When too much information can hurt you

If you’re like most modern healthcare consumers, you use the Internet to search for health, wellness or medical information. That can range from fairly benign searches for healthier foods, exercises and over-the-counter drug remedies, to more sophisticated inquiries on topics ranging from sleeping disorders or joint injuries to stomach distress and skin cancer. The good news is that there is a ton of information on the Web to help us navigate common concerns and keep us better informed. The bad news is that much of the information may not be accurate or reliable, and could lead us to make poorly informed decisions like not calling a physician when we should or, in a flip of that coin, calling all the time when it may not be necessary.

Everyone knows a hypochondriac.  If it’s harmless Aunt Agnes, who believes she has had every disease in the book, we wink, respond kindly and go back to our dessert. But for millions of Americans, the fear of disease and tendency to self-diagnose can be a serious issue. And easy access to legitimate – and often wrong or unsubstantiated medical information online – can seriously exacerbate or feed these concerns.

Hypochondriasis is the fear of a serious illness that continues despite the reassurance of physicians and testing. These fears and anxieties about illness may become debilitating and interfere with daily life. In the past people would go from friend to friend and from doctor to doctor seeking an answer. In today’s online world, however, many people never see a physician and rely solely upon electronically accessed information or what they may hear on television.

This interaction of excessive anxiety brought on by the use of online and broadcast health information is now being referred to, creatively, as “cyberchondria.” It is defined as an imagined illness with exaggeration of symptoms, no matter how insignificant, that lasts for at least six months and causes significant distress. It tends to develop in the 20s or 30s, and it affects men and women equally.

Most of us know when to see a physician or healthcare professional. The blinding headache that won’t go away, an obvious injury or severe irritation or a persistent virus or cough requires medical diagnosis and intervention. But, just for fun, go to your favorite search engine and look up “headache,” and you’ll be amazed (or not) at what you find:  An enormous online smorgasbord that could take months, or even years, to review. That information is punctuated by thousands of offers for remedies, as well, many of them from unscrupulous advertisers.

For many people, a headache may mean we’re tired, dehydrated, stressed or working too hard. If we have a family history of migraines, that could be a related cause.  But for the cyberchondriac, a headache may be seem as a brain tumor or aneurism, just as a pain somewhere else could be cancer or a chronic disease. The more research they do, the more their anxiety builds. When these misguided attempts at self-diagnosis escalate, pursuing these ailments results in medical tests or treatments costing billions of dollars annually.

What are quirks to some can be obsessive for others – but the suffering is real and can be emotionally paralyzing. Patients don’t have to actually have the disease to believe they are sick, or to exhibit certain related symptoms: Our brains are complex mechanisms that can turn against us in the forms of imaginary or misunderstood aches and pains and anxiety-related behaviors that appear very real to the afflicted. Hypochondriacs tend to be very aware of bodily sensations that most people live with and ignore. The stress that goes along with this worry can make the symptoms even worse, and the more time spent online “researching” – even when the information is accurate — further escalates the concern, and the symptoms.

Part of the problem, experts say, is that information on the Internet is not truly diagnostic or intuitive, compared to a face-to-face meeting with a healthcare professional. Information online tends to be very general, too complex, and easily misinterpreted. Physicians, on the other hand, bring years of diagnostic experience and insight. They have a wide variety of easily accessible testing available to the patient, translate the patient’s family, age, personal and emotional history, and can quickly eliminate or identify potential culprits and symptoms.

It is important to remember that search engines, unlike physicians, are not versed in diagnostic reasoning and do not discriminate between common benign disorders and less common serious problems. The information we can find online is often helpful for better understanding potential medical conditions and remedies, especially when the source is reliable.

Here are a few tips for avoiding or helping to control cyberchondria:

  • Stick with one physician, rather than changing doctors regularly
  • Avoid constant “self-checking” such as constantly monitoring your temperature, blood pressure and pulse
  • Be active, and exercise regularly, which are both good for reducing stress
  • Seek help from a professional therapist or psychologist
  • Join a support group to help you better understand your obsessions and related coping mechanisms.

Ultimately, the smart practice is to take anything we learn on the internet or on television with a grain of salt, realize the limitations to analyzing medical conditions through these media, and seek professional medical information and attention whenever we’re sick . . . or believe we may be sick.

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Be sure to check out the CBIA Healthy Connections wellness program at your company’s next renewal. It’s free as part of your participation in CBIA Health Connections!

Shingles: A throwback you’d like to throw back!

One in three of all adults reading this article will develop shingles in their lifetime, usually after age 50. Not because you’re reading this article – but because when you were a child, you probably had chickenpox.

Shingles is the reactivation of a viral infection in the nerves to the skin that causes pain, burning, or a tingling sensation, along with an itch and blisters in the skin supplied by the affected nerve.  It is caused by the varicella zoster virus, or VZV — the same virus that causes chickenpox.  When the itchy red spots of childhood chickenpox disappear, the virus remains in a dormant state in our nerve cells, able to strike again. This second eruption of the chickenpox virus is called shingles or herpes-zoster.  Shingles is not caused by the same virus that causes genital herpes, a sexually transmitted disease.

