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Of course there will be medicine. I am The Grumpy Doc.

 Doctors of the Deep Blue Sea

By

On March 25, 2025

In History, Medicine

A Brief History of the U.S. Navy Medical Corps

The U.S. Navy Medical Corps has a history that evolves from a humble beginning during the Revolutionary War to its current role as a vital component of modern military medicine. The Medical Corps ensures the health and well-being of sailors, Marines, and their families, while contributing to public health and advancements in medical science.

Origins in the Revolutionary War

The roots of Navy medicine trace back to the Revolutionary War, when medical care aboard ships was primitive at best. Shipboard surgeons, often lacking formal medical training, treated injuries and disease with the limited tools and knowledge available to them. In the early days of the U.S. Navy, physicians served without formal commissions, often receiving temporary appointments for specific cruises.  Their primary tasks included amputations, treating infections, and caring for diseases like scurvy and dysentery.

In 1798, Congress formally established the Department of the Navy, creating the foundation for organized medical care within the naval service.  Surgeon Edward Cutbush published the first American text on naval medicine in 1808. The Naval Hospital Act of 1811 marked another milestone, authorizing the construction of naval hospitals to support the growing fleet.

Establishment of the Navy Medical Corps (1871)

The U.S. Navy Medical Corps was officially established on March 3, 1871, by an act of Congress. This legislation created a formal medical staff to support the Navy, setting standards for the recruiting and training naval physicians. These physicians were initially known as “Surgeons” and “Assistant Surgeons,” tasked with providing care on ships and at naval hospitals.  The act granted Navy physicians rank relative to their line counterparts, acknowledged their role as a staff corps, and established the title of “Surgeon General” for the Navy’s senior medical officer.

During this period, the Navy Medical Corps began to expand its scope. It embraced emerging medical technologies and scientific discoveries, setting the stage for its later contributions to public health and medical innovation.

The Navy Hospital Corps

The U.S. Navy Hospital Corps was established on June 17, 1898. Its creation was prompted by the increased medical needs during the Spanish-American War. Since then, the enlisted corpsmen have served in every conflict involving the United States, providing critical medical care on battlefields, aboard ships, and in hospitals worldwide.

Corpsmen are trained to perform a wide range of medical tasks, including emergency battlefield triage and treatment, surgery assistance, and disease prevention. They are often embedded directly with Marine Corps units, making them indispensable on the battlefield.

The Hospital Corps is the most decorated group in the U.S. Navy. To date, its members have earned numerous high-level awards for valor, including: 22 Medals of Honor, 182 Navy Crosses, 946 Silver Stars, and 1,582 Bronze Stars.

World Wars and the Expansion of Military Medicine

Both World War I and World War II were transformative for the Navy Medical Corps. During World War I, Navy medical personnel treated injuries and illnesses both aboard ships and in field hospitals. Their efforts were instrumental in managing wartime epidemics, including the devastating 1918 influenza pandemic.

World War II brought further advancements. The Navy Medical Corps played a pivotal role in addressing the challenges of warfare in diverse climates, including tropical diseases in the Pacific Theater. It also pioneered methods for treating trauma, burns, and psychiatric conditions.

Cold War Era and Modernization

The Cold War era marked a time of significant innovation for the Navy Medical Corps. The establishment of the Navy Medical Research Institutes advanced studies in areas such as tropical medicine, submarine medicine, and aerospace medicine. These efforts supported the Navy’s global missions and contributed to broader medical advancements.

In the latter half of the 20th century, Navy medical personnel became key players in humanitarian missions, responding to natural disasters and providing aid in conflict zones. Their expertise in public health, infectious disease control, and trauma care enhanced the Navy’s ability to spread goodwill worldwide.

Modern Contributions and Future Challenges

Today, the Navy Medical Corps supports both military readiness and global health. Its personnel provide care on ships, submarines, aircraft carriers, and for Marine Corps forces, and at shore-based facilities. They also participate in humanitarian missions and disaster response, reflecting the Navy’s commitment to a broader vision of security and well-being.

In recent years, Navy medicine has faced challenges such as the COVID-19 pandemic, addressing mental health issues among service members, and adapting to emerging threats like climate change and cyber warfare defense. These challenges underscore the evolving role of the Navy Medical Corps in a complex world.

From its early days of rudimentary care to its modern role in global health and innovation, the U.S. Navy Medical Corps has been a cornerstone of military medicine. Its contributions extend beyond the battlefield, shaping public health, medical research, and humanitarian efforts worldwide.

As the Navy Medical Corps continues to adapt to new challenges, it remains a testament to the enduring value of medical service in the defense of the nation and the promotion of global health.

More Than Just Glasses – Eye Health for Adults

By

On March 7, 2025

In Medicine

Most of us don’t consider getting an eye exam until we think we need new glasses or maybe when we think we need glasses for the first time. But that’s not the only reason we should be visiting the eye doctor.  For adults, maintaining eye health becomes increasingly important as we get older. Vision changes are a natural part of aging and many serious eye conditions can be managed or even prevented with regular care. Conditions such as cataracts, glaucoma, macular degeneration, and diabetic retinopathy can be discovered during routine exams. Additionally, there are rarer eye conditions that can be detected, such as ocular cancers, that may not be symptomatic initially but can lead to vision loss and can even be fatal.

Timely diagnosis and treatment of eye diseases are crucial to preserving sight and overall quality of life.  Your eye exam is about far more than just a new pair of glasses.

This issue will cover major eye diseases affecting adults, the symptoms, available treatments, and complications of late diagnoses.

Cataracts

A cataract is a clouding of the eye’s natural lens, leading to blurry or diminished vision. Cataracts are one of the most common causes of vision loss in older adults.

Symptoms:

  • Blurred or cloudy vision
  • Difficulty seeing at night
  • Sensitivity to light and glare
  • Seeing halos around lights
  • Fading or yellowing of colors
  • Double vision in one eye

Treatment:

In the early stages, stronger lighting and prescription glasses may help. However, the only definitive treatment is cataract surgery, where the cloudy lens is replaced with an artificial intraocular lens (IOL). Cataract surgery is one of the safest and most effective procedures available.

Complications of Late Diagnosis:

Delaying treatment can lead to significant vision impairment, increasing the risk of falls, depression, and loss of independence. In advanced cases, cataracts can cause complete blindness.

Glaucoma

Glaucoma is a group of diseases that damage the optic nerve, often due to high intraocular pressure. Open-angle glaucoma is the most common form. It typically develops slowly without noticeable symptoms. Angle-closure glaucoma appears more suddenly and generally involves severe eye pain.  Glaucoma is a leading cause of blindness worldwide and often develops without noticeable symptoms until significant vision loss occurs.

Symptoms:

  • Gradual loss of peripheral vision (in open-angle glaucoma)
  • Sudden, severe eye pain (in angle-closure glaucoma)
  • Blurred vision
  • Halos around lights
  • Nausea and vomiting (in acute cases)

Treatment:

Glaucoma cannot be cured, but it can be managed with:

  • Prescription eye drops to reduce intraocular pressure
  • Laser therapy to improve fluid drainage
  • Surgery in severe cases

Complications of Late Diagnosis:

Glaucoma-related vision loss is irreversible. Without timely intervention, glaucoma can lead to tunnel vision and complete blindness.

Age-Related Macular Degeneration (AMD)

Macular degeneration, or age-related macular degeneration (AMD), primarily affects the macula, the central part of the retina responsible for sharp, central vision. There are two main forms of AMD: dry (non-neovascular) and wet (neovascular). Dry AMD is more common and progresses slowly, while wet AMD is less common but more severe and leads to rapid vision loss.

