Rheumatoid Arthritis

 Rheumatoid Arthritis is a type of arthritis that is a chronic autoimmune disease.  It causes pain, swelling, decreased flexibility, stiffness and inflammation, primarily in the lining of joints (synovium) (Cleveland Clinic, 2024)(Mayo Clinic, 2025)((Henderson, 2023).  Joints that are typically affected include:

• joints in hands and fingers
• knees
• ankles
• feet 
• toes (Cleveland Clinic, 2024)(Henderson, 2023)

Both sides of the body are usually affected.  Other parts of the body can also be affected, including:

• eyes
• heart
• lungs
• skin (Cleveland Clinic, 2024)(Mayo Clinic, 2025)(Henderson, 2023)(Arthritis Foundation, 2021).

With Rheumatoid Arthritis being an autoimmune condition, the immune system within the body attacks the joints and organs.  This immunological attack causes the joint pain, swelling, changes in flexibility, and stiffness (American College of Rheumatology, 2026).  Currently, there is no cure for Rheumatoid Arthritis, therefore, diagnosing Rheumatoid Arthritis as early as possible can help to alleviate symptoms and prevent joint damage and/or disability.

There are two types of Rheumatoid Arthritis, seropositive and seronegative.

• Seropositive:  Two types of antibodies are present in the blood, anti-cyclic citullinated peptides (anti-CCPs) and rheumatoid factor (RF).  These antibodies cause the symptoms associated with Rheumatoid Arthritis.  One or both can be present in the blood and may be seen in blood tests as soon as five to ten years before the symptoms are present.
• Seronegative:  anti-CCPs and RF are not present.  Diagnosis is made through other means (Henderson, 2023)

There are several symptoms of Rheumatoid Arthritis.  There are periods of time where the symptoms are increased and more active.  This is referred to as a flare.  Periods of time will follow flares with decreased symptoms.  These periods are referred to as remission.  Symptoms include:

• joint pain
• joint swelling
• joint stiffness
• joint tenderness
• body stiffness - particularly in morning or after sitting
• fatigue
• weakness
• fever
• poor appetite
• rheumatoid nodules - firm lumps beneath skin (elbows and hands)
• anemia
• neck pain
• dry eyes
• dry mouth (Cleveland Clinic, 2024)(Mayo Clinic, 2025)(Henderson, 2023)

There are four stages that define the progression of Rheumatoid Arthritis.  

• Stage 1:  The earliest stage with joint inflammation characterized by joint pain and stiffness.
• Stage 2:  Inflammation causes cartilage damage in this stage.  Is characterized by joint stiffness and decreased range of motion.
• Stage 3:  Severe inflammation causing bone damage.  Characterized by more joint pain and stiffness and decreased range of motion.  Physical changes may appear.
• Stage 4:  inflammation does not increase but is characterized by severe pain, swelling, stiffness and loss of mobility (Cleveland Clinic, 2024).

Several risk factors increase the possibility of developing Rheumatoid Arthritis.  They include:

• Gender - women are at increased risk
• Age -  most often begins in middle age.  Referred to as Juvenile Idiopathic Arthritis when diagnosed in children.
• Family History - having a family member with Rheumatoid Arthritis or another autoimmune condition increases risk.
• Smoking - increases risk
• Periodontal disease - damages soft tissue in mouth and raises risk.
• Excess weight - increases risk.
• Genetics - variations in the human leukocyte antigen (HLA) gene increases risk.(Cleveland Clinic, 2024)(Mayo Clinic, 2025)

Several tests/exams can be performed in order to daignose Rheumatoid Arthritis, including:

• Physical exam
• Blood tests:
• Erythrocyte Sedimentation Rate (ESR) - indicates inflammation level
• C-Reactive Protien (CRP) - indicates inflammation level
• RF antibodies level
• anti - CCP antibodies level
• Imaging tests - Shows joint damage and inflammation
• X-rays
• Magnetic Resonance Imaging
  
• Ultrasound (Cleveland Clinic, 2024)(Mayo Clinic, 2025)

Treatments are available for Rheumatoid Arthritis.  If treatment is delayed, joint damage occurs.  Treatments include:

• Medications
• NSAIDs - relieves pain and swelling
• steroids - eases inflammation and pain, slows joint damage
• Conventional Disease Modifying Anti-Rheumatic Drug (DMARD) - slows progression of disease
• Biologic response modifiers - slows joint damage.  Works best when used with conventional DMARDs.
• Surgery - knee or hip replacements may restore function and decreases pain.
• Healthy diet
• Activity
• Hot and cold treatments
• Stress Management (Cleveland Clinic, 2024)(Mayo Clinic, 2025)(Arthritis Foundation, 2021)

There are complications that can result from Rheumatoid Arthritis.  These include:

• Osteoarthritis - both Rheumatoid Arthritis and medications used to treat can increase risk.
• Rhematoid nodules 
• Dry eyes and mouth -  Rheumatoid Arthritis can cause Secondary Sjogren's Sundrome which lowers moisture in eyes and mouth.
• Infections - Rheumatoid Arthritis and medications can harm immune system
• Carpal Tunnel Syndrome - Rheumatoid Arthritis affects wrists causing swelling that can press on nerves.
• Heart problems -  Rheumatoid Arthritis can contribute to hardened or blocked arteries.
• Lung disease - Rheumatoid Arthritis can cause inflammation and scarring in lungs leading to shortness of breath.
• Lymphoma (Mayo Clinic, 2025)

American Colloge of Rheumatology. (2026)  Rheumatoid Arthritis.  American College of Rheumatology.  Retrieved from https://rheumatology.org/patients/rheumatoid-arthritis

Arthritis Foundation. (2021)  Rheumatoid Arthritis.  Arthritis Foundation.  Retrieved from https://www.arthritis.org/diseases/rheumatoid-arthritis

Cleveland Clinic. (2024)  Rheumatoid Arthritis.  Cleveland Clinic.  Retrieved from https://my.clevelandclinic.org/health/diseases/4924-rheumatoid-arthritis#overview

Henderson, J. (2023) Rheumatoid Arthritis: Types, Causes, Symptoms and Treatments.  BlackDoctor.org.  Retrieved from https://my.clevelandclinic.org/health/diseases/4924-rheumatoid-arthritis#overview

Mayo Clinic. (2025)  Rheumatoid Arthritis.  Mayo Clinic.  Retrieved from https://www.mayoclinic.org/diseases-conditions/rheumatoid-arthritis/symptoms-causes/syc-20353648

Grave's Disease

Graves Disease is a condition that affects the thyroid.  The thyroid is a gland that produces hormones responsible for controlling metabolism, Thyroxine (T4) and Triiodothyronine (T3) (Medline Plus, 2024).  It is a small butterfly shaped gland and is located in the neck (Cleveland Clinic, Thyroid, 2026).   Graves Disease is a chronic, autoimmune condition that causes the thyroid to make too much thyroid hormone, Hyperthyroidism (Medline Plus, 2024).  Graves Disease is more common among women, as well as individuals over 30 years old (Mayo Clinic, 2024).

Grave's Disease is caused by the immune system producing antibodies against the thyroid.  These antibodies cause the thyroid cells to work overtime causing them to overproduce and release thyroid hormones (Cleveland Clinic, 2026)(Mayo Clinic, 2024).

Because the overproduction of thyroid hormones affect all other  organ systems, the symptoms of  Graves Disease are widespread.  Symptoms include:

• Nervousness
• Irritability
• Slight tremor in fingers and hands
• Heat sensitivity
• Weight loss despite increased hunger
• Goiter - enlarged thyroid gland
• Menstrual changes
• Erectile dysfunction
• Decreased Libido
• Increased bowel movements
• Graves Opthalmopathy (Thyroid Eye Disease) - includes: bulging of eyes, double vision, gritty eyes, eye pain and pressure, photophobia - light sensitivity
• Grave's Dermopathy - thick discolored skin
• Fatigue
• Heart palpatations
• Insomnia
• Hair loss
• Dyspnea - shortness of breath
• Tachycardia - rapid heartbeat
• Muscle weakness (Medline Plus, 2024)(Mayo Clinic, 2024)(Cleveland Clinic, 2026),

There are several risk factors for Graves Disease.  Risk factors include:

• Family history - often family history of either thyroid conditions or autoimmune conditions raise risk of Graves Disease
• Sex - women are at increased risk
• Age - increased occurence between 30 - 60 years of age
• Other autoimmune conditions
• Smoking - increases risk
• Selenium and Vitamin deficiences (Medline Plus, 2024)(Mayo Clinic, 2024)(Cleveland Clinic, 2026).

