Category Archives: Health

Help my Son Who is not Growing Well

Poor weight gain isn’t an uncommon problem among children, and it’s a very prevalent problem that prompts a visit to a pediatric gastroenterologist. Poor weight gain is typically noticed by the parents (usually the mother) or primary physician, who notice that the child isn’t growing well – or their weight gain deviates from a normal growth pattern. When that weight trend is poor, doctors may describe the child as “failing to thrive” or “malnourished.”

When Does a Drop in Weight Become Concerning?

Often, the trend in weight over time is more important than a single drop in weight measurement. It’s important for weight to be compared to height to ensure that the child is gaining weight well in comparison to his or her height. This height and weight correlation is plotted using a weight for length chart or Body Mass Index chart.

Sometimes, toddlers will lose weight as they become more active. In this circumstance, their weight may drop in relation to their height, but the child will still continue to progress at a normal rate for their age. When there is a significant drop in weight with a single measurement, that may be concerning. In this situation, the child will have to be seen by a doctor and re-measured in order to see if the drop in weight is significant enough to warrant further action.

What Are the Reasons a Child May Not Grow?

The most common reason that accounts for over 90 percent of these cases is a lack of adequate caloric intake. This can occur when a child is not interested in eating due to variety of reasons, or when there is a lack of understanding by the parents regarding the caloric needs of the child. This happens with toddlers who are active and otherwise well, but who are less interested in eating. For even younger children in their first few months of life, this may be due to an inadequate supply of breast milk or to the improper mixing of formula in a formula-fed baby. Occasionally, a caregiver with emotional problems may not adequately feed the child. In the case of an older child or teenager, they may limit calories secondary to body image issues, which is considered nutritional insufficiency (previously called anorexia nervosa).

A child may also not feed well if he or she has heightened oral sensitivity or neurological issues. Such problems may affect their ability to swallow and may be caused by conditions such as cerebral palsy or a cleft palate. Sometimes, a child cannot keep their formula or food down due to excessive vomiting. This may be due to severe acid reflux; in a child with neurological issues, this causes low muscle tone and a variety of other disorders. Most infants with acid reflux will improve, and their growth will continue without issue. Less frequently, a younger infant with excessive vomiting may have a narrowing of the outlet of the stomach called pyloric stenosis and may need a special evaluation that would include an ultrasound of the abdomen.

A child with the inability to digest food due to poor capacity of the pancreas may not gain weight well. In this scenario, parents report their children as having bulky, frothy, loose, foul smelling and greasy stools. Disorders affecting lining of the bowel, including celiac disease or Crohn’s disease can also cause children to have poor weight gain. In celiac disease, symptoms start when foods that contain gluten are introduced into the diet.

In some situations, a child may burn too many calories if he or she has an over-active thyroid gland. A child with a heart disorder that leads to heart failure may also not feed well if they’re working too hard to breathe. Rarely, kidney failure or other kidney disorders will affect weight gain (as well as height) by affecting certain mechanisms of growth. Additionally, some children may have genetic disorders that affect weight gain and require evaluations by specialists.

How Should Poor Weight Gain Be Evaluated and Managed?

If you’re concerned that your child is not gaining weight well, you should seek the help of your child’s primary care provider. The child would need a good physical exam, and his or her doctor should be looking for signs of medical disorders other than simply inadequate caloric intake. The BMI chart may need to be closely monitored, and your child may need frequent follow-ups and weight checks during this time. Negative signs from the exam would be fatigue, paleness, thin extremities, loose folds of skin on the arms and thighs, and loss of fat over the cheeks. The provider may run tests to evaluate for anemia, nutritional status and kidney function. Based on the clinical assessment, further tests may be ordered to check for possibilities of celiac disease, Crohn’s disease or a pancreatic enzyme deficiency. For these, the provider may seek the help of a specialist like a pediatric gastroenterologist or pediatric dietitian.

Most children require subtle increases in their caloric intake to improve weight gain. This may require some imagination on the part of parent, and extra calories could be in the form of additional oil, sugar or special formulas in the diet. Interestingly, growth only requires 5 to 10 percent of the total caloric intake after six months of life.

A child with persistent poor weight gain despite increase in caloric intake may require admission to the hospital to observe weight and feeding trends and for testing and evaluation by a pediatric dietitian. Children with persistent poor weight gain may need be started on supplementary feeding though tubes placed into the stomach through the nose called naso-gastric feeding. Certain medications that stimulate appetite may be beneficial in some children. Diet modification in the form of a gluten-free diet will be required for celiac disease, digestive enzyme supplementations will needed to aid pancreatic enzyme and the help of specialists should be sought to treat heart problems, Crohn’s disease, thyroid problems or pyloric stenosis.

Ways to Sleep Better With Diabetes

Sad but true: If you have diabetes, quality sleep may be hard to get.

However, you should work with your doctor to try and pinpoint just what’s causing your sleep problems.

“While a good night’s sleep and maintenance of a healthy weight are good for everyone, those good habits promise special health benefits for people with diabetes,” says Dr. Paris Roach, an endocrinologist with Indiana University Health in Indianapolis.

There are a few reasons why you may not get the restful sleep you need when you have diabetes.

First, major swings in your blood sugar at night can disrupt your sleep. “Very high blood glucose levels can lead to excessive urination, and sleep may be interrupted by frequent visits to the bathroom if blood sugar is poorly controlled,” Roach says. If your blood sugar gets too low at night, symptoms like restless sleep, excessive sweating and a pounding heart can occur.

A common condition called sleep apnea is more common when you have diabetes. “Apnea literally means ‘not breathing,’ and sleep apnea refers to brief periods of a minute or two when breathing is extremely shallow or absent during sleep,” Roach says. Usually, it’s a partner who spots this problem because you’re snoring or breathing shallowly at night. However, you also may feel fatigue or sleepiness during the day or have trouble concentrating.

Sleep apnea increases your chance of a heart attack and stroke, and the more severe the sleep apnea, the more severe the risk for diabetes, says Dr. Christopher Winter, medical director of Sentara Martha Jefferson Hospital Sleep Medicine Center in Charlottesville, Virginia, and author of “The Sleep Solution: Why Your Sleep Is Broken and How to Fix It.”

