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Friday Giveaway – Free Health Research Worksheet for Patients

By Nathan Blake | 7/27/18
Project Manager, HealthWeb Navigator

Our team of medical reviewers talk with countless patients about health information on the internet. But many more patients don’t mention what they read online. Either they’re afraid the doctor will ignore them, or will think they’re being “difficult” for talking about what they learned, or they just don’t have time to bring it up.

Doctors and patients need to talk openly about what patients are reading. Browsing the web before and after a doctor’s appointment is something most of us do, as it lets us participate in healthcare decisions. But a doctor’s medical training can help us avoid dangerous or irrelevant advice. And if doctors refuse to listen to what patients have read, or if patients are afraid to speak up, then everyone misses out on valuable insights.

That’s why we’re providing this free resource to help you collect your thoughts before meeting with a healthcare professional. As you research health topics on the internet, use this worksheet to write down what you want to talk about with your doctor.

Make sure you’re clear from the start of your next appointment what you want to discuss and why it’s important to you. Then, let your doctor respond, and write down their thoughts too. Together, you can come to a decision about what to do next.

And don’t forget to browse our collection of reviews to find the most reliable health websites available today!

Download file: Health Research Worksheet

HealthWeb-Navigator-Health-Research-Worksheet

 

Editor’s Pick – “Act Early,” from the U.S. Centers for Disease Control & Prevention

By HWN Editorial Staff | 7/6/18

Are you worried your child isn’t developing on schedule?

You may want to check out the Centers for Disease Control and Prevention’s (CDC) “Act Early” resource center. This page of the CDC website helps parents and caregivers compare their child’s mental, emotional, and physical growth against current medical guidelines.

The CDC states that “from birth to 5 years, your child should reach milestones in how he plays, learns, speaks, acts and moves.” This section allows visitors to see those important milestones for babies aged 2 months up through age 5, all in one place.

Features and Highlights

Among the site’s free resources, readers will find:

  Common development milestones organized by age

  Videos and interactive books

  A customizable growth chart

  Training for early care and healthcare providers

  A mobile app for tracking activities like crawling or waving “bye bye”

What Our Editors Liked

The CDC promotes early intervention, or identifying and supporting developmental delays early in life. Practicing early intervention as soon as possible, the website states, helps your child “improve their abilities and learn new skills.”

In the event that early intervention is needed, the website helpfully provides state-specific contacts for accessing early intervention services and emotional support.

Each milestone is also accompanied by instructive images and videos. And for concerned parents, the website spells out when a doctor’s advice might be needed. That way you will know when it is, and isn’t, necessary to schedule an appointment.

By giving parents guidance on how their child is expected to develop, this site serves as a helpful roadmap for when and how to talk to doctors and school officials when children aren’t meeting important development milestones.

Educators and early care providers will find this website useful too, especially the site’s free continuing education training course “Watch Me! Celebrating Milestones and Sharing Concerns”. There’s even a subsection for healthcare professionals offering an autism case training continuing education course.

The Bottom Line

The CDC’s “Act Early” page is a great resource for parents, caregivers, educators, and healthcare professionals. Visitors who want to learn how to recognize the signs of typical childhood development — or find help if a child isn’t meeting those milestones — won’t be disappointed.

Read our full review of the CDC’s “Healthy Living” section to find out why our editors find it trustworthy.

Why I Teach First-Year Medical Students

By Mark A. Kelley, MD |5/24/18
Founder, HealthWeb Navigator

I teach first-year medical students how to take a medical history and perform physical exams on patients.

These skills are the foundation of medicine. The health history and physical exam (plus a few basic tests) are time-tested methods for diagnosing disease. Using these tools, a skilled physician can reach an accurate diagnosis more often than not.

We humans share a standard range of symptoms. Pain, weight loss, fever, cough, abdominal complaints—are all examples of the body’s response to injury, infection, and inflammation. The range of diseases, while large, is still dominated by common conditions such as cancer, infections, heart and lung disease, etc. And how the human body reacts to these diseases has remained constant. A cough is still a cough—whether now or 4000 years ago.

As a former pulmonary and critical care physician, I treated patients with diseases ranging from common to exotic. No matter the scenario, the diagnosis becomes apparent if you are a good listener. As I tell students, if you ask patients the right questions, their answers will help solve the problem.

