Tag Archives: healthnetwork foundation

New shingles vaccine 97% effective for middle-aged

Shingles is a painful rash that is caused by the varicella-zoster virus, the same virus that causes chickenpox. After you have had chickenpox, the virus lies inactive in the nerve tissues near your spinal cord and brain. Shingles is the result of reactivation of the virus. For most patients, an episode of shingles is self-limited.

Susan Locke

Susan Locke

According to the CDC, the infection strikes about 1 million people in the U.S. each year, and nearly one in three adults will experience an incidence of shingles in his lifetime. About 2 percent of patients over 60 can go on to develop post-herpetic neuralgia, which is defined as pain which persists beyond four months after the initial onset of the rash.

Now the preferred vaccine…

A new shingles vaccine Shingrix is now recommended as the preferred vaccine over Zostavax for the prevention of herpes zoster and post-herpetic neuralgia. The CDC recommends two doses of Shingrix (separated by 2-6 months) for adults over the age of 50.

The vaccine should be given:

  • Whether or not you have had a previous shingles outbreak
  • Whether or not you have had a prior dose of Zostavax
  • To patients with chronic medical conditions

It can be used in patients who are taking low-dose immunosuppressive medication, have recently recovered from an immunocompromising illness, and in patients who may become immunocompromised. It should not be given during an acute episode of herpes zoster or within two months of receiving Zostavax.

Even if you do not recall ever having chicken pox, 99 percent of adults age 50 and older have been exposed to the varicella zoster virus and persons born after 1980 are considered immune to varicella.

…because it works so well

  • In adults 50-69, Shingrix was 91 percent effective in preventing post-herpetic neuralgia. Over the age of 70, 89 percent effective.
  • In adults 50-69, Shingrix was 91 percent effective in preventing post-herpetic neuralgia. Over the age of 70, 89 percent effective.

Side effects of the vaccine are mild. Most patients get a sore arm and some get redness or swelling at the injection site. Occasionally people feel tired, have muscle aches, shivering, fever, stomach pain, or nausea. Symptoms may last 2-3 days. Severe allergic reaction is very rare.

Modest cost, readily available

The total cost of the vaccine is $200-300. No prescription is needed. It is recommended that you check with your insurance or Medicare plan regarding reimbursements.

Medicare Part D covers the vaccine, although there may be some cost to you depending on your plan. Since this is a pharmacy benefit, most plans require that you get vaccinated at the pharmacy, not at your doctor’s office. Medicare Part B does not cover this vaccine.

Contact your insurer to find out if this vaccine is covered under “prescription” or “medical”:

  • Prescription coverage requires you to get the vaccine at your local pharmacy.
  • Medical coverage means that you can get your prescription at your doctor’s office.

SUSAN LOCKE is Healthnetwork Foundation’s medical director.

HEALTHNETWORK is a Legatus membership benefit, a healthcare “concierge service” that provides members and their families access to some of the most respected hospitals in the world. One Call Starts It All: (866) 968-2467 or (440) 893-0830. Email: help@healthnetworkfoundation.org

HEALTHNETWORK FOUNDATION is a non-profit whose mission is to improve medicine for all by connecting CEOs with leading hospitals and their doctors to provide the best access to world-class care and increase philanthropic funding for medical research.

Playing by 7 ‘healthy’ numbers tips the advantage

Knowing your “healthy” numbers is a great way to establish baselines and determine what you may need to change to maintain optimal health.

Susan Locke

7. Blood lipid values

Triglycerides are the chemical form in which most fat exists in food as well as in the body. A person’s total cholesterol score is calculated by adding his HDL and LDL cholesterol levels and 20 percent of his triglyceride level.

Penn Medicine reminds us that it is important to work with your health care provider to set your cholesterol goals. Newer guidelines steer doctors away from targeting specific levels of cholesterol. Instead, they recommend different medicines and doses depending on a person’s history and risk-factor profile. General targets are:

LDL: 70 to 130 mg/dL (lower numbers are better)
HDL: More than 50 mg/dL (high numbers are better)
Total cholesterol: Less than 200 mg/dL (lower numbers are better)
Triglycerides: 10 to 150 mg/dL (lower numbers are better)

6. Body mass index (BMI) & waist circumference

BMI is used as a screening tool to identify possible weight problems for adults. The normal range for an adult is 18.5 – 24.9. Here is how you calculate BMI:

BMI = ( weight in pounds / (height in inches) x (height in inches)) x 703

With a cloth measuring tape, measure waist circumference just above hipbones. Circumference for males should measure less than 40 inches; females less than 35 inches. Increased girth can signify increased risk of cardiovascular disease and diabetes.

