Are GMOs Really That Harmful to Eat?

Corn cob with GMO spelled in dark kernels.

In some genetically modified foods, scientists may add a gene from a different organism.

Jane Goodall started eating long before organic food was in. It comes as no surprise that the 81-year-old British primatologist – known best for her work with chimpanzees – does so in large part to pay tribute to animals.

“People do beastly things to animals,” Goodall said at​ an event at the National Press Club Tuesday, referencing animals such as​ mice, cows and pigs that have experienced adverse effects – ranging from diarrhea to tumors – from eating genetically modified feed. “At least if the animals have suffered in this way, let’s listen to what they’re telling us. Let’s take heed,” she said.

Goodall, who has written books that include chapters on , or GMOs, was promoting Steven Druker's new book, “Altered Genes, Twisted Truth: How the Venture to Genetically Engineer Our Food Has Subverted Science, Corrupted Government, and Systematically Deceived the Public,” for which she wrote the forward.

At the event, Druker​, a public interest attorney, argued that the U.S. Food and Drug Administration has misrepresented the safety of genetically modified foods and violated federal food safety law by allowing them onto the market. Until they’re proven safe with testing​, as the law requires, Americans should , he and Goodall said.

“The entire venture to reconfigure the genetic core of the world’s food supply has been chronically and crucially reliant on deception,” says Druker, executive director of the nonprofit Alliance for Bio-Integrity, who filed a lawsuit against the FDA in 1998. Although the judge ultimately ruled in favor of the FDA, the case forced the administration to divulge files that revealed some of its own scientists were concerned about GMOs. For example, Edwin Mathews of the FDA's toxicology group  ​that genetically modified plants could "contain unexpected high concentrations or plant toxicants," while the director of the FDA's Center for Veterinary Medicine at the time, Gerald Guest,  that "animal feeds derived from genetically modified plants present unique animal and food safety concerns." ​


The safety​ of GM ​foods has not been "based on sound science, as its proponents would have us believe, but is actually based on the systematic subversion of science,” Druker says. “If there were a full and honest airing of the facts, of the evidence, it would collapse.”

Scientific Conflict

Genetically modified foods – also called genetically engineered foods – contain DNA that scientists have modified in an unnatural way, such as by adding a gene from a different organism, according to the . Proponents, including the American Association for the Advancement of Science​, say GM foods represent scientific advances and have been shown to be safe. For example, a  last year in the Journal of Animal Science that reviewed nearly 30 years of data on livestock – both before and after animals consumed GE feed – found GE feed wasn't linked to any "disturbing trends in animal performance or health indicators," the authors write.

“It’s simply the use of the most modern technology available and our absolutely fabulous increase in knowledge over the last 40 years or so to improve [plants] in many different ways,”​ says Nina Fedoroff,​ a professor of biology and life science at Pennsylvania State University who served as chair of AAAS’s board of directors when it released its on GMO labeling in October 2012.

say GM crops don't pose a health threat and can help feed the world’s population since many are bred to resist insects that carry diseases and to tolerate herbicides targeted at weeds. “If the entire world went to organic tomorrow, we could probably feed half of our current population,” Federoff said in a  last year. ​

But opponents, including Druker and Goodall, worry that GM foods could harm human health and say support for GMOs is based on misinformation.​ “[The FDA] has given the consumers basically a false vision of reality and said, ‘These foods are safe, they’re OK and we can put them on the market without any testing,’” Druker says.

For foods introduced after 1958 to be ​“generally recognized as safe,​" and therefore allowed to forgo additional testing, they must be considered safe by an overwhelming consensus of experts and that consensus must be based on scientific procedures like peer-reviewed journals, according to the Food Additives Amendment of the Food, Drug and Cosmetic Act.​

But Druker argues there’s no consensus, citing studies like a 2015 in the journal Environmental Sciences Europe signed by over 300 scientists called “No scientific consensus on GMO Safety.” “The mere fact that there’s scientific conflict when there shouldn’t be is good reason not to be eating these foods,” Druker says. What's more, he and Goodall say animal studies and farmers' observations have linked genetically modified feed with health problems in animals. A 2012 in the Journal of American Science, for example, found rats fed GM corn lost or gained weight, or experienced other changes in their organs or biochemistry compared to rats fed non-GM corn. "
Still, the FDA holds that “foods derived from genetically engineered plants must meet the same requirements, including safety standards, as foods from traditionally bred plants,”​ FDA spokeswoman Juli Putnam​ wrote in a statement to U.S. News. “The agency is not aware of any information showing that foods from genetically engineered plants on the market differ from other foods in any meaningful or uniform way, or that, as a class, such foods present different or greater safety concerns than their non-genetically engineered counterparts.”


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What Does 'Natural' Really Mean?

A young woman reads the label on a food jar while shopping at a grocery store.

The FDA considers “natural” to mean the food does not contain added colors, artificial flavors or synthetic substances.

Take a stroll through your . You’ll be hard-pressed to find a box, bag or bottle that isn’t covered with labels touting the food’s nutritional merits. Among the most confusing labels are “natural,” “made with 100 percent natural ingredients” and “all natural.”

But ? Largely, whatever the food manufacturer – and its marketing division – want it to mean, says Marion Nestle, a professor of nutrition, food studies and public health at New York University and author of “Food Politics."

While no regulatory agency has settled on a definition of “natural,” the does have some parameters food manufactures must follow when using the term, says FDA spokeswoman Jennifer Corbett Dooren. The administration considers “natural” to mean the food does not contain added colors, artificial flavors or synthetic substances.

Fortunately for food manufacturers – and unfortunately for consumers – that leaves a lot of wiggle room, says registered dietitian Wesley Delbridge, a spokeswoman for the Academy of Nutrition & Dietetics.

Foods that sport a “natural” label can contain , trans fats and genetically modified ingredients, or GMOs. They aren’t necessarily organic, grass-fed or free-range. They can be deep-fried, covered in icing or filled with artificial ingredients, he says. No, “artificial” and “synthetic” do not actually mean the same thing.

“At present, the word ‘natural’ in food marketing is meaningless, and that’s the way food companies want it,” says Gary Ruskin, executive director of U.S. Right to Know, a nonprofit organization that promotes transparency within the food industry. “It’s a swindle. It’s a scam. It’s a term crafty marketers use to make you buy something.”

It’s working. One 2014  found that 62 percent of supermarket shoppers seek out “natural,” “all natural” or “100 percent natural” when selecting nutritious choices. And in , this one from Consumer Reports, about two-thirds of respondents said they believe the term “natural” means that a food has no artificial ingredients, pesticides or .

As such, a  published in the Journal of Public Policy & Marketing shows that consumers are increasingly filing lawsuits against food manufacturers using the term “natural.” In 2009, 30 percent of newly launched foods claimed to be natural but by 2013 this dropped to 22 percent, possibly due to an increase in the number of consumer lawsuits,” wrote the authors, explaining that “lawyers are increasingly willing to take cases which regulatory agencies have abandoned.”

In 2014, in response to a series of lawsuits over “natural,” the FDA said it didn’t have the resources to devote to defining the term once and for all. The administration’s letter to the courts explains, “At present, priority food public health and safety matters are largely occupying the limited resources that FDA has to address foods matters … Because, especially in the foods arena, FDA operates in a world of limited resources, we necessarily must prioritize which issues to address.”


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Everyone Benefits From Research, But What Are Your Responsibilities?

A doctor with a digital tablet comforts an older man in a hospital.

Patients are now involved in all phases of research, and that includes being privy to the results.

We spend a lot of time at Global Healthy Living Foundation thinking about – its impact on people, families, communities and countries. For many of us, a chronic disease is a struggle between managing the day-to-day and dreaming about a future where discoveries lead us to better health. Living with challenges from a chronic disease fuels our hope that during our lifetime, better treatments – or cures (yes, even cures!) – will be discovered. The advances that have been made with technology amplify this hope, and today, technology directly intersects with medicine, science and communication advances. The result? We’re able to harness the power of our health information to participate in research more efficiently, dramatically quicker, much less expensively, with results that matter most and with far greater power than previously possible.

