The Celestial Care Way

According to the Mayo Clinic, Multiple Sclerosis (MS) is a potentially disabling disease of the brain and spinal cord (central nervous system).

In MS, the immune system attacks the protective sheath (myelin) that covers nerve fibers and causes communication problems between the brain and the rest of our body. Eventually, the disease can cause the nerves, themselves, to deteriorate or become permanently damaged.

Signs and symptoms of MS vary widely and depend on the amount of nerve damage and which nerves are affected. Some people with severe MS may lose the ability to walk independently or at all, while others may experience long periods of remission without any new symptoms.

There’s no cure for Multiple Sclerosis. However, treatments can help speed recovery from attacks, modify the course of the disease and manage symptoms.

MS is a personal cause that I feel very strongly about due to the loved ones in my life being affected. Included are very close friends, distant family members and patients I’ve helped. I feel it’s a disease that isn’t talked about as much as other diseases, and I wish to bring more light to it!

MS Run the US is a non-profit whose goal is for entrants to run for those who cannot, to raise awareness and raise money for research. This includes raising money for people who are struggling with MS; whom may need items like wheelchairs and ramps to help them get into their house. What we participants do is run from LA to NYC! There are 18 segments, broken down to about a week. Each relay runner is assigned a segment where they will, on average, run a marathon each day (26-plus miles) for that week, to raise $10,000 for their segment.

I was lucky enough to have been chosen to take part in this relay in 2014. I had the last segment, which began in Sunbury, PA and ended in NYC, totaling 170 miles.

I recently ran it again, and you may wonder why.  You see, a woman named Ashley founded MS Run the US. She was inspired by her mother, Jill, who was severely affected by the disease, to run across America herself with the same mission in mind as the relay.

Not only is Jill an inspiration for Ashley; she’s the entire MS community’s inspiration. In 2014, Jill couldn’t walk, but she wanted to walk across the finish line when the relay ended in New York. Guess what? She trained all summer long to get the strength in her legs in order to accomplish her goal. With Ashley holding an arm on one side of Jill, and another runner on the other side, Jill had the New York City spectators cheering her on as she crossed the finish line. It was a sight to be seen; there wasn’t a dry eye in the park.

Jill was also an inspiration to me. Her disease allowed me to flourish. It allows others to become aware and also do incredible things just as she and her daughter have. Jill passed away this year. I heard about her passing as I was going into Hobby Lobby. I remember it so well. I had to sit down and cry and soak it all in. I realized, in that very moment, how monumental Jill and this relay have been in my life.

I felt compelled to help the relay, as well as my family. I asked Ashley what I could do to help. The first segment of the relay this year had lost its runner due to her father’s decline, with his very own, horrific MS. I told them I could run, as I had been training for something already. This act sparked other “alumni runners” to come along and help pitch in some miles for the first segment, as well. We were a family who had come together to run miles to honor our beloved Jill – who couldn’t take any more steps forward, as she had been taken far too soon.

Once again, I laced up my shoes and put one foot in front of the other to accomplish another challenging feat to help honor those who cannot do the same. I started running in Palmdale, CA and ended in Barstow, CA. It ended up being 77 miles, which was run in three days. After I was finished, I almost felt a sense of completion. Like I was able to help Jill, as if it was my turn to help her.

I want to give great thanks to my family here at Celestial Care for allowing me to have the time off to do this. I appreciate those who covered my shifts. I also love that you came together to chip in money in support of The Run. It means the world to me. Thank you so very much.

We will not stop running until there’s a cure to end Multiple Sclerosis.

By Valerie Olberding, Celestial Care Employee

Pictured is Valerie at the MS Run the US

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Drug prevents heart attacks in high-risk patients

A new heart drug cuts cholesterol levels to once-unthinkable lows, a treatment that doctors hope may prevent future heart attacks or stroke in high-risk patients, according to results from a highly anticipated study released Friday.

However, the drug comes at a high price: approximately $14,000 a year.

The injectable drug, Repatha, appears to cut LDL or “bad” cholesterol to extremely low levels, more than statins or lifestyle changes in people who had prior heart attacks or were at high risk. More than 27,000 heart patients in 49 countries were followed for two years in the largest study of its kind.

But it hasn’t cut deaths yet.

“It’s a big deal for patients,” said cardiologist Dr. Marc Sabatine of Brigham and Women’s Hospital, the study’s lead author. “These data strongly suggest that patients benefit from lower LDL cholesterol well below current targets.”

Repatha, known generically as evolocumab, was approved in 2015 for people who couldn’t manage their cholesterol in any other way — but it wasn’t clear whether cutting LDL blood cholesterol to extremely low levels would protect against further heart attacks or stroke.

The drug lowered patients’ cholesterol from a median LDL of 92 down to 30, something that’s usually almost impossible to do with medication. In addition, the drug decreased heart attacks and strokes by 20 percent compared to patients taking a placebo.

Even patients who started with a relatively low baseline LDL were shown to benefit from the additional drop Repatha offered them, compared to other treatments.

The benefit began six months after taking the drug, and lasted and increased the longer the patient took it. Repatha was also shown to be relatively safe, with few side effects.

The drug could be “life changing” for the millions of people with coronary artery disease, Dr. Steven Nissen, Chairman of the Department of Cardiovascular Medicine at the Cleveland Clinic, told NBC News.

Once a patient has had a heart attack, they are at an increased risk of having another. And they can die.

“After a heart attack, many people are never the same,” said Nissen. “There’s benefit in preventing a heart attack.”

While Repatha demonstrated sizeable reductions in future heart attacks and stroke, the trial didn’t show that people were less likely to die.

The researchers hope that with more time, they can show Repatha can prevent early deaths.

With the $14,000 price tag, Repatha is an expensive drug compared to widely used statins like Lipitor, which are now available in generic formulations. Lipitor costs in the low hundreds of dollars annually.

As a result, insurers may balk at covering the huge cost. But doctors are hopeful that the results of this major study may lead to new guidelines regarding the treatment of high-risk patients, Dr. Robin Dullaart from the University of Groningen in the Netherlands wrote in an editorial in the New England Journal of Medicine, which published the research findings.

