What is Celiac Disease and Why Is It on the Rise?

Historically, the United States Senate has designated September 13th as “National Celiac Awareness Day.”  According to the original resolution, the Senate “recognizes that all people of the United States should become more informed and aware of celiac disease” and encourages all Americans to participate in activities to observe this day.

Why September 13th?  The 13th is the birthday of Samuel Gee, a pediatrician who published the first complete clinical description of celiac disease in 1888.  Gee was the first to recognize the symptoms of celiac disease are related to diet.

Celiac disease affects an estimated 3 million Americans, 85% of whom remain undiagnosed or misdiagnosed.  It is generally considered an autoimmune disorder with genetic predisposition. Some important exceptions notwithstanding, the prevalence of celiac disease is estimated to range between 0.6 and 1 percent of the world’s population.

The name celiac derives from the Greek word for “hollow,” as in bowels. Gluten proteins in wheat, barley and rye prompt the body to turn on itself and attack the small intestine. Complications range from diarrhea and anemia to osteoporosis and, in extreme cases, lymphoma.

Celiac disease

Overview

Celiac disease (gluten-sensitive enteropathy), sometimes called sprue or coeliac, is an immune reaction to eating gluten, a protein found in wheat, barley and rye.

If you have celiac disease, eating gluten triggers an immune response in your small intestine. Over time, this reaction damages your small intestine’s lining and prevents absorption of some nutrients (malabsorption). The intestinal damage often causes diarrhea, fatigue, weight loss, bloating and anemia, and can lead to serious complications.

In children, malabsorption can affect growth and development, in addition to the symptoms seen in adults.

There’s no cure for celiac disease — but for most people, following a strict gluten-free diet can help manage symptoms and promote intestinal healing.

Symptoms

The signs and symptoms of celiac disease can vary greatly and are different in children and adults. The most common signs for adults are diarrhea, fatigue and weight loss. Adults may also experience bloating and gas, abdominal pain, nausea, constipation, and vomiting.

However, more than half of adults with celiac disease have signs and symptoms that are not related to the digestive system, including:

  • Anemia, usually resulting from iron deficiency
  • Loss of bone density (osteoporosis) or softening of bone (osteomalacia)
  • Itchy, blistery skin rash (dermatitis herpetiformis)
  • Damage to dental enamel
  • Mouth ulcers
  • Headaches and fatigue
  • Nervous system injury, including numbness and tingling in the feet and hands, possible problems with balance, and cognitive impairment
  • Joint pain
  • Reduced functioning of the spleen (hyposplenism)
  • Acid reflux and heartburn

Children

In children under 2 years old, typical signs and symptoms of celiac disease include:

  • Vomiting
  • Chronic diarrhea
  • Swollen belly
  • Failure to thrive
  • Poor appetite
  • Muscle wasting

Older children may experience:

  • Diarrhea
  • Constipation
  • Weight loss
  • Irritability
  • Short stature
  • Delayed puberty
  • Neurological symptoms, including attention-deficit/hyperactivity disorder (ADHD), learning disabilities, headaches, lack of muscle coordination and seizures

Dermatitis herpetiformis

Dermatitis herpetiformis is an itchy, blistering skin disease that stems from intestinal gluten intolerance. The rash usually occurs on the elbows, knees, torso, scalp and buttocks.

Dermatitis herpetiformis is often associated with changes to the lining of the small intestine identical to those of celiac disease, but the disease may not produce noticeable digestive symptoms.

Doctors treat dermatitis herpetiformis with a gluten-free diet or medication, or both, to control the rash.

Causes

Celiac disease occurs from an interaction between genes, eating foods with gluten and other environmental factors, but the precise cause isn’t known. Infant feeding practices, gastrointestinal infections and gut bacteria might contribute to developing celiac disease.

Sometimes celiac disease is triggered — or becomes active for the first time — after surgery, pregnancy, childbirth, viral infection or severe emotional stress.

When the body’s immune system overreacts to gluten in food, the reaction damages the tiny, hair-like projections (villi) that line the small intestine. Villi absorb vitamins, minerals and other nutrients from the food you eat. If your villi are damaged, you can’t get enough nutrients, no matter how much you eat.

Some gene variations appear to increase the risk of developing the disease. But having those gene variants doesn’t mean you’ll get celiac disease, which suggests that additional factors must be involved.

