Why is it Important to Know My Family Health History?

Family Health History: Why It’s Important and What You Should Know
Why is it important to know my family history?

by Kimberly Holland

Family members share more than similar appearance. You may recognize that you have your father’s curly hair or your mother’s button nose. Thank goodness my kids got my wife’s food looks. What is not so easy to see is that your great-grandmother passed along an increased risk for both breast and ovarian cancer.

That’s why discovering and knowing your family health history is vitally important. Your medical history includes all the traits your family shares you can’t see. These traits may increase your risk for many hereditary conditions and diseases, including:

• cancer
• diabetes
• asthma
• heart disease and blood clots
• Alzheimer’s disease and dementia
• arthritis
• depression
• high blood pressure and high cholesterol

Whose history do I need?

The general rule for family health history is that more is better. First, you’ll want to focus on immediate family members who are related to you through blood. Start with your parents, siblings, and children. If they’re still alive, grandparents are another great place to start. They may know partial histories of many members of your family.

You can also gather information from your aunts and uncles, and other blood relatives. Once you move beyond this core circle of family, genetic makeups change so greatly that you may not be able to learn much about your own risk. Still, keep information handy for any family members you learn about during your search for medical history. It may be helpful down the road.

How can I gather this information?

Talking about health may not come naturally to you or your family. You can start the conversation by letting your family members know why you want to gather health information. Also, let them know that you’re willing to share information with them, so that you can all have more complete health histories. It may be easier to start out by having one-on-one conversations.

Get the right information

When you’re ready to gather family health history information, keep these things in mind:

Major medical issues: Ask about every major medical issue anyone in close relation to you has been diagnosed with. In this fact-finding stage, nothing is too small, though issues are only significant if the cause was genetic. Lyme disease, injuries, and other things caused by external factors can’t be inherited.
Causes of death: Find out the cause of death for any family members who’ve passed away. That might provide a clue to your family medical history, too.
Age of onset: Ask when each family member was diagnosed with each condition. This may help your doctor recognize the early onset of certain diseases.
Ethnic background: Different ethnicities have varying levels of risk for certain conditions. As best you can, identify your ethnic background to help spot potential health risks.
Environment: Families share common genes, but they also share common environments, habits, and behaviors. A complete family history also includes understanding what factors in your environment could impact your health.

5 questions to ask

Here are some questions you can ask to start the conversation:

  1. How old was my relative when they died, and what was the cause of death?
  2. Are there health problems that run in the family?
  3. Is there a history of pregnancy loss or birth defects in my family?
  4. What allergies do people in my family have?
  5. What is my ethnicity? (Some conditions are common among certain ethnicities.)

What should I do with this information?

Knowing your own health history is important, and sharing it with your doctor may be more important. That’s because your doctor can help you interpret what it means for your current lifestyle, suggest prevention tips, and decide on screening or testing options for conditions you may be more at risk for developing.

The genes you’re born with can’t be changed or altered. If you know your family history, you’re one step ahead of the game. You can take the initiative to adopt healthier lifestyle habits. For example, you could decide to stop smoking or drinking alcohol, or to start exercising regularly and maintaining a healthy weight. These lifestyle changes may reduce your chances for developing hereditary conditions.

Is incomplete information still useful?

Even a family health history that’s incomplete is still useful to your doctor. Share any information you have with them.

For example, if you know that your sibling was diagnosed with colon cancer at age 35, your doctor may suspect a possible genetic issue. They may then decide it’s important that you have regular colon cancer screenings before the recommended age of 50. Your doctor may also suggest you undergo genetic counseling or testing to identify any genetic risks.

What if I was adopted

Environment plays an important part in your health history, and you can get the details for this from your adoptive family. Learning more about your birth family’s health history may require a large investment of time and energy.

Ask your adoptive parents if they have any information about your birth parents. It’s possible family health history information was shared during the adoption process. If not, ask the agency that arranged the adoption if they retained any personal health history information for your birth parents. Understand your state’s statutes before you begin requesting adoption history information.

If all of these avenues come up short, you may need to make a choice about seeking out your birth parents. You may not wish to pursue that route, or you may be unable to connect with them. In that case, alert your doctor to your personal history. The two of you can then work to identify ways to screen for and detect your risk of certain conditions.

What if I’m estranged from my family?

If you’re estranged from only part of your family, you can try a few things to collect your family health history:

Talk to the family members you’re connected with. You may not need to reconnect with your whole family to collect your family health history.
Reach out via your doctor. Some medical offices may be able to send out questionnaires to family members asking for information in an official capacity. This may prompt people to respond.

Do some research. You may be able to discover the cause of death of your relatives from death certificates. Search online to find state-specific death records or check ancestry sites for this information. Obituaries, often available online or archived by public libraries, might also provide health information.