And we just got started.

It all began a few years ago, when the Patient-Centered Outcomes Research Institutewas formed, and out of it the Patient-Centered Outcomes Research Network was created. PCORnet is an independent, non-profit research funder, authorized by Congress, to support studies of which health care options work best, for whom and under what circumstances – so naturally GHLF was keen to get involved. A massive effort got underway to bring patients, health care providers and health systems together for an unprecedented data-driven research project. Patients and their families are now at the center of the research, because patients and hold countless clues those researchers, doctors and scientists can incorporate into their work and their decisions. Who are we as people living with these conditions, and how are we impacted by its day-to-day (and the treatments we take)? These are the most meaningful clues that we can contribute to science.

This is an important paradigm shift for so many reasons, but mainly because traditional methods of conducting health research haven’t focused on the questions and outcomes that matter most to us patients, our families or our doctors. What we know about diseases is not applied to clinical practice. Old paradigm research is done in a very sterile vacuum, and ignores the ‘humanity’ behind each subject or participant. Patient-centered research thrusts life and reality into the equation, measuring how patients manage and also respond to their disease and its treatments. PCORnet was designed to draw upon the wealth of useful information generated during patients’ routine doctor visits, centered on patients’ needs and priorities, while respecting their data security.

It’s as exciting as it sounds. And no, there isn’t a "catch."  

Here’s how it will work: PCORnet has linked 29 to large amounts of clinical and health data that are embedded in our . This is broken down to 18 “patient-powered research networks” and 11 clinical data networks (health systems). The "rules of engagement" that patients established clearly dictate that everyone who participates does so willingly, and is protected with their personal identifying information removed. Who you are as a person is preserved, but who you are as someone one can personally track or identify, is removed. Information about our disease and how we’re managing it gets pooled and is accessed by researchers (although there is no “data warehouse” where everyone’s information is collectively stored). Instead, the individual networks, ensuring the most control and most conservative approach to security, manage the data privacy and security measures. So it’s safe.

What does this mean in practical terms? Take and related forms of arthritis as an example. It’s the best example I can share, because I was involved in its development. “” is a patient-powered research network formed to efficiently track patient reported outcomes of people living with autoimmune arthritis (such as rheumatoid arthritis) and related conditions – using our computers and smartphones. Arthritis Power was designed to help researchers understand how we respond to different treatments over time, and gives us an opportunity to propose future questions that the community can help answer (hence, the "patient-powered" component). Anyone living with arthritis should participate in this initiative because it was designed for patients and by patients – to help the world understand us better. This is a “node” of the PCORnet network, so Arthritis Power participants will help researchers understand their condition better, and when linked with networks that include nearly 100 other conditions, will begin to unlock clues never before discoverable, in relation to “co-morbidities” (also known as “the other diseases that come knocking when we get diagnosed with something”).

Imagine the impact we will have, when we all lend key measures of how we’re managing our diseases, and that information is aggregated and analyzed by the experts – in real time!

The promise of PCORnet means that soon our doctors will be able to see how hundreds of thousands of other patients, just like us, are responding to a diverse range of approaches in our care and disease management. This is the new meaning of patient-centered. No more decisions made based on a doctor’s “best guess” or data from a limited number of subjects in a very rigid study. This is real-time information that helps everyone get better, quicker.

PCORnet is a breakthrough for everyone, because patients are now involved in all phases of research, and that includes being privy to the results. “How we’re doing” as patients is no longer sealed in a vault of other results, and instead will be applied in real-time to the decisions we make with our doctors about how to manage our conditions – today and in the future.

If you or someone you know suffers from a chronic disease – as ubiquitous as high cholesterol, heart disorders, arthritis, sleep apnea, , multiple sclerosis, ; or as rare as vasculitis, Duchenne muscular dystrophy or any of the other nearly 100 conditions that PCORnet has an interest in learning more about, it’s your duty to participate in this new approach to research. Millions of people have stepped forward to participate in key research that has gotten us this far. What will you do in order to help the next generation burdened by these diseases? Give technology a chance to live up to its promise.

To learn more about PCORnet or the individual networks within it, visit .


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Signs You Could Have 'Silent Reflux'

Older man suffering the effects of acid reflux.

People who suffer from this reflux disease may frequently clear their throat or have trouble swallowing.

Does the thought of a plate full of pasta drenched in tomato sauce sound delicious or make you wince? For those , door No. 2 is typically true.

An antacid may be a quick fix, but for many folks, that burning chest pain is a constant complaint and could be a symptom of a chronic condition called gastroesophageal reflux disease, or , where acid and partially digested food from the stomach make their way back into the esophagus, the tube connecting the stomach to the throat.

While an estimated 20 percent of Americans suffer from GERD, there’s another reflux disease plaguing millions of people, some without their knowledge.
 
Laryngopharyngeal reflux, or LPR, is a medical condition that results from the backflow of stomach contents, including stomach acid and digestive enzymes, into the airway, explains Dr. Jamie Koufman, director of the Voice Institute of New York. “[LPR] encompasses acid reflux into all parts of the airway, including the nose, sinuses, voice box, throat, trachea, bronchi and lungs.”

Those afflicted with LPR may have hoarseness or a chronic cough, constantly have to clear their throat, have trouble swallowing or suffer from that nagging feeling of something being stuck in the back of their throat, says Dr. Gary Reiss, a gastroenterologist at the Louisiana State University Health Sciences Center in New Orleans. LPR can also exacerbate existing asthma and sleep-breathing disorders such as obstructive sleep apnea. These type of symptoms may be mistakenly attributed to , sinus issue or pulmonary disease, especially given that a majority of patients do not experience obvious heartburn or indigestion. Because of this, LPR is commonly referred to as silent reflux.

LPR, which can also cause scarring of the voice box and windpipe, results from a faulty lower esophageal sphincter, the muscle that separates the esophagus from the stomach.

“The lower esophageal sphincter can become damaged and weak over time – often [due to] distention from overeating – and no longer maintain an adequate barrier between the stomach and esophagus,” Reiss says. “The stomach, particularly if there is increased pressure from a large meal and excess abdominal fat, will reflux contents into the esophagus. Small droplets can reach the upper airway and back of the throat and induce inflammation and resulting symptoms.”

Any untreated reflux increases the risk of ; in fact, reflux-induced esophageal cancer is the fastest growing cancer in the U.S. And while every patient with LPR does not develop this complication, they do, however, experience a greatly reduced quality of life due to poor sleep, voice changes that limit social interaction and asthma that limits physical activity, Reiss says.

To diagnose the disease, a detailed history, physical examination and tests are necessary, explains Dr. Atif Iqbal, medical director of the MemorialCare ​Digestive Care Center at Orange Coast Memorial Medical Center in Fountain Valley, California. A camera attached to an instrument is used to view the throat and vocal cords, which may be red and irritated from acid reflux damage, while in another exam, a small catheter inserted through the nose and into the throat and esophagus measures the amount of acid that backwashes into the throat.

Overeating, and an unhealthy diet – especially one that is too acidic and involves a lot of late-night eating – are the common culprits of LPR.

For those affected, Iqbal advises eliminating acid-causing foods such as chocolate, mint, tomatoes and onions and replacing them with alkaline foods that actually reduce the amount of acid your stomach creates, including green vegetables, bananas, almond milk and oatmeal.

Also , citrus, cocktails and carbonated beverages, Iqbal says, all of which can stir up acid in the stomach. And whenever possible, choose fresh or all-natural foods over processed and canned foods.

“So much of what we eat today undergoes a chemical acidification process with ingredients like citric acid and ascorbic acid in order to be preserved in cans or packages,” Iqbal says. “When we eat those foods, we expose our throats to those additional acids, which of course can then activate the enzymes that eat away at our esophageal lining.”

Other suggested modifications include:

“If there is no response to lifestyle change and the diagnosis is clear, therapy to treat the weakened lower esophageal sphincter is a reasonable next step,” Reiss says. Endoscopic therapy – one such process uses radiofrequency energy to remodel and thicken the muscle tissue between the stomach and esophagus – or surgical options to tighten the valve between the stomach and esophagus are available.

