Category: Health & Wellness

Having trouble finding reliable health information? Our medical professionals can do it for you.

By Nathan Blake | 11/14/18
Project Manager, HealthWeb Navigator

Readers sometimes ask what a typical day looks like here at HealthWeb Navigator.

Mostly we spend a lot of time browsing the web. Whether it’s groundbreaking medical research, user reviews of a diabetes smartphone app, or a new website that helps you understand your health insurance plan, we try to stay on top of everything health-related the internet has to offer.

Our tireless web browsing has helped us become one of the internet’s leading resources for finding and evaluating reliable healthcare websites. We are, to date, the only place that publishes in-depth reviews of health websites written by actual health experts. Yet we’re still on the lookout for innovative and helpful ways to meet your healthcare research needs.

That’s why we’re excited to announce a new service that gathers the web’s best health information specific to your needs or interests. Yep — we’ll check every nook and cranny to give you personalized resources from the internet’s most trusted sources. No more wondering if what you’re reading is credible. We pre-screen every resource for reliability and only send you the cream of the crop.

Start by shooting us an email at info@healthwebnav.org. Fill us in on the details — what topic you want to learn about, your preferred language and medium, the level of detail you’re comfortable with, etc. — and we’ll respond with relevant, trustworthy resources that specifically meet your preferences.

Maybe you want a Spanish-language video that introduces type 1 diabetes. Or perhaps you’re looking for clinical trials for new a Parkinson’s disease drug treatment. You might even like to know the side effects of your wife’s chemotherapy, or if there’s a support group for teens with cystic fibrosis, or where to download a podcast for caregivers. Whatever the case, we’ll see what’s out there.

We can’t guarantee that we’ll find something you haven’t seen already. And nothing we send you can substitute for medical advice. But no matter what, you’ll walk away with credible and up-to-date information that has been verified by at least one medical professional.

So what are you waiting for? Send us an email and get started today!

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

 

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.

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.

Why Everyone Should Get a Flu Shot (Yes, Even You)

By Mark A. Kelley, MD |1/15/18
Founder, HealthWeb Navigator

According to the Centers for Disease Control, we are in the midst of a significant flu season. Headlines tend to amplify danger, but when it comes to the flu, there is reason to worry. After all, the 2012-2013 flu season killed an estimated 56,000 Americans.

Influenza is highly contagious. Even those with mild symptoms can infect others in the first day of their illness. And once the flu virus is in the community, it can spread quickly.

There are two viruses that cause influenza: Type A and B. Type A changes its molecular appearance frequently. That means a strain that caused an epidemic one year may not be the next year’s culprit.

Sometimes a new flu strain emerges that is particularly aggressive and has a higher mortality rate. These frequent changes in the flu virus mean that humans cannot develop long-lasting immunity to its infection.

The solution is to provide a new vaccine each year that protects against the strains of virus that seem most likely to cause a new epidemic. But that prediction is imperfect. It takes six months to develop the vaccine, and in that time the targeted viruses may mutate. Some years, the vaccine hits the target and provides excellent protection. In other years—the aim is not as good.

For most healthy people, the flu is usually an inconvenient sickness from which they recover. But there are exceptions. Even healthy people can die from the flu.

Who’s At Risk and Why?

Children are particularly at risk, as are the elderly, pregnant women, and those with chronic illness. These groups account for most of the flu-related deaths every year.

So what makes the flu so deadly?

Research suggests that the flu virus can overwhelm those with weakened immune systems. Normally, our immune system fights off infection pretty well. But for children—whose immune systems aren’t fully developed—and adults over the age of 65, the immune system loses some of its effectiveness. Patients with chronic disease and pregnant women are especially susceptible to the additional stress.

These weaknesses allow the flu more time to invade the body before the immune system can stop it. The most common complication is pneumonia, which can lead to other infections elsewhere. These series of events can also lead to organ failure, long hospitalization, and even death.

Thankfully medical science is able to create the flu vaccine, reducing the flu-risk for millions of Americans.

Why You Should Get the Flu Vaccine

Here are some quick facts about this live-saving vaccine:

1. The flu shot reduces flu-related adult hospitalization by 57%, and as much as 70% in the elderly. For children, the flu vaccine reduces mortality by a whopping 65%.

2. Even if you get the flu, the vaccine will reduce the length of illness and reduce the risk of complications. And you will likely get back on your feet sooner.

3. The flu vaccine helps you protect others. If you are a healthy young or middle-aged adult, you will likely survive the flu—but you will also expose the rest of your family to the virus. Vulnerable family members are more likely to have complications from the flu, and have higher risks of hospitalization and even death. No one wants to expose loved ones to such danger.

The flu vaccine comes with little risk and protects all of us, particularly our children, the elderly, and those with health challenges. If you are healthy, the flu may not pose a great danger to you. But if you pass the virus on to someone who is vulnerable, it may threaten their life.

That alone is a good reason to get a flu shot every year.

Should I Get the Shingles Vaccine?