The rate of celiac disease in Western countries is estimated at about 1 percent of the population. Celiac disease is most common in Caucasians; however, it is now being diagnosed among many ethnic groups and is being found globally.

Risk factors

Celiac disease can affect anyone. However, it tends to be more common in people who have:

  • A family member with celiac disease or dermatitis herpetiformis
  • Type 1 diabetes
  • Down syndrome or Turner syndrome
  • Autoimmune thyroid disease
  • Microscopic colitis (lymphocytic or collagenous colitis)
  • Addison’s disease
  • Rheumatoid arthritis

Complications

Untreated, celiac disease can cause:

  • Malnutrition. The damage to your small intestine means it can’t absorb enough nutrients. Malnutrition can lead to anemia and weight loss. In children, malnutrition can cause slow growth and short stature.
  • Loss of calcium and bone density. Malabsorption of calcium and vitamin D may lead to a softening of the bone (osteomalacia or rickets) in children and a loss of bone density (osteoporosis) in adults.
  • Infertility and miscarriage. Malabsorption of calcium and vitamin D can contribute to reproductive issues.
  • Lactose intolerance. Damage to your small intestine may cause you to experience abdominal pain and diarrhea after eating lactose-containing dairy products, even though they don’t contain gluten. Once your intestine has healed, you may be able to tolerate dairy products again. However, some people continue to experience lactose intolerance despite successful management of celiac disease.
  • Cancer. People with celiac disease who don’t maintain a gluten-free diet have a greater risk of developing several forms of cancer, including intestinal lymphoma and small bowel cancer.
  • Neurological problems. Some people with celiac disease may develop neurological problems such as seizures or peripheral neuropathy (disease of the nerves that lead to the hands and feet).

In children, celiac disease can also lead to failure to thrive, delayed puberty, weight loss, irritability and dental enamel defects, anemia, arthritis, and epilepsy.

Nonresponsive celiac disease

As many as 30 percent of people with celiac disease may not have, or be able to maintain, a good response to a gluten-free diet. This condition, known as nonresponsive celiac disease, is often due to contamination of the diet with gluten. Therefore, it’s important to work with a dietitian.

People with nonresponsive celiac disease may have additional conditions, such as bacteria in the small intestine (bacterial overgrowth), microscopic colitis, poor pancreas function, irritable bowel syndrome or intolerance to disaccharides (lactose and fructose). Or, they may have refractory celiac disease.

Refractory celiac disease

In rare instances, the intestinal injury of celiac disease persists and leads to substantial malabsorption, even though you have followed a strict gluten-free diet. This combination is known as refractory celiac disease.

If you continue to experience signs and symptoms despite following a gluten-free diet for six months to one year, your doctor may recommend further testing and look for other explanations for your symptoms. Your doctor may recommend treatment with a steroid to reduce intestinal inflammation, or a medication that suppresses your immune system. All patients with celiac disease should be followed up to monitor the response of their disease to treatment.

Celiac is on the Rise

While we know proteins called gluten provoke celiac disease; and, we understand the disease is treated with a gluten free diet, the rapid increase in prevalence of celiac disease, which has quadrupled in the United States in just 50 years, is mystifying.

Scientists are pursuing some intriguing possibilities. One is that breast-feeding may protect against the disease, and it has been on the decline in our fast paced, Self-care society.  Another is that we have neglected the microbes teeming in our gut — bacteria that may determine whether the immune system treats gluten as food or as a deadly invader.  The microbiome wants us to survive.

Nearly everyone with celiac disease has one of two versions of a cellular receptor called the human leukocyte antigen, or H.L.A. These receptors, the thinking goes, naturally increase carriers’ immune response to gluten.

This detailed understanding makes celiac disease unique among autoimmune disorders. Two factors — one a protein, another genetic — are clearly defined; and in most cases, eliminating gluten from the patient’s diet turns off the disease.

When to see a doctor

Consult your doctor if you have diarrhea or digestive discomfort that lasts for more than two weeks. Consult your child’s doctor if your child is pale, irritable or failing to grow or has a potbelly and foul-smelling, bulky stools.

Be sure to consult your doctor before trying a gluten-free diet. If you stop or even reduce the amount of gluten you eat before you’re tested for celiac disease, you may change the test results.

Celiac disease tends to run in families. If someone in your family has the condition, ask your doctor if you should be tested. Also ask your doctor about testing if you or someone in your family has a risk factor for celiac disease, such as type 1 diabetes.

