Monthly Archives: September 2020

HPV (Human Papilloma Virus) the Silent Killer

What is HPV?

HPV (Human Papilloma Virus) is the most common sexually transmitted infection. There are 79 million Americans, most in their late teens and early 20s, are infected with HPV. There are many different types of HPV. Some types can cause health problems including genital warts and cancers. There are vaccines that can stop these health problems from occurring.

How does HPV spread?

HPV by having vaginal, anal, or oral sex with someone who has the virus. It is most commonly spread during vaginal or anal sex. HPV can be passed even when an infected person has no signs or symptoms. Anyone who is sexually active can get HPV, even sexual activity with only one person. You can develop symptoms years after you have sex with someone who is infected. This makes it hard to know when you first became infected.

HPV & Cancer

HPV can cause cervical and other cancers including cancer of the vulva, vagina, penis, or anus. It can also cause cancer in the back of the throat, including the base of the tongue and tonsils. Cancer often takes years to develop after a person gets HPV. The types of HPV that can cause genital warts are not the same as the types of HPV that can cause cancers. The lag in time from infection to showing symptoms makes it hard to pinpoint the exact time of infection.

HPV Prevention

  • Use Condoms
  • Engage in monogamous relationships
  • Get vaccinated

Who can get vaccinated?

HPV vaccination is recommended at age 11 or 12 years and for everyone through age 26 years, if not vaccinated already. Vaccination is not recommended for everyone older than age 26 years. Some adults age 27 through 45 years who are not already vaccinated may get the HPV vaccine after speaking with their healthcare provider about their risk for new HPV infections and the possible benefits of vaccination. HPV vaccination in this age range provides less benefit. Most sexually active adults have already been exposed to HPV, although not necessarily all of the HPV types targeted by vaccination.

Vaccine in vial with syringe. Vaccination concept. 3d

Hypertension: Get the Real Facts on the Silent Killer

Hypertension – What is it exactly?

Hypertension, also known as high blood pressure, is a common condition in which the long-term force of the blood against your artery walls is high enough that it may eventually cause health problems.

Blood pressure is determined both by the amount of blood your heart pumps and the amount of resistance to blood flow in your arteries. The more blood your heart pumps through your narrow arteries, the higher your blood pressure.

“I may have high blood pressure but I feel fine so I don’t need to treat it.”

Hypertension doesn’t usually show symptoms. One third of people don’t even know they have it! A few people with high blood pressure may have headaches, shortness of breath or nosebleeds. Uncontrolled high blood pressure can lead to can lead to congestive heart failure, chronic kidney disease, stroke, coronary artery disease. This explains where it get’s it nickname, Silent Killer!

“Thank goodness I’m young. I don’t have to worry about high blood pressure yet.”

It is recommended to begin screening for high blood pressure at age 18. During adolescence, age, body size and level of sexual development have roles in determining blood pressure.

“High blood pressure runs in my family so I’ll just deal with it when it happens.”

Although it may run in your family, you can take steps to prevent it! Exercising and limiting sodium in your diet can help prevent high blood pressure. Also, don’t smoke and limit your amount of stress.

“I’m a woman, isn’t it more common in men? I don’t have to worry.”

Women are at risk for high blood pressure too! Some women who might be at an increased risk for high blood pressure include those who are overweight, taking a birth control pill, pregnant, related to people with high blood pressure, African-American, postmenopausal.

“I can finally stop taking my blood pressure medication! My readings are low!”

High blood pressure can be a lifelong disease. Do not stop taking your blood pressure medications without speaking with your healthcare provider. Make sure you are always following their recommendations carefully!

American Heart Association. (n.d.). Retrieved September 13, 2020, from https://www.heart.org/

High blood pressure (hypertension). (2018, May 12). Retrieved September 13, 2020, from https://www.mayoclinic.org/diseases-conditions/high-blood-pressure/diagnosis-treatment/drc-20373417

Steen, L., MD. (n.d.). Hypertension myths and facts: A conversation with Lowell H. Steen Jr., MD. Retrieved September 13, 2020, from https://www.healio.com/news/cardiology/20181129/hypertension-myths-and-facts-a-conversation-with-lowell-h-steen-jr-md

The HPV Vaccine: What is it, and Why Do You Need it?