5. Daily fat intake

Not all fats are bad – the key is moderation. Cleveland Clinic recommends a dietary reference intake (DRI) for fat in adults is 20% to 35% of total calories from fat. That is about 44 grams to 77 grams of fat per day if you eat 2,000 calories a day.

4. Minutes of physical activity

Physicians at Houston Methodist recommend regular aerobic activity, such as walking, biking, or swimming to help lower blood pressure and cholesterol. The preferred amount is 30 minutes of moderate physical activity, at least five days per week.

3. PSA screening (men) | mammography scans (women)

Johns Hopkins recommends that you discuss with your physician the optimal time to start testing for prostate cancer in men, and breast cancer in women. Previous guidelines recommended testing at age 40; however, you and your physician should set your schedule depending on multiple factors, including your age and family history.

2. Blood pressure

University Hospitals in Cleveland shares this explanation: The systolic, or higher number, reflects the pressure the blood vessels are under while the heart is actively pumping. Diastolic is the pressure during the resting part of the cycle.

Generally speaking, you want your BP to be less than 140/90. Otherwise, you run the risk of developing high blood pressure, a “silent killer” that affects one out of every three adults over age 20. New American Heart Association guidelines suggest that you should start to treat hypertension with lifestyle changes starting at 130/80.

1. Important “healthy” number to keep handy – Healthnetwork’s phone number!

1-866-968-2467 | 1-440-893-0830 OR help@healthnetworkfoundation.org

When you need access to medical information or to the best hospitals, one call to Healthnetwork will provide you connections to the most respected hospitals in America.

SUSAN LOCKE is Healthnetwork Foundation’s medical director.

HEALTHNETWORK is a Legatus membership benefit, a health care “concierge service” that provides members and their families access to some of the most respected hospitals in the world. One Call Starts It All: (866) 968-2467 or (440) 893-0830. Email: help@healthnetworkfoundation.org

HEALTHNETWORK FOUNDATION is a nonprofit whose mission is to improve medicine for all by connecting CEOs with leading hospitals and their doctors to provide the best access to world-class care and increase philanthropic funding for medical research.

Stopping IBS from creating daily lockdown

Irritable bowel syndrome (IBS) is a chronic disorder of the digestive system. Its primary symptoms are abdominal pain and altered bowel habits (constipation and/or diarrhea).

Susan Locke

IBS is the most commonly diagnosed gastrointestinal disorder. It is estimated that 10-20% of people suffer from IBS, although only 15% of those affected seek medical attention. It is twice as common in women in the U.S. and western countries, and often starts in young adulthood. IBS does NOT increase risk of colorectal cancer.

Causes: Though definitive causes are unknown, these factors play a role in the development of IBS:

  • Spastic colon theory (overactive contractions cause cramps, bloating and diarrhea; weak contractions cause constipation)
  • Nervous system theory (poorly coordinated signals between the brain and intestines cause the body to overreact)
  • Inflammation of the intestines (increased number of immunesystem cells)
  • Severe infection or gastroenteritis
  • Changes in bacteria in the intestines (microflora)

Triggers:

  • Food (dairy products, wheat, citrus fruit, beans and carbonated drinks)
  • Stress – (stress is not a cause of IBS, but an aggravator)
  • Hormones (may worsen around menstrual period)

Diagnosis: There is no single diagnostic test for IBS. Symptoms can be similar to malabsorption, inflammatory bowel disease, celiac disease, and microscopic colitis.

Treatment: Primarily aimed at relieving symptoms, treatments are often used in combinations.

  • Identify factors that worsen symptoms
  • Modify diet accordingly to relieve symptoms
  • Reduce stress and anxiety
  • Exercise daily
  • Medications (traditionally used for treatment of symptoms). These include:
    • Anticholinergic medications (e.g., Bentyl, Levsin)
    • Antidepressants (tricyclic antidepressants, serotonin reuptake inhibitors)
    • Antidiarrheal drugs (e.g., IMODIUM®, Lomotil)
    • Antianxiety drugs (e.g., Valium, Ativan)
    • Herbal remedies are UNPROVEN

We asked Dr. Ali Rezaie, medical director, GI Motility Program at Cedars-Sinai Medical Center in Los Angeles about the IBS medications that have been heavily marketed on TV.