Though “there is no one-size-that-fits-all treatment program,” Koufman says, “dietary and lifestyle changes are the key to treatment both in the short-run and long-term.” As for preventing silent reflux, diet, exercise and are key, says Reiss, which, he concedes is “easy to say, hard to do.”


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Breaking the Cycle of Shame: a Future Beyond Our Own Blue Dresses

The Associated Press

Public shaming runs rampant on social media.

“We're all a mixture of talents and wisdom and stupidity and idiocy, and that's what human beings are.”

Wise words, from one of our most important modern day thinkers, Jon Ronson. He is neither a psychologist nor a psychiatrist, and to my knowledge has never treated anyone for any psychiatric illness, and yet he has written one of the most therapeutic books imaginable. “So You Have Been Publicly Shamed” addresses the pandemic of public shaming on , which leads to untold human suffering and even mental health issues. The book illustrates how poorly thought-out actions can lead to punishments that ultimately do not fit their respective crimes. The stories in Ronson’s book teach us that if we can be more forgiving of others and ourselves we can ultimately become better, more psychologically healthy people.

When I was 13-years-old on October 27, 1992, Bill Clinton visited my hometown, Tampa, for a rally. In school that day, I watched with my classmates as our downtown area filled like I had never seen before. On January 26, 1998, this man, who I was certain would change America forever and for the better, made the most famous statement of his presidency: "I did not have sexual relations with that woman, Ms. Lewinsky."

Following the failed attempt to force President Clinton from office, the affair became part of a bigger picture of a man of unparalleled strengths but all-too-common shortcomings. For just under 20 years, history has not been so good to Ms. Lewinsky. The affair, the cigar, the blue dress became her defining elements in the public mind. While the president would have a chance to keep on adding chapters to his biography, his former intern’s legacy appeared to be etched in stone. Ms. Lewinsky was like many everyday people who these days find themselves the subject of notoriety – and public shaming – on social media.

This past month, though, Monica Lewinsky may have made her blue dress just a small part of her life’s legacy. On March 19, she gave a , “slut-shaming” and all other manner of torture doled out on the internet on a daily basis and often by and against the young. The speech showed a confident woman of 41 whose lecture could have easily been given by a college professor. The crowd reacted with the equivalent of a warm embrace, and you could sense her transition from a shamed 22-year-old judged for her earlier actions to someone respected for her ability to speak out against an issue that not only affected her, but that is afflicting today’s youth.

In Ronson’s book, we're introduced to people who became overnight internet sensations – and not for the better. They are people who surely made mistakes, mostly through impulsive comments made louder by the seemingly infinite echo chamber that is social media. Many paid with their reputations and jobs, and some even with their families and friends.

There's the woman who devoted her professional life to helping ; a woman beloved by her clients and their families alike. In an insensitive and poorly thought-out moment, she posted a photo on Facebook of her making a lewd gesture at Arlington National Cemetery. Within weeks, the image flew around the internet and so much pressure was applied that her employer fired her, to the dismay of those she had spent years helping.

Monica Lewinsky and the woman with her middle finger extended both had their moment of shame. Their blue dresses were out there for all to see. Who were the shamers? All of us who clicked on links calling for their condemnation. Not only did we as a society allow one mistake to define these human beings, many of us also relished in deriding these individuals until we moved on to the next person who made a regrettable decision.

After a great deal of time suffering shame, unemployment and uncertainty, the woman from Arlington Cemetery is employed, taking care of and her indiscretion has been mostly forgotten.

It bears repeating: “We're all a mixture of talents and wisdom and stupidity and idiocy, and that's what human beings are.” We can take ourselves out of the shame business by standing up when the next foolish post is made by a friend or stranger and remind people that everyone has had their worst hour, just many of us are fortunate to have not had it play out in front of millions of people.

As a , I often find the “shamer” and the “shamed” in the same person. I see people suffering shame after being exposed for an embarrassing but wholly common and natural indiscretion. Other times I see people suffering near unbearable guilt after participating in the shaming of others. Some of the worst suffering in my patients are those “caught” by the public for the very actions they excitedly shamed others for committing. My time with patients proves again and again to me the overall argument of Ronson’s book. If you are able to forgive others, you will move closer to being able to forgive yourself. and yourself can serve as a thruway from despair to self-acceptance. Breaking the cycle of shame leaves you more able and willing to give strength to others who may one day walk in your shoes.


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Surviving My Digital-Age Miscarriage

Woman looking at baby scan

Technology can amplify the emotional aftermath of pregnancy loss.

All forms of technology are lucky to have survived recent months in our house.

As much as technology has enriched our lives, it has the power to magnify and exacerbate difficult situations. There was no giant "I HAD A MISCARRIAGE" button or emoticon to express how I felt when I lost what we lovingly called “sprout.”

I've heard everything from 1 in 3 to 1 in 5 pregnancies results in a miscarriage. There are countless articles with advice on how to overcome sadness and the well-intentioned, but regrettable, . Everyone knows someone who has had a miscarriage. Yet contrary to our millennial tendency to overshare both mundane and intimate life details, people seem blissfully unaware of the subject. Are miscarriages still something too private or taboo to openly discuss in 2015?

I also can’t fathom why, up until now, I knew so little about miscarriage, other than it being possible. I went to a progressive all-girls school growing up and am surrounded by strong females. But no one told me how physically taxing the experience would be and that it would involve far more than just heavy cramping. Mine came with diarrhea and vomiting, followed by a fever – all of which my doctor later assured me were totally normal. When all of this was happening at 3 a.m., we were wishing we had filled the prescription for painkillers because ibuprofen wasn’t cutting it.

When I went to the the day the miscarriage started, the doctor, who is around my age, told me countless times that it wasn't my fault and that I couldn't have done anything to stop it – something that had never even occurred to me.

Why did I have to be told it wasn't my fault? Repeatedly saying it wasn't my fault, while avoiding eye contact, had the opposite effect on me. It might be comforting to some, but it only made my inner-feminist angry. I don’t remember her telling my husband it wasn’t his fault. While I don’t blame my doctor (she checked in on me and emailed in the weeks after the miscarriage) speaks to her inexperience breaking this type of news, and perhaps to the shame we still carry from previous generations, when miscarriages were seen as a mark on one's womanhood.

A suggests that indeed, most Americans still think miscarriages are rare, despite their frequency, and harbor outdated notions about why they happen, contributing to the shame and isolation so many women experience, according to the researchers from Albert Einstein College of Medicine of Yeshiva University and Montefoire Medical Center. Where those polled got it right, however, was in believing that for many women, the emotional aftermath of a miscarriage can be on par with losing a child. I will forever empathize with sobbing women leaving the OB-GYN waiting room, as I did that day.

Although miscarriages are considered one of the most common pregnancy complications, I can't recall the last time I felt so alone. Like many women on the cusp of motherhood, I had downloaded the popular pregnancy apps the day we found out I was pregnant. Bad move. Even before the miscarriage, my inbox was brimming with junk emails about cord blood and diapers. Afterward, it only got worse.

While grieving, I was – and still am – bombarded by ads for baby formula and other infant products that were always delivered with template notes congratulating me on my pregnancy – dubbed an “exciting” life stage. Clearly I hadn’t read the fine print closely enough, because the apps had apparently shared my email address with their sponsors.

How responsible is that when odds are good that a significant number of the women on their distribution lists have had or will have a miscarriage or other serious pregnancy complication? Why was I magically added to one company’s mailing list more than a month after the miscarriage? And why is there no easy way (or one I could find) to unsubscribe from the apps in general and to stop the flood of these ads?

I wildly deleted everything from my phone, unsubscribed from every email I could and hit dismiss on countless Google diaper ads. In a moment of calm, I tried to leave feedback only to be directed to the app store. But at the time, I was not interested in publicly sharing that I wished it had been easier to unsubscribe in the wake of my miscarriage, when I had only downloaded the apps because I wanted to see my baby’s weekly growth compared to the size of a sesame seed, lentil, lime, etc.