Symptoms:

  • Blurred or distorted central vision
  • Difficulty reading or recognizing faces
  • Straight lines appearing wavy
  • Need for brighter light when reading
  • Dark or empty areas in the center of vision

Treatment:

There is no cure for AMD, but treatment options include:

  • Injections to slow the progression of wet AMD
  • Laser therapy in some cases
  • Lifestyle changes, including a diet rich in leafy greens, omega-3 fatty acids, and antioxidant supplements

Complications of Late Diagnosis:

Without early treatment, AMD can progress to severe vision loss, making everyday activities like reading and driving difficult.

Diabetic Retinopathy

This condition occurs in people with diabetes when high blood sugar damages the blood vessels in the retina. In early stages it is not symptomatic, but it can lead to blindness if untreated.

Symptoms:

  • Floaters or dark spots in vision
  • Blurry vision
  • Difficulty seeing colors
  • Vision loss in advanced cases

Treatment:

  • Better blood sugar control to slow progression
  • Injections to prevent spread
  • Laser treatment to seal leaking blood vessels
  • Surgery for severe cases

Complications of Late Diagnosis:

Delaying treatment can result in retinal detachment, complete vision loss, and an increased risk of other eye diseases.

Cancers of the Eye

Although rare, cancers such as ocular melanoma can develop in the eye. This is a diverse group of malignancies that can affect different parts of the eye and its surrounding structures. They can originate within the eye or can spread to the eye from other parts of the body. They can be aggressive and vision threatening requiring prompt diagnosis and treatment.

Symptoms vary depending on the type and location of the cancer and can include many of the same symptoms as other eye diseases. Prognosis and treatment depend on the type of cancer and stage at the time of diagnosis. Treatment can include surgery, radiation therapy, laser therapy, chemotherapy and targeted immunotherapy. Early diagnosis is critical.

The Importance of Regular Eye Examinations

The American Academy of Ophthalmology recommends that adults over 65 have a comprehensive eye exam at least once a year, even if they have no noticeable vision problems. Those with conditions like diabetes, glaucoma, or AMD may need more frequent exams.

Maintaining Good Eye Health

  • Eat a Vision-Friendly Diet: Foods rich in vitamin A, C, E, zinc, and omega-3 fatty acids help protect eyesight.
  • Control Chronic Conditions: Managing diabetes and high blood pressure reduces the risk of eye complications.
  • Protect Your Eyes: Wear sunglasses with UV protection and blue light filtering when using digital screens.
  • Quit Smoking: Smoking significantly increases the risk of AMD, cataracts, and other eye diseases.
  • Stay Active: Regular exercise improves circulation and overall eye health.
  • Use Proper Lighting: Ensure good lighting at home to prevent strain and falls.
  • Follow Medication Instructions: Use prescribed eye drops and medications consistently to manage conditions like glaucoma.

Prioritizing Eye Health for a Better Quality of Life

Vision loss can significantly impact independence, mobility, and mental well-being. The key to maintaining good eye health is early detection and timely treatment. By scheduling regular eye exams and adopting healthy habits, you can preserve your vision and enjoy a higher quality of life.

If you’re haven’t had an eye exam in the past year, now is the time to schedule one. It’s about more than just a new pair of glasses. Protecting your eyesight today can ensure a clearer, brighter tomorrow.

Telehealth: Revolutionizing Healthcare

By

On February 12, 2025

In Medicine

Or Is It Simply a Band-Aid?

When I first started hearing about telemedicine in the 1990s, I was dubious at best. How can I treat a patient I can’t examine? Too many things ran through my mind. I couldn’t listen to their heart, I couldn’t listen to them breathe, I couldn’t even look in their throat or their ears. What if I needed an EKG? How could I check their blood pressure? I was worried that telemedicine might be “second rate medicine”. 

I was worried about misdiagnosis and overprescribing antibiotics. If you couldn’t actually examine a patient, you might decide to play it safe and prescribe an antibiotic whether it was really needed or not. It might result in people being sent to the emergency room who might have been treated as an outpatient if you could have examined them in person.

As I looked into it, I discovered that the idea of telemedicine was not really new. As early as 1879, the British Medical Journal The Lancet discussed the possibility of using the telephone, then a revolutionary new technology, to reduce unnecessary doctors’ visits.  It took the advent of the computer age and audio-video technology to make telemedicine a real possibility.  But even then, I was still skeptical. I preferred to see my patients in person and did not get involved in telemedicine until the great societal upheaval of COVID.

I happened to retire from the emergency department three months before COVID hit. I was still doing primary care two days a week for an employee’s clinic. Like everyone else, we were shut down.

Reluctantly, we decided the only way to provide a service to our patients was to start using telehealth. Of course, we had none of the audio-video equipment we needed so we initially did it by telephone. That just confirmed most of my worries about providing poor care. We soon acquired the audio-video capabilities which gave us a little more insight into the patients we were dealing with. Over the next few months, I learned who was and was not a good candidate for telemedicine and how I could best care for patients that I could not physically examine. I’m going to share with you some of the things that I’ve learned over the past four years. Thankfully telehealth is now an exception rather than the rule as it was early in COVID. But it’s here to stay and we need to learn how to make it work.

Advantages of Telehealth

Convenience and Accessibility: Telehealth’s most immediate and tangible benefit is convenience. With the simple click of a button, patients can consult a physician from the comfort of their home. This is particularly helpful for those living in rural areas or those who are physically unable to travel to a clinic or hospital. According to a study by the American Medical Association, telehealth has increased access to care for patients who otherwise might not be able to receive it, whether due to geographical limitations, lack of transportation, or mobility issues.

For working professionals or parents who find it difficult to carve out time for in-person visits, telehealth allows consultations to occur from anywhere, drastically reducing travel time and missed work or family obligations. Patients also benefit from shorter wait times, as virtual queues tend to move more quickly than physical ones.

 Cost Efficiency:  Telehealth services can be more cost-effective for both patients and healthcare providers. For patients, the expenses associated with travel, parking, and time away from work are minimized. Healthcare providers, particularly in large hospital networks, can allocate resources more efficiently by integrating telemedicine into their workflow. Many telehealth services also offer more affordable consultation fees compared to in-office visits. A report from the National Bureau of Economic Research found that telemedicine visits are often less expensive for both insurers and healthcare systems.

Continuity of Care:  Telehealth allows for more frequent follow-ups, which is critical for managing chronic diseases such as diabetes, hypertension, and asthma. Instead of requiring patients to come to the clinic for every minor adjustment or medication change, telehealth allows for regular check-ins from home. This facilitates better long-term disease management and patient compliance. It can also enable quick intervention in cases where a patient’s symptoms escalate, potentially reducing the likelihood of emergency room visits.

Disadvantages of Telehealth

Limited Physical Examination:  The inability to perform a comprehensive physical examination is a significant limitation of telehealth. While many aspects of healthcare can be effectively managed through conversation, video, and shared data, some conditions require a hands-on exam. For example, a doctor might not be able to detect subtle signs of a skin condition, a heart murmur, or abdominal tenderness through a video screen. This limitation can hinder accurate diagnoses and delay proper treatment.

Privacy and Data Security:  Healthcare data is among the most sensitive forms of personal information. The shift to telehealth introduces significant concerns about data security, especially given the increase in cyberattacks on healthcare systems. The Health Insurance Portability and Accountability Act (HIPAA) mandates strict guidelines for protecting patient privacy, but not all telehealth platforms may be fully compliant. In some cases, platforms may use third-party applications that could compromise patient information. The risk of hacking, data breaches, or improper data handling adds another layer of complexity to the telehealth debate.

