The Bones Have It

People say change is constant, and that’s certainly no exception when it comes to our bones.  New bone is made and old bone is broken down. When we’re young, our body makes new bone faster than it breaks down old bone, increasing bone mass. Most people reach their peak bone mass around age 30. After that, we lose more bone mass than we gain.

Osteoporosis is a condition that causes bones to become weak and brittle, making them easier to fracture or break. Our likelihood of developing osteoporosis depends on how much bone mass we attain by the time we reach age 30 and how rapidly we lose it after that. The higher our peak bone mass, the less likely we are to develop osteoporosis as we age.

Obviously, it’s important to take steps now so our bones will be healthy and strong throughout our lifetime.  Unless you have a time machine there’s no going back, so protecting what we have now is the smart play.

We can build strong bones by getting enough calcium and weight-bearing physical activity during the tween and teen years, when bones are growing the fastest. Young people in this age group have calcium needs that they can’t make up for later in life. In the years of peak skeletal growth, teenagers build more than 25 percent of adult bone. By the time teens finish their growth spurts around age 17, 90 percent of their adult bone mass is established.

Don’t Overdraw Your Calcium Bank

Since our bodies continually remove and replace small amounts of calcium from our bones, stemming the loss of calcium is important. After age 18, we can’t add more calcium to bones, but can try to maintain what is already stored to help our bones stay healthy.

Calcium is found in a variety of foods. Low-fat and fat-free milk and other dairy products are great sources of calcium. Tweens and teens can get most of their daily calcium from three cups of low-fat or fat-free milk, but they also need additional servings of calcium to get the 1,300 mg necessary for strong bones.

Other good sources of calcium include dark green, leafy vegetables such as spinach, broccoli and bok choy.  Other sources of calcium include almonds, broccoli, kale, canned salmon with bones, sardines and soy products such as tofu. If you find it difficult to get enough calcium from your diet, ask your doctor about supplements.

There also are foods with calcium added, such as calcium-fortified tofu, orange juice, soy beverages, and breakfast cereals or breads. Adults or kids who can’t process lactose also can take calcium supplements, but should check with their physician to ensure compatibility with other medicines or conditions.

When muscles push and tug against bones during physical activity, bones and muscles become stronger. Weight-bearing exercises, such as walking, jogging, tennis and climbing stairs can help build strong bones and slow bone loss. So exercise, as well as proper nutrition, play vital roles in helping us build and maintain healthy bones at any age.

A number of additional factors can affect bone health.

  • Tobacco and alcohol use. Research suggests that tobacco use contributes to weak bones. Similarly, having more than two alcoholic drinks a day increases the risk of osteoporosis, possibly because alcohol can interfere with the body’s ability to absorb calcium.
  • Gender, size and age. You’re at greater risk of osteoporosis if you’re a woman, because women have less bone tissue than do men. You’re also at risk if you’re extremely thin (with a body mass index of 19 or less) or have a small body frame, because you may have less bone mass to draw from as you age. Also our bones become thinner and weaker as we age.
  • Race and family history. You’re at greatest risk of osteoporosis if you’re white or of Asian descent. In addition, having a parent or sibling who has osteoporosis puts you at greater risk — especially if you also have a family history of fractures.
  • Hormone levels. Too much thyroid hormone can cause bone loss. In women, bone loss increases dramatically at menopause due to dropping estrogen levels. Prolonged absence of menstruation before menopause also increases the risk of osteoporosis. In men, low testosterone levels can cause a loss of bone mass.
  • Eating disorders and other conditions. People who have anorexia or bulimia are at risk of bone loss. In addition, stomach surgery (gastrectomy), weight-loss surgery and conditions such as Crohn’s disease, celiac disease and Cushing’s disease can affect our body’s ability to absorb calcium.
  • Certain medications. Long-term use of corticosteroid medications, such as prednisone, cortisone, prednisolone and dexamethasone, are damaging to bone. Other drugs that may increase the risk of osteoporosis include aromatase inhibitors to treat breast cancer, selective serotonin reuptake inhibitors, methotrexate, some anti-seizure medications and proton pump inhibitors.

In summation, to help prevent or slow bone loss, include plenty of calcium in your diet, pay attention to vitamin D, include physical activity in your daily routine, and avoid smoking tobacco products or drinking too much alcohol. The health of our bones, in a manner of speaking, is in our own hands!