Several exams/tests should/can be done in order to diagnose Grave's Disease.  Firstly, a physical exam, medical history and family history should be performed.  Tests that can be conducted in order to diagnose includes:

• Blood tests - Thyroid Stimulating Hormone (TSH), T3 and T4 levels.  TSH levels, produced by the pituitary gland, are lower, while T3 and T4 levels are higher.
• Radioactive iodine uptake - scan of thyroid after ingesting a small amount of radioactive iodine and shows the rate of iodine uptake by the thyroid.
• Thyroid antibody blood test
• Doppler Ultrasound - looks for increased blood flow in thyroid.  Can be used during pregnancy when Radioactive iodine uptake cannot be performed
• Orbit CT Scan (Medline Plus, 2024)(Mayo Clinic, 2024)(Cleveland Clinic, 2026).

Several treatments can be used for Grave's Disease.  Treatment can either stop hormone production in the thyroid or block the effect of the hormones within the body (Mayo Clinic, 2024).  Treatments include:

• Radioactive iodine therapy - destroys thyroid hormone producing cells causing them to shrink.  May increase risk of Thyroid Eye Disease.  Cannont be used with pregnant women.
• Anti-Thyroid medications - blocks iodine from being used by thyroid to produce hormone.
• Beta Blockers - block the effects of hormones within the body.  Cannot be used with individuals with asthma or diabetes. 
• Thyroidectomy - surgery where thyroid is removed.
• Treatments for Thyroid Eye Disease
• Corticosteroids - decreases inflammation behind eyeballs and delivered through vein.
• Teprotumumab (Tepezza) - delivered through IV every three weeks
• Prisms - used in eye glasses to correct for double vision.
• Orbital Decompression Surgery - orbit bone between the eye socket and orbital sinuses are removed increasing space for eyeballs to move into usual placement.  Used if pressure on optic nerve increases possibility of loss of vision.
• Orbital Radiotherapy - X-rays destroys some tissue behind eyes (Medline Plus, 2024)(Mayo Clinic, 2024)(Cleveland Clinic, 2026).

Complications may occur due to Grave's Disease.  If it is untreated or undermanaged, the likelihood of the complications occuring increases.  Complications od untreated Grave's Disease include:

• Pregancy concerns - miscarriage, premature delivery, fetal thyroid issues, poor fetal growth, heart failure in mother, pre-eclampsia
• Heart Conditions - irregular heart rhythms, heart failure
• Thyroid Storm - development of hyperthyroidism is accelerated and the sudden increase in thyroid hormones can cause fever, sweating, confusion, delirium, severe weakness, tremor, irregular heartbeat, severe low blood pressure, and coma.  Is a medical emergency.
• Brittle bones -  increased thyroid hormones makes it difficult for Calcium to move into the bones. (Medline Plus, 2024)(Mayo Clinic, 2024)(Cleveland Clinic, 2026)

For Grave's Disease resources, visit:

https://www.thyroid.org/graves-disease/

https://www.niddk.nih.gov/health-information/endocrine-diseases/graves-disease

References

Cleveland Clinic (2026)  Grave's Disease.  Cleveland Clinic.  Retrieved from https://my.clevelandclinic.org/health/diseases/15244-graves-disease#diagnosis-and-tests

Cleveland Clinic (2026)  Thyroid.  Cleland Clinc.  Retrieved from https://my.clevelandclinic.org/health/body/23188-thyroid

Mayo Clinic. (2024)  Grave's Disease.  Mayo Clinic.   Retrieved from https://www.mayoclinic.org/diseases-conditions/graves-disease/symptoms-causes/syc-20356240

Medline Plus (2024) Grave's Disease.  Medline Plus.  Retrieve from https://medlineplus.gov/ency/article/000358.htm

Breast Cancer

Breast Cancer occurs when cancerous cells grow out of control within breast tissue.  Although all of the causes of breast cancer are not known, it is known that cancerous cells within breasts begin with changes in the DNA of breast cells (Mayo Clinic,  2025).  These cells may join together to form a tumor which can not only grow in size, but also travel to and invade other tissues in the body (metastisize) (Mayo Clinic, 2025).  Eighty percent of breast cancer cases metastisize to other parts of the body (Cleveland Clinic, 2025).  Cancers metastisize through blood and lymphatic systems.  As part of the immune system, the lymphatic system is compromised of lymph nodes, ducts, vessels and organs.  Together, the parts of the lymphatic system remove lymph from throughout the body and drain it into the blood system.  The lymphatic system drains lymph from breast tissue through:

• Auxillary Lymph Nodes - Lymph nodes under the arm.
• Internal Mammary Lymph Nodes - Lymph nodes in the chest under the breastbone.
• Supraclavicular Lymph Nodes - Lymph nodes above the collar bone.
• Infraclavicular Lymph Nodes - Lymph nodes below the collar bone (ACA, 2021).