Also, Repatha is an injection which some patients may find inconvenient or unpleasant compared with popping a pill.

But with the trial results, “we now have definitive data that by adding evolcumab to a background of statin therapy, we can significantly improve cardiovascular outcomes and do so safely,” said Sabatine.

NBC News

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Arizona Doctor Details the negative impact sugar has on people

SCOTTSDALE, Ariz. (KSAZ) – It’s a truth that some would say is self-evident: many people like sugar, but the problem is, there can be too much of a good thing. The rate of obesity in America has nearly tripled over the past five decades, and the Centers for Disease Control and Prevention (CDC) said Diabetes treatments cost Americans $1 billion, per day. New research is also showing that sugar is responsible for many more health problems.

Now, a Valley doctor is warning people that sugar is in almost everything we eat. “80% of all the foods in the grocery store has sugar in it,” said Dr. Richard Jacoby.

“The human genome has never been assaulted as viciously as this molecule to our nerves,” said Dr. Jacoby.

Despite the warnings, getting people to give up sugar is a hard sell. So, Scottsdale-based Dr. Jacoby, who is an extremity nerve surgeon, co-wrote a book. He has seen the effects of sugar first hand, from patients who suffer from Diabetic Neuropathy. He has also treated the severe wounds it can cause.

The book, however, is about much more.

“I think Autism is a part of this equation,” said Dr. Jacoby. “I think Alzheimer’s for sure is sugar.”

It is Sugar’s chemical cousin that worries Dr. Jacoby the most.

“We should be getting off of sugar,” said Dr. Jacoby. “Get high-fructose corn syrup out of our diet.”

High-fructose corn syrup, sometimes labeled as HFCS, can be seen on the label of many products. Dr. Jacoby said it is also disguised with other names, like “glucose syrup”, “maize syrup”, and “dahlia syrup”.

“It’s a conspiracy to put this sugar into our diet, and disguise them with multiple different words with ‘o-s-e’ at the end, or ‘o-l’ words you’ve never heard of,” said Dr. Jacoby

High-fructose corn syrup became a cheaper alternative to sugar in the 1970s, and it is subsidized by the government because it comes from corn, which is one of America’s biggest cash crops. Suddenly, there was a cheaper way to make food taste better, and HFCS started showing up everywhere.

It’s not hard to know that there is plenty of Sugar, or HFCS, in soda, candy and cookies. They also lurk in places one would never suspect.

“Power bars, energy drinks, yogurt, certainly bread, because it’s so enticing, so convenient,” said Dr. Jacoby.

There are also other books and studies on sugar that will generate concern for others, including one on milk.

“Milk is a good food, it’s a perfect food. But we homogenize it, mix it together. Well, that’s not good. Fat is bad so you take it out, what are you left with? Sugar water. That’s all milk is without the fat.”

The sugar industry is not happy about these claims, as one might suspect. Representatives with US Sugar did not return the station’s calls or e-mails for comment. In addition, evidence, linking sugar to various ailments is often challenged.

Dr. Jacoby, however, said it’s there.

While Dr. Jacoby quit sugar cold turkey a few years ago, he does not recommend others taking that approach. Instead, take a gradual approach.

“Start with breakfast,” said Dr. Jacoby. “No cereals. That is another killer. To me, bacon and eggs is a perfect meal. You want to throw some spinach in your omelet, go for it. Butter in your coffee, perfect meal.”

Yes. Dr. Jacoby said butter in coffee.

For Dr. Jacoby, the formula is simple: cut sugar and add fat, as long as it’s natural and grass-fed.

Fox 10 News, originally posted February 16, 2017

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Do you know what an Ileus is?

Your intestines are about 25 feet long. This means the foods you eat have a long way to travel before they’re fully digested or excreted. Your intestines complete this task by moving in a wave-like motion. Known as peristalsis, these muscle contractions move forward your digested food. However, if something slows down or blocks this motion, the result can be a major traffic jam in your intestines.

Ileus is the medical term for this lack of movement in the intestines that leads to a buildup or blockage of food material. An ileus can lead to an intestinal obstruction. This means no food material, gas, or liquids can get through. It can occur as a side effect after surgery. However, there are other causes of this condition.

An ileus is a serious concern. But people often don’t know that food is building up in their intestines and continue to eat. This pushes more and more material toward the blockage. Without treatment, the ileus can perforate or tear the intestine. This causes bowel contents, which have high levels of bacteria, to leak into areas of your body cavity. This can be deadly. If an ileus does occur, it’s important to get treatment as quickly as possible.

What are the symptoms of an ileus?
An ileus can cause extreme abdominal discomfort. Symptoms associated with ileus include:
• abdominal cramping
• appetite loss
• feeling of fullness
• constipation
• inability to pass gas
• stomach swelling
• nausea
• vomiting, especially vomiting stool-like contents

Gastrointestinal symptoms are the most common signs of an ileus. Your stomach and intestines will start to fill with gas that can’t pass out the rectum. This causes the stomach to take on a tight and swollen appearance.
If you experience these symptoms, especially after surgery, it’s important to seek immediate medical attention.

What are the causes of an ileus?
It is common after surgery because people are often prescribed medication that can slow intestinal movement. This is called a paralytic ileus. In this instance, the intestine isn’t blocked. Rather, it isn’t moving properly. The result is little or no movement of digested food through the intestines.
Examples of medicines that can cause a paralytic ileus include:

• hydromorphone (Dilaudid)
• morphine
• oxycodone
• tricyclic antidepressants, such as amitriptyline and imipramine (Tofranil)
However, there are several other causes of an ileus. These include:
• colon cancer
• Crohn’s disease, which causes the intestinal walls to get thicker
• Diverticulitis
• Parkinson’s disease, which affects muscles and nerves in the intestines

These are the most common ileus causes in adults. Children can also be afflicted. According to The Mayo Clinic, intussusception is the most common cause for the disorder in children. This is when the intestine “telescopes,” or slides into itself.