Shingles occurs when an unknown trigger causes the virus to become activated.  It afflicts approximately one million Americans annually, and children are vulnerable, too. However, about half of all cases occur in men and women 60 years old or older.

People who develop shingles typically have only one episode in their lifetime, though it can strike a person a second or even third time. Since most of us had chickenpox as children, we’re at risk, even if the case was so mild that it may have passed unnoticed.  In the original exposure to VZV (chickenpox), some of the virus particles settle into nerve cells where they remain for many years in an inactive, hidden (latent) form.

When the VZV reactivates, it spreads down the long nerve fibers that extend from the sensory cell bodies to the skin. As the virus multiplies, a telltale rash erupts. With shingles, the nervous system is more deeply involved than it was during the bout with chickenpox, and the symptoms are often more complex and severe.

Incidence increases with age – shingles is 10 times more likely to occur in adults over 60 than in children under 10.  People with compromised immune systems, a natural consequence of aging, or from use of immunosuppressive medications such as prednisone are at increased risk of developing shingles.

What does shingles look like?

Shingles is a painful rash that develops on one side of the face or body. The rash forms blisters that typically scab over in seven to 10 days and clear up within two to four weeks.

Before the rash develops, people often have pain, itching or tingling in the area where the rash will develop. This may happen anywhere from one to five days before the rash appears. Most commonly, the rash occurs in a single stripe around either the left or the right side of the body. In other cases, the rash occurs on one side of the face. In rare cases (usually among people with weakened immune systems), the rash may be more widespread and look similar to a chickenpox rash. Shingles can affect the eyes and cause loss of vision.

Other symptoms of shingles can include fever, headache, chills and an upset stomach.

Shingles cannot be passed from one person to another. However, the virus that causes shingles, the varicella zoster virus, can be spread from a person with active shingles to another person who has never had chickenpox. In such cases, the person exposed to the virus might develop chickenpox, but they would not develop shingles.

The virus is spread through direct contact with fluid from the rash blisters caused by shingles.  A person with active shingles can spread the virus when the rash is in the blister-phase. A person is not infectious before the blisters appear. Once the rash has developed crusts, the person is no longer contagious.

Shingles is less contagious than chickenpox and the risk of a person with shingles spreading the virus is low if the rash is covered.

If you have shingles, here are some important steps to remember:

  • Keep the rash covered.
  • Avoid touching or scratching the rash.
  • Wash your hands oftento prevent the spread of varicella zoster virus.

Until your rash has developed crusts, avoid contact with:

  • Pregnant women who have never had chickenpox or the chickenpox vaccine;
  • Premature or low-birth-weight infants; and
  • People with weakened immune systems, such as people receiving immunosuppressive medications or undergoing chemotherapy, organ transplant recipients, and people with human immunodeficiency virus (HIV) infection.

Reducing the chance of contracting shingles

Several antiviral medicines – acyclovir, valacyclovir, and famciclovir – are available to treat shingles. These medicines will help shorten the length and severity of the illness. But to be effective, they must be started as soon as possible after the rash appears.  Analgesics (pain medicine) may help relieve the pain caused by shingles. Wet compresses, calamine lotion, and colloidal oatmeal baths may help relieve some of the itching.

The only way to reduce the risk of developing shingles and the long-term pain from post-herpetic neuralgia (PHN) – a condition that can afflict people after they’ve recovered from shingles – is to get vaccinated. Shingles vaccine (Zostavax®) reduces the risk of developing shingles and the long-term pain that can sometimes afflict those who have had shingles. The Center for Disease Control (CDC) recommends that people aged 60 years and older get one dose of shingles vaccine. Shingles vaccine is available in pharmacies and doctor’s offices.

Additionally, the chickenpox vaccine became available in the United States in 1995.  Immunization with the varicella vaccine (or chickenpox vaccine) – now recommended in the United States for all children between 18 months and adolescence – can protect people from getting chickenpox.  People who have been vaccinated against chickenpox are probably less likely to get shingles because the weak, “attenuated” strain of virus used in the chickenpox vaccine is less likely to survive in the body over decades.

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Be sure to check out the CBIA Healthy Connections wellness program at your company’s next renewal. It’s free as part of your participation in CBIA Health Connections!

Talk the walk

We spend a lot of time and money staying active and fit. Between the cost of memberships, athletic equipment, and appropriate clothing, fitness is a mutli-billion-dollar business. Yet there’s one incredibly basic, common and essentially cost-free activity most of us can pursue that’s easy, rewarding, convenient and okay alone or in crowds – yup, you guessed, it is walking!

Walking at a moderate pace for 30 to 60 minutes burns stored fat, builds muscle and speeds up our metabolism. Here are some other benefits:

  • Walking can reduce our risk of heart disease, breast cancer, colon cancer, diabetes and stroke.
  • Walking is low-impact, which means it causes less stress to our joints and our body than high-impact activities such as running.
  • Walking is a weight-bearing exercise, which helps prevent the onset of osteoporosis in women.
  • Walking reduces stress, improves blood flow and circulation, aids our respiratory system and helps reduce or limit weight gain.

