Tag Archives: Your Health

Suicide epidemic driven by despair’s partner — loneliness

Contemporary America’s main problem has been defined by many as “addiction”: addiction to technology, to pain medication, or to the freedom of non-commitment. But these are only symptoms of a deeper root-cause.

The perils of misdiagnosis afflict many patients. An elderly gentleman comes in with stomach pain, only to be sent home with antacid medication and advice to avoid certain foods. After three months of persistent pain, weight loss, and fatigue, he is diagnosed with stage four colon cancer. For this gentleman, and for America, focusing on symptoms over root-cause can prove deadly.

Since the turn of the century, Americans have been suffering “Deaths of Despair” at an unprecedented rate. Suicide is now the second leading cause of death for American teenagers and the tenth leading cause of death for Americans overall. Equally harrowing, drug overdose is the leading cause of death for Americans under the age of fifty.

While the statistics are daunting, the reality is devastating. In every age group, and across every geographic region, mothers are finding themselves childless, husbands are suddenly without a wife, and sisters are left without a brother. Americans are having less sex and fewer children (historically, signs of diminished hope), anger defines politics, and a silent feeling of dissatisfaction permeates American life. Although Americans are materially prosperous, our psychological and spiritual lives are in freefall.

The diagnosis: loneliness.

Just last week a young woman who intentionally severed her airway and spinal cord with an 8-inch kitchen knife saw me in the emergency room. She cited the isolation associated with caring for her ill grandmother, and the paucity of individuals with whom she could meaningfully discuss such challenges, as the drivers of her despair. Unfortunately, patients like her are far too common. Loneliness, like hers, is defined by an absence of meaningful relationships that now plagues 40% of all Americans.

What caused this loneliness? The answer is not as simple as “blame social media.” Technology is both symptom and cause — much like changes in religious participation, family structure, and the economy. The unifying theme, however, is that we no longer live in community.

Compared to 25 years ago, Americans spend half as much time at the dinner table and don’t invite neighbors over nearly as often. Participation in community organizations has plummeted. The resulting lack of connection and “social capital” is proving fatal.

The solution: be present.

Close your computer and engage your colleague while waiting for a meeting to start. Re-define “FaceTime” by opting for a shared coffee over a phone call. Check in on the widow down the street. Acknowledge the power, and importance, of civic involvement. Recognize the sacred space of the home by designating “tech-free” spaces. Reclaim the dinner table. In short, cultivate the virtues of selflessness and sacrifice

This unique American moment asks not for a call to arms, but for a call to neighborliness.

FRANCIE HART BROGHAMMER, MD is the chief psychiatry resident at UC Irvine Medical Center, doing clinical work and research examining the social, relational, and spiritual determinants of mental health. In addition to speaking nationwide on these topics, she serves as an American Psychiatric Association Leadership Fellow and is a member of the UC Irvine Medical Ethics Committee. Francie can be reached atfbrogham@uci.edu.

Recipe for skin cancer: 15 sunny steps

1. Believe, “skin cancer can’t happen to me. I won’t be one of the 10,000 Americans diagnosed daily with skin cancer.” If you apply sunscreen, use the lowest number you can find and apply it like a typical American who puts it on so thin that they achieve only a quarter to half the protection listed on the sunscreen bottle.

2. Remove as much clothing, hats, and glasses as possible when in the sun.

3. Marinate in the sun for your vitamin D, even though half of Hawaiian surfers who spent 29 hours/week in the sun year-round were vitamin D deficient

4. Ignore non-healing sores lasting more than a month – especially on the face.

5. If you wear a hat, use a visor or baseball hat, and stay away from hats with a 2” or wider circumferential brim.

6. Win the ‘lobster-man’ or ‘lobster-woman’ award for the best ‘grimace-inducing sunburn’ at your local Yacht Club – as many years running as possible.

7. Choose parents who will give you fair skin, for as a red-headed, fair-skinned Irish priest patient once said, “The Irish are God’s gift to dermatology.”

8. Repeat, “Skin cancer can’t happen to me. I won’t be in the one-third of Americans who will grow one by the age of 70.”

9. Braise in a tanning bed to acquire the mythical ‘base tan’ that requires killing skin cells to alert other skin cells to make a tan – that provides as much protection as SPF 3 (three!) sunscreen – and don’t forget, the tanning bed rays accelerate skin wrinkles compared to the sun. Wrinkles give your face character.