Risk factors
Ileus is the second most common reason for hospital readmission in the first 30 days after surgery. It is more likely if you’ve recently had abdominal surgery.
Surgical procedures on the abdomen usually involve stopping intestinal movement for a period of time; this allows the surgeon to access your intestines. Sometimes peristalsis can be slow to return. Other people are more likely to experience scar tissue that can also lead to an ileus.

A number of medical conditions can increase your risk of ileus. They include:
• electrolyte imbalance, especially for potassium and calcium
• history of intestinal injury or trauma
• history of intestinal disorder, such as Crohn’s disease and diverticulitis
• sepsis
• history of irradiation of or near the abdomen
• peripheral artery disease
• rapid weight loss

Aging also naturally slows down how fast the intestines move. An older adult is at greater risk for having it, especially since they tend to take more medications that could potentially slow digestion.

Treatment

Treatment depends on its severity. Examples include:

Partial obstruction

Sometimes a condition like Crohn’s disease or Diverticulitis will mean that part of the intestine isn’t moving. But some bowel material can get through. In this instance, a doctor may recommend a low-fiber diet. This can help reduce the bulky stool, making it easier to pass. However, if that doesn’t work, surgery to repair or move the affected portion of the bowel may be needed.

Complete obstruction

A complete obstruction is a medical emergency. Treatment will depend upon your overall health. For example, some people can’t handle an extensive abdominal surgery. This includes the very elderly and those with colon cancer. In this case, a doctor may use a metal stent to make the intestine more open. Ideally, food will start to pass with the stent. Abdominal surgery to remove the blockage or the damaged intestine portion may still be needed.

Paralytic ileus

Treatment starts by identifying the underlying cause. If medicine is the cause, a doctor may be able to prescribe another medication to encourage motility (intestine movement). An example is Metoclopramide (Reglan). Discontinuing the medications that caused it, if possible, can also help. However, you shouldn’t stop taking a medicine, especially an antidepressant, without your doctor’s approval.

Treatment without surgery is possible during the early stages, but until the issue is fully resolved you may still require a hospital stay to get the proper fluids. A doctor may also use a nasogastric tube. Known as nasogastric decompression, this procedure calls for a tube to be inserted into your nasal cavity to reach your stomach. Essentially the tube suctions out the extra air and material that you may otherwise vomit.

According to Mount Sinai Hospital, most surgery-related ileus will resolve in two-to-three days. However, some people do require surgery if the condition doesn’t improve.

Considerations for surgery

Your intestines are very long, so you can live without a portion of it. While it may affect the digestive process, most people do live a healthy life with a part of their intestine removed.
In some instances, a doctor may have to remove the entire intestine. In this case, a doctor will create a special pouch called an ostomy. The bag allows stool to drain from the stomach. You have to care for the ostomy, but you can live without your intestine after an ileus.

Outlook
An ileus is common, but it’s highly treatable. If you’ve had a recent surgery, or have other risk factors, you should be aware of the symptoms. Seeking medical care is important in the hope it can be resolved without invasive medical treatment.

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Health trends not worth keeping in 2017

Health trends come and go — some helpful, some not so helpful, and some downright dangerous. CBS News asked medical experts about some of the popular trends they recommend ditching in 2017.

Trend: Cooking with coconut oil

“People seem to be eating it and drinking it with everything — adding it to coffee, cooking their vegetables with it — and it’s giving them large quantities of fat. I wish this trend would go away,” said Dr. Andrew Freeman, a cardiologist and director of Cardiovascular Prevention and Wellness at National Jewish Health in Denver, Colorado.

The latest guidelines from the American College of Cardiology recommend against tropical oils, he said. Freeman is the chair of the American College of Cardiology’s nutrition and lifestyle working group.

Coconut oil, a tropical oil, is not recommended because it’s likely to be artery clogging.

“Years ago, it was fed to lab animals to induce atherosclerosis,” said Freeman.

“It’s not a recommended oil by any of the guidelines that I know of. In general, it can contribute to cardiovascular disease risk because of its very high saturated fat content. The standard American diet most people already eat is already high-fat and full of a lot of processed meats and cheese, and now everyone’s adding coconut oil and we’re going in the wrong direction,” he said.

People who already have cardiovascular risk factors should definitely avoid it, he advised.

“Coconut oil is not a ‘superfood.’ Coconut meat by itself is probably not a bad thing to eat, but it’s when you start extracting the oil out of a plant — that’s when you get into trouble. I’m not entirely sure why it’s caught on the way it has,” Freeman said.

Trend: Guzzling water all day long

Carrying a water bottle around and chugging H20 all day long won’t bolster health, said Dr. Stanley Goldfarb, a professor at Perelman School of Medicine at the University of Pennsylvania.

The human body is an efficient water-regulating machine, said Goldfarb, who studies kidney function.

“Thirst is designed to make sure we get water in when we need it. The kidneys excrete it rapidly when it’s not needed and you also lose some water through the skin,” he said.

Pushing ourselves to drink more water than we need, he said, “doesn’t make a lot of sense from the way the kidney works or from an evolutionary standpoint.”

Drinking more than eight 8-ounce glasses of water a day isn’t required for most people, unless you’re an athlete or a soldier stationed in desert climes, or have other special hydration needs. Kids, for example, can sometimes get too little water. In Philadelphia, where he works, some schools don’t have functioning water fountains due to lead pipe issues, or some don’t have water fountains near where they’re playing sports, so kids in those situations should have access to bottled water.

Goldfarb said other water-related myths include the notion that gulping lots of it flushes toxins from the body, but there’s no research supporting that claim. It won’t improve your complexion, either, unless you’re very dehydrated.

“When you drink a glass of water, it’s not targeted to the skin in your face. The percentage of cells in your face compared to the rest of your body is about the same as a 6-foot-tall man standing by the Eifel Tower. The amount of water that actually gets to the face is a thimbleful and that includes the scalp,” Goldfarb said.

“It’s not that we don’t need water — 60 to 70 percent of body weight is water — but you have a system that is very carefully designed to be sure you have the proper amount of water,” Goldfarb said.

Eight glasses a day should be plenty to do the job.