By Mark A. Kelley, MD |1/11/17
Founder, HealthWeb Navigator

I have seen more and more friends and patients who have suffered with shingles. For no apparent reason, a very painful rash appears, most often on the chest or abdomen. The rash eventually disappears but the pain can last for weeks.

Fortunately, this condition can be prevented.

What Causes Shingles?

Shingles can’t be “caught,” and you can’t get shingles if you’ve never had chickenpox. Both chickenpox and shingles are caused by the varicella zoster virus.

In chickenpox, the virus spreads through the body because the patient has no immunity to it. Once immunity develops and controls the virus, the patient recovers.

However, some of the virus hibernates in our nerve cells, locked away by our immune system. As we age, our immune system is not as effective in keeping the virus in check.

For some folks, the zoster virus emerges and spreads along the nerve cells, causing them to become painfully inflamed. The result is a localized rash that resembles chickenpox. Weeping fluid from the rash contains live zoster virus and can cause chickenpox in anyone who has never been exposed to zoster, such as infants.

With shingles, the body usually fights off the virus successfully. However, it takes a long time for the inflamed nerves to settle down and for the pain to subside. Ask anyone who has had shingles and you will be impressed with how disabling the pain can be.

Roughly 1 in 4 adults will develop shingles at some point during their lifetime. Those odds increase with age.

In a healthy person, shingles is usually not life-threatening, but it can lead to chronic pain or, if it affects the eye, can cause blindness. More serious complications, including death, can occur in patients whose immune systems are weakened by anti-inflammatory drugs, chemotherapy, or chronic disease.

What Are My Options?

Currently there are two injectable vaccines that can prevent shingles.

Zostavax is a single injection that delivers a weak form of varicella zoster. That exposure awakens the immune system to quickly fight off the virus. This vaccine prevents shingles in about 50% of patients, but that protection is only good for about 5 years. However, for immunized patients who develop shingles, the vaccine reduces the severity of the symptoms.

Shingrix is a new vaccine that was engineered to look like the zoster virus to our immune system. Since it is not a real virus, it cannot cause any infection. The vaccine requires two separate shots and may be more effective than Zostavax. In numerous trials, the Shingrix vaccine has protected over 90% of elderly patients from shingles for about 8 years. Zostavax, on the other hand, has protected only half of similarly aged patients. Shingrix is approved by the FDA but will not be available until later this year.

Is the Shingles Vaccine Right for Me?

The CDC’s current recommendation is that every adult over the age of 60 should be immunized with Zostavax, whether or not they have had chickenpox. The reason is that most American adults have antibodies to varicella, suggesting they were once infected with the virus. There has been no consensus on whether to recommend periodic booster shots. Younger patients with immune systems weakened by disease or treatments may also be considered for the vaccine.

These recommendations may change to favor the newer vaccine Shingrix, because it appears to be more protective. No formal policy has yet been published, although one is expected later this year.

The retail price for both vaccines is about the same. The single shot of Zostavax costs about $220, and the two shots of Shingrix together are estimated to cost about $240. Insurance or discount coupons may cover some or all of this cost. It pays to check with your insurance company and shop around.

I think the shingles vaccine makes sense for most patients over the age of 60. It substantially reduces the risk of developing a very painful condition that can last weeks. We now have one—and soon two—safe, effective vaccines.

Consult your physician to see if and when the shingles immunization is right for you.

How to Effectively Manage Appointments with Your Doctor

By Mark A. Kelley, MD |7/12/17

Everyone in health care is busy these days. Most doctors have full schedules and patients often can’t afford to take time off from work.

Neither patients nor doctors are satisfied with this situation. However, once you and your doctor get together, there are ways you can make the visit more valuable.

Doctor appointments fall into two different categories:

• Urgent visits: For true emergencies, you should seek immediate medical attention. For a problem that is not an emergency but worries you,  the best approach is to contact your doctor’s office. Your doctor may be able to solve the problem by phone or work you quickly into the office schedule.

• Routine planned visits: These visits are usually for a new consultation or a follow-up for a known condition. You can get more from these scheduled visits if you do some preparation.

The New Consultation

You can take a few steps to ensure a new consultation goes as smoothly as possible.

Educate yourself beforehand: Understand the reason for the consultation from your referring doctor. Have you read up on your particular problem? Have you checked the credentials and experience of the new doctor? Is this new doctor affiliated with a hospital that you like? Does the doctor accept your insurance?

Bring your medical records, drug list, and results of any lab/radiology studies: This step can make a major difference in your first visit. Medical records provide a clear picture of your health history. The doctor can read faster than you can talk, and this written information frees up time for the doctor to have a better conversation with you. The information may also reduce the need for more tests, allowing the doctor to focus on a diagnosis and treatment plan.

Prepare a list of questions in advance: Make a list that you can share with the doctor. This conversation will help you to understand the medical issues involved, as well as help the doctor understand your concerns.

Ask a close relative or friend to accompany you on the visit: This has several advantages. Your relative may remember something about your medical history that you forgot to mention. They may also be helpful in remembering specific details that the doctor mentions. Additionally, it is always comforting to have a close companion with you to provide support.

