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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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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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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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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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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Nod yes, not off, if you’re feeling sleepy

Some days, there’s more of the Sleepy Dwarf in us than we’d care to admit. Beyond the excuse of extremely active weekends and occasional late nights, we’ve gotten too used to feeling fatigued. We drag ourselves to work, school and activities with the promise that, next weekend – or when we take that last exam, get through this big project, or finish the season – we’ll get some much-needed sleep. But how much IS enough? Is five or six hours a night really cutting it for us?

The answer, for most human beings, is definitely “no.”  Everyone’s individual sleep needs vary. In general, most healthy adults require 16 hours of wakefulness and need an average of eight hours of sleep a night. However, some individuals are able to function without sleepiness or drowsiness after as little as six or seven hours of sleep. Others can’t perform at their peak unless they’ve slept 10 hours. And, contrary to common myth, the need for sleep doesn’t decline with age, although the ability to sleep for six to eight hours at one time may be reduced.

Sleep is essential for a person’s health and well-being, according to the National Sleep Foundation (NSF). Yet millions of people do not get enough sleep and suffer related consequences relating to performance, irritability, accidents and reduced productivity. Surveys conducted by the NSF revealed that at least 40 million Americans suffer from over 70 different sleep disorders, and 60 percent of adults report having sleep problems a few nights a week or more. Most of these problems go undiagnosed and untreated. In addition, more than 40 percent of adults experience daytime sleepiness severe enough to interfere with their daily activities at least a few days each month, with 20 percent reporting problem sleepiness a few days a week or more.

Psychologists and other scientists who study the causes of sleep disorders have determined problems directly or indirectly tied to abnormalities in the brain and nervous, cardiovascular and immune systems, and with metabolic functions. Furthermore, unhealthy conditions, disorders and diseases can also cause sleep problems, including:

  • Pathological sleepiness, insomnia and accidents
  • Hypertension and elevated cardiovascular risks (including stroke)
  • Emotional disorders (depression, bipolar disorder)
  • Obesity
  • Metabolic syndrome and diabetes
  • Alcohol and drug abuse

Though common, not everyone who is tired has a sleep disorder. There is a lot we can do to get a better night’s sleep, feel refreshed when we awake, and remain alert throughout the day. It’s called “sleep hygiene” and refers to those practices, habits, and environmental factors that are critically important for sound sleep.

We all have a day/night cycle of about 24 hours called the circadian rhythm. It greatly influences when we sleep and the quantity and the quality of our sleep. The more stable and consistent our circadian rhythm, the better our sleep. This cycle may be altered by the timing of various factors, including naps, bedtime, exercise, and especially exposure to light (from traveling across time zones to staring at television or a laptop in bed at night).

Aging also plays a role in sleep and sleep hygiene. After the age of 40 our sleep patterns change, and we have many more nocturnal awakenings than in our younger years. This not only directly affects the quality of our sleep, but also interacts with any other condition that may cause arousals or awakenings, like the withdrawal syndrome that occurs after drinking alcohol close to bedtime. Additionally, psychological stressors like deadlines, exams, marital conflict, and job crises may prevent us from falling asleep or wake us from sleep throughout the night.

Here are 10 sleep hygiene tips to help us relax, fall asleep, stay asleep, and get better sleep so we wake up refreshed and alert:

  1. Avoid watching TV, eating, and discussing emotional issues in bed. The bed should be used for sleep and sex only. When we associate the bed with other activities it often becomes difficult to fall asleep.
  2. Minimize noise, light, and temperature extremes during sleep with ear plugs, window blinds, or an electric blanket or air conditioner. Even the slightest nighttime noises or luminescent lights can disrupt the quality of our sleep. Try to keep the bedroom at a comfortable temperature — not too hot (above 75 degrees) or too cold (below 54 degrees).
  3. Try not to drink fluids after 8 p.m. This may reduce awakenings due to urination.
  4. Avoid naps if possible, but if you do nap, make it no more than about 25 minutes about eight hours after you awake.
  5. Do not expose yourself to bright light if you need to get up at night. Use a small night-light instead.
  6. Nicotine is a stimulant and should be avoided, particularly near bedtime and upon night awakenings. Smoking tobacco products before bed, although it may feel relaxing, is actually putting a stimulant into our bloodstream.
  7. Caffeine is also a stimulant and is present in coffee (100-200 mg), soda (50-75 mg), tea (50-75 mg), and various over-the-counter medications. Caffeine should be discontinued at least four to six hours before bedtime. But note that if we consume large amounts of caffeine and cut ourselves off too quickly, we may get headaches that could keep us awake.
  8. Although alcohol is a depressant and may help us fall asleep, the metabolic machinery that clears it from our body when we are sleeping causes a withdrawal syndrome. This withdrawal causes awakenings and is often associated with nightmares and sweats.
  9. A light snack may seem sleep-inducing, but a heavy meal too close to bedtime interferes with sleep. Stay away from protein and stick to carbohydrates or dairy products. Milk contains the amino acid L-tryptophan, which has been shown in research to help people go to sleep. So milk and cookies or crackers (without chocolate) may be useful and taste good as well.
  10. Do not exercise vigorously just before bed, especially if you are the type of person who is aroused by exercise. If possible, it’s best to exercise in the morning or afternoon (preferably an aerobic workout, like running or walking).

We know when we’re tired, but doing something about the negative effects of fatigue and sleeplessness requires focus, discipline and often, professional assistance. Seek help if you can’t seem to get the sleep you need.  And if you’re just afraid of missing something, wake up. If you don’t want to morph from chronically Sleepy to permanently Grumpy, get some rest!

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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!

Too much fun in the sun isn’t fun at all

Think about the years before wearing seat belts in automobiles was mandatory. Thousands of U.S. adults and children got seriously hurt or killed every year in car accidents, but that wasn’t enough to change behaviors. Safety officials and physicians advised people to install and use these restraints, and national legislation requiring mandatory seat belt installation in cars was passed in 1968. Still, it took until 1984 before the first state laws were passed requiring people to actually wear the belts. But thousands more died, unnecessarily, before seat belt use became commonplace.

Now, think about skin cancer, the most common form of cancer in the United States.  Each year, over 5.4 million cases of non-melanoma skin cancer are treated in more than 3.3 million people, and 90 percent of them are the result of exposure to UV radiation. In fact, more new cases of skin cancer are diagnosed than new cases of breast, prostate, lung, and colon cancer combined. One in five Americans will develop skin cancer in their lifetime, and one American dies from skin cancer every hour (most often from melanoma, the most fatal type of skin cancer).  And if that isn’t sobering enough, contemplate the economic reality: The annual cost of treating U.S. skin cancer cases is estimated at $8.1 billion.

There certainly aren’t any laws requiring that we protect ourselves, but are we paying attention yet? Unprotected exposure to UV radiation is the most preventable risk factor for skin cancer. In fact, UV radiation from the sun is classified as a human carcinogen by the U.S. Department of Health and Human Services and the World Health Organization.

Chronic exposure to the sun suppresses our natural immune system and also causes premature aging, which over time can make the skin become thick, wrinkled, and leathery. Since it occurs gradually, often manifesting itself many years after the majority of a person’s sun exposure, premature aging is often regarded as an unavoidable, normal part of growing older. However, up to 90 percent of the visible skin changes commonly attributed to aging are caused by the sun. With proper protection from UV radiation, many forms of skin cancer and most premature aging of the skin can be avoided.

How to protect ourselves from excess UV exposure

The best way to lower our risk of developing skin cancer is to protect our skin from the sun and ultraviolet light. Using sunscreen and avoiding the sun help reduce the chance of many aging skin changes, including some skin cancers. However, we can’t rely too much on sunscreen alone. Sunscreen and hats are helpful for reducing exposure, but not an excuse to increase the amount of time we spend in the sun. Even with the use of sunscreens, people should not stay out too long during peak sunlight hours; UV rays can still penetrate our clothes and skin and do harm.

