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 the 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

Stroke

 Stroke is a condition of blood arteries going to and in the brain, in which, becomes blocked and the blood supply is no longer able to traverse the artery.  As the blood does not reach its intended brain cells, the cells begin to die due to the lack of oxygen within minutes (CDC, 2023)(Cleveland Clinic, 2023).  Globally, stroke is the second most common cause of death (Cleveland Clinic, 2023).  Stroke is additionally a leading cause of disability.

There are two types of strokes: Ischemic stroke and hemorrhagic stroke.  A Transient Ischemic Attack (TIA), which are at times referred to as mini strokes, are medical emergencies as are stokes, however, are differentiated from strokes as it lasts for five minutes or less (CDC, 2023).  Ischemic strokes occur when either blood clots, fatty deposits (plaques), or other particles block the blood arteries (CDC, 2023).  These types of strokes account for 87% of strokes (ASA, 2023).  Hemorrhagic strokes occur when a blood artery ruptures or leaks blood and account for 13% of strokes (CDC, 2023)(ASA, 2023).  Two types of blood vessel malformations that can cause hemorrhagic strokes are aneurysms and arteriovenous malformations (AVMs) (ASA, 2023).  Uncontrolled hypertension is the most common cause of hemorrhagic stroke.  Hemorrhagic strokes can be either intracerebral, within the brain, or subarachnoid, between the inner and outer layer of dura that covers the brain (ASA, 2023).

Because death to brain cells can occur within minutes, it is important to recognize the signs and symptoms of stroke quickly and obtain treatment even quicker.  Symptoms of stroke include:

• Trouble speaking
• Trouble understanding what people are saying
• Paralysis or numbness of the face, arm, or leg
• Loss of muscle control on one side of the face
• Blurry or blackened vision
• Sudden partial or total loss of one or more senses
• Neck stiffness
• Emotional instability
• Dizzines
• Nausea
• Vomiting (Cleveland Clinic, 2023)(Mayo Clinic, 2023)

There are several risk factors for stroke.  They can be divided into Lifestyle, Medical, and other types of risk factors, and include:

• Lifestyle
• Obesity
• Physical inactivity
• Heavy or binge drinking
• Illegal drug use
• Medical
• Hypertension
• High Cholesterol
• Smoking
• Secondhand smoke exposure
• Diabetes
• Obstructive Sleep Apnea
• Cardiovascular Disease
• Personal or family history of stroke
• COVID-19 infection
• Clotting Disorders
• Atrial Fibrillation
• Migraine Headaches - there is an increased risk with migraines, especially if migraines are preceded by auras
• Other
• Age - people 55 years of age and older are at greater risk
• Race or ethnicity -  African Americans and Hispanics have a greater risk
• Sex - men have a higher risk than women
• Hormones -  birth control pills or hormonal therapy with estrogen can increase risk (Mayo Clinic, 2023)(Cleveland Clinic, 2023)

Once diagnosed, it is important to treat a stroke as quickly as possible.  Regardless of what type of stroke is being treated, Blood Pressure management should be part of the treatment plan.  When treating an Ischemic Stroke, it is important to restore blood flow to the brain.  For Ischemic Strokes, treatments include:

• Tissue plasminogen activator (TPA) - must be given within 4 1/2 hours from the start of symptoms.  Helps to dissolve blood clots.
• Emergency Endovascular procedures - medications can be delivered directly to the brain through a catheter that is inserted into the artery to deliver the medication directly to where the stroke is occurring,
• Removing clot with stent remover - useful with large clots and can be done with or without TPA
• Carotid Endarterectomy - removes plaques that are specifically blocking the carotid arteries
• Angioplasty and stents - a catheter is inserted into the artery.  A stent can be placed to help support the section of the narrowed artery that was expanded.  (Cleveland Clinic, 2023)(Mayo Clinic, 2023)

With hemorrhagic strokes, treatments include:

• Blood thinning medications
• Medications to decrease pressure in the brain
• Surgery -  with large bleeds, blood vessels may be repaired
• Surgical Clipping - clamps can be placed at the base of an aneurysms to stop blood from flowing to it
• Surgical AVM removal - when accessible, smaller AVMs can be removed
• Stereotactic Radiosurgery - multiple beams of highly focused radiation can be used to repair blood vessel malformations (Cleveland Clinic, 2023)(Mayo Clinic, 2023).

