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Source: UNC Health Talk.

Heart failure, also known as congestive heart failure, is a chronic condition that affects more than 6 million Americans, according to the American Heart Association.

Despite its name, heart failure does not mean your heart has stopped working. Rather, it means that your heart has weakened or been damaged so it isn’t able to pump enough blood to the rest of your body. In other words, your heart simply cannot keep up with the demands of your body at rest or during activities, such as work or exercise. Common symptoms include swelling in the abdomen and legs, shortness of breath with walking or lying down, and fatigue.

“Heart failure is a generic term that actually encompasses a lot of different syndromes,” says UNC REX cardiologist Elizabeth Volz, MD. “It can be caused by any number of things.”

Common and Not-So-Common Causes of Heart Failure

In the United States, one of the most common causes of heart failure is coronary artery disease, Dr. Volz says. Coronary artery disease results from the buildup of plaque or fatty deposits in your arteries. This slows blood flow, which can lead to a heart attack.

“If someone had a heart attack or damaged their heart muscle directly, it puts a significant strain on the heart,” she says.

In addition to coronary artery disease, uncontrolled high blood pressure may lead to heart failure.

“Chronically elevated blood pressure means your heart has to work harder than it should to circulate blood throughout your body,” Dr. Volz says. Over time, this extra workload can make your heart muscle too stiff or too weak to pump blood effectively. Damage to the heart muscle caused by drug or alcohol use or some viruses also increases the risk of heart failure. Diabetes is another strong risk factor for coronary artery disease and subsequent heart failure.

Dr. Volz says less common causes of heart failure include genetic predisposition, obesity and some medications, such as certain chemotherapy.

Warning Signs

Two of the most common symptoms of heart failure, Dr. Volz says, are shortness of breath and fatigue.

“These tend to be worse when people are trying to do activities, something as benign as walking from room to room, up a flight of stairs, carrying groceries or trying to work,” she says.

Another common symptom is retaining fluid. This is partly because the kidneys aren’t receiving enough blood to work properly; the fluid may build up in the arms, legs, lungs or other organs, and the body becomes congested—hence the term congestive heart failure. Also watch out for symptoms such as chest pain, dizziness or fainting, and fluctuations in blood pressure.

How to Treat Heart Failure

Heart failure is a serious condition that requires medical attention. However, with proper treatment and lifestyle changes, you can live a long, active life.

“There are prescription medications that address whatever it is that was causing the heart to fail. So if it’s high blood pressure, then the medications would address the high blood pressure. If it’s fluid retention, diuretics increase urination to help remove excess fluid from the body,” Dr. Volz says. “With good medical therapy, patients can have an improvement in symptoms and go on to lead normal lives.”

Patients who have heart blockages or have had a heart attack may need a procedure to place stents or bypass surgery to improve blood flow.

In addition to medication or a heart procedure, Dr. Volz says patients need to follow a low-salt diet and make other lifestyle changes. “We educate all of our patients on low-sodium diets because salt affects fluid retention. If you eat a high-salt diet, it tends to make you retain even more water, and that’s detrimental to someone who has congestive heart failure,” she says. “Smoking and alcohol use are strongly discouraged because of their impact on the heart and blood pressure.” Exercise and being active are also encouraged.

Dr. Volz encourages patients to weigh themselves every morning to monitor water retention. If they see a difference, they should call their doctor. “If a patient gains water weight quickly, we may instruct them to take additional water pills for a couple of days to help reduce fluid retention,” she says.

She also asks patients to monitor their blood pressure and heart rate daily. “This way we can make sure that we get them on the optimal dose of the medications,” she says. “To some degree, we want patients to have low blood pressure, because that helps the heart pump more efficiently.”

Improvement Takes Patience

Dr. Volz cautions that the medications may make people feel worse before they feel better. The medications focus on the chemical changes that happen with heart failure.

“When the heart’s failing, there are a lot of signals from the nervous system, a lot of chemicals and hormones that really snowball and make you feel worse,” Dr. Volz says.

“Patients need to hang in there and take their medication even if they don’t necessarily feel better right away,” Dr. Volz says.

An Ounce of Prevention

It’s important for everyone to see a primary care doctor regularly, Dr. Volz says. A physician’s monitoring can help limit the development of risk factors and eventually heart failure symptoms.

“If you’re overweight, have high blood pressure, diabetes or smoke, see a primary care provider to manage those things before they lead to heart disease,” she says. “Oftentimes we can intervene with regular medical care.”

People with a family history of heart failure or heart disease may benefit from seeing a cardiologist, who can detect any problems early.

If you are concerned about heart failure or have a family history of heart disease, call your doctor. If you don’t have one, find a doctor near you.

Click to find more articles like this at UNC Health Talk.

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Source: UNC Health Talk.

Swimmer’s ear peaks in the summer months, when people are more likely to go swimming, but you can get it without ever going in the water.

Each year, millions of people in the United States see a doctor or another health care provider to get treatment for a painful ear infection called acute otitis externa. You probably know it by its more popular name: swimmer’s ear.