Breasts are comprised of several parts including:

• Lobules - these are the glands where breast milk is produced. 
• Lobular Breast Cancer
• Ducts - these are the canals that connect lobules to the nipple and carry breast milk as it is produced. 
• Invasive Ductal Carcinoma (IDL)
• Ductal Carcinoma In Situ
• Nipples - location where ducts coalesce into larger ducts in a way that breast milk can leave the breast.
• Paget's Disease of the Breast
• Areola - the daarker thicker skin that surrounds the nipple.
• Stroma - fat and connective tissue that surround the ducts and lobules in order for them to stay in place.
• Phyllodes Tumor
• Blood Vessels and Lymph Vessels - carry blood and lymph to and from breast tissues.
• Angiosarcoma  (ACA, 2021)(Cleveland Clinic, 2025)

Behind Skin Cancer, Breast Cancer is the second most diagnosed cancer in women.  Breast Cancer, however, can also occur in men as well due to all people, including men, having breast tissue (Mayo Clinic, 2025).

Breast Cancer can also be impacted by hormones.Types of Breast Cancer can be further typed into hormonal receptor subtypes.  Cells have receptors attached which can react with specific hormones, such as estrogen and progesterone.  Both of these hormones impact cancerous cell growth.  Subtypes include:  

• ER positive (ER+):  have estrogen receptors.
• PR positive (PR+): have progesterone receptors.
• HR positive (HR+): have estrogen and progesterone receptors.
• HR negative (HR-): have no estrogen or progesterone receptors (Cleveland Clinc, 2025).

Women have an one in eight chance of developing Breast Cancer.  Women who are HR- and do not have irregular levels of the HER2 protein are said to have Triple Negative Breast Cancer.  Black women are at higher fisk of developing this aggressive cancer.  Black women are also more likely to die from Breast Cancer (ACA, 2025)

 

There are many symptoms of Breast Cancer, including:

• New lump near or in breast or armpit.
• Changes in breast size and shape.
• Puckering or dimples in skin.
• Nipple turning inward.
• Nipple discharge.
• Skin of nipple becoming scaly, red or swolen.
• Breast pain.
• Color changes of breast skin (Mayo Clinic, 2025)(Cleveland Clinic, 2025)(Medline Plus, 2025).

There are also many risk factors for Breast Cancer incluidng:

• Older age
• Gender
• History of Breast Cancer
• BRCA gene and other genetic mutations
• Dense breast tissue
• Menarche at an early age
• Older age at first childbirth
• Having never giving birth
• Menopause at older age
• Hormone Replacement Therapy
• Radiation Therapy to breast or chest area
• Obesity
• Alcohol
• Smoking (Mayo Clinic, 2025)(Cleveland Clinic, 2025)(Medline Plus, 2025)

Prevention options are available.  Making life changes can lower risk of Breast Cancer.  These changes include:

• Speak with health clinician about screening
• Do breast exams
• Moderation of drinking alcohol
• Regular exercise
• Limit menopausal hormone therapy
• Maintain healthy weight
• Eat healthy diet
• Genetic screening
• Preventative medicines
• Preventative surgery (ACA, 2021)(Medline Plus, 2025)(Mayo Clinic, 2025)(Cleveland Clinic, 2025)

Many things can be done in order to diagnose Breast Cancer, including:

• Medical history
• Breast exam
• Mammogram - x-ray of breast tissue
• Breast ultrasound - pictures are created using sound waves
• Breast MRI - pictures created using magnetic field and radio waves
• Biopsy - tissue sample removed for testing to see if cells are cancerous
• Staging of the Breast Cancer through:
• Blood tests
• Bone scan
• CT scan
• MRI
• PET scan
• Immunohistochemistry - looks for hormone receptors
• Genetic testing
• HER2 test - tests for the HER2 protein which is involved in cell growth

There are several types of treatments.  They include several types of options including:

• Chemotherapy
• Radiation therapy
• Hormone Therapy - blocks hormones from attaching to cancer cells
• Immunotherapy 
• Surgery
• Mastectomy
• Lumpectomy
• Breast reconstruction (Cleveland Clinic, 2025)(Medline Plus, 2025).

