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QUOTE FOR TUESDAY:

“Menopause is a point in time 12 months after a woman’s last period. The years leading up to that point, when women may have changes in their monthly cycles, hot flashes, or other symptoms, are called the menopausal transition, or perimenopause.

The menopausal transition most often begins between ages 45 and 55. It usually lasts about 7 years but can last as long as 14 years. During the menopausal transition, the body’s production of estrogen and progesterone, two hormones made by the ovaries, varies greatly. Bones become less dense, making women more vulnerable to fractures. During this period, too, the body begins to use energy differently, fat cells change, and women may gain weight more easily.”

NIH National Institute on Aging

Menopause and it’s effects on women’s health.

Menopause is when the ovaries naturally stop producing 2 hormones called estrogen and progesterone. Your ovaries are similar to what a car does in that over years it wears down, well so does the mechanism that regulates your hormones which is the ovaries. You go 12 consecutive months without having a period with no reasons to be explained for its occurrence, both biological or physical with it never returning. If both ovaries are removed surgically the menopause kicks in immediately. Menopause has signs and symptoms (s/s) that kick in which have varying intensities (it depends on the individual). You may experience mild to severe s/s.

Menopause is the time that marks the end of your menstrual cycles. It’s diagnosed after you’ve gone 12 months without a menstrual period. Menopause can happen in your 40s or 50s, but the average age is 51 in the United States. Menopause is a natural biological process.

Those s/s can be : 1- Hot Flashes 2-Irregular Periods 3- Breast Pains 4- Night Sweats 5- Mood Swings 6- Loss of Labido 7- Vaginal Dryness 8-Brittle Nails 9-Bloating 10-Irritability 11-Depression 12- Weight Gain 13-Sleep Problems 14- Osteoporosis-one of the worst symptoms of menopause. 15-Loss of breast fullness in some. 16- Thinning of the hair and dry skin.

Did you know over 60% of adult Americans are considered obese or overweight?
Weight gain happens when a person increases their body mass, whether it is a result of fat deposits, additional muscle tissue, or excess fluid. However, weight gain associated with menopause typically involves increased amounts of fat around the abdomen. One of the most accurate ways to see if you are obese is to measure your body mass index which is free online, check out the internet. I do every so often.
Go to Free BMI Calculator – AICR.org‎
www.aicr.org/bmi calculator‎.

On average, a women gains about 12 to 15 pounds between the ages of 45 and 55, this is usually when menopause typically occurs. This extra weight generally does not evenly distribute itself throughout a woman’s body. The weight tends to accumulate around the abdomen instead and women often notice the shape of their bodies slowly losing their hour-glass figure.

What can resolve this issue? As years progress the metabolism slows down; setting the physiological stage for weight gain. As a woman’s hormones fluctuate prior to menopause and preparing for a permanently reduced hormonal level, it is likely to experience weight gain.   Also include:

Keep up with regular visits with your doctor for preventive health care and any medical concerns. Continue getting these appointments during and after menopause.

Preventive health care as you age may include recommended health screening tests, such as colonoscopy, mammography and triglyceride screening. Your doctor might recommend other tests and exams, too, including thyroid testing if suggested by your history, and breast and pelvic exams.

QUOTE FOR MONDAY:

“The call for articles on the long term health effects of the 11 September 2001 terrorist attacks (9/11) has resulted in twenty-three papers that add a significant amount of information to the growing body of research on the effects of the World Trade Center (WTC) disaster almost two decades later. The attacks on 9/11 were a paradigm altering event in US history and have had major repercussions in the political landscape and response to terrorism. The toll of 9/11 includes the continued impact of accumulated health effects among those who were directly exposed to either the air pollution or re-suspended material that resulted from the collapse of the two WTC towers, and physical injuries or psychological trauma. This includes a wide range of physical and mental health disorders that continue to plague thousands of people 20 years later as well as newly identified conditions emerging as a result of prolonged disease latency.  Respiratory and lung problems are among the most prevalent and highly persistent physical health problems arising from 9/11 exposure to dust clouds from the collapsing building and the subsequent re-suspension of dust ”

U.S. Library of Medicine/National Institute of Health

 

Health Effects from 9/11 Disaster.