Are these medications helpful and should they be used as a first-line medications?

Currently, the FDA has approved five drugs for management of IBS:

  • Diarrhea-predominant IBS (IBS-D) XIFAXAN®, VIBERZI® and LOTRONEX®
  • Constipation-predominant IBS (IBS-C LINZESS® and AMITIZA

The efficacy of these medications has been shown in large multicenter clinical trials, with thousands of patients. They should be reserved for use when dietary and lifestyle modifications are not fully helpful in controlling IBS symptoms.

What is the difference between IBS, IBD & lactose intolerance?

Patients with lactose intolerance specifically develop symptoms of bloating, abdominal pain and diarrhea when they consume dairy products. IBS patients experience symptoms unpredictably which significantly affects their quality of life. Inflammatory bowel diseases, such as Crohn’s disease and ulcerative colitis, are associated with ulceration of the bowel which can further lead to bleeding, weight loss and bowel obstruction.

It is very important to note that these diseases are not mutually exclusive and can overlap. For example, up to 30% of IBD patients have overlapping IBS.

As the role of gut microbiome (microorganisms living in our bowels) is becoming clearer in IBS, multiple medications are being developed to modify the gut microbiome for treatment of IBS. There are also several drugs in the pipeline that aim to target the motility of the bowel to improve IBS symptoms.

SUSAN LOCKE is Healthnetwork Foundation’s medical director.

HEALTHNETWORK is a Legatus membership benefit, a health care “concierge service” that provides members and their families access to some of the most respected hospitals in the world. One Call Starts It All: (866) 968-2467 or (440) 893-0830. Email: help@healthnetworkfoundation.org

HEALTHNETWORK FOUNDATION is a nonprofit whose mission is to improve medicine for all by connecting CEOs with leading hospitals and their doctors to provide the best access to world class care and increase philanthropic funding for medical research.

New immunotherapy battles cancer harder in young patients

As world leaders in immunotherapy, Penn’s Abramson Cancer Center is imagining the day when its physicians can offer more successful, less toxic cancer treatments.

Dr. Susan Locke

August 30, 2017, marked a major milestone toward that goal. On that day, the U.S. Food and Drug Administration (FDA) granted Novartis approval for the world’s first-ever cancer cell and gene therapy for advanced leukemia. The chimeric antigen receptor T-cell (CAR-T) therapy, Kymriah™ (tisagenlecleucel, formerly CTL019) was approved for patients up to 25 years old with B-cell precursor acute lymphoblastic leukemia (ALL) that is refractory to treatment or in second or later relapse.

This fascinating approach, which is at the leading edge of the emerging field of immunotherapy, involves extracting a patient’s diseasefighting blood cells, modifying them to recognize and attack cancer cells more vigorously, and then reinjecting them into the patient.

Kymriah™ is available through a network of certified treatment centers throughout the United States. Penn Medicine and Children’s Hospital of Philadelphia (CHOP) became two of the first centers that met all levels of certification for approval.

This new immunotherapy was used at CHOP for the first pediatric patient in the world, a six-year-old whose leukemia stopped responding to conventional treatments. Her cancer remains in remission five years later. In a larger global clinical trial, sponsored by Novartis, researchers are seeing overall remission rates over 80 percent, which is a remarkable improvement upon previous treatment success rates.

Kymriah is a game-changer for the treatment of younger patients battling ALL (acute lymphoblastic leukemia) and a pivotal milestone in this new era of cellular therapies that treat cancer with a patient’s own immune system. Therapies like this open up opportunities for patients across the world who desperately need new options when traditional treatments become ineffective or their disease returns.

Penn Medicine’s success in harnessing the immune system to treat leukemia has led to breakthroughs in myeloma and lymphoma, progress in solid tumor cancers like breast, prostate, and lung cancer, and explorations into diabetes, cardiology, and Alzheimer’s and Parkinson’s. The goal is to eventually extend this work to many other diseases.

The development of Kymriah was a collaboration between industry, academia, healthcare professionals, patients and caregivers.