Once someone has had a stroke, they may experience complications, such as:

• Paralysis - particularly on one side
• Difficulty talking or swallowing - a stroke can affect the mouth and throat muscles
• Memory Loss
• Emotional Problems - may have difficulty in controlling emotions and/or develop depression
• Pain - pain and/or numbness may occur in parts of the body associated with locations in the brain that were affected by the locations in the brain that were affected by the stroke
• Changes in behavior and self-care ability (Mayo Clinic, 2023)

There are things people can do to try to prevent strokes, including:

• Controlling hypertension
• Lowering cholesterol and saturated fat intake
• Quitting smoking and other tobacco use
• Managing Diabetes
• Maintaining a healthy weight
• Eating fruits and vegetables
• Regular exercise
• Limit alcohol intake
• Treat Obstructive Sleep Apnea
• Avoid illegal drugs

Attached is the Cleveland Clinic's FAST reminder card.

For more information on stroke, visit one of the three references below.

ASA. (2023) About Stroke.  American Stroke Association.  Retrieved form https://www.stroke.org/en/about-stroke

Cleveland Clinic. (2023)  Stroke.  Cleveland Clinc.  Retrieved from https://my.clevelandclinic.org/health/diseases/5601-stroke#symptoms-and-causes

Mayo Clinic (2023) Stroke.  Mayo Clinic.  Retrieved from https://www.mayoclinic.org/diseases-conditions/stroke/symptoms-causes/syc-20350113

Menopause

 Menopause is a phase within a woman's reproductive cycle where there have been twelve consecutive months without a mentrual cycle.  Menopause can occur naturally or be the result of surgery (where the ovaries and/or uterus is removed), chemotherapy, radiation therapy, or primary ovarial insufficiency (Mayo, 2023).  Although menopause can occur during your 40s or 50s, the average age for menopause to occur is 51 (Mayo, 2023).

When occurring naturally, ovaries stop producing estrogen and progesterone.  It is a gradual process that occurs in stages.  The first stage is perimenopause that can begin anywhere between eight to ten years before monopause.  During this period, estrogen and progesterone are produced at different levels and decrease durin this period.  The next period is menopause where the varies cease to release eggs and producing estrogen for twelve consecutive months.  During this time, women tend to have increased symptoms.  The last stage is postmenopause.  In this stage, symptoms decrease and there is an increased risk of certain health conditions such as osteoporosis, stroke, and heart disease (Cleveland Clinic, 2023)(OASH, 2023(Duke, 2023).

There are many signs and symptoms of menopause to include:

• Hot flashes (vasomotor symptoms) - a sudden feeling of warmth that encompasses the entire body
• Night sweats
• Cold flashes
• Vaginal dryness
• Urinary urgency
• Urinary Tract Infections
• Insomnia
• Emotional changes - irritability, mood swings, anxiety
• Dry skin
• Dry eyes
• Dry mouth
• Racing heart rate
• Weight gain
• Joint and muscle aches
• Difficulty concentrating
• Changes in libido
• Breast tenderness
• Increasing symptoms of PMS
• Irregular periods
• Hair loss (Cleveland Clinic, 2023)

These symptoms can occur over several years.

Menopause is diagnosed after twelve months without a menstrual cycle.  Some blood tests may be helpful when menstruation is or becomes irregular such as:

• Estrogen levels
• Follicle Stimulating Hormone (FSH)
• Luteinizing Hormones (LH) (Medline, 2020)

There are several treatments available for menopause including:

• Hormone therapy - can replace hormones that the ovaries no longer make.  Helps symptoms like hot flashes and vaginal dryness.  It can also help to prevent Osteoporosis.
• Estrogen therapy (ET) - can be used only with women who have had their uterus removed.  There is a risk with ET when used with women who still have their uterus intact of endometrial cancer.
• Hormone Therapy with both Estrogen and Progesterone (EPT) - can be used with women who still have their uterus intact
• Risks of hormone therapy include:
• Gallstones
• Deep Vein Thrombosis
• Pulmonary Embolism
• Stroke
• Risks are lower when therapy is started within 10 years of menopause
• NNon-hormonaltherapy 
• Changing diet - limit caffeine and spicy foods
• Avoiding triggers of hot flashes
• Keep the bedroom cool at night
• Quitting smoking
• Losing weight
• Exercise - can help with insomnia
• Support groups - an outlet for emotions
• Anti-depressants - can manage mood swings 
• Gabapentin - decreases hot flashes
• Clonidine - decreases hot flashes
• Fezolinetant - decreases hot flashes
• Medications to prevent or treat Osteoporosis (Mayo, 2023)