If possible, avoid sun exposure during the peak hours of 10 a.m. to 4 p.m., when UV rays are the strongest. Clouds and haze do not protect us from the sun, so use sun protection even on cloudy days. Use sunscreens that block out both UVA and UVB radiation. Products that contain either zinc oxide or titanium oxide offer the best protection. Less expensive products that have the same ingredients work as well as expensive ones. Older children and adults (even those with darker skin) benefit from using SPFs (sun protection factor) of 15 and over. Many experts recommend that most people use SPF 30 or higher on the face and 15 or higher on the body, and people who burn easily or have risk factors for skin cancer should use SPF 50+.

When and how to use sunscreen:

  • Adults and children should wear sunscreen every day, even if they go outdoors for only a short time.
  • Apply 30 minutes before going outdoors for best results. This allows time for the sunscreen to be absorbed.
  • Remember to use sunscreen during the winter when snow and sun are both present.
  • Reapply at least every two hours while you are out in the sunlight.
  • Reapply after swimming or sweating. Waterproof formulas last for about 40 minutes in the water, and water-resistant formulas last half as long.

 

Here are additional safety tips for protection from harmful UV radiation:

  • Adults and children should wear hats with wide brims to shield from the sun’s rays.
  • Wear protective clothing. Look for loose-fitting, unbleached, tightly woven fabrics. The tighter the weave, the more protective the garment.
  • Buy clothing and swimwear that block out UV rays. This clothing is rated using SPF (as used with sunscreen) or a system called the ultraviolet protection factor (UPF) index.
  • Avoid surfaces that reflect light, such as water, sand, concrete, snow, and white-painted areas.
  • Beware that at higher altitudes we burn more quickly.

We all need the vitamins from the sun and can still enjoy the outdoors, but taking proper precautions allows us to be outdoors more safely, year round, and to reduce the risks of developing skin cancers and other skin-related diseases. As the old seat belt commercials used to tell us, “Don’t become a statistic.” Whether applying to car seats, consumption of tobacco products, or sun exposure, that’s sound advice for us and our children.

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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!

About Chronic Fatigue Syndrome

Let’s face it, most of us push ourselves too hard and burn the candle at both ends — as well as in the middle. We work a ton, chase the kids and animals, and prowl the grocery store at night. We run around days and weekends, go out for adult play, stay up late, and simply don’t get enough sleep.

Of course we’re tired. Even if we try to eat healthfully, exercise regularly and get better-than-average sleep, fatigue may set in. It could be stress related, a nutritional deficiency, or poor sleep hygiene ranging from sleep apnea to bad late-night eating habits. Sleep supplements and more rest may help; but what happens when nothing appears to be working and the fatigue gets so bad that it interferes with your job, your family or school time, and causes you to make mistakes, or worse, endanger yourself or others?

Chronic Fatigue Syndrome (CFS), sometimes called myalgic encephalomyelitis (ME), is a condition that makes you feel so tired that you can’t do all of your normal, daily activities. There are other symptoms too, but being very tired is the main one. Some people have severe fatigue and other symptoms for many years.

Your being tired isn’t just in your head . . . it may be your body’s reaction to a variety of factors. CFS is not well understood — most experts now believe that it is a separate illness with its own set of symptoms.

Most CFS patients have some form of sleep dysfunction. Common sleep complaints include difficulty falling asleep, hypersomnia (extreme sleepiness), frequent awakening, intense and vivid dreaming, restless legs, and nocturnal myoclonus (night-time muscular spasm). Most CFS patients report that they feel less refreshed and restored after sleep than they felt before they became ill.

Doctors don’t know what causes CFS. Sometimes it begins after a viral infection, but there is no proof of any connection. It’s likely that a number of factors or triggers come together to cause CFS, but since there are no tests for CFS, it is difficult to determine. Because of this, many people have trouble accepting their disease or getting their friends and family to do so.