If there’s any downside at all to walking, it’s that people who may have strained or damaged joints (knees and hips) or bad backs may find walking more difficult or painful. Ironically, though, back pain often is the result of wearing the wrong types of shoes for the activity of choice – or the wrong shoes, in general.  In fact, more than 50 percent of working Americans suffer from back pain each year, according to the American Chiropratic Association Not only that, but back pain ranks as the number-two reason people see a doctor, overall.

Often, there are two primary reasons why walking can hurt our backs. The first is what we choose to wear on our feet, and the second reason is how we actually walk, relative to posture, stride and form. For example, for women who wear high heels, these fashionable but typically uncomfortable shoes can throw off the alignment of our spine, adding extra stress and strain on the lower back. At the other extreme, shoes like flip flops are so flat that the lack of support can lead to arch, heel pain, ankle or knee pain.

Athletic shoes are grouped into categories for running, training and walking. This includes shoes for hiking, jogging and exercise walking. For a walking shoe, look for a comfortable soft upper, good shock absorption, smooth tread, and a rocker sole design that encourages the natural roll of the foot during the walking motion. Joggers, on the other foot, should wear a shoe with more cushioning impact. Running shoes are designed to provide maximum overall shock absorption for the foot. Such a shoe should also have good heel control. Walking shoes have more rigidity in the front so you can roll off your toes rather than bend through them as you do with running shoes.

We do not necessarily need a different pair of shoes for every sport in which we participate. Generally, people should wear sport-specific shoes for sports played more than three times a week. If you have worked out for some time injury-free, then stick with the particular shoe you have been wearing. There is really no reason to change.

Wearing the right shoes for the job or activity is critical, but so is making sure they’re the right size. If it’s been two or more years since your feet were professionally sized, there’s a good chance your shoes aren’t fitting you properly.  Feet change shape as we age, and tight-fitting footwear can lead to heel pain, deformed toes, bunions, corns, calluses, ingrown toenails, and a host of other painful problems.

Unless you’ve been sized recently, be careful about wearing shoes purchased over the Internet. Instead, go to a store with knowledgeable salespeople and have them measure your feet. If possible, purchase athletic shoes from a specialty store. The staff will provide valuable input on the type of shoe needed for your sport as well as help with proper fitting. This may cost a little more but is worthwhile, particularly for shoes that are used often.

Proper-fitting sports shoes can enhance performance and prevent injuries. Follow these fitting facts when purchasing a new pair of athletic shoes.

  • Try on athletic shoes after a workout or run and at the end of the day. Your feet will be at their largest.
  • Wear the same type of sock that you will wear for that sport.
  • When the shoe is on your foot, you should be able to freely wiggle all of your toes.
  • Since it’s common to have feet of different sizes, be sure to have both feet measured and fit to the larger of the two.
  • The shoes should be comfortable as soon as you try them on. There is no break-in period.
  • Walk or run a few steps in your shoes. They should be comfortable.
  • Always re-lace the shoes you are trying on. You should begin at the farthest eyelets and apply even pressure as you create a crisscross lacing pattern to the top of the shoe.
  • There should be a firm grip of the shoe to your heel. Your heel should not slip as you walk or run.

The importance of posture and stride

As with any form of exercise, good form plays a vital role in keeping us fit and healthy. How we stand, and the way we walk can cause back pain and muscle stress. Here are some tips for proper walking technique:

  • Posture: Stand up straight and look ahead. Don’t look down at your feet or the pavement below since that puts excessive and unnecessary strain on our neck and back.
  • Overstriding: Walk naturally. When we walk faster, a natural inclination is to lengthen our stride in front. Don’t. We should concentrate on taking shorter, quicker steps to avoid striking the ground too hard with our feet.
  • Understriding: On the flip side, avoid taking steps that are too small. This can constrict our muscles and their elasticity. We need to listen to our bodies. If we’re not comfortable as we move, we need to change our stride.
  • Flapping feet: If our feet hit the ground with a slap we’re probably fighting stiff shoes or our shins are too weak to let us roll through the step properly. Find a good pair of walking shoes that flex at the balls of the feet, and work on strengthening the shins.
  • Arm swing: A normal walking motion uses the arms to counterbalance the leg motion. We can add power and speed by using our arms effectively. To do this, bend your arms at a 90-degree angle and swing them naturally back and forth opposite your legs. Avoid under-using your arms by not moving them enough or overusing them by moving them faster than your legs.

Finally, no matter what we wear or how we walk, if our feet, legs or back are hurting us when we’re walking or when at rest, we need to visit a general physician or orthopedist, or to see a podiatrist, a doctor who specializes in foot care. A podiatrist checks out our feet, gait, and alignment.

He or she may recommend specialized footwear that has been modified to treat our particular foot condition, most often with inserts or orthotics that provide extra support. These can lead to improvements in foot and overall alignment, which can result in more efficient muscle use. You can also get shoes custom made to address your specific foot and back issues.

It’s important that we keep walking, whether indoors at the mall, at work and school, or outdoors enjoying nature and the elements around us.  Proper shoes and a basic understanding of the physiology of walking will go a long way toward enjoyment and improved health.

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Be sure to check out the CBIA Healthy Connections wellness program at your company’s next renewal. It’s free as part of your participation in CBIA Health Connections!