Although women who are in the post menopausal phase are not able to get pregnant, they should still take precautions to practice safe sex, such as using condoms, to protect themselves from sexually transmitted diseases.  If a woman experiences vaginal bleeding after menopause, she should seek medical attention as it can be a sign of serious medical conditions including:

• Endometrial or vaginal atrophy
• Uterine or endometrial cancer
• Endometrial hyperplasia
• Uterine polyps
• Cervical cancer
• Cervicitis
• Endometritis (Cleveland Clinic, 2023)

Cleveland Clinic. (2023)  Menopause. Cleveland Clinic. Retrieved from https://my.clevelandclinic.org/health/diseases/21841-menopause#symptoms-and-causes

Cleveland Clinic. Post-Menopausal Bleeding.  Cleveland Clinic.  Retrieved from https://my.clevelandclinic.org/health/diseases/21549-postmenopausal-bleeding

Duke. (2023) Menopause Treatment. Duke. Retrieved from https://www.dukehealth.org/treatments/obstetrics-and-gynecology/menopause?utm_source=google&utm_medium=cpc&cr=obgyn_treatments&utm_campaign=OB+GYN+-+Condition+-+NB&keyword=menopause&gclid=Cj0KCQjw6cKiBhD5ARIsAKXUdybehANc9eRjm6npusX8I1nH28VI6GXo5RbOovSGFWttSkfbp807hMsaArDjEALw_wcB

Mayo Clinic. (2023)  Menopause.  Mayo Clinic.  Retrieved from https://www.mayoclinic.org/diseases-conditions/menopause/diagnosis-treatment/drc-20353401

Medline. (2023) Menopause.  Medline Plus.  Retrieved from https://medlineplus.gov/menopause.html

NIH. (2023) What are the symptoms of menopause?  National Institutes of Health.   Retrieved from https://www.nichd.nih.gov/health/topics/menopause/conditioninfo/symptoms

OASH. (2023)  Menopause.  Office of Women's Health.  Retrieved from https://www.womenshealth.gov/menopause/menopause-basics

Endometriosis

 Endometriosis is a condition that affects the female reproductive system.  It is estimated that up to 10% of women between the ages of 15 and 44 suffer from endometriosis (John Hopkins, 2023).  Typically, every month, the endometrium lines the uterus in preparation for a potential pregnancy (fertilized egg).  If a fertilized egg does not implant into the endometrium, then it is broken down and shed during a women's menses (monthly period).  In the case of endometriosis, the endometrium grows outside the uterus and can involve the ovaries, fallopian tubes, and pelvis (Mayo Clinic, 2018).  Regardless of whether inside or outside the  uterus, the endometrium is broken down each month.  When inside the uterus, the endometrium exits the uterus through the cervix and the vagina.  With Endometriosis, there is no exit point for the endometrium and it therefore is trapped (Mayo Clinic, 2018).  This can cause tissues to become irritated and therefore scar tissue or adhesions may develop.  Adhesions occur when fibrous tissues create bands that cause organs and tissues to stick together (Mayo Clinic, 2018).  

The cause of Endometriosis has not conclusively been determined (John Hopkins, 2023).  Some possible causes include:

• Retrograde Menstruation-  menstrual blood flows backwards through the fallopian tubes
• Transformation of peritoneal cells - hormonal factors cause peritoneal cells to transform into endometrial cells
• Embryonic cell transformation - hormones cause embryonic cells (present in early development) to transform into endometrial like cells and to implant into the pelvis during puberty
• Surgical scar Implantation - endometrial cells may attach to surgical scar after surgeries such as a cesarian section 
• Endometrial cell transport -  endometrial cells are transported through blood vessels or lymphatic system 
• Direct transplantation:  after an abdominal surgery, endometrial cells may attach themselves to other parts of the body(Mayo Clinic, 2018)(John Hopkins, 2023)