Extreme tiredness, or fatigue, is the main symptom. If you have CFS:

  • You may feel exhausted all or much of the time.
  • You may have problems sleeping. Or you may wake up feeling tired or not rested.
  • It may be harder for you to think clearly, to concentrate, and to remember things.
  • You may also have headaches, muscle and joint pain, a sore throat, and tender glands in your neck or armpits.
  • Your symptoms may flare up after a mental or physical activity that used to be no problem for you. You may feel drained or exhausted.

Depression is common with CFS, and it can make your other symptoms worse. Since there are not tests for CFS, doctors can diagnose it only by ruling out other possible causes of your fatigue. And since so many other health problems can cause fatigue, most people with fatigue have something other than chronic fatigue syndrome.

Doctors can help people with CFS adopt good sleep habits. Patients are advised to practice standard sleep hygiene techniques, such as:

  • Establish a regular bedtime routine
  • Avoid napping during the day
  • Incorporate an extended wind-down period
  • Use the bed only for sleep and sex
  • Schedule regular sleep and wake times
  • Control noise, light, and temperature
  • Avoid caffeine, alcohol, and tobacco
  • Try light exercise and stretching earlier in the day, at least four hours before bedtime, because this may also improve sleep.

While there is no treatment for CFS itself, many of its symptoms can be treated. A good relationship with your doctor is important. That’s because the two of you have to work together to find a combination of medicines and behavior changes that will help you get better. Some trial and error may be needed, because no single combination of treatments works for everyone. If you believe you may have CFS, speak with your physician as soon as possible, and consider meeting with a behavioral health counselor as well.

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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!

Getting healthier is all in the wrist

When we were kids, pedometers were pretty cool . . . right up there with Dick Tracy two-way communication wristwatches, which weren’t real, but we knew they would be, some day. That day came and went with a yawn – people (the Boomers) really didn’t care that much. But then millennials took over the world, geeky became trendy, mobile phones changed our universe irrevocably, and personal fitness took center stage. So the marketing wizards figured out how to put chic back on our wrist and in our pockets by combining technology, health and wellness, and 20-somethings’ love of gadgets.

One of the oldest fitness gadgets is the pedometer. This simple device counts a person’s steps by detecting the motion of his or her hands or hips. Used originally by sports and physical fitness enthusiasts, pedometers are popular as an everyday exercise counter and motivator.

Today there are apps included on your mobile devices such as Apple Health for iOS and Google Fit for Android. And you can download even more apps to measure heart rate, track calories, set calendars, and engage step counters. There are related yoga and meditation apps, and apps for tracking where and how long you run, how many times you hydrated, calorie counters, when you should expect your period, when you took your medicine, how long you slept, and much more.

Function has replaced style for devices worn on the wrist. Devices like the Fitbit – which basically are just fancy pedometers – track steps, though the more sophisticated ones can detect things like heart rate, and sleep (how often you wake, tossing and turning, etc.). These can be synced to your phone and/or computer for tracking and analyzing data. Other popular wrist-worn devices include those from Jawbone, Garmin, Mio, and even Microsoft. The list continues to grow.

Finally, there also are “smart scales,” weight counters you step on, just like in the old days. These use WiFi and Bluetooth technology to sync weight results with your tablet, computer, phone or device. This allows you to integrate results in tracking and reporting programs. These modern scales are especially useful for helping physicians monitor weight loss or gain for chronically ill patients, shut-ins or people who can’t easily get to medical facilities. The results are sent via phone lines to a monitoring location, where technicians and nurses can identify red flags and call the patient or his or her doctor for an intervention.

The bottom line is that anything that helps you exercise more, set goals and measure your progress is good. But trends change, and people lose interest in their devices as new ones come along, and when they see it still requires work. And, sure, you could simply write down your numbers on a pad . . .  but what fun is that?

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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!