READ MORE HERE

Trend: Bottled fruit smoothies

Bottled fruit smoothies are packed with sugar, said Antinoro.

“Eat fresh fruit or make your own, versus the sugar-laden bottled ones. Not to bash any brands, but a 15-ounce bottle can have 40 to 50 grams of sugar. That is about 10 to 12 teaspoons of sugar,” Antinoro said.

The American Heart Association recommends limiting added sugars. For most American women, that means eating no more than 100 calories from sugar per day, or about 6 teaspoons of sugar. For men, it’s 150 calories per day, or about 9 teaspoons.

“If drinking fruit smoothies from a bottle is your only way of getting fruit, it’s better than nothing, but eating fresh fruit or making your own version with a vegetable blend is better,” Antinoro said.

Whole fruit gives you more intact fiber, she explained. And it takes more time to eat a whole apple than to gulp down a smoothie.

When making homemade smoothies, Antinoro suggested, “Add a teaspoon of chia seeds or flax to give them a fiber boost and omega 3s and other nutrients, using any fruits you enjoy. Pop in leafy greens, like spinach, kale, and broccoli, and carrots.”

Trend: High-tech medical tests

With medical technology booming, it’s tempting for some people to undergo tests “just to be sure.” But it may be risky.

Dr. Eliot Nierman, a general internist and associate professor of clinical medicine at the University of Pennsylvania, said people can overdo it on medical tests these days. He said it’s time to scale back and question the necessity of undergoing tests that aren’t recommended, based on the evidence, before they’re performed.

“People always think a test is the answer — there’s a belief in technology — but in some sense they are dangerous if you develop a lot of false positives. They an end up doing things to patients that may actually cause them problems down the road,” said Nierman.

He recalls a patient who wanted a routine stress test even though he did not have any heart problems at all. But the test came up with a false positive, so the patient went for a catheterization test. It turned into a real medical horror story.

“The catheterization broke off cholesterol in his heart and it caused complications and he lost both of his legs,” said Nierman.

He said a classmate of his had a PSA test for prostate cancer— a test whose widespread use has been the subject of ongoing medical debate— and it led to a false positive which required a biopsy.

“That procedure ended up causing an infection in one of his heart valves and he ended up getting open heart surgery,” said Nierman.

While it’s rare that such complications occur, the risks are not to be taken lightly, he said.

“If you start to do tests in people were it isn’t indicated, you tend to pick up a lot of noise. Occasionally we do help someone pick up a cancer that would have been missed, but most tests as a screen are not valuable,” he explained.

Doing too little is risky, too, he warned.

Tests that are of value include cholesterol, breast cancer, colon cancer, cervical cancer screenings and blood sugar tests, Freeman said. Patients should discuss with their doctors recommended health screenings and other questions they have about medical tests.

Trend: “I’m not a person who needs a lot of sleep”

“There are some people who claim they don’t need sleep,” said Penn’s Nierman, but it’s not true for most.

Most people need seven hours a night, and some even more, he said.

“Younger people in particular often need more and often don’t get it. That has a lot of deleterious effects on mental health, memory.”

Poor sleep habits, over time, can increase your risk of obesity, diabetes, and cardiovascular disease.

Lack of sleep may also take a toll on your immune system. “Studies show that people who don’t get quality sleep or enough sleep are more likely to get sick after being exposed to a virus, such as a common cold virus. Lack of sleep can also affect how fast you recover if you do get sick,” according to the Mayo Clinic.

Trend: Setting a weight-loss pound goal

“Setting a goal of losing like 30 or 50 pounds isn’t recommended,” said Elisabetta Politi, nutrition director of the Duke Diet and Fitness Center at Duke University.

It sets people up for frustration over time. Weight loss is a long, steady process, she said, and it may help to approach it with smaller, more reachable goals.

“There’s a reason gyms are packed in January and February and then in March start emptying out. Try goals that are more relevant to you, more reachable,” said Politi.

“Instead of signing up for the gym, try saying, ‘I’m going do more physical activity. I’m going to take a walk, 15 minutes, twice a day.’ Make very specific goals,” she said.

She said shows like “The Biggest Loser” can give a false impression that losing a lot of weight fast is doable for the average person.

The people on those shows have a whole team of trainers, nutritionists and chefs assisting them.

“It really doesn’t really help regular people who have jobs and can’t dedicate themselves completely to weight control,” she said.

Politi also recommends people try being more mindful about meal planning if they want to lose weight — in other words, pay attention to what foods give you energy and which ones make you feel uncomfortably full or sleepy or zapped of energy afterward.

“If you feel better, it will help you lead a long, productive healthy life,” she said.

Trend: No snacking after dinner

Snacking in the evening a couple of hours after dinner isn’t necessarily the big diet-buster it’s cracked up to be. It can actually be good for you if it’s healthy and light, said Dr. Michelle Terry, a clinical professor at the University of Washington and an attending physician at Seattle Children’s Hospital.

“Eating after 8 p.m. will not necessarily make you gain weight, unless you are eating low-nutrient foods in large quantities,” Terry told CBS News.

That means staying away from salty, high-calorie, high-fat, carbohydrate-packed chips and cookies. Instead, choose one of these healthier options: a small apple with peanut butter or a half-cup of cottage cheese, a half-cup of plain Greek yogurt, a cup of fat-free or low-fat milk, a small serving of raw vegetables and low-fat dip, or a handful of unsalted nuts.

If you have diabetes, eating a small snack in the evening  — about 150 calories and 15 grams of carbohydrates — that contains some protein can be a healthy choice.

“Before bed, it helps control blood sugar levels. And if you feel hungry before bed, having a small snack may help you sleep better too,” said Terry.

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Dementia Holiday Activities That Lower Stress and Raise the Joy

christmasHoliday stress can soar for caregivers whose loved ones have Alzheimer’s and other forms of dementia. And for good reasons: Your own already-bursting to-do load stretches longer than the lines at the post office. Safety worries intensify and the person who has dementia may want to drive to the mall to shop, wander away in a crowded store, or insist on resuming dangerous old habits or activities, like baking or woodworking. You may feel prickles of grief over things the person can no longer do (travel cross-country to visit grandchildren or set up the Christmas tree, for example). Beloved traditions — especially lots of lights, lots of company — may now be bothersome or frightening to your relative. And did I mention that longer-than-ever to-do list?