What about genetic testing and genetic predisposition?

Certain ethnic backgrounds and races may be predisposed to conditions for which a genetic test is useful. For example, women of Ashkenazi Jewish ancestry have an increased risk for breast cancer. A specific gene mutation is more common in these women than in other women. Genetic screening may help your doctor detect this gene mutation and prepare you for treatment options early.

Although genetic tests can help identify potential risks you may have inherited for a specific disease, they don’t guarantee you’ll develop that disease. Results may show you have a predisposition to several conditions. While you may never actually develop any of these, you might feel the added anxiety isn’t worth the knowledge. Seriously consider the benefits and concerns you may have with knowing your genetic risk factors before you do any testing.

How do I record the details?

Make sure you write down or electronically document the health information your relatives provide. You can use HealthLynked for this. Just complete one profile per family member whose medical records you are responsible for and have other family members complete and share their own with you.

Outlook

Knowing your health history helps you to be more proactive about your health. Share this information with your doctor so they can screen early for conditions you’re predisposed to and suggest lifestyle choices that can help reduce your risk.



Also talk to your doctor if you need more help figuring out how to uncover your health history or what questions you should ask. If you don’t have one you depend on today, you might find a great physician using the first of its kind social ecosystem designed specifically for everything described in the article.

Ready to get Lynked? Go to HealthLynked.com now to start compiling your medical history and sharing with those you choose, for Free, today!

Source

 

UV Exposure: Why Do We Ignore the Health Risks?

 

Published Thursday 17 July 2014

By Honor Whiteman

The sun is shining, so what are your plans? For many of us, the answer will be to hit the beach and soak up the rays. But while you are busy packing beachwear and towels, are you considering the dangers of sun exposure?

Exposure to ultraviolet (UV) radiation – from the sun, tanning beds, lamps or booths – is the main cause of skin cancer, accounting for around 86% of non-melanoma and 90% of melanoma skin cancers. In addition, excessive UV exposure can increase the risk of eye diseases, such as cataract and eye cancers.

The health risks associated with exposure to UV radiation have certainly been well documented, so much so that the World Health Organization (WHO) have now officially classed UV radiation as a human carcinogen.

This year alone, Medical News Today reported on an array of studies warning of UV exposure risks. One study, published in the journal Pediatrics, revealed that tanning bed use among youths can increase the risk of early skin cancer, while other research found that multiple sunburns as an adolescent can increase melanoma risk by 80%.

Furthermore, in response to reported health risks, the Food and Drug Administration (FDA) recently changed their regulation of tanning beds, lamps and booths. Such products must now carry a visible, black-box warning stating that they should not be used by anyone under the age of 18.

How does UV radiation cause damage?

UV radiation consists of three different wavebands: UVA, UVB and UVC. The UVC waveband is the highest-energy UV but has the shortest wavelength, meaning it does not reach the earth’s surface and does not cause skin damage to humans.

However, UVA has a long wavelength and accounts for 95% of solar UV radiation that reaches the earth’s surface, while UVB – with a middle-range wavelength – accounts for the remainder. Tanning beds and tanning lamps primarily emit UVA radiation, sometimes at doses up to 12 times higher than that of the sun.

Both UVA and UVB radiation can damage the skin by penetrating its layers and destroying cellular DNA. UVA radiation tends to penetrate deeper layers of skin, known as the dermis, aging the skin cells and causing wrinkles. UVB radiation is the main cause of skin reddening or sunburn, as it damages the outer layers of the skin, known as the epidermis.

Excessive UV exposure can cause genetic mutations that can lead to the development of skin cancer. The browning of the skin, or a tan, is the skin’s way of trying to stop further DNA damage from occurring.

Of course, it is not only the skin that can be subject to damage from UV radiation. Bright sunlight can penetrate the eye’s surfaces tissues, as well as the cornea and the lens.

Ignoring the risks of UV exposure

But regardless of the numerous studies and health warnings associated with UV exposure, it seems many of us refuse to take note.

A 2012 survey from the Centers for Disease Control and Prevention (CDC) found that 50.1% of all adults and 65.6% of white adults ages 18-29 reported suffering sunburn in the past 12 months, indicating that sun protection measures are not followed correctly, if at all.

A more recent study from the University of California-San Francisco stated that the popularity of indoor tanning is “alarming” – particularly among young people.

The study revealed that 35% of adults had been exposed to indoor tanning, with 14% reporting tanning bed use in the past year. Even more of a concern was that 43% of university students and 18% of adolescents reported using tanning beds in the past year.

Overall rates of tanning bed use, the researchers estimate, may lead to an additional 450,000 non-melanoma and 10,000 melanoma skin cancer cases every year.

It seems unbelievable that so many of us are willing to put our health at risk to soak up some sunshine. So why do we do it?

