Coronavirus (COVID - 19)

Coronavirus (COVID - 19) is a virus that is spread through saliva droplets and nasal discharge.  These can spread by coughing, sneezing, or talking (WHO, 2020).  Close personal contact increases the spread of the virus as does touching facial areas and not washing hands (NCDHHS, 2020).  It is also thought that touching a surface that has the surface then touching face or mouth can also spread the virus (CDC, 2020).

Symptoms of Coronavirus may appear 2-14 days after being exposed and includes:

• fever
• cough
• shortness of breath
• fatigue
• aches and pains
• shaking with chills
• new loss of taste or smell
• diarrhea
• nausea
• vomiting
• congestion
• running nose
• sore throat (WHO, 2022)(NCDHHS, 2020)(CDC, 2020).

Symptoms that would constitute being an emergency include:

• trouble breathing
• persistent pain or pressure in chest
• new confusion
• inability to arouse
• blush lips or face  (CDC, 2020).

When an individual becomes infected, they are more likely to experience mild or moderate symptoms and not require treatment.  People who are more susceptible to becoming infected with Coronavirus include:

• elderly
• individuals with underlying medical issues
• cardiovascular disease
• Diabetes
• chronic respiratory disease
• asthma
• COPD
• Cancer (WHO).

If you suspect you are experiencing symptoms of Coronavirus, call your doctor for next steps. 

There are several things that people can do to protect themselves and those around them from Coronavirus.  These things include:

• washing hands with soap and water
• use hand sanitizer (in conjunction with washing hands)
• maintain a minimum of 3 feet (6 feet recommended) between yourself and others (especially if they are coughing and/or sneezing)
• don't touch your face your mouth and nose when coughing and sneezing
• self-isolate if exhibiting symptoms
• don't smoke
• social isolation  (WHO, 2020).

Currently, there are viral and antibody tests that can test for Coronavirus.  Viral tests test for current infection and antibody tests test for a previous infection (CDC, 2020).

There are now vaccines for Coronavirus available.  There are three types of vaccines available.  Pfizer and Moderna have developed mRNA vaccines which teach cells how to make a protien which will trigger the body's immune response.  Johnson & Johnson has created a viral vector vaccine that presents a modified version of a different virus that delivers instructions on how to fight the COVID virus.  (CDC, 2022).  Pfizer and Moderna also provide a bivalent vaccine that also include components of the original COVID virus as well as the omicron variant  (CDC, 2023)  To hear about an experience about receiving a COVID vaccine watch the video below.

If someone has tested positive, typically symptoms will go away on their own, but medications to reduce fever or pain may be given.  Drinking fluids and getting rest are important steps (AAFP, 2020).

To track cases of Coronavirus go to the interactive map provided by John Hopkins at https://coronavirus.jhu.edu/map.html

To complete a self-check to help determine whether you should be tested, go to https://www.cdc.gov/coronavirus/2019-ncov/index.html

UPDATED 2/12/2023

Anerican Academy of Family Physicians. (2020)  Coronavirus Disease (COVID - 19).     

                Familydoctor.  Retrieved from https://familydoctor.org/condition/coronavirus/

CDC. (2020) Coronavirus (COVID - 19).  Centers for Disease Control and Prevention.  Retrieved                      from  https://www.cdc.gov/coronavirus/2019-ncov/index.html

CDC. (2023)  COVID Bivalent Vaccine Boosters.  Centers for Disease Control and Prevention.  Retrieved from https://www.fda.gov/emergency-preparedness-and-response/coronavirus-disease-2019-covid-19/covid-19-bivalent-vaccine-boosters

CDC. (2022)  Overview of COVID- 19 Vaccines.  Centers for Disease Control and Prevention.  Retrieved from https://www.cdc.gov/coronavirus/2019-ncov/vaccines/different-vaccines/overview-COVID-19-vaccines.html

CDC. (2020)  Symptoms of Coronavirus.  Centers for Disease Control and Prevention.  Retrieved from https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/symptoms.html

CDC. (2020).  What you should know about COVID-19 to Protect Yourself and Others. Centers for Disease Control and Prevention.  https://www.cdc.gov/coronavirus/2019-ncov/downloads/2019-ncov-factsheet.pdf

John Hopkins University and Medicine. (2020) Coronavirus Resource Center. John Hopkins                                University and Medicine.  Retrieved from https://coronavirus.jhu.edu/map.html

NCDHHS. (2020) What is COVID - 19?  North Carolina Department of Health and Human Services.

