. It does not have to be a sudden onset of severe pain. In fact, more frequently it starts slowly with mild pain and discomfort. People also sometimes describe it as a feeling of pressure or fullness in the center or left side of their chest. Some people experience pain down the arm, which can start in the chest or directly in the arm. It typically spreads down one or both arms and is most common on the left side. Women in particular can have pain in either arm, not just the left one as experienced by many men.

Other symptoms of a heart attack may include pain or pressure in the center of your chest that spreads up into your throat or jaw. The pain can be gradual or sudden, and it may come and go before becoming more intense. This is another symptom that is more prominent in women. Additionally, feeling short of breath, having trouble breathing or feeling as though you are gasping for air can be a symptom of a heart attack as is feeling dizzy, lightheaded or like you are about to faint or pass out. Women are more likely to report symptoms that they feel sick to their stomach.  Sometimes the nausea gets so severe that vomiting occurs. If you have a stomach ache, nausea or indigestion do not mistakenly associate it with a gastrointestinal problem; it could be your heart. Breaking out in a nervous, cold sweat can be heart-related and is also more common in women. Further, you may feel as though your heart is skipping beats or beating rapidly.

Finally, if you feel fatigued or winded after doing something you typically have no problem doing, you should speak with your doctor. Some people describe this symptom as feeling as though they are extremely fatigued or have a heavy chest even though they are not exerting themselves. Others say they feel like they are coming down with the flu and have no energy at all.

Call 9-1-1 immediately if any of the following signs and symptoms of stoke occur,  including: a sudden numbness or weakness in the face, arm or leg, especially on one side of the body; confusion or trouble speaking or understanding; difficulty seeing in one or both eyes; trouble walking, dizziness, loss of balance or lack of coordination; severe headache with no known cause. If possible note the time when the symptoms first appeared. If you think someone may be having  a stroke, after calling 9-1-1, you can do the following simple F.A.S.T. test:

F - Face: Ask the person to smile. Does one side of the face droop?

A - Arms: Ask the person to raise both arms. Does one arm drift downward?

S - Speech: Ask the person to repeat a simple phrase. Is their speech slurred or strange?

T - Time: If you observe any of these signs call 9-1-1 immediately. 

Time is of the essence in heart attack and stroke victims. Acting quickly can save lives. If given quickly after symptoms, clot-busting and artery-opening medications can stop a heart attack, and having a catheterization with a stent put in may open a closed blood vessel. The longer you wait for treatment, the more chances of survival go down and damage to the heart or brain goes up. 

Cerebrovascular diseases are conditions that develop as a result of problems with the blood vessels that supply the brain. Four of the most common types of these diseases are: stroke, transient ischemic attack (TIA), subarachnoid hemorrhage and vascular dementia.Current research ties lowering blood pressure and cholesterol to lowering the risk of heart disease. Other things you can do to reduce your chance of heart disease include: following instructions to ensure safe use of medications and over-the-counter drugs, quitting smoking, eating a diet low in salt, sugar, total fat, saturated fat and cholesterol and one that is high in fresh fruits and vegetables, exercising regularly, avoiding excessive intake of alcohol and taking steps to reduce stress and anxiety. For specific heart-related questions and information check the website of the American Heart Association. 

Cancer

Cancer is a group of diseases related to the uncontrolled growth of abnormal cells. Cancer affects people of all ages; however, the risk of most types of cancer increase with age. While skin cancer is the most common cancer in the United States, the three leading causes of death from cancer for men are lung, prostate and colon/rectal cancer; while for women it is lung, breast and colon/rectal. Both men and women can benefit from avoiding some of the major cancer risk factors including tobacco use, alcohol abuse, chronic inflammation, obesity and extreme sun exposure. Some cancers have a significant hereditary component like BRCA1 and 2, while others are still being tested for genetic markers. Cancer research is making giant strides as investigators are exploring previously unknown causes of cancer, new targets for cancer drugs and new methods for harnessing the body's own cancer-fighting power called immunotherapy.

If you are diagnosed with cancer it is important to get basic information like whether it is curable and the rationale behind the treatment protocol as well as side effects and lifestyle changes anticipated. Like with any major diagnosis, especially with cancer, strong consideration should be given to obtaining a second opinion, since it is essential to be sure what is being treated is really what the problem is. 

There is no known way to avoid cancer, however the following healthy living behaviors are recommended: have regular cancer screenings including skin checks, mammograms, pap smears, prostate and thyroid exams; maintain a healthy weight, eat a balanced diet and get regular exercise; quit smoking and restrict alcohol intake; and avoid direct exposure to ultraviolet rays.