The desire for a ‘healthy tan’

A recent study published in the journal Cell suggested that UV radiation causes the body to release endorphins – “feel-good” hormones – which makes sun exposure addictive.

But Tim Turnham, executive director of the Melanoma Research Foundation, told Medical News Today that many people simply favor a tanned body over health:

“Despite elevated awareness of the dangers of UV radiation, people still choose to ignore the dangers in the pursuit of what they consider to be a ‘healthy tan.’ This is particularly an issue among young people who tend to ignore health risks in favor of enhancing their social status and popularity. We know that tanning appeals to people who are interested in being included, and this is a primary driver for teens – being part of the ‘in’ crowd.”

Anita Blankenship, health communication specialist at the CDC, told us that the desire for a tan is particularly common among young women.

“In the US, nearly 1 in 3 young white women ages 16-25 years engages in indoor tanning each year,” she said. “These young women may experience pressure to conform to beauty standards, and young people may not be as concerned about health risks.”

Turnham agreed, telling us that the indoor tanning industry specifically targets this population. “Aggressive marketing, deep discount and package deals are used routinely by tanning salons, who market their services preferentially to young women,” he said.

Blankenship added that the public are also presented with “conflicting messages” when it comes to the safety of excess UV exposure. She pointed out that a recent US report found that only 7% of tanning salons reported any harmful effects from tanning beds, booths or lamps, while 78% reported health benefits.

“It is important to monitor deceptive health and safety claims about UV exposure, as they may make it difficult for consumers to adequately assess risk,” she told us. “It is important for people to understand that tanned skin is damaged skin, and that damage can lead to wrinkles and early aging of the skin, as well as skin cancer including melanoma – the kind of skin cancer that leads to the most deaths.”

Progress has been made, but more needs to be done

This month is UV Safety Month – an annual campaign that aims to increase public awareness of the health implications caused by UV exposure.

With the help of such campaigns and an increase in studies detailing UV risks, many health care professionals believe there has been a change for the better in attitudes toward UV exposure.

Many health care professionals believe much progress has been made in increasing awareness of UV exposure risks in recent years, but more needs to be done.

“Certainly the scientific community, a number of federal agencies, and possibly the general public are more aware of the risk of UV exposure,” a spokesperson from the National Cancer Institute (NCI) told Medical News Today.

“Action and more coordinated efforts increased markedly about 4 years ago, when a number of epidemiological studies documented the harms of indoor tanning, the FDA held their scientific advisory committee meeting to discuss need for changing indoor tanning device regulations, and they also acted on their previous proposals to change sunscreen regulations.”

The spokesperson continued:

“We think these summaries acted as a catalyst for efforts to make the public and policy makers aware of the risks of indoor tanning, and also they gave a boost to efforts to increase awareness of outdoor sun exposure risks and encourage sun safe protective behaviors.”

In addition, some studies have indicated that many youngsters may even be moving away from the use of tanning beds. A recent Youth Risk Behavior Survey found that among high school students, indoor tanning activity decreased from 15.6% in 2009 to 12.8% in 2013.

Turnham told us that since sunless tanning – such as the use of spray tans – is on the increase, it may be that youngsters are using this as an alternative to tanning salons. But the NCI spokesperson said such an association needs to be investigated before any conclusions can be reached:

“We do not know if changes in indoor tanning are related to increases in use of spray-on and sunless tanning products and services,” they told us. “Some studies indicate that sunless products and services are used by people who continue to engage in indoor tanning, but it is an area we continue to research. We are hopeful that we will be able to measure this in an upcoming national survey supplement that is being developed by NCI and CDC.”

But despite widespread efforts to increase UV safety awareness, Turnham believes there is still a lot more that can be done to protect public health:

“Regulators could and should do much more to fight the ravages of UV exposure. We need federal legislation banning the use of tanning beds by minors. We need more funding for awareness and prevention efforts.”

He added that doctors can also play a role in increasing UV exposure awareness by warning patients of associated risks – something the US Preventive Services Task Force (USPSTF) recommend. They state that health care providers should counsel fair-skinned youths between the ages of 10 and 24 about the risks of indoor tanning and how to protect themselves against UV radiation from the sun.

However, Turnham noted that doctors do not have much time with each patient and proposes that signage in waiting areas warning of the risks of UV exposure may also be effective.

Protecting against UV radiation

Whether there will be further regulation for indoor tanning or an increase in awareness efforts is unclear. But one thing is certain: we can help ourselves to avoid the negative health implications associated with UV exposure.

The American Cancer Society notes young children need extra protection from the sun, as they spend more time outside and can burn easily.