This common condition happens to 10 percent of people at some point. Here’s what to know.

You Don’t Have to Swim to Get Swimmer’s Ear

The infection is usually caused by one of two types of bacteria, Pseudomonas aeruginosa or Staphylococcus aureus. Water left in the ear canal after swimming provides an environment that is favorable for these bacteria to grow, but there are other ways for the germs to take root in the ear, says Christine DeMason, MD, an ear, nose and throat physician at UNC Medical Center in Chapel Hill.

Any water, sand or other debris that gets into the ear canal and stays there can cause the infection.

“Lots of people who get swimmer’s ear don’t go near the water,” Dr. DeMason says.

“Sometimes people try to clean their ears with cotton swabs. This can cause damage or irritation to the lining of the ear canal, and that gives bacteria a way to get in and cause an infection.”

That’s why doctors recommend that you never put any foreign objects, including cotton swabs or your fingers, inside your ears.

People who wear hearing aids are at risk of developing swimmer’s ear because hearing aids can break down the natural protective barrier of the skin and trap moisture. That doesn’t mean people who need hearing aids shouldn’t wear them, Dr. DeMason says; she simply recommends that people take them off when they aren’t using them, such as at night.

Signs, Symptoms and Treatment of Swimmer’s Ear

Some of the more common signs and symptoms of swimmer’s ear include:

  • Itching inside the ear
  • Pain inside the ear that gets worse when you tug on the outer ear
  • Sensation that the ear is blocked or full
  • Drainage from the ear
  • Decreased hearing

In most cases, swimmer’s ear can be treated with a careful cleaning of the ear canal (which should be done by a health care professional) and prescription eardrops that inhibit bacterial or fungal growth and reduce inflammation. These drops often contain antibiotics and steroids. You may also be prescribed medication to reduce pain.

If your ear canal is swollen, your doctor might place an ear wick in the ear canal to help the drops reach their target. In rare cases, patients may also be given IV antibiotics if eardrops aren’t enough to clear the infection by themselves.

If left untreated, swimmer’s ear can lead to more serious problems, such as a deep tissue infection called cellulitis, or to bone and cartilage damage. That’s why you should always see your health care provider if you think you might have swimmer’s ear, Dr. DeMason says.

How to Reduce Your Risk

To reduce your risk of swimmer’s ear, the Centers for Disease Control and Prevention recommends that you keep your ears as dry as possible when swimming by wearing a bathing cap, earplugs or custom-fitted swim molds. You should also dry your ears thoroughly after swimming or showering. However, you should not try to use cotton swabs, or anything else, to remove your earwax, because earwax helps protect your ear against infection.

Your risk of swimmer’s ear is higher when you swim in natural bodies of water, such as rivers, lakes or the ocean, compared with swimming in a chlorinated swimming pool, Dr. DeMason adds. That’s because natural bodies of water are more likely to have higher levels of bacteria.

That doesn’t mean you should never swim in a natural body of water, she says, but if you want to reduce your risk of swimmer’s ear, a swimming pool is the safer option.

You can also use over-the-counter eardrops to help dry out your ears after swimming. They’re often called drying eardrops or swimming eardrops. But Dr. DeMason recommends that people make their own: Mix one part rubbing alcohol with one part white vinegar. Add a few drops to the ear when it’s wet.

For people with eczema, who are also prone to swimmer’s ear, the problem is the opposite: The skin is too dry, which can lead to infection in the ear canal. For these people, Dr. DeMason recommends mineral oil, which lubricates without water.

If you are experiencing symptoms that may be swimmer’s ear, call your primary care doctor or visit an urgent care location. If you have a persistent problem with swimmer’s ear, talk to your doctor about seeing an ENT specialist or a pediatric ENT specialist. Need a doctor? Find one near you.

Click to find more articles like this at UNC Health Talk.

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Source: UNC Health Talk.

Strokes can be tricky: They tend to come without warning and don’t announce themselves like other types of illnesses.

“Humans’ usual way of sensing danger is pain, and unfortunately most strokes don’t come with pain,” says David Y. Huang, MD, PhD, neurologist and director of UNC Hospitals Comprehensive Stroke Center.

So how do you know when to head to the emergency department?

The acronym BE FAST—loss of Balance, Eyes (loss of vision or double vision), Facial drooping, Arm weakness, Speech difficulties and Time to call emergency services—is used as a benchmark for when to get help. That is, if someone is experiencing any of those symptoms, you should call 911 immediately. (Calling 911 is preferred to driving to the emergency department, as stroke care can begin in the ambulance.)

But it’s important to know that strokes manifest in myriad ways, and BE FAST doesn’t cover every warning sign. Here, Dr. Huang explains what happens to the body during a stroke and what it means for those who might experience it.

What Happens During a Stroke

“What generally all strokes have in common is that brain cells die,” Dr. Huang says. There are different types of brain cells, but the most critical ones are the neurons, which act like wires that transmit signals from cell to cell. There are other cells in the brain that can be affected, such as the cells that insulate neurons, like plastic coating around a wire.