Sometimes, getting stuck isn’t bad

Can you remember the last time you had a tetanus shot?  In fact, can you remember the last time you had any kind of shot at all? If you can, chances are it was a flu shot, since most of the immunizations we require are received during childhood. But there are other immunizations we should be receiving periodically, because some lose their effectiveness over time.

Checking up on your personal immunization record, and making sure your loved ones are properly immunized as well, is a simple and critical step for helping to protect yourself and your family from preventable illness and related serious medical conditions. And if you’re an employer, encouraging your staff to do the same helps protect them, their families and everyone around them.

Even though some diseases, such as polio, rarely affect people in the U.S., all of the recommended childhood immunizations and booster vaccines are still needed. These diseases still exist in other countries. Travelers can unknowingly bring these diseases into the U.S. and infect people who have not been immunized. Without the protection from immunizations, these diseases could be imported and could quickly spread through the population, causing epidemics.

Additionally, influenza – the flu – mutates and reappears in different strains, requiring different vaccines every year. Organizations like the Centers for Disease Control (CDC) and World Health Organization work together to try and identify likely strains and prepare millions of doses of flu vaccines, which typically are administered from late summer to early winter to children and adults. They are safe, readily accessible and effective – and side effects are rare.  When employees get the flu or another preventable illness, they miss work and get other people sick.  That has a negative impact on productivity and service, and the related healthcare costs are significant.

August is National Immunization Awareness Month. Non-immunized people living in healthy conditions are not protected from disease; only immunizations prepare the immune system to fight the disease organisms. Most of us choose to immunize our children from the day they’re born. In fact, children can’t attend public school, go to camp, compete in many sports or travel outside of the country without a proven medical history of required immunizations. But as adults, we may not have received all the necessary immunizations, some of them may no longer be working effectively, and others, such as the vaccination for tetanus, have to be repeated periodically … in the case of tetanus, once every 10 years.

Today, children and adults receive a “Tdap” booster for tetanus, diphtheria, and pertussis. If you doubt the importance of this, note that pertussis (Whooping Cough) has recently reappeared in Connecticut. Pertussis is caused by bacteria spread through direct contact with respiratory droplets when an infected person coughs or sneezes. The reason for its reemergence, experts believe, is because our bodies may have stopped producing antibodies in response to the vaccinations we received as children, or because some parents are not protecting their children through recommended vaccinations. This disease is particularly dangerous for babies, so protecting yourself also protects others.

Diphtheria, also prevented through the Tdap booster, is a very contagious bacterial disease that affects the respiratory system, including the lungs. And Tetanus, which is caused by bacteria found in soil, enters the body through a wound, such as a deep cut. When people are infected, the bacteria produce a toxin in the body that causes serious, painful spasms and stiffness of all muscles in the body. This can lead to “locking” of the jaw so a person cannot open his or her mouth, swallow, or breathe. Complete recovery from tetanus can take months. Three of 10 people who get tetanus die from the disease.

If you can’t remember if or when you had your Tdap booster, talk to your doctor. Additionally, if you or your employees plan to travel outside of the United States or Canada, it’s wise to speak with a physician or an infectious disease specialist about immunizations to consider, such as protection against Hepatitis A, before traveling. In many foreign countries, especially third-world nations, diseases can still be contracted through impure water systems, through food that hasn’t been properly protected, and by air-borne particles.

If your personal immunization record doesn’t exist or has been lost, your physician can order a simple blood test that checks for the antibodies currently active in your system. He or she can then offer you the missing vaccinations, bringing you up-to-date as required. Typically, you’ll only have to do this once, unlike the vaccination for preventing influenza, which has to be received annually. Influenza may lead to hospitalization or even death, even among previously healthy children, so it’s smart to speak with your doctor annually about whether or not you should respond proactively rather than take your chances.

Protecting ourselves and our loved ones is our most important job. Today’s medical advances and access make that far easier, but only if we each take personal responsibility to ensure that our immunizations are up-to-date. Encourage staff to stay on top of their personal immunization histories, consider offering flu-shot clinics at your worksite, and share this information to promote good health and wellness for everyone. For more information, call toll free 1-800-CDC-INFO (1-800-232-4636) or visit http://www.cdc.gov/vaccines.

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Opiate addiction: Alive and well and thriving

The statistics involving opiates and opioids in Connecticut are grim, and unless you’ve been paying attention, may be surprising: Our State has surpassed the national death rate for drug and opioid overdoses since 2013. From 2000 to 2014, nearly half a million persons in the United States died from drug overdoses, according to the Centers for Disease Control and Prevention (CDC).

The number of prescriptions for some of these medications has increased dramatically since the early 1990s. A consumer culture willing to “take a pill for what ails us” — and the perception of prescription drugs as less harmful than illicit drugs — are other contributors to the problem.  As a result, unintentional overdose deaths involving opioid pain relievers have quadrupled since 1999, and by 2007, outnumbered those involving heroin and cocaine. There has been a rash of high-profile tragedies involving these drugs, including the recent death of singer/songwriter Prince from an overdose of fentanyl. But you don’t have to be rich or famous to access and abuse drugs.

