The Beat Goes On | Heart Transplants Still a Marvel of Modern Medicine

On this day in 2001, a petite 44-year-old woman received a successful heart transplant at Ronald Reagan UCLA Medical Center, thanks to an experimental Total Artificial Heart designed for smaller patients.

The UCLA patient was the first person in California to receive the smaller Total Artificial Heart, and the first patient in the world with the device to be bridged to a successful heart transplant — that is, to go from needing a transplant to receiving one.

The 50cc SynCardia temporary Total Artificial Heart is a smaller investigational version of the larger 70cc SynCardia heart, which was approved for use in people awaiting a transplant by the Federal Food and Drug Administration in 2004 and has been used by more than 1,440 patients worldwide.

The 50cc device is designed to be used by smaller patients — including most women, some men and many adolescents — with end-stage biventricular heart failure, where both sides of the heart are failing to pump enough blood to sustain the body. The device provides mechanical support until a donor heart can be found

Nemah Kahala, a wife and mother of five, was transferred to UCLA from Kaiser Permanente Los Angeles Medical Center in March.  She was suffering from restrictive heart muscle disease and in critical condition.  Her heart failure was so advanced that repair surgery and other mechanical assist devices could not help.

Kahala was placed on a life support system called extra corporal membrane oxygenation, but this only works for about 10 days before a person’s organs begin to deteriorate.

With the clock ticking, doctors needed to buy time by replacing Kahala’s failing heart with an artificial heart while she waited for a heart transplant.  Her chest cavity was too small for her to receive the larger 70cc artificial heart.  However, under a one-time emergency use permitted under FDA guidelines, her doctors were able to implant the experimental 50cc device.

“Mrs. Kahala’s condition was deteriorating so rapidly that she would have not survived while waiting for a transplant,” said her surgeon, Dr. Abbas Ardehali, a professor of cardiothoracic surgery and director of the UCLA Heart and Lung Transplant Program. “We were grateful to have this experimental technology available to save her life and help bridge her to a donor heart.”

The artificial heart provides an immediate and safe flow of blood to help vital organs recover faster and make patients better transplant candidates.

After the two-hour surgery to implant the artificial heart, Kahala remained hospitalized in the intensive care unit and eventually began daily physical therapy to help make her stronger for transplant surgery.

Two weeks after the total artificial heart surgery, she was strong enough to be placed on the heart transplant list.  After a week of waiting, a donor heart was found.

“In addition to the high-tech medicine that kept her alive, Mrs. Kahala and her family exemplified how a solid support system that includes loved ones and a compassionate medical team practicing what we at UCLA have termed ‘Relational Medicine’ plays an important role in surviving a medical crisis,” said Dr. Mario Deng, professor of medicine and medical director of the Advanced Heart Failure, Mechanical Support and Heart Transplant program at UCLA.

Kahala was discharged from UCLA on April 18.

Since 2012, the UCLA Heart Transplant Program has implanted eight 70cc SynCardia Total Artificial Hearts. UCLA also participated in the clinical study of a 13.5-pound Freedom portable driver — a backpack-sized device that powers the artificial heart, allowing the patient to leave the hospital — that received FDA approval on June 26, 2014.

The FDA cautions that in the United States, the 50cc SynCardia temporary Total Artificial Heart is an investigational device, limited by United States law to investigational use.  The 50cc TAH is in an FDA-approved clinical study.

First Fully Contained Artificial Heart

On the same day, a patient was implanted with the world’s first self-contained mechanical heart after a 7-hour operation, a hospital in Louisville, Kentucky. The procedure was the first major advance in the development of an artificial replacement heart in nearly two decades.

The device, created by Danvers, Massachusetts-based Abiomed Inc., replaces the lower chambers of a patient’s failing heart with a plastic-and-metal motorized hydraulic pump which weighs 2 pounds (1 kg) and is about the size of a grapefruit.

It was the first artificial heart to be free of wires connecting it to the outside.

“This is the first time this has ever been done,” said Kathy Keadle, a spokeswoman at Jewish Hospital where the procedure was performed by University of Louisville surgeons Laman Gray and

Neither Abiomed nor hospital officials would disclose the name, sex or gender of the patients, all of whom are seriously ill.  The long-awaited surgery had been expected by June 30 but was delayed because the company had not completed patient screening.

Abiomed got U.S. Food and Drug Administration approval in February’s 2001 to test the device on as many as 15 patients, all of whom are too ill to be candidates for a heart transplant.  Unlike existing devices, which serve as a temporary solution to extend a patient’s life until a patient can secure a donor heart, the AbioCor heart is designed to be a fully functioning replacement heart.

The trial involved severely ill patients with less than 30 days to live, said John Thero, vice president and chief financial officer of Abiomed.

“This is not a bridge to transplant. There is a scarcity of donor hearts available,” Thero said in a telephone interview. “We are starting with patients who are at the ends of their lives. They are not candidates for transplant and are near death. Our goal is to provide them with a reasonable quality of life and an extension of life.”

Thero said the current candidates had a life expectancy of two months. “While the device is designed to eventually go much longer, if we were able to double someone’s life expectancy, we would be very pleased,” he said.

The 40,000 patients awaiting heart transplants far outnumber the number of hearts available, and a successful mechanical heart could fill a huge need.

Earlier versions of the artificial heart were bulky and provided limited benefit to patients.  In 1982, Dr. Barney Clark, 61, of Salt Lake City, Utah, received the first permanent artificial heart, known as Jarvik-7. He was bound to his bed by protruding cables, tubes and a noisy box-like air compressor during the 112 days that he survived with the artificial heart.

With the Jarvik-7 and other “bridge devices,” the outside connectors leave patients exposed to infection.  The AbioCor contains a small electric motor attached to an implanted battery and is designed to last for years. Patients could wear a battery pack or plug into an electrical outlet to recharge the heart’s battery.

A Brief History of Heart Transplant

Long before human-to-human transplantation was ever imagined by the public, scientists were conducting pioneering medical and surgical research that would eventually lead to today’s transplantation successes. From the late 1700s until the early 1900s, the field of immunology was slowly evolving through the works of numerous independent scientists. Among the notable breakthroughs were Ehrlich’s discovery of antibodies and antigens, Lansteiner’s blood typing, and Metchnikoff’s theory of host resistance.

Because of advances in suturing techniques at the end of the 19th century, surgeons began to transplant organs in their lab research. At the start of the 20th century, enough experimentation had taken place to know that xenographic (cross species) transplants invariably failed, allogenic transplants (between individuals of same species) usually failed, while autografts (within the same individual, generally skin grafts) were almost always successful. It was also understood that repeat transplants between same donor and recipient experienced accelerated rejection, and that graft success was more likely when the donor and recipient shared a “blood relationship.”

Alexis Carrel was a French surgeon and Nobel laureate whose experiments involved sustaining life in animal organs outside the body. He received the 1912 Nobel Prize in Medicine or Physiology for his technique for suturing blood vessels. In the 1930s, he collaborated with the aviator Charles Lindbergh to invent a mechanical heart that circulated vital fluids through excised organs. Various organs and animal tissues were kept alive for many years in this fashion.

Throughout the 1940s and 50s, small but steady research advances were made. In 1958, Dickinson Richards, MD, chairman of the Columbia University Medical Division, and Andre Cournaud were awarded the same Nobel Prize for their work leading to fuller understanding of the physiology of the human heart using cardiac catheterization.

In that same year, Keith Reemtsma, MD, a member of the faculty of Tulane University who later became chairman of the Department of Surgery at Columbia University Medical Center, showed for the first time that immunosuppressive agents would prolong heart transplant survival in the laboratory setting.

At this time, Norman Shumway, MD, Richard Lower, MD, and their associates at Stanford University Medical Center were embarking on the development of heart-lung machines, solving perfusion issues, and pioneering surgical procedures to correct heart valve defects. Key to their success was experimentation with “topical hypothermia,” the localized hyper-cooling of the heart which allowed the interruption of blood flow and gave the surgeons the proper blood-free environment and adequate time to perform the repairs. Next came “autotransplantation,” where the heart would be excised and resutured in place.

By the mid-1960s, the Shumway group was convinced that immunologic rejection was the only remaining obstacle to successful clinical heart transplantation. In 1967, Michael DeBakey, MD, implanted an artificial left ventricle device of his design in a patient at Baylor College of Medicine in Houston.

In 1967, a human heart from one person was transplanted into the body of another by a South African surgeon named Dr. Christiaan Barnard in Cape Town. In early December, Dr. Barnard’s surgical team removed the heart of a 25-year-old woman who had died following an auto accident and placed it in the chest of Louis Washkansky, a 55-year-old man dying of heart damage. The patient survived for 18 days. Dr. Barnard had learned much of his technique from studying with the Stanford group. This first clinical heart transplantation experience stimulated world-wide notoriety, and many surgeons quickly co-opted the procedure. However, because many patients were dying soon after, the number of heart transplants dropped from 100 in 1968, to just 18 in 1970. It was recognized that the major problem was the body’s natural tendency to reject the new tissues.

Over the next 20 years, important advances in tissue typing and immunosuppressant drugs allowed more transplant operations to take place and increased patients’ survival rates. The most notable development in this area was Jean Borel’s discovery of cyclosporine, an immunosuppressant drug derived from soil fungus, in the mid 1970s.

The cardiac transplant program at Columbia University Medical Center began in 1971 as part of an investigational surgery program initiated by Dr. Keith Reemtsma. At that time, Columbia University Medical Center was one of only a handful of medical centers in the nation actively engaged in cardiac transplant research. Columbia University Medical Center’s first cardiac transplant was performed by Dr. Reemtsma in 1977, when survival rates had begun to improve significantly. That patient survived for 14 months. Two additional transplants were performed that year. Initially Columbia University Medical Center accepted patients deemed too risky for transplantation by Stanford and the Medical College of Virginia, the only other medical centers in the country performing heart transplants.

Thanks to the persistence of pioneers in immunosuppression research, transplant patients have dramatically expanded life expectancies. The first immunosuppressant drugs used in organ transplantation were the corticosteroids. In 1983, Columbia University Medical Center became one of a small group of medical centers to initiate clinical trials of cyclosporine; approved for commercial use in November of that year, it is still the most commonly prescribed immunosuppressant used in organ transplantation. General information on the variety of medications that may be prescribed for you is found in the chapter on Medications in the section Care and Concerns after Your Operation.