The primary cause of skin cancer is exposure to UV rays from the sun or tanning beds. People of all skin colors can develop skin cancer. It's one of the easiest cancers to detect and most types are highly curable. 

Risk factors for skin cancer include:

• A history of frequent or intense sun exposure
• Tanning bed use
• One or more blistering sunburns
• Red or blond hair, fair skin, freckles and blue or light-colored eyes
• More than 50 moles
• A family history of melanoma
• A personal history of melanoma
• A personal history of basal cell or squamous cell skin cancers

Many suggest that a regimen of vitamins and nutrients can help protect your skin including: Vitamin B3, Vitamin D, Selenioum, Omega-3 fatty acids, anti-oxidants like Lycopene, Polypodium leucotomos and polyphenols. 

For specific cancer related questions and information check the websites of the American Cancer Society or of disease specific organizations. 

Respiratory Disease and Pneumonia

Pneumonia causes inflammation of the lungs. In people with pneumonia, air sacs in the lungs fill with fluids which prevents oxygen from reaching the bloodstream. With too little oxygen in the blood, the body's cells cannot work properly. Pneumonia is especially dangerous in the elderly as difficulty in breathing leads to less physical activity and a more complicated recovery.

Chronic lower respiratory disease (CLRD) is a collection of lung diseases that cause airflow blockage and breathing-related issues, including primarily chronic obstructive pulmonary disease (COPD), bronchitis, emphysema and asthma.

Signs and symptoms of COPD may include: difficulty breathing (breathlessness), especially when active; a persistent cough with phlegm; frequent chest infections.

Smoking is a primary risk factor of COPD, and approximately 80 percent of COPD deaths can be attributed to smoking. Tobacco smoke is a key factor in the development and progression of COPD, although exposure to air pollutants, genetic factors, and respiratory infections can  also play a role.

To help prevent COPD you can: quit smoking, avoid second hand smoke, avoid air pollution, avoid chemical fumes and avoid dust.

For further information on respiratory diseases see the American Lung Association website.

Kidney Disease

Nephritis, nephrotic syndrome, and nephrosis are all conditions, disorders, or diseases of the kidneys. Nephritis, or kidney inflammation, can be caused by an infection, a medication, or an autoimmune disorder. Nephrotic syndrome is a condition which causes your kidneys to produce high levels of protein in your urine. It’s often the result of kidney damage. Nephrosis is a type of kidney disease that ultimately can lead to kidney failure and is often the result of damage to the kidney from either physical or chemical changes. Chronic kidney disease (CKD) is a condition in which the kidneys are damaged and cannot filter blood as well as healthy kidneys.

An estimated 10 percent of adults in the U.S. - more than 20 million people - are thought to have CKD to some degree. Kidney disease is more common among people with other chronic conditions, including diabetes, high blood pressure and recurrent kidney infections; people who smoke; people who are overweight or obese; or people who have a family history of kidney disease. In some cases the CKD is so severe as to require dialysis which is the process of removing waste products and excess fluid from the body. Dialysis is necessary when the kidneys are not able to adequately filter the blood. There are two types of dialysis: hemodialysis and peritoneal dialysis. Each type of dialysis has advantages and disadvantages. Patients can usually choose the type of long term dialysis that best matches their needs.

The early symptoms of chronic kidney disease are the same as many other illnesses. Symptoms may include: loss of appetite, general ill feeling and fatigue, headaches, itching (pruritus) and dry skin, nausea and weight loss without trying to lose weight.

Symptoms that may occur when kidney function has become severe include: abnormally dark or light skin, pain in the bone, drowsiness and difficulty concentrating, numbness or swelling in the hands and feet, muscle cramps, easy bruising, excessive thirst, frequent hiccups, problems with sexual function, shortness of breath, sleep problems, vomiting, often in the morning. 

To reduce your risk of chronic kidney disease: avoid excessive intake of alcohol, follow instructions on OTC medications, especially when using non-prescription pain relievers, maintain a healthy weight, quit smoking, low sodium diet, manage medical conditions with the help of a health care professional, have regular blood and urine tests if you have a family history of the disease.

For additional information see the National Kidney Foundation website. 

Diabetes

Diabetes is a disease in which the body can no longer carefully control blood glucose, leading to abnormally high levels of blood glucose (hyperglycemia). Persistently elevated blood glucose can cause tissue damage -- including nerves, blood vessels and tissues in the eyes. When a person has diabetes, the body either does  not make enough insulin or cannot use insulin properly; this causes sugar to build up in the blood. Diabetes can cause serious health conditions including heart disease, blindness, kidney failure and vascular compromise, which can lead to amputation of extremities.