Locations that Endometriosis can occur include:

• Fallopian tubes
• Ovaries
• Vagina
• Peritoneum
• Bladder and Ureters
• Intestines
• Rectum
• Diaphragm (Cleveland Clinic, 2022)

There are several risk factors for Endometrosis.  They include:

• age
• family history
• race
• having never given birth
• early age of menarche (start of period)(before 11 years old)
• going through menopause at older age
• short menstrual cycles
• heavy menstrual cycles
• high levels of estrogen
• low BMI
• one or more relative with Endometriosis
• other reproductive tract disorders (Cleveland Clinic, 2022)(Mayo Clinic, 2023)(Healthline, 2021)

A few things that can reduce the risk of endometriosis.  They include:

• pregnency
• breastfeeding
• healthy weight
• mestrual period starting at a later age (Cleveland Clinic, 2022)

Signs and symptoms of endometriosis include:

• painful menstrual cramps
• abdominal or back pain during or between periods
• pain during sex
• heavy bleeding during period
• spotting between periods
• infertility
• bloating
• lower back pain
• Painful bowel movements
• diarrhea
• constipation
• nausea (Cleveland Clinic, 2022)(Mayo Clinic, 2023)(Healthline,  2021)

There are several tools used to diagnose Endometriosis including a medical history and physical exam which includes a pelvic exam.  A procedure that can provide a definite diagnosis is a laparoscopy where a thin tube that has a camera attached on the end is inserted through a small insertion ad is used to remove any suspicious tissue (John Hopkins, 2023).  Other tests that may also be helpful include:

• ultrasound - creates an image of internal organs
• CT scan - creates images of successive planes of the body
• MRI - creates a two dimensional view of internal organs (Mayo Clinic, 2018)(John Hopkins, 2023)

There are several options for the treatment of Endometiosis.  The options include both medications or surgery.  The options include:

• NSAIDS:  can be used for pain relief
• Hormone Therapy: can be used to reduce or eliminate pain through slowing the growth of endometrial lining and preventing implantation of endometrial tissue
• Hormonal Contraceptives:  control the hormones involved in endometrial tissue building up
• Gonadotropin-releasing hormone (Gn-RH) agonists and  antagonists:  these drugs  block ovarian stimulating hormones from being produced.  With these drugs, endometrial tissue can shrink.
• Progestin therapy: progestin can relieve the signs and symptoms by halting periods and halting endometrial implants from growing.  Therapies may be delivered through intrauterine deices, implants or injections
• Aromatase inhibitors:  reduce estrogen
• Surgery:  endometriosis implants can be removed either laporoscopically or abdominally.  A hysterectomy to include the ovaries may also be done.
• Fertility treatment:  range from ovary stimulation in order to produce eggs to in vitro fertilization. (Mayo Clinic, 2018)

For more information watch our video

For more information, go to the Mayo Clinic website:

https://www.mayoclinic.org/diseases-conditions/endometriosis/diagnosis-treatment/drc-20354661

Cleveland Clinic. (2022)  Endometriosis.  Cleveland Clinic.  Retrieved from https://my.clevelandclinic.org/health/diseases/10857-endometriosis

Healthline. (2021)  Endometriosis.  Healthline.  Retrieved from https://www.healthline.com/health/endometriosis#Takeaway

John Hopkins Medicine. (2023)  Endometriosis.  John Hopkins Medicine.  Retrieved from https://www.hopkinsmedicine.org/health/conditions-and-diseases/endometriosis

Mayo Clinic. (2018)  Endometriosis.  Mayo Clinic.  Retrieved from https://www.mayoclinic.org/diseases-conditions/endometriosis/diagnosis-treatment/drc-20354661

Cervical Cancer

The cervix is part of the female reproductive system and is located at the base of the Uterus and is connected to the vagina.  Cancer, regardless of where it occurs in the body, occurs when cells grow out of control.  There may not be symptoms of cervical cancer initially.  When symptoms do occur, they can include:

• Abnormal vaginal bleeding
• Unusual vaginal discharge
• Pain during sex
• Pelvic pain
• With advanced disease:
• Swelling in legs
• Blood in urine
• Problems with urination and defecation
• Kidney failure
• Bone pain
• Weight loss
• Lack of appetite
• Fatigue (WebMD, 2021)(ACS, 2020)