10. Bake exposed skin in the sun as close to the equator – and to mid-day – as possible.

11. Fertilize and cultivate your garden in the middle of the day. Not only does the sun feed your fruits, vegetables, and flowers, but nothing motivates a skin cancer like sunlight!

12. Appreciate those multi-colored, growing “moles” – after all, they’re just ‘beauty marks,’ and they can’t kill anyone (except 7,200 other people annually in America).

13. Avoid websites like www.skincancer. org that could help you prevent skin cancer or get it diagnosed early.

14. Contribute monthly (and don’t forget to fill out your company matching-gift form) to “MakeAmericaTanAgain.Com.”

If you have already had a skin cancer, follow all of these instructions, because doing these things will reduce your number of future cancers.

15. Stew slowly with the thought, “Skin cancer can’t happen to me”, and believe, ”Skin cancer isn’t a big deal, even if I get it, because Hugh Jackman and Melanie Griffith have proven that you can still be attractive with cancer surgery scars on your nose.”

Put your dermatologist on speed-dial; he/she will want to admire the results of your efforts.

TOM MCGOVERN is a Legate who practices Mohs Surgery full-time at Fort Wayne Dermatology Consultants in Fort Wayne, IN. He co-hosts the Doctor, Doctor radio shows/podcasts for the Catholic Medical Association.

Follow Church prescription for a Catholic living will

Living wills were first introduced by the Euthanasia Society of America in 1967, and were popularized by one of its members, advice columnist Abigail Van Buren (“Dear Abby”). Given the disreputable history of the living will, Catholic patients should ensure that end-of-life documents follow Church teaching. Living wills do not become activated until patients cannot speak personally to express their desires. Health care surrogates, usually family members, need to be assigned to speak for the patients then. A Catholic living will should also address the following 5 principles, to avoid the dangers of secular end-of life documents.

1. Relieving pain. Church teaching strongly supports patients being kept as free of pain as possible. This needs to be balanced with patients’ moral and family duties as they prepare with full consciousness to meet Christ.

2. Assessing treatments as ordinary or extraordinary. Patients and their families need to be given adequate information for a clear understanding of any end-of-life treatment. Is each treatment: 1) serving as a bridge to recovery from an acute medical problem, 2) alleviating suffering from an ongoing condition, or 3) offering little hope of benefit and actually becoming burdensome? There is no obligation to accept extraordinary treatments that have significant risks which may outweigh benefits.

3. Providing food and nutrition. A written request for receiving food and water, even if by artificial means, is generally not included in a standard secular living will that views assisted nutrition and hydration as medical treatment, but the Catholic Church views assisted nutrition and hydration as normal care. Pope St. John Paul II wrote:

“The administration of water and food, even when provided by artificial means, always represents a natural means of preserving life, not a medical act.”

When a terminally ill patient, however, is at the brink of death, body systems are shutting down and can no longer digest food. At this point assisted hydration and nutrition become burdensome and could be discontinued.

4. Prohibiting euthanasia. The immorality of Euthanasia and Physician-Assisted Suicide (PAS) predates Christianity, as Hippocrates prohibited this practice 2,400 years ago. The Catholic Church has always taught that these are grave violations of God’s law. In an age where PAS is being legalized, it is important to clearly state an opposition to this misguided autonomy and false mercy.

5. Requesting spiritual care. This provision asserts that a priest be notified and that the Sacraments be given. The Sacraments of Penance, Anointing of the Sick, and Viaticum are the healing Sacraments that give peace, strength, and grace in preparation for death. The Anointing of the Sick unites a person more closely to Christ’s Passion and uses suffering as a participation in His saving work.

A Catholic living will that includes these 5 principles — and a designated surrogate committed to Catholic principles to speak when the patient cannot — serves not only the patient’s own well-being, but also acts as a tool for evangelization by witnessing to the truth about human dignity, the redemptive value of suffering, and hope in eternal life. For a model Catholic end-of-life document: https://www. flacathconf.org/documents/2018/11/CDLD.pdf

Dr. PETER MORROW is the immediate past-president of the Catholic Medical Association, and practices geriatric medicine in Saint Cloud, Florida.

Accessing priceless, timely health intervention

Healthnetwork has been a Godsend to our family. My first experience with Healthnetwork was over 10 years ago. While on a family vacation to Egypt, my mother (85) slipped and dislocated her shoulder. She was taken to a local hospital, where they manipulated her shoulder back into place, then immobilized her arm until she could return home to a specialist.