The CDC recommend the following for protecting against UV radiation:

  • Stay in the shade if possible, particularly when the sun is at its strongest – usually around midday
  • Wear clothing that covers your arms and legs
  • Wear a wide-brimmed hat that provides shade for your head, face, ears and neck
  • Wear wrap-around sunglasses that protect against both UVA and UVB radiation
  • Use sunscreen with a minimum sun protection factor (SPF) of 15 that protects against UVA and UVB radiation, and reapply every 2 hours
  • Avoid indoor tanning.

In addition, the American Cancer Society notes young children need extra protection from the sun as they spend more time outside and can burn easily. They add that babies younger than 6 months should be kept out of direct sunlight and be covered with protective clothing. Sunscreen should never be used on an infants skin.

As  we embark on the glorious, sunny days of the summer season and enter into the Fourth of July Celebration, let’s do all we can to protect ourselves and our little ones from UV rays’ potential threats to our skin. Remember, UV rays are the major causes of several deadly skin cancers and sunscreen is one of the most easy and accessible ways to protect against them. So, get out those sunscreen tubes and cover your head with a hat and your eyes with some shades because sun protection is trending today and everyday!

And, if you do find an odd spot on your body’s biggest organ, you can use HealthLynked to find a great physician near you and get the help you need.  Simply go to HealthLynked.com and sign up for free, then Connect and collaborate through HealthLynked to heal your skin!

 

Genes linked with sunburn, skin cancer risk

 

May 8, 2018

Certain genes can determine which people are more at risk of getting sunburn and possibly develop skin cancer as a result..

In a trawl of the genetics of nearly 180,000 people of European ancestry in Britain, Australia, the Netherlands and United States, researchers found 20 sunburn genes.

Eight of the genes had been associated with skin cancer in previous research, according to findings published in the journal Nature Communications.

And in at least one region of the genome, “we have found evidence to suggest that the gene involved in melanoma risk… acts through increasing susceptibility to sunburns,” co-author Mario Falchi of King’s College London told AFP.

Sun exposure is critical for the body’s production of vitamin D, which keeps bones, teeth, and muscles healthy, and which scientists say may help stave off chronic diseases, even cancer.

But too much can be painful in the short-term, and dangerous for your health.

The new study, which claims to be the largest to date into the genetics of sunburn, helps explain why people with the same skin tone can have such different reactions to exposure to sunlight—some burn red while others tan brown.

It may also begin to explain factors in skin cancer risk.
“It is necessary to explore these genes in more detail, to understand the mechanism by which they contribute to propensity to burn,” said Falchi.

In future, the research may help identify people at risk, through genetic testing.

“People tend to ‘forget’ that sunburns are quite dangerous,” said Falchi.

“Given the rise in incidence in skin cancer, we hope that knowing there is a genetic link between sunburn and skin cancer may help in encouraging people to lead a healthy lifestyle.”

More information: Genome-wide association study in 176,678 Europeans reveals genetic loci for tanning response to sun exposure, Nature Communications (2018).
nature.com/articles/doi:10.1038/s41467-018-04086-y
Journal reference: Nature Communications

Millennials aren’t getting the message about sun safety and the dangers of tanning

Many millennials lack knowledge about the importance of sunscreen and continue to tan outdoors in part because of low self-esteem and high rates of narcissism that fuel addictive tanning behavior, a new study from Oregon State University-Cascades has found.

Lead author Amy Watson and her colleagues found that those with higher levels of self-esteem were less likely to tan, while those with lower self-esteem and higher levels of narcissism were more likely to present addictive tanning behavior. The motivation for the addictive tanning behavior was the perception of improved appearance.

“This study gives us a clearer understanding of actual consumer behavior,” said Watson, an assistant professor of marketing at OSU-Cascades. “The number of people still deliberately exposing their skin to the sun for tanning purposes is alarming. We need to find new ways to entice people to protect their skin, including challenging the ideal of tan skin as a standard of beauty.”

The findings were published recently in the Journal of Consumer Affairs. Co-authors are Gail Zank and Anna M. Turri of Texas State University.

Skin cancer is the most common type of cancer worldwide, with more than 3.5 million cases diagnosed annually. Melanoma cases among women rose sharply between 1970 and 2009, with an 800 percent increase among women 18 to 39.

In an effort to improve consumer education about the role of sunscreen in the prevention of skin cancer, the Centers for Disease Control and the Food and Drug Administration developed a new “Drug Facts” panel of information now required on all sunscreen bottles. The panel includes directions for sunscreen use and advice on other sun protection measures, among other information.

The researchers’ goal with the study was to gauge whether the information on this new label is effective at curbing tanning behavior and if new information is helping to increase consumer knowledge about how and when to use sunscreen and how much to use.