 

HEALTH EFFECTS FROM SEPTEMBER 11 DISASTER

The world trade center (WTC) terrorist attact and its aftermath exposed hundreds of thousands of people to dust, debris, smoke and fumes.  I was one that went down that day as a volunteer RN to help out my country.  It was a sight I will never forget and thank God nothing like it has happened since including developing anything from being exposed to the environment of this disaster.  September 11, 2001, among rescue and clean up workers, office workers, building evacuees, and residents of lower Manhattan living down their have shown increased respiratory and other physical health problems, like developing cancers after this terrible terrorist tragedy.  Following is a outline of the most common conditions experienced by individuals exposed to the WTC attacks and their aftermath.  The types of conditions are:

Upper Airway Cough Syndrome:  Formerly named postnasal drip syndrome which is commonly caused by continuous irritation or infection of the sinuses and the nose either due to allergies or from environmental irritants.  The signs or symptoms that arise from this are cough, nasal congestion, postnasal drip and frequent need to clear the throat.

Asthma/Reactive Airways Dysfunction Syndrome:  Some people exposed to the WTC disaster area have developed asthma related to exposure to irritants (also called reactive airways dysfunction syndrome [RADS]).  Signs and symptoms include:  Shortness of Breath (SOB); chest tightness, wheezing, coughing, phlegm, possible triggering of symptoms by colds or seasonal allergies or exercise or fragrances or extremes of temperature or humidity, recurrent episodes of respiratory infections requiring antibiotic treatment.

GASTROESOPHAGEAL REFLUX DISEASE OR LARYNGOPHARYNGEAL REFLUX DISEASE:  Some people exposed to the WTC disaster developed this condition.  GERD results from the flow back or return (reflux) of stomach contents into the esophagus. LPRD results from the reflux of stomach contents into the voice box or throat.

Symptoms of GERD: Heartburn, acid regurgitation, upset stomach, cough made worse with meals or at night

Symptoms of LPRD: Hoarseness or other vocal changes, sore throat, cough, sensation of having a lump in the throat

Long-Term Physical Health Concerns

There has been increased concern about sarcoidosis and cancer among individuals who were highly exposed during the WTC disaster. The NYC Department of Health and Mental Hygiene, in conjunction with other programs, is closely monitoring these conditions in order to detect any increases in these diseases.

At this time, there is no evidence of an increased rate of cancer among individuals highly exposed to the WTC disaster. Increased rates of sarcoidosis have been documented among fire department personnel ( Izbicki G, Chavko R, Banauch, GI, et al. World Trade Center “Sarcoid-Like” Granulomatous Pulmonary Disease in New York City Fire Department Workers. Chest. 2007;3:131;1414-1423). Rates of sarcoidosis among other groups are currently under investigation.

Sarcoidosis is difficult to verify because NYC providers are not required by law to report sarcoidosis cases to the Health Department.  Based on New York City death certificate records over the   past 10 years, there have been an average of 32 sarcoidosis deaths per year, with the annual number remaining the same since the WTC attacks. During the   same period, there have been between 362 and 439 sarcoidosis-related hospitalizations per year in NYC (five per 100,000 people), with the annual   rate remaining the same since the disaster.

* Breathing in beryllium, other metal dust or fumes or moldy materials can cause lung disease, which may resemble sarcoidosis.

.Sarcoidosis

Sarcoidosis* is an auto-immune disease that can attack any organ   of the body, although it often starts in the lungs or lymph nodes. It mainly   affects people between 20 and 40 years of age, with African-Americans three  times more likely to develop the condition than Caucasians and women twice as   likely to develop it as men. While most sarcoidosis patients recover without treatment, less than one-third develop chronic debilitating sarcoidosis and  fewer than 5% die from the disease. The exact cause of sarcoidosis is unknown.

Sarcoidosis and World Trade Center (WTC) Dust Exposure

While studies have not definitively linked dust exposure from   the WTC disaster to new-onset sarcoidosis among exposed workers, the data   does suggest elevated levels of sarcoidosis among firefighters.

There have been a few reported sarcoidosis cases among rescue   workers that may be related to Ground Zero dust exposure. In May 2007, the New York City Chief Medical Examiner determined that dust exposure from the disaster contributed to a sarcoidosis death, based on published epidemiologic findings among exposed firefighters.

Cancers

The collapse and burning of the WTC and neighboring buildings   released a complex mixture of irritant dust, smoke and gases. The dust cloud   also contained heavy metals, as well as asbestos and other carcinogens. In   addition, smoke released from the fires contained hazardous and potentially   cancer-causing substances.