Connectivity Issues: High-speed internet is a luxury that is still not available in many rural and underserved areas. Telehealth relies heavily on stable and fast internet connections to facilitate real-time communication between patient and provider. In regions where broadband access is limited, telehealth appointments can be riddled with delays, interruptions, or complete disconnections. This not only disrupts the flow of the consultation but can also compromise the quality of care provided.

Lack of Universal Standards: Unlike in-person healthcare, where the processes are well-established and regulated, telehealth practices can vary significantly between providers and systems. The lack of universal standards for telehealth can lead to inconsistencies in the quality of care. Some platforms might not integrate well with electronic health records (EHRs), making it difficult for physicians to access a complete patient history during the virtual consultation.  Platforms may not function seamlessly across different devices (i.e., Android vs. iOS) or different browsers. Technical support may not always be readily available to address these issues, leading to delays in care or missed appointments.

Medical Problems Not Appropriate for Telehealth

While telehealth has proven to be effective for certain conditions, it is not a one-size-fits-all solution. There are specific medical problems that necessitate an in-person visit, where a physical examination and specialized equipment are crucial.

 Acute Injuries and Trauma:  Telehealth is not suitable for diagnosing or treating acute injuries such as fractures, deep cuts, burns, or other types of trauma. These conditions require immediate hands-on evaluation, imaging (e.g., X-rays or CT scans), and possibly surgical intervention. A telehealth consultation cannot provide the necessary tools to address these problems adequately, and any delays in care could worsen the patient’s condition.

Cardiovascular Emergencies: Conditions such as chest pain, heart attack symptoms, or strokes demand immediate in-person evaluation. The time-sensitive nature of these issues means that telehealth would not be appropriate for diagnosis or treatment. Patients experiencing these symptoms require rapid testing, monitoring, and possibly life-saving interventions that cannot be performed remotely.

Neurological Symptoms: Patients presenting with acute neurological symptoms such as sudden onset of weakness, slurred speech, confusion, or seizure activity require immediate in-person evaluation. These symptoms could indicate a stroke, transient ischemic attack (TIA), or another serious neurological condition that cannot be diagnosed or managed through a telehealth appointment.

Surgical Consultations: While telehealth can be a valuable tool for follow-up appointments post-surgery, the initial evaluation for surgical candidates should take place in person. Surgeons often rely on physical examinations and imaging results to determine whether surgery is necessary and to plan the procedure effectively.

Striking a Balance

Telehealth has transformed healthcare in a multitude of ways, providing unprecedented access to care for millions of patients. Its convenience, cost efficiency, and ability to promote continuity of care make it a powerful tool in the modern healthcare landscape. However, the limitations of telehealth, especially in cases requiring hands-on care or in emergencies, cannot be ignored. As healthcare systems continue to integrate telehealth into routine practice, it is essential to strike a balance between virtual and in-person care to ensure that all patients receive the level of medical attention they need. For now, I believe telehealth should be viewed as a complement to, rather than a replacement for, traditional healthcare.

Hijacked Healthcare- A System In Crisis 

By

On February 8, 2025

In Commentary, Medicine, Politics

For more than 30 years I have watched our health care system become increasingly more politicized. As a physician I have become concerned with the direction it has recently taken. 

Until the early 20th century healthcare was mostly private, and medical expenses were out of pocket. Early calls for national health insurance began with labor organizations and were quickly joined by progressive politicians. President Franklin Roosevelt wanted to include health insurance in the Social Security Act of 1935 but was unable to get it passed. President Harry Truman also proposed a National Health Insurance program in 1945, but it was denounced as socialized medicine.  All these efforts were opposed by business interests, conservative politicians — particularly southern— and surprisingly, the American Medical Association. 

Finally in the 1960s as part of his “Great Society” programs President Lyndon Johnson pushed for the passage of both Medicare and Medicaid. Rising costs of health care under President Richard Nixon led to the introduction of Health Maintenance Organizations (HMOs) as an attempt to encourage cost efficiency. President Ronald Reagan reduced federal health care spending and pushed for more privatization. In the 1990s President Bill Clinton attempted to introduce universal health coverage but it was met by fierce opposition from the insurance industry, business, and the Republican Party who labeled it as government “overreach”. Finally in 2010 President Obama’s Affordable Care Act (ACA) also called “Obamacare” became the most significant health care reform since Medicare and Medicaid. It also faced legal challenges and political resistance with the Republicans consistently attempting to repeal it. During his first term, President Donald Trump reduced ACA funding and repealed the individual mandate penalty that had required people who did not maintain health insurance to pay a fee. The elimination of the penalty weakened the law and reduced the number of people who sought coverage.  We can expect further efforts to weaken the provisions of the ACA but given that it is well entrenched in the US healthcare system now is unlikely that it will be completely repealed. 

While early health care programs faced significant controversy and strong debate, progress in providing expanded coverage and improved care was continuous.  I’m concerned that we’re about to enter an era where many of our gains in public health are going to be reversed.  The United States remains unique among wealthy nations as the only one without universal health care and I fear that we will begin to lose what gains we have made over the past several decades. 

I’ve written previously about my concerns with vaccine resistance and the elimination of vaccination requirements for school children. I believe that this is an impending public health disaster and I’m afraid there are even greater disasters on the horizon. 

Robert F. Kennedy Jr has been nominated by President Trump to be the secretary of Health and Human Services and by the time you read this he may well have been confirmed. During his confirmation hearings Kennedy has made a few positive statements. He’s expressed an intent to increase focus on chronic diseases such as diabetes and obesity. He has indicated support for rural hospitals. He would like to increase training for physicians in addiction care and increase access to treatment programs. He is also indicated plans to improve American diet by targeting ultra processed foods, contaminants in food, and placing restrictions on food additives. He also has proposed reforms to include stricter FDA oversight of the food supply. 

However, there are several very troubling aspects to his nomination. He has a history as a vaccine denier although he is currently denying that denial. He said he is not anti vaccine but is pro safety. He has stated he will support polio and measles vaccines and that all his children have been vaccinated. (In 2020, while speaking on the podcast of his nonprofit organization Children’s Health Defense, Kennedy said that he would do anything, pay anything to be able to go back in time to avoid giving his children the vaccines that he gave them.)  Given his history of anti vaccine statements and the fact that he profits from anti vaccine litigation it’s likely he will return to previous anti vaccine positions once confirmed.   

He has proposed significant changes to both the CDC and the NIH including significant staff changes. He has proposed redirecting funding to preventative/alternative medicine. 

Most troubling is his poor understanding of Medicare and Medicaid programs. During questioning he showed a lack of understanding of the funding sources and statutory requirements of the two programs. 

The Centers for Disease Control (CDC) faces considerable threat. House Republicans have proposed a $1.8 billion cut (22%) to CDC’s budget. These budget cuts target programs that address opioid overdoses, firearm injuries and food safety monitoring. This budget conflicts with Kennedy’s statements about his priorities and it remains to be seen how this will be resolved. The Heritage Foundation’s Project 2025 has advocated splitting the CDC into two separate entities: one for data collection and another for limited public health guidance. The intent is to reduce its influence on social policies. The administration has already imposed communications restrictions, requiring that CDC announcements, social media posts and scientific reports undergo political review. There is currently a proposal to reduce the in-house reviews of medical research; there is even a proposal to “deputize the public” to challenge scientific findings used in regulations. This would leave medical research open to review by the least qualified. Unfortunately, he current nominee for CDC director, David Weldon, a physician and former republican congressman, has signaled his intent to narrow the agency’s scope and his support for administration policies. 