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Assessing the Risk for Heart Attacks and Strokes: How a Coronary Artery Calcium Score May Help, and Who Needs the Test

A doctor making the shape of a heart with their hands.

Heart disease can often be prevented or controlled.

First, some good news:

Now for the bad: Often referred to as hardening of the arteries, atherosclerosis occurs when cholesterol, fatty substances, calcium and a clotting protein called fibrin – collectively known as plaque – build up on the inner walls of arteries. The arteries can become inflamed, hardened and stiff. Plaque can break off and cause the formation of a blood clot inside the damaged vessel. Diseases fueled by this process, such as heart attacks and strokes, are the leading causes of illness and death for both men and women in the United States.

But because atherosclerosis is a slow process that occurs over decades, it can often be detected early, and preventive treatment can be initiated to ward off its most devastating consequences.

Are you at risk for atherosclerosis?

The first step in preventing and treating atherosclerosis is to determine if you are at risk.

While everyone should focus on making healthy lifestyle changes, those with elevated cardiovascular risk can benefit from preventive therapy with aspirin and cholesterol-lowering drugs called statins. Risk is determined by a combination of factors, including age, gender, blood pressure, cholesterol, diabetes and smoking. The latest estimates 10-year risk of heart attack and stroke among people ages 40 to 79 and can gauge the 30-year risk for those 20 to 59 years old.

In many cases, risk calculation is straightforward and treatment decisions are clear-cut, but for some patients with borderline risk scores, treatment choice can fall in a gray zone of uncertainty. Complicating matters further is that in certain groups of people, the risk score calculator can underestimate or overestimate risk. In cases of uncertainty, an additional test called a coronary artery calcium scan could provide much-needed clarity and move the needle in terms of treatment choice.

What is a coronary artery calcium score?

The test is based on CT scan images of the heart that visualize the presence and amount of calcium buildup inside the heart’s major blood vessels. Because it is dense like bone calcium, coronary calcium shows up on CT scans as bright white spots. Large calcium deposits signal hardening and narrowing of the arteries and portend elevated . In large studies, CAC scores have been shown to predict future risk of heart attacks better than age and other traditional risk factors such as cholesterol and blood pressure. The test is quick and painless, but there is a small amount of radiation exposure – about the same as a mammogram – and the test may occasionally pick up other incidental findings, such as nodules in the lung that require additional work-up.

Studies show that people with a CAC score of zero have a very low risk of heart attack over the next five to 10 years. These patients might not need any drug treatment now and can focus on maintaining a healthy lifestyle. But patients with scores greater than 100 may be at higher risk and may benefit from targeted prevention with medication.

Should I have a coronary artery calcium scan?

A coronary artery calcium scan isn’t for everyone, but among people with uncertain or borderline cardiac risk, the test can provide valuable information and guide treatment choice.

Patients at very low or very high risk for heart attack and stroke as determined by traditional risk calculation don’t need a CAC scan, as results are unlikely to change one’s recommended treatment plan.

The following groups of people might benefit from a CAC scan:

1. Patients with normal cholesterol but with elevated 10-year risk score of 5 percent or more due to other factors such as age, race or high blood pressure.

2. Patients who have a 10-year risk score of 15 percent or more and who normally would be treated with statins but who have serious side effects or are reluctant to take the medication; a CAC score may help guide the need for alternative .

3. Patients who are low risk as determined by the latest risk calculator but have other compelling factors to start treatment, such as:

My CAC Score is elevated. Now what?

An elevated CAC score spells an increased risk for a heart attack and should lead to a conversation with your physician about treatment with aspirin or a statin. People who have high CAC scores but no symptoms require no further cardiac testing. Elevated CAC scores become more common as people age and not everyone with an elevated CAC score eventually gets a . Furthermore, getting a repeat CT scan to follow CAC scores is not recommended, as treatment lowers your risk for heart disease but does not make the calcium go away nor does it lower the score.

Concluding thoughts:

To prevent the onset and development of disease-fueling atherosclerosis, we recommend that patients eat less, eat smarter, move more daily and . Patients should “know their numbers” for blood cholesterol, blood sugar and blood pressure and discuss their family history with their doctors. However, when risk remains uncertain, a CAC scan can be a reliable new tool to help define one’s risk. Using all the available data, patients and physicians can engage in risk discussion and, working together, choose the best course of action to prevent heart attacks and strokes.


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Coping With a Mental Health Crisis in the Family

Father with young son on his shoulders.

Experts advise parents who have children with a mental illness to do plenty of research and trust their instincts when deciding how to seek help.

Tracy and Terry Greenberg wake up each day, unsure how it will unfold. At age 12, their oldest son Bryce has a slew of mental health diagnoses, including ADHD, , anxiety and .

“My son looks like everyone else. He’s loving, sweet, kind and adorable,” Tracy says.

Bryce loves video games, jumping on his trampoline, playing with his dog Griffin and riding his scooter. He’s the epitome of boyhood.

The Greenberg family (left to right: Terry, Tracy, Bryce and Cole).

When they adopted Bryce as an infant, the Greenbergs knew his biological parents had a history of drug abuse and mental illness. But they assumed everything would be OK. The first 12 months, he was a textbook baby, Terry says. “Everything you’d expect as far as milestones … he was right on point. He was a relatively early walker at 10 months, and he slept well,” Terry recalls.

The First Sign of Trouble

At 18 months, the began. Bryce awoke in the middle of the night and didn't recognize his parents. Sometimes he wouldn’t get into bed at all and often laid under the bathroom sink. In preschool, he wouldn’t sing along or clap during music class like the other children his age, so Terry and Tracy took him to a new preschool.

“That’s when things started going south very fast,” Terry says.

They sought the help of a psychologist, who diagnosed Bryce with and a mood disorder.

The preschool then asked that Bryce leave the school because of his severe tantrums. Tracy took a leave of absence from work, and things continued to spiral downhill.

“I remember getting the first report from the psychiatrist before he began kindergarten, and it said he wasn’t going to be able to go to kindergarten without medication,” Tracy says. She was devastated.

The were worse with Bryce than his brother, Cole, 16 months younger, who was also adopted from a family with a history of drug abuse. The Greenbergs often left full shopping carts at the grocery store and walked out of countless restaurants in the middle of dinner. Typical punishments weren’t working, and Tracy found herself ridiculed by other parents and even family members.

“People think it’s a lack of parenting," she says. "You feel very isolated and alone because everybody thinks you’re doing something wrong.”

The Decision to Hospitalize

In 2009, Bryce had a violent outburst while friends were visiting their home in North Potomac, Maryland. The Greenbergs made the painful decision to take him to the emergency room. The only hospital that would accept him due to his age was located in Virginia.

Did they make the right choice? Terry says he went over the decision in his mind "over and over again."

Dr. Meena Vimalananda, a psychiatrist and medical director of child and adolescent services at in Towson, Maryland, says guilt is common among parents who admit a child to inpatient care. “One of the things we tell families all the time is that this is not a forever situation. The crisis by definition is just a crisis,” Vimalananda says.

However, the first hospitalization didn’t work, Terry says. By the summer after first grade, Bryce continued to deteriorate.

“He was attacking me at least three times a day,” Tracy says.

Her goal was to get him into the second grade, but the stress from the first day of school set him over the edge.

Later at home that day, Bryce took a mirror off of the wall, threw it and ran out of the house. Tracy followed him, and Bryce threatened to hit her. He banged on neighbors’ doors and fences. He even attempted to climb into the sewers and made .

Terry and Tracy managed to get him into the car and went straight to the ER. He was admitted to a for 45 days – this time in Pennsylvania, two hours away.

“I felt like I failed him because here I adopted a child and now I had to send him away,” Tracy says.

Bryce was hospitalized several more times – twice per year from ages 7 to 10, and again most recently in February. “It’s hard emotionally, and draining,” says Tracy, explaining that their friends and family often don't know how to approach them.

“When a child is sick or has cancer, people go out of their way to make dinners for the family and do whatever they can. They rally a support system," Terry says. "With this, you get none of that. You are completely isolated and alone. When children have cancer, the parents can be at their bedside 24 hours a day. In a psychiatric hospital, you get only one hour per day.”