Upon her return, although not in pain, Mom was still unable to move her arm. She consulted two different orthopedic specialists, who both stated that she tore her rotator cuff and needed surgery. She scheduled surgery, but something just did not feel right to me. We were longtime Legatus members, and I thought maybe Healthnetwork could be of help for a third opinion!

Since my mom was already scheduled for surgery, Healthnetwork secured an appointment in just three days with Dr. John Brems at Cleveland Clinic. He spent 45 minutes with my mother, explaining test results and why he felt her rotator cuff damage was age-related, not a result of the fall. He ordered a test which confirmed the auxiliary nerve to the deltoid muscle was damaged. Dr. Brems gave her exercises to remedy her mobility issues; no surgery was required.

Following his advice, Mom gained full use of her arm, rather than partial movement that surgery would have allowed. In my opinion, Healthnetwork saved her months of pain, rehabilitation, and risk of surgical complications. Most of all, it gave her continued quality of life and enabled her to leave a few weeks later for her winter home in Florida.

Four years ago, the shingles virus attacked my brother-in-law Tim’s heart, causing significant heart damage and resulted in him going in and out of AFib five times in those four years. On the fifth episode, Tim was in AFib for six weeks. Because he was frustrated, I asked if he’d like me to try my Healthnetwork connections. Cleveland Clinic offered the top heart specialists in the country.

Tim got an appointment with Dr. Amman Hussein, a specialist in cardiac electrophysiology. After spending 45 minutes reviewing test results with Tim, Dr. Hussein and Tim felt an ablation was the best course of action. Tim just completed his three-month check-up following the procedure. His heart is no longer enlarged, and ejection factor is back to normal. Tim says this is the best he has felt in years, and is grateful for Dr. Hussein.

My husband, Lee, had a triple bypass and two stents by a local cardiologist. He had great respect for his doctor; unfortunately, he was transitioning to a more administrative role, and Lee needed a new specialist. A call to Healthnetwork and we had an appointment. We are very pleased with a specialist in Interventional Cardiology that Cleveland Clinic has recommended. Lee’s appointment is approaching, and we are confident he’ll be in good hands.

I have witnessed two life-changing events facilitated by Healthnetwork. Fellow Legatus members should realize how easy it is to work with Healthnetwork. In my opinion, working through Healthnetwork guarantees a positive experience. We have become GOLD supporters because of the extraordinary care and attention we received from both Healthnetwork and Cleveland Clinic.

DIANE HUSS, (and her husband Lee) from LaSalle, Michigan, are Legates in the Genesis Chapter, as well as Healthnetwork GOLD supporters.

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.

Beating professional burnout

An unintended consequence of modern technology and all that it allows us to accomplish is the “burnout syndrome.”

Dr. Michael Parker

Burnout occurs when the excessive stressors of our work lives aren’t balanced by adequate rest and recovery. The hallmark symptoms of burnout include physical and emotional exhaustion, cynicism and feeling ineffective in our work. These symptoms can develop acutely or over an extended period of time.

Factors that promote burnout are multiple and varied. They include excessive workload, and a chaotic and inefficient work environment. Low inner work-life satisfaction occurs when there is a lack of alignment on values, mission, purpose and degree of meaning derived from work. Those who have difficulty with work-life integration or lack social support outside work are also at greater risk.

Circuit-overload signs

The effects of the chronic stress can result in a number of physical symptoms and illness. Warning signs of burnout include poor sleep, poor concentration and reduced job performance. Chronic stress compromises the immune system leading to decreased physical conditioning and increased absences due to illness such as colds and flu. At the extreme, it can lead to chronic illness such as heart disease, diabetes, thyroid dysfunction, anxiety and depression. Interpersonal relationships are affected, leading to disruptive employees, employee negativity and lack of engagement in work-related activities.

Organizations that have high rates of burnout experience greater employee turnover, lower employee satisfaction, increased number of absences due to illness and inability to perform the job well. Every day, about 1 million employees miss work because of stress-related concerns. The cost can be enormous. It has been estimated that excessive employee stress can cost from $150 to $300 billion dollars annually. Excessive workload affects employee performance through decreased ability to focus, poor organization and decreased engagement in work.