Another common problem in some people with diabetes is diabetic neuropathy. That can cause painful sensations in the feet like burning or stinging that can disrupt sleep. Another sleep disorder called restless legs syndrome can cause an urge to move your legs when you fall asleep. “Diabetic neuropathy and restless legs syndrome can be present in the same person, making the two sometimes difficult to separate diagnostically,” Roach says.

Because of these problems, insomnia is often more common in people with diabetes, says Dr. Rajkumar Dasgupta, an assistant professor of clinical medicine at Keck Medicine of USC in Los Angeles. Insomnia also can occur as a side effect of certain medications such as antidepressants – and depression can be more common in people with chronic diseases such as diabetes.

That lack of sleep can cause an increase in stress hormones, which then make it harder to control your weight. It can start a tricky cycle that connects to diabetes, obesity and sleep deprivation, Dasgupta explains.

To find out what’s causing your sleep issues, your doctor will likely recommend a sleepstudy. During a sleep study, your heart rate, body movements and brain activity are monitored to see how well you sleep and to determine what may cause your sleepproblems. Although these tests are often done in a lab, they can also now be done at home, Dasgupta says. This makes these tests more common and less of a hassle.

It’s important that you get treatment for any sleep disorders so you can have deeper rest at night and better function during the day. For example, if your doctor says you have sleep apnea, one common treatment is a CPAP mask, short for continuous positive airway pressure. You wear the mask over your mouth and/or nose, and it helps provide pressure to the upper airway so it stays open during sleep. “Most people can be fitted with a mask they can sleep with comfortably and are often surprised how much better they feel during waking hours when their sleep apnea is effectively treated,” Roach says.

Sleep apnea treatment may help with blood sugar control, insulin resistance and other signs associated with heart disease, Winters says. Also, losing weight can help improve and possibly eliminate sleep apnea.

For less-severe sleep apnea, doctors may recommend a dental device that moves your jawbone slightly forward while you sleep.

For blood sugar swings, some people will use a continuous glucose monitoring device, Roach says. Another solution is waking up once or twice at the night for a week to check your blood sugar and track trends. Usually, adjustments in medication or diet can help address this problem.

For RLS, your doctor may prescribe medications. You may also have to get your iron level checked, as that can contribute to the problem, especially in premenopausal females, Dasgupta says. If you smoke and you have RLS, there’s yet one more reason to quit: Smoking cessation can help alleviate the problem, Roach says.

There are some things you can do on your own to help improve your sleep:

Make sleep a priority. Sleep at consistent times and in adequate amounts, advises says Susan M. De Abate, a nurse and certified diabetes educator and team coordinator of the diabetes education program at Sentara Virginia Beach General Hospital. Many Americans are not getting the recommended seven to eight hours. Make a commitment to better sleep.

Sleep in a dark, quiet cool room, De Abate recommends. And put the technology away, as it can work against going to sleep.

Avoid sleep medications. They can make sleep apnea worse and have other side effects.

Use your bed for sleep only. If you have trouble going to sleep after 15 to 20 minutes, leave the bed and go read a book (preferably not on a tablet or electronic device, Dasgupta cautions). Do something that’s not stimulating for your brain.

Make exercise a habit. It will help you sleep better at night.

Talk about sleep problems with your doctor. Dasgupta sees a lot of focus on what’s happening in patients’ lives during the day and how that relates to health problems, but he’d like more talk about sleep issues. By diagnosing and treating sleep issues, you can improve your quality of life and your health, he says.

What is Lymphedema

Among the many side effects you’ll potentially deal with during the course of treatment for breast cancer, one of the most unpredictable, intractable and difficult to address is lymphedema, a chronic condition that can result after surgery and radiation treatment for breast cancer. As The Memorial Sloan Kettering Cancer Center explains, “Lymphedema develops when the lymph vessels in an area are no longer able to carry all the fluid away from the area. If this happens, the fluid can build up and cause swelling.”

In breast cancer patients, lymphedema usually occurs along the arm that’s on the same side where the cancer is located. It can develop any time after surgery or treatment, so it’s something to look out for no matter how long ago you completed treatment. Dr. Roman Skoracki, division chief for oncologic reconstructive surgery at the Ohio State University Wexner Medical Center, says the first symptom is often a feeling of heaviness in the limb. Some patients may also have rings or watch bands that start to feel too tight. Lymphedema is a staged, chronic condition, and over time, it can progress to a noticeable swelling of the hand and fingers and/or the arm and armpit area. As swelling increases, the skin becomes tight, and the site can become inflamed and painful. In later stages, some patients may lose function in the affected limb.

Although it sounds like a relatively simple problem, lymphedema is related to the vastly complex human immune system, and it’s not completely understood why some people develop lymphedema after lymph nodes have been removed or damaged while others don’t. According to the MSKCC, 15 to 25 percent of patients who undergo an axillary lymph node dissection to treat breast cancer will develop lymphedema after surgery. This is a relatively high risk of a troubling and chronic side effect that has no cure, so some doctors are trying to avoid this more invasive treatment in favor of sentinel node biopsy. Patients who undergo sentinel node biopsy have a reduced risk of developing lymphedema, which MSKCC estimates at about 7 percent, but a 2011 review article in the International Journal of Radiation Oncology Biology Physics reports that “published incidence rates for [breast cancer-related lymphedema] vary substantially with a range of 2 to 65 percent based on surgical technique, axillary sampling method, radiation therapy fields treated and the use of chemotherapy.”

Skoracki explains that the lymph fluid that can build up and cause lymphedema is like “liquid mortar” that flows between the cells or “bricks” that make up our organs, bones, and other tissues. “This fluid is generated during the process of bringing nutrients to each one of the cells,” and it’s critical for exchanging oxygen, nutrients and waste from inside the cells.