In the early 2000’s, a vaccine was released with a claim few vaccines could make; it could help prevent cancer.  This seems like a bold claim, but what we know about Human Papilloma Virus (HPV) supports it.  As of 2017, the vaccine has reduced cervical cancer cases by about 90% (New Study Points to Long-term Effectiveness of 9-Valent HPV Vaccine: Vaccine could prevent 90% of cervical cancer cases worldwide, 2017).  However, since the release, it’s not been implemented as widely as doctors would have liked.  Many of the objections parents have is that it’s a vaccine against a sexually transmitted virus, which is given to largely to young girls starting around age 11, well before they are expected to be sexually active.

What, exactly, is HPV, and why is it a big deal?  Doctor Mike Evans gives a rundown of HPV on his YouTube channel DocMikeEvans, in a video titled “Should You Get the HPV Vaccine?”

As Doctor Evans explains, warts caused by HPV can happen anywhere on the body.  Of the many strains, or types of the virus, some are sexually transmitted and can cause warts on the genitalia.  Two strains, known as strain 6 and strain 11, cause 90% of genital warts.  I’m sure we can all agree that genital warts, though embarrassing and unpleasant, are not life-threatening.  So, why is there a vaccine for it?  Because some strains can cause cervical cancer, most commonly cervical cancer.  HPV causes 99% of cervical cancers, with strains 16 and 18 causing a total of 70%.  As Doctor Evans mentions, the virus can also cause cancer in the anus and penis as well.  Many HPV infections are cleared by the body with no lasting effects, but a persistent infection can lead to cancer (Donken et al., 2020).  Cervical cancer is one of the leading cause of death in women.  Getting a diagnosis can be devastating.  In this clip from WXXI News, discussing a documentary about the HPV vaccine, a woman’s story about her diagnosis is shown.

While the link between HPV and cervical cancer was made in 1999, the idea of viruses causing cancer has been around since the 50’s or 60’s.  Doctor Sydney McElroy discusses the history of the HPV vaccine with her husband Justin in their podcast Sawbones: A Marital Tour of Misguided Medicine.

The HPV Vaccine

As Doctor McElroy notes, one of the biggest roadblocks in the way of getting adequate vaccination is the reaction parents have: “my kid doesn’t have sex.”  But the point of a vaccine is to receive it before being exposed to the disease, so that the patient does not ever contract it.

The vaccine is usually given in three doses.  Completing all the doses is necessary for the vaccine to be effective.  It’s important to get parents on board when the time comes to give the vaccine.  In 2020, only 47-52% of women age 19-24 had received all three doses, and a large contributing factor was how supportive of the vaccine their parents were (Rosen et al., 2020).  Cervical cancer could be almost nonexistent if we can only make sure a vast majority of the at-risk population receives the HPV vaccine.

References

Donken, R., Hoes, J., Knol, M. J., Ogilvie, G. S., Dobson, S., King, A. J., Singer, J., Woestenberg, P. J., Bogaards, J. A., Meijer, C. J. L. M., & de Melker, H. E. (2020). Measuring vaccine effectiveness against persistent HPV infections: a comparison of different statistical approaches. BMC Infectious Diseases, 20(1), 1–11. https://doi.org/10.1186/s12879-020-05083-7

New Study Points to Long-term Effectiveness of 9-Valent HPV Vaccine: Vaccine could prevent 90% of cervical cancer cases worldwide. (2017). Contraceptive Technology Update, 1–3.

Rosen, B. L., Szucs, L. E., Wilson, K. L., Reyes, J. V., Fontenot, H. B., & Lee Smith, M. (2020). Factors associated with HPV vaccination before first sexual intercourse among female college students. Women’s Healthcare: A Clinical Journal for NPs, 8(1), 38–44.

Still Confused About Masks?

Surgical Mask


Pros:
-Acts as a fluid barrier to capture respiratory droplets
-Easy to breathe
Cons:
-Does not capture particles sized 0.3 microns and below

N95


Pros:
A respirator, that has a denser filter to prevent particles sized 0.3 microns and below.
Cons: Hard to find and hard to breathe

Cloth Mask


Pros:
Acts as a fluid barrier to capture large droplets
Cons:
-Needs to be constantly washed

Wearing a Mask: Myths and Facts

Wearing a Mask can reduce the risk of getting or transmitting corona virus. 

MYTH: Masks can cause CO2 build up.

FACT: Properly fitted mask can make the accumulation of a C02 impossible 

MYTH: You only need to wear a mask when you are feeling sick

FACT: The CDC recommends the general public to wear a mask. Many people with the corona virus are asymptomatic.

MYTH: Cloth Masks don’t protect you from corona virus

FACT: Although cloth masks aren’t the most effective type of mask the do still create a barrier between your mouth and nose and the outside world. 