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!

Look Into Your Phone and Say “Aaahhh”

For those of us old enough to remember The Jetsons, their flying car was only one of the many futuristic perks imagined way back in 1962 by the show’s creative producers, Hanna-Barbera. The pioneering duo also foretold holographs, robot servants, talking computers . . . and tele-medicine!

Their version of remote diagnostic care was to have a family member stick their arm in a portal in the wall, which would “read” their symptoms and offer a diagnosis. As far-fetched as that might have seen back in the day, today it’s far closer to reality. Patients with congestive heart failure, diabetes and other ailments can step on automated scales in their homes, which measure their weight and send the data electronically to monitoring services. An appreciable weight loss or gain could indicate a problem – it’s flagged by the system, and a nurse then calls the patient to check in. People also can have their blood pressure, heart rate and sugar levels checked remotely using electronic sensors, communicate online with their physician’s offices, and access a wide variety of personal medical information and history via private electronic portals.

More than 15 million Americans received some kind of medical care remotely last year, according to the American Telemedicine Association, a trade group, which expects those numbers to grow by 30 percent this year. And according to the American Academy of Family Physicians, 41 percent of family practice physicians use electronic portals for secure messaging, another 35 percent use them for patient education, and about one-third use them for prescribing medications and scheduling appointments.

For all the rapid growth, however, significant questions and challenges remain. Physicians groups are issuing different guidelines about what care they consider appropriate to deliver in what forum. Complicating matters, rules defining and regulating telemedicine differ widely from state to state and are constantly evolving. In Connecticut, for instance, physicians cannot be compensated for services provided over the telephone, via fax or electronically, and are not allowed to prescribe controlled substances through tele-health services.

Another huge hurdle is physician compensation. Legislation today severely limits telemedicine. And without financial incentives to provide care electronically, physicians are reluctant to get onboard, especially since health insurance, which varies from plan to plan, covers only a narrow range of electronic services.

The future of telemedicine in the United States will depend on how regulators, providers, payers and patients can address these challenges, and the issue of quality versus convenience.  For example, there are a variety of on-line services now available where a patient can connect with a clinician for one-time phone, video or email visits on demand. These, typically, are for non-urgent-care issues such as colds, rashes and headaches. They cost far less than a trip to a physician’s office, or to an urgent care center or hospital.

Many large employers and their insurance providers are offering these services to the employees as a cost-saving alternative.  However, these services lack the bonds of trust and communication that are built over time between patient and caregiver, and can’t replace the value of a personal physician or health expert listening to your heart or lungs, peering into your throat, eyes or ears, drawing a culture sample or tapping other in-person diagnostic skills.

Over the past year, more than 200 telemedicine-related bills have been introduced in 42 states, many regarding what services Medicaid will cover and whether payers should reimburse for remote patient monitoring as well as store-and-forward technologies (where patients and doctors send records, images and notes at different times), in addition to real-time phone or video interactions. Medicare, the federal health plan for the elderly, covers a small number of telemedicine services — only for beneficiaries in rural areas, and only when the services are received in a hospital, doctor’s office or clinic.

There are many additional challenges. Everyone is looking at how to manage state’s rights against national priorities and demands, never an easy task. Malpractice issues are complicated, and many physicians simply do not feel comfortable rendering services online or via a phone. Still, every day brings new technologies, legislation and efforts to respond to changing patient and physician needs.

When you look at emerging smart phone technology and the portable monitoring devices we now wear on our wrists to monitor steps, sleep, heart rate and more, it’s easy to imagine how quickly future generations of health monitoring tools will evolve. And it’s probably a safe bet that we’ll be using them to help manage our health long before we’re flying to work in our own personal aero-cars!


 

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!

Using Steroids Safely and Appropriately

The use of steroids and other natural and synthetic substances by professional athletes often is in the news.  Used primarily for building muscle mass and expanding strength and endurance, these drugs, many obtained illegally, give users an “edge” that is considered unfair.  Many Russian athletes were not allowed to compete in this summer’s Olympic Games in Rio due to their use of banned drugs, and controversy has swirled around famous baseball players, runners and biking legend Lance Armstrong over their use of steroids and other performance-enhancing supplements.  But there are many kinds of steroids, including those used by physicians to treat allergies, asthma, arthritis and many chronic illnesses.