Because each part of the brain controls certain functions, the results of a stroke will differ depending on which part of the brain is damaged. “When the average person experiences a stroke, they will develop some sort of weakness or a deficit,” Dr. Huang says. That deficit could be:

  • Speech problems (slurred speech, inability to understand or produce language)
  • Weakness or numbness on one side of the body
  • Vision issues (double vision, inability to see or process what you’re seeing)
  • Impairment of a motor activity
  • Confusion

“Depending on the cell that dies and in what part of the brain damage occurs, you get certain degrees of damage. If you kill neurons, the damage is pretty much as permanent as it gets,” Dr. Huang says. “You might have other neurons that can recover some function, but it’s not going to be great function. But if you injure the insulating cells, there is some level of recovery with that.”

This is one of the biggest differences between strokes and heart attacks. “Unlike heart attacks, where you damage heart tissue but your heart hopefully keeps pumping, in the brain, stroke can present in varying different ways: Your left side might be weak, your right side might be weak, you might not be able to speak or you could have blurry vision, and that function might not be recovered,” Dr. Huang says. “It’s more complex, which can make it hard to diagnose a stroke.”

To make matters more complicated, most brain cells don’t have nerves, which means they can’t sense pain. “When you have a stroke, more often than not, you’re not going to feel pain,” Dr. Huang says. “So again, unlike heart attack, where you might have pain that signals people to go to the emergency room, with a stroke, you probably won’t feel anything. That’s why some people tend to go, ‘Hmm, I guess I’ll just sleep this off’— because there’s not this huge warning sign that something really bad is happening.”

Different Types of Strokes

There are two main types of strokes: ischemic and hemorrhagic. Most strokes are ischemic, caused by a blockage of a blood vessel. In this case, the blockage doesn’t allow nutrients such as oxygen and glucose to get to the brain, which causes brain cells to die.

Hemorrhagic strokes are caused by a rupture of a blood vessel. The rupture can be very small within the brain tissue, which forces blood into the tissue, or an aneurysm, a weakened area in an artery, can rupture and pool blood into the space outside of the brain. Unlike with ischemic strokes, people who have hemorrhagic strokes may experience a headache.

“Unlike brain cells, the outside lining of the brain does have the ability to sense pain,” Dr. Huang says. Because hemorrhagic strokes put pressure on the brain, it’s possible for the lining of the brain to perceive that pressure, resulting in a person getting a severe headache as a symptom of the stroke.

“But it’s not a hard-and-fast rule,” he says. “Long story short: You can never tell, and you should seek help immediately.”

What About “Ministrokes”?

The term “ministroke” is commonly used to describe a stroke with mild symptoms, but Dr. Huang says that belittles the seriousness of stroke.

“A ministroke is a really bad term, and we as neurologists are trying to eradicate it and get doctors to understand that there really is no such thing as a ministroke,” Dr. Huang says.

Instead, Dr. Huang breaks down “ministroke” into two categories: transient ischemic attacks (TIAs) or strokes with mild symptoms (mild stroke).

With a TIA, people will experience stroke symptoms, but those deficits will resolve and people will return to normal within 24 hours. Doctors will start people on a preventive track to reduce the risk of a future stroke, though no rehabilitation is needed. A preventive track consists of medications (and sometimes surgical procedures) to reduce the chance of future strokes as well as modifying stroke risk factors, such as controlling blood pressure, high cholesterol and diabetes. If appropriate, smoking cessation counseling is provided.

Conversely, after a mild stroke, a person will experience a deficit, though it might not manifest as significant damage. “This means they might have a bit of slurred speech or their coordination is a little clumsy and so on, and though they might seem OK, they are not back to 100 percent,” Dr. Huang says. People who experience a mild stroke will probably need some form of therapy—physical, occupational or speech therapy—to make a full recovery.

The tricky part is that mild strokes are commonly misdiagnosed as TIAs, and a deficit left untreated can cause additional problems or disability. For example, imagine that a patient has had a mild stroke and, because it was not debilitating, he or she is sent home from the hospital without therapy.

“But if they’re having trouble swallowing and no one picks that up, the next thing you know they could start choking on their food,” Dr. Huang says. “Oftentimes they need therapy, but no one has identified that they need it, so they go on with their lives and don’t optimize their recovery.”

It’s important to note that in both TIAs and mild strokes, a person may first exhibit severe stroke symptoms. Because stroke severity is classified by long-term damage rather than initial symptoms, the difference between a more serious stroke event and a TIA is that with a TIA, you will suddenly get better. For a mild stroke, if it’s treated appropriately, you can regain most function.

Either way, doctors can only differentiate between a TIA, a mild stroke or a more significant stroke through a physical exam and testing.

“We never know which way it’s going to go: You can have a severe stroke that gets better or a mild stroke that gets worse,” Dr. Huang says. “The reason why it’s important for people to come quickly after experiencing symptoms is that doctors have a big toolkit that we can use to not just treat strokes but actually prevent them while they’re happening. The sooner the patient gets to the hospital, the more chances we have to be able to treat them.”