To learn more about the revolution happening in immunotherapy and to get involved, visit www. PennMedicine.org/ ImmunoRevolution

SUSAN LOCKE is Healthnetwork Foundation’s medical director.

Learn More:
Treatment for ALL usually needs to start very soon after it is diagnosed, but if time permits, traditional treatment of ALL could involve several different stages of treatments over the course of two years – The main types of treatment used for ALL are:

  • Chemotherapy
  • Targeted therapy (drugs that target specific parts of cancer cells)
  • Stem cell transplant

In general, about 80% to 90% of adults will have complete remissions at some point during these treatments. This means leukemia cells can no longer be seen in their bone marrow. Unfortunately, about half of these patients relapse, so the overall cure rate is around 40%. Again, these rates vary depending on the subtype of ALL and other prognostic factors.

Penn Medicine in Philadelphia is the latest addition to Healthnetwork’s GOLD Hospitals. This hospital brings a world-class team of medical experts and innovative medical research to all.

HEALTHNETWORK is a Legatus membership benefit, a healthcare “concierge service” that provides members and their families access to some of the most respected hospitals in the world. One Call Starts It All: (866) 968-2467 or (440) 893-0830. Email: help@healthnetworkfoundation.org

HEALTHNETWORK FOUNDATION is a non-profit whose mission is to improve medicine for all by connecting CEOs with leading hospitals and their doctors to provide the best access to world-class care and increase philanthropic funding for medical research.

Adult acne isn’t kid stuff

“It’s not fair!” I hear this from patients all over the country, especially women in their 30s, 40s, and 50s who thought that acne was a teenage malady. Though acne prevalence peaks at age 15, significant percentages of women in their 30s (35%), 40s (26%), and 50s (15%) complain of acne; male prevalence is roughly half that in women.

Dr. Thomas McGovern

Acne occurs where the oil glands surrounding body hairs are particularly large, and in adult women, it particularly attacks the jawline and chin. Acne starts with testosterone — a hormone produced in both males and females once puberty begins — that stimulates oil gland and hair follicle lining cells to proliferate. Therefore, all acne at all ages is hormonal.

New cells and oil build up beneath the skin surface, forming whiteheads and blackheads that can’t escape through the pores, that is, unless patients squeeze them out! Increased oil in these plugs prevents oxygen from entering and provides ‘food’ for normal skin bacteria (P. acnes) that thrive in the absence of oxygen and convert oil into irritating byproducts. When a plug bursts into surrounding skin, it creates the redness, swelling, and pain experienced as annoying pimples.

Because dirt is not the cause of acne, vigorous scrubbing only serves to give sufferers a redder face.

As well, high glycemic index diets — sugar, white bread, white potatoes, candy — are linked to higher rates and more severe cases of acne; low glycemic index diets can improve acne.

And while smoking also increases acne severity in adults, quitting reduces the acne burden.

Though the cause of adult acne is the same as adolescent acne, adult women with acne are especially sensitive to testosterone. Standard treatment that works in adolescence and the early 20s often fails in older women, and 30% or more relapse after a course of isotretinoin, the “miracle drug” of acne treatment.

Furthermore, the FDA requires women on isotretinoin to sign a form stating they will use two forms of contraception to avoid pregnancy due to the 25-50% chance of severe birth defects in children conceived while mom is taking isotretinoin. While contraceptives can be morally used to treat acne, they cannot be morally used to prevent conception in patients using isotretinoin. Fortunately, most physicians are willing to prescribe isotretinoin if a woman promises to abstain from sexual intercourse during and one month after taking it.

However, a better option for women with moderate-to-severe acne is the noncontraceptive spironolactone, a hormonal treatment that blocks testosterone action at the oil gland-hair follicle unit. Spironolactone is both safer and more effective than oral contraceptives (and does not serve as a near occasion-of-sin as contraceptives do). More frighteningly, in 2005, the World Health Organization recognized oral contraceptives as a Group One Carcinogen (with cigarettes, radiation, and asbestos) for increasing the risk of breast cancer.

Spironolactone helps virtually every woman who tries it at appropriate doses and who patiently allows three to six months to reach maximal improvement. It even reduces oiliness and unwanted facial hair growth. For mild cases of adult acne with only whiteheads and blackheads — and maybe a few pimples and red bumps — the combination of over-the-counter adapalene (that unplugs pores) and benzoyl peroxide (that releases oxygen to kill P. acnes) is highly effective within three months. See a dermatologist for more details.