One solution: Help the person keep busy and engaged with repetitive seasonal activities. Repetition that seems tedious to the rest of us is often soothing to someone with cognitive impairment. These activities stoke feelings of accomplishment and pride. All good: Call it repetitive de-stress syndrome. Some ideas:

Make decorations

  • Set the person to work stringing garlands. All you need is a long heavy thread and a darning needle. Try stringing cranberries, popcorn, even O-shaped cereal (Fruit Loops are cheerfully colorful).
  • Fashion paper chains. These require a bit more dexterity: You have to cut the strips of paper, then curl them around one another and staple. A good project to have an older grandchild supervise while the person with dementia helps in whatever way she can. Use construction paper or, for a really festive look, heavy-stock wrapping paper.
  • Make pomanders. Clove-studded oranges to hang or display in a bowl are not only lovely, but their scent may evoke calming, happy memories. Again, they require a little dexterity but not much.

Have fun with food

  • Make cookies. Someone once famous for their Christmas cookies may miss the kitchen activity. Together you could mix up a simple slice-and-bake dough (or do it for them in advance) and then let them slice the log and arrange the cookies on a baking sheet. Or set out colored sugar, sprinkles, and other decorations for decorating a tray of sugar cookies or gingerbread men you’ve already cut-out. (Kids love this, too.)
  • Crack nuts. Put the person to work with an old-fashioned nutcracker and a big bowl of walnuts, pecans, and Brazil nuts. A nice, soothing activity during family gatherings. *

Make a soothing atmosphere.

  • Stock up on classic holiday movies. Favorites to put in your Netflix queue or pick up cheap at the local superstore: “It’s a Wonderful Life,” “Miracle on 34th Street,” “White Christmas,” “Christmas in Connecticut,” “How the Grinch Stole Christmas,” (animated Seuss version), and “A Christmas Story” (that’s the 1983 modern classic about the boy who dreams of a Red Ryder BB gun). Invite your relative to choose if decision-making is not yet too fraught.
  • Put together a photo album of holidays past. This one takes a little time, but pays off in hours of repeated reviewing. Better yet, get a child to jot down the person with dementia’s descriptions of each photo — faces, places, funny things that happened (you may be surprised what’s remembered, though also be prepared for nothing to be recalled); insert the notes in the album next to each picture.
  • Play holiday music throughout the day. Mental grooves are deep for these tunes, which makes them especially soothing. Stick to classics you know the person is familiar with. This is probably not the year to spring Bob Dylan’s or Taylor Swift’s new Christmas album. (Although you never know!)
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The truth about the vitamins you actually need

“How can I make sure I’m getting my vitamins?” . . . is actually a very loaded question. The answer? It depends on whom you ask.

If you’re talking to someone “hawking” supplements, they’re going to tell you about the latest nutritional “miracle,” and may not even answer your question. A conventional MD might simply direct you to buy a bottle of multivitamins and quit worrying about it, while a registered dietician might start listing from their encyclopedic vegetable knowledge, confusing you in the process.

It’s hard to get a straight answer. This is partly because experts don’t know the exact answer, and the science of nutrition is constantly changing as researchers try to figure it all out.

What we do know, however, is that there are 13 essential vitamins, so named because your body truly could not function without them. These compounds keep your heart pumping, your cells growing and your food digesting. Without them, people develop old-timey-sounding conditions including scurvy (Vitamin C deficiency), anemia (iron deficiency) and rickets (Vitamin D deficiency).

We also know quite a bit about each one of the vitamins’ basic properties. Some vitamins, such as Vitamin D, are fat soluble, meaning your body can store excess amounts of them. But others, such as the B Vitamins, are water soluble, meaning that you’ll just “pee-out” the excess, rather than “stocking up.” Luckily (as you’ll see in this article), it’s pretty easy to get everything you need just by eating a balanced, healthy diet and going outside of it every once in a while.

That’s why most Americans don’t need to take vitamin supplements at all. You also don’t need to be taking extra amounts of these compounds. For instance, despite the hype, a mega-dose of Vitamin C will not prevent a cold. In fact, if you consistently take too much, you can actually overdose on vitamins, and have a dangerous reaction to some.

That said, there are instances when certain supplements become necessary. Here are a few of your essential vitamins:

Vitamin A (Retinol) Why you need it: Vitamin A helps keep many of your organs working properly, including your kidneys, heart and lungs. It’s also necessary for maintaining healthy teeth and skin. It’s especially important for vision. People with Vitamin A deficiencies have trouble seeing in low light. And Vitamin A deficiency is the leading cause of preventable blindness worldwide.

Where you’ll find it: Many animal products have Vitamin A, including cheese, eggs and meat. But because these also come with high levels of saturated fat and cholesterol, they shouldn’t be your main sources of the vitamin. Instead, focus on eating your leafy greens as well as red and yellow fruits and vegetables (e.g., mangoes and carrots). Read more.

Vitamin C (Ascorbic Acid) Why you need it: Your body needs Vitamin C in order to repair itself. That includes making collagen, a protein needed in order to heal wounds, as well as keeping your teeth, bones, and cartilage in good shape. Plus, Vitamin C can help your body absorb iron from other foods.

Where you’ll find it: We often think of citrus fruits as the ultimate Vitamin C sources — and they’re definitely good choices. But other foods (including potatoes, tomatoes, and broccoli) pack a big Vitamin C punch, as well. Some cereals are also fortified with extra Vitamin C, so be sure to check the label.

Vitamin D Why you need it: Vitamin D helps your body absorb calcium, and you need both to keep your bones healthy. As a kid, Vitamin D was especially important to make sure your skeleton grew with you properly. But you still need it as an adult. Vitamin D deficiency can make you feel especially fatigued and lead to conditions like Osteoporosis, as you get older.