Get Help

Find a physician in our first of its kind, social ecosystem for healthcare.  We are here to help patients connect with providers who really care, and who will collaborate closely on your care.

Ready to get Lynked to a physician who understands the microbiome and celiac?  Go to HealthLynked.com, sign up for free, and start healing your gut today!

 

Sources Adapted from:

MayoClinic.org

nyt.com

 

 

 

What are the First Five Steps in First Aid?

According to a Red Cross Survey, too many people have a fear of taking action when someone needs help. The report suggests, for anyone finding themselves in a life-threatening emergency situation, there’s a 50-50 chance  someone will actually step forward to offer first aid.

The survey found:

  • While most (88%) would want someone to come to our aid, only half (50%) of adults would actually feel confident about helping.
  • The majority of those asked (70%) said that they would worry about making it worse or doing something wrong.
  • Most worryingly, just 4% of people knew the correct first aid skills, and said they were both confident and likely to help someone in three of the most life-threatening scenarios, such as heavy bleeding or someone stopping breathing.

By administering immediate care during an emergency, you can help an ill or injured person before EMS, or Emergency Medical Services, arrive.  You may even help save a life.  However, even after training, remembering the right first aid steps – and administering them correctly – can be difficult.  In order to help you deliver the right care at the right time, the Red Cross has created this simple step-by-step guide that you can print up and place on your refrigerator, in your car, in your bag or at your desk.


1.  Before administering care to an ill or injured person, check the scene and the person. Size up the scene and form an initial impression.

Pause and look at the scene and the person before responding. Answer the following questions:

  • Is the scene safe to enter?
  • What happened?
  • How many people are involved?
  • What is my initial impression about the nature of the person’s illness or injury?
  • Does the person have any life-threatening conditions, such as severe, life-threatening bleeding?
  • Is anyone else available to help?

2.  If the Person is awake and Responsive and there is no severe life-threatening bleeding:

  • Obtain consent: Tell the person your name, describe type and level of training, state what you think is wrong and what you plan to do, and ask permission to provide care.
  • Tell a bystander to get the AED and first aid kit: Point to a bystander and speak out loud.
  • Use appropriate personal protective equipment (PPE); Put on gloves, if available.
  • Interview the person: Use questions to gather more information about signs and symptoms, allergies, medications, pertinent medical history, last food or drink and events leading up to the incident.
  • Conduct a head-to-toe check: Check head and neck, shoulders, chest and abdomen, hips, legs and feet, arms and hands for signs of injury.
  • Provide care consistent with knowledge and training according to the conditions you find.

3.  If the Person Appears Unresponsive:

Shout to get the person’s attention, using the person’s name if it is known. If there is no response, tap the person’s shoulder (if the person is an adult or child) or the bottom of the person’s foot (if the person is an infant) and shout again, while checking for normal breathing. Check for Responsiveness and breathing for no more than 5-10 seconds.

4.  If the person is breathing:

  • Send someone to call 911 or the designated emergency number and obtain an AED and first aid kit.
  • Proceed with gathering information from bystanders using questions.
  • Conduct a head-to-toe check.
  • Roll the person onto his or her side into a recovery position if there are no obvious signs of injury.

5.  If the person is NOT breathing:

  • Send someone to call 911 or the designated emergency number and obtain an AED and first aid kit.
  • Ensure that the person is face-up on a firm, flat surface such as the floor or ground.
  • Begin CPR (starting with compressions) or use an AED if one is immediately available.
  • Continue administering CPR until the person exhibits signs of life, such as breathing, an AED becomes available, or EMS or trained medical responders arrive on scene.

Note:  End CPR if the scene becomes unsafe or you cannot continue due to exhaustion.


Often, the first responders that save lives are not medically trained professionals.  It is essential, in those first few minutes, those who need medical attention receive care, even from those not necessarily medically trained.

The first steps you take in medicine are often the most important.  Just like taking control of a First Aid situation, taking control of your healthcare today can be the first important step toward wellness.  At HealthLynked, we can help.

Mange your own medical records and those of your family, carry them with you wherever you go, and make appointments on the fly.  All this for Free!

Go to HealthLynked.com, now, to take the fist steps to better wellness.

July is Sarcoma Awareness Month – Raise Awareness for this “Forgotten Cancer”

If you see yellow ribbons around your community during the month of July, it may mean something different than the usual “Support Our Troops” many think of when first sighted. Instead, they could be displayed in honor of Sarcoma Awareness Month, observed each July.