Highly contentious issues such as gender affirming care and reproductive health have already been severely restricted. It is likely that these areas will come under continued attack by the current administration. 

This administration also poses a threat to global health. By executive order the US was withdrawn from the World Health Organization. Additionally, the US Agency for International Development (USAID) has been significantly reduced with all major programs placed on hold. Not only does USAID support foreign aid programs, but it is also a major player in global health. 

USAID sponsored programs identify and monitor disease outbreaks, provide treatment and preventive measures for local populations and provide global disease alerts that help protect United States citizens.  We are already seeing the beginnings of a worldwide humanitarian healthcare emergency.  Not only will this affect healthcare systems but eventually the economic systems in countries who have lost their access to modern medical assistance.  We will lose the advanced notice about disease outbreak and spread.  Without this remote surveillance, it is possible that we may be caught unaware by the next pandemic until it is ravaging our population. 

This administration claims to support “the average American” yet it seems to be intent on destroying all our health. 

Demystifying Diabetes

By

On January 21, 2025

In Medicine

Understanding the Types, Symptoms, and Management

Have you ever wondered why your family doc asks you to get a blood test when you make a routine office visit? Checking your A1c is one of the reasons why.  At any age, but especially as you get older, you need to watch for symptoms of diabetes.  Caring for ourselves and others in managing this disease is important. Something as simple as planning a dinner for family and friends may involve thinking about a person’s dietary restrictions, particularly if they have recently been diagnosed and are not yet comfortable with the diet. Even if you are not diabetic, please continue to read as I’ve included pertinent information about this disease to help you understands how it can affect your family and friends.

Diabetes is a group of chronic conditions affecting millions of people worldwide and not all cases of diabetes are the same. The two most common types, Type 1 and Type 2, involve elevated blood sugar levels but differ in their causes and management. At its simplest, Type 1 diabetics do not produce insulin and require supplementation. Type 2 diabetics produce insulin, but their bodies are resistant to its effects.  According to the American Diabetes Association, as of 2021, approximately 11.6% of the U.S. population, or 38.4 million Americans had diabetes. Additionally, almost one-third of Americans have prediabetes. This includes both diagnosed and undiagnosed cases.

This guide will explain the key differences between the two types, highlight the role of the A1c test in diagnosis and care, and explore the consequences of poorly managed diabetes. Additionally, we will discuss a related condition, prediabetes, which serves as an early warning sign for Type 2 diabetes.

If you have been diagnosed with diabetes you probably are familiar with most of what is in this article. If you have not been diagnosed with diabetes you may find it interesting as it describes the diagnosis, management and genetic properties of diabetes.  It also discusses how you can support family and friends who are living with the disease.

Type 1 vs. Type 2: What’s the Difference?

Historically, terms like “insulin-dependent” and “non-insulin-dependent” diabetes, as well as “juvenile” and “adult-onset” diabetes, were used to describe these conditions. Modern terminology now reflects their underlying causes as Type 1 and Type 2 diabetes.

Type 1 Diabetes

Type 1 diabetes is an autoimmune disorder in which the immune system attacks insulin-producing cells in the pancreas. Without insulin, glucose cannot enter cells for energy, leading to its buildup in the bloodstream. Symptoms such as excessive thirst, frequent urination, fatigue, and unintentional weight loss often appear suddenly, typically in childhood or early adulthood.

Type 1 diabetes has a strong genetic component, with heritability estimates ranging from 40% to 50%.  Having a first-degree relative—parents and siblings—with Type 1 diabetes increases the risk, but the inheritance pattern is complex.  Identical twins have a 40-50% concordance rate for Type 1 diabetes

Management requires:

  • Insulin Therapy: Administered through injections or an insulin pump.
  • Dietary Management: Balanced meals to regulate blood sugar levels.

Type 2 Diabetes

Type 2 diabetes is often associated with lifestyle factors, including obesity, poor diet, and inactivity, though genetics also play a significant role. In this condition, the body becomes resistant to insulin, and over time, the pancreas may fail to produce enough insulin. Symptoms develop more gradually and may include fatigue, increased thirst, and slow-healing wounds.

Type 2 diabetes has an even stronger genetic component than Type 1, with heritability estimates ranging from 20% to 80%.  First-degree relatives of individuals with Type 2 diabetes are about 3 times more likely to develop the disease.  The lifetime risk is 40% for individuals with one parent with Type 2 diabetes and 70% if both parents are affected.  Identical twins have a higher concordance rate (about 70%) compared to fraternal twins (20-30%).

Management strategies include:

  • Lifestyle Modifications: Weight loss, improved diet, and regular exercise.
  • Medications: Oral and injectable medications are the usual management choice, though insulin may be needed in advanced stages.
  • Reversal Potential: Some individuals can manage or even reverse the condition through sustained lifestyle changes.

Prediabetes: An Early Warning Sign

Prediabetes—first recognized as a distinct medical condition in the late 1990s—occurs when blood sugar levels are higher than normal but not high enough to be classified as diabetes. It is a significant risk factor for developing Type 2 diabetes and associated complications like heart disease. Risk factors include:

  • Being overweight, especially with abdominal fat.
  • Physical inactivity.
  • Family history of Type 2 diabetes.
  • Age over 45.
  • Certain ethnic backgrounds (e.g., African American, Hispanic, Native American, or Asian American).
  • Coexisting conditions such as high blood pressure, high cholesterol, or polycystic ovary syndrome (PCOS).

Early intervention—including weight management, improved diet, and regular physical activity—can often prevent or delay progression to diabetes.

Diet management: Keystone to Lifestyle Modification.

 Managing diabetes involves maintaining stable blood sugar levels, and diet plays a crucial role in achieving this. While no food is entirely off-limits, certain restrictions help control blood sugar and prevent complications.

Carbohydrates are the primary focus in a diabetic diet, as they directly impact blood sugar. Foods like white bread, sugary drinks, pastries, and processed snacks should be limited due to their high glycemic index, which causes rapid blood sugar spikes. Instead, opt for complex carbs such as whole grains, legumes, and vegetables, which release glucose slowly.

Sugary foods, including desserts, candies, and sweetened beverages, should also be restricted. These items can cause unpredictable blood sugar fluctuations. If indulging occasionally, pair them with a protein or healthy fat to moderate the impact.

Saturated and trans fats, commonly found in fried foods, processed snacks, and fatty cuts of meat, should be minimized. These fats increase the risk of heart disease, which is already higher in people with diabetes.

The Role of A1c in Diagnosis and Management

The hemoglobin A1c test provides a snapshot of average blood sugar levels over the past two to three months. It is a critical tool for diagnosing and managing diabetes.

Diagnosis

  • Normal: Below 5.7%.
  • Prediabetes: 5.7% to 6.4%.
  • Diabetes: 6.5% or higher on two separate tests.

Management

For most people with diabetes, the goal is to maintain an A1c level below 7%. Individual targets may vary based on age, health, and risk of hypoglycemia. Some studies have found that Type 2 diabetics can suffer adverse outcomes from consistently lowering the A1c below 5%.   All management decisions should be made in consultation with your physician. Never start, stop or change dosage of diabetic medications on your own. 

Key considerations include:

  • Type 1 Diabetes: Insulin adjustments based on daily glucose checks and A1c trends.
  • Type 2 Diabetes: A combination of lifestyle changes, oral or injectable medications, and insulin as needed.
  • Prediabetes: Lifestyle modifications to lower A1c and reduce the risk of diabetes.

