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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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!

Fending off the Zika virus

Thanks to the incessant coverage of the U.S. presidential nominating process, the Zika virus alarm bells being sounded by the Centers for Disease Control and Prevention (CDC) have been temporarily overshadowed. But we are getting closer to the Summer Olympics in Rio de Janeiro this August. In addition to the superb athletics, people will be buzzing about Zika, which has been far more widespread in South America than in North America. Cases have been reported here in Connecticut now, and people have to be cautious and concerned.

The Zika virus is spread to people primarily through the bite of an infected Aedes aegypti mosquito. While this mosquito species is not currently present in Connecticut, a closely related species, Ae. albopictus, the Asian tiger mosquito, and related species are and may become carriers of the disease in Connecticut.

The Ae. aegypti, also common known as the Yellow fever mosquito, is found throughout tropical regions of the world and are the same mosquitoes that spread dengue and chikungunya viruses. Mosquitoes become infected with the Zika virus when they bite a person already infected with the virus. Infected mosquitoes can then spread the virus to other people through bites.

Symptoms include fever, rash, joint pain, and conjunctivitis (red eyes). According to the CDC, illness is usually mild with symptoms lasting several days to a week — deaths are rare. There is no vaccine to prevent or medicine to treat Zika virus infection; however there is medication to treat some of the symptoms.

People are cautioned to contact their health care provider if they develop symptoms after returning from areas where Zika virus has been identified.  Of enormous concern, Zika virus can spread from a pregnant woman to her fetus, which can cause serious birth defects. Because of this, pregnant women should not travel to areas where Zika is present. Zika virus can also be spread from men to women by sexual contact.

Zika virus was first discovered in 1947 and is named after the Zika forest in Uganda. In 1952, the first human cases of Zika were detected and since then, outbreaks of Zika have been reported in tropical Africa, Southeast Asia, and the Pacific Islands. Zika outbreaks have probably occurred in many locations. In May 2015, the Pan American Health Organization (PAHO) issued an alert regarding the first confirmed Zika virus infection in Brazil, and on Feb 1, 2016, the World Health Organization (WHO) declared Zika virus a public health emergency of international concern. Transmission has been reported in many other countries and territories, especially in Latin America. Brazil has confirmed 2,844 cases of Zika in pregnant women.

Avoid infection by preventing mosquito bites. Use insect repellent according to label instructions, wear long-sleeved shirts, long pants and hats, empty any items around your property that can hold water, and use air conditioning or window/door screens. It is important to practice these protective measures when traveling to areas where Zika virus is found, and these are useful steps to help reduce mosquito and insect bites in general.

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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!

The Main Event: Vegan vs. Vegetarian

In this corner, at five feet, four inches, weighing 130 pounds and eating only fruit, vegetables, eggs, dairy products, and grains we have our challenger, Veggie Betty. In the opposite corner, at five feet five inches, eating only grains, fruit and vegetables and tipping the scales at 125 is our current champion, the queen of clean, Vegan Vicky. We’re looking for an apples-to-apples fight over the advantages and benefits of not ingesting meat and fish, and the differences between these two philosophies. Now, at the bell, come out arguing, and may the healthiest eater win!

Eating healthfully is a battle, no doubt. But both of these contestants are winners – people following vegetarian and vegan diets tend to live longer, have fewer health issues and generate less negative impact on the environment. The real battle is about staying healthy, but the debate over established and faddy diets and the advantages of veganism over vegetarianism rages on.

The term vegetarian generally means a person who does not consume animal products; this includes land and sea animals. Most vegetarians generally do consume eggs and dairy products (milk products). Vegetarian diets are considered excellent dietary methods for controlling weight, are heart-healthy, and excellent for controlling and preventing diabetes.

On the other hand, vegans eliminate all animal and dairy products (including eggs and honey) from their diet, as well as anything made with gelatin, which comes from animal bones and hooves. Vegans load up on fruits, vegetables, leafy greens, whole grains, nuts, seeds, and legumes. Research has found a low-carb vegan diet reduces cholesterol levels, plus risk for developing heart disease.