Steroids, known medically as corticosteroids, can reduce inflammation associated with allergies, rashes or itching. They prevent and treat nasal stuffiness, sneezing, and runny nose due to seasonal or year-round allergies. They can also decrease inflammation and swelling from other types of reactions.

Systemic steroids are available in various forms as pills or liquids for serious allergies or asthma, locally acting nasal sprays for seasonal or year-round allergies, topical creams for skin allergies, or topical eye drops for allergic conjunctivitis.

Steroids are highly effective drugs for allergies, but they must be taken regularly, often daily, to be of benefit — even when you aren’t feeling allergy symptoms. In addition, it may take one to two weeks before the full effect of the medicine can be felt.

Steroids are used for reducing joint or bone inflammation and for battling osteoporosis. They also are known to increase recovery times in individuals dramatically. Cortisol is a hormone which is produced inside our body to help it handle stress. Cortisol is responsible for causing damage to muscle tissues and slowing down the time taken for a human body to recuperate. Steroids are known to regulate the production of this hormone when an individual’s body is stressed. This helps bodies to recover from sustained injuries a lot faster than normal and allows more stamina while an individual is exercising.

Of note, potential side effects from oral steroids may include insomnia, increased appetite and weight gain, high blood pressure, lowered immune system resistance, stomach irritation and water retention.

Anabolic steroids were developed in the late 1930s primarily to treat hypogonadism, a condition in which the testes do not produce sufficient testosterone for normal growth, development, and sexual functioning. The primary medical uses of these compounds are to treat delayed puberty, some types of impotence, and wasting of the body caused by HIV infection, cancer or other diseases.

The dangers of steroid abuse

When we take small, prescribed doses of steroids for a short time in response to an inflammation or allergic reaction, our bodies eliminate or flush most of the residual compounds. However, people who abuse anabolic steroids usually take them orally or inject them into the muscles, where they remain for longer periods of time, and travel to our brains and other organs. These doses may be 10 to 100 times higher than doses prescribed to treat medical conditions. Steroids are also applied to the skin as a cream, gel, or patch.

Anabolic steroids do not have the same short-term effects on the brain as do other abused drugs. The most important difference is that steroids do not trigger rapid increases in the brain chemical dopamine, which causes the “high” that drives people to abuse other substances. However, long-term steroid abuse can act on some of the same brain pathways and chemicals — including dopamine, serotonin, and opioid systems — that are affected by other drugs. This may result in a significant effect on mood and behavior.

Abuse of anabolic steroids also may lead to mental problems, such as:

  • Paranoid (extreme, unreasonable) jealousy
  • Extreme irritability
  • Delusions (false beliefs or ideas)
  • Impaired judgment

Extreme mood swings can also occur, including “roid rage” — angry feelings and behavior that may lead to violence. Additionally, anabolic steroid abuse may lead to serious, even permanent, health problems such as:

  • Kidney problems or failure
  • Liver damage
  • Enlarged heart, high blood pressure, and changes in blood cholesterol, all of which increase the risk of stroke and heart attack, even in young people

As with most medicines, supplements or drugs, steroids should be taken under the direction of a physician or medical professional. When used properly and as prescribed, they are incredibly effective and valuable. When abused or taken improperly, they can lead to a variety of negative side effects and behaviors with potentially long-term and life-threatening consequences.


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!

All the Dirt on Antibacterial Soaps, Colds, and the Flu

The long hot days of summer have blown by as if propelled by Hurricane Hermine’s winds. The sun sets earlier, sugar maples are starting to tinge, and the evenings already bear traces of autumn chill. September is upon us – the kids are back in school, pumpkins are showing up in the supermarkets, and the “Get your flu shot here” signs are appearing all around us. Sadly, colds, influenza, and throat, ear and sinus infections can’t be far behind.

With kids and adults in close proximity, poor hand-washing habits, and everyone sneezing around us, our natural immunities to bacterial and viral infections are taxed, leaving us more likely to contract a variety of illnesses. The late summer and early fall also bring a resurgence in seasonal allergies. Sometimes it’s hard to tell one malady from another  . . . with the aches and pains, runny noses, itchy throats and increased body temperature, we’re off to the doctor in search of an antibiotic, or searching at the drug store for magic pills to cure or, at the least, relieve us.