There are two known types of diabetes. Type 1 diabetes, which was previously called insulin-dependent diabetes mellitus (IDDM) or juvenile-onset diabetes, accounts for about 5 percent of all diagnosed cases of diabetes. Type 2 diabetes, which was previously called non-insulin-dependent diabetes mellitus (NIDDM) or adult-onset diabetes, accounts for about 90-95 percent of all diagnosed cases of diabetes. While Type 1 diabetes is assumed to be genetically derived, Type 2 diabetes is often a reaction to lifestyle risk factors including obesity, diet and exercise.

Prediabetes is literally a "pre-diagnosis" of diabetes; it's like a warning. It occurs when your blood sugar level is higher than normal, but not high enough to be considered diabetes. It is an indication that you could develop Type 2 diabetes if you don't make some lifestyle changes. In many circumstances it is possible to prevent prediabetes from developing into type 2 diabetes by eating healthy food, losing weight and staying at a healthy weight and by being physically active to bring your blood sugar level back into normal range. 

Warning signs and symptoms of diabetes (and pre-diabetes) include: frequent urination, excessive thirst, unexplained weight loss, extreme hunger, sudden vision changes, tingling or numbness in the hands or feet, feeling tired, having very dry skin, sores that are slow to heal, having more infections than usual, experiencing nausea, vomiting or stomach pain. 

Currently there is no known way to prevent Type 1 diabetes. Weight loss, attention to nutritional intake and increased physical exercise can help prevent or delay Type 2 diabetes and in some cases return blood glucose levels to within the normal range.

For more information about diabetes see the Juvenile Diabetes Research Foundation (JDRF) or the American Diabetes Association websites.

Dementia including Alzheimer's Disease

Dementia is a general term for diseases and conditions characterized by a decline in cognitive function that affects one’s ability to perform everyday activities. Dementia is caused by damage to nerve cells in the brain; neurons no longer function normally and may die which leads to changes in memory, behavior, and the ability to think clearly. Data on dementia finds that for people in their 70s the average rate of dementia is 9%, during the 80s the rate increases to 33%, and by the time we are in our 90s, 41% are diagnosed with formal dementia, and only 0.5% show no cognitive decline at all. Alzheimer's disease and vascular dementia are the two most common forms of dementia. Alzheimer's is a fatal disorder that results in the loss of brain cells and function and affects 60-80% of those with dementia. Vascular dementia occurs after a stroke and accounts for about 10% of all dementia cases. 

Alzheimer's disease is often used as a catch all for altered mental states though it is not the cause of all dementia. An estimated 5.4 million Americans have Alzheimer's disease currently, including approximately 200,000 individuals who are younger than 65 years of age and have “younger-onset Alzheimer's.” With an additional 500,000 Americans anticipated to be newly diagnosed each year with Alzheimer's, brain research is focused on both the cure as well as slowing down the progression of the disease.

The following are common signs and symptoms of dementia:

• Memory loss which disrupts everyday life
• Challenges in planning or solving problems
• Difficulty completing familiar tasks at home or at work
• Confusion with time or place
• Trouble understanding visual images and spatial relationships
• Problems speaking or writing
• Misplacing things and losing the ability to retrace steps
• Decreased / poor judgment
• Withdrawal from work or social activities
• Changes in mood and personality such as  apathy and depression

Many of the factors that increase the risk of cardiovascular disease have also been connected to an increased risk of Alzheimer's disease. In fact, results of autopsies have revealed that close to 80% of people with Alzheimer's also have cardiovascular disease. Accordingly, preventative measures include: stopping smoking, avoiding excess alcohol intake, eating a health, balanced diet, exercising regularly, staying active mentally including reading, writing, learning new things, playing an instrument, managing blood pressure, diabetes or pre-diabetes.

For additional information see the Alzheimer's Disease website. 

Mental Illness / Behavioral Health Conditions

Mental Illness/Behavioral health concerns include a wide range of conditions which affect thinking, mood/emotions, behaviors and one’s ability to function. Conditions include: ADHD, anxiety disorders, bipolar disorder, depression, eating disorders, obsessive-compulsive disorder, post traumatic stress disorder (PTSD) and schizophrenia. According to the Centers for Disease Control and Prevention, (CDC) and National Institute of Mental Health (NIMH) 1 in 5 Americans experience mental illness and 1 in 25 experience a serious mental illness (SMI) each year. SMI is more common among women and people ages 26 to 49.