But since animal products are the most convenient sources of protein and iron, vegans have a harder time getting an equal fix and have to work harder at balancing their diet through protein-packed alternatives such as lentils, black beans and soy products, and by increasing iron absorption by pairing foods rich in iron with foods rich in vitamin C, such as leafy vegetables and citrus. As a warning, vegans often suffer from Vitamin B12 deficiencies, so should consult their physician or nutritionist to ensure a healthy balance and determine if supplements are needed.

Vegetarians eliminate most animal products from their diet, too, but typically eat dairy and eggs. Like vegans, vegetarians consume a lot of fruits and vegetables, leafy greens, whole grains, nuts, seeds and legumes. But unlike vegans, According to the American Heart Association, there is no single vegetarian eating pattern.

For example, a lactovegetarian eats plant-based foods, cheese, and dairy, while a lacto-ovovegetarian (lacto-ovo) eats all of the above and eggs. There are also semi-vegetarians, or people who don’t eat red meat but eat chicken and fish with their plant-based foods, dairy, and eggs. Most vegetarians are lacto-ovo.

Vegetarians have long been hailed as the healthiest eaters. A study published by the American Heart Association found people who mostly adhere to a pro-vegetarian diet (70 percent of food intake is derived from plants) were less likely to die from cardiovascular disease. And research  associates this particular diet with reduced risk for certain types of cancer, high blood pressure, and early death.

And again, like vegans, maintaining a mostly plant-based diet is beneficial to the environment. One cow’s annual output of the greenhouse gas methane is equivalent to the emissions generated by a car burning 235 gallons of gasoline. And the amount of feed necessary to raise beef, chicken and pork requires an enormous amount of energy and resources, including fossil fuels, medicine and water.

Until recently, the benefits of vegetarianism and veganism were more anecdotal than clinically proven. However, over the past couple of decades numerous studies have indicated that a person who adopts a vegan or vegetarian diet will:

  • Have a lower body weightOne study found that those who continue eating meat will put on more weight over a five year period, compared to those who switched over to vegetarianism. The same study found that vegans put on even less weight as they get older, compared to vegetarians and meat eaters. The study looked at 22,000 meat eaters, fish eaters, vegetarians, and vegans.
  • Have better cholesterol levels– Scientists have demonstrated that a vegetarian diet made up of specific plant foods can lower cholesterol as effectively as a drug treatment. The study, published in the Journal of the American Medical Association, compared a diet of known cholesterol-lowering, vegetarian foods to a standard cholesterol-reducing drug called lovastatin.
    The diet reduced levels of LDL the ‘bad’ cholesterol known to cause clogging in coronary arteries — in participants by almost 29 percent, compared to a 30.9 percent decrease in the lovastatin participants. The diet consisted of a combination of nuts (almonds), soy proteins, viscous fiber (high-fiber) foods such as oats and barley and a special margarine with plant sterols (found in leafy green vegetables and vegetable oils).
  • Live longer– Several studies have shown that vegans and vegetarians have a much lower risk of becoming obese, developing diabetes, cancer and cardiovascular diseases. All these conditions and diseases reduce one´s life expectancy.
  • Have a lower risk of developing cancer– Several studies have shown a reduced risk of developing many different types of cancer among vegans and vegetarians, compared to meat eaters. The study also found, however, that vegetarians have a higher risk of developing cancer of the colon.
  • Have a lower risk of developing several diseases– A 2012 article published in Food Technology documented that plant-based diets either reduce or completely eliminate people’s genetic propensity to developing long-term diseases including diabetes type 2, cardiovascular disease, and cancer. Additionally, plant-based diets have shown to be effective in treating diseases like Multiple Sclerosis.

Vegetarian food is generally lower in fat, especially saturated fats, and much higher in fiber, than animal based foods. However, a vegetarian, like a meat eater, has to watch his or her intake of calories, snack foods, refined carbohydrates, whole milk dairy products, and non-meat junk foods.