He says this lymph fluid moves across the cell membrane and then through channels that route through the body. The problem is, these channels only flow in one direction, so if there’s a blockage or the fluid arrives at an area where a cluster of lymph nodes used to be but are now missing, it can get backed up and pool there. “If there’s a dysfunction either because of genetic reasons, underdeveloped lymph nodes or more commonly because of an insult to the lymph nodes from a dissection, radiation or chemotherapy… anything that’s downstream encounters a blockage where the intervention took place. The fluid continues to get produced and collected and moves up the extremities and hits a dead end. That’s where it starts to swell like a traffic jam.”

In most people, Skoracki says, there’s redundancy in the lymph system that enables it to continue functioning despite the loss of some lymph nodes, which is likely why patientswho have only one to three sentinel lymph nodes removed tend to have lower rates of lymphedema than patients who have all of the axillary lymph nodes removed during dissection or radical mastectomy. Even so, “in some people [the lymph system] gets overwhelmed or there’s not enough collateral channels,” so the fluid backs up and the area swells.

Although there’s currently no way to prevent lymphedema, there are ways to treat and manage the condition after it develops. Kate Howell, a doctor of physical therapy and certified lymphedema therapist with Peltz and Associates Physical Therapy in Santa Rosa, California, says that when lymphedema develops, it’s best to address it as soon as possible and stay vigilant for flare ups and other signs of worsening prognosis. The sooner you can address the issue, the better your chances are of reducing the severity of the condition.

“The standard of care is called complete decongestion therapy,” an intensive program of physical therapy that helps move pooled lymph fluid, Howell says. “This is initiated after someone has presented with lymphedema. We start with manual lymphatic drainage,” which Howell says is a specific type of “geographical massage that moves the lymph in the regions where there’s lymphatic vessels that can take it up and moves it to nodes that are not compromised.”

In addition to this hands-on approach that Howell says should only be executed by a certified lymphatic therapist, compressive bandages that look something like an ACE bandage but have compressive properties also help. These fitted garments apply pressure to the affected area to restrict how swollen it can get, but it’s a cumbersome, ongoing process to keep the swelling in check. “It’s really complicated. You have to come back to PT almost every day to get it rewrapped and you can’t shower with it, so it’s really a hassle. But the idea is that your limb has returned to normal or almost normal size and then you wear a garment for the rest of your life to keep that limb decongested to a size that’s palatable for you.”

These garments can be uncomfortable and expensive if your insurance company doesn’t cover them. Medicaid and, consequently, many other insurers do not cover lymphedema garments, which is why the Lymphedema Treatment Act has recently been introduced to Congress. If enacted, the bill will change Medicare law to cover the cost of lymphedema garments and set a precedent for other insurers to follow.

Beyond decongestion and compression, the National Lymphedema Network notes that exercise is an important aspect of treating lymphedema. The action of flexing and stretching the muscles during exercise helps move lymph fluid along. Skoracki says some newer surgical procedures are also helpful. These can involve creating a bypass channel to shunt fluid off or transplanting lymph nodes from other parts of the body. Skorecki says these procedures “are by no means a cure, but they usually help the majority of patients and they’ll reduce the volume [of fluid] significantly.”

Howell also says that whether you’ve experienced any symptoms of lymphedema or not, if you’ve had lymph nodes removed, you’re at risk for developing lymphedema. Therefore, it’s critical to avoid any kind of injury to the limb, as that can trigger additional swelling as the body tries to fight the damage or subsequent infection by sending more lymph fluid to the area. “You need to take extra good care of that limb. You don’t want manicures. You don’t want to garden without gloves. Technically, you shouldn’t even shave. Try not to get sunburned.” A small infection resulting from any of these sources can trigger swelling. “You can have survived cancer, had a mastectomy and dealt with all of that, and then you get a mosquito bite and the limb puffs up. So take really good care of it even if you don’t have symptoms,” she says. Howell also advises patients to regularly take and keep a log of measurements of the arm so you’ll be able to tell right away if something changes.

How To Provide Social Support To Overcome Depression

Humans are social animals by nature. But modern life has disrupted many of the traditional social norms that people have relied on for millennia, to the detriment of our overall health. The American Psychological Association reports that loneliness has been linked to health problems including “high blood pressure, diminished immunity, cardiovascular disease and cognitive decline” and that “low levels of social support have even been linked to increased risk of death from cardiovascular disease, infectious diseases and cancer.” Social support plays a big role in depression, as well.

Individuals with poor social support have a higher probability of developing depression, according to a study in the Journal of Clinical Nursing. And many Americans today don’t feel like they have a social network they can count on. The APA reports that 55 percent of survey respondents said they could use “at least a little more emotional support” when talking about problems or making difficult decisions. Strong social support can help people cope with problems and improve self-esteem and a sense of autonomy, the APA says. But not everyone has the skills to be socially connected, while many others find that maintaining those connections are harder these days.

“At its worst, depression is a disease of isolation,” says Dr. Drew Ramsey, assistant clinical professor of psychiatry at Columbia University and chair of the American Psychiatric Association’s Council on Communications. “People generally tend to be social creatures. We feel best when we are connected to others and to our community. That is a huge part of the human identity.” It also provides us with important psychological benefits. “It’s like the keel on the ship,” Ramsey says. “You can have an awful day, but if you can lean on social support, be that your regular Tuesday basketball game, your church choir or whatever you use, the bumps in life are digested much better.”

Breaking Out of the Cycle

While social support is one of the most powerful protections against depression, it’s also one of its most challenging treatments. “In the depths of depression, someone’s self-esteem is awful,” Ramsey says. “They know they are not their best selves, and so they don’t want other people to see them that way. They are alone in the darkness, which perpetuates the depression and is also dangerous. Our biggest fear is that they end up isolated and disconnected, which leads to the worst outcome, which is suicide.”

Carl Tishler, a psychologist and adjunct associate professor of psychiatry and psychology at The Ohio State University, adds that trying to help depressed people back into the world when they don’t want to go can be difficult for those trying to help them. “The ‘alone’ feeling is something they don’t know what to do about. The friend or relative or significant other who is trying to help the person gets frustrated and throws her hands up and walks away,” he says. “That causes frustration for support-givers, who can feel overburdened, and then the depressed person feels increased guilt and becomes more withdrawn. It’s a viscous circle.”