Sarcoma is a soft-tissue cancer that may occur in a variety of the body’s soft tissues, including the nerves, muscles, joints, blood vessels, fat and more. Sarcoma may also occur in the bones.  Although rare in adults, making up just ONE percent of adult cancers, sarcoma is relatively common in children, accounting for fifteen percent of childhood cancer cases.  Bone and joint cancer is most frequently diagnosed among teenagers, while soft tissue cancers typically affect those 55 years or older.

Sarcoma is most often found in the arms and legs, where the majority of connective tissues are located, but it can occur virtually anywhere. Because the disease often starts deep in the body, it may not be noticeable until a large lump or bump appears — and at this point the cancer may be difficult to treat.

The Sarcoma Foundation of America (SFA) estimates that about 20 percent of sarcoma cases are curable by surgery while another 30 percent may be effectively treated with surgery, chemotherapy and/or radiation. However, in about half of cases, the disease is resistant to all form of treatments, highlighting an urgent need for new therapies.

Soft tissue sarcomas form in cartilage, fat, muscle, blood vessels, tendons, nerves, and around joints. Osteosarcomas develop in bone; liposarcomas form in fat; rhabdomyosarcomas form in muscle; and Ewing sarcomas form in bone and soft tissue.

In 2018, over 13,000 cases of soft tissue sarcoma and 3,400 cases of bone sarcomas are expected to be diagnosed in the United States, according to data from the National Cancer Institute’s Surveillance, Epidemiology, and End Results Program (SEER). Approximately 5,100 and 1,590 people are expected to die from soft tissue and bone sarcomas, respectively. The five-year survival rate for soft tissue sarcomas is 50 percent, while the survival rate is 66 percent for bone sarcomas.

Because sarcomas are difficult to distinguish from other cancers when they are found within organs, their incidence is probably underestimated, according to the National Cancer Institute.

 Fast facts on sarcoma

  • There are over 50 types of soft tissue sarcoma.
  • Symptoms may not be apparent; often, the only sign of sarcoma is a lump.
  • Pain may occur depending on where the tumor is located, or if it presses on nearby nerves.
  • Treatment, as for other forms of cancer, can include surgery, radiation therapy, and chemotherapy.

Symptoms of soft tissue sarcoma

People with soft tissue sarcomas often have no symptoms. There may be no signs until the lump grows to a large size and can be felt; however, even this may go unnoticed. The main symptoms are:

  • Pain – the most obvious symptom. Once the tumor affects local tissues, nerves, or muscles, it can be felt as pain in the general area.
  • Inflammation – the tumor grows and eventually affects the area with inflammation and swelling.
  • Location specific symptoms – inability to move limbs properly (if the sarcoma is on the arms or legs for example) and other impairments depending on the location.

Specific symptoms may reflect the particular type of sarcoma. For instance, tumors in the gastrointestinal system may bleed, so these sarcomas might produce symptoms like blood in the stool, or a stool that has a black, tarry appearance.

Types of sarcoma

Types of soft tissue sarcoma are defined by the specific tissue or location affected; they include:

  • Undifferentiated pleomorphic sarcoma – previously known as malignant fibrous histiocytoma – this tumor is most often found in the arms or legs but sometimes at the back of the abdomen.
  • Gastrointestinal stromal tumor (GIST) – this affects specialized neuromuscular cells of the gut.
  • Liposarcoma – sarcoma of fat tissue.
  • Leiomyosarcoma – affects smooth muscle in organ walls.
  • Synovial sarcomas – these are usually found around a joint in the arms or legs.
  • Malignant peripheral nerve sheath tumor – also known as neurofibrosarcoma, it affects the protective lining of the nerves.
  • Rhabdomyosarcoma – this forms in muscle and is a childhood cancer. While rare overall, it is a relatively common tumor in children.
  • Angiosarcomas – these develop in the cells of the blood or lymph vessels.
  • Fibrosarcomas – sarcomas that usually form in the limbs or on the trunk, forming from fibroblasts, the most common cell type in connective tissue.
  • Kaposi’s sarcoma – a sarcoma that affects the skin and is caused by a virus. The most common form of Kaposi’s sarcoma is related to AIDS.  Kaposi’s tumors often produce distinctive skin lesions but also affect other soft tissues.  Kaposi’s sarcoma is caused by the human herpesvirus 8.
  • Further examples – these include dermatofibrosarcoma protuberans, a skin lesion; epithelioid sarcoma, which often affects young adults’ hands or feet; myxoma, which affects older adults, usually in the arms and legs; mesenchymomas, which are rare and combine elements of other sarcomas and can be found in any part of the body; vascular sarcomas, containing many blood vessels; and malignant neurilemmoma (also known as schwannoma).  Sarcoma of the bone includes osteosarcoma, Ewing sarcoma, and chondrosarcoma.