                Retrieved from https://www.ncdhhs.gov/divisions/public-health/coronavirus-disease-2019- covid-19-response-north-carolina/what-covid-19

WHO. (2020)  Coronavirus.  World Health Organization.  Retrieved                                                                      from https://www.who.int/health-topics/coronavirus#tab=tab_3

Anxiety

Although it is normal to experience some anxiety in situations such as public speaking or test taking, when dealing with anxiety disorders, it can alter how an individual lives their life.  Anxiety stems from the fight or flight response and was useful in determining when someone was in danger.  Because individuals in 2020 are not typically running from large animals and the like, the full fight or flight response is not typically necessary.

 Anxiety disorders develop when the length or severity of the anxiety is disproportionate with the stimulus (Felman, 2018).  Anxiety involves excessive nervousness, fear, apprehension and worry (Felman, 2018).  Common types of anxiety disorders include:

• Generalized Anxiety Disorder
• Panic Disorder
• Phobia Related Disorder
• Agoraphobia (NIMH, n.d.)

There are approximately 40 million people in the United States  who are affected by an anxiety disorder, but only about 36.9% of the receive treatment (Felman, 2018).  Anxiety disorder can occur any age and affects more women than men (Healthline, 2018).  Some possible causes of anxiety disorders include:

• Environmental stressors
• Genetics
• Medical factors
• Brain chemistry
• Withdrawal from an illicit drug (Felman, 2018).

Generalized Anxiety Disorder (GAD) lasts most days for at least six months along with three or more symptoms.  During this time, an individual has excessive anxiety which will negatively impact their life.  When struggling with GAD, it is difficult to interrupt the worry cycle, even when there is the realization that there is an imbalance with the severity of the situation and the level of worry.  With mild or moderate disorders, it is possible to function socially, however, as the severity of the disorder increases, the ability to function socially typically decreases (ADAA, 2018).  Symptoms of GAD include:

• Restlessness
• Difficulty concentrating
• Muscle tension
• Difficulty controlling feelings of worry
• Sleep issues
• Sense of impending danger
• increased heart rate 
• Feeling weak or tired
• GI issues (AADA, 2018)(n.d.)

Panic Disorder is characterized by an intense fear coming on rapidly and peaking in several minutes.  These episodes are referred to as panic attacks.  Because they can occur unexpectedly or triggered by something, an individual can often worry about when the next panic attack will occur.  They may also try to avoid places or situations (n.d.).  Some symptoms of Panic disorder include:

• Heart palpitations
• Sweating
• Trembling
• Shortness of breath
• Feelings of impending doom
• Feelings of being out of control
• Confusion (Felman, 2018)(n.d.)

Phobia Related Disorder is the irrational fear of a situation, animal, or thing.  There are individuals who have phobias of heights, needles, flying, bridges, dogs, etc.  Although it is natural to have some fear regarding these things, having a disproportionate amount of fear can cause distress.  Most phobias develop before 30 years old and may develop after a traumatic experience, or learned from a family member (Brazier, 2017).  With a phobia, people may experience:

• Irrational worry about situation or thing
• Actively trying to avoid situation or thing
• Immediate irrational fear when encountering situation or thing
• Abnormal breathing
• Increased heart rate
• Chest pains
• Trembling
• Butterflies in stomach (Brazier, 2017)(n.d.).

Agoraphobia is comprised of both a fear and avoidance of places and situations where flight or escape may be difficult.  It may also be believed that help would not be available in the event that they became trapped.  There may also be the fear of crowds, bridges, or being outside alone (McIntosh, 2017).  Several things to remember about Agoraphobia are:

• Can develop after one or more panic attacks
• Can lead to various fears
• Can make it difficult to leave home
• Can improve with treatments such as antidepressants or anti-anxiety medications (2017).

Other types of Anxiety disorders include:

• Selective mutism:  An anxiety that occurs in childhood causing them to not speak in certain situations (2019).  Is often diagnosed with other anxiety disorders (n.d.).
• Social Anxiety Disorder:  Anxiety stems from an intense fear of social situations and public humiliation.  This causes an avoidance of social situations (2019).
• Separation Anxiety:  Although commonly thought of with children, can also occur in adults.  Anxiety occurs when separated from someone who is important to the individual.  There can be a feat that harm will occur to the person they are attached to and nightmares as a result (n.d.).