I teach first-year students because they have a refreshing perspective on medicine. They are eager to meet patients, who in turn seem to enjoy the experience.

Unfortunately, my students will likely spend more time with these patients now than when they are practicing physicians.

During their hospital rotations, students will quickly learn that time has become medicine’s coin of the realm. Filling out forms and clicking through computer billing systems devour time, leaving very little for a meaningful discussion with a patient, much less for developing a relationship.

Many dedicated physicians work within this time trap, and their patience is wearing thin. The warning signs are clear. More than 50% of physicians are experiencing burnout. Many respond by leaving clinical practice or retiring.

Is clinical practice becoming a sweatshop, where physicians are treated like assembly line workers and the only important metric is the bottom line?

Maybe—but only if we ignore human nature. When illness strikes, we all seek comfort from others. For millennia, our ancestors have received such help from trusted healers. I doubt that is going to change. One of life’s certainties is that we all become a patient eventually.

Medicine is having a Dickensian moment: we are now witnessing both the best and worst of times. We have a dysfunctional healthcare system complicated by high costs, mediocre quality, and chaotic public policy. Yet we are also on the verge of major scientific breakthroughs in basic science, information technology, and data analytics.

My bright first-year medical students understand this paradox and view it as an opportunity to improve healthcare. As I reflect on my own student days, I can remember feeling the same way. Throughout history, medicine has lived at the intersections of science, technology, social reform, and economics. Most problems have solutions, if we are bold enough to execute them.

Each new generation is equipped with the courage, creativity, and energy to create lasting change. As my students begin their careers, the most important lesson I can teach them is to make patient care their top priority. That happens only when the doctor-patient relationship is held sacred.

If students set their sights on this one goal, they, like countless students before them, can improve the lives of patients in ways we cannot imagine.

Hopefully I have gotten them off to a good start. After all, one of them may take care of me some day.

Skinny Health Insurance — Cheap Plans that Come With a Cost

By Mark A. Kelley, MD |5/1/18
Founder, HealthWeb Navigator

The Affordable Care Act (ACA), widely known as “Obamacare,” has survived several repeal attempts by Congress. Storm clouds, however, are still on the horizon.

The ACA’s “individual mandate” obligates every American to be covered by comprehensive health insurance. This requirement has been the most unpopular feature of the law. That’s because healthy people, especially those who are self-employed or between jobs, have found the ACA premiums too expensive.

They are not alone. Health insurance premiums continue to rise at a rate of 5% per year. Meanwhile, the average American makes about $55,000 per year and has seen little increase in wages.

The ACA suffered a blow last December when Congress passed the recent tax bill, which eliminates the penalty for the individual mandate in 2019. Some health experts think this will encourage as many as 13 million individuals to forgo health insurance. Without healthy people paying into the insurance pool, insured patients will end up paying higher premiums to cover the loss. Fearing this, some states may impose their own penalties for non-enrollees.

The individual mandate makes economic sense to policy-makers, but not to the average voter. The fines for refusing to buy ACA health insurance have been much lower than the cost of premiums. Over 8 million Americans chose to pay the fine rather than buy insurance in 2016. The federal government had planned to implement higher penalties, but the new law closes that option.

Many healthy Americans still want health insurance — but only on their own terms. That may happen through an emerging option called “skinny” health insurance.

With this type of insurance, the premium price is based on likelihood and size of the loss. If you have an expensive house or fancy car, you will pay more for insurance. If you want to lower the premium, you can take more risk and pay a greater portion of any losses. The lender for a car or home will also make you buy enough insurance to cover a car loan or a mortgage. These are all factors that go into your decision about purchasing insurance.

Skinny health plans work the same way. Unlike ACA insurance which offers only full coverage, you can use skinny plans to buy what you think you need. The benefits can vary and may depend on how individual states regulate the plans. Major insurance companies are beginning to offer these plans, which suggests that they see a market opportunity. Here are some features of these policies:

• They are often marketed as supplemental coverage for consumers who already have traditional, comprehensive health insurance.

• Skinny plans may help patients cover the costs of deductibles, or co-insurance.

• Most skinny plans have strict caps on total expenditures per year.

• Some plans provide little or no coverage for patients with previous conditions.

• The coverage may be limited to doctors services hospitalizations.

• Because of these coverage limitations, premiums may cost as much as 60% lower than ACA insurance.

• Skinny plans can be purchased at any time of the year and for shorter durations, such as three or six month contracts.