Where you’ll find it: Very few foods contain Vitamin D, and those that do, such as milk and orange juice, are fortified, (meaning Vitamin D was added). Humans get most of their Vitamin D from sun exposure, the original source. When you’re exposed to UV rays, your skin converts a hormone into D3, a form of Vitamin D that we can’t readily use. That then gets sent to your liver and kidneys, which turn it into the active form of Vitamin D.

Vitamin E Why you need it: Your immune system needs Vitamin E in order to keep you safe from viruses and bacteria. It also helps you use Vitamin K (more on that later). Vitamin E is also an antioxidant, which means it helps protect the body from damage to tissues and organs caused by free radicals. These are molecules that are thought to play a role in the aging process. However, researchers are still figuring out exactly how helpful antioxidants are, if at all.

Where you’ll find it: There are actually several different antioxidant compounds all referred to collectively as “Vitamin E.” You’ll find them in the highest amounts in seeds, nuts and vegetable oils. But they’re also in avocado and dark-green veggies.

Vitamin K Why you need it: Vitamin K’s role is simple and vital. Without it, your blood wouldn’t clot. People who have a condition in which the blood doesn’t clot properly, such as Hemophilia, bleed longer after an injury than others and may suffer from internal bleeding. That can damage your organs and even be life threatening.

Where you’ll find it: Dark, leafy greens are your best bet for getting Vitamin K. However, soybeans, pumpkin, eggs, and meats also are good options.

Vitamin B1 (Thiamine) Why you need it: Thiamine is especially helpful for converting carbohydrates into usable energy — glucose. Your body, brain and nerves need that to function normally. Where you’ll find it: Get your hands on some whole grains, legumes, eggs, nuts and seeds, and you’ll be all set. A hearty grain bowl is the perfect way to get all of them in one meal.

Vitamin B2 (Riboflavin) Why you need it: Like all B Vitamins, Riboflavin helps your body convert carbs, proteins, and fats into energy you can use. But riboflavin deficiency has also been linked to vision problems and migraines. Researchers are still figuring out exactly what that association means.

Where you’ll find it: The best sources of Riboflavin are lean meats, dairy (including milk) and eggs. But you can also get it from leafy veggies, legumes, and nuts.

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What a real “Fault in Our Stars” couple taught us about love and medicine

Katie and Dalton on their wedding day in 2011

Katie and Dalton on their wedding day in 2011

(CNN) They became known as “The Real ‘Fault in Our Stars Couple,” and soon became nearly as famous as the couple in the novel and movie.

Katie Donovan and Dalton Prager — like Hazel Grace Lancaster and Augustus Waters, the teenagers in the 2014 film — fell in love even though they knew the other could die at any time.

The real-life couple also shared a diagnosis of cystic fibrosis. Adding to their drama was the fact that Katie’s doctors had directed her to not meet up with Dalton, because he had a highly contagious infection, and if she caught it, her life could be drastically shortened.

She defied her doctors and went on a date with Dalton, and two years later, they married when they both were 20.

Indeed, Katie did catch Dalton’s infection. She died September 22. Dalton died on September 17.

Their love story captivated readers. But their story was more than just a touching and tragic tale that went viral on the Internet. Katie and Dalton’s story teaches us lessons about love and medicine.

You get to make a choice that might hasten your death

For the most part, online bystanders were supportive of Katie and Dalton, wishing them well, and praying for them after they died. But there also were haters because of Katie’s choice to meet up with Dalton even though he had that infection.

According to the National Library of Medicine, the average life expectancy for a cystic fibrosis patient who reaches adulthood is 37, Katie died at 26. “There’s bullies behind names on the Internet that are, like, “You’re so stupid,” she said.

Less than a week before she died, Katie sat down for an interview with CNN at her home in Flemingsburg, Kentucky, and said she never regretted meeting up with Dalton. “I’d rather have five years of being in love and just really completely happy than 20 years of not having anybody and just having nothing,” she said.

Dr. Chris Feudtner, an ethicist at Children’s Hospital of Philadelphia, said the haters are wrong, and Katie had the right to make a decision that would probably shorten her life. “We honor people’s ability to make decisions for themselves,” he said.

He mentioned that his elderly mother, for example, wants to stay alone in her home instead of moving into assisted living, even though living at home increases the chances she could fall and no one would be immediately available to help her. He said his family is still working it out, but his mother might get her wish. “We let people make decisions about how they want to live even in the face of pretty substantial risk,” he said.

Medicaid sometimes fails the very sick

CNN first brought Katie and Dalton’s story to light in April 2015 because she was having trouble getting a lung transplant. Doctors in her home state of Kentucky were reluctant to give her the transplant. They wanted her to go to a larger program at the University of Pittsburgh that had more experience performing transplants for people with infections. Kentucky Medicaid had refused to pay for her to have a lung transplant in another state. It agreed to only after CNN published its story. Dr. Pam Shaw, a professor of pediatrics at the University of Kansas Medical Center, said Medicaid, which operates independently in each state, often won’t pay for care in another state, even when it’s clear the patient would be much better off.

“Unfortunately, this is quite common,” said Shaw, a member of the board of directors of the American Academy of Pediatrics. “Our hospital is 1,000 feet from the Missouri state line, and we won’t accept Missouri Medicaid, even though for some medical problems, we have the best services for children,” she said. “It just breaks my heart to tell a family ‘I can’t take care of you because you live in Missouri.'” Shaw suggested that the government change Medicaid so it’s more like Medicare, the insurance program for the elderly that’s run by the federal government, not state governments. “I know that’s pie in the sky, but it would be a lot better for patients, their families and the physicians who care for them,” she said.

It’s a real phenomenon: Spouses often die within a close time frame

Katie and Dalton died just five days apart, and several studies show this isn’t unusual. Researchers call it the  “widowhood effect.” Studies have found that an elderly person’s chance of dying increases by as much as 90% in the three months after his or her spouse dies, according to a 2008 study by researchers at Harvard University and the University of Wisconsin. The physiological reason for this — what actually is happening inside someone’s body — is pretty much a mystery.