Mental health can be influenced by a variety of factors including the environment, life events, physical health and biology and genetics. Although most mental illnesses do not improve on their own, and in fact can get worse over time, in many cases the symptoms of these conditions can be successfully managed by a combination of medications and counseling.

Some common signs of mental illness include:

• Being unable to carry out day-to-day activities and chores
• Confusion, forgetfulness, irritability, anxiety, sadness, fright
• Anger, fighting, arguing
• Mood swings that cause relationship problems
• Hopelessness, helplessness, feeling lost
• Not eating enough or overeating
• Insomnia or sleeping too much
• Distancing yourself from other people and activities
• Fatigue even with enough sleep
• Numbness or lack of empathy
• Unexplainable body pains or achiness
• Smoking, drinking or use of illicit drugs
• Flashbacks or thoughts you can’t get out of your head
• Voices in your head
• Thoughts of hurting yourself or other people

If you have suicidal thoughts or think you may hurt yourself or others, get help right away:

Call 911 or the National Suicide Prevention Lifeline at 1-800-273-TALK (1-800-273-8255).

Summaries of Mental Health Conditions

Attention Deficit Hyperactivity Disorder (ADHD): ADHD is typically a persistent pattern of inattention, difficulty keeping focused and/or excessive or inappropriate motor activity. Children with ADHD can have difficulty performing in school, following through on tasks, and interacting with other children, while adults with ADHD are often easy distracted and have difficulty with organization. ADHD is one of the more common mental disorders diagnosed among children and occurs four times more often among boys than girls. An estimated 9% of children between the ages of 3 and 17 have ADHD and it is estimated that the prevalence of ADHD among adults is 4%. (NIMH and CDC) With ADHD, signs of inattention include: becoming easily distracted, and jumping from one activity to the next, becoming bored quickly, difficulty focusing attention, trouble completing or turning in homework, losing things, not listening or paying attention and struggling to follow directions. Signs of hyperactivity include: fidgeting; squirming; having trouble sitting still; and nonstop talking and signs of impulsivity include: impatience, acting out without regard for consequences, difficulty taking turns, waiting or sharing and interrupting others.

Anxiety Disorders: Anxiety disorders are the most common mental illness in the United States and although highly treatable, only 36.9% of those suffering from anxiety receive treatment.  (Anxiety and Depression Association of America) Anxiety disorders are characterized by excessive fear or concern for a real, perceived or future threat which is difficult to control and has a negative impact on daily life. The disorders can range from specific fears (called phobias -- such as the fear of flying) to more generalized feelings of worry and tension. Anxiety disorders typically develop in childhood and persist through adulthood. National prevalence data indicates that nearly 40 million people in the United States (18%) experience an anxiety disorder in any given year. Generalized Anxiety Disorder (GAD) is characterized by persistent, excessive worry about money, health, family, work or other issues. People with GAD worry more than seems warranted and / or expect the worst even when there is no apparent reason for concern. They find it difficult to control their worry and can become exhausted and experience headaches and nausea. Social Anxiety Disorder causes intense fear about social interaction that leads to isolation. It is often driven by irrational worries about being humiliated. With this disorder, panic attacks are often a common reaction to either anticipated or forced social interaction. Panic Disorder is characterized by panic attacks and sudden feelings of terror. It is often mistaken for a heart attack because the physical symptoms include chest pain, heart palpitations, dizziness, shortness of breath and stomach upset.

Bipolar Disorder (formerly known as “manic depression”): Bipolar disorder is a mental health condition that causes extreme mood swings from emotional highs to lows and depression. People with bipolar disorder can experience feelings of intense happiness to feelings of intense sadness, hopelessness and depression. These radical mood swings can affect sleep, energy, activity, and judgment / the ability to think clearly. Although bipolar disorder is a lifelong condition, mood swings and other symptoms can be managed by following a treatment plan. In most cases, bipolar disorder is treated with medications and psychotherapy.

Depression: Loss of a loved one, getting a divorce, losing your job or other difficult situations can make a person feel sad, hopeless, lonely or scared. These are normal reactions to challenging life events but for those diagnosed with depression as a psychiatric disorder, the low mood is much more severe and persists causing emotional and cognitive changes that significantly interfere with daily life. Depressive disorders are among the most common mental health disorders in the United States, affecting about 6.7% of the US population ages 18 and older in a given year. Depression occurs more often in women than men, and in men often manifests as tiredness, irritability, anger, reckless behavior and abuse of drugs/alcohol; whereas in women the symptoms of depression are more typically sadness, worthlessness and guilt. Major Depressive Disorder (MDD) is the leading cause of disability in the US for ages 15 to 44 and is defined as having a “depressed mood for most of the day and a marked loss of interest or pleasure nearly every day for at least a two-week period.” (In children and adolescents, MDD may manifest itself as an irritable disposition.) Other symptoms include: a decrease or increase in appetite, insomnia or hypersomnia, fatigue, feelings of worthlessness or guilt, recurrent thoughts of death and suicidal ideation with or without specific plans for committing suicide and a diminished ability to concentrate and make decisions.