Because of these exposures, there has been concern about the   possibility of increased cancer rates among WTC-exposed people. The NYC   Department of Health and Mental Hygiene, the Fire Department of New York and   other researchers are carefully monitoring cancer rates among highly exposed   people.

In 2007, the NYC Department of Health and Mental Hygiene brought together a panel of experts, including representatives from FDNY, the Mount Sinai School of Medicine, the New York State Department of Health and the National Institute for Occupational Safety and Health, to discuss the potential impact of the WTC disaster on cancer rates and mortality.

In 2010, after beginning the process of confirming cancer   diagnoses within their cohorts, the NYC Department of Health and Mental   Hygiene and FDNY co-chaired another conference of outside experts, including biostatisticians, environmental health scientists and cancer epidemiologists,   to help address the complex methodological questions associated with their   preliminary cancer investigations. The conference produced several   recommendations which are described in the 2010 WTC Medical Working group annual report.

Although cancer associated with specific exposures takes a long   time to develop, three early cancer studies based on verified diagnoses   within their cohorts through 2008 (the latest year for which data was   available when these analyses began) have been published:

  • FDNY found that nearly 9,000 firefighters with WTC exposure may be at greater risk for cancer than firefighters  who weren’t exposed.
  • The WTC Health Registry found small increases in rates of prostate cancer, thyroid cancer and multiple myeloma, a blood cancer, among nearly 34,000 WTC rescue and recovery workers in comparison to rates among New York State residents after adjusting for age, race/ethnicity and sex.
  • Prostate and thyroid cancer rates were higher than expected among nearly 21,000 rescue and recovery workers enrolled in the WTC Health Program in comparison to rates in New York, New Jersey, Connecticut and Pennsylvania where the majority  of workers lived.

Cancer analyses continue at FDNY, the WTC Health Registry and at   the Mount Sinai School of Medicine.

In 2012, the National Institute for Occupational Safety and Health  added many different types of cancers to the list of conditions that can be treated at the World Trade Center Health Program.

What the New York City  Health Department Is Doing:

Through the World Trade Center (WTC) Health Registry, the Health Department is conducting a cancer study that will help determine if cancer rates are higher among those exposed to the WTC disaster. Results of   the study will appear on this Web site and will be submitted to peer-reviewed scientific journals.

The Department is also conducting a broader public awareness campaign about cancer testing, and is working with its clinical partners to offer free cancer screenings. Identifying cancer early in the course of the disease reduces the risk of developing disability from cancer. Department efforts to reduce the rates of smoking among WTC disaster-exposed people also help reduce their risk for developing cancer and other diseases.

What You Can Do

Seek medical care.

If you were exposed to the WTC disaster and have developed symptoms or conditions you feel are related to this exposure, tell your doctor and bring the Clinical Guidelines for Physicians Treating Adults   Exposed to the WTC Disaster to   help your doctor diagnose and treat your symptoms. The Health Department also   released clinical guidelines  for   health care providers on how to treat children and adolescents exposed to the WTC disaster.

If you or your doctor believe that you require more specialized   care, you may be eligible for free treatment at a WTC   Center of Excellence or affiliated facility.

Practice preventive   health.

Whether or not you are currently experiencing symptoms, there   are things you can do to maintain your current health status, prevent   worsening of your health, and detect any new conditions. Suggested measures   include:

    1. If you smoke, quit! Tobacco is known to cause   cancer and make existing respiratory conditions worse. If you currently   smoke, there are programs in place to help you quit.
    2. Lead a healthy lifestyle by drinking alcohol   in moderation and avoiding more than moderate sun exposure. Increase physical   activity, keep your weight down and eat a healthful and nutritious diet.
    3. Have a physical exam every year that includes a   complete blood count (CBC). Be sure your exam includes all tests appropriate   for your sex and age, including cancer screenings.
    4. Avoid   risks at work and during leisure time. If you have any respiratory conditions  try to reduce your exposure to irritants such as dust, pollen, grass and   smoke both at home and at work. Consider giving up activities that expose you to irritants, and if activities cannot be avoided, wear personal protective   equipment to minimize exposure.