There are several treatments available for anxiety:

• Psychotherapy:  Geared towards specific Anxiety.
• Cognitive Behavioral Therapy:  A type of psychotherapy that focuses on teaching new thinking, behaviors and reactions towards anxiety.
• Anti-Anxiety Medications:  Typically Benzodiazepines are used to relieve anxiety.
• Antidepressants:  Improves the way the brain use chemicals to change mood (n.d.).

REFERENCES

AADA. (2019) Generalized Anxiety Disorder (GAD).  Anxiety and Depression Association of America.  Retrieved from https://adaa.org/understanding-anxiety/generalized-anxiety-disorder-gad

Brazier, Y. (2017)  Everything You Need to Know About Phobias.  Medical News Times.  Retrieved from https://www.medicalnewstoday.com/articles/249347.php

Felman, A. (2018)  What to Know About Anxiety.  Medical News Times.  Retrieved from https://www.medicalnewstoday.com/articles/323454.php

Holland, K. (2018)  Everything You Need to Know About Anxiety.  Healthline.  Retrieved from https://www.healthline.com/health/anxiety 

McIntosh, J. (2017)  What you Need to Know About Agoraphobia.  Medical News Timed.  Retrieved from https://www.medicalnewstoday.com/articles/162169.php

National Institutes of Mental Health. (n.d.)  Anxiety Disorders.  National Institutes of Health.  Retrieved from https://www.nimh.nih.gov/health/topics/anxiety-disorders/index.shtml#part_145336

Lupus

Lupus is an autoimmune disease that affects the entire body.  The immune system attacks both tissues and organs within the body, causing inflammation.  Parts of the body that are affected include joints, skin, kidneys, blood cells, brain, heart and lungs, among others (Mayo Clinic, 2023).

There are four forms of lupus:

• Systemic
• Cutaneous
• Drug-induced
• Neonatal (Lupus Foundation, 2023).

Systemic Lupus makes up 70% of cases and involves a major organ in about half of the cases.  Cutaneous Lupus involves the skin and makes up 10% of cases.  Drug Induced Lupus is caused with high doses of some medications and makes up 10% of cases and can diminish after the medication has been stopped.  Neonatal Lupus occurs when the antibodies of the mother impacts the fetus causing symptoms at birth that subside within six months (Lupus Foundation, 2023).  

Risk factors of developing Lupus include:

• Gender
• Age
• Race
• Family history (Lupus Foundation, 2023) (Mayo Clinic, 2023).

There are approximately 1.5 million people in the United States diagnosed with Lupus and is more common in women of childbearing age.  In fact, 90% of those diagnosed with Lupus are women.  The most common age range for diagnosis is between 15 and 44 years old (Lupus Foundation, 2023).  Of individuals who have Lupus, 1 in 3 have also been diagnosed with another autoimmune disorder (Lupus Foundation, 2023).  Lupus is more common in women of color.  African American women have a 2 to 3 times higher prevalence rate than White women and Latina, Asians, and Native Americans also have a higher prevalence rate (Medline, 2019).  Genetics plays a role  in developing Lupus.  Genetic variants can impact  both who develops Lupus and how severe it is (Medline, 2016).  

There are several symptoms that someone with Lupus can experience.  The symptoms include:

• Fatigue
• Fever
• Joint pain
• Joint stiffness
• Joint swelling
• Butterfly shaped facial rash
• Photosensitive skin lesions
• Raynaud's Phenomenon
• Shortness of breath
• Chest pain
• Dry eyes
• Headaches
• Confusion
• Memory loss
• Hair loss
• Swollen glands (Mayo Clinic, 2023)(Medline, 2019).

There are several tools clinicians use to diagnose Lupus.  Lupus can be mistaken for other diseases so it is important that certain tests are done.  When considering Lupus, it is important to complete:

• Medical history
• Complete exam
• Blood tests
• Complete Blood Count
• Erythrocyte Sedimentation Rate
• Liver and Kidney tests
• Urinalysis
• Antinuclear Antibody test
• Skin biopsy
• Kidney biopsy (Mayo, Clinic 2023) (Medline, 2016)

An individual may experience complications due to Lupus.  These may include:

• skin scarring
• heart attack
• joint deformities
• bone fractures
• kidney failure
• cataracts
• avascular necrosis
• pregnancy complications
• cardiovascular disease
• headaches
• dizziness
• behavior changes
• vision problems
• seizures (Mayo Clinic, 2023) (Johns Hopkins, 2023)

Once diagnosed, there are treatments that can be used to control symptoms, as there is no cure.  Because Lupus affects many systems in the body, it is often required to see a team of doctors including a Primary Care Physician, Rhuematologist and others as needed.  