 Eating Disorders: Eating disorders are serious, chronic conditions that can be life-threatening. These conditions typically take root during the adolescent years and most often affect females. Symptoms include: reduction of food intake or overeating, depression or distress, concern about weight and body shape, and poor self-image. The three most common types of eating disorders are: Anorexia Nervosa characterized by the refusal or inability to maintain a normal body weight, an intense fear of gaining weight and denial of low weight. People with anorexia nervosa may see themselves as overweight, even when they are dangerously underweight. According to the National Institute of Mental Health, anorexia nervosa has the highest mortality rate of any mental disorder. Many young people with this disorder die from complications associated with starvation, while others die of suicide. In women, suicide is much more common in those with anorexia than with most other mental disorders. Bulimia Nervosa involves binge eating followed by purging, fasting, excessive exercise or the misuse of diet pills of laxatives. Binging and purging can severely harm the parts of the body involved in eating and digesting food. For instance, teeth can be damaged by frequent vomiting and acid reflux is common. Excessive purging can also cause dehydration, which can lead to cardiac arrhythmias or even heart failure. Binge Eating Disorder is a loss of control over eating with symptoms that can include: eating large amounts of food, eating very fast, eating until uncomfortably full, or eating alone. Unlike bulimia nervosa, periods of binge-eating are not followed by purging, excessive exercise, or fasting and so people with binge-eating disorder are often overweight or obese. Binge-eating disorder is the most common eating disorder in the US.

Obsessive Compulsive Disorder: Obsessive-compulsive disorder (OCD) causes constant and/or repetitive thoughts or obsessions and the unnecessary or unreasonable need to carry out certain behaviors or compulsions. Intrusive, unwanted thoughts cause distress or anxiety and the person with OCD feels compelled to perform certain behaviors (as examples excessive cleaning, checking or organization) in order to ease their distress and anxiety. Many people with OCD realize their thoughts and actions are unreasonable yet cannot stop them. Approximately 2% of Americans are diagnosed with OCD in their lifetime.

 Post Traumatic Stress Disorder (PTSD): PTSD causes people who have experienced traumatic events, such as rape, military combat, terrorist incidents, natural disasters, or accidents, etc. to experience ongoing psychological challenges. Rape is the most likely trigger of PTSD. 65% of men and 45.9% of women who are raped will develop the disorder. It is also more common among active service members and military veterans. Some of the symptoms of PTSD include: depression, stress, anxiety, flashbacks or being easily startled. PTSD affects 3.5% of the US population and women are more likely to be affected than men According to the National Alliance on Mental Illness, symptoms of PTSD generally fall into these broad categories:

• Re-experiencing type symptom, such as recurring, involuntary and intrusive distressing memories, which can include flashbacks of the trauma or bad dreams

• Avoidance which can include staying away from certain places or objects that are reminders of the traumatic event

• Cognitive and mood symptoms which can include trouble recalling the event and feeling numb, guilty, worried or depressed

• Arousal symptom such as hypervigilance. Examples might include being intensely startled by stimuli that resembles the trauma, trouble sleeping or outbursts of anger

Schizophrenia: Schizophrenia is a brain disorder which impacts the way a person thinks and is characterized by cognitive, behavioral and emotional experiences including: delusions, hallucinations, disorganized thinking and grossly disorganized or abnormal motor behavior. Symptoms of schizophrenia typically manifest between the ages of 16 and 30 years of age and are chronic and severe. People with schizophrenia often struggle to start or follow through with activities, show very little interest in life, and have difficulty sustaining relationships. The most common symptoms of schizophrenia include: hearing voices, hallucinations (including seeing or smelling things others cannot perceive), delusions (false beliefs that don’t change even when the person is presented with facts), social withdrawal, incoherent speech and abnormal reasoning. People with delusions often have problems concentrating, confused thinking, or the sense that their thoughts are blocked. People with schizophrenia often struggle to remember things, organize their thoughts and complete tasks. Commonly, they “lack insight” which means they are unaware they have the illness, which can make treatment much more challenging.