In 1984, the world’s first successful pediatric heart transplant was performed at Columbia on a four-year-old boy. He received a second transplant in 1989 and lived until he succumbed to other health issues in 2006.

Also, in 1984, in Loma Linda, California, Leonard Bailey, MD, implanted a baboon heart into a 12-day-old girl who came to be known as “Baby Fae.” The infant survived for twenty days as the most famous recipient of xenographic transplantation. Throughout the decade of the 1980s and into the 90s, physicians continue to refine techniques for balancing dosages of immunosuppressant medications to protect the new heart yet allow the patient sufficient immunologic function to stave off infection. In 1994 a new drug, tacrolimus or FK-506, originally discovered in a fungus sample, was approved for immunosuppression in transplant patients. Newer formulations of cyclosporine now enable efficacy (effectiveness) at lower, less toxic dosages.

While research on transplantation issues continues, other techniques for the management and cure of heart disease are also under development. Some future directions include:

Coronary assist devices and mechanical hearts are being developed or perfected to perform the functions of live tissues. Artificial hearts have been under development since the 1950s. In 1966, Dr. DeBakey first successfully implanted a booster pump as a temporary assist device. Columbia’s cardiac surgeons have been instrumental in the development of a LVAD (left ventricular assist device) to function as a bridge-to-transplantation for those waiting for a new heart to become available. Columbia University Medical Center’s lead role in the REMATCH clinical trial helped to lead to approval for the the LVAD as a permanent, or destination, therapy as well.

In 1969, Dr. Denton Cooley implanted the first completely artificial heart in a human, again on a temporary basis. The first permanent artificial heart, designed by Dr. Robert Jarvik, was implanted in 1982. Numbers of patients have received Jarvik or other artificial hearts since, but surviving recipients have tended to suffer strokes and related problems.

There is a tremendous gap in the number of patients waiting for new hearts and the number of organs that actually become available. In addition to avoiding the immunosuppression and rejection complications of transplantation, success in clinical application of such mechanical devices can help resolve the issue of organ availability and thus, stakes are high to continue research in this arena.

Advances in immunosuppression have most recently involved the development and expanded use of polyclonal and monoclonal antibodies to counteract steroid-resistant rejection. Research continues into the management, reversal and avoidance of accelerated atherosclerosis in the transplanted heart, believed to be caused or aggravated by the required suppression of the body’s normal immunology. From the development of more powerful and specific immunosuppressants to new treatments for accelerated graft atherosclerosis, advances in the science of immunology appear to hold the key to expanding the success of heart transplantation in our treatment of end-stage cardiac disease.

If your ticker needs an update, or you are just feeling a little BLAH, go to HealthLynked to find a physician near you. It is a first of its kind medical network built as a social ecosystem with a higher purpose – improving healthcare. Go to HealthLynked.com to learn more, sign up for free, connect with your doctor, find a new doctor, and securely store and share your health information. Download our HealthLynked app available on Apple and Android devices.

Sources

UCLAnewsroom.edu

Wired.com

Columbiasurgery.org

Title:  The Beat Goes On | Heart Transplants a Marvel of Modern Medicine

Happiness Goes Viral

What is it about laughter that’s contagious? Sometimes you just can’t stop from smiling when you hear or see it. Last September, an elderly couple from Iowa infused the internet with laughter and joy. Their random act of happiness at Mayo Clinic hit You Tube and made more than 6 million people smile. And that, say Francis and Marlow Cowan, is what keeps them young.

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To find a healthcare professional, use HealthLynked. It is a first of its kind medical network built as a social ecosystem with a higher purpose – improving healthcare. Go to HealthLynked.com to learn more, sign up for free, connect with your doctor, find a new doctor, and securely store and share your health information. Download our HealthLynked app available on Apple and Android devices.

11 Ways Laughter IS the Best Medicine, and It IS Contagious !

Do you remember that last time you had a good, hearty, deep from your very soul laugh? For my family, it was last night while we enjoyed fireworks with friends over the lake in anticipation of the 4th of July celebration. Josh Billings said, “Laughter is the fireworks of the soul”; and great wisdom can be found in Proverb (17:22): “A cheerful heart is good medicine, but a broken spirit saps a person’s strength.”

There are tremendous health benefits found in laughing – it strengthens your immune system, triggers the release of endorphins that lift your mood, helps protect your heart, diminishes pain and protects you by reducing effects of stress.

One of the best feelings in the world is that deep belly laugh – to have one and even to hear it in others. While the ability to laugh is a powerful health resource, mentally, emotionally and physically. it can also bring people together and establish amazing connections. Everything from a slight giggle to a side-splitting guffaw can change the atmosphere of a room from chilly unfamiliarity to warm and family-like. Studies have shown a strong, positive bond is created when we laugh with one another.

So, when was the last time you found yourself laughing out loud? Hopefully, you are one of the fortunate ones that has enjoyed the delights of laughing recently – and the powerful preventive benefits its joy offers. There is so much to love about laughter and many ways it promotes wellness and wellbeing in everyday life, at home, work and at play.

What is laughter?

While the brain mechanisms behind laughing (and smiling) remain a mystery, it is often a spontaneous response to humor or other visual, auditory, or emotional stimuli. And, too, it can occur on command—as either voluntary or contrived.

When we laugh, air is forced through the vocal cords as a result of chest wall contractions, in particular from the diaphragm. It is often followed by a deep inspiration of air. Thus, laughter recruits a number of muscles—respiratory, laryngeal, and facial. And when “exuberant,” it can also involve the arms and legs.

When do humans begin laughing?

Our first laugh typically occurs between 3 to 4 months of age—even before we learn to speak! It is believed that a baby’s laugh serves as a way to communicate, bond, and, too, explore sound and vocalization.
There is already so much to love for laughter that it seems greedy to look for more, but that’s exactly what researchers Dr. Lee Berk and Dr. Stanley Tan at the Loma Linda University in California have done. These two doctors have researched the benefits of laughter and found amazing results.

1. Lowers blood pressure
People who lower their blood pressure, even those who start at normal levels, will reduce their risk of stroke and heart attack. So, grab the Sunday paper, flip to the funny pages, and enjoy your laughter medicine, or pull up the latest memes in social media. Of even better, watch your favorite funny movie.

2. Reduces stress hormone levels
By reducing the level of stress hormones, you’re simultaneously cutting the anxiety and stress that impacts your body. Additionally, the reduction of stress hormones may result in higher immune system performance. Just think: Laughing along as a co-worker tells a funny joke can relieve some of the day’s stress and help you reap the health benefits of laughter.

Psychologically, having a good sense of humor—and applying it by laughing—may permit us to have a better perspective on things by seeing situations in a “more realistic and less threatening light.” Physically, laughter can put a damper on the production of stress hormones—cortisol and epinephrine—as well as trigger the release of endorphins. Endorphins are our body’s natural painkillers and can boost our mood. And, too, it has been shown that a good LOL or ROTFL — texting slang for “laugh out loud” or “rolling on the floor laughing” — can relax our muscles for up to 45 minutes after.

3. Works your abs
One of the benefits of laughter is that it can help you tone your abs. When you are laughing, the muscles in your stomach expand and contract, similar to when you intentionally exercise your abs. Meanwhile, the muscles you are not using to laugh are getting an opportunity to relax. Add laughter to your ab routine and make getting a toned tummy more enjoyable.

4. Improves cardiac health
Laughter is a great cardio workout, especially for those who are incapable of doing other physical activity due to injury or illness. It gets your heart pumping and burns a similar number of calories per hour as walking at a slow to moderate pace. So, laugh your heart into health.

The American Heart Association states that laughter can help our hearts. Research shows that by decreasing stress hormones, we can see a decrease in blood pressure as well as artery inflammation and bad cholesterol levels. Elevated blood pressure forces our heart to work harder in order to generate the force needed to pump against the increased resistance. And inflammation and high cholesterol contribute to the development of fatty plaques that decrease blood flow to the heart, or, even, complete blockage that can cause a heart attack.

5. Boosts T-cells
T-cells are specialized immune system cells just waiting in your body for activation. When you laugh, you activate T-cells that immediately begin to help you fight off sickness. Next time you feel a cold coming on, add chuckling to your illness prevention plan.

6. Triggers the release of endorphins
Endorphins are the body’s natural painkillers. By laughing, you can release endorphins, which can help ease chronic pain and make you feel good all over.

7. Produces a general sense of well-being
Laughter can increase your overall sense of well-being. Doctors have found that people who have a positive outlook on life tend to fight diseases better than people who tend to be more negative. Smile, laugh, and live longer!

8. Improves bonding
There has been much written that laughter is not primarily about humor, but, instead, social relationships. When we laugh, we create a positive emotional climate and a sense of connection between two people. In fact, with romantic partners, shared laughter—when you laugh together—is an indicator of relationship well-being, in that it enhances closeness and perceptions of partner supportiveness.

9. Can shed pounds
In a study published in the International Journal of Obesity, researchers found that 15 minutes of genuine laughter burns up to 40 calories, depending on the individual’s body weight and laughter intensity. While this cannot replace aerobic physical activity, 15 minutes of daily LOL, over the course of a year, could result in up to 4 fewer pounds.

10. Enhances our ability to fight off germs
Laughter increases the production of antibodies—proteins that surveillance for foreign invaders—as well as a number of other immune system cells. And, in doing so, we are strengthening our body’s defenses against germs. Additionally, it is a well-known fact that stress weakens our immune system. And because laughing alleviates our body’s stress response, it can help dampen its ill-effects.

11. A natural pain-killer
The iconic Charlie Chaplin stated: “Laughter is the tonic, the relief, the surcease for pain.” Although Mr. Chaplin probably meant this figuratively, laughter can literally relieve pain by stimulating our bodies to produce endorphins — natural painkillers. Laughter may also break the pain-spasm cycle common to some muscle disorders. The best part: You do not need a prescription and there are no known side-effects.

Is it contagious?

Yes. The saying “laugh and the whole world laughs with you” is not just figurative, it is literal. When we hear laughter, it triggers an area in our brain that is involved in moving the muscles in our face, almost like a reflex. This is one of the reasons television sitcoms have laugh tracks—a separate soundtrack that contains the sound of audience laughter. We are more likely to find the joke or situation funny and chuckle, giggle, or guffaw.