According to several national surveys, prescription medications, such as those used to treat pain, attention deficit disorders and anxiety are being abused at a rate second only to marijuana among illicit drug users. The consequences of this abuse have been steadily worsening, reflected in increased treatment admissions, emergency room visits, and overdose deaths.

Why are opioids effective – and dangerous?

Opioids are synthetic drugs manufactured to work similarly to opiates like heroin or morphine. They include drugs like oxycodone, methadone, hydrocodone, hydromorphine, and fentanyl. In the past several years, the use of opiates, including heroin, has increased significantly in Connecticut, as have fatal doses. In 2015 alone, heroin played a role in 415 deaths in our state.

Opioids act by attaching to specific proteins called opioid receptors, which are found in the brain, spinal cord, gastrointestinal tract, and other organs in the body. When these drugs attach to their receptors, they reduce the perception of pain. Opioids can also produce drowsiness, mental confusion, nausea, constipation, and, depending upon the amount of drug taken, can depress respiration.

Some people experience a euphoric response to opioid medications, since these drugs also affect the brain regions involved in reward. Those who abuse opioids may seek to intensify their experience by taking the drug in ways other than those prescribed. For example, OxyContin is an oral medication used to treat moderate to severe pain through a slow, steady release of the opioid. People who abuse OxyContin may snort or inject it, increasing their risk for serious medical complications, including overdose.

Data shows that people who use opioids non-medically don’t typically get them from doctors or prescriptions. Rather, they come from a relative’s medicine cabinet or a friend, and more often than not, the addiction can stem from a legitimate use, such as a prescription for painkillers following dental work, surgery or to help manage chronic pain.

Although most people take prescription medications responsibly, an estimated 52 million people (20 percent of those aged 12 and older) have used prescription drugs for non-medical reasons at least once in their lifetimes. A National Institute on Drug Abuse survey found that about one in 12 high school seniors reported past-year nonmedical use of the prescription pain reliever Vicodin, and one in 20 reported abusing OxyContin — making these medications among the most commonly abused drugs by adolescents.

Tightening controls on prescription pain killers, however, drives some people abusing pills to switch to heroin, which is cheaper and far more available. In fact, according to CDC data, heroin use is rising again even as abuse of opioids is leveling off.  From 2014 to 2015, the number of times fentanyl was found in the bloodstream of overdose victims increased 150 percent, and last year it was responsible for one quarter of all drug overdoses. Law-enforcement officials report an increased availability of illicitly manufactured fentanyl, and drug dealers cut heroin with fentanyl to increase the potency of the product.  Drug overdose deaths involving heroin continue to climb sharply, with heroin overdoses more than doubling from 2012 to 2015.

Addressing the problem

Addiction, which can include physical dependence, is distinguished by compulsive drug seeking and use despite sometimes devastating consequences. Someone who is physically dependent on a medication will experience withdrawal symptoms when use of the drug is abruptly reduced or stopped. These symptoms can be mild or severe (depending on the drug) and can usually be managed medically or avoided by progressively reducing dosage and frequency.

Dependence is often accompanied by tolerance, or the need to take higher doses of a medication to get the same effect. When tolerance occurs, it can be difficult for a physician to evaluate whether a patient is developing a drug problem, or has a real medical need for higher doses to control their symptoms.

Taken as prescribed, opioids can be used to manage pain safely and effectively. However, when abused, even a single large dose can cause severe respiratory depression and death. Properly managed, short-term medical use of opioid analgesics rarely causes addiction.

Only under a physician’s supervision can opioids be used safely with other drugs. Typically, they should not be used with other substances that depress the central nervous system, such as alcohol, antihistamines, barbiturates, benzodiazepines, or general anesthetics, because these combinations increase the risk of life-threatening respiratory depression.

Always follow the prescribed directions, be aware of potential interactions with other drugs, never stop or change a dosing regimen without first discussing it with a healthcare provider, and never use another person’s prescription. Additionally, unused or expired medications should be properly discarded per U.S. Food and Drug Administration (FDA) guidelines or at U.S. Drug Enforcement Administration collection sites.

For people experiencing dependency or addiction issues, there are medical solutions. Years of research have shown that addiction to any drug (illicit or prescribed) is a brain disease that can be treated effectively. Treatment takes into account the type of drug used and the needs of the individual. Successful treatment may need to incorporate several components, including detoxification, counseling, and sometimes the use of addiction medications. Multiple courses of treatment may be needed for patients to make a full recovery.

Rich or poor, black or white, living in the city or in the country, it doesn’t matter – the reach of illicit drug use touches all walks of life. If someone you know may be abusing pain killers, consider speaking with them and suggesting they talk with their physicians or other healthcare providers for guidance, and recognize the same issues in yourself if you’ve been using pain medications, even for legitimate purposes.

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Be sure to check out the CBIA Healthy Connections wellness program at your company’s next renewal. It’s free as part of your participation in CBIA Health Connections!

If I had a nickel for every time I got itchy

Moving beyond molds, dust, food and plant-based allergens that we ingest or inhale – especially in the spring and early summer – another entire allergy realm exists . . .  and the culprits are likely to be dangling from our ears or adorning our wrists, fingers or other body parts.