MYTH: I don’t need to wear a mask if I am social distancing.

FACT: Wearing a mask,practicing social distancing and hand hygiene , together reduces the risk of getting COVID 19

 

 

CDC Mask Guidelines
1
Total Confirmed Cases in RI
1
Total Recovered in RI
1
Total Deaths in RI

How to Wear Masks

-The mask must cover both your mouth and nose.

The mask should be secured with ties or loops

Make sure the mask securely fits

If you are wearing a cloth mask ensure frequent washing

Never put the mask  down on your neck for a break because the neck is an exposed area so when you put your mask back on you are breathing that exposed area. 

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Stop The Spread

We know that COVID 19 is a respiratory disorder and primarily lives in the throat and lungs which means the most common way of transmission is through a sneeze or cough. Not wearing a mask and just social distancing is not enough because some respiratory droplets such as the ones in a cough or sneeze can travel up to 9 feet. 

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Effects of meditation on the body

What benefits does meditation have on the human body?

Meditation is commonly known to calm the mind and body.  Many have claimed that it has effects on the nervous system, immune system, and neural activity.  Is there any scientific truth to these claims?

 

 

 

 

 

What is meditation?

Meditation is a practice that unites mind and body taught by a trained professional that is used to increase calmness and relaxation (nccih.nih.gov).  It involves quieting the body and mind without distractions, sitting in a comfortable place, opening the mind, and focusing the attention on a specific sensation or thought.  Meditation can be done by any person of any experience level.

 

Meditating to manage high blood pressure

High blood pressure is a common chronic condition that affects many people.  It is usually treated with a low sodium diet and antihypertensive medications.  A study was done to examine the effects of regular meditation on patients who suffer from hypertension (Schneider & Reangsing, 2019).  This study was an extensive literature review of studies done to examine the effects of transcendental meditation on patients who suffer from chronic hypertension.  The study concluded that participants exhibited lower blood pressure readings after regular meditation practice.  Another benefit is the reduction of side effects.  Patients who practiced regular meditation were able to reduce their dosage or eliminate the medication altogether.

 

Meditation to reduce heart disease

Additional research has shown that regular meditation can help reduce the symptoms of heart disease (American heart association, 2017).  An extensive study showed that participants who practiced regular meditation exhibited possible improvements in their conditions.  Those who suffered from myocardial ischemia showed improvements in maximum workload and exercise duration, those who had a history of hypertension showed reduced readings, and carotid wall thickness reduction was found on those who had a history of subclinical antheroschlerosis.  Although more research is needed to solidify these claims, the trends all suggest that meditation is beneficial to cardiac health and wellbeing both as a treatment and as a preventative.

 

Meditation to reduce stress

Mindfulness meditation is a tool that can be used to calm the effects of everyday stressors.  Mindfulness meditation consists of two parts:  directing one’s attention to the present thoughts, feelings, and sensations, and and accepting those feelings without any judgements before releasing them (APA.org, 2019).  This is a powerful coping mechanism that influence the brain’s stress pathways, resulting in less negative emotions and more control.  It creates a new habit of focusing on the present, reducing stress and anxiety.

 

Meditation to improve immunity

Long term chronic stress leads to decreased immunity (Bae, et. el., 2019).  When the body is stressed, sympathetic hormones are activated and the body goes into “fight or flight” mode.  The chronic excess of stress hormones in the body leads to increased chance of infection, autoimmune disorders or diseases.  When meditation is used to control stress and anxiety, the body’s immune system is stronger and less susceptible to disease and illness.

 

 

 

Although the practice of meditation is still currently being researched, most studies show it is beneficial for all body systems and it is beneficial for both the body and the mind.  It has no negative side effects, and can be practiced for no cost by all people.  It is a valuable tool to improve quality of life and health.

 

References:

8 Things to Know About Meditation for Health. (n.d.). Retrieved from https://www.nccih.nih.gov/health/tips/things-to-know-about-meditation-for-health
Bae, Y., Shin, E., Bae, Y., & Van Eden, W. (2019, January 28). Editorial: Stress and Immunity. Retrieved from https://www.frontiersin.org/articles/10.3389/fimmu.2019.00245/full
Levine, G. N., Glenn N. Levine, R. A., Lange, C. N., Richard, R. J., Bairey‐Merz, K. (2017, September 28). Meditation and Cardiovascular Risk Reduction. Retrieved from https://www.ahajournals.org/doi/10.1161/JAHA.117.002218
Meditation: In Depth. (n.d.). Retrieved from https://www.nccih.nih.gov/health/meditation-in-
depth
Schneider, J., & Reangsing, C. (2019). Effects of Transcendental Meditation on Blood Pressure in Adults: A review. Retrieved from http://library.neit.edu:2215/nup/pdfviewer/pdfviewer?vid=6&sid=40252762-cd49-45b3-ac41-43704eb7fc6e@pdc-v-sessmgr05

 

 

 

 

 

 

 

 

 

Medication administration errors- are we doing enough?