How to use laughter to heal and uplift.

Laughter is a physical expression of pleasant emotions among human beings. It is preceded by what one sees, hears or feels. When shared, it serves to connect people and increases intimacy and is a good anti-stress medicine.

LOL or lol, has become a very popular element of internet communications and texting in expressing great amusement in a chat. As well, according to research, the smiling and “tears of joy” laughing emoji faces are tops in digital communications. Their usage is so widespread and so common, that we now actually have data that demonstrates that the use and placement of emojis carries an emotional weight which impacts our perception of the messages that frame these icons (understanding the mental states of others is crucial to communication). And yes, in today’s busy world we may be utilizing =D and LOL’s at every turn, but let’s lean in to the hilarious and enjoy the good, hearty health benefits of laughter.

And remember, know when not to laugh. Laughter at the expense of others or in hurtful situations is inappropriate.

Now, make a commitment to laugh more.

In his book, The Travelers Gift, Andy Andrews challenges the traveler to start each day with laughter within moments of waking. It changes your whole being, even if you only laugh for seven seconds. I have tried it. I have faked it, and even as I start with the fake laugh, I can’t stop after seven seconds.

Practice laughing by beginning with a smile and then enact a laugh. Although it may feel contrived at first, with practice, it will likely become spontaneous. At Laughter University (yes, there is one) they encourage at least 30 seconds. There is so much going on around us that is laughable!

We can also move towards laughter by being with those who laugh and return the favor by making them laugh. And, too, surround ourselves with children and pets. On average, children laugh 300 times a day! And we know that laughter is contagious. Studies have shown people are immensely happier just seeing a picture of a dog!

Even make an effort to find the humor in an unpleasant situation, especially with situations that are beyond our control.

For all this, you will be made glad. Laughter wipes away stress, decreases blood pressure, burns calories, alleviates pain, connects us to others, reinvigorates us with hope, helps ward off germs … (the list goes on) – and feels soooo good. LOL for better health, connection and joy!

Want to find a physician who tickles your funny bone or at least knows where it is? To find a healthcare professional, use HealthLynked. It is a first of its kind medical network built as a social ecosystem with a higher purpose – improving healthcare. Go to HealthLynked.com to learn more, sign up for free, connect with your doctor, find a new doctor, and securely store and share your health information. Download our HealthLynked app available on Apple and Android devices.

Sources:
Gaiam.com
laughteronlineuniveristy,com
Dr. Nina Radcliff, Laugh, giggle, be joyful — for lol; ‘The fireworks of the soul’. Washington Post

The Truth About Coffee

Sure the smell of bacon in the morning is great and all, but nothing beats coffee. Let’s get down to the facts: Is coffee good or bad for you? Get the answer to this and more of your coffee questions.

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To find a healthcare professional, use HealthLynked. It is a first of its kind medical network built as a social ecosystem with a higher purpose – improving healthcare. Go to HealthLynked.com to learn more, sign up for free, connect with your doctor, find a new doctor, and securely store and share your health information. Download our HealthLynked app available on Apple and Android devices.

Make the Difference: Preventing Medical Trainee Suicide

Pressure in the high-stakes environment of medical training can be overwhelming. This video from Mayo Clinic and the American Foundation for Suicide Prevention explains how everyone can help prevent suicide by being alert for the signs of depression and escaping stress and how to be most helpful.

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To find like minded healthcare professionals, use HealthLynked. It is a first of its kind medical network built as a social ecosystem with a higher purpose – improving healthcare. Go to HealthLynked.com to learn more, sign up to be an in-network provider, connect with your fellow consituents, and securely share health records with your patients. Download our HealthLynked app available on Apple and Android devices.

Relativity, Radiology and 6 Things You May not Know About Einstein

More than any other profession, radiologists and radiologic technologists put theoretical quantum physics to practical use Improving the health and lives of their patients. Although quantum light theory can explain everything from the tiniest subatomic particles to immense galaxy-devouring black holes, radiologists apply this technology at the human level to diagnose and treat disease and thus alleviate human suffering.

More than 100 years ago in 1895, Wilhelm Conrad Roentgen discovered a form of radiation which had strange new properties. These new rays were so unique and mysterious that he named them “X-rays”, for the unknown. Although often described as a fortuitous discovery, chance favors the prepared mind, and Roentgen’s astute observations back then are still accurate today.

X-rays

6 Things You May not Know About Einstein
Digital portrait of Wilhelm Roentgen holding a cathode ray tube. Image by Mark Hom
  • transmit in complete darkness
  • invisible to the human eye
  • originate from a cathode ray tube
  • expose covered photographic plates
  • diminish in intensity following the inverse square law of light emission
  • soft tissues appear trans­parent, but metal and bone appear opaque.
  • transparency of intervening objects depends on their molecular density and thickness
  • not reflected by mirrors nor deflected by glass prisms
  • travel at a constant speed – the speed of light
  • share some properties with visible light, yet also have uniquely different properties

For the very first time, doctors (without using a scalpel) could see beyond the skin surface of their patients and peer deep inside the human body. It was later found that X-rays were a form of electromagnetic radiation with wavelengths shorter and with energies greater than visible light.

Subsequent research into particle theory by Albert Einstein and others led to the physics principles that not only laid the groundwork for state-of-the-art medical imaging but also changed the understanding of our entire universe, from the mechanics of the atom to the largest objects in the universe. In 1901, Roentgen received the very first Nobel Prize awarded in physics, an indication that his discovery of a form of invisible light was the beginning of a remarkable scientific journey.

Albert Einstein

Albert Einstein’s theories of relativity soon followed and would explain the space time continuum and the equivalence of mass and energy. Throughout his brilliant career, Einstein was fascinated and preoccupied with the strange properties of light. Einstein once said, “For the rest of my life I will reflect on what light is.”

His concept of special relativity came to him when he was riding his bicycle towards a lamp post. He realized that the speed of light was the only constant for all observers and that the classic Newtonian measurements of mass, distance, and time were all subject to change at velocities approaching the speed of light. Einstein’s relativity means that the science fiction adventures of galaxy-hopping space travel in Star Trek and Star Wars are mere fantasy. The vast distances of space and the universal speed limit of light make intergalactic travel too impractical. If a hypothetical space craft approaches the speed of light, time slows, length compresses, the mass of the space craft increases, and impossibly high amounts of energy are required. At a certain point, the space craft stops accelerating, despite greater and greater energy input.

A result of Einstein’s special theory of relativity has been called the most famous equation in all of science. Energy (E) equals mass (m) multiplied by the speed of light squared (c2), that is E=mc2. This simple equation, which states that energy and mass are interchangeable quantities, is often misinterpreted as the formula of the atomic bomb. The principle of the atomic bomb is bom­bardment of a uranium atom with a neutron that splits the uranium atom into two smaller atoms and more neutrons that trigger a fission chain reaction. Although tremendous energy is released, it is the energy of internuclear binding forces, and there is no appreciable change in mass.

A much better demonstration of E=mc2 is the physics of positron emission tomography (PET scan­ning), in which an electron and positron (the antiparticle of an electron) annihilate each other and convert their masses into pure light energy, consisting of photons traveling in opposite directions. This light is detected and calculated as a three-dimensional image of the patient. Einstein was another founder of radiology because his theory of the Photoelectric Effect (published in 1905 and awarded the Nobel Prize in 1921) explained how X-rays interact with matter. This theory also showed that light was absorbed and emitted in discreet packets of energy, leading to the Quantum Theory revolution in physics. 6 Things You May not Know About Einstein

Here are a few more interesting things to know about Einstein’s theory of relativity:

  1. Einstein relied on friends and colleagues to help him develop his theory. 
    Though the theory of general relativity is often presented as a work of solo genius, Einstein actually received considerable help from several lesser-known friends and colleagues in working on the math behind it. College friends Marcel Grossmann and Michele Basso (Einstein supposedly relied on Grossmann’s notes after skipping class) were especially important in the process. Einstein and Grossman, a math professor at Swiss Polytechnic, published an early version of the general relativity theory in 1913, while Besso—whom Einstein had credited in the acknowledgments of his 1905 paper on the special theory of relativity—worked extensively with Einstein to develop the general theory over the next two years. The work of the great mathematicians David Hilbert—more on him later—and Emmy Noether also contributed to the equations behind general relativity. By the time the final version was published in 1916, Einstein also benefited from the work of younger physicists like Gunnar Nordström and Adriaan Fokker, both of whom helped him elaborate his theory and shape it from the earlier version.
  2. The early version of the theory contained a major error. 
    The version published by Einstein and Grossmann in 1913, known as the Entwurf (“outline”) paper, contained a major math error in the form of a miscalculation in the amount a beam of light would bend due to gravity. The mistake might have been exposed in 1914, when German astronomer Erwin Finlay Freundlich traveled to Crimea to test Einstein’s theory during the solar eclipse that August. Freundlich’s plans were foiled, however, by the outbreak of World War I in Europe. By the time he introduced the final version of general relativity in November 1915, Einstein had changed the field equations, which determine how matter curves space-time.
  3. Einstein’s now-legendary paper didn’t make him famous—at first. 
    The unveiling of his masterwork at the Prussian Academy of Sciences—and later in the pages of Annelen Der Physik—certainly afforded Einstein a great deal of attention, but it wasn’t until 1919 that he became an international superstar. That year, British physicist Arthur Eddington performed the first experimental test of the general relativity theory during the total solar eclipse that occurred on May 29. In an experiment conceived by Sir Frank Watson Dyson, Astronomer Royal of Britain, Eddington and other astronomers measured the positions of stars during the eclipse and compared them with their “true” positions. They found that the gravity of the sun did change the path of the starlight according to Einstein’s predictions. When Eddington announced his findings in November 1919, Einstein made the front pages of newspapers around the world.
  4. Another scientist (and former friend) accused Einstein of plagiarism. 
    In 1915, the leading German mathematician David Hilbert invited Einstein to give a series of lectures at the University of Gottingen. The two men talked over general relativity (Einstein was still having serious doubts about how to get his theory and equations to work) and Hilbert began developing his own theory, which he completed at least five days BEFORE Einstein made his presentation in November 1915. What began as an exchange of ideas between friends and fellow scientists turned acrimonious, as each man accused the other of plagiarism. Einstein, of course, got the credit, and later historical research found that he deserved it: Analysis of Hilbert’s proofs showed he lacked a crucial ingredient known as covariance in the version of the theory completed that fall. Hilbert actually didn’t publish his article until March 31, 1916, weeks after Einstein’s theory was already public. By that time, historians say, his theory was covariant.
  5. At the time of Einstein’s death in 1955, scientists still had almost no evidence of general relativity in action. 
    Though the solar eclipse test of 1919 showed that the sun’s gravity appeared to bend light in the way Einstein had predicted, it wasn’t until the 1960s that scientists would begin to discover the extreme objects, like black holes and neutron stars, that influenced the shape of space-time according to the principles of general relativity. Until very recently, they were still searching for evidence of gravitational waves, those ripples in the fabric of space-time caused (according to Einstein) by the acceleration of massive objects. In February 2016, the long wait came to an end, as scientists at the Laser Interferometer Gravitational Wave Observatory (LIGO) announcedthey had detected gravitational waves caused by the collision of two massive black holes.
  6. You can thank Einstein for GPS. 
    Though Einstein’s theory mostly functions among things like PET scanners and in the black holes and cosmic collisions of the heavens, on an ultra-small scale (think string theory), it also plays a role in our everyday lives. GPS technology is one outstanding example of this. General relativity shows that the rate at which time flows depends on how close one is to a massive body. This concept is essential to GPS, which takes into account the fact that time is flowing at a different rate for satellites orbiting the Earth than it is for us on the ground. As a result, time on a GPS satellite clock advances faster than a clock on the ground by about 38 microseconds a day. This might not seem like a significant difference, but if left unchecked it would cause navigational errors within minutes. GPS compensates for the time difference, electronically adjusting rates of the satellite clocks and building mathematical functions within the computer to solve for the user’s exact location—all thanks to Einstein and relativity.