The study of 250 college students, most between 18 and 23 years old, measured their sun safety knowledge and included: questions about their beliefs regarding sunscreen effectiveness and ultraviolet light exposure danger; questions about tanning motivation and behavior; an assessment of tanning addiction; and personality questions relating to self-esteem, narcissism, appearance and addictive behavior.

The study participants, 47 percent male and 53 percent female, scored an average of 54 percent on an 11-question sun safety knowledge test, which included true/false statements such as: “On a daily basis I should use at least one ounce of sunscreen on exposed skin” (true); and “When applied correctly, SPF 100 is twice as effective as SPF 50” (false).

About 70 percent of the study participants reported purposefully exposing their skin to the sun to achieve a tan. About a third of the participants reported that having a tan is important to them, while about 37 percent said they feel better with a tan, and 41 percent indicated that having a tan makes them more confident in their appearance

The participants’ levels of tanning addiction were measured through questions such as “I get annoyed when people tell me not to tan,” and “I continue to tan knowing that it is bad for me,” and “I feel unattractive or anxious to tan if I do not maintain my tan.”

The researchers found that those with lower self-esteem and higher narcissism rates were also more likely to exhibit addictive tanning behavior. They found no evidence that increased knowledge about sun safety leads to lower levels of addictive tanning.

“What we found is that this knowledge doesn’t matter to the consumers,” Watson said. “That tactic to require sunscreen manufacturers to include this information is not effective.”

Sun safety and sunscreen messaging from the CDC is all statistics-based, emphasizing the likelihood of a skin cancer occurrence or diagnosis, Watson said. But that type of message isn’t resonating with millennials. The next step for Watson and her colleagues is to begin testing other types of messages to identify ways millennials would respond more positively to sun safety measures.

“People are starting to get the message about the dangers of using tanning beds, but a large number of people are still tanning outdoors, deliberately exposing their skin to the sun, because they think it’s attractive,” she said.

“We need to move away from the narrative where tan skin is associated with health and youth. That’s the opposite of reality. Because reality is tan skin is damaged skin.”

More information: Amy Watson et al, I Know, but I Would Rather Be Beautiful: The Impact of Self-Esteem, Narcissism, and Knowledge on Addictive Tanning Behavior in Millennials, Journal of Consumer Affairs (2018). DOI: 10.1111/joca.12179
Provided by: Oregon State University

Here comes the sun, and kid sun safety

(HealthDay)—Summer sun brings childhood fun, but experts warn it also brings skin cancer dangers, even for kids.

“Don’t assume children cannot get skin cancer because of their age,” said Dr. Alberto Pappo, director of the solid tumor division at St. Jude Children’s Research Hospital in Memphis, Tenn. “Unlike other cancers, the conventional melanoma that we see mostly in adolescents behaves the same as it does in adults.”

His advice: “Children are not immune from extreme sun damage, and parents should start sun protection early and make it a habit for life.”

So, this and every summer, parents should take steps to shield kids from the sun’s harmful UV rays.

Those steps include:

* Avoid exposure. Infants and children younger than 6 months old should avoid sun exposure entirely, Pappo advised. If these babies are outside or on the beach this summer, they should be covered up with hats and appropriate clothing. It’s also a good idea to avoid being outside when UV rays are at their peak, between 10 a.m. and 2 p.m.

* Use sunscreen. It’s important to apply a broad-spectrum sunscreen to children’s exposed skin. Choose one with at least SPF15 that protects against both UVA and UVB rays. Pappo cautioned that sunscreen needs to be reapplied every couple of hours and after swimming—even if the label says it is “water-resistant.”

However, sunscreen should not be used on infants younger than 6 months old because their exposure to the chemicals in these products would be too high, he noted.

* Keep kids away from tanning beds. Melanoma rates are rising among teenagers, partly due to their use of indoor tanning beds. Use of tanning beds by people younger than 30 boosts their risk for this deadly form of cancer by 75 percent, according to the International Agency for Research on Cancer.

* Get children screened. Early detection of melanoma is key to increasing patients’ odds of survival. Children with suspicious moles or skin lesions should be seen by a doctor as soon as possible, Pappo advised. Removing melanoma in its early stages also increases the chances of avoiding more invasive surgical procedures later on, he added.

More information: There are more sun-safety tips at the Skin Cancer Foundation.

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.com to find the right physician for you.  We are the world’s first every healthcare ecosystem designed to connect physicians to patients in unique ways for the efficient exchange of information.

Transplant the old ways of finding and sharing with your doctor.  Restore great relational medicine.  Go to Healthlynked.com today and sign up for free!

Sources

UCLAnewsroom.edu

Wired.com

Columbiasurgery.org

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

 

#heart,#transplant,#immunosuppression

 

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.comClick here for the original.

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.