How can depressed individuals escape this circle? Psychotherapy can help patients reframe their view of the world, making it less scary for them to re-enter. “Depression is a distortion in the mirror we evaluate ourselves in,” Ramsey says. “When we see or more importantly feel our role in others’ lives, that is very protective from the worst of depression.” Mental health professionals screen suicide risk by asking patients what keeps them alive. “We are reassured when people look you in the eye and say, ‘I know I need to be here for my children’ or ‘I need to show up to work because my employees depend on me,’” Ramsey says.

He also reminds patients that, even in the depths of depression, “their light can still shine and people can enjoy them. I spend a lot of time with people who are depressed, and I often find them making me laugh. I remind them that, in the midst of feeling horrible, they are still themselves.”

Start Small

Someone who is depressed isn’t likely to go to a big party. But he may be convinced to make baby steps back into society. That may be a small community function without much social interaction, or going to a movie instead of dinner with a friend to limit conversation, or simply taking a walk in a park, Ramsey says. “I want to chip away at their isolation,” he says. “One of the tips I learned from patients is that it is easier to socialize if there is something other than yourself to focus on.”

He also tries to add structure to their lives by creating commitments they need to meet. “It’s hard to go work out when you’re depressed, but it’s easier if you have a commitment of a class to go to.” He might also suggest less stressful ways to revisit activities patients usually enjoy. “If they used to like dinner parties, they might take a cooking class or go to a tasting menu, or simply go to a farmers’ market,” he says. “The goal is to get them out of the home and with other individuals. What makes you feel good is being with other people mutually enjoying an activity. Getting out of your head and into your life is one of the things I try to engage people in.”

Tishler adds that taking care of another living thing is also helpful. “[Caring] for plants or animals makes them feel they have some responsibility for another life, not just their own,” he says. “I have had a number of patients who, were it not for their dog, wouldn’t get out of the house. The dog forces them to meet the neighbors, say hello, go to the vet or to buy dog food. It forces interaction.”

Ramsey provides one more caution. “The word ‘social’ has changed because of social media,” he says. “Socializing online doesn’t count.” Indeed, data suggest that social media networks lead to more depression, he says. “Social media provides the potential for connecting us, but is real human connection really happening? When we spend hours online comparing ourselves to others, counting ‘likes,’ that is horrible for the human psyche. Make sure social media is actually social in that it is making you feel good and connecting you with friend outside the house. That is what feels best as humans, and I don’t need any research to support that.”

How To Keep Us Happy During This Summer

Does the summer sun have you feeling extra thirsty? Me, too. When I’m thirsty, I want to choose something that’s refreshing and hydrating, but with so many different beverage options, it’s difficult to know what the healthiest selection is. Let’s navigate the sea of beverage choices that are available for you and your child.

Gold Medal Winner: Water

Water itself may sound like a boring and obvious choice, but its benefits are insurmountable. Water restores the fluids in your body that are lost through metabolism, excretion (sweating) and breathing. One of water’s most important jobs is to cool the body. During the summer months, your body requires more replacement fluids and cooling methods than at other times throughout the year. The cool thing is, your body could live off water alone (and food, of course), but no other beverages are really necessary to survive and thrive. Another benefit of water is that it’s virtually costless. Imagine how much you could save not buying that daily high-end coffee drink or not stopping by the vending machine for your afternoon sugar kick.

I always encourage parents to continue to provide and promote water even if their child doesn’t care for it. It’s so important to the body that you just can’t go without it. Try adding fruit and herbs, like lemon, berries and mint, to make infused water. Kids can choose which add-ins they want to use to flavor the water and make their own creations. While you’re working on getting your kids to enjoy drinking more water, here are some other acceptable hydration options:

Close Runners-Up

  1. Sparkling waters: Choose sparkling waters that are naturally flavored.
  2. Unsweetened iced tea: Tea has been shown to have numerous health benefits due to its antioxidant content, and it can be a great form of hydration. There are a variety of teas to choose from, but note that decaffeinated tea will be more hydrating that caffeinated.
  3. Milk or unsweetened milk alternatives: Although milk doesn’t seem like the most hydrating drink of choice in the summer, it’s a beneficial beverage full of protein, calcium and vitamin D. White milk has a natural sugar that’s OK to include daily.
  4. Sugar-free drinks (in moderation): Choose sugar-free drinks as an enhancement to your daily water intake, but not as a complete replacement. Choose drinks sweetened with more natural artificial sweeteners, like Stevia.

Leave These Out of the Running

  1. Sugar-sweetened beverages, including soda pop, lemonade, fruit punch drinks and sweet tea: These drinks provide zero nutritional benefit. They increase the risk of weight gain and associated diseases.
  2. Juice: Surprised to find juice in this category? There’s little room for it in your child’s (or anyone else’s) diet. Recent guidelines from the American Academy of Pediatricsrecommend no juice for any children under 1 year old, and suggest limiting juice to a maximum of 4 to 8 ounces per day for toddlers through adolescents. All the nutrients you receive from juice, you can get from eating a serving of fruit. Therefore, juice is an unnecessary addition to a hydration plan. The serving of actual fruit will also provide you with dietary fiber, which keeps you full and helps control blood sugar spikes. When juice is made, even 100 percent juice or juicing yourself at home, the fiber is stripped from the juice and all you’re left with is sugar.
  3. Energy drinks: Much like pop and lemonade, energy drinks are a giant blood sugar spike just waiting to happen. Additionally, the caffeine is a stimulant and not recommended for children, especially the excessive amounts in energy drinks.
  4. Coffee drinks: In addition to the caffeine concern for children, coffee drinks are typically loaded with sugary syrups and high-fat milks, and potentially whipped cream on top. You may think you’re getting an afternoon pick-me-up with that delicious frozen drink, but really, you’re getting a mega-dose of sugar that will leave you feeling sluggish shortly after. A healthier choice (for adults or adolescents only) would be a hot or iced coffee with milk or a milk alternative added.