So whichever path you are contemplating, a gradual change into vegetarianism or veganism works better as a general lifestyle change and longer-term strategy. Some people find that sudden changes to their eating patterns may have unpleasant consequences for their digestive systems, such as irritable bowel and other GI-related maladies. A healthful, gradual change includes increasing your intake of vegetables, fruits, legumes (beans, lentils), and whole grains, while cutting down on your intake of meats and fish.

Additionally, the American Dietetic Association offers these tips for people who want to convert to vegetarianism or veganism:

  • Select whole-grain products, including whole wheat bread, wild/brown rice, and whole-grain cereals
  • Make sure your diet is varied
  • Choose low- or non-fat dairy products (if you wish to continue consuming dairy)
  • Do not eat more than three or four egg yolks per week
  • Plan ahead when you go shopping
  • Read the food labels carefully when you are out shopping
  • Find out where specialty stores that cater to healthy eating are located, and try shopping there.

Fortunately, there is much information available on these diets. And anyone contemplating a significant dietary change should touch base with their physician and get their baseline numbers to help chart progress. Ultimately, though, everyone who participates is a winner!

For more information on plant-based diets, visit Ornish Lifestyle Medicine and Dr. McDougall’s Health & Medical Center.

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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!

 

Saying “Thanks” is Healthy for Giver and Receiver

Think about your own life, work, and accomplishments. It feels good when we do a good job. But while that satisfaction itself can be very rewarding, acknowledgement from our bosses, peers, family members, and friends is equally important. Telling someone he or she has done a good job isn’t just the right thing to do, but also is a mechanism for improving emotional and physical health, productivity, teamwork, and service.

When someone feels taken for granted, unrecognized or under-appreciated, it has a direct impact on their emotional health and stress levels. Lack of recognition, especially in the workplace, often is mentioned as a contributing factor to overall employee dissatisfaction. And the more unhappy employees are at work, the more productivity, teamwork and customer relations may suffer.  Quality suffers, as well, and increased stress is a known factor in promoting irritability, increasing conflict, interfering with sleep and diet, boosting absenteeism and increasing “presenteeism,” a loss of workplace productivity resulting from employee health problems and/or personal issues. It also contributes to increases in blood pressure, heart disease, poor nutrition and weight gain.

Americans like being told “thanks” but aren’t that great at thanking others, according to a national survey on gratitude commissioned in 2012 by the John Templeton Foundation. The polling firm Penn Shoen Berland surveyed over 2,000 people in the United States, capturing perspectives from different ages, ethnic groups, income levels, religions and more.

Gratitude was enormously important to respondents, who also admitted they think about, feel, and espouse gratitude more readily than expressing it to others. This might be why respondents also felt that gratitude in America is declining.

  • More than 90 percent of those polled agreed that grateful people are more fulfilled, lead richer lives, and are more likely to have friends.
  • More than 95 percent said that it is anywhere from “somewhat” to “very” important for mothers and fathers to teach gratitude.
  • People are less likely to express gratitude at work than anyplace else. Seventy-four percent never or rarely express gratitude to their boss. But people are eager to have a boss who expresses gratitude to them. Seventy percent would feel better about themselves if their boss was more grateful, and 81 percent would work harder.
  • 93 percent of those polled agreed that grateful bosses were more likely to be successful, and only 18 percent thought that grateful bosses would be seen as “weak.”

The bottom line is that we’re better at noticing and tallying what we personally do than what other people do.  According to the data, most of the people surveyed appreciate being appreciated, but lack in their tendency to say “thanks”– despite knowing that expressing gratitude can bring more happiness, meaning, professional success, and interpersonal connection into their lives.

Ultimately, there are so many ways to say “thanks” to our employees. Whether verbally, through written or public commendation, one-on-one, or in front of peers at staff meetings, gratitude is an important employee relations, productivity and stress-reduction tool. And while bonuses, pay raises, gift cards, and compensatory time off are terrific recognition tools, employees want to feel like it is more than simply “doing their jobs and meeting expectations” that matters.

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