If you or someone near you is experiencing stroke symptoms, call 911 immediately. For long-term care, find a neurologist near you.

Click to find more articles like this at UNC Health Talk.

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Source: UNC Health Talk

We’ve all been there. One minute you’re asleep, and the next you’re jarred awake by severe stomach cramps and nausea. As you stumble to the bathroom, you recall the odd-tasting potato salad you had at your neighbor’s barbecue, and it hits you—you have food poisoning.

Food poisoning, or more accurately foodborne illness, affects 48 million people in the United States and causes 128,000 people to be hospitalized annually. It can even be deadly, with 3,000 people dying from foodborne illnesses each year.

The good news is that most people get better without medical treatment. The bad news is that it’s really, really unpleasant to experience.

So what causes food poisoning, and how can you prevent it? We talked to UNC Medical Center infectious disease specialist Arlene Seña, MD, MPH, to learn more.

Common Causes of Foodborne Illnesses

There are more than 250 foodborne diseases. Most are caused by infections from bacteria, viruses or parasites, but toxins such as pesticides also cause food poisoning. These illnesses can be transmitted on food itself or by the person handling the food.

The most common cause of foodborne illnesses in the United States is norovirus. “This one is most commonly associated with cruise ship outbreaks, where many individuals are grouped together in close quarters and may eat similar food items that can become contaminated from an ill person,” Dr. Seña says. People typically develop symptoms 12 to 72 hours after exposure to the norovirus.

And if you eat something and get sick right away? You might be dealing with Staphylococcus aureus (staph) bacteria, which can cause a reaction as soon as 30 minutes after you eat the contaminated food because of a bacterial toxin.

“It’s an immediate reaction and is usually caused by eating foods that have been sitting out, such as deli meats that are not cooked after handling,” Dr. Seña says.

Other bacteria that can cause food-related illnesses are salmonella, shigella, campylobacter, listeria and E. coli.

After norovirus, Dr. Seña says salmonella is most common, and symptoms such as stomach cramps, vomiting, diarrhea and fever occur within 72 hours of exposure. Salmonella can be found in raw meats, eggs, fruits and vegetables. Bloody diarrhea can be a sign you have salmonella or other bacterial foodborne infections.

When to Seek Treatment for Food Poisoning

If you experience symptoms of food poisoning, what can you do? Often, you can treat yourself at home. Dr. Seña says if you have stomach cramps but no vomiting or diarrhea, you can take a medicine for upset stomach such as Pepto-Bismol. Over-the-counter medicines such as Imodium also can be taken for diarrhea, which should resolve in one to two days if caused by a viral infection.

If you are vomiting or have diarrhea, it’s important to stay hydrated, so drink lots of fluids. “You need lots of water because you lose a lot of fluids through both of those symptoms,” Dr. Seña says. “Norovirus can cause watery diarrhea several times a day, so keeping hydrated is very important, especially for the young, the old and those with weakened immune systems.”

These populations can experience more severe symptoms and often need to be hospitalized, Dr. Seña says. These symptoms can include dizziness or lightheadedness.

“If you have these symptoms and just can’t keep fluids down, then it’s very possible that you need to go to the emergency room for intravenous hydration,” she says.

You should also go to an urgent care facility or emergency room if you develop a fever, have bloody diarrhea or your symptoms get worse.

In the hospital, health care providers will take a stool sample and perform diagnostic tests, such as a gastrointestinal pathogen panel that can detect norovirus, bacterial infections and other parasitic infections.

If in doubt about whether to seek medical attention, call your doctor. You may need antibiotics for bacterial foodborne infections, especially if you have other medical conditions, including pregnancy or a compromised immune system.

Preventing Food Poisoning

Dr. Seña says to take these steps to help prevent foodborne illnesses:

  • Wash your hands well with soap and water, especially after using the bathroom and before you eat. Antibacterial gels also may be effective, except against norovirus.
  • Avoid uncooked or undercooked meats and eggs.
  • Thoroughly wash raw vegetables and fruits.
  • Avoid contaminating other foods or kitchen surfaces when handling raw meat.
  • Make sure your food is properly cooked, heated and refrigerated.
  • Avoid raw shellfish.
  • If you’re pregnant, talk to your doctor about additional precautions, such as avoiding unpasteurized cheese.

If you’re experiencing symptoms of food poisoning and need medical care, visit an urgent care facility or emergency department near you or call your doctor. If you need a doctor, find one near you.

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Source: UNC Health Talk.

More than 30 million Americans have diabetes, but there are many misconceptions about what it does to the body, who can get it and how it’s treated. We talked to UNC Health Care experts to create this explainer.

The Disease

“Diabetes in all its forms is essentially excess sugar in the bloodstream,” says Deepa Kirk, MD, medical director of the UNC Hospitals Diabetes and Endocrinology Clinic at Meadowmont and associate professor of medicine in the UNC School of Medicine.