 

QUOTE FOR THE WEEKEND:

“Idiopathic thrombocytopenic purpura (ITP) is the condition of having a low platelet count (thrombocytopenia) of no known cause (idiopathic).  Although most cases are asymptomatic, very low platelet counts can lead to a bleeding.Detection of antiplatelet antibodies in the blood is considered to confirm the diagnosis of ITP.[] Treatment should be restricted to those patients with moderate or severe thrombocytopenia who are bleeding or at risk of bleeding. It should be limited in duration unless demonstrated that symptomatic thrombocytopenia persists. Patients with mild, asymptomatic thrombocytopenia, discovered incidentally on a routine blood count, should not be treated.”.

NCBI (U.S. Narional Library of Medicine/National Institute of Health)

Part II ITP Awareness Month

COMPLICATIONS:

-A rare complication of ITP, bleeding into the brain, which can be fatal.

-Pregnancy

In pregnant women with ITP, the condition doesn’t usually affect the baby. But the baby’s platelet count should be tested soon after birth.

If you’re pregnant and your platelet count is very low or you have bleeding, you have a greater risk of heavy bleeding during delivery.

DIAGNOSIS:

1.  M.D. will exclude other possible causes of bleeding and a low platelet count, such as an underlying illness or medications being the cause of low platelet count, not ITP.

2. Take a history of the child or adult, including their family.

3. Complete blood count (CBC).  Looks at red blood, white blood and platelet cells counts.

4 Blood smear. This test is often used to confirm the number of platelets observed in a complete blood count.

5.Bone marrow exam. This test may be used to help identify the cause of a low platelet count, though the American Society of Hematology doesn’t recommend this test for children with ITP.  All cells (platelets) are produced in the bone marrow.  Bone marrow will be normal because a low platelet count is caused by the destruction of platelets in the bloodstream and spleen — not by a problem with the bone marrow.

TREATMENT:

People with mild idiopathic thrombocytopenic purpura may need nothing more than regular monitoring and platelet checks. Children usually improve without treatment. Most ITP adults will eventually need treatment as it gets worse or becomes chronic.

1-The M.D will stop any meds that inhibit platelet production=Anti-platelet Meds (Ex. aspirin, ibuprofen (Advil, Motrin IB, others), ginkgo biloba and warfarin, also known as Coumadin)

2-Drugs that suppress your immune system.  M.D. might start you on oral corticosteroid, such as prednisone and when platelet count is normal gradually decrease the dosing till no longer on it.  The problem is that many adults experience a relapse after stopping corticosteroids. A new course of corticosteroids may be pursued, but long-term use of these medications is unusual, due to its long term side effects. These include cataracts, high blood sugar, increased risk of infections and thinning of bones (osteoporosis).

3-Injections to increase your blood count (Ex. immune globulin (IVIG). This drug may also be used if you have critical bleeding or need to quickly increase your blood count before surgery. The effect usually wears off in a couple of weeks.

4-Drugs that boost platelet production.  Examples romiplostim (Nplate) and eltrombopag (Promacta) — help your bone marrow produce more platelets.

5-Other immune-suppressing drugs. Rituximab (Rituxan) helps reduce the immune system response that’s damaging platelets, thus raising the platelet count.

6-Removal of your spleen.

7-Other drugs. Azathioprine (Imuran, Azasan) has been used to treat ITP. But it can cause significant side effects.

Review all treatments with your personal doctor.

QUOTE FOR THURSDAY:

“Immune thrombocytopenic purpura (ITP) is a blood disorder characterized by a decrease in the number of platelets in the blood. Platelets are cells in the blood that help stop bleeding. A decrease in platelets can cause easy bruising, bleeding gums, and internal bleeding. This disease is caused by an immune reaction against one’s own platelets. It has also been called autoimmune thrombocytopenic purpura.  Thrombocytopenia meaning a decreased number of platelets in the blood and purpura refers to the purple discoloring of the skin, as with a bruise.”

John Hopkins Medicine

Part I National ITP Awareness Month!

 

 

    

   

What is ITP?

ITP means idiopathic thrombocytopenic purpura which is an autoimmune disease. The immune system is mistakenly attacking and destroying good platelets.  In autoimmune diseases, the body mounts an immune attack toward one or more seemingly normal organ systems. In ITP, platelets are the target. They are marked as foreign by the immune system and eliminated in the spleen, the liver, and by other means. In addition to increased platelet destruction, some people with ITP also have impaired platelet production.

A normal platelet count is between 150,000 and 400,000/microliter of blood. If someone has a platelet count lower than 100,000/microliter of blood with no other reason for low platelets, that person is considered to have ITP.1 There is no accurate, definitive test to diagnose ITP.