Many of the illnesses that wreak havoc in the autumn and winter are caused by bacteria or viruses, and it’s important to know the difference. Bacteria are single-celled organisms usually found all over the inside and outside of our bodies, except in the blood and spinal fluid. Many bacteria are not harmful. In fact, some are actually beneficial. However, disease-causing bacteria trigger illnesses such as strep throat and some ear infections. Viruses are even smaller than bacteria. A virus cannot survive outside the body’s cells. It causes illnesses by invading healthy cells and reproducing.

Antibiotics are our chosen line of offense against many types of infections, but they don’t work against all. For example, we should not treat viral infections such as colds, the flu, sore throats (unless caused by strep), most coughs, and some ear infections with antibiotics.

Antibiotics are drugs that fight infections caused by bacteria. After the first use of antibiotics in the 1940s, they transformed medical care and dramatically reduced illness and death from infectious diseases. The term “antibiotic” originally referred to a natural compound produced by a fungus or another microorganism that kills bacteria which cause disease in humans or animals. Although antibiotics have many beneficial effects, their use has contributed to the problem of antibiotic resistance, which is the ability of bacteria or other microbes to resist the effects of an antibiotic.

Antibiotic resistance occurs when bacteria change in some ways that reduce or eliminate the effectiveness of drugs, chemicals, or other agents designed to cure or prevent infections. The bacteria survive and continue to multiply causing more harm. Almost every type of bacteria has become stronger and less responsive to antibiotic treatment. These antibiotic-resistant bacteria can quickly spread to family members, schoolmates and co-workers, threatening the community with a new strain of infectious disease that is more difficult to cure and more expensive to treat.

According to the Centers for Disease Control (CDC), the single most important thing we can do to keep from getting sick and spreading illness to others is to clean our hands. As we touch people, surfaces, and objects throughout the day, we accumulate germs on our hands. In turn, we can infect ourselves with these germs by touching our eyes, nose, or mouth and food.

Although it’s impossible to keep our hands germ-free, washing hands frequently helps limit the transfer of bacteria, viruses, and other microbes. According to CDC research, some viruses and bacteria can live from 20 minutes up to two hours or more on surfaces like cafeteria tables, doorknobs, ATM machines and desks. So wash before and after using a restroom. Wash after visiting the supermarket, ride a bus or train, or using an ATM. When it isn’t easy to wash, use a hand sanitizer. Don’t use anyone else’s toothbrush, and avoid sharing food, drinks or eating off of one another’s plates. And in late-breaking news, stop using antibacterial soaps and products – they aren’t useful in protecting you, and are causing more damage than good.

Antibacterial soaps aren’t good for us

The Food and Drug Administration (FDA) recently banned the sale of soaps containing certain antibacterial chemicals, saying industry had failed to prove they were safe to use over the long term or more effective than using ordinary soap and water.

In all the FDA took action against 19 different chemicals and has given industry a year to take them out of their products. About 40 percent of soaps – including liquid hand soap and bar soap – contain the chemicals. Triclosan, mostly used in liquid soap, and triclocarban, in bar soaps, are by far the most common.

The rule applies only to consumer hand washes and soaps. Other products may still contain the chemicals. The agency is also studying the safety and efficacy of hand sanitizers and wipes, and has asked companies for data on three active ingredients – alcohol (ethanol or ethyl alcohol), isopropyl alcohol and benzalkonium chloride – before issuing a final rule on them.

This decision comes after years of mounting concerns that the antibacterial chemicals that go into everyday products are doing more harm than good. Health experts have pushed the agency to regulate antimicrobial chemicals, warning that they risk damaging hormones in children and promote drug-resistant infections. Additionally, studies in animals have shown that triclosan and triclocarban can disrupt the normal development of the reproductive system and metabolism, and health experts warn that their effects could be the same in humans.

The chemicals were originally used by surgeons to wash their hands before operations. Their use has expanded significantly in recent years as manufacturers added them to a variety of products, including mouthwash, laundry detergent, fabrics and baby pacifiers. The CDC reports the chemicals from antibiotic soaps are found in the urine of three-quarters of Americans, one of the many factors they considered in issuing the ban.