Many people don’t realize how many calories are in the above beverages. Most of these drinks are classified as “empty calories” because they provide no nutrients for your body. In addition, 100 percent of the calories come from sugar; therefore, they’re not appropriate choices to hydrate your body or to promote a healthy body weight. Take a look at this sample day below to learn just how much those sugar-sweetened beverages can add up:

  • Breakfast: medium iced-coffee drink with cream and sugar – 150 calories
  • Lunch: 12 ounces soda – 140 calories
  • Mid-afternoon: 16 ounces lemonade – 220 calories
  • Dinner: water – 0 calories
  • After baseball practice: 20-ounce sports drink – 130 calories

Total calories from beverages: 640 calories. This intake from what one may think is just a simple day would equal nearly 40 percent of a 10-year-old child’s daily energy needs – from beverages alone.

The Skinny on Sports Drinks

Sports drinks or electrolyte-containing beverages can be incorporated into a healthy hydration plan if your child is exercising for more than 60 minutes. When kids are highly active and burning calories, these fluid replacement drinks are beneficial due to the added carbohydrates and electrolytes. However, if physical activity is less than that time period, water is enough to hydrate and replace all fluid losses. Sports drinks add to daily calorie and sugar intake in a large amount, just as any other sugar-sweetened beverage does. One bottle of a typical, 20-ounce sports drink contains approximately 34 grams of sugar – which is more than the sugar content of a full-size candy bar (around 27 grams).

Satisfying Smoothies

Smoothies are a highly consumed beverage, particularly in the summer, and they are a great way to get in some fruit and veggie servings. However, commercial smoothies, either pre-bottled or from your local smoothie shop, often contain added sugars from juices, frozen yogurts, honey or other additives. One medium smoothie contains about 60 grams of sugar, much of which is added sugar. To create a healthier smoothie, try making one at home and use water or milk as your liquid in place of juice. You can always ask at the smoothie shop to swap out the juice and frozen yogurt for low-fat milk or unsweetened milk alternatives.

What Is Diabetic Retinopathy

There are plenty of complications that can arise from diabetes, but one you may not have considered is diabetic retinopathy. Without regular screening, diabetic retinopathycan lead to blindness.

“Diabetic retinopathy is an eye disease that affects the tissues in the back of the eye – called the retina – which process light and vision for the brain,” says Dr. Nancy Kunjukunju, a retina specialist at Krieger Eye Institute at LifeBridge Health in Baltimore. “High blood sugar levels can cause the retinal blood vessels to leak, swell, grow abnormally or be blocked. If that happens, the lack of normal blood and oxygen flow can cause a loss of tissue function that seriously affects vision.”

Among people who have had Type 1 diabetes for five years, 25 percent will develop diabetic retinopathy, Kunjukunju says. That number shoots up to 60 percent after 10 years. The numbers vary a bit more when you have Type 2 diabetes, but 53 percent of people who have had Type 2 diabetes for more than 10 years develop the disease. Many people with diabetic retinopathy are not aware that they have it, says Dr. Gregory Dodell, an assistant clinical professor of medicine, endocrinology, diabetes and bone disease at the Icahn School of Medicine at Mt. Sinai in New York.

The risk for diabetic retinopathy increases as you get older. You’re also at higher risk if you smoke. Of course, elevated blood sugar over an extended period leads to a higher risk for diabetic retinopathy as well.

“Other factors may also be high blood pressure, high cholesterol and kidney disease,” Kunjukunju says. “All of the different components of the body work together so when anything affects our blood vessels, including heart disease, our eyes can also be affected.”

A recently published study found a link between obstructive sleep apnea and diabetic retinopathy in patients who have Type 2 diabetes. However, when those patientsreceived continuous positive airway pressure treatment, or CPAP, they were less likely to develop retinopathy.

Having poor vision that makes you wear glasses or contacts has no connection to the development of diabetic retinopathy.

Many times, diabetic retinopathy has no symptoms until it’s too late – and that’s why regular eye exams are so important. “If diabetic retinopathy is not treated, symptoms can worsen, and eventually an individual may become blind,” Kunjukunju says.

Other times, symptoms like blurred vision, loss of color vision and floaters can occur. Other symptoms include spots, bleeding in the eye and an inability to see from the center of the eye. That’s the kind of vision you use when you are driving or reading, says Dr. Mark Goldfarb, an ophthalmologist with Advanced Eye Care in River Edge, New Jersey. If you haven’t already seen an eye doctor, make sure to do so when you have these kinds of symptoms.

The American Diabetes Association recommends that adults with Type 1 diabetes have an eye exam within five years of diabetes onset; people with Type 2 diabetes should have an exam at the time of diagnosis. Although someone with Type 2 diabetes may be newly diagnosed, that person could have been living with diabetes for as little as a month or as long as several years. That’s why an eye exam right after a diabetesdiagnosis is so important.

Even women who have diabetes and get pregnant or those who develop gestational diabetes while pregnant should be screened, Goldfarb recommends.

Although guidelines aren’t as clear on how often to return for an eye exam, Goldfarb generally advises returning once a year – although that will become more frequent if you’re diagnosed with diabetic retinopathy.

“I aim to ask patients during every office visit when their last ophthalmology evaluation was,” Dodell says. “Ideally, the ophthalmologist should be sending a note to the endocrinologist or primary care doctor regarding the office visit.”

During an exam for diabetic retinopathy, your eye doctor will dilate your eyes to see the back of the eye (the retina). He or she will look for abnormalities like swelling or the leaking or closing off of blood vessels. There are also newer imaging devices, like optical coherence tomography, that help eye doctors better view the back of your eye, Goldfarb says. These exams are also important to check for other eye problems that are more common when you have diabetes, such as glaucoma and cataracts.

When you see your eye doctor, be ready to share some of your recent blood sugar readings, Goldfarb says. This information can be helpful.

If you’re diagnosed with diabetic retinopathy, your eye doctor may tell you that you have nonproliferative diabetic retinopathy – which is an earlier stage of the disease – or proliferative diabetic retinopathy. With the latter, blood vessels become so damaged they close off, according to the American Diabetes Association. Then, newer but weaker blood vessels grow and leak blood, which can block your vision and potentially lead to the growth of scar tissue. Proliferative diabetic retinopathy can also lead to something called retinal detachment, and that can cause permanent vision loss, Goldfarb says.