Sugar, specifically glucose, is the main source of energy for the cells in our body. Glucose from the carbohydrates we eat gets broken down by our digestive system and passed into our bloodstream, which we can think of as the energy delivery highway. Blood carries glucose throughout the body, delivering it to cells that absorb the nutrient.

“Cells are unable to absorb glucose without the hormone insulin, which is produced by beta cells in the pancreas,” Dr. Kirk says. “When that insulin is hampered in some way and glucose isn’t adequately absorbed by cells, glucose stays in the bloodstream causing high blood glucose, or hyperglycemia.”

Blood sugar can be measured through a variety of blood tests. High blood sugar has a number of effects on the body, including low energy and fatigue. If your cells aren’t getting the energy they need, they don’t perform at 100 percent, meaning you don’t feel 100 percent.

“Too much glucose in the bloodstream for too long can also hurt the blood vessels carrying that glucose,” Dr. Kirk says.

Higher than normal blood glucose levels cause blood vessels to contract more, allowing less blood to pass throughout the body. Poor blood flow can cause microvascular and macrovascular damage. Micro damage affects small blood vessels that supply blood to organs. The eyes, kidney and nerves are typically harmed by micro damage. Macro damage affects large blood vessels that supply blood to the heart, brain and limbs. Stroke, heart attack and amputation can result from macro damage.

The most common types of diabetes are type 1, type 2 and gestational. While the general effects of diabetes on the body are the same, the causes and management of high blood glucose vary among the different types of the disease.

Type 1 Diabetes

What causes it: An autoimmune response where the body’s defense system mistakenly attacks the beta cells in the pancreas that produce insulin, resulting in very little or no insulin being produced. Symptoms tend to appear quickly because of the drastic change in blood glucose levels.

Symptoms include: Increased thirst, frequent urination, bed-wetting in children who previously didn’t wet the bed, unintended weight loss, fatigue and blurred vision.

Who can get it: Anyone, no matter their weight, age or ethnicity. It used to be called juvenile-onset diabetes because the symptoms usually start when people are children or young adults, however diagnosis can happen at any age. Those with a family history of type 1 diabetes have a slightly higher chance of getting it and should be screened.

How common is it: About 1.25 million Americans have type 1 diabetes.

How is it managed: Regular insulin injections every day for people with type 1 diabetes are crucial. Without them, a patient could die. Patients have to continuously monitor their blood glucose levels and give themselves doses of insulin when needed. There are multiple options for patients to keep track of their blood glucose levels and deliver insulin injections. An insulin pump is a catheter placed under the skin that allows the patient to deliver insulin with more flexibility.

Can it go away: At this time, type 1 diabetes is considered a chronic disease that lasts a lifetime. More research needs to be done on what actually causes the autoimmune response that attacks the insulin-producing cells. In the most extreme cases, a pancreas transplant can potentially cure diabetes, though the side effects are significant.

Type 2 Diabetes

What causes it: Insulin resistance (the body doesn’t respond to insulin the way it should) and relative insulin deficiency (the body is making insulin, but not enough to counteract insulin resistance).

Symptoms include: The same as for type 1, along with slow-healing sores, frequent infections and areas of darkened skin—usually in the armpits and neck.

Who can get it: Type 2 diabetes used to be called adult-onset diabetes because it is commonly diagnosed in adults, but it can happen at any age. The exact causes are unknown but thought to be a combination of genetic and environmental factors. It can remain undetected for many years until it’s found during a screening or when high amounts of blood glucose start to cause complications. This is why routine screenings are important for those at higher risk for type 2 diabetes: people with a family history, people who are not Caucasian, people who smoke, people who are overweight or sedentary, people over the age of 45, women who have had gestational diabetes, and a child they carried during such a pregnancy.

The very early stages of type 2 diabetes are called prediabetes, which means the body’s blood glucose levels are higher than normal but not high enough to be diagnosed as diabetes. Those with prediabetes could develop type 2 diabetes over time.

How common is it: It’s the most common type of diabetes among the 30 million Americans with diabetes, accounting for 90 to 95 percent of all cases.

How is it managed: Type 2 also is also referred to as noninsulin-dependent diabetes, because unlike for patients with type 1 diabetes, insulin injections are not necessarily a required part of daily life. Type 2 can be managed with a combination of healthy diet, increased exercise, weight loss, medications and insulin injections if needed.

Can it go away: Yes. Some patients, with weight loss and lifestyle changes, can reverse type 2 diabetes, but that outcome is rare. Many patients can control it with diet and exercise at first but eventually need a combination of oral medications and insulin injections. That doesn’t mean that weight loss still can’t have significant effects; even modest degrees of weight loss and dietary changes can make a dramatic difference in diabetes control.

Gestational Diabetes

What causes it: Pregnancy. Something about pregnancy itself makes all pregnant women more resistant to insulin when they reach around 20 weeks gestation. More research is needed to understand exactly why this happens.

Symptoms include: Most women do not have symptoms, but if they do appear, they are similar to those for types 1 and 2 diabetes: increased thirst, frequent urination, fatigue and nausea.