Medication administration errors occur across all aspects of the healthcare system in every setting. They are also committed by many medical professionals including nurses, doctors, and pharmacists. Medication errors can also happen at home when self administering prescription drugs. This is not a highly publicized part of healthcare, however when they do occur they can have life altering effects on the patients. Harm is most often the outcome, and although some things can be reversed, there are adverse effects that can not be fixed. Death is the ultimate bad outcome and it does happen. Medication errors can also lead to increased costs for the facility and patient. Thousands of dollars are added on to a patients hospital stay in response to a medication error. Often times these event lead to a longer hospitalization or need for an intensive care unit (ICU) stay.

                     There have been strides in recent years to prevent medication errors such as the report that was published “To Err is Human”, and the implementation of the five rights of medication administration.

The five rights of medication administration are:

  • Right Patient
  • Right Medication
  • Right Dose
  • Right Time
  • Right Route

Recently, medical facilities have added to the five rights of medication administration independently based on observations and recorded errors that have occurred there. Even bigger strides were accomplished with the adaption of the barcode scanning system. However, this has not been universally adopted. In some areas of facilities that have turned to using barcode scanners they are still not used by every department. This leaves plenty of room for the continuation of medication errors. Electronic prescribing systems have become more popular in the last few years, and have reduced medication dispensing errors that can occur due to bad hand writing. The adoption of the online system also allows for more closer monitoring of allergies and drug interactions with previously prescribed medications.

One of the latest implementations is the need for dual sign offs on high risk medications. Two nurse verifications are required for medications such as insulin, heparin, and total parenteral nutrition (TPN). One of the highest rated medication errors occurs with the administration of insulin. The dual verification system has multiple steps such as verifying blood sugar levels and the amount of insulin in the syringe. Red warnings have also been placed on vials of high alert medications as a reminder that extra precaution should be taken with those drugs.

Lastly, and integral part of preventing further medication administration errors is to evaluate and learn from previous mistakes. Having an internal reporting system for all staff to be able to report errors should be put in place. In most systems the reporters and those involved can choose to stay anonymous. Having a culture where reporting errors is not punished and rather learned from could encourage more reporters. With all of these new interventions there were still hundreds of medication administration errors committed every day. The question is where are we not doing enough to prevent them?

References

Abuelsoud, N. (2018). Improving medication safety through implementation of medication error reporting systems in different medical specialities. Journal of Pharmacy Practice & Research, 48(6), 537-542.

Kavanagh, C. (2017). Medication governance: preventing errors and promoting patient safety. British Journal of Nursing, 26(3), 159–165.

Macias, M., Bernabeu-Andreu, F. A., Arribas, I., Navarro, F., & Baldominos, G. (2018). Impact of a barcode medication administration system on patient safety. Oncology Nursing Forum, 45(1), 1–13.

Congestive Heart Failure (CHF)

Congestive Heart Failure (CHF)

Congestive Heart Failure (CHF) is a condition in which the heart does not adequately pump blood, causing the blood to move through the heart slowly. Due to the heart not sufficiently pumping and doing its job, it, in turn, affects the rest of the body’s functions. Heart failure can be categorized as right-sided or left-sided, each type can be found to cause different symptoms.

Symptoms of CHF:

  • Pulmonary Edema is defined as the excess fluid within the lungs, inturn causing shortness of breath.
  • Ascites
  • Jugular Vein Distention
  • Pitting edema: especially within the lower extremities
  • Weight Gain
  • Fatigue
  • Rapid or, in some cases irregular heart rate
  • Decreased Kidney Function

How is CHF diagnosed?

CHF can be diagnosed using a combination of tests some of which are lab tests others being imaging. One test that can help diagnose CHF is an Echocardiogram, an echocardiogram can help determine the percentage at which the heart is functioning at and can also determine the type of heart failure right or left. Another test to help diagnose CHF is a lab test called B-type natriuretic peptide (BNP), helping determine the cardiac function as well. One more common test to help diagnose CHF is a Chest X-ray; on a chest X-ray, you may see an enlargement in the heart that is referred to as cardiomegaly which can be an indicator of CHF.