Allergies to metals that we wear or come into contact with regularly are extremely common, and often overlooked or misdiagnosed. Women tend to wear more jewelry and suffer in higher numbers, but men are far from immune. Often, the problem is that the metals we may be allergic to aren’t only in rings, necklaces or piercings – they’re also found in zippers, buttons on jeans, cooking and eating utensils, coins, cell phones and even eyeglass frames.

Sometimes metal allergies are sneaky. We may find that we get itchy or develop a rash when we wear jewelry made of silver, gold or platinum, but silver and gold allergies are pretty rare — the actual cause is the far more common, cheaper and utilitarian metal, nickel.

Nickel allergies have been on the rise in North America in recent years and now affect 24 percent to 36 percent of women and 7 percent to 15 percent of men. Nickel allergy is one of the most common causes of allergic contact dermatitis – an itchy rash that appears when our skin touches a usually harmless substance.

Nickel allergy can affect people of all ages, and usually develops after repeated or prolonged exposure. Treatments can reduce the symptoms of nickel allergy; however, once someone develops a nickel allergy, they will always be sensitive to the metal and need to avoid contact.

Normally, our immune system reacts to protect our body against bacteria, viruses or toxic substances. If we have a nickel allergy, our body reacts to nickel and possibly to other metals, such as cobalt and palladium. Essentially, our bodies mistakenly identify nickel as something that could harm us. That means anytime we come into contact with nickel, our immune system will respond and produce an allergic response.

Our immune system’s sensitivity to nickel may develop after our first exposure or after repeated or prolonged exposure. The cause of nickel allergy is unknown, but sensitivity to nickel may, in part, be inherited (genetic).

When someone with a nickel allergy is exposed to a nickel-containing item, the allergic reaction (contact dermatitis) usually begins within 12 to 48 hours after exposure. The reaction may persist for as long as two to four weeks. The features usually appear only where our skin came into contact with nickel, but they may appear elsewhere on our body. Nickel allergy signs and symptoms include:

  • Rash or bumps on the skin
  • Itching, which may be severe
  • Redness or changes in skin color
  • Dry patches of skin that may resemble a burn
  • Blisters and draining fluid in severe cases

Common sources of nickel exposure

Nickel allergy is most commonly associated with earrings and other jewelry for body piercings that contain some nickel.  By looking at a piece of jewelry it is very difficult to determine whether or not it contains nickel. Common sources of nickel exposure include:

  • Jewelry for body piercings
  • Other jewelry, including rings, bracelets, necklaces and jewelry clasps
  • Watchbands and belt buckles
  • Clothing fasteners such as zippers, snaps and bra hooks
  • Eyeglass frames and cell phones
  • Coins, metal tools and keys

Testing for metal allergies is easy. There are over-the-counter tests available, and testing is done by dermatologists and allergists. Small quantities of potential allergens (including nickel) are applied to our skin and covered with patches, usually for two days. If we have a nickel allergy, the skin under the nickel patch will be inflamed when the patch is removed or in the days after removal of the patch.

There is no cure for nickel allergy. Once we develop a sensitivity to nickel, we will develop a rash whenever we come into contact with the metal. Once a particular site, such as an earlobe, has reacted to nickel, that site will react even more when re-exposed to nickel.

How to protect ourselves from metal allergies

It’s best to purchase jewelry that’s made of materials that aren’t likely to cause allergic reactions. Look for jewelry made from such metals as nickel-free stainless steel, surgical-grade stainless steel, titanium, 18-karat yellow gold, or nickel-free 14-karat yellow gold, sterling silver, copper and platinum. Avoid jewelry with nickel, as well as cobalt and white gold, which may contain nickel and trigger allergic reactions. Surgical-grade stainless steel may contain some nickel, but it’s generally considered hypoallergenic for most people.

Be sure that your earring backings also are made of hypoallergenic materials. Wear gloves, if possible, when working with metals that cause an allergic reaction, and try to determine the composition of the items you will come in contact with on a regular basis. However, since it’s virtually impossible to completely avoid exposure, there are a variety of common remedies doctors can prescribe to reduce irritation and improve the condition of a rash from a nickel allergy reaction. Most involve corticosteroid creams or oral medicines, or oral antihistamines.

If these treatments don’t help or the rash worsens, contact your doctor. Home remedies include the following:

  • Use soothing lotions,such as calamine lotion, which may ease itching.
  • Moisturize regularly.Our skin has a natural barrier that’s disrupted when it reacts to nickel and other allergens. Using emollient creams or lotions, such as petroleum jelly or mineral oil, could reduce our need for topical corticosteroids.
  • Apply wet compresses,which can help dry blisters and relieve itching. Soak a clean cloth in Burow’s solution, an over-the-counter medication containing aluminum acetate; diluted white vinegar (one ounce of white vinegar to 16 ounces of water); or tap water. Place the compress over the rash for 15 to 45 minutes. You can repeat this process several times a day.
  • Apply over-the-counter topical corticosteroids (hydrocortisone),which may lessen itching and improve the rash. You can apply to the affected area before applying a wet compress to allow better penetration into the skin. Talk to your doctor about how long you can safely use the product.
  • Try over-the-counter oral antihistamines,such as diphenhydramine (Benadryl), which may help relieve itching for a short time.