If  you or someone you know have been diagnosed with Breast Cancer, there are resources available.

American Cancer Society

Susan B. Komen for the Cure

ACS. (2021)  Breast Cancer.  American Cancer Society.  Retrieved from https://www.cancer.org/cancer/types/breast-cancer.html

ACS. (2025)  Key Statistics for Breast Cancer.  American Cancer Society.  Retrieved from https://www.cancer.org/cancer/types/breast-cancer/about/how-common-is-breast-cancer.html

Cleveland Clinic. (2025)  Breast Cancer.  Cleveland Clinic.  Retrieved from https://my.clevelandclinic.org/health/diseases/3986-breast-cancer

Mayo Clinic. (2025)  Breast Cancer.  Mayo Clinic  Retrieved from https://www.mayoclinic.org/diseases-conditions/breast-cancer/symptoms-causes/syc-20352470

Medline Plus. (2025)  Breast Cancer.  Medline Plus.  Retrieved from https://medlineplus.gov/breastcancer.html

Stress Management

Stress, either psychological or physical, is a natural reaction and the response that the human body has to changes or stressors.  There are three types of stress:

• Acute - an event that is short term  in nature.
• Acute episodic -  frequent short term event.
• Chronic - events that are persistant in nature (Harvard, 2021).

The stress reaction is one of protection and the human designed to react to stress.  As parrt of the Autonomic Nervous System, the hypothalamus in the brain sets off the fight or flight reaction when an individual perceives a threat.  In response to nervous and hormonal signals, adrenal glands, on top of the kidney, release hormones such as adrenaline and cortisol (stress hormones).  Adrenaline increases the heart rate, blood pressure, and energy, while cortisol increases glucose, enhances the use of glucose by the brain and increases substances that repair tissues.  Cortisol also slows down bodily functions that are not useful in the fight or flight reaction (Mayo Clinic, 2025)(Cleveland Clinic, 2024).

With acute stress, the stress resolves quickly.  Everyone, at different parts of their lives, experience acute stress.  With chronic stress, if the stress is not managed, health issues may arise.  As a result of the activation of the Autonomic Nervous System and the resulting in nervous and hormonal sequalae.  There are many symptoms of stress that can occur.  The symptoms  can be physical, psychological, or behavioral.  Symptoms include:

Physical

• Muscular pain
• Chest pain
• Exhaustion
• insomnia
• Headaches
• Dizziness
• Hypertension
• Muscle Tension
• Jaw clenching
• Digestive problems
• Weakened immune system
• Infertility

Psychological

• Anxiety
• Irritability
• Depression
• Panic attacks

Behavioral

• Alcohol Use Disorder
• Gambling Disorder
• Eating Disorder
• Hypersexuality
• Smoking
• Substancce Use Disorder (Mayo Clinic, 2025)(Cleveland Clinic, 2024)(Medline Plus, 2024).

There are things that can be done to manage stress when it happens in order to manage stress when it happens in order to decrease the impact of the stress, including:

• Eating a healthy diet
• Mindful eating
• Regular exercise
• Getting enough sleep (Read our article on Sleep hygiene, https://healthylivingforyourself.blogspot.com/2025/05/sleep-hygiene.html) 
• Meditation
• Journaling
• Hobbies
• Friendships
• Volunteer
• Work - Life balance
• Set goals
• Social support
• Mental Health counseling (Harvard, 2021)(Mayo Clinic, 2025)(Cleveland Clinic, 2024)(Medline Plus, 2024).