 

  Disruptive Technology Turns 11; Creator Set to Break Through $1T

It  was the worst kept tech secret of all time; and though everyone knew it was coming,  no one predicted how the iPhone would change the world.  11 years after its launch, Apple is now poised to become the first ever $1T company.

While people published rumors and others guessed at design, buyers began to camp outside stores days in advance to snag a $600 device they’d never seen. Before its release, the hype for an Apple-devised phone was off the scale. It even garnered the nickname the “Jesus phone” — or “jPhone”.  Some felt it would be miraculous, while most believed it could in no way live up to the hype.

It wasn’t the first time in tech history a frenzy was create over a new device. The first whispers came in the summer of 1944: a Hungarian inventor living in Argentina had created something sensational. On the day of its release, New Yorkers “trampled on another” in 1945 to buy the first commercially available ballpoint pens, where they paid the equivalent of $175 in today’s money. That was for a pen, not an Ubersmart mobile device that connects you to the universe.

Despite drawing hordes of fans, the iPhone didn’t immediately charm its way into the mainstream because of its high price tag. Just two months after the iPhone’s initial release, Apple trimmed the handset’s price down to $400. That helped a little, but it wasn’t until 2008 — when Apple unveiled the iPhone 3G with a new $200 price tag and access to the faster 3G network — that the smartphone exploded in popularity. Apple sold over 10 million iPhone 3G units worldwide in just five months.

It wasn’t the faster network or the price tag that really set the iPhone ahead of its competitors. Apple’s core philosophy, then and now, is that software is the key ingredient; and the operating system lying beneath the iPhone’s sleek and sexy touchscreen broke new ground. Unlike other cellphones’ software, the iPhone’s operating system was controlled by Apple rather than a mobile carrier.

Just as the Apple II in 1977 was the first computer made for consumers, the iPhone was the first phone whose software was designed with the user in mind. It was the first phone to make listening to music, checking voicemail and browsing the web as easy as swiping, pinching and tapping a screen — pleasant like a massage.

“An iPod, a phone, an internet mobile communicator,” Jobs said when preparing to introduce the iPhone in 2007. “An iPod, a phone, an internet mobile communicator…. These are not three separate devices!”  Apple put a miniature computer in consumers’ pockets.

But that wasn’t enough for iPhone users. Operating on a closed platform, the iPhone was limited to the few apps that Apple offered — and the handset was restricted to one U.S. carrier — AT&T. The iPhone’s software limitations gave birth to an underground world of hackers seeking to add third-party applications, known as the Jailbreak community. And the AT&T exclusivity created a subset of that hacker community focusing on unlocking the iPhone to work with various carriers — today famously known as the iPhone Dev-Team.

Apple did benefit tremendously from iPhone hackers. The company learned from the Jailbreak community that third-party applications were in high demand and would add even more appeal to the phone. This revelation led to Apple opening its iPhone App Store, which launched concurrently with the second-generation iPhone, iPhone 3G.

Fast forward.  The iPhone turned out to be a game-changer – the proverbial paradigm shift wrapped in a sleek black case housing powerful innovative technology.  It has gone on to Impact the lives of hundreds of millions of people around the world, changing the way we communicate, work, learn and play.

77.3 Million iPhones were sold in the fourth quarter of 2017.  Assuming that each boxed iPhone weighs approximately 500g, give or take, that’s around 39,000 metric tons of iPhones, which is the equivalent of 630  Abrams M1A2 battle tanks.  The Sales volume works out to almost ten iPhones a second, and they sold for an average of $796.  This is how Apple will likely crest $1T this year.

Just like that, Apple flipped cellphone business on its head and transformed mobile software into a viable product. But the most surprising thing about the iPhone is the impact it’s had on six major industries.

The PC Industry –  Apple’s stroke of genius was to put one in your pocket. Until the iPhone shipped, PC sales were around 400 million a year.  As the iPhone and smartphones in general have become critical tools for information, used for productivity, communications and pleasure, the PC has become less important to many people. Until the mobile revolution that came with the iPhone, the only way people could access the Internet was from a PC or laptop.

Today, thanks to the iPhone, iPad and all the Android equivalents inspired by Apple’s ideas, people have many more options to make the connections they need regardless of location. Consequently, the PC industry is now shipping only about 275 to 290 million PCs a year, and this has caused a level of industry consolidation that is now concentrated around Lenovo, HP, Dell, Acer and Apple.

Telecom – Before the iPhone, most of the original telco business models were around voice. Voice over IP became popular by 2000 and had already started pushing the telecom companies to move to digital voice instead of traditional landline voice delivery methods. But with the advent of the iPhone, they were effectively forced out of the traditional voice business altogether.  While there were millions of payphones in place a decade ago, Try and locate a payphone today.

Now, telecom providers are data communications companies whose business models have been completely transformed. All have added things like information and entertainment services, and all have become conduits for multiple types of data services to their customers.