There are several risk factors for Cervical Cancer.  Human Papillomavirus (HPV) is a risk factor for Cervical Cancer.  HPV is a virus spread through sexual contact.  Most women who contract HPV do not develop Cervical Cancer, however, there are several strains of  that can cause Cervical Cancer (Medline, 2021)(Mayo, 2021).  Other risk factors include:

• Many sexual partners - increases potential exposure to HPV.  Increased number of partners increases risk.
• Early sexual activity - the younger a woman is when she initiates sexual activity, the increased exposure, potentially, to an increased number of partners.
• Other sexually transmitted infections 
• Weakened immune system - due to diminished ability to fight infections
• Smoking
• Exposure to miscarriage prevention drug, diethylstilbestrol
• Using Birth Control Pills for more than 5 years - risk decreases after stopping use
• Giving birth to more than 3 children - due to possible increased exposure.  Studies also show that hormonal changes during pregnancy may possibly make women more susceptible.
• Young age with first full term pregnancy 
• Economic status - can affect a woman's access to health care.
• Diet - a diet low in fruits and vegetables increases risk
• Family history (ACS, 2020)(Medline Plus, 2021)(CDC, 2021)(Mayo Clinic, 2021)(WebMD, 2021)

There are several types of Cervical Cancer.  These types include:

• Squamous Cell Carcinoma - occurs in the squamous cells that line the cervix on the portion projecting into the vagina.  Makes up approximately 90% of cases.
• Adenocarcinoma - occurs in glandular cells in the cervical canal that produce mucous.
• Mixed carcinoma - has features of both Squamous Cell Carcinoma and Adenocarcinoma.  (WebMD, 2021)(Mayo Clinic, 2021).

In order for Cervical Cancer to be diagnosed, certain tests can be performed.  The primary test to screen for Cervical Cancer is the Pap Smear.  The Pap Smear involves obtaining cells from the cervix in order to detect precancerous or cancerous cells.  Another screening test that can be helpful is an HPV test (Mayo Clinic, 2021).  After these screening tests are performed, if Cervical Cancer is suspected, other tests can be done to confirm the diagnosis.  These tests include:

• Colposcopy - colposcope (magnifying instrument) is used to help identify abnormal cells in cervix,
• Punch Biopsy - can be performed with Colposcopy and small samples are removed from the cervix for examination.
• Endocervical Curettage - either a small spoon shaped instrument or a brush scrapes a cervical sample for examination.
• Electrical Wire Loop - low voltage electrified wire is used to remove a sample of tissue for examination.
• Cone Biopsy - deeper layers of cervix are removed as a cone shaped sample to include the transformation zone.  This is the boundary between the exocervix (outer layer of cervix) and endocervix (inner layer of cervix).  It is in this zone that precancerous cells and cancers are most likely to be found and begin.
• Loop Electrosurgical Excursion Procedure (LEEP) -  a wire loop, heated by electricity, is used to remove a tissue sample for examination (ACS, 2020)(Mayo Clinic, 2021)(WebMD, 2021).

Once Cervical Cancer is diagnosed, tests can be performed to assess whether the cancer has metastasized, or moved to other areas of the body.  These tests may include:

• Cystoscopy: - tube with lens and light is inserted into bladder to assess cells.
• Proctoscopy - a tube with light is inserted into rectum to inspect visually.
• Imaging studies 
• Chest X-ray - used to view the lungs
• Computed Tomography (CT Scan) - used to find larger tumors and looking for metastasis
• Magnetic Resonance Imaging (MRI) - examines soft tissues
• Positron Emission Tomography (PET Scan) -  radioactive sugar is injected into blood where it will collect in cancer cells.  When used with CT scan can produce detailed picture (Mayo Clinic, 2021)(ACS, 2020)

After diagnosis, treatments are available.  Which treatments are used may depend on how far along the cancer is, or which stage it is.  When Cervical Cancer is diagnosed and treated early, the survival rate is high.  If cell changes are found before the become cancerous (precancerous), with treatment, the survival rate is almost 100%.  For stage 0, the survival rate is 90%.  In Stage I, the survival rate is 80-93%.  Once Cervical Cancer reaches stage II, survival drops to 58-63%.  Stage III survival is 32-35% and Stage IV survival rate is 16% (WebMD,  2021).  Treatments include:

• Cone Biopsy - technique used for diagnosis can also be used as treatment when cancer is early
• Cryosurgery -  cold probe freezes cells, killing them
• Laser Ablation - laser is used to vaporize abnormal cells
• Surgery - typically with early stages where the cancer is removed.
• Trachelectomy -  removal of  cervix and upper vagina
• Hysterectomy - uterus and cervix are removed.  Ovaries and lymph nodes may or may not be removed.
• Chemotherapy - medications are used to kill cancer cells
• Targeted Therapy -  medication therapy focuses on the weaknesses of the cancer cells, killing them.
• Radiation - high powered beams kill cancer cells.
• Immunotherapy - Medications that help immune system attack cancer cells (ACS, 2020)(Mayo Clinic, 2021).

There are ways to protect yourself from Cervical Cancer.  First, limit the number of sexual partners.  This limits exposure to HPV.  Routinely be screened for Cervical Cancer with Pap Smears and HPV.  Also, don't smoke.  If you currently smoke, take steps to quit.

If you have been diagnosed with Cervical Cancer, use this link to an American Cancer Society website for resources:  https://www.cancer.org/treatment/understanding-your-diagnosis.html

ACS. (2020)  About Cervical Cancer.  American Cancer Society.  Retrieved from https://www.cancer.org/cancer/cervical-cancer/about.html

CDC. (2021)  Basic Information About Cervical Cancer.  Center for Disease Control and Prevention.  Retrieved from https://www.cdc.gov/cancer/cervical/basic_info/index.htm

Mayo Clinic. (2021) Cervical Cancer.  Mayo clinic.  Retrieved from https://www.mayoclinic.org/diseases-conditions/cervical-cancer/symptoms-causes/syc-20352501

Medline Plus. (2021)  Cervical Cancer.  Medline Plus.  Retrieved from https://medlineplus.gov/cervicalcancer.html#cat_92

WebMD. (2021)  Cervical Cancer.  WebMD.  Retrieved from https://www.webmd.com/cancer/cervical-cancer/cervical-cancer

Prostate Cancer

The prostate is a small gland present in males that produces seminal fluid.  It is shaped like a walnut.  Prostate Cancer is a common cancer and typically is a slow growing cancer that tends to remain confined to the prostate (Mayo, 2023).  There are some Prostate Cancers, however, that are aggressive, grow and spread.  The estimates for Prostate Cancer in the United States in 2021 are 248,530 new cases and 34,130 deaths (ACS, 2021).  Approximately 1 out of every 8 men will be diagnosed with Prostate Cancer is more likely to develop in older men and non-Hispanic men of African descent (ACS, 2021).

There are several symptoms of Prostate Cancer including:

• Frequent urination
• Blood in urine
• Erectile dysfunction
• Painful ejaculation
• Loss of appetite
• Weight loss (UCF, 2018)(Mayo, 2023).

There are also several risk factors including:

• Age: risk increases with age
• Race: men of African descent are at greater risk overall and at increased risk for aggressive or advanced disease
• Family history:  increased with relative being diagnosed
• Obesity:  increased risk overall and of aggressive disease
• Geography:  more common in North America, Northwestern Europe, Australia, and Caribbean
• Genetics: BRCA1, BRCA2, and HNPCC genes increase risk
• Diet: increased intake of dairy products increases risk
• Chemical exposures: exposure to chemicals such as agent orange may increase risk
• Vasectomy: slight increased risk
• Smoking: increases risk (ACS, 2020)(Mayo, 2023)(UCF, 2021)

There are several tests, screenings and parts of the physical exam that can be used to help diagnose Prostate Cancer.  These include:

• Digital rectal exam:  the prostate is palpated physically for abnormalities
• Prostate Specific Antigen (PSA):  PSA is normal in small amounts but increases with infection, inflammation, enlargement and with cancer.
• Ultrasound: determines size and shape of prostate
• MRI: creates detailed picture of prostate
• Prostate Biopsy: cells are collected from the prostate (ACS, 2020)(Mayo, 2023)(UCF, 2021)

Once Prostate Cancer has been diagnosed, these tests can help determine whether the cancer has spread and if so, to where.