Consequences of Poorly Managed Diabetes

Failing to manage diabetes can lead to severe complications affecting nearly every organ system:

  • Cardiovascular Disease: High blood sugar damages blood vessels, increasing the risk of heart attacks, strokes, hypertension and reduced circulation to the legs.
  • Neuropathy (Nerve Damage): Tingling, pain, or numbness, particularly in the legs and feet, can contribute to infections and amputations.
  • Kidney Disease (Nephropathy): Damaged kidney blood vessels can result in kidney failure, requiring dialysis or transplant.
  • Eye Damage (Retinopathy): Diabetes is a leading cause of blindness due to damage in the retina.
  • Increased Infections: Impaired circulation and healing make infections harder to treat.
  • Diabetic Ketoacidosis (DKA): A life-threatening condition in Type 1 diabetes caused by acid buildup due to fat metabolism.
  • Hyperosmolar Hyperglycemic State (HHS): Seen in Type 2 diabetes, this condition involves severe dehydration and confusion due to extremely high blood sugar levels.

What Can You Do to Help?

Supporting a loved one with diabetes requires understanding, encouragement, and teamwork. Family and friends can play a vital role in helping someone manage their condition effectively.

  • Educate yourself: Learn about diabetes, its challenges, and treatment options. Understanding the basics of blood sugar levels, medication, and dietary needs enables you to provide informed support.
  • Be supportive, not critical: Avoid judgmental comments about their food choices or habits. Instead, encourage them to make healthier decisions without pressure or guilt.
  • Create a supportive environment: Keep healthy food options available at home and participate in physical activities together, like walking or cycling. This fosters a shared commitment to well-being.
  • Offer emotional support: Diabetes management can be stressful. Be a good listener and offer reassurance during difficult times. Celebrate their successes, no matter how small.
  • Attend appointments or classes: If invited, accompany them to medical appointments or diabetes education classes. This shows you’re invested in their health journey.
  • Learn to respond to emergencies: Know the signs of hypoglycemia (low blood sugar) or hyperglycemia (high blood sugar) and how to act. This preparedness can be life-saving.

By being empathetic and proactive, family and friends can help a loved one with diabetes feel empowered, cared for, and less isolated.

Conclusion

Type 1 and Type 2 diabetes, though different, are both serious conditions requiring proactive management. The A1c test plays a vital role in diagnosis and long-term care, offering insight into overall blood sugar control. Proper management, including lifestyle changes, medications, and regular monitoring, can prevent complications and significantly improve quality of life. Staying informed and working closely with healthcare providers are essential steps to living well with diabetes.

By taking action early and consistently, individuals can mitigate risks and lead healthier, more fulfilling lives.

Ignorance Redux

By

On January 16, 2025

In Commentary, Medicine, Politics

On his first day in office, the new far right governor of West Virginia issued an executive order allowing for extensive exemptions from the school vaccination mandate. When taken with the nomination of a virulent anti vaxxer for Secretary of Health and Human Services, I am concerned that we are in a rush to allow our children to die of easily preventable diseases. With this in mind, I’m reposting my article The Triumph of Ignorance from last April. At that time—as you will see in the first paragraph—I had some hope. Those hopes have since been dashed.

“There are two ways to be fooled. One is to believe what is not true; the other is to refuse to believe what is true.”– Søren Kierkegaard

Saturday morning, I was reading in the newspaper about the resurgence of measles in West Virginia. I find it appalling that this disease should be returning, given that we have safe and effective vaccinations.  What is next, polio, smallpox, or even plague?  It is only through the unexpected veto by our governor that the ill-advised bill passed by our legislature to make all vaccinations virtually optional did not become law.

Some people may wonder why vaccinations are important. There are two principal reasons to ensure that a large portion of the population is vaccinated against communicable diseases. The first is that it reduces the individual vulnerability to disease. The person who is vaccinated is protected. But there is also a second, sometimes not well-understood, reason.  That is herd immunity.

Communicable diseases require a large susceptible population to spread. When a significant portion of the population has been vaccinated the disease does not have the core of potential victims to allow spreading. This means that the vaccinated are protecting the non-vaccinated. However, it does require a large portion of the population to be vaccinated. The idea is that herd immunity will protect those who are unable to be vaccinated either due to age, allergies, or other medical conditions that would prohibit vaccination. It is never going to protect a large proportion of the population who just choose not to be vaccinated.  For example, about 90-95% of the population needs to be vaccinated against measles to provide herd immunity.

So why do people who otherwise can be vaccinated choose not to be?

There are, of course, those who have true religious objections to vaccination.  There are others who object to vaccination on the basis of personal autonomy. They believe their right to refuse vaccination outweighs any consideration of the health concerns of the frail members of our community.

There are many who mistrust the medical system. There were some cases in the past where unethical studies were conducted on unsuspecting populations. Given the rigorous oversight of medical research now, this no longer happens. Information about research into vaccinations and their safety and efficacy can be found on websites for the Centers for Disease Control and Prevention and the World Health Organization among others. (Website references are provided at the end of this post.)

What concerns me most are those who refuse to believe reputable medical authorities, government agencies, and mainline news services. They prefer to get their information from anonymous websites or from conspiracy theory websites that still give credence to the now-discredited 1999 study linking the MMR vaccine to autism. They completely ignore the fact that 10 of the 11 reported co-authors disavowed any part in the conclusions of the study. They also ignore the fact that the principal author was found guilty of fraud for personal gain as he was employed by the manufacturer of rival drugs. They also ignore the fact that he lost his medical license over his falsifications in this study. Yet, he is still cited in anti-vaccine literature as an expert source.

Equally disturbing is the fact that vaccine resistance has become a part of political identification. Certain reactionary political groups have, for some unfathomable reason, decided that refusing vaccination is a badge of their political allegiance.  They seem to care more about maintaining their political purity than they care about science, public health, or even the welfare of their family and friends.  Politicizing public health is dangerous for all of us.  I’m not sure how we overcome this. It is easy to find the truth and verify it through fact-based studies, yet people refuse to do it.

I encourage everyone to work hard to ensure that our political leaders do not remove vaccination mandates for school children. For those of us of my age, we already have immunity through vaccination or prior exposure to the disease.  It is our grandchildren and their children and their children’s children who will suffer through the return of these deadly diseases.

SOURCES:

  World Health Organization: https://www.who.int/health-topics/vaccines-and-immunization#tab=tab_1

  CDC:  https://www.cdc.gov/vaccines/index.html   https://www.cdc.gov/vaccines/hcp/vis/index.html

   WV DHHR: https://oeps.wv.gov/immunizations/Pages/default.aspx

   Immunise.org:  https://www.vaccineinformation.org/

The ABCs of Hypertension

By

On January 3, 2025

In Medicine

What Everyone Should Know

High blood pressure (hypertension) is a common but frequently unrecognized condition that affects millions of people worldwide. Often referred to as the “silent killer,” it rarely shows symptoms until significant damage has been done to vital organs like the heart, kidneys, or brain. We are going to explore the importance of blood pressure control, goals, comorbid conditions that increase risk, and the dangers of leaving hypertension unchecked.

What is Blood Pressure?

Blood pressure measures the force exerted by circulating blood on the walls of the body’s arteries. It is recorded with two numbers:

  • Systolic (the top number), measures the pressure during the heart’s contraction. Systolic hypertension reflects the stiffness of the arterial system. It is a strong predictor of cardiovascular events, especially in older adults. It is often the primary focus of management of hypertension.
  • Diastolic (the bottom number), measures the pressure when the heart is resting between beats.  While less emphasized than systolic hypertension, elevated diastolic pressure can reflect the resistance in small vessels. This can lead to long term organ damage, especially in people under 50.