The demise of the individual mandate is not likely to affect the future of the ACA. Most Americans had health insurance coverage before the ACA. This was provided either by their employers or by programs such as Medicare and Medicaid.

Caught in the middle were the working poor and lower middle class who could not afford health insurances premiums. The majority of newly insured patients are in this group. ACA subsidies allowed them to buy health insurance. Politically it is unlikely this support will be withdrawn.

The ACA enabled about 17 million uninsured Americans to receive health insurance.

However, several years after the ACA was implemented, the effort appears stalled. Since 2014, 27 million Americans (11% of the population) remain uninsured. Almost half of the uninsured say the costs of insurance are too high, followed by a third who cite job loss or lack of employer-sponsored insurance. Many of the uninsured are trapped in states that refused federal subsidies for their citizens.

This stalemate is all about the price of insurance. If you have a good income and an employer-based health plan, you are protected by the financial ability to cover most costs. With low to mid-range income, you may not be able to afford any health insurance, especially if you must buy it yourself. The ACA subsidies can help, but only if they are allowed in your state and your income is low enough to qualify. Many Americans are caught in this vulnerable position, especially the self-employed, contract workers, and employees of small companies.

Skinny plans may be useful in providing a stopgap for healthy folks who are between jobs. But there is a potential risk. These plans offer limited coverage, similar to dental insurance. For a taste of that experience, ask anyone who had dental insurance but still paid a tidy sum for a root canal.  A hospital stay is even more expensive and, without adequate insurance coverage, can lead to enormous  debt.

“Make America Great Again” has been the rallying cry for opponents of the ACA and universal health coverage. Yet it’s hard to imagine that in the world’s leading nation, many productive citizens cannot afford health insurance

That’s nothing any American should boast about.

E-Cigarettes — Helpful, Risky, or Both?

By Mark A. Kelley, MD |4/9/18
Founder, HealthWeb Navigator

Walking down the street, sometimes I see people who appear to be strolling in a cloud. These folks are wrapped in vapor they inhale from e-cigarettes — a practice called vaping.

Vaping devices first emerged in the late 1990s. They feature a battery-powered heating element that heats up liquid nicotine to create an aerosol, which is free from the toxic byproducts of cigarette combustion. In theory, this device could make it easier and safer for smokers to kick the habit.

As a pulmonary physician, I wince when I hear about people voluntarily inhaling any foreign substance. We are already exposed to more environmental toxins than we realize, and adding something else seems unwise. However, quitting smoking is extremely difficult. Most remedies have been only slightly effective at best. Could vaping help?

After a decade or more of scientific studies, we know a few facts about e-cigarettes, although many questions still remain. Here are the key points:

1. The e-cigarette market is growing. Several studies have shown that between 2010-2013, the use of these devices had more than tripled to include 7% of the U.S. population. Most users are young and/or former smokers. About one-third have never smoked before. Nicotine is highly addictive which is why smokers have difficulty stopping. Vaping is popular among high school students, and their teachers fear that this will lead to cigarette smoking and other addictive habits.

This effect has been observed in a few studies but the trend is unclear. In 2015, the e-cigarette use rate among high school students declined from 16% to 11%. However, there is some evidence that e-cigarette use in high school students is a risk for taking up cigarette smoking.

2. E-cigarettes are safer than regular cigarettes. Both e-cigarette vapor and cigarette smoke contain nicotine, but only cigarette smoke has the harmful products of tobacco combustion. For that reason, most experts consider the e-cigarette to be safer than a regular tobacco cigarettes. However, in both cases, inhaled nicotine stimulates the cardiovascular system. It is unknown whether this effect has long-term consequences such as heart disease or hypertension.

3. E-cigarettes may help smokers quit — but the effect is small. The vast majority of e-cigarette users are current or former smokers. Based on research surveys, these patients are either trying to quit smoking or at least reduce their cigarette consumption. Many studies have compared e-cigarettes to other methods of smoking cessation such as nicotine patches, counseling etc. These studies have been inconclusive. A panel of experts recently suggested that e-cigarettes may slightly improve smoking cessation but the magnitude of the effect is small.