Quantum Theory

Following Einstein’s ideas that light was transmitted in packets of energy, Niels Bohr and Werner Heisenberg developed a model of the atom that diverged from classic Newtonian physics. The Rutherford atomic model consisting of electrons orbiting the central nucleus was inadequate because charged particles changing direction in an orbit would lose energy and fall into the nucleus. Bohr’s model had to explain the Photoelectric Effect, chemical reactions, and the inherent stability of atoms.

A carbon atom can undergo countless chemical reactions yet remains a carbon atom. As Bohr further investigated the atom, the simplistic idea of light just being a wave and electrons just being particles was no longer valid. With the Photoelectric Effect, Einstein showed that light could be a photon particle. Louis de Broglie then showed that particles could be waves. Both photons and electrons have particle-wave duality. The electron therefore could exist as a standing wave around the nucleus, absorb and emit quanta of light energy, and yet remain stable.

The paradoxes that resulted from Bohr’s quantum theory shook the foundations of science. Werner Heisenberg found that the method of investiga­tion alters the result of an experiment. He explained this idea mathematically in his Uncertainty Principle, which remains a major tenet of quantum mechanics. The light used to measure particles imparts energy, altering the momentum or location of the particles, thus changing the results by the mere act of obser­vation. An experiment can be designed to measure either momentum or location precisely, but not both (the experimenter must choose).

“The violent reaction on the recent development of modern physics can only be understood when one realizes that here the foundations of physics have started moving; and that this motion has caused the feeling that the ground would be cut from science.” – Werner Heisenberg

This finding was unsettling for physicists who strove for precise measurements, because precision was not possible at the atomic and subatomic levels. Heisenberg showed that every experiment (and radiologic examination) is subject to limitation. Einstein objected to this inherent fuzziness, stating that “God does not play dice with the Universe.”

The Doppler Effect

Christian Doppler was a professor who studied mathematics, physics, and astronomy. He published a paper on spin­ning binary star systems, noting that starlight shifts to the violet spectrum when a star is moving toward an observer on Earth, and that starlight shifts to the red when a star is moving away. The explanation was that the wavelength of the light wave was compressed or elongated depending on the motion of the source relative to the observer.

When the Doppler Effect is applied to sound, it explains the tone of an approaching or departing train whistle; when applied to radar it pre­dicts violent weather; when applied to ultrasound (another radiology modality) it determines the direction and velocity of blood flow; and when applied to distant starlight it explains our expanding (red shifted) universe. Using Doppler ultrasound, a technologist can screen for: the risk of stroke from carotid artery stenosis, renal arterial causes of hypertension, abdominal aortic aneurysms, periph­eral vascular disease, deep vein thrombosis, portal vein thrombosis and varices, and post-catheterization pseudo-aneurysms.

Countless lives have been saved or improved because of a phenomenon originally observed in starlight. Doppler’s idea extends well beyond the sonography suite and even tells us about the origins of our universe. Edwin Hubble demonstrated that all objects observed in deep space have a Doppler red-shifted veloc­ity that is proportional to the object’s distance from the Earth and all other interstellar bodies. This tells us that our universe is expanding and supports the theory that the universe was created by the Big Bang, which occurred about 13.7 billion years ago.

Old Master Painters

Artists such as Rembrandt and Vermeer (17th century) were adept at depicting light to create the illusion of realistic three-dimensional subjects on two dimensional canvases. These artists studied the interaction of light with their models and understood visual percep­tion of subtle shading and light to make their artwork dramatic and convincing.

Rembrandt van Rijn’s famous por­traits and self-portraits displayed skill with light source positioning and intensity, later duplicated by movie director Cecil B DeMille who coined the term “Rembrandt lighting,” a technique that is still used today by portrait photographers. Johannes Vermeer was skilled at depicting subjects in naturally lit interiors with a subtle photorealistic style that is con­sidered uncanny even today.

Some believe Vermeer used special optics and mirrors because his depiction of light was too subtle for the naked eye to detect.  For example, scientific analysis showed that his backgrounds demonstrated the inverse square law, with exponential diffusion of light, which is difficult to capture when using only an artistic eye.

Experienced radiologic technologists use artistic vision when they create radiographs. By positioning and framing their subjects and by adjusting contrast and exposure, each image can be a work of art, not only pleasing to the eye but also containing a wealth of infor­mation.

Light as the Medium for Medical Imaging

Light, as visual information, is portrayed in art. Light also is the medium for medical imaging, whether in the form of a backlit film, cathode ray tube monitor, liquid crystal display screen, or plasma monitor. The eye is our most complex and highly evolved sense organ, capable of detecting subtle changes in light and color, and transferring this information (via the optic nerves and optic tracts) to the visual cortex of our occipital lobes.

However, what distinguishes artists and seasoned radiology professionals from other people is post-pro­cessing (i.e., the thinking that occurs after perceiving visual data). Much of science and medicine is about logic, language, analysis, and categorization (left brain functions). However, visual processing (the artistic eye) is about conceptualization, spatial orientation, and pattern recognition (right brain functions). These right brain skills are harder to teach and measure but are just as important in radiology.

With the rapid increases in digital image resolution and in the number of multi-planar images involved with each case, developing the right brain is crucial to make sense of this visual information overload. Knowingly or unknowingly, seasoned radiologists develop the right side of their brains through the experience of viewing thousands of medical images. This “artistic eye” can be further enhanced in radiolo­gists and radiologic technologists who appreciate the techniques used by great artists. Or better yet, they can train their right brains by creating original art themselves.

Conclusion

Radiologists and radiologic technologists use light technology and artistic vision in their daily work. They sense subtle shades, recognize patterns, and use symmetry and bal­ance to detect abnormalities. When this artistic skill is applied in combination with an appreciation for the underlying physics that created the images, a thorough knowledge of human anatomy, and an understanding of the pathophysiology of disease, they serve their patients by providing timely diagnosis and excellent medical care.

Sources:  This is the synthesis of two articles:

[1]  PRUITT, SARAH.  6 Things You Might Not Know About Einstein’s General Theory of Relativity, MARCH 18, 2016, History.com

[2]  Hom, Mark. Radiology: Combining Quantum Theory, Medicine, and Artistic Vision, http://scitechconnect.elsevier.com/radiology-quantum-theory-medicine, January 25, 2016

More Information

For more about Dr. Hom’s writings, concepts, and artwork, please refer to his recent articles and book:

The Art and Science of Light: An Illustrated Retrospective, Mark Hom, Radiologic Technology, July/Aug 2015 86 (6), 702-708.
The Artistic Eye and the Radiologist, Mark Hom, American Roentgen Ray Society, Senior Radiologists Section Notes, Fall 2014.
The Science of Fitness: Power, Performance, and Endurance, Greg LeMond and Mark Hom, Publisher: Elsevier, December 2014.

This article first appeared on Memeburn.com

Dr. Mark Hom is a Johns Hopkins University trained biologist, an award-winning medical illustrator, an interventional radiologist, an educator of young doctors, an Elsevier author, and an avid fitness cyclist. Dr. Hom’s work with Greg LeMond in their recent book The Science of Fitness: Power, Performance, and Endurance explains how the human body, various organ systems, and individual cells function in the biologic process of exercise. He is currently a member of the Department of Radiology at Virginia Commonwealth University in Richmond, VA, USA.

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Antibody helps detect protein implicated in Alzheimer’s, other diseases

May lead to novel ways to diagnose, monitor brain injury

by Tamara Bhandari•April 19, 2017

Researchers use mouse brains (above) to study ways to measure the brain protein tau, which plays a role in neurodegenerative diseases such as Alzheimer’s. A team led by scientists at Washington University School of Medicine in St. Louis has found a way to measure tau levels in the blood. The study, in mice and a small group of people, could be the first step toward a noninvasive test for tau

Damaging tangles of the protein tau dot the brains of people with Alzheimer’s and many other neurodegenerative diseases, including chronic traumatic encephalopathy, which plagues professional boxers and football players. Such tau-based diseases can lead to memory loss, confusion and, in some, aggressive behavior. But there is no easy way to determine whether people’s symptoms are linked to tau tangles in their brains.

Now, however, a team led by scientists at Washington University School of Medicine in St. Louis has found a way to measure tau levels in the blood. The method accurately reflects levels of tau in the brain that are of interest to scientists because they correlate with neurological damage. The study, in mice and a small group of people, could be the first step toward a noninvasive test for tau.

While further evaluation in people is necessary, such a test potentially could be used to quickly screen for tau-based diseases, monitor disease progression and measure the effectiveness of treatments designed to target tau.