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Be sure to check out the CBIA Healthy Connections wellness program at your company’s next renewal. It’s free as part of your participation in CBIA Health Connections!

Is organic natural, or natural organic?

The wide variety of mouth-watering fresh fruit and vegetables this time of year is astounding.  The produce sections in grocery stores are overflowing with colorful, ripe options that are attractive to our eyes and palettes, and farm stands and markets surround us, typically offering just-picked alternatives and luscious offerings that remind us why we love living in New England. But whether you purchase your fresh zucchini, peaches, corn or lettuce off the back of a pickup truck or at your local supermarket, it’s easy to get befuddled by signs and labels proclaiming “natural,” “organic,” “non-GMO” and related labels, constant reminders that we’re very trusting when it comes to our food sources and what we put into our bodies.

Natural and organic are not interchangeable.  Other truthful claims, such as free-range, hormone-free, and locally grown can still appear on food labels.  However, don’t confuse these terms with “organic.”  Only food labeled “organic” has been certified as meeting U.S. Department of Agriculture (USDA ) organic standards.

The label “all natural” or “100 percent natural” can be found on diverse food products ranging from peanut butter and cereal to “all-natural” sodas.  However, the U.S. Food and Drug Administration (FDA), responsible for regulating and supervising food production, does not define or regulate use of the label “natural” on food products. Instead, the FDA official policy is that “the agency has not objected to the use of the term if the food does not contain added color, artificial flavors, or synthetic substances,” an ambiguous policy that leaves interpretation of “natural” largely up to the food industry.

In contrast to the FDA, the United States Department of Agriculture (USDA) does regulate use of the word “natural” when applied to meat, poultry, and eggs, stating that a “natural” food is “a product containing no artificial ingredient or added color and is only minimally processed.”  Although consumers purchasing “natural” meat, poultry, and eggs can be confident that there are no artificial ingredients or colors added, it’s important to note that “natural” does not necessarily mean hormone-free or antibiotic-free; these are separate labels, also regulated by the USDA.

Being organic

Organic food is produced by farmers who emphasize the use of renewable resources and the conservation of soil and water to enhance environmental quality for future generations.  Organic meat, poultry, eggs, and dairy products come from animals that are given no antibiotics or growth hormones.

Organic food is produced without using most conventional pesticides; fertilizers made with synthetic ingredients or sewage sludge; bioengineering; or ionizing radiation.  Farmers who grow organic produce don’t use conventional methods to fertilize and control weeds. Examples of organic farming practices include using natural fertilizers to feed soil and plants, and using crop rotation or mulch to manage weeds.

Before a product can be labeled “organic,” a Government-approved certifier inspects the farm where the food is grown to make sure the farmer is following all the rules necessary to meet USDA organic standards.  Companies that handle or process organic food before it gets to your local supermarket or restaurant must be certified, too.

The USDA makes no claims that organically produced food is safer or more nutritious than conventionally produced food.  Organic food differs from conventionally produced food in the way it is grown, handled, and processed.

Along with the national organic standards, the USDA has developed strict labeling rules to help consumers know the exact organic content of the food they buy.  The “USDA Organic” seal tells us that a product is at least 95 percent organic.

The “USDA Organic” seal also means that any animals involved in producing your food were treated according to USDA organic livestock living-condition standards. Organic dairy cows, for example, don’t live in crowded, unsanitary feed lots, and they spend at least 120 days per year grazing on pasture.

Look for the word “organic” and a small sticker version of the USDA Organic seal on vegetables or pieces of fruit.  Or they may appear on the sign above the organic produce display. The word “organic” and the seal may also appear on packages of meat, cartons of milk or eggs, cheese, and other single-ingredient foods.

However, even when it comes to organic labels, not everything is as clear as it seems. For example:

  • Products labeled “100% Organic”contain 100% organic ingredients.
  • Products labeled “Organic”contain a minimum of 95 percent organic ingredients, and the remaining 5 percent are produced using no GMOs, sewage sludge or irradiation.
  • Products labeled “Made with Organic Ingredients”contain a minimum of 70 percent organic ingredients, and the remaining 30 percent are produced using no GMOs, sewage sludge or irradiation.
  • Products with less than 70 percent organic ingredientsmay list organic ingredients on the package’s side panel, but may not make any organic claim on the front of the package.

Many factors influence the decision to choose organic food. Some people choose organic food because they prefer the taste. Yet others opt for organic because of concerns such as:

  • Conventional growers use synthetic pesticides to protect their crops from molds, insects and diseases. When farmers spray pesticides, this can leave residue on produce. Organic farmers use insect traps, careful crop selection (disease-resistant varieties), predator insects or beneficial microorganisms instead to control crop-damaging pests. Some people buy organic food to limit their exposure to these residues. Organic produce typically carries significantly fewer pesticide residues than do conventional produce. However, residues on most products — both organic and nonorganic — don’t exceed government safety thresholds.
  • Food additives.Organic regulations ban or severely restrict the use of food additives, processing aids (substances used during processing, but not added directly to food) and fortifying agents commonly used in nonorganic foods, including preservatives, artificial sweeteners, colorings and flavorings, and monosodium glutamate.
  • Some people buy organic food for environmental reasons. Organic farming practices are designed to benefit the environment by reducing pollution and conserving water and soil quality.