Blood Pressure Goals

  • Normal Blood Pressure:  Systolic less than 120 and diastolic less than 80.
  • Elevated Blood Pressure: Systolic 120-129 and diastolic less than 80.
  • Hypertension Stage 1:  Systolic 130-139 or diastolic 80-89.
  • Hypertension Stage 2:  Systolic 140 or higher or diastolic 90 or higher.
  • Hypertensive Crisis:  Systolichigher than180 and/or diastolic higher than 120.

Some practitioners use 130 / 80 as a blood pressure goal because they feel it is more attainable and manageable than 120 / 80.

Seniors and Blood Pressure

Blood pressure guidelines for seniors have been evolving.  In the past, recommendations were higher with 140 / 90 recommended for most older adults and recommendations for those aged 60 and over as high as 150 / 90.  At that time, it was felt that lower blood pressure thresholds for older adults may lead to increased dizziness, falls or other complications.  Several recent studies of hypertension show that more intensive blood pressure control in older adults reduces the risk of cardiovascular events and mortality with few significant side effects when compared to previous recommendations.

Comorbid Conditions

  • Chronic Kidney Disease: For individuals with chronic kidney disease (CKD), the target is less than 120/80, though some groups recommend a goal of 130/80. Good control is essential because these individuals have a higher risk of cardiovascular complications and worsening of kidney function. Patients with a kidney transplant have a recommended blood pressure target of less than 130 / 80. Dialysis patients have a pre dialysis blood pressure target of less than 140 / 90 and a post dialysis blood pressure target of 130 / 80, although some groups have not issued specific recommendations for dialysis patients.
  • Coronary Artery Disease: Patients with heart disease may also have more stringent blood pressure goals to reduce the risk of further cardiovascular events.  Blood pressure recommendations may vary based on specific medical conditions such as congestive heart failure or myocardial infarction.

Specific blood pressure goals may vary among organizations and professional groups. It is essential to individualize treatment based on factors like overall health, risk of side effects, and tolerance to medications. Always consult your healthcare provider to determine the most appropriate blood pressure target and management plan for you.

Risk of Uncontrolled Blood Pressure

Uncontrolled hypertension can lead to devastating health consequences, especially over time. Below are some of the most significant risks:

  • Heart Disease and Stroke: High blood pressure forces the heart to work harder than normal to pump blood. Over time, this can cause the heart muscle to thicken (hypertrophy) and weaken, increasing the risk of heart failure. Hypertension is also a major contributor to atherosclerosis (narrowing of arteries), which can lead to heart attacks and strokes.
  • Kidney Damage: The kidneys rely on a network of blood vessels to filter waste from the blood. Elevated blood pressure can damage these vessels, leading to kidney disease or even kidney failure.
  • Vision Loss: Hypertension can damage the tiny blood vessels in the eyes, leading to a condition known as hypertensive retinopathy, which can result in vision loss if left untreated.
  • Aneurysms: High blood pressure can cause blood vessels to weaken and form bulges called aneurysms. These can rupture, resulting in life-threatening internal bleeding.
  • Dementia and Cognitive Decline: There’s a growing body of evidence linking high blood pressure to an increased risk of dementia and cognitive decline. The damage caused by hypertension to the brain’s blood vessels may lead to a condition called vascular dementia.

Why You Might Not Know You Have High Blood Pressure

One of the most dangerous aspects of hypertension is that it often presents with no symptoms. Many people can live with elevated blood pressure for years without feeling any different, which is why regular monitoring is crucial.

Common reasons why a person may not realize they have hypertension include:

  • Lack of Symptoms: Unlike some health conditions that cause noticeable pain or discomfort, high blood pressure doesn’t usually cause obvious symptoms. You may feel perfectly fine even if your blood pressure is dangerously high.
  • Gradual Onset: Blood pressure often rises gradually over time, so the body adapts to the higher levels. You may not feel the physical effects until damage has occurred to your organs.
  • Delayed Health Checkups: Some people, especially if they feel healthy, might avoid routine medical checkups where blood pressure is measured. Without regular monitoring, hypertension can go undiagnosed for years.
  • Misconceptions: Many individuals believe that hypertension will give warning signs like headaches or dizziness, but these symptoms typically occur only in extreme cases (like hypertensive crisis) or after the damage has been done.

The Importance of Regular Monitoring

Given that high blood pressure is often symptomless, regular blood pressure screenings are essential. Your doctor can determine your risk factors based on age, family history, and lifestyle. Home blood pressure monitors are also widely available and can help you track your numbers between doctor’s visits.

For those with a family history of hypertension or conditions like diabetes, it’s critical to be proactive in getting your blood pressure checked.

Conclusion

While high blood pressure may not make you feel sick, it’s a condition that requires attention. Managing your blood pressure according to your overall health and any comorbid conditions can dramatically reduce your risk of heart attack, stroke, and other life-threatening complications. Regular monitoring, lifestyle modifications, and working closely with your healthcare provider can help ensure that your blood pressure stays within a healthy range.

Make an appointment today to have your blood pressure checked, especially if it’s been a while since your last screening. Remember, you won’t know unless you check!

Ten Essential Health Tips for Senior Citizens

By

On December 19, 2024

In Commentary, Medicine

As we age, maintaining good health becomes increasingly important to ensure a high quality of life. While everyone’s health needs are unique, there are universal strategies that can help seniors stay fit, independent, and active. Below are ten key health tips tailored for senior citizens, designed to promote both physical and mental well-being.

1. Stay Physically Active

Regular physical activity is one of the most important ways to maintain overall health as you age. Exercise helps improve cardiovascular health, keeps muscles and bones strong, and enhances flexibility. Engaging in activities like walking, swimming, or gentle strength training can also help reduce the risk of falls. Most health experts recommend about 150 minutes of moderate exercise per week.  Be sure to consult with your physician prior to starting a new exercise program to get a check-up and discuss any concerns or limitations, particularly if you have not had a regular exercise program for a while.

Begin with low-impact activities to avoid injury. Gradually increase intensity and duration.  Consider joining an organized exercise group. It will make your time more enjoyable and give you a ready source of motivation.  Additionally, the group will increase your safety should you fall or become injured.

If you have mobility issues, start with low-impact activities like chair exercises, tai chi, or yoga, which are great for improving balance and joint mobility.  Stretching is also important for maintaining flexibility.  Don’t forget to hydrate before, during, and after exercise.  Our thirst cues decrease as we get older, making us more susceptible to dehydration.

2. Maintain a Balanced Diet

Nutrition plays a critical role in maintaining health and vitality. As we age, our metabolism slows down, making it important to eat nutrient-dense foods that provide essential vitamins and minerals without excess calories. Focus on a diet rich in fruits, vegetables, whole grains, lean proteins, and healthy fats.

Incorporate foods that are high in fiber to support digestion, and make sure you’re getting enough calcium and vitamin D to protect your bones. Stay hydrated, as seniors may sometimes feel less thirsty but still require plenty of fluids.

3. Get Regular Health Screenings and Checkups

Preventive healthcare becomes increasingly important with age. Regular checkups and screenings allow doctors to catch potential health issues early, when they are more easily treatable. Seniors should monitor blood pressure, cholesterol levels, and blood sugar to detect conditions like hypertension, diabetes, and heart disease. Managing chronic conditions is important not just for physical health but for mental well-being too.

Annual vision, dental, and hearing checkups are equally important. Additionally, keep up with vaccinations, including the flu shot, pneumonia vaccine, and shingles vaccine, to prevent serious illnesses.  Take advantage of any home health services that are available.