How Parents Can Cope

Darcy Gruttadaro, director of the National Alliance on Mental Illness's in Arlington, Virginia, says parents who have children with a mental illness should trust their instincts when it comes to seeking help.

“Find support in the community that you need,” she says. “Learn as much as you can about your child’s condition; research the best and most effective treatments and how to be the best advocate for your child.”

She also advises to not be afraid about what you might learn: "The more educated and informed you are, the better the end result.”

When it comes to interventions, Gruttadaro says parents should ask the following questions:

Dr. John Boronow, a psychiatrist and medical director of adult services at Sheppard and Enoch Pratt Hospital, says a psychiatric social worker can often offer  experiencing a mental health crisis.

“I would certainly encourage people to see a psychiatric social worker interested in chronic mental illness who can be a coach for the family and give them some good advice as to when they should do what – in terms of escalating the treatment process,” Boronow says.

Today, Tracy says life isn't perfect, but the family is coping better. Bryce now attends , a year-round special education school supported by the Sheppard Pratt Health System in Rockville, Maryland, where he has matured and is exposed to smaller classrooms with professionals who know how to work with him. “Our lives have gotten better gradually,” Tracy says.

Tracy started working part-time recently and finally feels like she can breathe a little easier. What's more, the Greenbergs have learned to become their child’s best advocate, despite the stigma attached to having a mental illness in the family.

In , Tracy says people often tell her how brave she is.

“I’m not brave. I have a kid that has an illness [I want to help]," she says. "That doesn’t make me brave – that makes me a mom."​


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Girls Get Autism Diagnosis Later Than Boys

Rear view of a girl holding a balloon looking at a boy walking away from her.

New research shows a gender difference in the diagnosis of children with autism.

Girls with high-functioning autism are diagnosed about a half-year later than boys, a large new study finds. But – like having trouble picking up on social cues – may point to an autism diagnosis. If so, a type of therapy called social skills training can help girls make friends and meet their full potential.

Gender Gap

On Tuesday, Dr. Paul Lipkin, director of medical informatics at Kennedy Krieger Institute in Baltimore, on nearly 10,000 children with autism, using data from the Interactive Autism Network registry. On average, boys were diagnosed with Asperger’s syndrome, an autism spectrum disorder, at about 7.1 years old, while girls were diagnosed at 7.6 years.

Digging deeper, the researchers also compared types of symptoms for about 5,100 of these children. Girls were more likely to have problems with social cognition ­­– the ability to recognize and interpret social cues, says Lipkin, the director of IAN. What other kids learn by experience doesn’t come as naturally to them.

Boys were more likely to exhibit obvious mannerisms, such as hand flapping and other repetitive behaviors, and to have narrowly restricted interests. Autism is much more common in boys. In the IAN registry, the ratio of enrolled boys to girls was about 4.5 to 1.

The gender gap only held for higher-functioning children, with a slightly narrower gap for pervasive developmental disorder, a moderate diagnosis on the autism spectrum. However, “in those with frank autistic disorder, there was no difference in age of diagnosis” Lipkin says. "Those children's problems are quite overt and easily recognizable, even to the general public. So when girls are having those severe problems, they probably aren't looking much different than the boys."

Fitting In or Faking It?

The new findings come as no surprise to clinical psychologist Shana Nichols, owner of the Aspire Center for Learning and Development in Melville, New York. Nichols says many girls arrive at the Center between ages 10 and 12. Until then, they’ve been able to get by with their peers. But even earlier, she says, “parents often say they’ve noticed their daughters aren’t quite as attuned to the social nuances ­­­­– although they’re good at faking it.”

By sharing common activities and nodding and smiling during conversations, girls with autism may look like they’re participating well, Nichols says. But in reality, she continues, there’s “a more surface-level, almost an intellectual understanding of the social interaction.”

Amy Keefer, a clinical psychologist with Kennedy Krieger’s Center for Autism and Related Disorders, starts seeing patients around age 8. With autism, she says, “boys’ interests tend to stand out more." For example, boys may have a deep fascination with city sewer systems, while girls may be really into the movie “Frozen.”

Intense focus on their is what sets girls with autism apart, Nichols says. Being a girl who “really, really loves horses” is not the same as “being a girl who really loves horses and also knows a million different facts about all the different breeds, and that becomes an exclusive interest.”

Keefer says when kids with autism play with others, it’s different. “Maybe the girl tells her friends what to do,” she says. “It has to fit her rules and be exactly her way.”

Rising Social Demands

As preteens, Nichols says, girls with autism “hit that age at which the demands of social relationships exceed their skill sets” and expectations for friendship change. Now, she says, the attitude becomes, “’We’re going to have more conversations and begin to talk on the phone.’ There are more emotions involved.”

Still, many young girls who don’t have autism find it hard to breeze through social interactions. “A lot of girls struggle with fitting in and wanting to be with the popular crowd ­­– it’s very difficult for girls in general,” Nichols says.

What distinguishes girls with autism is that “their core social understanding and social perspective-taking abilities are impaired,” she says. “Whereas girls who are more shy and awkward wouldn’t show the same kinds of deficits in social understanding and interactions that our girls on the spectrum show.” Standardized tools, like the Social Responsiveness Scale used in the Kennedy Krieger study, are one way clinicians pinpoint social impairment.


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10 Ways to Make Your Childbirth Easier

A Better Birth

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(Getty Images)

In her nearly 40 years as a midwife, Eileen Ehudin Beard ​has been at “a gazillion” births. (Translation: More than 1,000.) She’s also given birth to five children ​of her own. “Every birth is different, every woman is different,” says Beard, the senior practice advisor at the American College of Nurse-Midwives. Still, smoother births often share common traits. Here’s what Beard and other experts say women can do to help make childbirth as positive – and painless – ​as possible:

Next:

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Study: Video Games Don't Trigger Aggression in Adults With Autism

Play game with a joystick, game controller isolated on blue background

Prior to this study, there was speculation about the impact violent video games have on adults with autism spectrum disorder.

Politicians pushed for a crackdown on violent video games after speculation arose that they spurred Newtown school shooter Adam Lanza – who had autism spectrum disorder – to commit one of the deadliest massacres in U.S. history, killing and educators before taking his own life.

But a new study from the University of Missouri indicates that violent video games do not increase aggression in adults with autism spectrum disorder any more than they do in people without autism.

“We wanted to try to provide some evidence on the issue,” says lead author Christopher Engelhardt, a postdoctoral fellow in the University of Missouri School of Health Professions and the Thompson Center for Autism and Neurodevelopmental Disorders. “We couldn’t specifically study [what triggers violence in individuals] because it's not ethical to do so. But what we could do is study the willingness to aggress following exposure to violent video games.”

The study – which was recently accepted for publication in the journal Psychological Science – is the first of its kind to test the effects of violent video games on aggression in adults with , according to Engelhardt.

Researchers examined 120 young adults – 60 who had autism spectrum disorder, and 60 who showed normal neurological development. Participants played one of two versions of a violent video game. The first, which contained heightened graphic imagery, called for players to shoot aliens on a military base in space. The second game had subdued graphics and a noble mission to help the creatures find their way back to their home planet.

After playing one of the two games, participants engaged in a task for the researchers to measure aggression. They were told they were competing against another person in a trial to test their reaction times. If an individual won that challenge, he or she could “blast” their opponent with a loud noise. Researchers measured aggression levels in participants from both groups by monitoring how long – and how loudly – each participant “blasted” the defeated party.

The results, experts say, were surprising – and not just because they found that short-term exposure to violent video games didn’t amplify aggression in adults with autism.

“The more surprising finding to most researchers in this field will be that the effect of playing violent video games on the immediate aggressive behavior, aggressive thoughts and aggressive emotions of normally developing youth was not found to be statistically significant,” says L. Rowell Huesmann, a professor of communication studies and psychology at the University of Michigan, who was not involved in the study.

Experts have long disagreed over whether video games like Grand Theft Auto are . One defense against this hypothesis, Engelhardt says, is violent video game sales have risen over the years, whereas . “The argument is that if violent video games caused increases in violence, then [researchers] should see a different trend,” he notes.