4. It’s too early to know all the risks of using e-cigarettes. These devices expose the user to liquid nicotine and chemicals that create the vapor. The chemicals involved with vaping — propylene glycol and glycerol — when heated, are known to produce carcinogens and compounds that irritate the airways. The exact risk from this exposure is currently unknown, though it is thought to be much lower than that of a regular cigarette. Therefore, for a smoker, switching to the lower risk e-cigarette is a good trade-off. But for non-smokers, using an e-cigarette introduces potential risk for lung disease and cancer. Outbreaks of asthma have already been reported in association with vaping.

5. E-Cigarettes are regulated differently around the world. The World Health Organization has called for strict regulatory control of e-cigarettes by keeping them away from non-smokers and minors. Some countries have banned the devices altogether.

In the U.S, many initially opposed these devices, presuming that they would lead to an increase in cigarette smoking. Some of this fervor has died down and is now focused on minors. At the moment, most states prohibit the sale of e-cigarettes to minors — the same policy as for cigarettes.

The FDA’s new director, Dr. Scott Gottlieb, has taken a fresh approach this problem. The FDA has established a program to fight nicotine addiction by reducing levels in tobacco and other products. Included in this mandate is continued surveillance of the safety and public health effects of e-cigarettes.

If this program is implemented, the role of e-cigarettes in public health may become clear. Ideally, e-cigarettes will rescue smokers from their habit — without recruiting new ones.

Of course the e-cigarette industry has other plans. Although some vaping devices carry a hefty price tag, overall vaping is relatively cheap and safer than cigarettes to boot. The industry is using those facts to leverage the market. Analysts predict that the vaping industry will see annual growth of 20% over the next decade with worldwide revenues of $50 billion by the next decade.  Most of those dollars will come from the industry’s best customers — Americans and Europeans.

If vaping becomes widely used, we may learn that it is safe. But we can’t rule out the opposite outcome either. Widespread vaping across large populations may introduce us to new diseases that could have been prevented.

There is a high cost for ignoring such potential risks. Just ask any patient who has suffered from the toxic effects of asbestos, second-hand smoke, or radon exposure.

U.S. Health Leads the World in Costs, Technology, Not Much Else

By Mark A. Kelley, MD |3/28/18
Founder, HealthWeb Navigator

Why is U.S. health care so costly compared to other developed countries? A recently published report provides some insights.

In a study of 11 countries, Harvard researchers found that while the United States has the highest health costs relative to its GDP, its use of services is average. More specifically, the U.S. ranks lower than nearly every other country in doctors’ visits, hospitalizations, hospital days, and consultative services.

The difference is that the U.S. uses more expensive technologies with high numbers of surgical and cardiovascular procedures and imaging studies.

Other sources of high costs include brand-name drugs and administration of insurance programs. And while the U.S. has fewer physicians per capita, our physicians earn more than counterparts in every other nation.

With fewer doctors, hospitalizations, and office visits, one might conclude that U.S. health care is poor. In some respects, that is true. The U.S. has a low life-expectancy and high maternal and infant mortality compared to other wealthy nations.

One explanation is that the U.S population is larger and more geographically and economically diverse compared to its peer countries. As the Harvard group explained, if the state of Minnesota were compared to a similarly prosperous European country, it could hold its own. In contrast, Mississippi, a poorer state, would rank much lower.

The message is that if you cannot access the U.S. health system due to income or distance, your wellbeing is at risk. The ACA tried to fix this problem by expanding insurance eligibility with federal support. Surprisingly, some states whose citizens would have benefitted refused to cooperate.

The Harvard report suggests two remedies for curbing health care costs: price control of new brand-name drugs and curbing the proliferation and costs of new technology. These ideas are not new—as the famous economist Uwe Rinehart once wrote, “It’s the prices, stupid.”

Some countries like Great Britain and Canada have taken measures to control such costs. But little has been done in the U.S.

What we are left with is a dysfunctional system that creates high costs, expensive drugs and technology, and lacks a stable national health insurance plan. Is it any surprise the U.S. healthcare system has been ranked last among developed countries?

Worse, we may soon have another embarrassing statistic to report—medical bankruptcy. As healthcare costs continue to rise, many patients can’t afford to pay their medical bills. A recent study revealed that many patients deal not only with hefty hospital bills, but also lost wages and even unemployment when they are ill.

It’s also important to remember that medical bills remain the number one reason for bankruptcy in the United States.

Four years ago, experts in medical bankruptcy grew tired of seeing families lose their homes because of medical debt. They founded a nonprofit organization called RIP Medical Debt (RMD) to solve this problem.