Causes of sarcoma

The causes behind sarcoma are unknown, but there are some known risk factors. In adults, for instance, exposure to phenoxy acetic acid in herbicides or chlorophenols in wood preservatives may increase the risk. High doses of radiation are also known to cause sarcomas in some people, as are certain rare genetic alterations. The following inherited diseases are also associated with an increase sarcoma risk, according to SFA:

  • Li-Fraumeni syndrome, which is associated with alterations in the p53 gene
  • Von Recklinghausen’s disease (neurofibromatosis), which is associated with alterations in the NF1 gene

Having certain inherited disorders can increase the risk for other soft tissue sarcomas, including retinoblastoma, tuberous sclerosis, Werner syndrome, and nevoid basal cell carcinoma syndrome. Other risk factors for soft tissue sarcoma include past treatment with radiation therapy for certain cancers; exposure to certain chemicals, such as thorium dioxide, vinyl chloride, or arsenic; and long-term lymphedema in the arms or legs.

Past treatment with radiation can increase the risk of osteosarcoma and other types of bone cancers. Other risk factors for osteosarcoma include treatment with anticancer drugs called alkylating agents, having a certain change in the retinoblastoma gene, and having certain conditions including Paget disease, Diamond-Blackfan anemia, and Werner syndrome.

Tests and diagnosis of sarcoma

After understanding a patient’s medical history and completing a medical examination, medical imaging scans will help to inform a diagnosis, which will need to be confirmed through laboratory analysis of a tumor sample.

The following physical features should prompt a doctor to investigate:

  1. larger than 2 inches in diameter or growing in size
  2. fixed, immovable, or deep
  3. painful
  4. return of tumor previously removed

Medical imaging helps to locate, characterize, and give further information about a tumor to guide diagnosis. It may also be used to gauge the success of treatment or to look for spread of cancer.

Imaging techniques include X-rays, CT scan (computed tomography), MRI(magnetic resonance imaging), ultrasound, and PET (positron emission tomography).

Treatments for soft tissue sarcoma

The following treatment options can be used for sarcomas:

  • Surgery – the most common sarcoma treatment. It aims to remove the tumor and even some of the normal surrounding tissue. A biopsy sample is often taken at the same time to confirm the exact type of tumor.
  • Radiation therapy – this destroys cancer cells and may be done in addition to surgery, before or after the operation.
  • Chemotherapy – this could also be used in addition to surgery, though less often than radiation therapy.

Some soft tissue sarcomas have other available treatments, such as specific drug treatments, gene-targeted therapies, or biological therapies such as immunotherapy.

Treatment choice and intensity are also guided by the stage and grade of cancer, by the size of the tumor, and extent of any spread.

Prevention of sarcoma

Sarcoma is not typically preventable. Radiation therapy is a risk factor, so reducing exposure to it may be preventive, although a need for radiation therapy usually outweighs any subsequent sarcoma risk.

Observing Sarcoma Awareness Month

Sarcoma is still considered to be the “forgotten cancer.”  Efforts to encourage research and drug development are made more challenging due to a lack of awareness and understanding.  How as a community do we raise funds for vital research if people don’t know that this cancer exists?

Though the Sarcoma Foundation of America works tirelessly every day to raise awareness, during Sarcoma Awareness Month, they aim to further highlight the extraordinary challenges sarcoma patients face and the need for more sarcoma research and better sarcoma therapies.  Please join in efforts and pledge to bring awareness to your community.  Here are a few ways you can help highlight the need for ongoing research on sarcoma:

  • This July, take a moment to share a message via social media or speak with your friends and family about this relatively unknown condition.
  • Join sarcoma patients, survivors and their loved ones for the Steps to Cure Sarcoma.  Every dollar raised will be used to fund research, patient advocacy and education.
  • Take a moment to listen to a Sarcoma Awareness Month Public Service Announcement campaign. Share it online to raise awareness.
  • Get together with others in the sarcoma community and donate today!