So what is natural, anyway?

When you buy food labeled “natural,” it’s actually harder to know exactly what we’re getting because even when it appears on a U.S. food label, the word “natural” has no regulated definition.

“Natural” can mean any number of different things, depending on where in the country you are, who the food manufacturer is and what store is carrying the product. “Organic,” on the other hands, tells us we’re buying food made without the use of toxic persistent pesticides, GMOs, antibiotics, artificial growth hormones, sewage sludge or irradiation.

The only exception to this rule, as stated earlier, is when “natural” is used to describe meat or poultry. According to the USDA, “natural” meat and poultry contain no artificial ingredients or added color and are only minimally processed.

To add to our confusion, foods containing natural flavors, sweeteners, or other plant-derived substances can be labeled natural. In addition, foods containing highly processed high-fructose corn syrup (HFCS) can also be labeled “natural,” since the synthetic materials used to generate HFCS are not incorporated into the final product.  And foods containing genetically engineered or modified ingredients can be labeled “natural.”

Ultimately, consumers make their buying decisions based on their personal convictions, price, quality and accessibility. For many people, the fewer artificial ingredients and pesticides used, the better.  But whatever we choose, taking the time to understand the differences and knowing how to interpret the confusing array of regulations and labeling is a starting point for improved nutrition and better health.

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Be sure to check out the CBIA Healthy Connections wellness program at your company’s next renewal. It’s free as part of your participation in CBIA Health Connections!

Take a vacation already, will ya?!

Experts tell us it is important to occasionally turn off and restart our cell phones, computers, and “smart” TVs. This refreshes memory and allows system updates to download and install. Similarly, when we sleep, our bodies self-regulate, refurbishing depleted nutrients, switching focus to other parts of our brains, and promoting metabolic changes that help replenish and strengthen us.

Knowing this to be true, doesn’t it make sense that taking a vacation from work is just as vital for keeping us fresh, focused and healthy? You’d think so, yet it’s amazing how many people, including senior leaders, resist taking this critical personal time and suffer as a consequence . . .  as does their work and their businesses.

We don’t take time off for many reasons. Typically these include having too much work to do, fear of losing our jobs, or being unable to afford to go away. Of a more insidious nature, with tough workloads and schedules, cost issues and market demands, employers often send mixed signals to their staff about accommodating time off. Instead of being supportive, there’s often the unspoken caveat, “Sure, take the time off, but make sure all your work gets done and nothing falls through the cracks.” The insinuation is that vacations are inconvenient, and the time is allowed reluctantly instead of graciously as the earned benefit and healthy break it represents.

Time off from our jobs and our regular routines helps us manage stress, improves our bonds with family, friends and co-workers, can alleviate fatigue, and strengthens our immune systems. When we’re stressed our work performance suffers. That has an impact on customer service, as well as on safety, quality and productivity. Most of us are harder to get along with when we’re under pressure and feeling anxious, and more prone to depression, memory loss, distraction and bad decision making. We eat poorly and sleep less. And while vacation or time away from work and our regular routines won’t cure it all, vacations offer an important break.

Ironically, the United States lags behind most developed countries when it comes to paid vacation time, and vacation is typically not mandated in our country, or a legal right. In contrast, the United Kingdom requires employers to give at least 28 vacation days. In Finland, France and Greece the minimum is 25, and in Germany and Japan, it’s 20.

As in all other aspects of work, those in senior positions should lead by example. If a business owner or executive is not taking any paid time off – or if he or she goes on “vacation” but are still accessible 24/7 – they are making a clear statement about how employees should treat their own vacation time.

Here are some additional reasons why taking vacation time off for you and your staff is so critical:

  • Time away from work empowers and motivates employees. Leaving the office for a week or two forces you to shift major responsibilities to your supervisors and other employees. This fosters more of an entrepreneurial spirit, empowers staff, and can actually boost productivity. Furthermore, it instills confidence, promotes delegation, demonstrates that they are trusted, and shows that things won’t fall apart when the boss is away.
  • Vacations – or a failure to vacation – points to other potential problems. When employees are not using their vacation days, it can indicate a problem with the team, with their workload, or with delegation and supervision.  Employees may be overwhelmed or choose to not take time off to cover up wrongdoing or gaps that need to be addressed.
  • Time away helps you and your staff develop a new or fresher perspective.For many of us, time off actually fuels creativity and gives us the opportunity to think about solutions to problems and efficiencies that can’t be addressed at our normal work pace and with everyday work pressures and distractions.
  • Disengaging is healthy.Taking a break from work and our daily routines refreshes us physically, mentally and emotionally. Sometimes we simply need to be away from our work “families” and the constant pressure of deadlines, customer expectations, commuting and even the same boring lunches, sounds and surroundings.

Even when we enjoy and value our jobs and the people we work with, getting away promotes better health and reinvigorates us on many levels. Leaders need to remind their staff how important vacation time is to the employee and to the company, and walk the talk.

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If you’re not enjoying the benefits of a wellness program at your company, join CBIA Healthy Connections at your company’s next renewal. It’s free as part of your participation in CBIA Health Connections!