Like a mortgage, some medical debt is discounted and sold on the open market as a commodity. In some cases, the debt can be purchased for pennies on the dollar. The buyer then owns the debt and recovers whatever payment they can.

RMD purchases such debt and then raises donations to settle the account. For example, a donation of $100 can settle a debt of $10,000. A donation of $15,000 can retire $1M of medical debt. Over four years, the organization has retired millions of dollars of debt for patients and their families. While I applaud this program, its very existence speaks volumes about the inadequacies of health insurance in the U.S.

As I write this blog, the stock market has fallen dramatically due to the looming threat of trade warfare between the United States and China. If this crisis continues, the price of imported goods will rise for American businesses and consumers. It’s possible that companies may trim their healthcare benefits to cut costs, shifting the burden onto employees through higher premiums and/or higher deductibles. Such changes will nudge many employees even closer to financial ruin if they get sick.

An equally depressing but plausible scenario is that patients will choose to go without routine care because they cannot afford it.

The current national political agenda is aimed at creating more jobs for Americans. Unless those jobs offer adequate health insurance, medical bills will devour wages.

If elected officials are serious about helping Americans, they should stop playing political football with health insurance.

Only a stable single-payer system, similar to Medicare, will keep the average American family secure in times of illness. And armed with the same power of national price control enjoyed by Medicare, such a plan can tackle the escalation of health care costs.

Vitamin Supplements — Cure-All, or Snake Oil?

By Mark A. Kelley, MD |2/15/18
Founder, HealthWeb Navigator

Vitamins and other over-the-counter supplements are extremely popular in the United States. In fact, it’s estimated that Americans spend $21 billion on these products every year—a few billion dollars more than NASA’s entire annual budget.

Over the last century, there has been extensive research to understand the importance of vitamins and minerals in maintaining good health. Essential vitamins and minerals are chemicals that our bodies cannot manufacture on their own. Usually they’re introduced to our bodies by the food we eat.

There are some great stories surrounding the discovery of certain vitamins and minerals. Three centuries ago, sailors on long voyages often became very ill, many of whom died. The cause was lack of vitamin C in their diet, a condition known as scurvy. To provide vitamin C, these sailors were given limes to eat on the voyage. Miraculously the condition disappeared.

Another example comes from the early twentieth century, when patients were mysteriously dying from anemia despite an adequate diet. Studies showed that they lacked a protein that is necessary to absorb vitamin B12. When the patients were given vitamin B12 by injection, their anemia vanished.

Over time medical science has learned much more about how vitamins and minerals keep us healthy. Yet even in this era of health supplements, the average person still wonders, “What should I be doing to maintain good health?”

Below, we’ll look at a few of the consensus recommendations for vitamin use based on clinical studies to date.

Are Vitamins and Supplements Necessary?

For a healthy person, a well-balanced diet will supply the necessary minerals and vitamins. A balanced diet should include fruits, grains, vegetables, protein, and some dairy products. These foods have the right nutrients that our bodies are designed to absorb to keep us healthy.

Folic acid supplement during pregnancy has been shown to reduce neural tube (spinal) defects in infants. This major advance may save many infants from a lifetime of disability.

Strict vegans may need vitamin supplements. A completely vegetarian diet may lack vitamins B12 and D, and the patient may require oral supplements to correct these deficiencies. The same approach applies to anyone on a poor or restricted diet.

Vitamin D may require some supplement. Vitamin D is necessary for bone growth and strength and comes from two sources. The first is from food, and the second from our skin, which produces vitamin D in response to sunlight. Low vitamin D levels can be seen in patients whose diets are poor or who rarely go out in the sun. For this reason, many experts advise oral vitamin D supplements for older patients who may be at risk for osteoporosis or bone fracture.

Multivitamins are safe, but usually aren’t necessary. Patients with poor diets or digestion may benefit from multivitamins or other supplements. However, for an average person, the consensus is that these products are unnecessary. Nonetheless, multivitamin doses are generally modest and likely won’t harm healthy patients who want to use them within the usual recommended doses.

Beware of high doses of certain vitamins. High doses of the following vitamins can cause lasting damage to your health:

• Vitamin A: Birth defects, osteoporosis, increased cardiac mortality

• Beta-Carotene: Lung cancer

• Vitamin C: Kidney stones

Based on current research, there is no evidence that supplemental vitamins or antioxidants prevent or improve the outcomes of cancer or cardiac disease.