SYMPTOMS: 

Simple to understand. Platelets are for clotting our blood; if the platelet count is high we clot too much if low, in ITP, we bleed easy to hemorrage.

With few platelets, people with ITP often have bleeding symptoms such as spontaneous bruising, petechiae (pe-TEEK-ee-ay), tiny red dots on the skin, Bleeding from the gums or nose, and for women, possibly heavy menses. More severe bleeding symptoms include blood blisters on the inside of the mouth, blood in the urine or stool, or bleeding in the brain.

Idiopathic thrombocytopenic purpura or immune thrombocytopenia affects children and adults. Children often develop ITP after a viral infection and usually recover fully without treatment. In adults, the disorder is often long term.

Treatments for the disease vary depending on the platelet count, severity of symptoms, age, lifestyle, personal preferences, and any other associated diseases. Some people may choose to not treat their disease and live with low platelets.

While it may seem like ITP is a simple disease, there are nuances to the diagnosis, differences in the disease between children and adults, and variations in how the disease responds to treatments.

TYPES OF ITP:

Newly diagnosed ITP: within 3 months from diagnosis
Persistent ITP: 3 to 12 months from diagnosis. During this phase, patients have not reached spontaneous remission or maintained a complete response off therapy
Chronic ITP: lasting for more than 12 months
Severe ITP: presence of bleeding symptoms that need treatment or need an increase from prior treatment
Refractory ITP: does not respond or is resistant to attempted forms of treatment

RISK FACTORS:

-Your sex. Women are two to three times more likely to develop ITP than men are.

-Recent viral infection. Many children with ITP develop the disorder after a viral illness, such as mumps, measles or a respiratory infection.

COMPLICATIONS:

-A rare complication of ITP, bleeding into the brain, which can be fatal.

-Pregnancy

In pregnant women with ITP, the condition doesn’t usually affect the baby. But the baby’s platelet count should be tested soon after birth.

If you’re pregnant and your platelet count is very low or you have bleeding, you have a greater risk of heavy bleeding during delivery.

DIAGNOSIS:

1.  M.D. will exclude other possible causes of bleeding and a low platelet count, such as an underlying illness or medications being the cause of low platelet count, not ITP.

2. Take a history of the child or adult, including their family.

3. Complete blood count (CBC).  Looks at red blood, white blood and platelet cells counts.

4 Blood smear. This test is often used to confirm the number of platelets observed in a complete blood count.

5.Bone marrow exam. This test may be used to help identify the cause of a low platelet count, though the American Society of Hematology doesn’t recommend this test for children with ITP.  All cells (platelets) are produced in the bone marrow.  Bone marrow will be normal because a low platelet count is caused by the destruction of platelets in the bloodstream and spleen — not by a problem with the bone marrow.

TREATMENT:

People with mild idiopathic thrombocytopenic purpura may need nothing more than regular monitoring and platelet checks. Children usually improve without treatment. Most ITP adults will eventually need treatment as it gets worse or becomes chronic.

1-The M.D will stop any meds that inhibit platelet production=Anti-platelet Meds (Ex. aspirin, ibuprofen (Advil, Motrin IB, others), ginkgo biloba and warfarin, also known as Coumadin)

2-Drugs that suppress your immune system.  M.D. might start you on oral corticosteroid, such as prednisone and when platelet count is normal gradually decrease the dosing till no longer on it.  The problem is that many adults experience a relapse after stopping corticosteroids. A new course of corticosteroids may be pursued, but long-term use of these medications is unusual, due to its long term side effects. These include cataracts, high blood sugar, increased risk of infections and thinning of bones (osteoporosis).

3-Injections to increase your blood count (Ex. immune globulin (IVIG). This drug may also be used if you have critical bleeding or need to quickly increase your blood count before surgery. The effect usually wears off in a couple of weeks.

4-Drugs that boost platelet production.  Examples romiplostim (Nplate) and eltrombopag (Promacta) — help your bone marrow produce more platelets.

5-Other immune-suppressing drugs. Rituximab (Rituxan) helps reduce the immune system response that’s damaging platelets, thus raising the platelet count.

6-Removal of your spleen.

7-Other drugs. Azathioprine (Imuran, Azasan) has been used to treat ITP. But it can cause significant side effects.

Review all treatments with your personal doctor.