Getting Help

Since sarcoma is a rare cancer, many people are unfamiliar with the disease and have not been affected personally. However, many children’s lives have been altered because of this disease, and advances in early detection and treatment could help save lives.

A number of clinical trails are underway for people with sarcoma. If you’ve been recently diagnosed, ask your doctor if a clinical trial, which could give you access to novel treatment options, is right for you.

Trying to find the right doctor to determine if that lump or new pain is something more than just a little annoying is made easy at HealthLynked.  We are the first ever social ecosystem designed to connect physicians and patients in a truly collaborative platform to Improve HealthCare.

Ready to get Lynked?  Sign up for free today and take control of your wellness!

 

Sources:

Han, MD, Seunggu.  “Sarcoma: Symptoms, types, treatments, and causes.” Medical News Today.  23 May 2017.

https://www.curesarcoma.org/sarcoma-awareness-month/

https://www.aacrfoundation.org/Pages/sarcoma_awareness_month.aspx

https://www.gatewaycr.org/gateway-blog/posts/2017/july/july-is-sarcoma-awareness-month-what-is-sarcoma/

 

 

 

How is Excess Body Fat Priming Our Brains for Mental Decline?

As today marks the 81st birthday of Krispy Kreme – an American doughnut company and coffeehouse chain based in Winston-Salem, North Carolina built off an ancient, secret cajun recipe – it seems a fitting day to talk about obesity, fat, and its effect on the brain.  Let’s start with “skinny fat”.

Sarcopenia, which is the loss of muscle mass, tends to happen naturally with age. So, in older people with sarcopenia, excess body fat may not be readily visible. But hidden fat, paired with muscle mass loss later in life, could predict Alzheimer’s risk, researchers warn, and Sarcopenic obesity may exacerbate the risk of other cognitive decline later in life.

A recent study — the results of which have been published in the journal Clinical Interventions in Aging — has found that sarcopenia and obesity (independently, but especially when occurring together) can heighten the risk of cognitive function impairments later in life.

The research was conducted by scientists at the Comprehensive Center for Brain Health at the Charles E. Schmidt College of Medicine of Florida Atlantic University in Boca Raton.

“Sarcopenia,” explains senior study author Dr. James Galvin, “has been linked to global cognitive impairment and dysfunction in specific cognitive skills including memory, speed, and executive functions.”

“Understanding the mechanisms through which this syndrome may affect cognition is important as it may inform efforts to prevent cognitive decline in later life by targeting at-risk groups with an imbalance between lean and fat mass.”

Dr. James Galvin

“They may benefit from programs addressing loss of cognitive function by maintaining and improving strength and preventing obesity,” he adds.

Beware sarcopenic obesity

The scientists analyzed health-related data collected from 353 participants — aged 69, on average — all of whom registered to take part in community-based studies on aging and memory.

To establish whether or not there was a link between sarcopenic obesity — that is, the presence of excess body fat in conjunction with muscle mass loss — and cognitive decline, the team assessed participants’ performance on tests evaluating cognitive function, including the Montreal Cognitive Assessment and animal-naming exercises.

Also, the participants’ muscle strength and mass were evaluated through grip strength tests and chair stands, and they also underwent body compositions assessments, which looked at muscle mass, body mass index (BMI), and the amount of body fat.

The researchers discovered that the participants with sarcopenic obesity had the poorest performance on cognition-related tests.  The next poorest performance on cognition tests was seen in people with sarcopenia alone, followed by participants who only had obesity.

Both when occurring independently and when occurring in concert, obesity and loss of muscle mass were linked with impaired working memory — which is the type of memory we use when making spontaneous decisions on a daily basis — as well as less mental flexibility, poorer orientation, and worse self-control.

Keep changes in body composition in check

The scientists explain that obesity could exacerbate the risk of cognitive decline through biological mechanisms that influence vascular health, metabolism, and inflammation.

Moreover, they warn that in people who already face impaired executive functioning, obesity might also impact energy resources through poor self-control that affects nutrition.

As for sarcopenia, the researchers note that it could influence brain mechanisms related to conflict resolution skills and selective attention.

Based on the study’s findings, Dr. Galvin and his colleagues are particularly concerned that a mix of sarcopenia and excess body fat in older adults could become a serious public health issue, so they believe that any significant changes in body mass composition should be closely monitored to prevent negative health outcomes.