Beating burnout

As individuals, there must be a commitment to personal wellness through proper diet, exercise, sleep and social engagement. Employers can incentivize this through discounts in health insurance for meeting specific health goals, discounts to wellness facilities, offering healthy food choices in employee dining rooms and team-building events.

Mindfulness techniques such as meditation and breathing exercises, practiced throughout the day, also help to reduce stress. “Quiet spaces” where employees can engage in these practices should be made available.

Companies should offer productivity solutions that promote personal fulfillment. Executive coaching has been shown to help reduce the incidence of burnout and improve employee satisfaction, creativity and engagement in work. Teaching managers and leaders how to coach individuals improves teamwork creating more effective problem solving and sense of autonomy in co-workers.

Individuals must be empowered to seek help when feeling overwhelmed. Providing mental health or counseling services should be an essential employee benefit.

Aiming for balance

Increased work stress also affects personal life balance that can carry over into the workplace. Workers should assume permission to detach from work and prioritize that which brings meaning and balance. Flexible scheduling and working off site to accommodate for the family should be considered. Taking work home and answering emails at night should be discouraged.

Organizations must engage their employees to recognize burnout and build resiliency. A corporate culture of expected wellness developed through a commitment to employee well being leads to more engaged employees empowered to solve problems at the local level and focus on providing quality work.

MICHAEL S. PARKER, MD is an OB/ GYN at The Cleveland Clinic Foundation (Cleveland, OH). He is also director for caregiver wellness for the Women’s Health Institute of the Cleveland Clinic, tasked with addressing physician burnout and productivity, and is trained as an advanced peer coach to help fellow colleagues through coaching, mentoring and wellness. He is current treasurer of the National Catholic Medical Association. Along with Dr. Will Turek, he co-hosted the “Catholic Doctors Show” on St. Gabriel Catholic Radio, AM 820 for more than five years.

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.

 

Evaluating your health

Without good health, not much else matters. A complete physical exam is an excellent way to identify undetected illness, to pinpoint risk factors and to discuss lifestyle changes.

healthnetHow often should you be evaluated? A rule of thumb is three physicals in your 30s, four physicals in your 40s, five in your 50s, six in your 60s, etc. However, this frequency may depend upon your risk factors for different diseases. This article will explain several options for you.

Complete Physical Exam (CPE). These exams are most often done by your primary care physician (PCP). Most PCPs allot 60-90 minutes for a CPE. They schedule routine blood tests prior to your visit so your doctor can review the results and focus on abnormalities during the CPE. A chest X-ray and EKG are usually part of a CPE. Physicals should be tailored to your particular needs.

Executive Physical (Health Exam). Many of our partner hospitals offer executive physicals, which are designed to take 7-8 hours and get most, if not all, of your tests and procedures on the same day. This is very appealing to busy executives. Although the comprehensive exam is theoretically tailored to you, most patients get the standard evaluation which includes extensive laboratory testing, a cardiac health evaluation, visual exam, auditory exam, pulmonary evaluation, and weight, fitness and stress evaluations.

In addition to the standard evaluation, other options you may add on at an additional cost include genetic testing, whole body CT scan, dermatology consultation, etc. At the end of the day, your physician will review available test results with you and provide an overview of your health. In most cases, you will receive a written comprehensive report 2-3 weeks after the executive physical. The report will include recommendations for addressing problems and developing strategies for healthy living.

The main advantage is you can spend one day at the hospital and have all or most of your evaluation completed at one location. There are a few disadvantages to consider. Executive physicals entail comprehensive testing. While comprehensive testing may uncover some asymptomatic illness, it may lead to false positive results and unnecessary additional testing. Moreover, the physician who works with you during your physical will not be the same one to follow up with you if an issue is detected.

Destination Executive Health Programs. A destination executive health program (for example, Canyon Ranch in Tucson, Ariz.) includes a physical exam and comprehensive testing, but also places an emphasis on lifestyle changes with a more holistic approach. An advantage of a destination health program is that since you are in the unhurried atmosphere of a resort, it’s possible to focus on implementing lifestyle changes. It’s a more relaxing experience. The program can last four to seven days, with a condensed option lasting two days. Disadvantages include the longer time commitment, the expense and determining who will follow up on findings that are identified during the course of the evaluation.

The cost of these programs varies. The most cost effective is the CPE with your PCP, as most of the testing is covered by insurance. At an executive physical, some but not all testing will be covered by insurance. Destination programs are not covered by insurance.

SUSAN LOCKE, MD 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.