Diabetic macular edema is a condition that can also develop when you have diabetic retinopathy. It involves swelling in the macula of the eye, according to the American Academy of Ophthalmology.

Treatment for diabetic retinopathy is most effective when it’s started early. Your eye doctor may perform laser treatments on the retinal blood vessels to help stop them from bleeding and leaking and to reduce swelling. There are also injections that can be made in the eye to slow or stop tissue damage.

Because many patients do not see an eye doctor regularly, there are efforts underway to increase the use of telemedicine to screen more patients for diabetic retinopathy. “This is fantastic, and I suspect will lead to better outcomes for patients,” Dodell says. However, telemedicine screenings can’t replace a full eye exam, Goldfarb believes.

The best way to reduce your risk for diabetic retinopathy is to keep your blood sugar under control and follow other healthy habits, like eating a balanced diet, exercising, not smoking and using your medications as prescribed. “If blood sugar levels are close to normal, an individual is less likely to be at risk,” Kunjukunju says.

Will You Die Because Of Broken Heart

Elderly married couples have been known to die within hours or days of each other. Doctors sometimes treat patients with heart attack-like symptoms who have come directly from a funeral. In other words, a figurative broken heart can actually lead to a literal broken heart.

It’s called stress-induced cardiomyopathy, and it’s one of the more perplexing disorders for cardiologists. “It’s a fascinating condition,” says Dr. Chintan Desai, a cardiovascular disease specialist at Northwestern Medicine Regional Medical Group in Illinois. “We see it in people who have suffered severe emotional distress – a widow at her husband’s funeral, hearing a child is in a bad accident.”

Doctors have not completely unraveled the causes of the condition, also called broken heart syndrome. The symptoms are similar to a heart attack but are caused by a distinct process. “Our understanding is it is caused from adrenaline and other hormones related to adrenaline,” Desai says. “Whether that’s the whole story or not is not completely understood.”

An article in the June 2017 issue of the journal Circulation notes that positive and surprising news in a person’s life can also trigger the syndrome. Think winning the lottery, or a son or daughter who comes home from war to surprise a parent. According to the article: “Recently it has been shown that [stress-related cardiomyopathy] can occur after a positive life event, hence the recently proposed term happy heart syndrome.”

Regardless of whether it’s triggered by good news or bad, stress-induced cardiomyopathy occurs when acute stress leads to heart muscle distress. The left ventrical, the heart’s main pumping chamber, becomes weak and balloons out, leaving the heart unable to pump enough blood. The condition, first named in Japan in 1990, was described as takotsubo cardiomyopathy because the enlarged left ventrical resembles a Japanese octopus trap called takotsubo.

Doctors say the condition, now often called takotsubo cardiomyopathy, is not uncommon. “We’ve all seen a bunch of them,” says Dr. Pamela S. Douglas, Ursula Geller Professor of Research in Cardiovascular Diseases in the Department of Medicine at Duke University and director of the Multimodality Imaging Program at Duke Clinical Research Institute. “It’s not as rare as you might think it is.”

More than 90 percent of cases occur in women ages 58 to 75, according to Harvard Women’s Health Watch, a publication of Harvard Medical School. Up to 5 percent of women evaluated for a possible heart attack actually have stress-related cardiomyopathy. Researchers believe older women are more vulnerable because of a drop in estrogen after menopause.

Symptoms of stress-related cardiomyopathy are almost identical to a heart attack – sudden chest pain and shortness of breath – but the process that causes the event is quite different.

In a typical heart attack, the heart can’t get enough oxygen and blood because one or more arteries that lead to the heart are blocked by plaque and cholesterol. This prevents the heart from pumping effectively. During stress-induced cardiomyopathy, the heart is also pumping incorrectly, but the arteries are open and healthy, with mild or negligible signs of coronary artery disease. Doctors believe that stress hormones, not clogged arteries, cause the heart to pump inadequately. “A surge in stress hormones stuns the heart and creates changes in blood flow,” Douglas says. “It makes the heart stop squeezing effectively.”

Broken heart syndrome is usually diagnosed in an emergency room because the patient needs urgent care.

An electrocardiogram, or EKG, which measures the heart’s electrical activity, will often show the same abnormalities for patients who are having a heart attack as it does for those suffering from broken heart syndrome. In order to rule out a heart attack, doctors take images of the heart using a test such as a diagnostic cardiac ultrasound. About 20 percent of patients who experience broken heart syndrome have heart failure, according to Harvard Women’s Health Watch.

Another significant difference between a heart attack and broken heart syndrome is that a person experiencing a stress-related heart event will not have the same risk factors as a heart-attack victim, such as high blood pressure and narrowed arteries, and will also present as healthy prior to the heart muscles weakening. Because of that, people who suffer from stress-related cardiomyopathy recover quickly as long as they survive the event. The heart generally returns to normal within several weeks. “By definition, it gets better and normalizes over time,” Desai says.

Stress-induced cardiomyopathy is treated with standard medications that treat heart failure and improve the heart’s contraction function. Examples are ACE inhibitors, which correct blood flow and decrease the heart’s workload; beta blockers, which slow heart rate and reduce blood pressure; and diuretics, which prevent fluids from collecting in the body.

Treatment is evolving as doctors learn more about the condition. And unlike a heart attack, if someone has had stress-induced cardiomyopathy, it’s unlikely to occur twice. “It’s possible that you may have broken heart syndrome again if you have another stressful event,” according to the Mayo Clinic’s website. “However, the odds of this happening are low.”

Ways to Avoid Diabetes Product Scams

You have diabetes, and it can be challenging to manage. You’re watching TV one night and there’s a commercial for a product that says it can cure all of your diabetes woes, magically lowering your blood sugar. You wonder: Should I order that?

The lure of products that may not do all that they claim is understandable when you have diabetes. But that doesn’t mean everything that’s said to help you will actually do so.

“The unfortunate fact is that living with diabetes is difficult,” says Brian Dunning, a Laguna Niguel, California-based science writer and director of the film “Principles of Curiosity,” which focuses on how to evaluate dubious claims. “People who have diabetesare always going to be on the lookout for ways to improve their situation. In some cases, they get desperate. And when there is desperation, unfortunately, there are always charlatans waiting to take advantage.”