DR. THOMAS MCGOVERN is a dermatologist/Mohs surgeon member, Fort Wayne Chapter Legate, and Member of the National Board of the Catholic Medical Association – a national, physician-led community of healthcare professionals that informs, organizes, and inspires its members, in steadfast fidelity to the teachings of the Catholic Church, to uphold the principles of the Catholic faith in the science and practice of medicine.

 

Helps for healthy campus living

For many new college, living at school is the time when they first become responsible for their wellness. Preparing for this transition is best shared between parents and student.

Susan Locke

Susan Locke

VACCINATIONS FOR NEW STUDENTS:

Seasonal influenza vaccine (Annually)

Meningococcal Conjugate Vaccine

  • Many colleges require this for incoming college students.
  • If your child received the vaccination before age 16, a booster should be given for maximum protection.

Tdap Vaccine (Tetanus, Diphtheria, Pertussis)

  • A single dose of Tdap is usually given to preteens/ teens. If your child is 19 or older and did not receive Tdap earlier, a single dose of Tdap is recommended.
  • Tdap can be given regardless of when your child received his/her last Td booster.

Human Papillomavirus Vaccine (HPV) (Series Of 3 Shots, typically given at age 11 or 12)

  • Recommended for teens and young adults (women under 27 and men under 22) who did not receive or finish the HPV vaccine series
  • Young adults should complete the series if they only received one or two doses, even if time has elapsed. The HPV series does not need to be restarted, but outstanding doses should be given.

PREPARING FOR LIVING AWAY

Consider making a first-aid kit:

  • OTC pain telievers
  • OTC gastrointestinal distress relievers
  • Band-aids, gauze
  • Hydrogen peroxide
  • Bacitracin cream or Neosporin
  • Cortisone cream
  • Benadryl 25 mg tablets – 1-2 tablets for an acute allergic reaction

If your child takes prescription medications:

  • Prescriptions should be kept in original containers
  • If your child is on medication for ADHD, ensure the medication is kept in a secure place. Unfortunately, abuse of ADHD medications is common on college campuses.

Remind your child that when he has a persistent fever, severe pain or other unusual symptoms, he/she should not self-medicate, but seek treatment at student health facilities.

AND THEY DON’T ALWAYS TELL YOU…

For children with ongoing health issues

  • Explain the importance of ensuring his primary physician knows what the campus doctor is doing – which minimizes the chance of prescription conflict, or of important medical trends being overlooked in the crossover.
  • Have a game plan for prescription fulfillment.

Discussions Before College

  • Danger of combining medications with alcohol.
  • OTC medications are not risk-free; must follow dosage instructions and contra-indications.
  • Excessive caffeine (over 100 mg per day for adolescents; over 400mg for adults) can have serious consequences.
  • When-to-see-the-doctor basics (such as a “cold” that lasts a certain number of days without symptoms-relief), and knowing differences between viral and bacterial infections (how fever is often indicative of the latter).

Summer To-Do List

Since your kid’s phone is often his “wallet,” take screenshots of these and send them to him

  • Insurance card
  • List of current medication names and dosages
  • List of known medical or other allergies

Semesters Abroad

International study is an exciting experience, so protect your child’s health options with these tools:

  • Pre-travel vaccinations/health-risk reviews based on destination.
  • Research and enroll him in an air medical transport insurance membership. Domestic air-ambulance medical evacuations typically exceed $10,000, while international air ambulance medical evacuations can exceed $100,000. Peace of mind in having a paid membership prior to travel for emergencies is priceless.

SUSAN LOCKE is Healthnetwork Foundation’s medical director.

HEALTHNETWORK is a Legatus membership benefit, a healthcare “concierge service” that provides members and their families access to some of the most respected hospitals in the world. One Call Starts It All: (866) 968-2467 or (440) 893-0830. Email: help@healthnetworkfoundation.org

HEALTHNETWORK FOUNDATION is a non-profit whose mission is to improve medicine for all by connecting CEOs with leading hospitals and their doctors to provide the best access to world-class care and increase philanthropic funding for medical research.