Risk Factors For CHF?

People who are most at risk for developing CHF are individuals who already have conditions such as:

  • Coronary Artery Disease
  • Diabetes
  • Hypertension
  • Cardiomyopathy
  • Heart Valve Disease
  • Obesity

Treatment of Heart Failure: 

    Treatment for CHF ranges from different medications as well as lifestyle changes. These treatments do not cure the condition but are meant to prevent the progression of the disease and minimize symptoms of CHF. Some of the medications used to treat CHF are: 

  • Beta-Blockers: are used to decrease the heart rate; with CHF, the heart is working harder and has extra stress. This medication can help lower stress and improve blood flow.
  • Diuretics: such as Furosemide are used to remove excess fluid buildup within the body caused by the CHF.
  • Ace Inhibitors: are used to increase the elimination of excess fluid and salt within the body by decreasing constriction.

Lifestyle Modifications for Individuals with Heart Failure: 

Symptoms of CHF can be lowered and decreased by lifestyle changes to ensure your body is getting the correct care, such as:

  • Quitting Smoking
  • Eating low fat and low salt diet
  • Exercise as tolerated
  • Limiting Alcohol Intake
  • Weight Loss if needed
  • Tracking fluid intake and output
  • Monitoring Weight
  • Managing stress

What is it like living and coping with a diagnosis of CHF? 

References:

 Nigam, H., & Jain, R. (2017). Congestive Heart Failure (CHF). Homoeopathic Heritage, 43(6), 17–24.

Norberg, E.-B., Boman, K., Löfgren, B., & Brännström, M. (2014). Occupational performance and strategies for managing daily life among the elderly with heart failure. Scandinavian Journal of Occupational Therapy, 21(5), 392–399. https://doi.org/10.3109/11038128.2014.911955

Kearns, M., Malone, L., & Clarke, B. (2017). Congestive Cardiac Heart failure patients in the community: successfully managing complexity and polypharmacy. International Journal of Integrated Care (IJIC), 17, 1–2. https://doi.org/10.5334/ijic.3733

Intermittent Fasting — The Latest Diet Trend

Are you familiar with intermittent fasting, the latest dieting trend? Will it really make you lose weight? What should you know?

Intermittent fasting (IF) is a dietary modification that alternates between food restriction (fasting) and feeding that occurs on a schedule.  There are many variations to the fasting schedule such as:

Alternate day feeding (ADF):  24 hours of normal eating following by 24 hours of fasting

The 5:2 method:  eating normally for 5 days of the week, fasting for 2 days, then restarting the cycle

Time restricted feeding (TRF):  fasting for the majority of the day then ingesting a day’s worth of calories in a specific time span — common examples of this are the 18:6 & the 16:8 methods (hours fasting : hours feasting)

Why Should I Fast?

Today, many people believe that eating small meals consistently throughout the day is the best method to maintain weight as it keeps your metabolism active, but current studies have shown this to be untrue. Instead, intermittent fasting causes the body to switch from using glucose as its main energy source to utilizing fats instead — this is called ketosis. IF does not mean you are starving yourself. Instead, it means fasting causes your body to use stored fat for fuel.

Benefits of Intermittent Fasting

  1. Weight loss — nearly all studies show some degree of weight loss & associated fat mass loss.  This is most likely due to an overall reduction in caloric intake.
  2. Decreased insulin levels & normalized insulin sensitivity — overweight individuals typically have high leptin and low adiponectin levels which leads to insulin resistance.  Fasting causes reduced leptin levels, thereby improving insulin sensitivity.
    • Improvement of insulin sensitivity helps prevent diabetes mellitus type II
  3. Reduction of blood glucose — significant reduction in glycosylated hemoglobin (HbA1c) levels for those with elevated levels before initiating IF.
  4. Cardiovascular health benefits — IF has been shown to reduce cardiovascular disease due to:
    • ↑ high density lipoprotein cholesterol (HDL)
    • ↓ low density lipoprotein cholesterol (LDL)
    • ↓ triglycerides
    • ↓ systolic blood pressure
    • ↓ body mass index (BMI) & waist circumference
    • IF induces the release of hypoadiponectin which protects the heart against ischemic injury
  5. Cancer prevention — IF induces autophagy.  Autophagy technically means “self-eating” and it is the body’s way of cleaning out oxidatively damaged cells in order to regenerate newer, healthier cells and preserve organelle quality.
  6. Protection against neurodegeneration — fasting stimulates the production of brain-derived neurotrophic factor (BDNF) which aids in cognitive function, among other things.  Through reduced inflammation pathways and the stimulation of BDNF, neurons are better protected against tissue injury.  There is also evidence towards nerve cell restoration and synapse formation.
  7. Reduction of inflammation — IF decreases the expression of proinflammatory cytokines thereby reducing body inflammation.  Some of the inflammatory markers reduced by IF are:
    • homocyesteine
    • c-reactive protein
    • IL-6 & IL-1ß
    • TNF-∝
  8. Hormone stabilization
    • ↓ leptin
    • ↓ free androgen index
    • ↑ human growth hormone (HGH)
    • ↓ ghrelin (the hunger hormone)
  9. Lifespan extension — as a result of these changes, the prolongation of an individual’s lifespan ensues.