Medications used include:

•  Non-steroidal anti-inflammatory drugs (NSAIDS)
• Antimalarial drugs
• Corticosteriods
• Biologic Immunosuppressants
• Rituximab (Mayo Clinic, 2023)

These drugs are used to:

• decrease swelling
• decrease pain
• prevent flares
• decrease damage to joints (Medline, 2016)

There are lifestyle changes individuals can make to help cope with their Lupus symptoms in addition to their treatment.  Having regular checkups is important to prevent flare ups.  Wearing sun protective items (hat, long sleeves, etc) amd using sunscreen is important.  Regular exercise and a healthy diet are also important.  Smoking can increase the impact of Lupus on the cardiovascular system, so not smoking will help decrease the affects of Lupus on the heart and blood vessels (Mayo Clinic, 2023).

To learn more about Lupus, watch our youtube video.

If you have been diagnosed with Lupus and have questions, either contact your Primary Physician or contact a health educator through the Lupus Foundation at https://www.lupus.org/resources/health-educator .

Updated 3/11/2023

References

Johns Hopkins Medicine. (2023) Lupus Complications and Prognosis.  Johns Hopkins Medicine.  Retrieved from  https://www.hopkinsmedicine.org/health/conditions-and-diseases/lupus/lupus-complications-and-prognosis

Lupus Foundation. (2023)  What is Lupus?  Lupus Foundation.  Retrieved from https://www.lupus.org/resources/what-is-lupus

Mayo Clinic.  (2023) Lupus.  Mayo Clinic.  Retrieved from https://www.mayoclinic.org/diseases-conditions/lupus/symptoms-causes/syc-20365789

Medline. (2016) Lupus.  US National Library of Medicine.  Retrieved from https://medlineplus.gov/lupus.html

HIV Speaks on Jones Street: NC HIV & Hepatitis Advocacy Day

On Tuesday, March 12, 2019, the North Carolina AIDS Action Network (NCAAN) hosted its annual HIV Speaks on Jones Street event.  This year, there were two issues chosen to advocate for in the NC General Assembly.  The two issues included:

1. Allocate an increased appropriation of $900,000 to the Communicable Disease Branch of the NC Division of Public Health, and
2. Close the Medicaid coverage gap (NCAAN, HIV Speaks, 2019).

Although there has been progress made in addressing both HIV and Hepatitis C (HCV), there is still progress to be made.  Because a suppressed HIV viral load can prevent transmission through sexual contact, it is important that individuals living with HIV have access to medications (NCAAN, HIV Speaks, 2019).  It is also important that individuals who are HIV negative protect themselves.  One option is the use of PrEP, which is a medication that can help decrease the likelihood of contracting HIV.  Fifty percent of the 100,000 individuals living with HCV in North Carolina have yet to receive a diagnosis (NCAAN, HIV Speaks, 2019).  There is a need for testing for both HIV and HCV, HIV prevention and HCV treatment.  These needs were the basis for asking the NC General Assembly for $900,000 for the Communicable Disease Branch of the NC Division of Public Health to provide and support these services.

The expansion of Medicaid was the other issue advocated for.  Of the 400,000 people in North Carolina who would qualify for and obtain coverage through the expansion, more than 5,000 of those are currently living with HIV (NCAAN, Closing the Medicaid coverage gap, 2019).  Providing individuals would not only allow them to access needed healthcare services, but would also assist in combating the opioid epidemic by providing access to substance abuse and mental health treatment and services and boosting local economy by creating new jobs, increasing business activity and decreasing healthcare costs that are currently not being paid for, particularly in rural areas (NCAAN, Closing the Medicaid coverage gap, 2019).

On Tuesday, many advocates from different parts of the state met with state senators and representatives to garner support for these issues.  Support was expressed by some legislators concerning the issues.  Mike Woodard, Zack Hawkins, and Marcia Morey all expressed support while others and I met with each of them.  Jeremy Collins, the Director of the Office of Public Engagement in the Governor's Office, also expressed support when welcoming the advocates to the event.  Advocates, those who have been infected and those who have been affected, shared information and stories as to how the issues have impacted them.  There is much more work to be done in order for changes to be made.  In order for those in North Carolina to contact their state senators and representatives and express their support for these issues, check out www.ncleg.gov to find who represents your area.  Although this website is for North Carolina, there are other states that still have not expanded Medicaid.  Access to healthcare is still an issue within the United States and should be considered an important issue.