“Broken heart syndrome,” technically called stress-induced cardiomyopathy, is one explanation. It’s the heart’s reaction to a surge of stress hormones that can be caused by the loss of a loved one, a divorce, a betrayal or any similar traumatic event. But not all spouses die of this particular problem. The 2008 study found that after losing a spouse, people die within just a few months of all sorts of diseases, including diabetes, infections and cancer. Part of it might be practical, said Dr. Eric DeJonge, Director of Total Elder Care at The District of Columbia’s Medstar Hospital and associate professor of medicine at Georgetown University Hospital. “Elderly couples often become ‘co-dependent’ on each other for cognitive or physical daily functions,” he wrote in an email. “When that support gets knocked out, it can destabilize the survivor.”

Dr. Christine Todd, an assistant professor of internal medicine and chairwoman of the department of medical humanities at Southern Illinois University, said she thinks it also has to do with the effect that emotions have on the immune system, especially on someone who’s already in fragile health. “Grief plus depression has a very dynamic effect,” she said. “Stress hormones and depression affect all your organs; it’s enough to shut things down.”

The tragic end of the Pragers’ love story touched millions around the world.

Dalton was doing relatively well after his transplant in November 2014. But just as Katie’s health was declining this fall, he caught pneumonia. Still, his family hoped he’d beat the infection and get out of the hospital in time to visit Katie at home before she died. Family members never expected he would die before her, and when he did, Katie was “devastated,” said her mother, Debra Donovan.

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September is Pain Awareness Month

Pain types and chronic pain classification

Many pain specialists recommend that the term “chronic pain” be referred to as “persistent pain – which can be continuous or recurrent and of sufficient duration and intensity to adversely affect a person’s wellbeing, level of function, and quality of life.” Given its universal acceptance, the following information uses the term “chronic pain.”

Acute pain is characterized as being of recent onset, transient, and usually from an identifiable cause. Chronic or persistent pain can be described as ongoing or recurrent pain, lasting beyond the usual course of acute illness or injury healing, more than three to six months, and which adversely affects the individual’s wellbeing. Another definition for chronic or persistent pain is pain that continues when it should not.

Chronic pain is classified by pathophysiology (the functional changes associated with or resulting from disease or injury). It can be nociceptive (due to ongoing tissue injury), neuropathic (resulting from damage to the brain, spinal cord, or peripheral nerves), or a mixture of these.

Central Pain Syndrome is a neurological condition caused by a process that specifically affects the central nervous system (CNS), which includes the brain, brainstem and spinal cord. The disorder occurs in people who currently have or who have experienced strokes, multiple sclerosis, Parkinson’s Disease, brain tumors, limb amputations, brain injuries or spinal cord injuries. It may develop months or years after injury or damage to the CNS.

This also includes conditions such as chronic headaches, Fibromyalgia and Complex Regional Pain Syndrome (CRPS). Continuous pain is pain that is typically present for approximately half the day or more. Flare-up pain (the term break-through pain was coined to refer to cancer-related flare-ups) can be described as a transitory increase in pain in someone who has relatively stable and an adequately controlled level of baseline pain.

It may be caused by changes in an underlying disease, including treatment, or involuntary or voluntary physical actions such as coughing or getting up from a chair or other changes in activity level. It can also be caused by stress and emotions such as anxiety, anger, fear, or worry. Activity imbalance—doing too much or too little—can also cause flare pain.

Understanding more about the underlying causes of pain can help improve treatments and alleviate suffering. Johns Hopkins researchers are working on everything, from the molecular causes of pain to the latest advances in pain treatment.

Pain in older persons

Persistent or chronic pain is common in older adults. While medications are certainly an important part of treating chronic pain, use in older persons is fraught with potential problems. Physical rehabilitation and other interventional therapies, which may include targeted injections and acupuncture, can be helpful to reduce pain, maximize physical function, and decrease the need for medications. In fact, medical literature is full of studies showing the advantage of regular physical exercise in older adults. Additionally, psychological supports, including relaxation techniques, mindfulness practices and positive self-talk should always be considered for managing pain in elderly people.

In addition to chronic pain, older adults are more likely to have multiple medical conditions and to be taking multiple medications. Medication risks are greater for an individual when multiple medications are taken. It is important to discuss all medications (including over-the-counter or verbal/medications) with your healthcare provider. Certain medications carry greater risks than others, especially when used in combination.

Some older individuals may be more sensitive to medications, more likely to experience side effects, and more likely to be using multiple drugs with the associated risk of interactions between the drugs. In general, 30 percent of hospital admissions among the elderly may be linked to an adverse drug-related event or toxic effect from opioids and sedatives (i.e., a tranquilizer).

Nearly one-third of all prescribed medications are for persons over the age of 65. Unfortunately, many adverse drug effects in older adults are overlooked, considered to be age-related changes (general weakness, dizziness, and upset stomach) when in fact the person is experiencing a medication-related problem. In all persons, medication should be initiated at a low dose and adjusted slowly to optimize pain relief while monitoring and managing side effects. Multi-modal analgesia, which is the careful use of multiple pain-relieving drugs known to be hazardous.

The American Geriatrics Society, www.americangeriatics.org provides guidance on      Pharmacological Management of Persistent Pain in Older Persons, at www.americangeriatrics.org/files/documents/2009_Guideline.pdf.

How medications can help and harm

Many people with chronic pain are able to manage adequately without medications, and can function at a near-normal level. Others find that their overall quality of life, in terms of comfort and function, is improved with medications. However, even the most potent medications used for pain rarely completely eliminate pain, but may reduce the severity of pain. As such, medications are rarely adequate alone and should be considered as an optional part of a comprehensive approach to pain management and functional improvements.

While medications can help relieve symptoms, they also can cause unpleasant side effects that at a minimum can be bothersome and at their worst can cause significant problems including death. These side effects can often be avoided or at least managed with the help of a health care professional. It is important that the health care professional be aware of all prescription medications, over-the-counter (OTC) medications, and fitness, nutritional and herbal supplements that are being taken for general health or for pain or other medical conditions. This can ensure these are being taken appropriately and safely and that they do not interact with other prescribed medications or therapies.