What does all of this mean?

Intermittent fasting is a dietary pattern of periods of fasting and feeding that occur on a schedule.  There are different types such as alternate day fasting (ADF), which is 24 hours of eating normally followed by 24 hours of fasting, and time-restricted feeding (TRF).  During TRF a person ingests a full day’s worth of calories in a specific time span and then fasts the remainder of the day.

The literature regarding IF supports several metabolic health benefits which include: weight loss, reduced insulin resistance, decreased blood glucose levels, reduced blood pressure, and improved lipid profile.  In addition, IF contributes to cardiac protection, diabetes prevention, cancer prevention, protection against neurodegeneration, and reduction of inflammation.  As a result of these changes, the prolongation of an individual’s lifespan ensues.

IF has shown promising results for weight loss and reduction of BMI.  Individuals with high BMIs are at risk for metabolic syndrome.  Metabolic syndrome is a condition characterized by obesity, insulin resistance, hyperglycemia, hypertension, hypertriglyceridemia, and low high-density lipoprotein cholesterol (HDLc).  It increases the risk of cardiovascular disease, diabetes type II, coronary heart disease, stroke, vascular dysfunction, and many other disorders.  By reducing a person’s weight, which is a by-product of IF, several metabolic changes occur.  IF lowers leptin levels, which improves insulin sensitivity and overall glucose levels.  Furthermore, reduction of an individual’s weight contributes to lower blood pressure and better cardiovascular health due to lower cholesterol and triglyceride levels.  Also, IF induces the release of hypoadiponectin which protects the heart against ischemic injury.

Another helpful byproduct of IF is that it decreases the expression of proinflammatory cytokines thereby reducing body inflammation.  This goes hand in hand with another benefit of IF which is neurodegeneration protection.  Fasting stimulates the production of brain-derived neurotrophic factor (BDNF) which aids in cognitive function, among other things.  Through reduced inflammation pathways and the stimulation of BDNF, neurons are better protected against tissue injury.  There is also evidence towards nerve cell restoration and synapse formation. 

As with any diet, individuals are encouraged to seek medical advice before initiating.  While IF has many benefits, it is not recommended for all populations such as those who are pregnant or those with uncontrolled diabetes, chronic kidney disease, or other chronic health conditions.  Fasters may also endure side-effects of this lifestyle upon initiation.  Some of these side-effects include: dehydration, headache, heartburn, constipation, anemia, and poor sleep.  While these typically don’t cause any significant suffering, it is important to seek medical attention if they do not subside.

IF isn’t the easiest diet to follow.  Some find it difficult to stick with due to psychosocial influcences.  Fasters have said it is sometimes difficult to maintain fasting when one is expected to attend business lunches, dinners, or parties for work or personal reasons.  Also, this diet has high non-compliance rates due to unhappiness with the restrictions and excessive hungriness. Many overeat and exceed calorie intake requirements when breaking the fast due to excessive hunger.  Therefore, the sustainability of IF is questionable despite the proposed health benefits.

DISCLAIMER

Intermittent fasting has many different variations with little research indicating which option provides the most benefits.  While there are numerous animal studies regarding the benefits of IF, there is simply not enough data to substantiate all the claims IF is said to offer.  There are plenty of promising initial studies on humans, but further research must be done.  Most importantly, there haven’t been any studies related to the long-term effects of intermittent fasting.  It is unknown if this dieting pattern can be detrimental if continued indefinitely.