4. Prioritize Mental Health

Mental health is just as important as physical health. Seniors are sometimes at higher risk for depression, anxiety, and loneliness, especially after the loss of a spouse or friends. It’s important to stay connected with family and friends and to stay purposeful whether through social activities, religious activities, community centers, or volunteering. If seniors are struggling with anxiety, depression, or loneliness, it’s important to seek professional help. Many people benefit from counseling, cognitive-behavioral therapy (CBT), or support groups. There’s also growing evidence for the effectiveness of telehealth mental health services, making access to care easier.

5. Get Enough Sleep

Sleep patterns often change with age, but seniors still need about 6-9 hours of sleep per night for optimal health. Poor sleep can lead to increased stress, weakened immunity, and a higher risk of falls.

Create a restful environment and stick to a consistent sleep schedule. Avoid excessive napping during the day and limit caffeine intake in the evening. If you’re struggling with insomnia or sleep disorders, consult your doctor to address underlying causes.

6. Manage Medications Wisely

Many seniors take multiple medications for chronic conditions, which can increase the risk of drug interactions or side effects. Keep a current list of all medications, including over-the-counter drugs and supplements, and review it regularly with your healthcare provider.

Take medications exactly as prescribed, and don’t hesitate to ask your doctor or pharmacist about any concerns regarding when or how to take your medications.

7. Stay Socially Connected

Staying socially engaged is vital for mental health and emotional well-being. Isolation can lead to depression, cognitive decline, and a lower quality of life. Make an effort to nurture relationships, whether with family, friends, or through community groups.

Consider joining clubs, classes, or volunteer groups where you can meet people with similar interests. Regular social interaction has been shown to improve mood, reduce stress, and even boost immune function.

8. Focus on Fall Prevention

Falls are a leading cause of injury among seniors, often leading to serious complications such as fractures and other joint injuries. To minimize the risk of falling, make sure your home is safe by eliminating tripping hazards like loose rugs or clutter, installing grab bars in the bathroom, and ensuring adequate lighting.

Regular exercise can improve balance and strength, reducing fall risk. Additionally, vision checks and proper footwear can further lower the likelihood of accidents.

9. Keep Your Mind Active

Cognitive decline is a common concern for aging individuals, but staying mentally active can help delay or even prevent this process. Regularly challenging your brain with new and stimulating activities can improve memory, attention, and problem-solving skills.

Try hobbies that require mental effort, like learning a new language, playing a musical instrument, or tackling crossword puzzles. Engaging in lifelong learning through online courses or local adult education programs can also provide mental stimulation while keeping you socially connected.

    10. Practice Stress Management

    Chronic stress can take a toll on both physical and mental health, leading to issues such as high blood pressure, sleep disturbances, and weakened immunity. Seniors may face unique stressors, including health concerns or loss of independence, but there are effective strategies to manage stress.

    Mindfulness, meditation, deep breathing exercises, and spending time in nature can all help reduce stress levels. Engage in hobbies that you find enjoyable and relaxing, whether it’s gardening, painting, or simply spending time with loved ones.

    Conclusion: Embracing Healthy Aging

    Aging is a natural part of life, and by adopting healthy habits, seniors can enjoy a fulfilling and active lifestyle well into their golden years. Staying physically active, maintaining social connections, and prioritizing mental health are key to aging gracefully. By following these ten essential health tips, seniors can significantly improve their quality of life and continue to thrive.

    While it’s important to tailor these suggestions to your personal needs and health conditions, small changes in daily routines can lead to big benefits over time. Remember that your healthcare provider is a valuable partner in supporting your health, so maintain open communication with them about any concerns or changes in your health status.

    Blue Christmas

    By

    On December 3, 2024

    In Medicine

    Depression and the Holiday Season

    The holiday season, particularly around Christmas, is often seen as a time of joy, celebration, and togetherness. Yet for many people, it can also be a period marked by increased stress, anxiety, and even depression. While the holidays are frequently portrayed as cheerful and carefree, the reality is more nuanced.

    Approximately 38% of people report higher stress levels during the holidays, and 64% of individuals living with mental illness say their symptoms worsen during this time. Let’s explore why depression tends to spike during the holiday season, the factors that contribute to it, and practical strategies for coping.

    Why Does Depression Increase During the Holidays?

    1. Unrealistic Expectations and Social Pressure

    • The imagery of a “perfect holiday” — filled with laughter, family gatherings, and elaborate gift-giving — sets high expectations. Many feel pressured to live up to these ideals portrayed in advertisements and social media, leading to feelings of inadequacy when their reality falls short.
    • For those who have lost loved ones or are estranged from family, the contrast between the idealized holiday and their circumstances can amplify loneliness, disappointment, or sadness.

    2. Loneliness and Isolation

    • While the holidays are synonymous with social gatherings, they can feel isolating for those who are alone. People who live far from family, have strained relationships, or are grieving a loss may find the season particularly difficult.
    • Older adults and veterans, for instance, often feel a heightened sense of loss during this time, as they reflect on loved ones who are no longer present or celebrations that can no longer be recreated.

    3. Seasonal Affective Disorder (SAD)

    • Seasonal Affective Disorder is a type of depression triggered by changes in seasons, often starting in the fall and continuing through winter. Shorter days and reduced sunlight disrupt circadian rhythms and decrease serotonin levels, a neurotransmitter that regulates mood.
    • The holiday season coinciding with these darker months can exacerbate symptoms, adding another layer of difficulty.

    4. Financial Stress

    • The pressure to buy gifts, host events, and travel can create significant financial strain. Many feel anxious about spending beyond their means or ashamed if they cannot meet societal expectations around gift-giving.
    • In a culture that often equates material generosity with love and affection, financial struggles can worsen feelings of inadequacy or guilt.

    5. Reflection on the Past Year

    • The end of the year often prompts reflection. For some, this can lead to disappointment if they feel they haven’t met personal goals or have faced setbacks. When paired with the festive atmosphere, unresolved emotions and regrets may surface.

    6. Disruption of Routine

    • The holidays often disrupt normal routines. Overeating, drinking more alcohol, and skipping exercise are common, all of which can negatively impact mood and mental health.
    • For those who thrive on structure and predictability, the whirlwind of social obligations and changes in routine can be overwhelming, heightening stress and anxiety.

    Coping Strategies for Managing Holiday Depression

    1. Set Realistic Expectations

    • Recognize that the “perfect holiday” is a myth. Focus on what is meaningful to you and avoid comparing your experiences with idealized portrayals in media or on social platforms.

    2. Establish Boundaries

    • It’s okay to say no. Overcommitting to events or spending beyond your means often leads to unnecessary stress. Setting limits on your time and finances can help reduce the emotional toll of the season.

    3. Stay Connected

    • Reaching out to friends, community groups, or support networks can combat feelings of isolation. If you are far from family, consider volunteering. Helping others can foster connection and purpose, lifting your spirits.

    4. Practice Self-Care

    • Maintain a healthy routine. Regular exercise, mindfulness, or meditation, and moderation in alcohol consumption can counteract holiday disruptions and support mental well-being.

    5. Embrace or Create New Traditions

    • Holidays can be painful reminders of past losses, but creating new traditions can establish a sense of joy and control. Choose activities that bring personal fulfillment rather than conforming to societal expectations.

    6. Seek Professional Help

    • If sadness or depression persists and interferes with daily functioning, consider seeking help from a mental health professional. Therapy, support groups, or medication may be necessary for managing severe symptoms or Seasonal Affective Disorder.

    Conclusion

    While the holiday season is often depicted as a time of universal joy, it’s important to acknowledge that for many, it can be a period of increased vulnerability to depression. High expectations, social isolation, financial stress, and the biological effects of shorter days all contribute to this reality.