But before this study, there was still speculation about whether violent video games might have a different effect on adults with autism spectrum disorder.

Engelhardt’s study is valuable because “it may help lay to rest these ideas that there's a vulnerable population of people that are particularly influenced by violent video games,” says Christopher Ferguson, chair of the psychology department at Stetson University in Florida, who was not involved in the study. “After Newtown the case became, ‘What about those kids who are already teetering on the edge of not understanding reality? Would a violent video game put them over the edge and make them do something like Adam Lanza did?”

Experts point out that the study has its limitations. For example, participants were only exposed to the violent or nonviolent video games for 15-minute increments before researchers measured their aggressive behavior. Therefore, the study doesn’t provide answers on the potential long-term effects of violent video game exposure.

“Obviously, most people don't play video games for 15 minutes,” Ferguson says. “That's been the general weakness of a lot of the experimental literature; typically, [researchers] put people in front a video game for a very short period of time and then yank the controls from them in a way, sometimes, that can actually create aggression that has nothing to do with the game. That is obviously a concern for a lot of experiments with violent video games, including this one.”

Future research endeavors, Engelhardt says, include collecting longitudinal data to see how and other forms of media violence are associated with aggression.

But at the end of the day, the study demonstrates that violent video games do not “cause real world problems,” says Patrick Markey, an associate professor of psychology at Villanova University.

“We need to be more careful when horrific events [happen] to not blame health factors, or blame violent video games and so forth,” he says. “We have to make sure facts are in. Not only were we wrong in the case of Sandy Hook, this research shows that we’re probably correct that these violent video games don't [affect people] with autism spectrum disorder – or perhaps even people in general.”


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Pregnancy With a Chronic Disease

Pregnant woman with sunshine in a field.

A good rule of thumb: Ensure symptoms with any chronic disease are under control before conception.

Eat this, not that. Take this vitamin, but forget that one. Gain some weight, but not too much.

Women are inundated with information about what to do and avoid when expecting. But for some women with chronic health conditions such as Crohn's disease and lupus, these recommendations go a step further to keep mom and baby safe.

“We think of pregnancy as a stress test for the body” says Dr. Katherine Economy, a maternal-fetal medicine physician at  in Boston. “... If you add the stress of pregnancy to [a] disease, for some women it can be very serious.”

But having a chronic disease does not necessarily mean that you can't have a healthy pregnancy. A good rule of thumb with any chronic disease is to make sure symptoms are under control before conception, and to seek care from multiple specialists to ensure the condition is managed carefully during pregnancy, Economy says. Two women who did just that shared their experiences with U.S. News and offer advice for others.

Conceiving With Crohn's

Stephanie Hughes carries a bag wherever she goes. In fact, she’s quite attached to it. No, it’s not Michael Kors or Tory Burch. It’s an ostomy bag, a pouch-like medical device that collects fecal matter, because Hughes has .

Stephanie Hughes has entered her third trimester, and has had no complications with her ostomy bag.

The chronic inflammatory condition impacts the intestines and is often associated with unpleasant symptoms related to the gastrointestinal tract, including persistent diarrhea, rectal bleeding, an urgent need to defecate, abdominal cramps and pain, the feeling of an unfinished bowel movement or . The disease can also cause symptoms similar to those of irritable bowel disease, including fever, loss of appetite, weight loss, fatigue, night sweats and the loss of a normal menstrual cycle.

Hughes, 29, of Raleigh, North Carolina,​ says her symptoms began around age 10, but she wasn't diagnosed until age 13.

“Before then, I had been able to control things with diet, but when I turned 13, things got bad and I wound up in the hospital for about a month,” Hughes says. “... I spent a good part of high school dealing with flares here and there.”

It wasn’t until she left for college that she had another bad flare-up, landing her back in the hospital for two weeks during her freshman year. Eventually she learned how to live with it, but she was still sick most of the time. While most college students go out partying with friends, Hughes simply didn’t have the energy.

“I always had to be careful about what I ate when I did go out, and the first thing I did was scope out where the bathroom was,” Hughes says.

To make matters worse, she always wanted to become a runner, but her lack of energy and constant made it nearly impossible. Frustrated, she looked for a treatment.

In 2011, she tried an investigational drug that wound up causing more harm than good, as the side effects impaired her ability to think clearly.

The next step was colectomy, a surgery that removes all or part of the , but she was hesitant. Instead, Hughes decided to take herself off all medications, which didn’t bode well. The joint inflammation the medications had kept at bay became intolerable, and she had to quit her job. “It got to the point where I couldn’t get off the couch,” she says. “That’s when I realized how truly sick I was.”

Finally, Hughes agreed to the colectomy​, which created an ileostomy – an opening in the abdomen that helps remove waste​ and connects to the ostomy bag.

At first, she had only part of the intestines removed, but later the entire colon came out. “It was the best decision I’ve ever made. It completely turned my life around, almost immediately,” she says.

Although the ostomy bag is attached to her abdomen 24/7, she was still able to . Five months after her surgery, Hughes participated in her first triathlon and a half marathon one year later.
Hughes ​married in 2010, and she and her husband wanted to experience parenthood. Currently in her third trimester, she admits she was worried if she could even conceive. To her and her husband's surprise, Hughes became pregnant after just three months. 

She had been told that she could develop scar tissue due to having two surgeries, which could have interfered with conception. She did not have this complication, but knows that others with the disease often do.

"Once we found out, it was amazing knowing that with everything I had been through – and even with surgeries –  I was still able to do that," she says. "It was a weight off my shoulders, and an amazing gift to us." 

She's been told by her doctors that she should have no further complications and that she's not considered to be high risk.

"The one thing I do have to look out for is an intestinal blockage, which could happen in this later part of the pregnancy since my intestine comes around the front of my uterus. I have not dealt with that at this point, but it's something I know to watch out for and I avoid certain foods that are difficult to digest because of it," she says.

Dehydration can also be an issue, she says. "Having an ostomy dehydrates you, as does pregnancy, so it's doubly important for me to drink lots of water."

Pregnancy with an ostomy bag is possible, and there aren't any extraordinary sanitary issues associated with it, Hughes explains.
​​
"I treat it the same way as I would imagine someone in the health care field would with their job and the things they come into contact with; just washing hands well before and after any contact with the stoma itself," Hughes says. "For the most part, it's very clean."

One concern for women with Crohn's is how the disease will react during pregnancy. There are some cases where symptoms worsen, though some improve or stay the same. Because of her surgeries, Hughes has not had any symptoms of Crohn's while pregnant.


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Eating on Chemo: Tips to Overcome Taste and Weight Challenges

Woman slicing strawberries for a smoothie.

Smoothies with raw fruits can be a great between-meal option for people being treated for cancer.

When you’re being treated for cancer, food can lose all its appeal. But is more important than ever as you move toward recovery. Dietitians – and a patient who’s been there – share their advice for how to eat right.

The Nutrition Strategy

Linda Kao of Dallas has gone through a gamut of cancer treatment – chemotherapy, radiation and surgery. Kao, assistant dean of global programs at Southern Methodist University's Cox School of Business, was traveling in Chile in October 2010 when she says she noticed an “odd mass” in her mouth.

On her return to Dallas, Kao found out she had tonsil cancer, and she began treatment at the Baylor Cancer Center. “From the very first meeting with my oncologist, he introduced me to the nutritionist/dietitian and told me she would be my best friend – and one of the most important people throughout the treatment,” says Kao, who answered questions via email because the cancer treatment significantly weakened her voice.

It’s often difficult for patients with head and neck cancers to maintain their weight, so Kao's nutritionist recommended that she  early on. Throughout 18 weeks of chemo, antiemetic medications and careful monitoring of her diet staved off nausea and vomiting.

While Kao says she felt “miserable” during the first week, she forced herself to eat. By week three, she felt better and ate as much as she could before facing the next round of chemo. She says she actually gained about 15 pounds. Then came radiation.

Loss of Appetite

When it comes to cancer and nutrition, “everybody wants to do their best, try their hardest to increase their chances of survivorship – but also feel well in the moment,” says Stacy Kennedy, a registered dietitian and senior nutritionist at in Boston.