Movie and TV – In order to watch a movie, you once  had to go to a movie theater; and to watch a TV show, you had to sit in front of my television at home and scan three channels….plus PBS.  The iPhone created a mobile platform for video delivery, and since 2007, every major movie and TV studio has been forced to expand their distribution methods to include downloaded and streaming services to mobile devices.

We can thank the millions of iPhones in the field, capable of letting people watch video anytime and anywhere, for prodding these studios to make this so. We can also thank the iPhone for fueling new types of video services like YouTube, Netflix and Hulu — video powerhouses, at least 50% of whose content is viewed on some type of mobile device.

Software distribution.  With the launch of the App Store, Apple shook up the mobile industry again by reinventing software distribution. Apple designed the App Store’s model with a do-it-yourself mentality: All software developers had to do was code an interesting app, submit it to the App Store for approval and market the app however they wished.

The App Store’s method is proving far more effective than the old-fashioned computer shareware model, where developers would offer a free trial of their apps and then cross their fingers that consumers would eventually pay. The shareware model especially didn’t help independent coders, whose apps got trampled on by large software companies with fatter marketing budgets.

Video Gaming.  Before 2007, most games were either delivered by way of game consoles, a PC or a dedicated handheld device like the Nintendo DS or Sony PlayStation Portable. The iPhone expanded the market for mobile games as well as created an entirely new category of touch-based gameplay, persuading even holdouts like Nintendo to come aboard with games based on its iconic franchises.

And though the mobile dominant free-to-play model fractionalizes revenue, the potential for brand exposure is unprecedented: Niantic’s augmented reality-angled Pokémon Go alone has been downloaded over 750 million times. Contrast with Nintendo’s entire Mario franchise’s lifetime sales of just over 500 million.

HealthCare. Today, one can use an iPhone to monitor various health metrics as well as access detailed health information, connecting with health professionals and even receiving health advice virtually anytime and anywhere across a number of different applications.  And we’ve only begun to see how smartphones can impact the health industry – an impact that will doubtless expand as this industry embraces the smartphone for outpatient care.

And HealthLynked will be a huge part of this.  We are not unlike the iPhone.  Where multiple apps do one thing, we are combining all that makes mobile health great into one easy to use, secure platform.  It’s sort of a Swiss Army knife, meets iPhone meets medicine, wrapped in the sleek, easy to use interface of a social platform.  You can find it in the Apple Store.

Ready to start taking control of your health in ways never thought possible?  Get Lynked!  Go to HealtheLynked.com to sign up For Free!



Sources:  Blending the two fantastic articles below.

JUNE 29, 2007: IPHONE, YOU PHONE, WE ALL WANNA IPHONE, by  Brian X. Chen.  Brian wrote a book about the always-connected mobile future called Always On (published June 7, 2011 by Da Capo). Check out Brian’s Google Profile.

 

How Apple’s iPhone Changed These 5 Major Industries, By TIM BAJARIN June 26, 2017.  Tim is recognized as one of the leading industry consultants, analysts and futurists, covering the field of personal computers and consumer technology. Mr. Bajarin is the President of Creative Strategies, Inc and has been with the company since 1981 where he has served as a consultant providing analysis to most of the leading hardware and software vendors in the industry.

 

Photo: Young Steve Jobs
Credit: Ben Lovejoy in Tim Cook Tweets, 9to5Mac

 

Title:  Disruptive Technology Turns 11; Creator Set to Break Through $1T

 

#apple,#iPhone,#healthcareIT,#healthcarereform,#healthcareITreform

 

 

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.

325Click to share on Facebook (Opens in new window)325Click to share on Twitter (Opens in new window)1Click to share on Pinterest (Opens in new window)1Click to share on LinkedIn (Opens in new window)
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
williamsdia@wustl.edu
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
tbhandari@wustl.edu


Republished with permission.  See original and other great articles here.

Link between 2 key Alzheimer’s proteins explained | Targeting tau production may lead to treatment


by Tamara Bhandari•March 21, 2018

Alzheimer’s disease is characterized by clumps of two proteins – amyloid beta and tau – in the brain, but the link between the two has never been entirely clear. Now, researchers at Washington University School of Medicine in St. Louis have shown that people with more amyloid in the brain produce more tau, which could lead to new treatments for the disease based on targeting the production of tau.

It’s a paradox of Alzheimer’s disease: Plaques of the sticky protein amyloid beta are the most characteristic sign in the brain of the deadly neurodegenerative disease. However, many older people have such plaques in their brains but do not have dementia.

The memory loss and confusion of Alzheimer’s instead is associated with tangles of a different brain protein – known as tau – that show up years after the plaques first form. The link between amyloid and tau has never been entirely clear. But now, researchers at Washington University School of Medicine in St. Louis have shown that people with more amyloid in their brains also produce more tau.