• Bone scan
• Ultrasound
• Computerized Tomography (CT scan)
• Positron Emission Tomography (PET scan)
• MRI (ACS, 2020)(Mayo, 2023)(UCF, 2021)

Treatments are available for Prostate Cancer.  Treatment can depend on the stage and grade of the cancer, age, and preferences for long and short term side effects (UCF, 2021).  Treatments can be broken down into:

• Surveillance:
• Active Surveillance - monitors cancer with PSA tests, Digital rectal exams, and biopsies
• Watchful waiting: uses less involved system to monitor
• Surgery:
• Radical Prostatectomy - prostate is removed
• Radiation Therapy:
• External Beam Radiation - external radiation is used to kill cancer cells
• Brachytherapy: radioactive sources, sometimes called seeds are placed in prostate tissue
• Cryotherapy:  prostate tissue is frozen in order to kill cancer cells
• High-Intensity Focused Ultrasound and Focal Therapy: concentrated ultrasound energy heats and                                                                                           kills cancer cells
• Hormone Therapy (Androgen Suppression Therapy)
• Block Testosterone production: Luteinizing hormone-releasing hormone (LHRH) and                                                             Gonadotropin - Releasing Hormone (GRH) agonists and                                                         antagonists
• Block Testosterone from reaching and impacting cancer cells:  LHRH agonists
• Orchiectomy:  testicles are removed
• Immunotherapy:  can engineer immune cells to fight cancer cells or help immune cells to identify cancer cells (ACS, 2020)(Mayo, 2023)(UCF, 2021)

For more information on Prostate Cancer, visit the American Cancer Society site at https://www.cancer.org/cancer/prostate-cancer.html.

To learn more about Prostate Cancer, watch our video:

UPDATED 5/6/2023

ACS. (2020) Prostate Cancer.  American Cancer Society.  Retrieved from https://www.cancer.org/cancer/prostate-cancer.html

Mayo Clinic. (2023)  Prostate Cancer.  Mayo Clinic.  Retrieved from https://www.mayoclinic.org/diseases-conditions/prostate-cancer/symptoms-causes/syc-20353087 

Urology Health. (2021) Prostate Cancer.  Urology Health.  Retrieved from https://www.urologyhealth.org/urologic-conditions/prostate-cancer#Surgery

Sickle Cell Disease

Sickle Cell Disease is a group of disorders that are inherited and affect red blood cells.  It is inherited by both parents passing a Sickle Cell gene to the child.  Normally, red blood cells are round, smooth, and can bend.  Because of these qualities and the presence of Hemoglobin, red blood cells are able to carry Oxygen within blood and travel well in blood vessels.  The Sickle Cell gene causes the red blood cell to change shape to look like a sickle (GBT, 2020).  The change in shape of the red blood cell causes it to not be able to bend.  This lack of flexibility causes the red blood cells to block blood vessels and therefore, they get "stuck" in blood vessels and obstruct them (CDC, 2020).  Their decreased ability to travel in blood vessels affects their ability to deliver Oxygen to the body.  The change in shape also affects the length of time they are viable.  Typically, red blood cells remain in the body for up to 120 days.  Sickled red blood cells only remain in the body for 10 - 20 days (JHM, 2021).  The shorter life of sickled red blood cells causes an individual to suffer from chromic anemia.  Additionally, as they are filtered through the spleen, which filters the blood and is important in the immune system, they get stuck and damage the spleen. The damage to the spleen causes someone to be at an increased risk for infections (JHM, 2021).

There are several types of Sickle Cell Disease.  The most common is Sickle Cell Anemia (HbSS).  With HBSS, an individual has inherited two sickle cell genes (S), one from each parent.  This is the most severe form of Sickle Cell disease as symptoms occur more often and are more severe.  Other types of Sickle Cell Disease include:

• HbSC disease:  individual inherits a sickle cell gene (S) and an abnormal Hemoglobin gene (C).  This form is milder than HbSS.
• HbSBeta Thalassemia: individual inherits a sickle cell gene (S) and a Beta Thalassemia gene.  Because there are two types of Beta Thalassemia, + and 0.  HbSB+ is a mild form of Sickle Cell Disease.  HbSB0 is a severe form similar to HbSS.
• HbAS: also known as Sickle Cell Trait.  Individual inherits one Sickle Cell gene (S) and 1 normal gene (A).  There are usually no symptoms of disease. (CDC, 2020)(Healthline. 2017)