But side effects – including nausea and vomiting, appetite loss,  and diarrhea – interfere.

Suzanne Dixon, a registered dietitian and former chair of the Academy of Nutrition and Dietetics' , points out that cancer is not a single disease – no two cases are identical. Symptoms, treatments and responses vary widely from patient to patient. So it’s important to work with a , she says, ideally one who specializes in oncology nutrition.

To combat appetite loss, Dixon suggests doing light physical activity to stimulate appetite, keeping food handy for moments when appetite returns and eating by the clock instead of waiting for hunger cues. Eating small, frequent meals is another way to maintain nutrition as appetite shrinks, Kennedy says.

 also make great between-meal options. “You can kind of multitask in your glass,” she says. “If your goal is to get fruits and vegetables, protein, hydration, fiber, electrolytes – a smoothie can help you do all that at once.”

Nausea Control

Keeping nausea at bay is a balancing act – an empty stomach, a too-full stomach or even hunger can make it worse. Food odors can stimulate nausea, Dixon says. Eating low-odor foods, avoiding food preparation areas and using a lidded cup while drinking smoothies or nutrition supplements can minimize nauseating smells.

Acupuncture also has been shown to help prevent nausea and vomiting in people receiving chemotherapy, according to the , Dixon notes.

It’s important to replenish lost nutrients, especially when patients experience vomiting, Kennedy says. “With vomiting, you have to really focus on your hydration with electrolyte-rich fluids like broth – regular broth, not low sodium.”

Dixon emphasizes that patients should not endure vomiting as an “expected” chemo side effect to be tolerated: “If you’re vomiting profusely, that’s a medical problem – and you really need to talk to your physician or nurse,” she says. 


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When You Have Cancer And Can't Sleep

Woman with pillow over head.

Sleep problems can affect up to 80 percent of people who are undergoing chemotherapy.

Traci Gordon never had a problem falling asleep or staying asleep. In fact, she has a sleep disorder that causes her to sleep too much. “I could sleep through a whole weekend,” Gordon says.

That all changed when Gordon, a 47-year-old administrative assistant in New York, began chemotherapy for breast cancer about seven years ago. The treatment threw her body into an artificial state of , which caused unrelenting night sweats.

“My memory of it was waking up five, six, seven times a night, absolutely dripping,” Gordon says. Each time, she would change her clothes, stand in front of the air conditioner and wonder how much of her fatigue was caused by the cancer, how much was caused by the treatment and how much was caused by her through the night. “It was really having an impact on top of everything else,” she says.

Sleep problems during cancer are ubiquitous, affecting up to 80 percent of people undergoing chemotherapy, says Oxana Palesh​, an assistant professor in the Department of Psychiatry and Behavioral Sciences at Stanford University Medical Center who develops and tests sleep interventions for cancer patients and survivors. One of her  found that  is about three times more prevalent among cancer patients being treated with chemotherapy than it is in the general population.​ When you have cancer, Palesh says, "it's much more common to have sleep problems than not." ​ 

But at the same time,​ sleeping well during cancer treatment is critically important in fighting the disease. Without solid rest​, the body’s level of cortisol – known as "the stress hormone" – goes up and the count of “natural killer cells,” or NK cells, ​that help fight cancer go down, says Dr. Laeeq Shamsuddin​, medical director of the sleep clinic at ​Cancer Treatment Centers of America at Midwestern Regional Medical Center in Zion, Illinois.

might even shorten some cancer patients’ survival, Palesh’s preliminary work suggests. “There is a lot of comorbidity between poor sleep and depression, poor sleep and post-traumatic stress disorder, poor sleep and increase in pain,” says Palesh, who directs the Stanford Cancer Survivorship Research program. “Literally, it doesn’t make one thing better.”

When Good Sleep is Out of Reach

Anyone who’s ever lain ​awake counting sheep, or ruminating after a fight with a partner​ knows how hard it is to get a good night’s rest just when you need it most.

Now add cancer to the mix, and it’s easy to see why quality sleep is fleeting. A cancer diagnosis is scary, stressful and anxiety-provoking; cancer treatment can cause side effects including pain, and nausea; and life with cancer often means sleeping at odd hours or in unfamiliar places like a hospital. “Everything they say to promote healthy sleep habits … you’re not doing that,” says Gordon, who’s currently undergoing chemotherapy again for breast cancer in her other​ breast.

For Kym Sinclair​, a 31-year-old nurse in Santa Cruz, California, some of the most significant sleep disruptions from cancer were psychological. As a former college athlete with no family history of cancer, Sinclair’s Hodgkin’s lymphoma diagnosis at age 27 came as a shock. “I went from being the single ER nurse living in downtown Sacramento with my own cute little apartment to ‘I’m dependent on other people, I’m not working and I’m now the patient,’” she says.

That abrupt loss of identity sent Sinclair on a tailspin toward anxiety and . “All I wanted to do was sleep and get away from it … but the anxiety and depression keep you up,” she says. “That’s your first dance with not being able to sleep but wanting to do nothing but sleep.”

As she began chemotherapy, Sinclair struggled with side effects, including bone aches, vomiting, nausea, gastrointestinal distress and the chills – all of which put a good night’s sleep further out of reach. “You just can’t ever get comfortable. You just constantly feel like you have the flu,” she says.

And when Sinclair tried to catch up on the sleep she missed by napping during the day? There was the neighbor mowing the lawn or the other neighbor’s dog barking. “All you want to do is sleep, but life goes on,” she says. “It can’t just stop because you want to take a nap.”


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Smart Medication Reminders for the Tech-Savvy Patient

close up of male doctor pointing at smartphone

Thanks to apps like MyMedSchedule, managing your prescriptions just got a little easier.

When Andrew Stokrp was discharged from his second kidney transplant surgery last month, the Lebanon, Pennsylvania, resident was sent home with a cumbersome list of 32 morning pills and 22 evening pills that – if missed – could result in the rejection of his new kidney.

The number of pills he takes in a given day will decrease with time, but for now, Stokrp, 33, has to follow strict medication orders. He’s done so with the help of MyMedSchedule​, a smartphone app that alerts him of the exact medication, time and dose he needs to take via text message.

“My prescription coordinator at the hospital told me about this app, and it’s been amazing and made it a lot easier to keep my medications in line,” Stokrp says.

He’s not alone.

At 67-years-old, Ernie Wallace​ of Kansas City, Missouri​, says the same app has not only helped him remember to take his liver transplant medications at 8 a.m., 9 a.m. and 9 p.m. each day, but it has also been a valuable tool for informing multiple doctors and hospitals which medications he is currently taking. Wallace’s  downloaded the app for him and synced all his medications.

“It’s become very handy on subsequent doctor’s appointments when they ask you to bring a list of all your medications. Now, it’s there on my phone,” Wallace says.

Kathy Powers​ says she's not even out of bed before her first medication reminder ​each day. The 51-year-old from Odenton, Maryland, says she developed health issues related to thyroid and adrenal disease, as well as menopausal symptoms, since December.

"Everything hit me at once, and that was the trifecta. I started seeing a specialist and was prescribed a whole slew of supplements – eight at different times during day. I also take liquid supplements," she says. "I was totally overwhelmed with how to take them and when to take them."

That's when she began an online search for the . Since she has her phone on her 24/7, she says a text messaging system was the best option.


MyMedSchedule is just one of the growing number of medication reminder apps available to patients. ​On the heels of the Apple Watch release this week​, WebMD announced plans to launch an updated version of its app with a medication reminder feature. The app will allow consumers to view daily medication doses, drug instructions, pill images and reminders when to take medications directly on the Apple Watch. 


The reminders give patients four options: take the medication, skip, snooze or dismiss the reminder. If patients choose the snooze option, they’ll be reminded in 15 minutes. If they dismiss the reminder, they’ll be alerted at the time of the next scheduled dose.