The findings, available March 21 in the journal Neuron, could lead to new treatments for Alzheimer’s, based on targeting the production of tau.

“We think this discovery is going to lead to more specific therapies targeting the disease process,” said senior author Randall Bateman, MD, the Charles F. and Joanne Knight Distinguished Professor of Neurology.

Years ago, researchers noted that people with Alzheimer’s disease have high levels of tau in the cerebrospinal fluid, which surrounds their brain and spinal cord. Tau – in the tangled form or not – is normally kept inside cells, so the presence of the protein in extracellular fluid was surprising. As Alzheimer’s disease causes widespread death of brain cells, researchers presumed the excess tau on the outside of cells was a byproduct of dying neurons releasing their proteins as they broke apart and perished. But it was also possible that neurons make and release more tau during the disease.

In order to find the source of the surplus tau, Bateman and colleagues decided to measure how tau was produced and cleared from human brain cells.

Along with co-senior author Celeste Karch, PhD, an assistant professor of psychiatry, and co-first authors Chihiro Sato, PhD, an instructor in neurology, and Nicolas Barthélemy, PhD, a postdoctoral researcher, the researchers applied a technique known as Stable Isotope Labeling Kinetics (SILK). The technique tracks how fast proteins are synthesized, released and cleared, and can measure production and clearance in models of neurons in the lab and also directly in people in the human central nervous system.

Using SILK, the researchers found that tau proteins consistently appeared after a three-day delay in human neurons in a laboratory dish. The timing suggests that tau release is an active process, unrelated to dying neurons.

Further, by studying 24 people, some of whom exhibited amyloid plaques and mild Alzheimer’s symptoms, they found a direct correlation between the amount of amyloid in a person’s brain and the amount of tau produced in the brain.

“Whether a person has symptoms of Alzheimer’s disease or not, if there are amyloid plaques, there is increased production of this soluble tau,” Bateman said.

The findings are a step toward understanding how the two key proteins in Alzheimer’s disease – amyloid and tau – interact with each other.

“We knew that people who had plaques typically had elevated levels of soluble tau,” Bateman said. “What we didn’t know was why. This explains the why: The presence of amyloid increases the production of tau.”

Tau is strongly linked to brain damage, so overproduction of the protein could be a critical step in the development of Alzheimer’s, and reducing tau’s production may help treat the disease, the researchers said.

“These findings point to an important new therapeutic avenue,” Karch said. “Blocking tau production could be considered as a target for treatment for the disease.”

Sato C, Barthélemy NR, Mawuenyega KG, Patterson BW, Gordon BA, Jockel-Balsarotti J, Sullivan M, Crisp MJ, Kasten T, Kirmess KM, Kanaan NM, Yarasheski KE, Baker-Nigh A, Benzinger TLS, Miller TM, Karch CM and Bateman RJ. Tau Kinetics in Neurons and the Human Central Nervous System. Neuron. March 21, 2018.

This work was supported by the National Institutes of Health (NIH), grant number R01NS095773, R01NS078398, K01 AG046374, K01 AG053474, P30DK056341, P01AG003991, UL1TR000448, P30NS098577, P50AG005681, and P01AG026276; Brightfocus Foundation, grant number A2014384S; the National Institute of Neurological Disorders and Stroke, grant numbers P01NS080675 and P30NS098577; Tau SILK Consortium (AbbVie, Biogen, and Eli Lily); Metlife Foundation; ALS Association; DIAN-TU; Hope Center for Neurological Disorders; The Foundation for Barnes-Jewish Hospital; Kanae Foundation for the Promotion of Science; McDonnell Science Grant for Neuroscience; the Tau Consortium; the Knight Alzheimer’s Disease Research Center; Coins for Alzheimer’s Research Trust; Alzheimer’s Association; and resources provided by Washington University Biomedical Mass Spectrometry Research Facility (NIH P41GM103422), Diabetes Research Center (NIH P30DK020579), and the Nutrition Obesity Research Center (NIH P30DK056341).

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
Judy Martin Finch, Director of Media Relations

314-286-0105
martinju@wustl.edu
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.

314-286-0122
tbhandari@wustl.edu


In honor of ALzheimers and Brain Awareness Month, this has been reproduced with permission.

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.

You might also find a healthcare provider using the first of its kind medical ecosystem designed to help you more efficiently Connect and collaborate with your medical team.  Safe, secure and easy to use, HealthLynked is the future of healthcare, here today.

Ready to get Lynked?  Go to HealthLynked.com to sign up for Free and get help, right now!

 

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. Find an HIV/STD testing site.
  • 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.  Find an STD testing site.
  • 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