The research is published April 19 in Science Translational Medicine.

“We showed that you can measure tau in the blood, and it provides insight into the status of tau in the fluid surrounding cells in the brain,” said senior author David Holtzman, MD, the Andrew B. and Gretchen P. Jones Professor and head of the Department of Neurology at Washington University School of Medicine in St. Louis.

Tau is a normal brain protein involved in maintaining the structure of neurons. But when tau forms tangles, it damages and kills nearby neurons.

“People with tau diseases have a wide range of symptoms because basically, wherever tau is aggregating, those parts of the brain are degenerating,” Holtzman said. “So if it’s in a memory area, you get memory problems. If it’s in a motor area, you get problems with movement.”

A blood-based screening test, likely years away, would be a relatively easy way to identify people whose symptoms may be due to problems with tau, without subjecting them to potentially invasive, expensive or complicated tests.

“We have no test that accurately reflects the status of tau in the brain that is quick and easy for patients,” Holtzman said. “There are brain scans to measure tau tangles, but they are not approved for use with patients yet. Tau levels can be measured in the cerebrospinal fluid that surrounds the brain and spinal cord, but in order to get to that fluid, you have to do a spinal tap, which is invasive.”

In the brain, most tau proteins are inside cells, some are in tangles, and the remainder float in the fluid between cells. Such fluid constantly is being washed out of the brain into the blood, and tau comes with it. However, the protein is cleared from the blood almost as soon as it gets there, so the levels, while detectable, typically remain very low.

Holtzman, postdoctoral researcher Kiran Yanamandra, PhD, and MD/PhD student Tirth Patel, along with colleagues from C2N Diagnostics, AbbVie, the University of California, San Francisco, and Texas Health Presbyterian Hospital, reasoned that if they could keep tau in the blood longer, the protein would accumulate to measurable levels. Allowing the protein to accumulate before measuring its levels would magnify – but not distort – differences between individuals, in the same way that enlarging a picture of a grain of sand alongside a grain of rice does not change the relative size of the two, but does make it easier to measure the difference between them.

The researchers injected a known amount of tau protein directly into the veins of mice and monitored how quickly the protein disappeared from the blood. The researchers showed that half the protein normally disappears in less than nine minutes. When they added an antibody that binds to tau, the half-life of tau was extended to 24 hours. The antibody was developed in the laboratories of Holtzman and Marc Diamond, MD, of the University of Texas Southwestern Medical Center, and is currently licensed to C2N Diagnostics, which is collaborating with the pharmaceutical company AbbVie in developing the technology.

To determine whether the antibody could amplify tau levels in an animal’s blood high enough to be measured easily, they injected the antibody into mice. Within two days, tau levels in the mice’s blood went up into the easily detectable range. The antibody acted like a magnifying glass, amplifying tau levels so that differences between individuals could be seen more easily.

Tau levels in people’s blood also rose dramatically in the presence of the antibody. The researchers administered the antibody to four people with a tau disease known as progressive supranuclear palsy. Their blood levels of tau rose 50- to 100-fold within 48 hours.

“It’s like a stress test,” Holtzman said. “We appear to be bringing out the ability to see what’s coming from the brain because the antibody amplifies differences by prolonging the time the protein stays in the blood.”

Measuring tau levels in the blood is only useful if it reflects tau levels in the brain, where the protein does its damage, the researchers said.

Both high and low levels of tau in the fluid that surrounds the brain could be a danger sign. Alzheimer’s and chronic traumatic encephalopathy both are associated with high levels of soluble tau, whereas progressive supranuclear palsy and other genetic tau diseases are thought to be associated with low levels.

To see whether elevated brain tau is reflected in the blood, the researchers treated mice with a chemical that injures neurons. The chemical causes tau to be released from the dying neurons, thereby raising tau levels in the fluid surrounding the cells. The scientists saw a corresponding increase of tau in the blood in the presence of the anti-tau antibody.

To lower tau levels, the researchers turned to genetically modified mice that, as they age, have less and less tau floating in their cerebrospinal fluid. Such mice at 9 months old had significantly lower tau levels in their blood than 3-month-old mice with the same genetic modification, again demonstrating the antibody’s ability to reflect levels of tau in the brain.

“It will be helpful in future studies to see if the measurement of tau in the blood following antibody treatment in humans reflects the state of tau in the brain,” Holtzman said.

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Yanamandra K, Patel TK, Jiang H, Schindler S, Ulrich JD, Boxer AL, Miller BL, Kerwin DR, Gallardo G, Stewart F, Finn MB, Cairns NJ, Verghese PB, Fogelman I, West T, Braunstein J, Robinson G, Keyser J, Roh J, Knapik SS, Hu Y, Holtzman DM. “Anti-tau antibody markedly increases plasma tau in mouse and man: Correlation with soluble brain tau.” Science Translational Medicine. April 19, 2017.

This work was supported by the National Institutes of Health (NIH), grant number NIH R01AG048678, C2N Diagnostics, the Tau Consortium and the JPB Foundation.

Holtzman and other authors on this paper developed the antibody used in this study and are inventors on a submitted patent “Antibodies to Tau” that is licensed by Washington University to C2N Diagnostics LLC. This patent subsequently was licensed to AbbVie. Yanamandra was a postdoctoral researcher at Washington University during the course of these studies and now is an employee at AbbVie.

Washington University School of Medicine‘s 2,100 employed and volunteer faculty physicians also are the medical staff of Barnes-Jewish and St. Louis Children’s hospitals. The School of Medicine is one of the leading medical research, teaching and patient-care institutions in the nation, currently ranked seventh in the nation by U.S. News & World Report. Through its affiliations with Barnes-Jewish and St. Louis Children’s hospitals, the School of Medicine is linked to BJC HealthCare.

MEDIA CONTACT
Diane Duke Williams, Associate Director for Media Relations

314-286-0111
[email protected]
WRITER
Tamara Bhandari, Senior Medical Sciences Writer

Tamara Bhandari covers pathology, immunology, medical microbiology, cell biology, neurology, and radiology. She holds a bachelor’s degree in molecular biophysics and biochemistry and in sociology from Yale University, a master’s in public health/infectious diseases from the University of California, Berkeley, and a PhD in infectious disease immunology from the University of California, San Diego.

P314-286-0122
[email protected]


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Multiple Myeloma

In the following video, Rafael Fonseca, M.D., Director of the Cancer Center at Mayo Clinic in Arizona, provides an overview of the condition Multiple Myeloma (a cancer that arises from the blood marrow) and describes treatment options.

source Mayo Clinic


About HealthLynked

Improving healthcare is the mission of HealthLynked. HealthLynked focuses on improving healthcare services for patients as well as physicians. Our technology shortens wait time with online scheduling of appointments, Real-time appointments by local providers and provides easy access to yours as well as your family’s updated medical records.

Appointments can be comfortably made online and providing your healthcare provider access to your medical files. The website also makes it possible to link together family members and provide access to critical information in case of an emergency.

To find a healthcare professional, use HealthLynked. It is a first of its kind medical network built as a social ecosystem with a higher purpose – improving healthcare. Go to HealthLynked.com to learn more, sign up for free, connect with your doctor, find a new doctor, and securely store and share your health information. Download our HealthLynked app available on Apple and Android devices.

What is Post-traumatic Stress Disorder? | PTSD Explained

Post-traumatic stress disorder (PTSD) is a mental disorder that can develop after a person is exposed to a traumatic event, such as sexual assault, warfare, traffic collisions, or other threats on a person’s life. Symptoms may include disturbing thoughts, feelings, or dreams related to the events, mental or physical distress to trauma-related cues, attempts to avoid trauma-related cues, alterations in how a person thinks and feels, and an increase in the fight-or-flight response. These symptoms last for more than a month after the event. Young children are less likely to show distress but instead may express their memories through play. A person with PTSD is at a higher risk for suicide and intentional self-harm.

Most people who have experienced a traumatic event will not develop PTSD. People who suffer interpersonal trauma (for example rape or child abuse) are more likely to develop PTSD, as compared to people who experience non-assault based trauma, such as accidents and natural disasters. About half of people develop PTSD following rape. Children are less likely than adults to develop PTSD after trauma, especially if they are under ten years of age. Diagnosis is based on the presence of specific symptoms following a traumatic event.

Prevention may be possible when therapy is targeted at those with early symptoms but is not effective when provided to all individuals whether or not symptoms are present. The main treatments for people with PTSD are counseling and medication. Some different types of therapy may be useful. This may occur one-on-one or in a group. Antidepressants of the selective serotonin reuptake inhibitor type are the first-line medications for PTSD and result in benefit in about half of people. These benefits are less than those seen with therapy. It is unclear if using medications and therapy together has more significant benefit. Other medications do not have enough evidence to support their use, and in the case of benzodiazepines, may worsen outcomes.

In the United States, about 3.5% of adults have PTSD in a given year, and 9% of people develop it at some point in their life. In much of the rest of the world, rates during a given year are between 0.5% and 1%. Higher rates may occur in regions of armed conflict. It is more common in women than in men. Symptoms of trauma-related mental disorders have been documented since at least the time of the ancient Greeks. During the World Wars, the condition was known under various terms including “shell shock” and “combat neurosis”. The term “posttraumatic stress disorder” came into use in the 1970s in large part due to the diagnoses of U.S. military veterans of the Vietnam War. It was officially recognized by the American Psychiatric Association in 1980 in the third edition of the Diagnostic and Statistical Manual of Mental Disorders


Signs and symptoms

What Posttraumatic stress disorder | PTSD

Service members use art to relieve PTSD symptoms.

Symptoms of PTSD generally begin within the first three months after the inciting traumatic event, but may not begin until years later. In the typical case, the individual with PTSD persistently avoids trauma-related thoughts and emotions, and discussion of the traumatic event, and may even have amnesia of the event. However, the event is commonly relived by the individual through intrusive, recurrent recollections, dissociative episodes of reliving the trauma (“flashbacks”), and nightmares. While it is common to have symptoms after any traumatic event, these must persist to a sufficient degree (i.e., causing dysfunction in life or clinical levels of distress) for longer than one month after the trauma to be classified as PTSD (clinically significant dysfunction or distress for less than one month after the trauma may be acute stress disorder).