Who can get it: Pregnant women. It is associated with complications to both mother and baby during pregnancy.

How common is it: One in 25 pregnancies worldwide result in the development of gestational diabetes. All women with adequate access to health care, except those with known cases of diabetes, are screened for gestational diabetes during pregnancy.

How is it managed: Mild cases can be managed through diet and physical activity. Other cases require insulin injections. When managed well, pregnancies with gestational diabetes most often result in delivery of a healthy baby.

Can it go away: Yes. Gestational diabetes usually goes away within days or weeks after delivery. But women who develop gestational diabetes and the child they carried during that pregnancy are at a higher risk of developing type 2 diabetes later in life. About half of women with gestational diabetes develop type 2 diabetes five to 10 years after pregnancy.

Other Types of Diabetes

There are other, much less common types of diabetes. These include secondary diabetes, which is a rise in glucose caused by medications, such as those used for organ transplants or steroids. Damage to beta cells that occurs during pancreatitis can affect insulin production and cause diabetes. Specific gene mutations can also affect insulin production, but these cases are often misdiagnosed as type 1 diabetes. All of these types of diabetes are managed with insulin injections or a combination of injections and oral medications.

Common Misconceptions about Diabetes

Michelle Mielke, RD, LDN, is a certified diabetes educator for patients at the UNC Hospitals Diabetes and Endocrinology Clinic at Meadowmont. She says there are many misconceptions about diabetes. Some of them include:

You can’t eat carbs anymore: While patients with diabetes need to be aware of how many carbohydrates they are consuming, a diagnosis of diabetes doesn’t mean you have to cut them out of your diet completely. A balanced, healthy diet of fruits, vegetables, lean protein and complex carbohydrates is advised for most everyone, including people living with diabetes.

People only get type 2 because they’re overweight: Being overweight or obese is a contributing factor to type 2 diabetes and can make blood glucose levels more difficult to control. It is rarely the only reason for type 2 diabetes.

High blood glucose levels are all a person with diabetes needs to worry about: Patients with diabetes can also experience low blood glucose levels (hypoglycemia) if they take too much insulin, or if they do not eat enough or exercise more than anticipated when taking insulin or several other diabetes medications. If not addressed quickly, low blood glucose levels can cause someone to faint, have a seizure or go into a coma. Mielke teaches patients what to do if their blood glucose goes below 70 mg/dl. She says to quickly eat or drink 15 grams of easily digestible sugar such as three to four glucose tablets, a half cup of juice or soda, three to four hard candies, or one tablespoon of sugar.

Are you concerned about diabetes? Talk to your doctor about having your blood glucose levels tested. Learn about diabetes services offered by Johnston Health or call our Diabetes Hotline at 919-209-3386 to speak to one of our Certified Diabetes Educators.

Click to find more articles like this at UNC Health Talk.

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It’s Occupational Therapy Month and most of us at some point in our lives will need occupational therapy, but do you know what an occupational therapist does? Keep reading to learn a little bit about what they do and be sure to thank an occupational therapist for their hard work!

What is occupational therapy?

Defined by the American Occupational Therapy Association, occupational therapy is the only profession that helps people across the lifespan to do the things they want and need to do through the therapeutic use of daily activities (occupations). Occupational therapy practitioners enable people of all ages to live life to its fullest by helping them promote health, and prevent—or live better with—injury, illness, or disability.

There are two professional levels of occupational practice- occupational therapist and occupational therapist assistant.

You can find occupational therapists in a variety of settings:

  • Hospitals
  • Schools
  • Rehabilitation centers
  • Mental health facilities
  • Private practices
  • Children’s clinics
  • Nursing homes

According to the Bureau of Labor Statistics, occupational therapists typically do the following:

  • Review patients’ medical history, ask the patients questions, and observe them doing tasks
  • Evaluate a patient’s condition and needs
  • Develop a treatment plan for patients, identifying specific goals and the types of activities that will be used to help the patient work toward those goals
  • Help people with various disabilities perform different tasks, such as teaching a stroke victim how to get dressed
  • Demonstrate exercises—for example, stretching the joints for arthritis relief—that can help relieve pain in people with chronic conditions
  • Evaluate a patient’s home or workplace and, on the basis of the patient’s health needs, identify potential improvements, such as labeling kitchen cabinets for an older person with poor memory
  • Educate a patient’s family and employer about how to accommodate and care for the patient
  • Recommend special equipment, such as wheelchairs and eating aids, and instruct patients on how to use that equipment
  • Assess and record patients’ activities and progress for patient evaluations, for billing, and for reporting to physicians and other healthcare providers
Occupational Therapy vs Physical Therapy- what’s the difference?

The main difference between occupational therapy and physical therapy is that OT focuses on fine motor skills, cognitive skills and sensory- processing deficits and PT focuses on a person’s pain, strength, range of motion and endurance (KidsHealth from Nemours).

Johnston Health offers occupational therapy through our rehabilitation services. You must have a physician’s referral. Learn more about our rehabilitation services.