#NCHIV
#NCGA

NCAAN. (2019)  Closing the Medicaid Coverage Gap.  North Carolina AIDS Action Network.

NCAAN. (2019)  HIV Speaks on Jones Street:  NC HIV & Hepatitis Advocacy Day.  North Carolina AIDS Action Network.

Congestive Heart Failure

Congestive Heart Failure occurs when the heart is unable to pump adequately enough to meet the needs of the body.  There are several conditions that may result in Congestive Heart Failure including: 

• Coronary Artery Disease, 
• High Blood Pressure, 
• long term alcohol abuse, 
• heart valve disorders, 
• heart attack and 
• cardiomyopathy  (Kulik, 2018)(Mayo Clinic, 2023).  

There are approximately six million people in the United States affected by Congestive Heart Failure and approximately 670,000 people are diagnosed each year.  Among individuals 65 and older, Congestive Heart Failure is the leading cause of hospitalization (WebMD, 2018).

Because a heart is weakened by Congestive Heart Failure, its pumping ability is also weakened and moves blood throughout the body slower (decreased cardiac output) and increases the pressure within the heart.  As a result, decreased amounts of Oxygen and nutrients reach the body.  With the increase in pressure within the heart, its chambers are stretched and may become stiff and thickened.  The stiff, thickened heart muscle is less able to pump blood.  Ejection fraction is the measurement of how effective the heart is pumping.  Normal ejection fractions are above or equal to 50% (Mayo Clinic, 2023).  Congestive Heart failure can occur in the left, right or both sides of the heart, but usually starts in the left side of the heart (Mayo Clinic, 2023).  Types of Congestive Heart Failure include: 

• Systolic dysfunction - heart does not create enough force to pump Oxygen rich blood through the body
• Diastolic dysfunction - heart is able to contract, however, because the ventricles do not properly relax, less blood is able to enter the heart (WebMD, 2018).

As the heart muscle becomes weakened, stiff and thickened, its pumping effectiveness decreases.  As efficiency decreases, kidneys begin to retain fluid and salt.  The fluid building up in extremities (arms, legs, feet), lungs and organs causes the body to become congested.  Symptoms of Congestive Heart Failure include: 

• fluid retention
• dizziness
• fatigue 
• weakness
• rapid or irregular heartbeats
• shortness of breath 
• diminished exercise capacity (Kulick, 2018)(WebMD, 2018). 

Shortness of breath is the hallmark symptom and can occur at rest, with activity, lying flat or can wake an individual up during sleep.  Risk factors include: high blood pressure, coronary artery disease, heart attacks, Diabetes, some Diabetic medications, other medications, sleep apnea, congenital heart defects, valvular heart disorders, viruses, age, alcohol use, tobacco use, obesity, and irregular heartbeats (Mayo Clinic, 2023).

Tests, in addition to physical exam, can be performed to help diagnose Congestive Heart Failure.  Tests such as cardiac blood tests, chest x-ray, electrocardiogram, echocardiogram, stress test, cardiac CT scan, MRI, coronary angiogram, and myocardial biopsy may all assist in diagnosis.  Once Congestive Heart Failure has been diagnosed, the stage can be determined.  According to the American Heart Association and the American College of Cardiology, stages range from A to D and are based on symptoms present and treatments needed.  According to the New York Heart Association, stages range from I to IV and are based on symptoms and level of shortness of breath (Mayo Clinic, 2023).

Once diagnosed with Congestive Heart Failure, there are times when you should contact your primary clinician including:

• if your symptoms worsen suddenly
• you have a new symptom
• you gain 5 or more pounds within a few days 

These can implicate that Congestive Heart Failure is worsening or the current treatment is not appropriate.  (Mayo Clinic, 2023)

Complications of Congestive Heart Failure may include:

• Kidney damage or failure: due to reduced blood flow to kidneys
• Other heart problems: due to changes in heart size and/or function
• Liver damage:  due to fluid build up in the liver
• Sudden cardiac death:  due to irregular heart rhythm (Mayo Clinic, 2023)

Treatments for Congestive Heart Failure include medications, surgery, and devices.  Medications used are:

• ACE Inhibitors
• Angiotensin  II Receptor blockers
• Beta Blockers
• Diuretics
• Aldosterone Antagonists
• Inotropes
• Digoxin
  

Surgeries and medical devices that can be utilized are:

• Coronary Bypass Surgery
• Heart Valve Repair or Replacement
• Implantable Cardioverter-Defibrillators
• Cardiac Resynchronization Therapy
• Biventricular Pacing
• Ventricular Assist Devices
• Heart Transplant (WebMD, 2018)

Things that can be done to improve Congestive Heart Failure are:

• improve blood pressure
• monitor weight and swelling
• monitor fluid intake and output
• limit salt
• lose weight
• monitor symptoms (Kulick, 2018)(Mayo Clinic, 2023).

Eating a healthy diet, exercising, and obtaining vaccines to prevent respiratory infections can also improve living with Congestive Heart Failure (WebMD, 2018).

To learn more about Congestive Heart Failure, watch our Youtube video.

Updated 3/11/2023

Kulick, D. (2018) Congestive Heart Failure (CHF) Symptoms, Stages, Prognosis.  MedicineNet.com        Retrieved from https://www.medicinenet.com/congestive_heart_failure_chf_overview/article.htm

Mayo Clinic, (2023) Heart Failure.  Mayo Clinic.  Retrieved from

     https://www.mayoclinic.org/diseases-conditions/heart-failure/symptoms-causes/syc-20373142

WebMD. (2018) Congestive Heart Failure and Heart Disease.  Retrieved from

     https://www.webmd.com/heart-disease/guide-heart-failure#6-11

Alzheimer's Disease

Alzheimer's disease is a type of dementia that affects more than five million individuals in the United States.  This number could rise as high as sixteen million by 2050 (Alzheimer's Association, 2017).  Symptoms of dementias include progressive memory loss and decrease in cognitive abilities and social skills.   Alzheimer's Disease makes up 60 - 80% of the dementias experienced (2017).  The cause of Alzheimer's Disease is the degeneration and death of brain cells.  Plaques made up of Beta-amyloid protein damage and destroy the brain cells.  The plaques also interrupt communication between cells.  Threads of Tau protein within the brain carry nutrients throughout the brain.  The threads becoming tangled decreases nutrients reaching brain cells, which contribute to the death of the brain cells (Mayo Clinic, 2018).

The first symptoms of Alzheimer's include forgetfulness and confusion.  At a rate that is individual, the symptoms progress and worsen.  As the disease progresses, memory losses can affect lives in ways such as:

• Repeating statements and questions
• Forget everyday events such as conversations, appointments or events
• Misplacing possessions
• Getting lost, even in familiar places
• Forgetting names of family and friends
• Difficulty in identifying objects or expressing thoughts (Mayo Clinic, 2018).

Symptoms also include difficulty in identifying and thinking effectively responding to activities of daily living, performing activities with sequential steps and changes in behavior and personality.  These changes include:

• Depression
• Apathy
• Social withdrawal
• Mood Swings
• Distrust in others
• Irritability
• Aggressiveness
• Changes in sleeping habits
• Wandering
• Loss of inhibitions
• Delusions (Mayo Clinic, 2018).

Alzheimer's is diagnosed through a medical history, mental status test, mood testing, physical and neurological exam, and blood and brain imaging tests that rule out other disorders.  Risk factors include:

• Age
• Family history
• Down Syndrome
• Sex
• Mild cognitive impairment
• Past head trauma
• Lifestyle and heart health
• Lifelong learning and social engagement (Mayo Clinic, 2018).

Although there is no cure for Alzheimer's Disease, there are treatments.  There are medications used to treat memory loss, behavior changes, and  sleep changes (Alzheimer's Association, 2017).  A safe and Supportive environment should also be established.