Associated medical conditions

Drug abuse and alcohol abuse commonly co-occur with PTSD.  Recovery from post-traumatic stress disorder or other anxiety disorders may be hindered, or the condition worsened when substance use disorders are comorbid with PTSD. Resolving these problems can bring about improvement in an individual’s mental health status and anxiety levels.

Risk factors

What Posttraumatic stress disorder | PTSD

No quieren (They do not want to) by Francisco Goya (1746–1828) depicts an elderly woman wielding a knife in defense of a girl being assaulted by a soldier.

Persons considered at risk include combat military personnel, victims of natural disasters, concentration camp survivors, and victims of violent crime. Persons employed in occupations that expose them to violence (such as soldiers) or disasters (such as emergency service workers) are also at risk. Other occupations that are at higher risk include police officers, firefighters, ambulance personnel, health care professionals, train drivers, divers, journalists, and sailors, in addition to people who work at banks, post offices or in stores. The size of the hippocampus is inversely related to post-traumatic stress disorder and treatment success; the smaller the hippocampus, the higher risk of PTSD.


Trauma

PTSD has been associated with a wide range of traumatic events. The risk of developing PTSD after a traumatic event varies by trauma type and is highest following exposure to sexual violence (11.4%), particularly rape (19.0%). Men are more likely to experience a traumatic event, but women are more likely to experience the kind of high-impact traumatic event that can lead to PTSD, such as interpersonal violence and sexual assault.

Posttraumatic stress reactions have not been studied as well in children and adolescents as adults. The rate of PTSD may be lower in children than adults, but in the absence of therapy, symptoms may continue for decades. One estimate suggests that the proportion of children and adolescents having PTSD in a non-wartorn population in a developed country may be 1% compared to 1.5% to 3% of adults, and much lower below the age of 10 years. On average, 16% of children exposed to a traumatic event develop PTSD, varying according to type of exposure and gender.

Predictor models have consistently found that childhood trauma, chronic adversity, and familial stressors increase the risk for PTSD as well as risk for biological markers of risk for PTSD after a traumatic event in adulthood. Experiencing bullying as a child or an adult has been correlated with the development of PTSD. Peritraumatic dissociation in children is a predictive indicator of the development of PTSD later in life. This effect of childhood trauma, which is not well understood, may be a marker for both traumatic experiences and attachment problems. Proximity to, duration of, and severity of the trauma make an impact, and interpersonal traumas cause more problems than impersonal ones.

The risk of developing PTSD is increased in individuals who are exposed to physical abuse, physical assault, or kidnapping.  Women who experience physical violence are more likely to develop PTSD than men.

source https://en.wikipedia.org/wiki/Posttraumatic_stress_disorder


Diagnosis

To diagnose post-traumatic stress disorder, your doctor will likely:

Perform a physical exam to check for medical problems that may be causing your symptoms
Do a psychological evaluation that includes a discussion of your signs and symptoms and the event or events that led up to them
Use the criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association

Diagnosis of PTSD requires exposure to an event that involved the actual or possible threat of death, violence or serious injury. Your exposure can happen in one or more of these ways:

You directly experienced the traumatic event
You witnessed, in person, the traumatic event occurring to others
You learned someone close to you experienced or was threatened by the traumatic event
You are repeatedly exposed to graphic details of traumatic events (for example, if you are a first responder to the scene of traumatic events)

You may have PTSD if the problems you experience after this exposure continue for more than a month and cause significant problems in your ability to function in social and work settings and negatively impact relationships.


Treatment

Post-traumatic stress disorder treatment can help you regain a sense of control over your life. The primary treatment is psychotherapy, but can also include medication. Combining these treatments can help improve your symptoms by:

Teaching you skills to address your symptoms
Helping you think better about yourself, others and the world
Learning ways to cope if any symptoms arise again
Treating other problems often related to traumatic experiences, such as depression, anxiety, or misuse of alcohol or drugs

You don’t have to try to handle the burden of PTSD on your own.
Psychotherapy

Several types of psychotherapy, also called talk therapy, may be used to treat children and adults with PTSD. Some types of psychotherapy used in PTSD treatment include:

Cognitive therapy. This type of talk therapy helps you recognize the ways of thinking (cognitive patterns) that are keeping you stuck — for example, negative beliefs about yourself and the risk of traumatic things happening again. For PTSD, cognitive therapy often is used along with exposure therapy.
Exposure therapy. This behavioral therapy helps you safely face both situations and memories that you find frightening so that you can learn to cope with them effectively. Exposure therapy can be particularly helpful for flashbacks and nightmares. One approach uses virtual reality programs that allow you to re-enter the setting in which you experienced trauma.
Eye movement desensitization and reprocessing (EMDR). EMDR combines exposure therapy with a series of guided eye movements that help you process traumatic memories and change how you react to them.

Your therapist can help you develop stress management skills to help you better handle stressful situations and cope with stress in your life.

All these approaches can help you gain control of lasting fear after a traumatic event. You and your mental health professional can discuss what type of therapy or combination of therapies may best meet your needs.

You may try individual therapy, group therapy or both. Group therapy can offer a way to connect with others going through similar experiences.
Medications

Several types of medications can help improve symptoms of PTSD:

Antidepressants. These medications can help symptoms of depression and anxiety. They can also help improve sleep problems and concentration. The selective serotonin reuptake inhibitor (SSRI) medications sertraline (Zoloft) and paroxetine (Paxil) are approved by the Food and Drug Administration (FDA) for PTSD treatment.
Anti-anxiety medications. These drugs can relieve severe anxiety and related problems. Some anti-anxiety medications have the potential for abuse, so they are generally used only for a short time.
Prazosin. If symptoms include insomnia with recurrent nightmares, a drug called prazosin (Minipress) might help. Although not specifically FDA approved for PTSD treatment, prazosin may reduce or suppress nightmares in many people with PTSD.

You and your doctor can work together to figure out the best medication, with the fewest side effects, for your symptoms and situation. You may see an improvement in your mood and other symptoms within a few weeks.

Tell your doctor about any side effects or problems with medications. You may need to try more than one or a combination of medications, or your doctor may need to adjust your dosage or medication schedule before finding the right fit for you.

 Souce

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The Often Misunderstood Diagnosis of Post-Traumatic Stress Disorder

PTSD stands for Post-Traumatic Stress Disorder and is a condition that many veterans and non-veterans alike suffer; PTSD can occur when someone experiences or witnesses a traumatic event. This condition wasn’t always understood properly by the medical or military community, and Department of Defense press releases often point to earlier attempts to identify PTSD symptoms in the wake of service in World War 2, Vietnam, and other conflicts.

PTSD Awareness Day is observed today, Wednesday, June 27, 2018.

The History of PTSD Awareness Day

In 2010, Senator Kent Conrad pushed to get official recognition of PTSD via a “day of awareness” in tribute to a North Dakota National Guard member who took his life following two tours in Iraq.

Staff Sergeant Joe Biel died in 2007 after suffering from PTSD; Biel committed suicide after his return from duty to his home state. SSgt. Biel’s birthday, June 27, was selected as the official PTSD Awareness Day, now observed every year.

How Do People Observe Post-Traumatic Stress Disorder Awareness Day?

Much of what is done to observe PTSD Awareness Day involves encouraging open talk about PTSD, its’ causes, symptoms, and most important of all, getting help for the condition. When today, PTSD is often misunderstood by those lacking firsthand experience with the condition or those who suffer from it. PTSD Awareness Day is designed to help change that.

The Department of Defense publishes circulars, articles, and other materials to help educate and inform military members and their families about the condition. The Department of Veterans Affairs official site has several pages dedicated to PTSD, and when military members retiring or separating from the service fill out VA claim forms for service-connected injuries, illnesses, or disabilities, there is an option to be evaluated for PTSD as a part of the VA claims process.

What Is Post-Traumatic Stress Disorder?

The current American Psychiatric Association’s Diagnostic and Statistical Manual, DSM-IV, says PTSD can develop through a range of exposures to death or injury: direct personal involvement, witnessing it or, if it concerns someone close, just learning about it.  Post-traumatic stress disorder is a form of anxiety that can happen after experiencing or witnessing actual or near death, serious injury, war-related violence, terrorism or sexual violence.  While most people typically connect this disorder to military veterans or refugees, it can happen to anyone.

Almost no other psychiatric diagnosis has generated as much controversy.  The diagnosis is almost four decades old.  PTSD is not a sign of weakness, and people can be affected by PTSD even when they were not directly part of the traumatic event.

The specific nature of the trauma can and does vary greatly. Experts are quick to point out, while combat and combat-related military service can be incredibly challenging, and while witnessing or being a victim of an event that rips the fabric of daily life can be traumatic, not everyone responds the same way. Some may develop symptoms of PTSD, while others may be unaffected.

Post-Traumatic Stress Disorder: How Widespread Is It?

Some sources estimate that as many as 70% of all Americans have experienced a traumatic event sufficient to cause PTSD or PTSD-like symptoms. That does not mean that all 70% of Americans WILL suffer from PTSD. Using these statistics, some 224 million Americans have experienced a traumatic event. Of that number, some 20% will develop PTSD symptoms, roughly 44 million people.

Of that 44 million, an estimated eight percent experience active PTSD symptoms at any one time. An estimated 50% of all mental health patients are also diagnosed with Post-Traumatic Stress Disorder.

PTSD: Often Misunderstood and Misidentified

“Shell shock” and “combat shock” were earlier attempts to define and understand the symptoms of PTSD. Post-traumatic stress disorder was often stigmatized in popular culture after the Vietnam conflict, and many films and television shows featured antagonists or unsympathetic characters suffering from “Vietnam flashbacks” or other issues.

The misunderstanding of PTSD slowly began to change in 1980 when it was recognized as a specific condition with identifiable symptoms. It was then the disorder was listed in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM).

This manual is a diagnostic tool for mental health professionals and paraprofessional workers in the healthcare field and is considered a definitive reference. The addition of PTSD to the DSM was a highly significant development.

Today, the symptoms of Post Traumatic Stress Disorder are better understood, treatable, and recognized by the Department of Veterans Affairs as a service-connected condition. PTSD is not exclusive to veterans or currently serving members of the United States military, but a portion of those who serve are definitely at risk for PTSD.

What Are the Symptoms of Post-Traumatic Stress Syndrome?