Some substances and drugs may cause serious side effects if they are combined with other medications. Even over-the-counter and herbal preparations have possible side effects and the potential to cause serious interactions with other nonprescription and prescription medications and with each other. These include various OTC supplements and vitamins, homeopathic remedies, items grown in a home garden or bought in a store, and other substances, such as caffeine, alcohol, tobacco, and even marijuana and elicit drugs. It is strongly advised that all current medications, in the original bottles or boxes or tubes, and other items that are taken (including non-prescribed medications, vitamins and supplements) be brought to any appointments with the health care professional.

It is essential that the health care professional be told about all substances that are being taken (even if they are not legal, or if obtained from someone other than the prescriber). Even medications that may be used only occasionally such as cough and cold medications can have significant medication interactions. People with any medical condition including pain should keep a list of all of their medications in their wallet or purse. This list may be useful in an emergency.

To find out more about chronic pain, visit the American Chronic Pain Association website and view their 2016 Resource Guide to Chronic Pain Treatment.

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Early-onset Alzheimer’s: should you worry?

You may have forgotten where you put your car keys, or can’t seem to remember the name of the colleague you saw in the grocery store the other day. You fear the worst; maybe these are signs of Alzheimer’s disease.

You’re not alone. A recent study asking Americans aged 60 or older the condition they were most afraid of getting indicated the number-one fear was Alzheimer’s or dementia (35 percent), followed by cancer (23 percent) and stroke (15 percent).

And, when we hear of someone like legendary University of Tennessee women’s basketball Coach Pat Summitt dying (on June 28) from early-onset Alzheimer’s at age 64, fears are heightened.

Memory loss is normal; Alzheimer’s is not

Alzheimer’s is an irreversible, progressive brain disease that slowly destroys memory and thinking skills, leading to cognitive impairment that severely affects daily living. Often the terms Alzheimer’s and dementia are used interchangeably, and although the two are related, they are not the same. Dementia is a general term for the loss of memory or other mental abilities that affect daily life. Alzheimer’s is a cause of dementia, with over 70 percent of all dementia cases occurring as a result of Alzheimer’s.

The majority of Alzheimer’s cases occur in people 65 or older.

Slight memory loss is a normal consequence of aging, and, therefore, people, should not be overly concerned if they lose their keys or forget the name of a neighbor at the grocery store. If these things happen infrequently, there is scant reason to worry. You most likely do not have Alzheimer’s if you simply forgot one time where you parked upon leaving Disneyland, or the local mall during the holidays.

A key point to consider is whether these symptoms significantly affect daily living. If so, then Alzheimer’s disease might be the cause.

People frequently ask if they might be more apt to be afflicted with the disease if a grandparent had it. Again, the majority of cases occur in people 65 or older. In such late-onset cases, the cause of the disease is unknown (e.g. sporadic), although advancing age and inheriting certain genes may play an important role. Importantly, although there are several known genetic risk factors associated with late-onset Alzheimer’s, inheriting any one of these genes does not assure a prognosis of the disorder as one advances in age.

Early-onset is rare, but heredity does play an important role

In fact, less than five percent of five million cases cited were a direct result of hereditary mutations (e.g. familial form of Alzheimer’s). Inheriting these rare, genetic mutations leads to what is known as early-onset Alzheimer’s, which is characterized by symptoms often detected in one’s 40s and 50s, and is a more aggressive form of the disease; one that leads to a more rapid decline in memory impairment and cognition.

In general, most neurologists agree that the early-onset and late-onset forms are essentially the same disease, apart from the differences in genetic cause and age at onset. The one exception is the prevalence of a condition called myoclonus (characterized by muscle twitching and spasms) that is more commonly observed in the early-onset version.

In addition, some studies suggest that people with the early-onset type decline at a faster rate than those with late-onset. Even though, generally speaking, the two forms  are medically equivalent, the large burden early-onset poses on the family is quite evident. Often these patients are still in the most productive phases of their life, and yet the onset of the disease robs them of brain function. These individuals may still be physically fit and active when diagnosed, and more often than not still have family and career responsibilities. Therefore, a diagnosis may have a greater negative, ripple effect on the patient, as well as family members.

Although the genes giving rise to “early-onset” are extremely rare, these inherited mutations do run in families worldwide, and the study of them has provided critical knowledge about the molecular underpinnings of the disease. These familial forms  result from mutations that are typically defined as being autosomal dominant, meaning there needs only to be one parent that passes the gene on to their child. If this happens, there is no escape from an eventual Alzheimer’s diagnosis.

What scientists have learned from these rare mutations is that in every case they     lead to the overproduction of a rogue, toxic, protein, beta-amyloid. Its build-up in the brain produces plaques that are one of the hallmarks of the disease. Just as plaques in arteries can harm the heart, plaques on the brain can have dire consequences for brain function.

By studying families with early-onset, scientists now realize that the buildup of beta-amyloid can happen decades before the first symptoms of the disease manifest. This gives scientists tremendous hope in terms of a large therapeutic window to intervene and stop the beta-amyloid cascade.

Hope is high for large trial underway

Indeed, one of the most anticipated clinical trials underway at this moment involves a large Colombian family of over 5,000 members who may carry an early-onset Alzheimer’s gene. Three hundred family members will participate in this trial in which half are young, and years away from symptoms, but who have the Alzheimer’s gene. They will receive a drug that has been shown to decrease the production of beta-amyloid. The other half will take a placebo, and will comprise the control group.

Neither patient nor doctor will know whether they will be receiving the active drug, which helps eliminate potential biases. The trial will last five years, and although it will involve a small percentage of people with early-onset Alzheimer’s, the information from the trial could be applied to millions of people worldwide who will develop the more conventional, late-onset form.

Currently, there are no effective treatments or cure for Alzheimer’s, and the only medications available are palliative in nature. What is critically needed are disease-modifying drugs; drugs that actually stop the beta-amyloid in its tracks. Devastating as early-onset Alzheimer’s is, there is hope that prevention trials as described above could ultimately lead to effective treatments for this insidious disease in the near future.

Troy Rohn, Professor of Biology, Boise State University.

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