    By recognizing the emotional complexities of the season and employing strategies to manage stress, you can navigate the holidays with greater ease. Remember, it’s okay to not feel the “holiday spirit” all the time. Acknowledging your feelings and prioritizing your mental health can help make the season a bit brighter.

    Even Santa can get the Blues!

    In a later article we will take a more in-depth look at depression in general.

    For further reading and resources on coping with depression during the holidays, see the following:

    Do I Really Need To Go To The Hospital?

    By

    On November 22, 2024

    In Medicine

    Introduction

    Yes, it’s hard waiting in this room.  I get it, I really do!  After many years as an emergency doc I really understand what it’s like for you to be waiting for treatment for yourself or family members.  It’s particularly stressful during the holiday season when emergency departments are crowded and no one wants to inconvenience family or friends by having to make a trip to the hospital.  I have spent quite a few Christmases in the emergency department, so I’ve seen first hand how difficult it can be for patients and families to try to celebrate their holidays in the hospital. (By the way, that’s me in the white coat.)

    If you do need to go to the emergency department, be sure and check in with the triage nurse soon as you get there. Give as detailed a description of your symptoms as possible. The more information you provide, the better job the nurse can do of triaging you. Triage is method that emergency departments use to determine who needs to be seen first. It’s not first come first served.  If at any time your symptoms change during your stay, you need to immediately notify the nurse.

    During the holiday season emergency departments are frequently over crowded and under staffed. This can lead to long delays. If at all possible you should have someone with you in case you do start having problems they can immediately notify the nursing staff for you. 

    A word of caution. There is a common misconception that taking an ambulance will get you to the head of the line. This is not true. Even if you arrive by ambulance, if your initial assessment does not indicate an emergent condition, you may be triaged to the waiting room. Additionally, your insurance company may refuse to cover the ambulance trip for a non emergent condition.

     Now, here’s the big but…  A lot of people delay seeking medical care during the holiday season with sometimes disastrous results.  Below are 10 reasons that you should seek medical care at any time and particularly during the stressful  holiday season.

    1. Chest Pain

    • Symptoms: Pressure, tightness, or discomfort in the chest, which may radiate to the arms, back, neck, or jaw, often accompanied by shortness of breath, excessive sweating, or nausea. Women and diabetics may experience milder symptoms, such as isolated fatigue, dizziness, or nausea, and should maintain a high degree of suspicion.
    • Potential Outcomes If Ignored: Chest pain could signal a heart attack, potentially leading to heart muscle damage, heart failure, or death if not treated promptly.
    • Action: Seek emergency care. Call 911 or visit an emergency department (ED) immediately, as timely intervention can be life-saving. Contact your PCP for chest pain primarily in the chest wall, especially if it worsens with coughing or movement.

    2. Severe Shortness of Breath

    • Symptoms: Difficulty breathing, wheezing, gasping for air, or an inability to catch your breath.
    • Potential Outcomes If Ignored: Severe shortness of breath could indicate conditions like asthma, pneumonia, pulmonary embolism, or heart failure. If untreated, it may lead to respiratory failure or sudden death.
    • Action: Seek emergency care immediately. Severe shortness of breath requires prompt evaluation in the ED to determine the cause and provide necessary treatments. Mild shortness of breath with activity or when lying flat should be assessed by your PCP.

    3. Sudden Weakness, Numbness, or Difficulty Speaking

    • Symptoms: Sudden loss of strength or sensation, particularly on only one side of the body, difficulty speaking, confusion, or trouble walking or holding objects.
    • Potential Outcomes If Ignored: These symptoms often indicate a stroke. Without prompt treatment, brain damage can occur quickly, leading to permanent disability or death. If the symptoms resolve on their own, it could be a transient ischemic attack (TIA), a warning sign of an impending stroke.
    • Action: Seek emergency care. Call 911 immediately. Early treatment can significantly improve recovery outcomes. Do not ignore TIA symptoms, as a stroke may follow shortly.

    4. Severe Abdominal Pain

    • Symptoms: Sharp or intense pain in the stomach area, often accompanied by nausea, vomiting, or fever.
    • Potential Outcomes If Ignored: Severe abdominal pain could indicate appendicitis, bowel obstruction, or gallbladder disease. Untreated, these conditions can lead to infections or organ damage.
    • Action: Seek emergency care for sudden, intense pain. For persistent but less severe pain, contact your PCP for evaluation.

    5. High Fever with Severe Symptoms

    • Symptoms: A fever over 103°F (39.4°C), especially if accompanied by confusion, headache, weakness, dizziness, stiff neck, rash, or difficulty breathing.
    • Potential Outcomes If Ignored: High fever with severe symptoms may indicate serious infections like meningitis or sepsis, which can rapidly become life-threatening.
    • Action: Seek emergency care for high fevers with concerning symptoms. For lower but persistent fevers, consult your PCP.

    6. Persistent Cough or Coughing Up Blood

    • Symptoms: A cough lasting more than three weeks, wheezing, or producing blood-streaked mucus.
    • Potential Outcomes If Ignored: A chronic cough could be a sign of lung infections like pneumonia, chronic obstructive pulmonary disease (COPD), or even lung cancer. Coughing up blood may indicate a severe infection or pulmonary embolism.
    • Action: Contact your PCP for a persistent cough. Seek emergency care if you are coughing up blood or experiencing severe symptoms like high fever or shortness of breath.

    7. Severe Allergic Reaction (Anaphylaxis)

    • Symptoms: Swelling of the throat, lips, or tongue; difficulty breathing; rapid heartbeat; or dizziness following exposure to an allergen.
    • Potential Outcomes If Ignored: Anaphylaxis can be life-threatening if not treated immediately, potentially leading to shock or death.
    • Action: Seek emergency care. Use an epinephrine auto-injector if available and call 911 or go to the ED right away.

    8. Sudden, Severe Headache

    • Symptoms: Intense headache that comes on suddenly, often described as the “worst headache of your life”, sometimes accompanied by vomiting or visual changes.
    • Potential Outcomes If Ignored: A sudden, severe headache could indicate a brain aneurysm or stroke. Ignoring these symptoms may result in brain damage or death.
    • Action: Seek emergency care. Immediate attention is necessary, especially if the headache is accompanied by neurological symptoms like weakness or vision changes.

    9. Sudden Vision Loss or Changes

    • Symptoms: Sudden blurred vision, double vision, or complete or partial loss of vision in one or both eyes.
    • Potential Outcomes If Ignored: Sudden vision changes may indicate retinal detachment, stroke, or another neurological issue. Without treatment, permanent vision loss or brain damage can occur.
    • Action: Seek emergency care if vision loss is sudden or accompanied by other symptoms like headache or weakness. For gradual vision changes, consult your PCP or an ophthalmologist.

    10. Unexplained Weight Loss or Fatigue

    • Symptoms: Significant, unintended weight loss or extreme fatigue persisting without a clear cause.
    • Potential Outcomes If Ignored: Unexplained weight loss or fatigue could signal serious underlying conditions such as cancer, diabetes, thyroid disorders, or depression. Delayed diagnosis and treatment may lead to worsening health.
    • Action: Contact your PCP. While not usually an emergency, a comprehensive evaluation is needed to identify and address the underlying cause.

    Conclusion

    Recognizing when to seek medical attention can be life-saving. For severe, sudden symptoms like chest pain, shortness of breath, or signs of a stroke, emergency care is essential. For more gradual or less urgent issues, your primary care physician can provide diagnosis, guidance, and treatment. Don’t wait—early intervention often prevents serious complications down the road.

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