See the video below for further information regarding this…

References

Hyun Kang, S., Suk Park, Y., Ahn, S.-H., & Kim, H.-H. (2020). Intermittent fasting: Current evidence in clinical practice. Journal of Obesity & Metabolic Syndrome, 29, 81-83. https://doi.org/10.7570/jomes20022

Maideen, N. M. P., Jumale, A., Alatrash, J. I. H., & Sukkur, A. A. A. (2017). Health benefits of Islamic intermittent fasting. Journal of Fasting & Health, 5(4), 162–171. https://doi.org/10.22038/jnfh.2018.30667.1111

Stockman, M. C., Thomas, D., Burke, J., & Apovian, C. M. (2018). Intermittent fasting: Is the wait worth the weight? Current Obesity Reports, 7(2), 172–185. https://doi.org/10.1007/s13679-018-0308-9

How to Help Your Child Navigate Adolescence

 Adolescence is the period of transition period between childhood and adulthood. This period of time includes some major changes, not only to the body, but how a young person views themselves in the world. The physical, sexual, cognitive, social, and emotional changes happen swiftly during this time in a young person’s life. Such changes can cause anxiety and anticipation for the youth and their families. Understanding what to expect during each phase of adolescence can promote healthy development and an easier transition to early adulthood.

Early Adolescence (Age 10-13)

During early adolescence, the child starts to grow rapidly. This phase includes many body changes, including hair growth, breast development in females, and enlargement of the testicles in males. These changes typically start one to two years sooner in females versus males. It can be normal for these changes to begin at age 8 for girls, and 9 for boys. Many girls can start their period at age 12, which is typically 2-3 years following breast development. Such rapid development can cause curiosity and anxiety, if they do understand or do not know what is normal. Pre-teens also feel an increased need for privacy. In this process they may push boundaries and may respond poorly when parents reinforce limits.

Middle Adolescence (Age 14-17)

Physical changes from puberty can continue into middle adolescence. Most males at this point will begin their growth spurt, and puberty related changes will continue. Their voices may get deeper and acne may appear. At this point the physical changes may be nearly finished for females, and most typically have regular periods. Also at this age, many teens begin to explore romantic and sexual relationships. They may begin to question and explore their sexual identity. This can also be a stressful time if they do not have steady support from peers or family. Many middle adolescents have more arguments with their parents as they continue to struggle for independence. They may begin to spend more time with their peers compared to their families, causing peer pressure to peak at this age. The brain also continues to change and mature at this stage, but there still are many differences in how these middle adolescent think compared to adults.

Late Adolescents (Age 18-21)

Late adolescents typically have completed physical development fully and have grown to their adult height. At this point they typically also have more impulse control and are better able to gauge risk and reward. At this point they also may be more focused on the future and have a better sense of their own individuality.


How to Help Navigate Adolescence!

  • Help your child anticipate changes in their body.
  • Start early conversations about other important topics.
  • Keep conversations with your child positive.
  • Be supportive and set clear limits with high expectations.
  • Discuss risky behaviors and use consequences.
  • Respect independence and individuality.

Adolescent years can feel like a roller coaster! By maintaining positive relationships during these stages, this roller coaster ride can be more enjoyable!

References

Allen, B., MD, FAAP, & Waterman, H., DO. (2016). Stages of Adolescence. Retrieved September 03, 2020, from https://www.healthychildren.org/English/ages-stages/teen/Pages/Stages-of-Adolescence.aspx

Allen, M., Phd, RN, & Stollery, B., MD, FAAP. (2018). Late Adolescence. Emergent Brain Dynamics, 40(6). doi:10.7551/mitpress/11957.003.0017

Green, H. (Director). (2014). Adolescence: Crash Course Psychology #20 [Video file]. Retrieved 2020, from https://youtu.be/PzyXGUCngoU

Images, G. (n.d.). The Growing Child: Adolescent 13 to 18 Years [Photograph].

Stanley, H. (2016). Adolescent Physical Development and Health Issues. Child, Adolescent and Family Development, 20(3), 385-412. doi:10.1017/cbo9781139164948.022

Diabetes Mellitus

What is Diabetes?

Diabetes mellitus (DM) is the most common endocrinal metabolic disorder in which there is a deficiency of insulin in the body. This common disorder affects more than 100 million people worldwide Diabetes mellitus is categorized into two types, type I insulin-dependent DM (IDDM) and type II non-insulin dependent DM (NIDDM).