Another reason that someone with diabetes may turn to products that are not medications is because they want to try something more natural, says endocrinologist Dr. Deena Adimoolam, an assistant professor of diabetes, endocrinology and bone disease at the Icahn School of Medicine at Mount Sinai in New York.

Products advertised for diabetes outside of medications can include – but aren’t limited to – supplements, herbs, juices, shakes, “miracle” pills or products said to quickly help diabetes complications like diabetic neuropathy. These products may claim to lower blood sugar, reduce weight, cure complications or stifle your appetite. There are also books that heavily promote specific plans for weight loss to cure diabetes but don’t have the evidence to back up what they say, Dunning says.

Generally speaking, the nutritional products mentioned above are not regulated by the U.S. Food and Drug Administration. The FDA is the federal government agency that requires rigorous clinical studies before it will approve medications and medical devices. The studies required by the FDA help to ensure a product is as safe as possible. Still, products not approved by the FDA may appeal to people with diabetes if they’re easy to obtain and at a lower cost, says nurse practitioner Stephen Ferrara, an associate dean of clinical affairs and assistant professor at the Columbia University School of Nursing in New York City.

Health products and supplements not backed by the FDA do not undergo the same rigorous studies, and because they are sold as supplements, their manufacturers can make claims not supported by scientific evidence, Ferrara says. Additionally, the ingredients in supplements or similar nutritional products may vary widely from brand to brand.

The FDA approval process tends to run very slow, so it’s not perfect, Ferrara says. However, he notes that it does help to prevent scam treatments in diabetes.

Although not all diabetes products that you see advertised will harm you – except maybe your wallet – they won’t necessarily help you, Dunning says. “Where they become a risk is when they replace actual medical treatment,” he says.

Here are four ways to help avoid diabetes product scams:

Talk to your health professional about any treatments you are considering. He or she can help separate science from marketing hype. “Diabetes is a medical condition. When your car breaks down, you don’t take it to an accountant. When you have a medical problem, you need to seek medical care,” Dunning says.

Sometimes, certain products that aren’t medications may have some benefit, says physician assistant Daryl Wein, author of “Type 2 Diabetes: The Owner’s Manual.” Wein practices in Oakdale, California, and also has Type 2 diabetes. For example, cinnamon may have a slight positive effect on lowering blood sugar. However, that doesn’t mean it’s enough to make any major investment. “If you want to eat more cinnamon, go for it, but don’t expect much benefit from it,” Wein says. Again, check with your health provider first.

Some herbs that are helpful for diabetes can be added in small quantities, Adimoolam says. “I recommend using them in addition to medication and lifestyle to help control diabetes,” she says.

Be wary of certain buzzwords. If a product says that it’s “breakthrough,” “revolutionary” or “clinically proven” (with no studies to back it up), think twice before you buy. “FDA authorized” or “FDA cleared” are other phrases you might read or hear, when there’s really no such thing, Wein says. “FDA approved” is what is used for a product approved by the FDA.

If a product says it has dozens or hundreds of uses, that’s another reason to be cautious, Wein says.

And just because a product says it’s natural doesn’t mean it’s beneficial for your health.

Dunning also adds what he says is the “king of all red flags”: the word “miracle.” “If you see it, you are being scammed, guaranteed,” he says.

Be skeptical of recommendations from friends and family. Just because a friend or family member touts a product, that doesn’t mean it’s scientifically effective or will work for your diabetes, Wein cautions.

Let your health professional know about anything you are using for your diabetes. “Providers need to be aware of all medications, supplements and alternative treatments so that we can properly adjust prescription medication accordingly, since it’s possible that blood sugar levels can improve with some supplements,” Ferrara says.

You can use the Dietary Supplement Label Database from the federal government’s National Institutes of Health to help obtain additional information about specific supplement brands. You can share and discuss information from that database with your health providers about products that you are using.

Additionally, you can check the FDA’s website to see if a particular product is approved for diabetes, Adimoolam suggests.

Someone’s Mistakes Make Their Life Filled With Depression

Mental illness is difficult to treat, in no small part because patients’ thought processes are affected significantly. With depression, patients have distorted and unhealthy views of themselves and their illness, which can impair smart decision-making and get in the way of finding and following a proper treatment plan. As a result, many patients make mistakes about their disease and what they should do about it.

U.S. News asked two psychiatrists to list some of the more common errors they see their patients making. Dr. Peter D. Kramer is emeritus clinical professor of psychiatry and human behavior at Brown University. Dr. David Mischoulon is an associate professor of psychiatry at Harvard University and director of the Depression Clinical Research Program at Massachusetts General Hospital. Here are their top 10 mistakes.

1. Suffering in silence. Depression typically doesn’t go away on its own, and left untreated it can worsen and progress to a point where a person can become disabled and potentially suicidal. Seeking help is key to getting out of depression, Mischoulon says. “The motto in my psychiatric residency program was ‘don’t worry alone.’ If you are depressed, tell someone about it rather than suffering in silence.” Patients can start by telling a friend or relative, or their primary care physician. “This could represent your first step toward getting the help that you need,” he says.

2. Self-medicating. There are numerous over-the-counter products that claim to treat various psychiatric and emotional symptoms, Mischoulon says. “Many people will try these rather than seeing a practitioner. While some of these therapies have evidence to support efficacy, they have to be used with the same care as prescription medications, and preferably under the supervision of a clinician.” He adds that “self-medication” includes using alcohol or recreational drugs to alleviate depression symptoms. Also a bad idea. “While these may induce a temporary feeling of well-being, over the long term they tend to worsen depressive disorders as well as present a risk of addiction,” he says.

3. Staying wedded to a treatment that is not working. “Sometimes a patient will be intent on relying on alternative treatments, like exercise or yoga, which is fine if the practice brings substantial or decisive relief,” Kramer says. But, “if a given treatment is not working, it will make sense to switch, often to a standard, well-tested approach, like psychotherapy or medication.” Patients may be reluctant to try these, perhaps on idealistic or ideological grounds, he says. That’s a mistake, he explains, because “depressive episodes are harmful to mind, brain and body, and longer episodes are more destructive. We want them to remit.”