Risk and treatment of stroke

Brain damage from a stroke can be temporary or permanent. Early treatment and preventive measures can reduce the impact. Outcomes of strokes depend upon how much of the brain is damaged and how quickly treatment begins – which ideally should be within 4-6 hours of symptoms.

Susan Locke

Susan Locke

Know symptoms – and react quickly

  • Face drooping on one side or numbness. Ask the person to smile.
  • Arm weakness or numbness. Ask the person to raise both arms. Does one drift downward?
  • Speech difficulty, slurred or garbled speech. Ask him to say “The sky is blue.”
  • Time – Call 911, the faster a patient gets help, the lower his chances of permanent damage.

IN CASES OF A SUSPECTED STROKE, CALL 911 AND PROCEED TO THE NEAREST HOSPITAL, ideally one with a specialized stroke center.

Early diagnosis can save vital tissue

In addition to clinical symptoms, diagnosis is made usually by CT scan or MRI.

With new imaging modalities like CT perfusion, not only can diagnosis be made early but doctors can assess the degree of tissue damage as well as the degree of tissue that can be saved.

Treatment aim is to restore blood flow

For patient with an Ischemic stroke, the goal is to restore blood flow quickly, ideally within the first few hours of symptoms – with either intravenous thrombolytic treatment with the IV medication alteplase; or mechanical intra- arterial thrombectomy to open the blocked artery.

Longterm prevention:

  • Antiplatelet medications: aspirin 50-325 mg/ day, Clopidogrel (Plavix), or combination of aspirin and extended-release dipyridamole (Aggrenox)
  • Anticoagulant therapy: Coumadin, Pradaxa, Eliquis, Xarelto
  • Revascularization by angioplasty and stenting or by carotid endarterectomy (although not in an acute situation) are procedures that open a narrowed carotid artery

For patient with a Hemorrhagic stroke, treatment depends upon cause of bleeding, so it is crucial to identify the cause.

Medical treatment:

  • Control blood pressure.
  • Stop any medications that could increase bleeding.
  • Measure the pressure within the brain with a ventriculostomy tube. If pressure is elevated, cerebrospinal fluid or blood can be drained. This procedure is done in an ICU or in an operating room.

Surgical treatment:

  • The goal of surgical treatment is to prevent or stop bleeding and reduce the pressure in the skull.
  • If an aneurysm (ballooning) of a blood vessel has caused the bleeding, the aneurism can be clipped surgically. More recently, surgeons are doing a Coil embolization where a tiny flexible tube is guided up through the body into the vessel in the brain at the site of the aneurysm. The coil is advanced into the weakened area and diverts the blood ow to a more normal path.
  • Arteriovenous malformation (AVM) treatment depends on the patient’s age, AVM location and size and the abnormalities of the veins that drain. Treatment options include surgery, radiosurgery or embolization.
  • Decompressive craniotomy is a procedure where the skull is open to relieve the pressure on the brain.

 

SUSAN LOCKE is Healthnetwork Foundation’s medical director.

HEALTHNETWORK is a Legatus membership benefit, a healthcare “concierge service” that provides members and their families access to some of the most respected hospitals in the world. One Call Starts It All: (866) 968-2467 or (440) 893-0830. Email: help@healthnetworkfoundation.org

HEALTHNETWORK FOUNDATION is a non-profit whose mission is to improve medicine for all by connecting CEOs with leading hospitals and their doctors to provide the best access to world-class care and increase philanthropic funding for medical research.

Parenting a child with depression

Depression is on the rise in American teens and young adults. Adolescent girls seem most vulnerable, per research published in the Journal of Pediatrics. Data collected between 2005-2014, by Johns Hopkins University School of Public Health, concluded that “the 12-month prevalence of major depressive episodes in adolescents increased from 8.7% to 11.3%.” The reasons remain under discussion. However, cyberbullying is hypothesized to be a trigger, particularly for girls.

Susan Locke

Susan Locke

How can parents support their child or adolescent suffering from depression? Here are some general guidelines:

Observe your child’s behavior for changes. Children with depression may demonstrate low mood, irritability, anger, fear or anxiety, mood swings, disruptive or risk-taking behavior, disobedience/ defiance/ illegal behavior, isolation, lack of self-care/ hygiene, decreased interest in previously enjoyable activities, decreased energy, increased or decreased sleep, increased or decreased appetite, and changes in friendships or family relationships. Some children turn to drugs or alcohol. Others turn to the internet for support or socialization. School performance may deteriorate, or attendance may decrease due to physical complaints or blatant truancy. Some children engage in self-harming behaviors or talk of death and dying.