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Written by Dr. Karl Bowman, Jr., General Orthopedics with EmergeOrtho

Walking as exercise is a great way to improve your overall health and well-being. Walking burns up to 100 calories per mile, and can help to reduce fat, weight, and improve heart health. It is also an inexpensive way to begin an exercise program, as no expensive gym memberships are required. All you need is some motivation, a comfortable pair of supportive shoes, and weather appropriate clothing.

Here are 6 tips to help you to get started:

Walk at a conversational pace.

You should feel some effort while walking, but make sure that you can maintain a conversation.  In fact, walking with a friend or spouse is a great way to stay motivated while improving health and relationships!

Begin slow.

Depending on your fitness level, a gradual increase in walk length and intensity is recommended.  One example is to increase your walking time by 3-5 minutes every week.  National guidelines recommend performing 150 minutes per week of moderate aerobic exercise.  This would mean a 30 minute walk 5 days per week.  At the beginning this may seem like a lot, but even small amounts of exercise are beneficial to your health.  Ultimately, the goal is to be able to walk up to 1 hour at a time.

Set goals, but be realistic.

One way to stay motivated when beginning any new exercise program is to set goals.  Consider picking an event or activity, such as a local or charity 5K run/walk.  This helps to set a firm time line to achieve, and can help to motivate you to get outside and walk when your legs might feel a little bit tired, or the weather might not quite be perfect!

Dress for success.

Wearing comfortable and supportive shoes is a critical factor in improving and maintaining a walking program.  Your foot wear should provide adequate cushioning for your heel, and not cause blisters.  Comfortable, moisture wicking socks can also help to prevent blisters and minimize foot moisture.  Very thin or unsupportive footwear, such as flip-flops or sandals, can lead to toe and foot pain.

Clothing should be comfortable and breathable.  Avoid clothes that are too tight or cause chafing between your legs or in your armpits.  Make sure to dress appropriately for the weather and temperature.

Consult your doctor.

Consider visiting your doctor before beginning an exercise program if you have heart problems, diabetes, difficulty with shortness of breath or dizziness with standing up or walking, a history of fainting, are pregnant, or if you are over the age of 65 and are not currently involved in an exercise program.

Most importantly, have FUN!

Walking is a very social and enjoyable activity, and can lead to a healthier lifestyle!

Karl F. Bowman, Jr., MD
General Orthopedics, Sports Medicine

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If it’s your first time entering a race, then consider the Johnston Health Foundation’s Champions 5K/10K on April 13 at Johnston Health in Smithfield. The event is family friendly (including dogs and strollers), and helps local people in need.

The USATF-certified course starts at the hospital entrance, winds through historic neighborhoods, and follows a section of the Neuse River greenway. Volunteers along the way cheer on the runners, man the water stations, and keep participants on track. Before and after the race, there’s music, snacks and vendor booths, too.

Proceeds will go toward two of the foundation’s programs. The Healthy Kids fund provides at-risk youngsters with scholarships to a 12-week nutrition and fitness education program at HealthQuest. The Heart Fund provides assistance to financially challenged patients in need of life-saving heart care.

If you’re ready to take on a second challenge, why not try the Gobble Waddle 5K/10K on Nov. 16? The course is in south Smithfield, and follows gentle hills past historic homes and manicured neighborhoods. The race is also timed, and the course is certified. Proceeds will also go to the Heart and Healthy Kids funds.

Participants can register for both events in one transaction by clicking the “bundle” option on the registration page. Also notable, those who complete both races will receive a special long-sleeved T-shirt at the Gobble Waddle.

Visit www.johnstonhealth.org/champions to register as a participant, or to make a donation.

Pictured: Runners dash from the starting line at last year’s Champions 5K/10K, a fundraiser of the Johnston Health Foundation. Registration is now open for the race on April 13 and a second race, the Gobble Waddle, on Nov. 16.

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There’s pollen on the breeze. Suddenly your eyes begin to itch, and you have trouble breathing through your nose. It’s your allergies acting up again, and they seem to give you problems every year. But what’s going on inside your body when you have an allergy?

Turns out it’s all a big misunderstanding.

Allergies occur when the immune system misidentifies typically harmless allergens as invading foreign substances and tries to fight them off. The sneezing, congestion and hives you experience is your own body’s immune system battling what it perceives as a danger.

“Allergens are mostly innocuous,” says Millie Kwan, MD, PhD, an allergist with the UNC Allergy and Immunology Clinic. “But when someone who is susceptible to developing allergies encounters an allergen like pollen, for example, their immune system triggers a response to fight the perceived danger.”

Here’s what happens during an allergic reaction:
  1. Exposure to an allergen prompts white blood cells, called T and B cells, to spring into action. B cells are responsible for the immune system’s adaptive antibody response, so they play a critical role in our health. But sometimes, they overreact and identify substances, like tree pollen, as a threat. Then they produce antibodies to fight that allergen.
  2. These antibodies, known as immunoglobulin E (IgE), bind to another kind of white blood cell, called a mast cell. When you encounter an allergen, the antibodies signal to the mast cells that it’s time to fight.
  3. The mast cells release histamine and other inflammatory molecules to battle what the body perceives as a danger. Histamine causes small blood vessels, known as capillaries, to become leaky. This makes the blood vessels more permeable, causes tissue to swell, and allows more of the white cell troops to join the battle. Making matters worse, as the mast cells release these inflammatory molecules, they are also signaling the rest of the immune system to mobilize against the threat.