4. Choosing the wrong clinician or treatment option. There are many different approaches to treating depression, including but not limited to antidepressant medication; somatic therapies such as electroconvulsive and transcranial magnetic stimulation therapies; and various kinds of psychotherapies, such as psychoanalytic and cognitive behavioral therapy. “While all of these are supported as effective by research studies, they don’t all work for every single individual,” Mischoulon says. “A licensed psychiatrist, psychologist or psychiatric nurse practitioner is in the best position to recommend the right treatment for the right person.”

5. Not staying vigilant. Residual symptoms may occur as an episode of depression resolves or recur at the onset of a new episode. “A great problem with depression is insidiousness,” Kramer says. “It can slip up on you. And because depression brings an altered perspective, you may believe that you have always been a certain way, you deserve to feel bad, the situation is hopeless or entertain similar thoughts.” A spouse, relative or close friend can be of use, he says, if that individual is allowed and encouraged to let the patient know that he or she is slipping back into depression.

6. Not understanding insurance coverage. “Managed care today is very complicated, and insurance plans differ a great deal from each other in terms of what they will cover,” Mischoulon says. He suggests that patients work with their doctor’s office to learn what is covered under their plan, including which antidepressants, what kinds treatment and how many visits within a certain period. “This can prevent you from getting saddled with unexpected bills that your insurance refuses to cover,” he says.

7. Not following doctor’s orders. As with any other doctor, a psychiatrist or psychotherapist can only offer a course of treatment. It is up to the patient to follow instructions regarding how to take medications and how often to see the doctor. “For example, antidepressants should be taken daily and at certain doses, whether or not you are feeling depressed on that particular day,” Mischoulon says. “When you don’t take the medications as prescribed, they don’t work as well, and recovery can be delayed. Likewise, for psychotherapies to work, regular visits are paramount, and every effort should be made to see your therapist with the recommended frequency.”

8. Losing touch with a therapist. “I like to see patients with persistent or highly recurrent depression maintain a relationship with a mental health professional and check in at regular intervals – as a patient with diabetes might,” Kramer says. “The mistake would be in not recognizing that sort of depression for what it is, a chronic ailment. Why should we not need our doctors here as elsewhere?”

9. Not “doing it anyway.” People with depression often feel unmotivated about their work, leisure or social activities. Those who push themselves to remain active despite the depression often find that participating in those activities can actually lift their mood, at least temporarily, and provide a reprieve from depression. “If you are depressed, make every effort to stay engaged in your activities as much as possible, because this can have positive effects on your mood,” Mischoulon says.

10. Ignoring or hiding suicidal thoughts. People with depression may at times feel that life is not worth living or that they may be better off dead. They may think about killing themselves. Don’t push those feelings aside. “If you are depressed and having these thoughts, talk to someone,” Mischoulon says. “If you already have a doctor, talk to him or her about it. Or tell a trusted friend or family member who can assist you in getting the help that you need.” And those friends or loved ones who suspect that someone may be suicidal should be direct and ask about it. “Contrary to popular belief, asking about suicide will not encourage a person to do it,” Mischoulon says. “In fact it may prevent them from harming themselves.”

How to Treat Depression in Children

Depression is, by most accounts, on the rise among America’s children. A recent study published in the journal Translational Psychiatry provided the most disturbing news yet. It looked at data on adolescents ages 12 to 17, from the 2009 to 2014 editions of the National Survey of Drug Use and Health, an annual cross-sectional survey conducted in a representative sample of the U.S. population. Researchers concluded that a whopping 36.1 percent of girls had experienced a first bout of depression. Boys were recorded at 13.6 percent – much lower, but still alarmingly high.

Those children also exhibited more behavioral and academic problems than children with no history of depression, prompting the study’s authors to write: “High levels of impairment, suicide attempts, conduct problems and poor academic functioning argue against a ‘wait and see’ approach to clinical treatment of recent first-onset depression.” In other words, getting depressed kids into proper treatment is paramount.

But how do you treat a child with depression? Children, as most health practitioners are quick to say, are not “small adults.” They have their own biochemistry, their own cognitive capabilities and their own tolerances for medications, psychotherapy and other common treatments for depression. They also have more erratic and potentially dangerous reactions to those treatments, particularly medications. That’s why parents should employ the skills of a trained child and adolescent psychiatrist or psychologist for any child with mental illness.

Psychotherapy

“Most psychiatric symptoms were first described for adults, then later extrapolated to kids,” says Dr. Steven C. Schlozman, assistant professor of psychiatry at Harvard Medical School and associate director of the Clay Center for Young Healthy Minds. “That makes it a bit like fitting a square peg into a round hole.” That fit is made smoother by adding knowledge about childhood development into the geometry, he says. For instance, depression in children may manifest as irritability, rather than sadness or melancholy. “It is important for the physician to recognize this, because you might not think of someone who is irritable as being depressed,” he says.

Likewise, treatments must be adjusted to meet the developmental stage of the child. The treatments are, in broad strokes, the same as those used for adults. The American Academy of Child and Adolescent Psychiatry, or AACAP, says that treatment for childhood depression should include both psychotherapy and medication. “In milder forms of depression, it is reasonable to start with a psychotherapy, but treatment with a medication and psychotherapy should be considered for moderate to severe forms of major depression,” it recommends.

The AACAP says the following therapy styles can be used to help depressed children:

  • Individual therapy. Well-studies therapies include cognitive behavior therapy, or CBT, and interpersonal therapy, or IPT. CBT teaches how to recognize and change unhealthy patterns of thinking that cause feelings and moods that can affect behavior. IPT helps depressed children identify interpersonal events and how these events affect their relationships, their moods and their lives.
  • Family therapy. Here, a therapist helps the entire family – the child or adolescent, parents, siblings and even grandparents – improve communication and support skills to work together in more positive and constructive ways.
  • Group therapy. Multiple patients are led by one or more therapists who teach the group how to better understand and recover from depression.