Cleveland Clinic. (2024)  Stress.  Cleveland Clinic.  Retrieved from https://my.clevelandclinic.org/health/diseases/11874-stress

Harvard. (2021)  Stress and Health.  Harvard School of Public Health.  Retrieved from https://nutritionsource.hsph.harvard.edu/stress-and-health/

Mayo Clinic. (2025)  Stress Management.  Mayo Clinic.  Retrieved from https://www.mayoclinic.org/healthy-lifestyle/stress-management/in-depth/stress/art-20046037

 

Medline Plus. (2024)  Stress and your Health.  Medline Plus.  Retrieved from https://medlineplus.gov/ency/article/003211.htm

Vitamin D Deficiency

Vitamin D Deficiency is something that can affect anyone despite age, gender, or ethnicity.  The likelihood of it developing does depend on several factors, however.  It is said that someone is Vitamin D Deficient when the amount of Vitamin D is inadequate which may have health consequences (Yale, 2025).  Vitamin D is important for the process of the body, including bone, to absorb Calcium, phosphorus, and Magnesium.  Vitamin D Deficiency causes these to not be absorbed well.  Vitamin D also plays an essential role in the nervous, musculoskeletal, and immune systems (Cleveland Clinic, 2022).  Vitamin D Deficiency can also be linked to  increased risk of:

• Cancer
• Heart Disease
• Stroke
• Depression
• Muscular Sclerosis
• Type 2 Diabetes (Watson, 2024)

Several things may contribute to someone developing Vitamin D Deficiency.  These include:

• Not enough exposure to sunlight
• Darker skin Pigment
• Malnutrition
• Kidney or Liver failure
• Certain medications
• Certain cancers
• Family history of  Vitamin D Deficiency or Childhood Rickets
• Chorn's Disease, Cystic Fibrosis, and Celiac Disease
• Obesity
• Weight Loss Surgery (Yale, 2025)(Watson, 2024)

There are also some risk factors for developing Vitamin D Deficiency including:

• Age - 65 years old or older
• BMI greater than or equal to 30
• Melanated skin
• Smoking
• Not eating foods fortified with Vitamin D (Watson, 2024).

Although he signs and symptoms may be more obvious in kids, there are also signs and symptoms in adults  In kids, signs and symptoms include:

• Weak, sore, painful muscles
• Incorrerct growth (bowed or bent legs)
• Muscle weakness
• Bone pain
• Joint deficiencies (Watson, 2024)

In adults, signs and symptoms include:

• Fatigue
• Bone and joint pain
• Muscle weakness, aches, or cramps
• Increased sensitivity to pain
• "Pins and needles" sensations in hands and feet
• Muscle spasms
• Waddling while walking due to muscle weakness i n hips and legs
• History of broken bones
• Mood changes (Yale, 2022)(Watson, 2024)

You may be wondering how much vitamin D people need each day.  Well, it is age dependant.

• Birth to 12 months - 400 IU
• 1-13 years - 600 IU
• 14 - 18 years - 600 IU
• 19 - 70 years - 600 IU
• 71 - older - 800 IU
• Breastfeeding or pregnant - 600 IU (Medline Plus, 2024)

Who are individuals who may be at risk for Vitamin D Deficiency?

• Breastfed infants - breast milk is low in vitamin D.  Infants who are sole breast fed should be given a vitamin D supplement equal to 400 IU every day.
• Older adults - skin does not make vitamin D as efficient as it did when someone is younger.  Also, Kidneys do not convert vitamin D to its active form as well.
• People with increased melenation (darker skin) - darker skin has decreased ability to produce vitamin D when exposed to sunlight.  
• People dealing with Obesity - body fat binds sone vitamin D which decreases the amount available in the blood stream.  Increased body fat binds more vitamin D removing more vitamin D from bloodstream.
• People who have had Gastric Bypass Surgery - this surgery bypasses part of small intestine where vitamin D is absorbed.  Having part of the small intestine bypassed affects absorption of vitamin D.
• People with Chronic Kidney or Liver Dizease - affects ability to change vitamin D into active form.
• People taking certain medications - certain cholesterol, anti-seizure and weight loss medications can affect vitamin D level. 
• People with Cystic Fibrosis, Chrohn's Dizease, and Celiac Disease - these conditions prevent vitamin absorption in intestines.
• People who do not spend a lot of time in the sun.  (Medline Plus, 2024)(Cleveland Clinic, 2022)

There is a blood test that can be done to determine vitamin D levels.  Those individuals who are at risk for Vitamin D Deficiency can have a 25 - hydroxyvitamin D [25(OH)D] blood test done (Watson, 2024).

Once Vitamin D Deficiency has been diagnosed, there are ways that it can be treated.