Addiction and Substance Use Disorders

An addiction to drugs, alcohol and/or cigarettes can strike teenagers and adults when they face everyday stresses of school, work or family life, or for no reason at all - for instance when someone casually decides to try something new. Before realizing it, the substance becomes a way to cope and often before long, increasing amounts of the substance are required to gain the same high or avoid a painful low. Efforts to either scale back or stop the substance use can become difficult or in some cases, virtually impossible without intervention. Addiction is a disease that affects the brain and as a result stopping abuse is not as simple as changing behavior or applying willpower.

Over time, addiction impairs the person’s ability to make sound judgments, while also sending intense impulses to use the substance. Prolonged use of drugs, with the typical need for higher and higher doses, changes the brain so that it functions normally when the drug is present and abnormally when the drug is absent. Nearly all drugs target the brain's reward system, stimulating it with dopamine, which produces euphoric effects in response to the drug. This creates a pattern that encourages people to repeat the behavior of drug use. As a person continues to abuse drugs, the brain adapts to the dopamine surges causing the person to use more and more drugs to achieve a dopamine “high.”

Research shows combining treatment medications (as appropriate) with behavioral therapy is the best way to ensure successful treatment for most patients. Treatments that address the medical, psychiatric and social challenges help people get to the root of their issues and achieve long-term recovery. It is possible for addictions to be successfully treated so that a return to a productive life is possible.

Drug Abuse: The most recent census on drug addiction (www.drugabuse.gov) shows that nearly one in every ten Americans has a drug abuse problem. After a steady decline of drug addiction during the early millennium, substance abuse has sharply increased over the last ten years. Methamphetamine (speed or crystal meth) and methylenedioxymethamphetamine (MDMA, Ecstasy, or Adam) addiction remains high, though the drug is on the decline as people turn to less costly alternatives such as heroin.  Beyond illegal drugs, many of the drugs people abuse are prescriptions and legal medications.

Opioid addiction has seen a rising trend from both abusers who were given prescriptions from their doctors for pain (oxycodone or hydrocodone) and those who purchase the opioid drugs such as heroin illegally for recreational use. Opioids have been the key culprit in recent drug overdose deaths, which have risen from approximately 17,000 deaths in 1999 to more than 64,000 in 2016. Research from Blue Cross/Blue Shield ( BCBS) found that from 2010 to 2016, the number of people diagnosed with an addiction to opioids -- including both prescription drugs and illegal drugs, climbed 493%! Yet in the same time period, there was only a 65% increase in the number of people getting treatment to manage their addiction.

Alcohol Abuse: A new study published in JAMA Psychiatry finds that the rate of alcohol use disorder (alcoholism) rose by 49% in the first decade of the 2000s. One in eight American adults, or 12.7 percent of the U.S. population, now meets diagnostic criteria for alcohol use disorder. According to the National Survey on Drug Use and Health (NSDUH) — in 2014 slightly more than 50% of Americans ages 12 and over report being current drinkers of alcohol and most drink alcohol in moderation. However, of those 170+ million alcohol users, an estimated 17 million have an alcohol use disorder. The Centers for Disease Control and Prevention (CDC), reports that excessive alcohol use causes 88,000 deaths a year and men are 2 to 4 times more likely than women to develop this disorder. Prolonged use of excessive amounts of alcohol damages many organs of the body, particularly the liver with conditions such as liver inflammation (hepatitis), fatty liver, liver scarring (cirrhosis) and liver failure. Heavy long-term abuse of alcohol can also result in irreversible brain damage and psychosis.

Tobacco Abuse: According to the CDC, cigarette smoking is the leading cause of preventable disease and death in the United States, accounting for more than 480,000 deaths every year, or 1 of every 5 deaths. Unlike drug and alcohol use, cigarette smoking is on the decline. In 2015, about 15 of every 100 U.S. adults aged 18 years or older smoked cigarettes whereas in 2005, 21 of every 100 adults smoked.

Influenza aka the Flu

Influenza is a contagious viral infection and often can be one of the most severe illnesses of the winter season. Influenza can be spread quite easily from person to person, usually when an infected person coughs or sneezes. You can catch the flu more than once because the virus can be one of three different influenza virus families: A, B or C. Generally speaking Type A viruses have a greater effect on adults, while type B viruses are a greater problem in children. While anyone can get the flu, some people have higher chances of getting complications fro it including pneumonia, bronchitis, sinus infections and ear infections. Those at increased risk are: children under 5, adults over 65, pregnant women or women who have recently given birth, people who live in nursing homes or long-term care facilities or those diagnosed with another medical condition like asthma, chronic lung disease, diabetes, heart disease, disorders of the blood, hormones, kidneys, liver or metabolism, compromised immune system, obesity and those under age 19 on long-term aspirin therapy.