Vitamin and mineral supplements can sometimes be helpful. But for those of us who take prescription medications, they can also cause dangerous interferences. This field is complex, and the science behind it is constantly evolving. Before taking any supplements, it is wise to consult your physician and discuss what is best for you.

A Permanent Vaccine for the Flu?

By Mark A. Kelley, MD |2/5/18
Founder, HealthWeb Navigator

The current flu season is the most severe in nearly a decade. In a typical year, influenza causes 3 to 5 million cases of severe illness, and anywhere from 290,000 to 650,000 deaths around the globe.

But this year may be even more worse because the flu vaccine has been only 10-20% effective in preventing the flu—less than half its usual protection.

The flu virus mutates rapidly, so creating an effective vaccine is largely a game of chance. The process requires scientists to decide in advance which strains they think will be the most prevalent each flu season. That decision determines how the flu vaccine is manufactured, a process that takes about six months.

This year the H3N2 virus emerged unexpectedly. It is particularly nasty and tends to be more resistant to flu vaccines.

The flu virus, particularly type A, can also blend its genes with other viruses, including those infecting animals like pigs and birds. These changes produce new surface coatings on the virus, which pose a major challenge for our body’s defenses. If our immune system recognizes a virus from a previous infection or vaccine, it can quickly kill it. However, new forms of the virus are hard to recognize and can make it difficult for the immune system to react quickly. Such a delay can be deadly if it allows the infection to gain a foothold.

Compared to vaccines for polio, smallpox, and measles, the current flu vaccine falls considerably short:

• It offers limited protection that changes year to year.

• It does not provide lifelong immunity.

• It is unlikely to protect against more dangerous strains of flu like the 1918 pandemic that killed 50–100 million of the world’s population.

Can we produce a better and more effective flu vaccine? The short answer is yes—but only if we have the will to do it.

Scientists have known that certain parts of the flu virus do not change their genetic profile. These areas hide from our immune system. A more effective vaccine would expose and target those areas so that our immune system can always recognize the virus and eliminate it. Other approaches include reengineering some of our own cells to look like the flu virus and making the immune system better prepared to reject it.

These and other innovations are aimed at developing more effective and predictable protection against the influenza virus. Although it will likely take years and considerable funding to develop, the costs are paltry compared to the estimated $8.4 billion in lost productivity every year in the U.S. resulting from the flu. A new vaccine that uses modern technology and offers better protection would be a bargain.

Influenza has plagued mankind for centuries. Every winter, this disease reappears around the world. It may spread even more rapidly with population growth, international travel, and urbanization.

There are reasons to be optimistic about a new vaccine. In this era of “precision medicine,” the science of virus biology has advanced far beyond the 70-year-old technology used for the current vaccine. If the nations of the world choose to accept this challenge, we may be able to protect millions of people who suffer or die from influenza every year.

Are Allergies Preventable? You May Be Surprised

By Mark A. Kelley, MD |1/30/18
Founder, HealthWeb Navigator

Chances are you or someone you know has experienced an allergic reaction at some point. The statistics are eye-opening:

Allergies affect as many as 30% of American adults and 40% of children in the U.S. An estimated 20% of Americans have hay fever; about 4% of children and adults have a food allergy; and 10-20% of children and 3% of adults have significant skin allergies. Also common are allergies to dogs and cats.

Thankfully medical science can prevent and even eliminate some of these conditions. But how?

Our immune system is finely tuned to recognize and repel invaders, especially bacteria and viruses. An allergy develops when the body’s immune system detects a foreign protein and reacts to its presence.

Take the example of pollen. Most people have no problems with pollen. However, anyone with seasonal rhinitis (like me) suffers through the pollen season with a runny nose and cough.

Peanuts are the source of another common allergy. Most people have no problem with peanut products, but for others, peanut consumption can be dangerous. When exposed to a peanut product, these patients can develop serious breathing problems within minutes. Without treatment, this reaction can lead to life-threatening shock.

Of course, the best defense against an allergy is to avoid exposure to the agents that trigger it. Never eat peanuts if you are allergic; stay away from grass and flowers in pollen season; and give away your pet if you are allergic to it.