 Type I DM        

The exact cause of this type of diabetes is not known, all that is known is that it is an autoimmune disease. In this case the body’s immune system attacks the B-cells of the pancreas. When this occurs the production of insulin in the body is significantly reduced. Type I diabetes are normally adolescent individuals who are not obese when they first develop the symptoms. Symptoms for this type of DM include excessive hunger, excessive thirst, blurred vision, fatigue, frequent urination, dramatic weight loss, rapid breathing, flushed face, nausea, vomiting and stomach pain. For those with type I diabetes the first drug of choice is insulin in the form of injections or pumps. There are different types of insulins such as long acting (Lantus) and short acting (Humulin N, Novolin N) which can be used in conjunction or on their own. Diet and exercise also plays a big part in the treatment of this type of DM.

Type II DM

This type of DM has a very strong powerful genetic predisposition. With this type the body is lacking in insulin production by the beta-cells due to insulin resistance. People of middle age or older are most likely to get this kind of diabetes, so at times it is called adult-onset diabetes. Symptoms for this type of DM include increased hunger, increased thirst, increased urination, blurred vision, tiredness, sores that are hard to heal. Individuals with type II DM the most useful treatment are oral hypoglycemic medications and insulin along with diet and exercise. These drugs are used to correct the resistance of insulin and the insufficient insulin secretion. Some of the most common oral medications used are: Metformin, Glimepiride, Glipizide, Pioglizatone and Acarbose.

How do I self-manage Diabetes Mellitus?

 Self-management of DM includes a variety of things but when done in conjunction DM can be monitored and be controlled.

  • Checking and Monitoring blood sugar levels – Individuals with DM are recommended to check their blood sugar levels regularly or as instructed by their doctor. This can be done efficiently at home by using glucometers.
  • Proper dietary choices and maintaining a healthy weight – Following a meal plan that involves portion control and choosing healthy foods to help control calorie andcarbohydrate intake. Meeting with
    a registered dietitian regularly is also a great resource.
  • Exercising Regularly – This can help control blood sugar levels, promote weight loss and improve well-being. It is suggested that individuals exercise at least 30 minutes a day on most days of the week.
  • Taking medication properly – Knowing what each medication and insulin is and what is does to the body is important. Taking is regularly and on time is also key in managing DM.
  • Monitoring symptoms – Knowing the signs and symptoms of hypoglycemia/hyperglycemia and knowing what appropriate action to take
  • Foot care – Individuals with DM are prone to having skin and wound issues especially on their feet. Inspecting feet daily, bathing feet in lukewarm water, moisturizing feet but not in between toes, cutting nails carefully and regular visits with a podiatrist is recommended.

 

How does DM affect other symptoms of the body?

 Individuals with DM may have complications like retinopathy, nephropathy, neuropathy, cardiovascular disease and ulceration issues. Those with type I DM are more susceptible to coronary artery, heart, and peripheral vascular disease. Individuals with type II DM have a high risk of atherosclerosis associated with hypertension, hyperlipidemia, obesity, and renal diseases. A study was conducted to demonstrate how thyroid dysfunctions and DM are two of most commonly prevalent endocrine disorders encountered in clinical practice. Diabetes affects thyroid functions at various levels and thyroid hormones influence carbohydrate metabolism and pancreatic functions. Thyroid functions are significantly altered in those with DM due to the changes in thyrotropin-releasing hormone (TRH). Therefore, periodic screening for their coexistence is recommended among diabetic individuals. Below is a video that further explains the association between thyroid function and diabetes mellitus.

 

Additional resources:

https://www.cdc.gov/learnmorefeelbetter/programs/diabetes.htm

https://www.diabetes.org 

 

References:

Bhavani, K., Manivasagam, G. A., & Kumar, N. P. (2020). A review on diabetes mellitus – An         annihilatory metabolic disorder. Drug Invention Today, 13(5), 787–790.

Habebo, T. T., Pooyan, E. J., Mosadeghrad, A. M., Babore, G. O., & Dessu, B. K. (2020).     Prevalence of Poor Diabetes Self-Management Behaviors among Ethiopian Diabetes            Mellitus Patients: A Systematic Review and Meta- Analysis. Ethiopian Journal of Health    Sciences, 30(4), 623–638. https://doi.org/10.4314/ejhs.v30i4.18

Hall, G. (2015). Supporting successful self-management in diabetes. Diabetes & Primary Care, 17(2), 94–101.

VAMSHIDHAR, I. S. (2020). A Study of Association of Thyroid Dysfunctions in Patients with Type 2 Diabetes Mellitus. Maedica – a Journal of Clinical Medicine, 15(2), 169–173.     https://doi.org/10.26574/maedica.2020.15.2.169