• Foods that naturally have vitamin D include:
• Fatty Fish - salmon, tuna, markel and sardines
• Rainbow Trout
• Beef liver
• Mushrooms
• Egg yolks
• Cod liver oil
• Foods that are often fortified with vitamin D include:
• Cow's, soy, almond and oat milk
• Breakfast cereals
• Orange juice
• Dairy products
• Vitamin D supplements may be taken.

Your healthcare provider should be consulted to determine the best way to increase vitamin D levels if deficient (Medline Plus, 2024).

What happens if you have too much vitamin D?

Although not common, it is possible to concume too much vitamin D, primarily through supplements.  Signs and symptoms of vitamin D toxicity include:

• Nausea
• Increased thirst and urination
• Poor Appetite
• Constipation
• Weakness
• Confusion
• Ataxia - impaired balance or coordination
• Dysarthria - unclear speech
• Irregular heartbeat
• Kidney Failure (Medline Plus, 2024)

Cleveland Clinic, (2022)  Vitamin D Deficiency.  Cleveland Clinic.  Retrieved from https://my.clevelandclinic.org/health/diseases/15050-vitamin-d-vitamin-d-deficiency#diagnosis-and-tests

Medline Plus. (2024)  Vitamin D Deficiency.  Medline Plus.  Retrieved from https://medlineplus.gov/vitaminddeficiency.html

Watson, L. (2024)  Vitamin D Deficiency.  WebMD.  Retrieved from https://www.webmd.com/diet/vitamin-d-deficiency

Yale. (2025) Vitamin D Deficiency.  Yale University.  Retrieved from https://www.yalemedicine.org/conditions/vitamin-d-deficiency

Sleep Hygiene

What is Sleep Hygiene you may ask?

Sleep Hygiene is a group of healthy sleep habits that can improve your sleep.  Good sleep hygiene can improve overall health.  

How does good sleep hygiene improve health?

Some benefits of having good sleep hygiene and obtaining adequate, good quality sleep include:

• Your body having the ability to repair itself, particularly the heart and blood vessels
• Boost of immune system
• Supports hunger hormone balance
• Supports regulated insulin levels
• Supports health growth and development
• Decreases risk of conditions such as heart disease, High Blood Pressure, obesity, Diabetes and stroke
• Helps to maintain a healthy weight
• Emotional and cognitive renewal
• Decreases stress
• Lower risk of motor vehicle crashes
• Improves attention and memory (Solodar, 2025)(CDC, 2024)(NIH,2022)

What can you do to have better sleep hygiene?

There are behaviors you can incorporate and habits you can develop to increase the quaility of your sleep.  These include:

• Make your sleep environment comfortable - keep bedroom  quiet, relaxing and at a cool temperature
• Maintain a consistent sleep schedule -try to go to sleep at the same time every day
• Turn off electronic devices at least 30 minutes before bedtime
• Follow a bedtime routine that helps you fall asleep
• Exercise regularly - even 30 minutes of aerobic exercise can increase sleep quality      
• Avoid lage meals and alcohol before bedtime
• Avoid caffeine in afternoon or evening - effects of caffeine can last 3 - 7 hours
• Avoid smoking - Nicotine is a stimulant
• Limit napping
• Manage stress
• Manage light exposure (Solodar, 2025)(CDC, 2024)(Healthline, 2024)

What is meant by sleep quality?

Quality sleep encompasses not only how many hours you sleep, but also how well you sleep.  Poor sleep quality may include:

• Trouble falling asleep
• Waking up during the night
• Feeling sleepy or tired after a full night's sleep (CDC, 2024)

What are some common sleep disorders?

• Insomnia - trouble falling or staying asleep 
• Restless Legs Syndrome (Willis - Ekbom Disease) - a neurological condition causing an irresistible urge to move legs
• Narcolepsy - a chronic disorder causing someone to be very sleepy during day hours and disrupts nighttime sleep.  An individual may fall asleep during daily activities
• Sleep Apnea - a condition where breathing stops and restarts many times (NIH, 2022)(NIH, 2022) (NIH, 2025)(NIH, 2025)(NIH, 2025)

According to the CDC, the following is how much sleep is recommended for each age group every day:

• 0 - 3 months:    14 - 17 hours
• 4 - 12 months:   12 - 16 hours
• 1 - 2 years:  11 - 14 hours
• 3 - 5 years:   10 - 13 hours
• 6 - 12 years:  9 - 12 hours
• 13 - 17 years:  8 - 10 hours
• 18 - 60 years:  7 or more hours
• 61 - 64 years: 7 - 9 hours
• 65 years and older:  7 -8 hours (2024)