Some PTSD symptoms may seem vague and non-specific, others are more readily identified specifically as evidence of PTSD. In this context “non-specific” means that the symptoms may be related to other mental health issues and not specifically limited to Post-Traumatic Stress Disorder.

In the same way, more “specific” symptoms may be manifest outside PTSD, but when looking for specific signifiers, these issues are common “red flags” that indicate PTSD may be the cause of the suffering rather than a different condition. This is often circumstantial, and there is no one-size-fits-all diagnosis for the condition.

Suicidal thoughts or self-destructive acts are often a result of PTSD or related symptoms. Anyone experiencing thoughts or urges to self-harm should seek immediate care to prevent the condition from getting worse in the short-term. (See below)

That said, more non-specific symptoms include varying degrees of irritability, depression, and suicidal feelings. More specific problems-especially where veterans and currently serving military members are concerned-include something known as “hypervigilance” or “hyperarousal”.

Other symptoms include repeatedly experiencing the traumatic event(s) in the form of flashbacks, nightmares, persistent memories of the event(s), and intrusive thoughts about the traumatic event(s).

These symptoms vary in intensity depending on the individual and are not ‘standardized”. They may come and go, or they may be persistent over a span of time. Sometimes PTSD sufferers can be high-functioning, other times they may be more debilitated by the condition.

Get Treatment For PTSD

Those who experience symptoms of PTSD or PTSD-like issues should seek help immediately. Department of Veterans Affairs medical facilities, private care providers, counselors, and therapists can all be helpful in establishing an initial care regimen or refer those suffering from PTSD to a qualified care provider.

The Department of Veterans Affairs has more information on help for PTSD on its’ official site including help finding a therapist.

Those experiencing suicidal feelings or self-destructive urges should get help immediately. The Suicide Crisis Hotline (1-800-273-8255) has a specific resource for veterans and the Department of Veterans Affairs offers a Veterans’ Crisis Hotline confidential chat resource.

To find a healthcare professional, use HealthLynked. It is a first of its kind medical network built as a social ecosystem with a higher purpose – improving healthcare. Go to HealthLynked.com to learn more, sign up for free, connect with your doctor, find a new doctor, and securely store and share your health information. Download our HealthLynked app available on Apple and Android devices.

Adapted from https://militarybenefits.info/ptsd-awareness-day/

“Doing It My Way, Testing for HIV” | HIV Testing Day 2018

National HIV Testing Day (NHTD) is an annual observance encouraging people of all ages to get tested for HIV and to know their status.  Too many people are unaware they have HIV. At the end of 2014, an estimated 1.1 million persons aged 13 and older were living with HIV infection in the United States, including an estimated 166,000 (15%, or 1 in 7) persons whose infections had not been diagnosed.

Getting tested is the first step to finding out if you have HIV. If you have HIV, getting medical care, taking medicines regularly and changes in behavior help you live a longer, healthier life and will lower the chances of passing HIV on to others.

Testing is the only way for the Americans living with undiagnosed HIV to know their HIV status and get into care. CDC estimates that more than 90% of all new infections could be prevented by proper testing and linking HIV positive persons to care. HIV testing saves lives! It is one of the most powerful tools in the fight against HIV

How do I know if I am at risk to get HIV? 

Knowing your risk can help you make important decisions to prevent exposure to HIV.  Overall, an American has a 1 in 99 chance of being diagnosed with HIV at some point in his or her lifetime. However, the lifetime risk is much greater among some populations. If current diagnosis rates continue the lifetime risk of getting HIV is:

  • 1 in 6 for gay and bisexual men overall
  • 1 in 2 for African American gay and bisexual men
  • 1 in 4 for Hispanic gay and bisexual men
  • 1 in 11 for white gay and bisexual men
  • 1 in 20 for African American men overall
  • 1 in 48 for African American women overall
  • 1 in 23 for women who inject drugs
  • 1 in 36 for men who inject drugs

Your health behaviors also affect your risk. You can get or transmit HIV only through specific activities. HIV is commonly transmitted through anal or vaginal sex without a condom or sharing injection and other drug injection equipment with a person infected with HIV. Substance use can increase the risk of exposure to HIV because alcohol and other drugs can affect your decision to use condoms during sex. To learn more about your HIV risk and ways to reduce these risks, visit: https://wwwn.cdc.gov/hivrisk/

How do HIV, Viral Hepatitis, and STDs relate to each other? 

Persons who have an STD are at least two to five times more likely than uninfected persons to acquire HIV infection if they are exposed to the virus through sexual contact. In addition, if a person who is HIV positive also has an STD, that person is more likely to transmit HIV through sexual contact than other HIV-infected persons.

Hepatitis B virus (HBV) and HIV are bloodborne viruses transmitted primarily through sexual contact and injection drug use. Because of these shared modes of transmission, a high proportion of adults at risk for HIV infection are also at risk for HBV infection. HIV-positive persons who become infected with HBV are at increased risk for developing chronic HBV infection and should be tested. In addition, persons who are co-infected with HIV and HBV can have serious medical complications, including an increased risk for liver-related morbidity and mortality.

Hepatitis C Virus (HCV) is one of the most common causes of chronic liver disease in the United States. For persons who are HIV infected, co-infection with HCV can result in a more rapid occurrence of liver damage and may also impact the course and management of HIV infection.

How do I protect myself and others from HIV, Viral Hepatitis, and STDs? 

HIV Prevention

Your life matters and staying healthy is important. It’s important for you, the people who care about you, and your community that you know your HIV status.  Knowing give you powerful information to help take steps to keep you and others healthy. You should get tested for HIV, and encourage others to get tested too.

For people who are sexually active, there are more tools available today to prevent HIV than ever before. The list below provides a number of ways you can lower your chances of getting HIV. The more of these actions you take, the safer you can be.

  • Get tested and treated for other STDs and encourage your partners to do the same.All adults and adolescents from ages 13-64 should be tested at least once for HIV, and high-risk groups get tested more often.  STDs can have long-term health consequences.  They can also increase your chance of getting HIV or transmitting it to others. It is important to have an honest and open talk with your healthcare provider and ask whether you should be tested for STDs.  Your healthcare provider can offer you the best care if you discuss your sexual history openly.
  • Choose less risky sexual behaviors. Oral sex is much less risky than anal or vaginal sex for HIV transmission. Anal sex is the highest-risk sexual activity for HIV transmission. Sexual activities that do not involve the potential exchange of bodily fluids carry no risk for getting HIV (e.g., touching).
  • Use condoms consistently and correctly.
  • Reduce the number of people you have sex with.  The number of sex partners you have affects your HIV risk. The more partners you have, the more likely you are to have a partner with HIV whose viral load is not suppressed or to have a sex partner with a sexually transmitted disease. Both of these factors can increase the risk of HIV transmission.
  • Talk to your doctor about pre-exposure prophylaxis (PrEP). CDC recommends that PrEP be considered for people who are HIIV-negative and at substantial risk for being exposed to HIV.For sexual transmission, this includes HIIV-negative persons who are in an ongoing relationship with an HIV-positive partner. It also includes anyone who 1) is not in a mutually monogamous relationship with a partner who recently tested HIV-negative, and 2) is a gay or bisexual man who has had sex without a condom or been diagnosed with an STD in the past 6 months; or heterosexual man or woman who does not regularly use condoms during sex with partners of unknown HIV status who are at substantial risk of HIV infection (e.g., people who inject drugs or have bisexual male partners). For people who inject drugs, this includes those who have injected drugs in the past 6 months and who have shared injection equipment or been in drug treatment for injection drug use in the past 6 months.
  • Talk to your doctor right away (within 3 days) about post-exposure prophylaxis (PEP) if you have a possible exposure to HIV. An example of a possible exposure is if you have anal or vaginal sex without a condom with someone who is or may be HIV-positive, and you are HIV-negative and not taking PrEP. Your chance of exposure to HIV is lower if your HIV-positive partner is taking antiretroviral therapy (ART) consistently and correctly, especially if his/her viral load is undetectable. Starting medicine immediately (known as post-exposure prophylaxis, or PEP) and taking it daily for 4 weeks reduces your chance of getting HIV.
  • If your partner is HIV-positive, encourage your partner to get and stay on treatment.  ART reduces the amount of HIV virus (viral load) in blood and body fluids. ART can keep people with HIV healthy for many years, and greatly reduce the chance of transmitting HIV to sex partners if taken consistently and correctly.

Hepatitis Prevention

The best way to prevent both Hepatitis A and B is by getting vaccinated.   There is no vaccine available to prevent Hepatitis C.  The best way to prevent Hepatitis C is by avoiding behaviors that can spread the disease, such as sharing needles or other equipment to inject drugs.

STD Prevention

The only way to avoid STDs is to not have vaginal, anal, or oral sex. If you are sexually active, you can do several things to lower your chances of getting an STD, including:

  • Get tested for STDs and encourage your partner(s) to do the same. It is important to have an honest and open talk with your healthcare provider and ask whether you should be tested for STDs.  Your healthcare provider can offer you the best care if you discuss your sexual history openly.
  • Get vaccinated. Vaccines are safe, effective, and recommended ways to prevent hepatitis A, hepatitis B, and HPV.
  • Be in a sexually active relationship with only one person, who has agreed to be sexually active only with you.
  • Reduce your number of sex partners.  By doing so, you decrease your risk for STDs. It is still important that you and your partner get tested, and that you share your test results with one another.
  • Use a condom every time you have vaginal, anal, or oral sex. Correct and consistent use of the male latex condomis highly effective in reducing STD transmission.

What puts me at risk for HIV, Viral Hepatitis, and STDs? 

Risks for HIV

The most common ways HIV is transmitted in the United States is through anal or vaginal sex or sharing drug injection equipment with a person infected with HIV. Although the risk factors for HIV are the same for everyone, some racial/ethnic, gender, and age groups are far more affected than others.

What puts me at risk for Hepatitis A?

Hepatitis A is usually spread when a person ingests fecal matter — even in microscopic amounts — from contact with objects, food, or drinks contaminated by the feces or stool of an infected person. Due to routine vaccination of children, Hepatitis A has decreased dramatically in the United States. Although anyone can get Hepatitis A, certain groups of people are at higher risk, including men who have sex with men, people who use illegal drugs, people who travel to certain international countries, and people who have sexual contact with someone who has Hepatitis A.