Signs and symptoms of influenza include: fever, headache, cough, sore throat, chills, nasal congestion, muscle aches, loss of appetite and malaise. If the symptoms worsen contact your medical provider especially if you have any of the following signs and symptoms of pneumonia, which include: fever, wheezing, cough, chills, rapid breathing, chest pain, loss of appetite and weakness. 

Prevention methods for influenza and pneumonia include:

• Vaccination against flu
• Vaccination against pneumococcal pneumonia
• Washing hands frequently
• Quitting smoking -- Smokers have been found to be at a higher risk of getting pneumonia
• Hib vaccine prevents pneumonia in children from Haemophilusinfluenzae type B

Parkinson's Disease

Parkinson's disease (PD) is a neuro-degenerative disorder that affects predominately dopamine-producing (“dopaminergic”) neurons in a specific area of the brain called substantia nigra. Symptoms of Parkinson's generally develop slowly over years. The progression of symptoms is often a bit different from one person to another due to the diversity of the disease.

People with PD may experience:

• Tremor, mainly at rest and described as pill rolling tremor in hands. Other forms of tremor are possible
• Slowness of movements (bradykinesia)
• Limb rigidity
• Gait and balance problems

Scientists are exploring ways to identify biomarkers for PD that can lead to earlier diagnosis and more tailored treatments to slow down the disease process. Currently, all therapies used for PD improve symptoms without slowing or halting the disease progression.

It can be hard to tell if you or a loved one has Parkinson's disease (PD). The following are 10 signs of the disease. If you have more than one sign you should consider making an appointment to talk to your doctor.

1. Tremor: Have you noticed a slight shaking or tremor in your finger, thumb, hand or chin? A tremor while at rest is a common early sign of Parkinson's disease. (Shaking can be normal after lots of exercise, if you are stressed or if you have been injured. Shaking could also be caused by a medicine you take.)
2. Small Handwriting: Has your handwriting gotten much smaller than it was in the past? You may notice the way you write words on a page has changed, such as letter sizes are smaller and the words are crowded together. (Sometimes writing can change as you get older, if you have stiff hands or fingers or poor vision.)
3. Loss of Smell: Have you noticed you no longer smell certain foods very well? If you seem to have more trouble smelling foods like bananas, dill pickles or licorice, you should ask your doctor about Parkinson's. (Your sense of smell can be changed by a cold, flu or a stuffy nose, but it should come back when you are better.)
4. Trouble Sleeping: Do you thrash around in bed or act out dreams when you are deeply asleep? Sometimes, your spouse will notice or will want to move to another bed. (It is normal for everyone to have a night when they 'toss and turn' instead of sleeping. Similarly, quick jerks of the body when initiation sleep or when in lighter sleep are common and often normal.)
5. Trouble Moving or Walking: Do you feel stiff in your body, arms or legs? Have others noticed that your arms don’t swing like they used to when you walk? Sometimes stiffness goes away as you move. An early sign might be stiffness or pain in your shoulder or hips. People sometimes say their feet seem “stuck to the floor.” (If you have injured your arm or shoulder, you may not be able to use it as well until it is healed, or another illness like arthritis might cause the same symptom.)
6. Constipation: Do you have trouble moving your bowels without straining every day? Straining to move your bowels can be an early sign of Parkinson's disease. (If you do not have enough water or fiber in your diet, it can cause problems in the bathroom. Also, some medicines, especially those used for pain, will cause constipation. If there is no other reason such as diet or medicine that would cause you to have trouble moving your bowels, you should speak with your doctor.)
7. A Soft or Low Voice: Have other people told you that your voice is very soft or that you sound hoarse? Sometimes you might think other people are losing their hearing, when really you are speaking more softly. (A chest cold or other virus can cause your voice to sound different, but you should go back to sounding the same when you get over your cough or cold.)
8. Masked Face: Have you been told that you have a serious, depressed or mad look on your face, even when you are not in a bad mood? This is often called facial masking. (Some medicines can cause you to have the same type of serious or staring look, but you would go back to the way you were after you stopped the medication.)
9. Dizziness or Fainting: Do you notice that you often feel dizzy when you stand up out of a chair? Feeling dizzy or fainting can be a sign of low blood pressure and can be linked to Parkinson's disease. (Everyone has had a time when they stood up and felt dizzy, but if it happens on a regular basis you should see your doctor.)
10. Stooping or Hunching Over: Are you not standing up as straight as you used to? (If you have pain from an injury or if you are sick, it might cause you to stand crookedly. Also, a problem with your bones can make you hunch over.)