To find Sleep Hygiene resources, visit the National Sleep Foundation's website at:  

https://www.thensf.org/sleep-health-topics/

CDC. (2024)  About Sleep.  Centers for Disease Control and Prevention.  Retrieved from https://www.cdc.gov/sleep/about/index.html

Healthline. (2024)  12 Tips For Better Sleep Hygiene.  Healthline.  Retrieved from https://www.healthline.com/health/sleep-hygiene

NIH (2022)  Insomnia:  What is Insomnia?   National Heart, Blood and Lung Institute.   Retrieved from https://www.nhlbi.nih.gov/health/insomnia

NIH (2022)  Sleep Deprivation and Deficiency:  How Sleep Affects Your Health.   National Heart, Blood and Lung Institute.Retrieved from https://www.nhlbi.nih.gov/health/sleep-deprivation/health-effects

NIH. (2025) Narcolepsy.   National Heart, Blood and Lung Institute.  Retrieved from https://www.nhlbi.nih.gov/health/narcolepsy

NIH. (2025)  Restless Leg Syndrome.  National Institute of Neurological Disorders and Stroke.   Retrieved from https://www.ninds.nih.gov/health-information/disorders/restless-legs-syndrome

NIH (2025) Sleep Apnea:  What is Sleep Apnea?  National Heart, Blood and Lung Institute.  Retrieved from https://www.nhlbi.nih.gov/health/sleep-apnea

Solodar. (2025)  Sleep Hygiene: Simple practices for better rest.  Harvard Health Publishing.  Retrieved from https://www.health.harvard.edu/staying-healthy/sleep-hygiene-simple-practices-for-better-rest

Distracted Driving

Distracted driving is when an activity takes away a driver's attention while driving.  These activities can be:

Visual - taking your eyes off the road

Manual - taking your hands off the wheel

Cognitive - taking your mind off driving (CDC, 2024).

Texting while driving is a common distraction.  Either sending or reading a text can take someone's eyes off the road for five seconds.  If someone is driving 55 MPH, the distance driven can be the length of a football field (NHTSA, n.d.).  Other examples of activities that can be distracting while driving are talking on a cell phone, using a GPS, or eating.  

In 2019, more than 3,100 people were killed and approximately 424,000 people were injured in the United States in motor vehicle accidents involving a distracted driver (CDC, 2024).  This equates to nine people in the United States every day being killed in a motor vehicle accident involving a distracted driver (CDC, 2024).  When looking at motor vehicle accidents involving distracted drivers, there is a higher percentage of drivers aged 15 - 20 than those 21 and older.  Of fatal crashes among drivers 15 - 20 years old, 9% were distracted at the time of the crashes (CDC, 2024).  When surveyed, 39% of high school students stated that they had either texted or emailed at least once in the past 30 days while driving (CDC, 2024).

There are ways to prevent distracted driving.  Many states enacted laws to prevent distracted driving to include banning texting while driving, hands-free laws, and limiting the number of young passengers riding with teen drivers (CDC, 2024).  Physical alerts, such as rumble strips, are installed in some states to alert individuals when drowsy or distracted (CDC, 2024).  Federally, the United States Department of Transportation released the National Roadway Safety Strategy in 2022 to support vehicle technology to detect distracted driving.  President Obama issued an Executive Order in 2009 that prohibits federal employees from either texting while driving a government-owned vehicle or while on government business.  Additionally, commercial vehicle drivers were banned from texting while driving in 2010 by the Federal Motor Carrier Safety Administration (CDC, 2024). 

 To learn state laws concerning distracting driving where you live, visit the Governor's Highway Safety Association.  The National Highway Travel Safety Administration provides education concerning distracted driving, develop campaigns and Public Service Announcements, partner with states and local police to enforece laws (NHTSA, n.d.).

CDC. (2024).  Distracted Driving.  Centers for Disease Control and Prevention.  Retrieved from https://www.cdc.gov/distracted-driving/prevention/index.html

NHTSA. (N.D.)  Distracted Driving.  National Highway Travel Safety Administration.  Retrieved from https://www.nhtsa.gov/risky-driving/distracted-driving