But sometimes these steps are impractical. For the peanut allergy, any food can be risky because peanut products are common in many foods. In pollen season, staying inside may be impossible if you work outside. As for a cat or dog allergy, patients are very reluctant to part with their pets.

Another way to fight an allergy is to “teach” the body to be more tolerant to allergens. The key is to introduce the offending proteins to the immune system in very small doses. This therapy of “allergy shots” has been around for decades. Small injections of the offending allergy protein (like ragweed) tone down the immune system so that any future reaction produces minimal symptoms. This approach is called “immunotherapy.”

For decades, this tolerance-building approach has been widely used for common allergies such as pollen and animal dander. With new technology, the allergens can now be delivered more easily, either under the tongue or orally, instead of by injection.

New evidence suggests that tolerance develops naturally in early childhood. From birth to about 4 years of age, the immune system seems to have a learning curve about how and when to react to allergens like animal dander and peanuts.

It was once thought that if children had less exposure to allergens, they wouldn’t be as likely to develop an allergy. For years, parents were advised to keep peanuts and other complex food away from children until the age of four. Similar advice pertained to exposure to pets.

Recent research has changed this thinking. New studies have shown that infants introduced to oral peanut extract before the age of one have much lower rates of peanut allergy. In other studies, children who grow up around domestic animals and pets have much lower rates of animal allergies and hay fever. This research suggests that childhood exposure to some allergens teaches the immune system tolerance and reduces the likelihood of developing some allergies.

Most mild allergies are easily treated and prevented. However, others are more serious, their therapies more complex. It is wise to discuss any allergies with your doctor and, if necessary, consult an allergy specialist.

If You’re Considering Psychotherapy…

By Kay O’Laughlin, Ed.D. |1/25/18
Licensed Psychologist

Some of the reasons people start psychotherapy might surprise you. The most obvious reasons for seeing a therapist include:

• Relationship problems

Overwhelming sadness or depression

Grief over death or other serious losses

• Intense anxiety

Thoughts of hurting oneself or others

But people also choose to see a therapist when they feel stuck or lost. For example, having no sense of direction about a career path or feeling that something is missing from life.

Others decide to talk to a therapist when they realize they are using addictive behaviors to cope with stress and it’s not working. The addiction may be overeating, overusing alcohol, misusing drugs, or even compulsively over-exercising. Of course, the trap is that such behaviors create new problems instead of solving the old ones.

Therapy helps to identify negative thought patterns, misperceptions, and unhelpful behavior patterns—and then make plans for changing them.

You may wonder what therapy is and whether it really helps. Psychotherapy is generally known as “talk therapy,” though today many therapists incorporate specialized approaches such as cognitive-behavioral techniques, EMDR, guided imagery, mindfulness, and forms of deep relaxation.

Interestingly, research tells us that the most crucial factor in successful therapy is a positive connection between the client and therapist, meaning that the client feels the therapist both understands and empathizes. The American Psychological Association reported major research showing that 50% of people in therapy improved noticeably after eight sessions, and 75% improved noticeably by the six-month point. In recent years numerous rigorous studies have shown therapy has positive effects on one’s overall health and immune system.

So, in a nutshell, therapy helps most people who give it a try.

Therapists include psychologists, psychiatrists, psych nurse practitioners, social workers, pastoral counselors, and licensed mental health counselors. All of these disciplines involve licensing at a state level. Your insurance company keeps a list of providers in their network, but you should also ask whether they cover out-of-network therapists. Your doctor may be familiar with local therapists and able to recommend someone in particular.

If you need medication, a psychiatrist or psych nurse practitioner can prescribe. They may also do talk-therapy, but some prefer to work in conjunction with therapists from other fields. Often primary care doctors are comfortable with first-level medication for anxiety and depression.

All therapists help clients deal with relationship issues and solve problems. When you first meet a therapist, notice whether that person actively listens to you, seems to understand, and helps you formulate a roadmap of where you want to go and how to get there. You should feel comfortable and safe in the office environment.

One of the benefits of therapy is having time during a week devoted solely to you—how often does that happen in your busy life?

Often, people who are nervous about starting therapy soon find themselves looking forward to each session. One of the biggest surprises for many clients is how much they enjoy therapy and the sense of growing strength, clarity, and focus. I tell my new clients that the work may be intense at times, but along the way we’ll also find humor and reasons to laugh.

Are you considering talk therapy as an option? Check out these websites to help you find a therapist online.

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