Engage your child in daily conversation or other activities to open communication. Gently ask questions about your child’s change in mood, daily life/issues. Find ways for your child to communicate his or her feelings.

If your child expresses suicidal thoughts or wishes, please take him or her to the local emergency room for further evaluation.

Talk to your pediatrician or family doctor about your child’s mood or changes in behavior. They can arrange timely assistance for your child and provide you with qualified mental health professionals.

Monitor and limit phone, computer and electronics time. Watch internet history, texting, and social media. Kids often scout in the wrong places and meet the wrong people.

Ascertain healthy and consistent sleep schedules. Children and teens need about 8-10 hours of sleep per night. A regular presleep routine that does not include electronics, along with a scheduled bedtime/wake-up time encourage healthy sleep habits.

Encourage healthy eating habits. Observe behaviors at meals, such as restricting calories,  or leaving the table to go to the restroom and hiding/throwing food away. Watch for weight loss, excessive exercising, or obsessive concerns with body image that may indicate an eating disorder.

Be consistent and firm with limit-setting. Maintain the same or even slightly more stringent rules with your child to maintain structure. Treat all children in the family equally. Be aware of your child’s whereabouts and safety at all times.

Safety-proof your home. Lock up all medications, alcohol and OTC medications. Secure anything that could be used as a weapon, particularly firearms.

Ensure that you are taking care of your own well-being and mental health. Depression can run in families. Resist the urge to tell your child that you know how they must feel or that you were once, or are currently, depressed. Practice listening attentively and reassuring your child that you will get them whatever help is needed. Be sure to get help for yourself as well.

Identifying child and adolescent depression and dealing with it can be overwhelming. The key is to reach out for assistance and allow others to provide their support and expertise, so that a team approach can be utilized to its fullest.

By Jennifer L. Shoenfelt, MD
Board Certified Child, Adolescent, and Adult Psychiatrist
Lindner Center of HOPE (a partner to Healthnetwork Foundation)

SUSAN LOCKE is Healthnetwork Foundation’s medical director.
HEALTHNETWORK is a Legatus membership benefit, a healthcare “concierge service” that provides members and their families access to some of the most respected hospitals in the world. One Call Starts It All: (866) 968-2467 or (440) 893-0830. Email: help@healthnetworkfoundation.org

HEALTHNETWORK FOUNDATION is a non-profit whose mission is to improve medicine for all by connecting CEOs with leading hospitals and their doctors to provide the best access to world-class care and increase philanthropic funding for medical research.

Advance Directives for peace of mind

Life is to be enjoyed and the thought that we may one day face a sudden health crisis due to an accident or serious illness can be very scary. What if you are unable to make your own medical decisions? Who will make these decisions for you? Will they make the same choices you would make? Fortunately, there is a legal means to addressing this potential future concern — it’s called an Advance Directive.

Susan Locke

Susan Locke

An Advance Directive is a written statement that you complete in advance of a serious illness. Within this document you will name someone to act on your behalf or you will outline how you want medical decisions to be made when you are no longer able to make decisions for yourself.

There are several advantages to communicating your wishes about treatment. You will have the opportunity to make very personal health care decisions. You will prevent arguments and you will spare loved ones from the anxiety of having to guess your wishes.

There are two types of Advance Directives and it is important to have both kinds.

1) LIVING WILL: This document specifically spells out what types of treatment you want at the end of your life or if you are unable to speak for yourself. It may include decisions about:

• The use of Cardiopulmonary resuscitation (CPR) if your heart stops or if you stop breathing. Do you want extraordinary measures taken or do you prefer a Do Not Resuscitate order (DNR) which is a request not to have CPR?

• The use of breathing machines (mechanical ventilation) and/or dialysis

• Sustainment by tube feeding

• Organ and tissue donation preferences

2) HEALTH CARE POWER OF ATTORNEY: This document appoints someone to make health decisions if you can’t communicate on your own. The person you designate as your Health Care Power of Attorney, also known as a Health Care Proxy, is your advocate, not only concerning life-prolonging treatments, but also for other medical treatments. This is different from a regular Durable Power of Attorney which covers financial matters.