“That’s how you get the typical allergic response,” Kwan says. “Your immune system is trying to tell your nose to sneeze to get rid of the pollen, and your eyes to water because pollen particles are landing there. Your nose is producing a large amount of mucus to get what it perceives as foreign substances out of your body—in essence, that’s the body’s goal during an allergic response.”

If you experience seasonal allergies, talk to your doctor about the best treatment for you. Need a doctor? Find one near you.

Click to find more articles like this at UNC Health Talk.

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Colorectal cancer is a cancer that starts in the colon or the rectum, both of which are parts of the large intestine, located in the lower part of the body’s digestive system. During digestion, food moves through the stomach and small intestine into the colon.

All cancer starts when genes in a cell mutate thereby causing abnormal cells within the body. Colorectal cancer often begins as a growth called a polyp, which may form on the inner wall of the colon or rectum. Some polyps become cancerous over time. Finding and removing polyps via colonoscopies can prevent colorectal cancer.

  • Older age.The great majority of people diagnosed with colon cancer are older than 50. Colon cancer can occur in younger people, but it occurs much less frequently.
  • African-American race.African-Americans have a greater risk of colon cancer than do people of other races.
  • A personal history of colorectal cancer or polyps.If you’ve already had colon cancer or adenomatous polyps, you have a greater risk of colon cancer in the future.
  • Inflammatory intestinal conditions.Chronic inflammatory diseases of the colon, such as ulcerative colitis and Crohn’s disease, can increase your risk of colon cancer.
  • Inherited syndromes that increase colon cancer risk.Genetic syndromes passed through generations of your family can increase your risk of colon cancer. These syndromes include familial adenomatous polyposis and hereditary nonpolyposis colorectal cancer, which is also known as Lynch syndrome.
  • Family history of colon cancer.You’re more likely to develop colon cancer if you have a parent, sibling or child with the disease. If more than one family member has colon cancer or rectal cancer, your risk is even greater.
  • Low-fiber, high-fat diet.Colon cancer and rectal cancer may be associated with a diet low in fiber and high in fat and calories. Research in this area has had mixed results. Some studies have found an increased risk of colon cancer in people who eat diets high in red meat and processed meat.
  • A sedentary lifestyle. If you’re inactive, you’re more likely to develop colon cancer. Getting regular physical activity may reduce your risk of colon cancer.
  • Diabetes. People with diabetes and insulin resistance have an increased risk of colon cancer.
  • Obesity. People who are obese have an increased risk of colon cancer and an increased risk of dying of colon cancer when compared with people considered normal weight.
  • Smoking. People who smoke may have an increased risk of colon cancer.
  • Alcohol. Heavy use of alcohol increases your risk of colon cancer.
  • Radiation therapy for cancer.Radiation therapy directed at the abdomen to treat previous cancers increases the risk of colon and rectal cancer.

Colorectal cancer (CRC) is the fourth most commonly diagnosed cancer among adults in the United States. More than 140,000 Americans are expected to be diagnosed with CRC this year. It is the second leading cause of cancer death. And every year, more than 50,000 people die with this disease.

Screenings help find cancer at an early stage before a person has any symptoms. The earlier that abnormal tissue or cancer is found, the easier it may be to treat. By the time symptoms appear, cancer may have already begun to spread.

It is important to remember that your doctor does not necessarily think you have cancer if he or she suggests a screening test. Screening tests are given when you have no cancer symptoms. Screening tests may be repeated regularly.

If a screening test result is abnormal, you may need to have more tests done to find out if you have cancer. These are called diagnostic tests.


The American Cancer Society 2018 guideline for colorectal cancer screening recommends that average-risk adults aged 45 years and older undergo regular screening with either a high-sensitivity stool-based test or a structural (visual) exam, based on personal preferences and test availability. As a part of the screening process, all positive results on non-colonoscopy screening tests should be followed up with timely colonoscopy.

What cancer screening methods are available?

While many methods exist, we will focus on two of the preferred methods.

  • Colonoscopies are the gold standard in colorectal cancer screening. A colonoscopy allows your provider to view the entire colon, and biopsy and remove polyps if found.
    • The National Comprehensive Cancer Network (NCCN) recommends that average-risk adults have a colonoscopy once every ten years if no abnormalities are found.
  • Fecal immunochemical test (FIT) require no pre-test diet or medication changes and sampling can be done in the comfort of your own home.
    • NCCN guidelines recommend rescreening in three years if no abnormalities are found.

Looking to schedule a colonoscopy? Find a gastroenterologist near you.

Source: The National Cancer Institute, Mayo Clinic, American Cancer Society, and the National Comprehensive Cancer Network

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