Symptoms typically begin within the first year of life.  Symptoms and complications of Sickle Cell Disease include:

• Fatigue
• Fussiness in babies
• Bedwetting - due to kidney problems
• Jaundice
• Hand - Foot syndrome - swelling and pain in hands and feet.  Accompanied by fever.
• Frequent infections - there is increased risk, especially of bacterial infections due to splenic damage.  A leading cause of death in infants and children is Pneumonia.
• Acute Chest Syndrome - chest pain, coughing, difficulty breathing, and fever.  Can be life-threatening.
• Anemia - due to red blood vessels dying after 10 to 20 days.
• Delayed growth or puberty
• Vision issues - sickle cells block blood vessels in eye damaging retina.
• Pain Crisis - sickled red blood cells get stuck and block blood vessels causing sudden mild to severe pain.
• Splenic Sequestration - occurs when many sickle cells get stuck within the spleen causing it to enlarge.  This enlargement causes sudden weakness, pale lips, fast breathing, extreme thirst, abdominal pain and fast heartbeat.
• Leg ulcers - several factors cause ulcers, usually in lower leg.  They occur more commonly in men and between 10 to 50 years old.
• Stroke - occurs when sickle cells block blood vessel to brain.
• Deep Vein Thrombosis (DVT) & Pulmonary Embolism (PE): sickled cells contribute to blood coagulation and increase risk of blood clots either in deep veins or lungs.
• Gallstones: the increased rate at which sickled red blood cells die cause increased byproducts that form gallstones.
• Pregnancy problems: increased risk of Hypertension and blood clots during pregnancy. (CDC, 2021)(Healthline, 2017)

Approximately 90% of those diagnosed with Sickle Cell Disease in the United States are of African descent with about 1 in every 365 individuals of African descent being affected and 1 in 13 having Sickle Cell Trait (NIH, 2020).  In order to be diagnosed with Sickle Cell Disease, a blood test must be done which is typically done as one of the screening tests done with newborns (CDC, 2021).  Blood tests can also determine type of Sickle Cell Disease.

There are several treatments for Sickle Cell Disease including:

• Medications:
• Voxelotor - prevents sickle shape.
• Crizanlizumab - tmca - used to treat pain crises.
• Penicillin - decreases risk of severe infections particularly by pneumococcus bacteria.
• Hydroxyurea - decreases complications and should not be used during pregnancy.
• L - glutamine oral powder -  decrease pain crises.
• Hydration - help to keep cells from deforming.
• Regular exercise and reducing stress - reduce pain crises
• Transfusions - help to treat and prevent complications.
• Blood and Bone Marrow Transplant: the only cure for Sickle Cell Disease.  Risky in adults.  Individual must have a matched donor. (Mayo, 2020)(Healthline, 2017)

To learn more about Sickle Cell Disease, watch our Youtube video:

For more information on Sickle Cell Disease, view the CDC factsheet at https://www.cdc.gov/ncbddd/sicklecell/documents/SCD-factsheet_What-is-SCD.pdf

CDC. (2021) What is Sickle Cell Disease?.  Center for Disease Control and Prevention.  Retrieved from https://www.cdc.gov/ncbddd/sicklecell/facts.html

GBT. (2020) Sickle Cell Disease.  Global Blood Therapeutics.  Retrieved from https://www.gbt.com/research/sickle-cell-disease/

  

Healthline. (2017) Sickle Cell Anemia.  Healthline.  Retrieved from https://www.healthline.com/health/sickle-cell-anemia#risk-factors

JHM. (2021) Sickle Cell Disease.  John Hopkins Disease.  Retrieved from https://www.hopkinsmedicine.org/health/conditions-and-diseases/sickle-cell-disease

Mayo Clinic. (2020) Sickle Cell Anemia.  Mayo Clinic.  Retrieved from https://www.mayoclinic.org/diseases-conditions/sickle-cell-anemia/diagnosis-treatment/drc-20355882

NIH. (2020) Sickle Cell Disease.  National Heart, Lung, and Blood Institute.  Retrieved from https://www.nhlbi.nih.gov/health-topics/sickle-cell-disease