​WebMD President Dr. Steven Zatz says the reminder feature was designed to address the issue of medication adherence, or how well patients follow their medical instructions. “There are many reasons for medication non-adherence, including forgetfulness, cost of medications and copayments, fear of side effects​ and lack of clarity around the effectiveness of medications," he says. "Over the years, there have been a number of efforts to increase compliance; unfortunately, to date no approach has achieved widespread success."​

Adherence​ tends to vary among patients, according to Dr. Patricia Hale​, associate medical director for informatics at Albany Medical Center and board member of the Healthcare Information and Management Systems Society. Unintentional non-adherence happens when people simply forget to take their medication. ​Intentional non-adherence occurs when patients think about taking their medication and make a conscious decision not to, Hale says​.

Hale knows firsthand how important a reminder system can be in . As her mother aged, she required more medications to manage stomach issues, and , in addition to daily supplements. “I went on a search to find tools to help her,” Hale says.

But this was six years ago, and her mother didn’t use a smartphone. Instead, Hale found a hands-on device that provided alerts and kept track of missed doses. She was able to set up her mother's medication doses exactly how the pharmacist recommended, she says. That was the most difficult feat – ensuring her mother took her medications at the right time, each time – even when she wasn't around to assist. It's an obstacle that medication adherence apps may help solve for other caregivers.

“These apps can not only help caregivers ... but it helps health care aides tremendously who come to the home to assist with reminders; making sure things are done properly,” Hale says.

The 2015 Healthcare Information and Management Systems Society’s ​ found that nearly 90 percent of ​238 health care providers surveyed use mobile devices to engage with patients. Health care providers also reported that mobile health – or mHealth – technologies provided savings and improved care.

Dr. Dallas Swendeman​, co-director of the University of California–Los Angeles Center for HIV Identification, Prevention and Treatment Services, has studied​ a prototype app​, AndWellness​, with alarm functions and medication reminders for . He says the app improved patients' medication adherence​ and reduced factors associated with non-adherence, such as substance abuse and stress.

Lindsey ​Dayer​, a pharmacist and assistant professor at the University of Arkansas College for Medical Sciences, and Dr. Bradley Martin, head of pharmaceutical evaluation and policy at​ UAMS,​ authored a study​ in 2013 examining the potential patient and provider benefits of smartphone medication reminder apps. The , published in the Journal of the American Pharmacists Association, ranked 160 apps. MyMedSchedule, MyMeds and RxmindMe ranked the highest for their basic medication reminder features and functionality.

In their most recent ​study, presented at the American Pharmacist Association ​annual meeting last month, they developed a new grading system that included added app features. Of the 461 apps they identified, the highest ranked based on adherence grades alone included Medisafe, Care4Today and Mango Health.

“For people who have smartphones, this is a very assessable and scalable technology,” Martin says. “I personally would like to see more pharmacists, physicians and nurses be more proactive in using this as a potential tool to help people who struggle with adherence with medications.”

Martin adds that medication adherence reduces the and death, especially among patients with​ .

“It sounds dramatic, but it ... really is a matter of life or death when it comes to medications for some patients now," he says. "This is a problem that transcends nearly all specialties of care.” 


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Doctor Shortage: Who Will Take Care of the Elderly?

Cheerful doctor talking to senior woman in hospital's waiting room. Selective focus to senior patient.

By 2030, people 65 and older are expected to account for nearly 20 percent of the U.S. population.

A shortage of health care providers who specialize in geriatrics at a time when the is rapidly growing threatens to jeopardize the health of older Americans, according to experts in the field.

“We are not prepared as a nation. We are facing a crisis,” says Dr. Heather Whitson, associate professor of medicine at the Duke University School of Medicine in Durham, North Carolina. “Our current health care system is ill equipped to provide the optimal care experience for patients with multiple chronic conditions or with functional limitations and disabilities.”

Nancy Lundebjerg, chief executive officer of the American Geriatrics Society, says the shortage “means that people who really need the services of a won’t necessarily have access to that kind of expertise. That’s probably true right now across the country.” AGS is a nonprofit organization based in New York that focuses on improving the health and quality of life of older adults.

Demand for Care on the Rise

Americans are living longer, with many needing to manage a host of chronic diseases, including hypertension, arthritis, heart disease, diabetes, osteoporosis and dementia. One in 5 Americans will be eligible for Medicare by 2030, with people 65 and older expected to account for almost 20 percent of the nation’s population by then.

“We routinely see people over 100 years old. It’s remarkably common,” says Dr. Wayne McCormick, AGS president and professor of medicine in the University of Washington’s division of gerontology and geriatric medicine at Harborview Medical Center in Seattle, Washington.

Despite the projected increase in the number of older Americans, few medical students are choosing geriatrics, putting the future supply of geriatricians in jeopardy. In 2010, only 75 residents in internal medicine or family medicine entered geriatric medicine fellowship programs, the AGS reported.

There are more than 7,500 certified geriatricians in the U.S. But the nation needs an estimated 17,000 geriatricians to care for about , according to AGS projections. AGS estimates that about 30 percent of the 65-plus patient population will need a geriatrician and that one geriatrician can care for 700 patients.

“Realistically that isn’t going to happen,” McCormick says.

Economics is one factor contributing to the shortage: A career in geriatrics can be financially unattractive for doctors carrying large medical school debt. Geriatricians treat patients who are covered by Medicare and Medicaid, which traditionally have lower reimbursement rates than private health insurance companies.

“Geriatrics is the only sub-specialty where physicians can expect to ultimately earn less even though they did extra years of training,” Whitson says. “We need a restructuring of the reimbursement system so there isn’t a financial disincentive to go down this career path.”

Developing Geriatric Skill Sets

Lundebjerg says AGS will continue pushing for additional funding to educate future geriatricians. “But given the shortage of geriatricians, we’re also focused on how we can help the rest of the workforce be ready to care for older patients,” she says.

The Geriatrics-for-Specialists Initiative, for example, helps medical specialists develop the tools and knowledge they need to . Last year, the initiative worked with surgeons to release guidelines on post-operative delirium. Emergency medicine physicians spearheaded an effort to define the elements of a geriatrics-friendly emergency department. The initiative has led to about 100 “champions” nationwide, with many conducting research on age-related aspects of their specialties.

Medical schools and residency programs also need to include geriatrics in the curriculum, in the same way that all students are exposed to pediatrics even if they don’t plan to become pediatricians. “It’s beginning to happen,” Whitson says.

Non-medical disciplines – such as nursing, , occupational therapy, home health care and clinical social work, which are part of the care team for older adults – require additional training, as well. “The national need for more geriatrics education and training extends to all those disciplines, rather than just medical school and medical residency,” Whitson says.

Holistic Care

Unlike other physicians who might specialize in one organ system or disease, geriatricians must be adept at treating patients who sometimes are . “The focus is on understanding the patient’s goals and preferences, which could mean pulling back on some of the aggressive care for certain medical conditions,” Whitson says. “Otherwise you develop a care plan that is not feasible.”

Geriatricians also “pay special attention” to a person’s cognitive and functional abilities, including walking, eating, dressing and other activities of daily living, McCormick says. “Geriatricians take a holistic approach. We look at how we can help patients to be as functional as possible and exist in the community in the best way possible,” he says.

For example, older adults may have a hearing or visual deficit that impacts their physical health and quality of life. Something as simple as eye glasses or hearing aids can make a world of difference.

“We look for little things that can improve quality of life and surprisingly enough you can often make things quite a bit better,” McCormick says.

Geriatricians typically work across many settings as part of an interdisciplinary team that includes medical specialists, , registered nurses, physical therapists, occupational therapists, social workers, mental health professionals and others.

Whitson, for example, is part of an interdisciplinary team that works with surgeons to improve perioperative outcomes for frail and at-risk older adults who must . McCormick sees patients at home, the hospital, nursing homes, assisted living centers, rehabilitation centers, community clinics and hospice.

“Following people as they move into different settings is one of the things I enjoy most about being a geriatrician,” he says. “I like sticking with people through thick and thin.”

Despite the challenges that lie ahead, McCormick is optimistic the next generation of physicians will be prepared to address the health care needs of older people.

“They know they are going to need a good tool box of geriatric care skills to be effective providers in the future,” he says.


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