Watch Youtube video below.  Click like, share and subscribe.

https://www.youtube.com/watch?v=DXu4XJyn6W4

Alzheimer's Association. (2017) Diagnosis of Alzheimer's Disease and Dementia.  Alzheimer's Association.  Retrieved from https://www.alz.org/alzheimers_disease_diagnosis.asp

Alzheimer's Association. (2017) Treatment of Alzheimer's Disease.  Alzheimer's Association.  Retrieved from https://www.alz.org/alzheimers_disease_treatments.asp

Mayo Clinic (2018) Alzheimer's Disease.  Mayo Clinic.  Retrieved from https://www.mayoclinic.org/diseases-conditions/alzheimers-disease/diagnosis-treatment/drc-20350453

Migraines

Migraines are a type of headache that can be intense and at times, debilitating.  They can occur with an aura, a classical migraine, or without an aura, a common migraine.  Common migraines are more common than classical migraines.  The fact that migraines not only involves debilitating pain, but also has classic migraine symptoms differentiate them from other types of headaches.  They are indeed different from a "really bad headache".  Symptoms associated with migraines are:

• nausea
• pain behind one eye or ear
• pain in the temples
• seeing spots or flashing lights
• sensitivity to light and/or sound
• temporary vision loss
• vomiting (Nall, 2015)

It is common for migraines to affect one side of the head.  Another characteristic that differentiates migraines is that the intense pain has a throbbing quality.  A migraine can cause debilitating pain for either hours or days (Mayo, 20).  Without treatment, a migraine can last 72 hours or longer.  As someone who suffers from migraines, I can attest to the fact that they can indeed last this long.  I have had migraines for up to four days.

There are several types of migraines, including:

• Migraine with aura (Classical migraine)
• Migraine without aura (Common Migraine)
• Basilar - Type Migraine:  may include temporary partial or total blindness
• Hemiplegic Migraine:  rare and can cause temporary paralysis
• Migraine without headache:  aura symptoms without a headache
• Status Migrainosus:  rare, severe and can last over 72 hours (NIH, 2023)

Classical migraines occur after an aura which occurs ten to thirty minutes before the migraine.  Common migraines do not have these symptoms beforehand.  Sensations that occur during an aura are:

• feeling less mentally alert or having trouble thinking
• seeing flashing lights or unusual lines
• tingling or numbness in the face or hands
• blurred vision
• unusual sense of smell, taste, or touch (Nall, 2015)

A prodrome may also occur one to two days before a migraine.  Symptoms that can occur during this phase are:

• constipation
• neck stiffness
• increased thirst and urination
• frequent yawning (Nall, 2015)

A postdrome may also occur for approximately 24 hours after the migraine.  Symptoms during this phase include:

• confusion
• moodiness
• dizziness
• weakness
• sensitivity to light and sound (Mayo, 2023) 

There are several theories as to why migraines occur.  Changes in the brainstem and how it interacts with the trigeminal nerve is thought to be involved.  It is also thought that imbalances in brain chemicals, particularly serotonin, also plays a role.  It is thought that when serotonin levels decrease, the trigeminal nerve release neuropeptides which cause the pain associated with migraines by acting on the meninges, the brains outer coverings (Mayo, 2023).

Several things can be done to diagnose migraines.  These include:

• Medical History
• Family History
• Physical Exam
• Including a Neurological examination
• MRI
• CT scan (Mayo. 2023)

There are certain things that may trigger migraines including:

• hormonal changes in women
• foods - salty foods, chocolate
• food additives
• drinks - alcohol and highly caffeinated drinks
• stress
• sensory stimuli - bright lights, loud sounds, strong smells
• changes in wake - sleep patterns
• Intense physical exertion
• changes in environment
• medications (Mayo, 2023)

There are risk factors that make some people more susceptible to migraines.  These individuals who have a family history of migraines are more likely to develop them as well.  Although migraines can occur at any age, they tend to increase during an individual's 30s, then decrease.  Women are three times more likely to be affected by migraines (Mayo, 2023).

There are several treatments for migraines.  

• Pain relievers: ibuprofen or Tylenol
• Triptans: help to block pain pathways. 
• Ergots: block pain messages
• Ubrelvey: relieves both pain and symptoms
• Preventive medications
• Beta blockers
• Calcium channel blockers
• Tricyclic antidepressants
• Anti-seizure medication (NIH, 2023)

To learn more about Migraines, watch our Youtube video.

REVIEWED AND UPDATED 4/7/23

Mayo Clinic. (2023) Migraine.  Mayo Clinic.  Retrieved from http://www.mayoclinic.org/diseases-conditions/migraine-headache/symptoms-causes/dxc-20202434

Nall, R. (2015) Migraines vs Headache: How to tell them apart.  Healthline.  Retrieved from http://www.healthline.com/health/migraine/migraine-vs-headache#overview1

NIH (2023)  Migraine.  National Institutes of Health.  Retrieved from https://www.ninds.nih.gov/health-information/disorders/migraine#