“Sarcopenia either alone or in the presence of obesity, can be used in clinical practice to estimate potential risk of cognitive impairment,” notes study co-author Magdalena Tolea.

But such health issues can be kept under control, and the risks associated with them averted, she suggests.

“Testing grip strength by dynamometry can be easily administered within the time constraints of a clinic visit, and body mass index is usually collected as part of annual wellness visits,” concludes Tolea.

How Aging and Obesity Prime the Brain for Alzheimer’s

According to another new study, the effects of natural aging processes, combined with those of obesity and a poor diet, affect certain brain mechanisms, thereby boosting the risk of Alzheimer’s. The new study, conducted on mice, uncovered how a high-fat, high-sugar diet renders the aging brain more vulnerable to Alzheimer’s.

Alzheimer’s disease is a neurodegenerative condition that is characterized primarily by memory loss and impaired cognition.  Some risk factors for the development of this disease are aging and metabolic conditions such as obesity and diabetes.  However, many of the biological mechanisms underlying the onset and progression of this disease remain unknown.

This is despite the fact that our understanding of the predisposing risk factors is growing all the time.  Now, Rebecca MacPherson, Bradley Baranowski, and Kirsten Bott — of Brock University in Ontario, Canada — have conducted a study that has allowed them to uncover some more of the mechanics at play in the development of this type of dementia.

The team worked with aging mice to investigate how a high-fat, high-sugar (HFS) diet that fueled obesity might also prime the brain for neurodegeneration in this sample.  Their findings are described in a paper now published in the journal Physiological Reports.

How unhealthful diets impact the brain

Specifically, the researchers examined how an HFS diet, in conjunction with the effects of normal biological aging, would affect insulin signaling, which helps to regulate the amount of glucose (simple sugar) absorbed by muscles and different organs.

They also looked at how this obesity-inducing diet might alter biomarkers relating to inflammation and cellular stress.

To understand the impact of an HFS diet on aging mice, the research team put some mice on a regular type diet, while others were given food that had a high fat and sugar content.

After the mice had been fed their respective diets for a period of 13 weeks, the team looked for signs of inflammation and measured cellular stress levels in two brain areas associated with memory and cognitive behavior: the hippocampus and the prefrontal cortex.

The researchers also compared the effects of an HFS diet on the brains of aging rodents’ baseline measurements effected on the brains of younger mice.

They found older mice on an obesity-inducing diet had high levels of brain inflammation and cellular stress, as well as insulin resistance in parts of the hippocampus linked to the development of Alzheimer’s disease.

Although more markers of insulin resistance were observed in the prefrontal cortices of mice that had been on an HFS diet, inflammation status and cellular stress markers remained the same.

The study authors hypothesize that “region-specific differences between the prefrontal cortex and hippocampus in response to aging with an HFS diet [suggest] that the disease pathology is not uniform throughout the brain.”

Obesity boosts aging’s negative effect

Notably, the researchers also found that brain inflammation levels had also increased in the mice that had been on a regular diet, compared with baseline measurements.

The researchers note that this could be taken as evidence of aging’s role as an independent risk factor in Alzheimer’s. Obesity, they add, boosts the risk by affecting key mechanisms in the brain.

“This study,” they claim, “provides novel information in relation to the mechanistic link between obesity and the transition from adulthood to middle age and signaling cascades that may be related to [Alzheimer’s] pathology later in life.”

“These results add to our basic understanding of the pathways involved in the early progression of [Alzheimer’s] pathogenesis and demonstrate the negative effects of an HFS diet on both the prefrontal cortex and hippocampal regions.”

Every day, there are physicians in the HealthLynked system ready to help those combating obesity and care for Alzheimer and dementia patients  to help them live the best lives possible.  If someone you love is showing signs of memory loss beyond what might be considered normal for their age, or if too many donuts have made their way into your system, go to HealthLynked.com to connect and collaborate with any number of specialists at the ready.

 

Ready to get Lynked and get help?  Go to HealthLynked.com today to register for free!

 

Adapted from:

Cohut, Maria. ”Skinny fat’ linked to cognitive decline, study warns.” Medical News Today, Friday 6 July 2018

Cohut, Maria. ”Aging, obesity may prime the brain for Alzheimer’s.” Medical News Today, Monday 2 July 2018

 

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!

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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.

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Sources

UCLAnewsroom.edu

Wired.com

Columbiasurgery.org

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

 

#heart,#transplant,#immunosuppression