What puts me at risk for Hepatitis B?

Hepatitis B is usually spread when blood, semen, or another body fluid from a person infected with the Hepatitis B virus enters the body of someone who is not infected. This can happen through sexual contact with an infected person or sharing needles, syringes, or other drug-injection equipment. Hepatitis B can also be passed from an infected mother to her baby at birth.

Among adults in the United States, Hepatitis B is most commonly spread through sexual contact and accounts for nearly two-thirds of acute Hepatitis B cases. Hepatitis B is 50–100 times more infectious than HIV.

What puts me at risk for Hepatitis C?

Hepatitis C is usually spread when blood from a person infected with the Hepatitis C virus enters the body of someone who is not infected. Today, most people become infected with the Hepatitis C virus by sharing needles or other equipment to inject drugs. Hepatitis C was also commonly spread through blood transfusions and organ transplants prior to the early 1990’s. At that time, widespread screening of the blood supply began in the United States, which has helped ensure a safe blood supply.

STDs

Risks for  Genital Herpes

Genital herpes is a common STD, and most people with genital herpes infection do not know they have it.   You can get genital herpes from an infected partner, even if your partner has no herpes symptoms.  There is no cure for herpes, but medication is available to reduce symptoms and make it less likely that you will spread herpes to a sex partner.

Risks for Genital Human Papillomavirus (HPV)

HPV is so common that most sexually active people get it at some point in their lives. Anyone who is sexually active can get HPV, even if you have had sex with only one person. In most cases, HPV goes away on its own and does not cause any health problems. But when HPV does not go away, it can cause health problems like genital warts and cancer. HPV is passed on through genital contact (such as vaginal and anal sex). You can pass HPV to others without knowing it.

Risks for Chlamydia

Most people who have chlamydia don’t know it since the disease often has no symptoms.  Chlamydia is the most commonly reported STD in the United States.  Sexually active females 25 years old and younger need testing every year. Although it is easy to cure, chlamydia can make it difficult for a woman to get pregnant if left untreated.

Risks for Gonorrhea

Anyone who is sexually active can get gonorrhea, an STD that can cause infections in the genitals, rectum, and throat. It is a very common infection, especially among young people ages 15-24 years. But it can be easily cured.  You can get gonorrhea by having anal, vaginal, or oral sex with someone who has gonorrhea. A pregnant woman with gonorrhea can give the infection to her baby during childbirth.

Risks for Syphilis

Any sexually active person can get syphilis. It is more common among men who have sex with men. Syphilis is passed through direct contact with a syphilis sore. Sores occur mainly on the external genitals, anus, or in the rectum. Sores also can occur on the lips and in the mouth. A pregnant women with syphilis can give the infection to her unborn baby.

Risks for Bacterial Vaginosis

BV is common among women of childbearing age. Any woman can get BV, but women are at a higher risk for BV if they have a new sex partner, multiple sex partners, use an intrauterine device (IUD), and/or douche.

Managing Your Appointments

HIV is a treatable condition. If you are diagnosed early, get on antiretroviral therapy (ART), and adhere to your medication, you can stay healthy, live a normal life span, and reduce the chances of transmitting HIV to others. Part of staying healthy is seeing your HIV care provider regularly so that he or she can track your progress and make sure your HIV treatment is working for you.

Your HIV care provider might be a doctor, nurse practitioner, or physician assistant. Some people living with HIV go to an HIV clinic; others see an HIV specialist at a community health center, Veterans Affairs clinic, or other health clinic; and some people see their provider in a private practice. Current guidelines recommend that most people living with HIV see their provider for lab tests every 3 to 4 months. Some people may see their provider more frequently, especially during the first two years of treatment or if their HIV viral load is not suppressed (i.e. very low or undetectable). Current guidelines say that people who take their medication every day and have had a suppressed viral load at every test for more than 2 years only need to have their lab tests done two times a year.

In addition to seeing your HIV care provider, you may need to see other health care practitioners, including dentists, nurses, case managers, social workers, psychiatrists/psychologists, pharmacists and medical specialists. This may mean juggling multiple appointments, but it is all part of staying healthy. You can help make this easier by preparing a plan for yourself.

Before Your Visit

For many people living with HIV, appointments with their HIV care provider become a routine part of their life. These tips may help you better prepare for your visits to your HIV care provider and get more out of them:

  • Start with a list or a notebook. Write down any questions you have before you go. (The Department of Veterans Affairs offers a useful list of sample questions you can bring with you.)
  • Make a list of your health and life goals so that you can talk about them with your HIV provider and how she/he can help you reach them.
  • Make a list of any symptoms or problems you are experiencing that you want to talk to your provider about.
  • Bring a list of all the HIV and non-HIV medications that you are taking (or the medications themselves), including over-the-counter medications, vitamins, or supplements. Include a list of any HIV medications you may have taken in the past and any problems you had when taking them.
  • Bring along a copy of your medical records if you are seeing a new provider who does not already have them. You have the right to access your medical records and having copies of your records can help you keep track of your lab results, prescriptions, and other health information. It can also help your new provider have a better understanding of your health history. The best way to do this is by using a global, portable personal health record like the one you will maintain here at HealthLynked.
  • Be prepared to talk about any changes in your living situation, relationships, insurance, or employment that may affect your ability to keep up with your HIV appointments and treatment or to take care of yourself. Your provider may be able to connect you with resources or services that may assist you.
  • Be on time. Most healthcare providers have full appointment schedules—if you are late, you throw the schedule off for everyone who comes after you. If you are late, there is a chance your provider will not be able to see you the same day.

During Your Visit

  • If your provider wants to run some lab tests during your visit, make sure you understand what the lab tests are for and what your provider will do with the results. If you don’t understand, ask your provider to explain it in everyday terms. Typically, you will be asked to give a sample (blood, urine) during your visit and your provider’s office will call you with your results in a few days. Keep track of your results and call your provider back if you have any questions.
  • Be honest. Your provider isn’t there to judge you, but to make decisions with you based on your particular circumstances. Talk about any HIV medication doses you have missed. Tell your provider about your sexual or alcohol/drug use history. These behaviors can put you at risk of developing drug resistance and getting other sexually transmitted infections (STIs) as well as hepatitis. Your provider will work with you to develop strategies to keep you as healthy as possible.
  • Describe any side effects you may be having from your HIV medications. Your provider will want to know how the HIV medications are affecting your body in order to work with you to solve any problems and find the right combination of medications for you.
  • Ask your provider about your next visit and what you should bring to that appointment.
  • Ask for a list of your upcoming appointments when you check out. Work with your case manager, if you have one, to develop a system to help you remember your appointments, such as a calendar, app, or text/e-mail reminders.

Asking Questions and Solving Problems

It’s important for you to be an active participant in your own health care and it’s your right to ask questions. You may need to direct your questions to different people, depending on what you need/want to know:

HIV care providers (doctors, nurse practitioners, physician assistants) can answer specific questions about a wide range of issues that affect your health. They can also help you find resources and solutions to problems you may have that affect your health, including:

  • Your prognosis (how your HIV disease is affecting your body)
  • How to manage any symptoms you may be experiencing
  • Medication issues, including medication changes, new medications, and how the HIV medications may interact with other medications you take.
  • Sexual health issues, including questions about any sexual symptoms you may be having, and how you can prevent or treat STIs, and how you can prevent transmitting HIV to your partner(s).
  • Family planning considerations, including your goals; birth control options for you and/or your partner, if relevant; your options for having children should you wish to do so; and, if you are an HIV-positive woman who is pregnant or considering getting pregnant, how you can reduce the risk of transmitting HIV to your baby
  • Substance use issues, including how alcohol/drug use can affect your HIV treatment and overall health, and whether you should be referred for substance abuse treatment
  • Mental health issues, including questions about any mental health symptoms you may be having, and whether you should be referred for mental health treatment
  • Referrals for other medical issues you may be experiencing
  • The meaning of lab test results
  • The need for surgical procedures, if relevant
  • Medication adherence strategies (tips for keeping up with your medication and ensuring you take it as scheduled and exactly as prescribed)
  • Any clinical trials or research studies that may be relevant for you
  • Information about resources and services that can help you with issues or challenges you may be having that affect your health.

Nurses and case managers often have more time to answer questions about what you discuss with your provider and to help identify solutions to problems that are affecting your health, particularly around:

  • Understanding your HIV treatment plan, including how many pills of each medicine you should take; when to take each medicine; how to take each medicine (for example, with or without food); and how to store each medicine
  • Understanding possible side effects from your HIV medication and what you should do if you experience them
  • Challenges you may have in taking your medications and/or keeping your medical appointments, and strategies for overcoming these challenges
  • Resources to help you better understand lab reports, tests, and procedures
  • Mental health and/or substance abuse treatment, housing assistance, food assistance, and other resources that exist in your community
  • Insurance and pharmacy benefits, and other aspects of paying for care
  • Understanding other medical conditions you may have
  • How to quit smoking and resources that are available to assist you
  • Information about resources and services that can help you with issues or challenges you may be having that affect your health.

If you are HIV positive, attending your medical appointments is one of the most important things you can do to ensure your HIV is optimally managed. Make sure you are ready for your appointments with HealthLynked.  Using our novel healthcare ecosystem, you can collate your medical information in one place and Connect there with the physicians who care for you.

Ready to get Lynked?  Go to HealthLynked.com today to sign up for Free!

Adapted from:

HIV.org

CDC.foc

Aidsinfo.NIH.gov

What Is Ear Wax For?

Why do we even have oily, sticky stuff coming out of our ears? Is there a point to gross ear wax?

Source


About HealthLynked

Improving healthcare is the mission of HealthLynked. HealthLynked focuses on improving healthcare services for patients as well as physicians. Our technology shortens wait time with online scheduling of appointments, Real-time appointments by local providers and provides easy access to yours as well as your family’s updated medical records.

Appointments can be comfortably made online and providing your healthcare provider access to your medical files. The website also makes it possible to link together family members and provide access to critical information in case of an emergency.

To find a healthcare professional, use HealthLynked. It is a first of its kind medical network built as a social ecosystem with a higher purpose – improving healthcare. Go to HealthLynked.com to learn more, sign up for free, connect with your doctor, find a new doctor, and securely store and share your health information. Download our HealthLynked app available on Apple and Android devices.