The surest bet for a healthy fall and winter is to be vigilant about hand washing, and to take reasonable precautions such as getting flu shots (note that the CDC is questioning the effectiveness of the nasal spray version of the flu vaccine for the 2016/2017 flu season) and avoiding people who are coughing, feverish or obviously ill. When sick, try to stay home from work or school to avoid spreading the joy, and seek medical care if you feel you may require antibiotics or other medicinal remedies. You also can speak with your physician about antibiotic resistance, or take the time to learn more about this important subject by visiting reliable websites such as www.cdc.gov.


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!

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!

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!

Connecticut and medical cannabis — laws and rights

While the debate about the use of medical marijuana continues unabated at the state and federal levels, 24 U.S. states (plus the District of Columbia), including Connecticut, have legalized the use of cannabis and its cannabinoids for medicinal purposes for treating a variety of conditions.  Use must be approved by a Connecticut-licensed physician, who must write a prescription that only can be filled at a licensed dispensary using products produced locally by a handful of State-approved growers.

To qualify, a patient needs to be diagnosed as having one of the following debilitating medical conditions that is specifically identified in the law, including:  Cancer, glaucoma, HIV, AIDS, Parkinson’s disease, multiple sclerosis, certain types of damage to the nervous tissue of the spinal cord, epilepsy, cachexia, wasting syndrome, Crohn’s disease or post-traumatic stress disorder. Other approved medicinal uses include:

  • Sickle Cell Disease
  • Post Laminectomy Syndrome with Chronic Radiculopathy
  • Severe Psoriasis and Psoriatic Arthritis
  • Amyotrophic Lateral Sclerosis
  • Ulcerative Colitis
  • Complex Regional Pain Syndrome

The laws regarding medical marijuana are fluid and constantly changing as a board of physicians and legislators reflect on patient needs, other available drugs and therapies, and new research. Effective October 2016, the following additional medical conditions will be covered for patients over 18 (excluding inmates confined in a correctional institution of facility under the Department of Correction, regardless of their medical condition), although patients under 18 also qualify, with certain restrictions and requirements:

  • Cerebral Palsy
  • Cystic Fibrosis
  • Irreversible Spinal Cord Injury with Objective Neurological Indication of Intractable Spasticity
  • Terminal Illness Requiring End-Of-Life Care
  • Uncontrolled Intractable Seizure Disorder

The first step is to make an appointment with the physician treating you for the debilitating condition for which you seek to use medical marijuana. You will not be able to register in the system until the Department receives a certification from your physician that you have been diagnosed with a condition that qualifies for the use of medical marijuana and that, in his or her opinion, the potential benefits of the palliative use of marijuana would likely outweigh the health risks.

Patients with a prescription for medical marijuana need to complete an application with the State Department of Consumer Protection, which oversees this program in Connecticut. The process involves providing proof the patient still lives in Connecticut; an updated photograph; five certifications that have to be completed online or in writing; and the payment of a $100 program fee. Medical marijuana in Connecticut is not a covered health insurance benefit.

Qualifying patient applications take between two to three weeks to process. Upon approval of the application, a temporary certificate is emailed to the patient. This temporary certificate is valid for 30 days from the approval date of the application. The temporary certificate will allow patients to use their selected dispensary facility while their permanent Medical Marijuana Certificate is being mailed.

Patients must visit their selected dispensary in advance of filling their prescription as part of the screening process. Then, once approved, they can fill their prescription by accessing medical marijuana in a variety of forms and strengths. This includes product for smoking for those who might have trouble ingesting this medicine, or who prefer this delivery method. Prescriptions also cover the use of liquids, lozenges, edibles and other styles.

Though legalized, there are rules restricting use. For example, the law prohibits ingesting marijuana in a bus, a school bus or any moving vehicle; in the workplace; on any school grounds or any public or private school, dormitory, college or university property; in any public place; or in the presence of anyone under 18. It also prohibits any use of palliative marijuana that endangers the health or well-being of another person, other than the patient or primary caregiver.

Finally, not every physician may be willing to write a prescription for medical marijuana, despite legalization. The Department of Consumer Protection does not require physicians or hospitals to recognize marijuana as an appropriate medical treatment in general or for any specific patient. If you believe that your physician is not providing you with the best medical care for your condition, then you may want to consider working with a different physician.

For more information, visit http://www.ct.gov/dcp and look under the section for medical marijuana.

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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!