Your Health Care Power of Attorney should be someone who knows you well and someone who is willing to carry out your directions regardless of personal feelings or influence of family and friends. An alternative Health Care Power of Attorney should also be named.

Advance Directive forms may vary slightly from state to state. State-specific forms are available on the AARP website. Your physician should also have these forms available for you to complete.

Copies of Advance Directive forms should be kept by your Health Care Proxy and given to your physician to become part of your medical record.

You can change or cancel your Advance Directives at any time, if you are considered of sound mind. These changes should be signed and notarized. Inform your doctor and family members that you have made changes to these directives.

SUSAN LOCKE is Healthnetwork Foundation’s medical director.

HEALTHNETWORK is a Legatus membership benefit, a healthcare “concierge service” that provides members and their families access to some of the most respected hospitals in the world. One Call Starts It All: (866) 968-2467 or (440) 893-0830. Email: help@healthnetworkfoundation.org

HEALTHNETWORK FOUNDATION is a non-profit whose mission is to improve medicine for all by connecting CEOs with leading hospitals and their doctors to provide the best access to world-class care and increase philanthropic funding for medical research.

Weekend Warrior

Current health recommendations call for 150 minutes of moderate exercise or 75 minutes of vigorous physical activity every week. Due to busy weekday schedules, many people just can’t get the exercise in during the week. The good news is that if you only get your exercise in on the weekends, you will reap a benefit just by being active as compared to those who remain inactive.

Susan Locke

Susan Locke

Making up for lost time by exercising excessively may cause sports injuries. Nonprofessional sports injuries are the second most common reason for doctor visits, with the average cost of more than $18 billion a year.

Sprains (stretching or tearing of a ligament) and strains (stretching or tearing of a muscle or tendon) are the most common sports injuries. The areas of the body that seem most susceptible to sprain or strain include the ankle, groin, hamstring and lower back.

How to prevent them?

• Warm up and stretch first.
• Start slowly and increase activity gradually by no more than 10 % per week.
• Spread out your exercise. Do not try to make up for a week’s worth of inactivity in a day or two. Ideally exercise at least three days a week.
• Listen to your body – stop when it hurts, see a doctor if it doesn’t stop hurting.
• Recognize that for most people, what you could do at age 20 is not the same as what you can do at age 50.
• Before starting an exercise program, educate yourself and develop a balanced program, or hire a professional trainer.

In addition to sprains and strains, several other injuries are frequently experienced by the weekend warrior. “Shin splints” present as tenderness, soreness or pain along the inner part of your lower leg., most commonly brought on by running. Additionally, sudden stops or turns can cause a strain or a tear of the anterior cruciate ligament (ACL) of the knee. A tear is usually heralded by a popping sound.

Patellofemoral also causes pain felt in front of your knee, and results from repetitive movement of your kneecap against your thigh bone. Iliotibial band syndrome is the cause of lateral knee pain common in long-distance runners and cyclists. Tennis elbow (epicondylitis) usually presents as pain on the outside of your elbow into your forearm and wrist with pain also occurring when you extend your wrist.

Most sports injuries are mild or moderate and can be treated with the PRICE therapy method.

P – Protect from further injury by using splints, pads, or crutches if necessary.
R – Restrict activity.
I – Ice the injury immediately after it occurs. Use ice for 20 minutes every one to two hours for the first 48 hours after the injury.
C – Compression with an elastic bandage will reduce swelling.
E – Elevate the injured area to reduce swelling.

Seek medical attention if you suspect a serious injury — like bone deformity, excess swelling, radical skin-color change, inability to bear weight, or no sign of improvement.

Supplementing a sedentary week with highly physical activity on the weekend is tempting. Just remember, the drastic change of physical stress on your body can come with a hefty PRICE tag.

SUSAN LOCKE is Healthnetwork Foundation’s medical director.

HEALTHNETWORK is a Legatus membership benefit, a healthcare “concierge service” that provides members and their families access to some of the most respected hospitals in the world. One Call Starts It All: (866) 968-2467 or (440) 893-0830. Email: help@healthnetworkfoundation.org

HEALTHNETWORK FOUNDATION is a non-profit whose mission is to improve medicine for all by connecting CEOs with leading hospitals and their doctors to provide the best access to world-class care and increase philanthropic funding for medical research.