Ask the doctor to summarize their findings and recommendations for you: Then, in your own words, repeat the summary back to the doctor. This will help you remember details and ensure that you and your doctor are on the same page regarding your problem and action plan. Don’t be shy about asking questions. Doctors want their patients to be well informed.

Understand the plan and goals before the next visit: These may include any new medications, tests, procedures, or therapies. For each one, consider asking the following questions: How does this test or therapy work? Why do I need it? How long will I need it? What are its benefits? What are its risks? For a new medication, what side effects should I look for? Will it interfere with my current medication? If I have a problem, who should I contact?

Ask for a printout: Request hardcopies of any diagnosis, medications (especially new ones), or tests before you leave the office. You can also ask the doctor to send you a written summary of the visit for your records. By law, you are entitled to this information, and physicians are usually glad to provide it.

Learn more about your condition: Although you may have read about the subject beforehand, your doctor may direct you to other helpful resources. The information may come in the form of written materials or online resources. HealthWeb Navigator can direct you to the most trustworthy, independently reviewed health websites online today.

The Follow-Up

Follow-up visits are scheduled so that the doctor and patient can monitor progress together. You should expect to discuss the following issues with your doctor:

• Are you feeling better or worse?

• Are there any problems to report? If so, let the doctor know early in the visit. They can evaluate whether this issue is serious and/or related to other conditions.

• Are you taking your medicines as prescribed?

• Have you had any new tests or other doctor visits recently? The doctor may not have the results but should be able to get them quickly.

• Do you have any questions about your condition?

• Do you understand the treatment plan? Before you leave the appointment, be sure you receive written summaries and instructions.

Based on my decades of practice, this preparation makes the office visit more productive for doctor and patient alike.

Final Tip

Sometimes routine follow-up visits become “too routine.” Physicians know that patients spend a lot of time and money on medications and doctor visits. If you are doing well and everything has been under control, you may want to pose the following questions to your doctor:

• Can I cut back on any of my medicines (or even stop them)?

• Can I reduce the number of routine follow-up visits?

• Can some of these follow-ups be done by phone or email?

Physicians are modernizing their practices to suit your needs. I suspect that most are more than willing to discuss these requests.

Firearm Fatalities – What Are the Issues?

By Mark A. Kelley, MD |6/22/17

The recent shooting at a Congressional baseball practice is another example of firearm violence. When such crimes grab headlines, it is helpful to review the national statistics concerning guns and safety.

According the Centers for Disease Control, 33,000 Americans die from gun injuries annually. About 65% of these deaths are from suicides. Easy access to firearms, especially in the home, is associated with higher rates of suicide.

Because self-inflicted gun injuries are highly lethal, most suicide attempts by this method are successful. However, patients with unsuccessful suicide attempts rarely succumb to suicide later. Therefore, keeping these patients away from guns is life-saving.

The second major cause of firearm death is homicides (33%). Nearly all of these deaths are in the home or among people who know one another. Random shooting fatalities are rare.

The final cause of firearm deaths is accidental shootings, usually in the home, and often involving children. These deaths account for 2% of firearm fatalities.

Mass shootings, such as at the Sandy Hook Elementary School in 2012, are heart-breaking tragedies. From 2007-2016, the national fatalities per year from mass shootings ranged from eight to 67 victims. Over that decade, the nation averaged 38 deaths per year, or 0.3% of the total gun-related homicides.

Firearm mortality statistics can be summarized as follows:

• The majority of Americans who die from gunshot wounds are the victims of suicide.

• Most other fatalities are due to domestic violence or among people who know one another.

• Mass shootings, while dramatic, are a very small part of this problem.

In all these scenarios, easy access to firearms increases the likelihood of a fatal outcome.

Mass shootings are a relatively new phenomenon in our country. Many hypotheses have been raised to explain this change. Among them are the expansion of social and news media, the availability of automatic weapons, and weak gun control laws.

These who commit these crimes share some common characteristics. In many cases, they do not know their victims. Most of the perpetrators act alone, have no plans for escape, and die violently, often by their own hand. Many obtain firearms legally.

Why motivates such people? Psychologists have suggested that this violence stems from rage at society because of some grievance. The result of this anger is mass casualties and usually the shooter’s own death by gunfire, often self-inflicted.

This raises several issues. Are mass shootings a form of public suicide? If so, will they occur more often? While no one has the answers, one fact is clear. The behavior behind these shootings is highly abnormal and suggests serious mental health problems as the root cause of the violence.

Our society has two problems that are closely linked—lethal weapons and mental health. Those with mental health issues and violent intent are more likely to harm themselves or others if they have access to guns. However, gun control is only a partial solution.

The major challenge is early recognition and treatment of mental illness. We need to help mentally ill patients well before their depression or rage reaches the breaking point.

Our elected officials are now considering cuts to healthcare benefits, particularly in mental health. Such cuts would be a major public policy mistake. In this era of gun violence, public safety requires that we make mental health one of our top priorities.

Health Web Navigator