If you are diagnosed with Parkinson's work with your doctor to create a plan to stay healthy. This might include the following: referral to a neurologist, a doctor who specializes in the brain, care from an occupational therapist, physical therapist or speech therapist, meeting with a medical social worker to talk about how Parkinson's will affect your life. Also it helps to start a regular exercise program to delay further symptoms and to talk with family and friends who can provide you with the support you need. When speaking with a family member who has been diagnosed with Parkinson's you will know that the disease frequently affects a person's ability of communicate by weakening muscles in the mouth, lips, tongue and diaphragm as well as the potential for the lack of facial expressions, and the softening or slurring of words in their voice. Some helpful ways to cope with communication changes are to consider speech therapy, the timing of medications to encourage communication during "on" periods, maximize focus by communicating eye to eye and in a one to one environment, keep communication simple by changing subjects clearly and avoiding grouping subjects together, practice patience as Parkinson's patients are cognizant of their communication challenges and frustration will only compound problems and insecurity. As Justin Haims tell us, as with any debilitating disease, "Support those living with Parkinson's by helping them to live each day to their fullest ability." 

 For more information check the Parkinson Foundation website.

Thyroid Diseases

The thyroid’s main role in the endocrine system is to regulate our metabolism, which is our body’s ability to break down food and convert it to energy. The thyroid keeps our metabolism under control through the action of thyroid hormone, which it makes by extracting iodine from the blood and incorporating it into thyroid hormones. Thyroid cells are unique in that they are highly specialized to absorb and use iodine. Every other cell depends on the thyroid to manage its metabolism. The two main hormones the thyroid produces and releases are T3 (tri-iodothyronine) and T4 (thyroxine). A thyroid that is functioning normally produces approximately 80% T4 and about 20% T3, though T3 is the stronger of the pair. To a lesser extent, the thyroid also produces calcitonin, which helps control blood calcium levels.

 There are many diseases and disorders associated with the thyroid. They can develop at any age and can result from a variety of causes—injury, disease, or dietary deficiency, for instance. But in most cases, they can be traced to the following problems: too much or too little thyroid hormone (hyperthyroidism and hypothyroidism, respectively), abnormal thyroid growth, nodules or lumps within the thyroid and thyroid cancer.

Some of the most common thyroid disorders are:

• Goiters: A goiter is a bulge in the neck. A toxic goiter is associated with hyperthyroidism, and a non-toxic goiter, also known as a simple or endemic goiter, is caused by iodine deficiency.
• Hyperthyroidism: Hyperthyroidism is caused by too much thyroid hormone. People with hyperthyroidism are often sensitive to heat, hyperactive, and eat excessively. Goiter is sometimes a side effect of hyperthyroidism. This is due to an over-stimulated thyroid and inflamed tissues, respectively.
• Hypothyroidism: Hypothyroidism is a common condition characterized by too little thyroid hormone. In infants, the condition is known as cretinism. Cretinism has very serious side effects, including abnormal bone formation and mental retardation. If you have hypothyroidism as an adult, you may experience sensitivity to cold, little appetite, and an overall sluggishness. Hypothyroidism often goes unnoticed, sometimes for years, before being diagnosed.
• Solitary thyroid nodules: Solitary nodules, or lumps, in the thyroid are actually quite common—in fact, it’s estimated that more than half the population will have a nodule in their thyroid. The great majority of nodules are benign. Usually a fine needle aspiration biopsy (FNA) will determine if the nodule is cancerous.
•  Thyroid cancer: Thyroid cancer is fairly common, though the long-term survival rates are excellent. Occasionally, symptoms such as hoarseness, neck pain, and enlarged lymph nodes occur in people with thyroid cancer. Thyroid cancer can affect anyone at any age, though women and people over thirty are most likely to develop the condition.
• Thyroiditis: Thyroiditis is an inflammation of the thyroid that may be associated with abnormal thyroid function (particularly hyperthyroidism). Inflammation can cause the thyroid’s cells to die, making the thyroid unable to produce enough hormones to maintain the body's normal metabolism. There are five types of thyroiditis, and the treatment is specific to each.

For more information check the Endocrine Web.

back to top

Additional Resources

Centers for Disease Control - Diseases and Conditions

Healthline - Dementia

Endocrine Web - Diabetes and prediabetes, thyroid and information on other endocrine conditions

National Institute of Mental Health

Mental Health America

Anxiety and Depression Association of America