Multiple Sclerosis

Multiple Sclerosis (MS) is a chronic illness.  It is an autoimmune disease that affects the Central Nervous System (CNS).  The parts of the body that make up the CNS are the brain, the spinal cord and the optic nerves (NMSS, 2020).  In the brain, MS will affect areas such as the brainstem, the cerebellum and white matter (MNT, 2019).   An individuals' immune system attacks the protective layer of nerve fibers called myelin (Healthline. 2022)  As the myelin is destroyed, communication between the brain and the body is altered (Mayo, 2020).  Over time, the nerves deteriorate and are permanently damaged due to inflammation, scar tissue and lesions (Healthline, 2022).  As nerves are damaged, CNS messages are altered, symptoms arise and scar tissue forms (NMSS, 2020).

There are several symptoms of MS.  Symptoms will vary from person to person.  Common symptoms include:

• Fatigue: occurs in 80% of cases.  May occur at levels that interfere with daily life.
• Difficulty walking:  occurs due to such things as weakness, loss of balance, numbness, balance difficulties, and muscle spasticity.
• Numbness/Tingling: occurring in face, body, arms and legs and is many times is the first symptom.
• Spasticity: includes stiffness and involuntary movements.  Is more common in legs.
• Weakness: results from the deconditioning of muscles.
• Dizziness: may experience lightheadedness or vertigo.
• Bladder Dysfunction: occurs in 80% of cases.
• Bowel issues: both constipation and loss of control of bowels.
• Sexual problems: may result due to CNS damage
• Pain: may occur in up to 55% of cases
• Cognitive changes: In more that 50% of cases, high level brain functions are affected.
• Lhermitte's sign: electric shock with neck movement
• Emotional changes: mood swings, irritability.
• Depression: common with MS.

Less common symptoms include:

• Speech problems: slurring, loss of volume.
• Swallowing: dysphagia.
• Tremor: uncontrollable shaking
• Seizures
• Breathing problems
• Hearing loss (NMSS, 2020)(MNT, 2019)(Healthline, 2022).

There are four types of MS.  They include:

• Clinically Isolated Syndrome: an initial single episode of symptoms lasting at least 24 hours.
• Relapse Remitting MS (RRMS): most common type.  Involves "attacks" where neurological symptoms are exacerbated then periods of either partial or complete relapse.  Based on whether  someone is having symptoms or relapses or not, can be characterized as active or not active.  Based on if the level of disability is increasing, it will be characterized as worsening or not worsening.
• Secondary Progressive MS (SPMS): begins in the same manner as RRMS.  At a point, the neurological function will transition in where it progressively worsens over time and there is increased disability.  Like RRMS, SPMS can be characterized as active or not active.  It can also be characterized as with progression or without progression based on whether there is evidence of a current increase in disability.
• Primary Progressive MS (PPMS):  neurologic function worsens and disability increases or remissions.  Can also be characterized as active or not active and with progression or without progression (NMSS, 2020)(MNT, 2019)(Healthline, 2022).

Risk factors that may play a role in developing MS.  They include:

• Age: most often diagnosed between 20 and 40 years of age.
• Gender: 2-3 times more likely to be diagnosed in women
• Family history: at increased risk if you have a parent or sibling who has MS.
• Smoking: increased likelihood of developing MS.
• Vitamin D deficiency: is thought low levels of vitamin D impacts immune system
• Vitamin B12 deficiency: Vitamin B12 is necessary for Myelin production.
• Infections: Some viruses increase the risk of developing MS.
• Race: MS is more common in Whites.
• Geography: locations further from the equator have higher incidence of MS (Mayo, 2020)(Healthline, 2022)(NMSS, 2020).

When trying to diagnose MS, there is no one test that specifically tests for MS.  Diagnosis of MS typically occurs with ruling out other similar conditions.  A medical history and a neurologic exam are important in making a diagnosis.  Parts of the history and exam that should be done include:

• history of:
• past and present symptoms
• birthplace
• family history
• environmental exposures
• illnesses
• travel history
• test
• Cranial nerves
• sensation
• reflexes coordination
• walking
• balance

Tests used to help in diagnosis also include:

• Blood tests: may find biomarkers associated with MS.
• Lumbar Puncture: can rule out infections and other conditions
• Magnetic Resonance Imaging (MRI): can show areas of lesions in brain and/or spinal cord
• Evoked potential tests: use stimuli to measure speed of information travelling nerve pathways
• Optical Coherence Tomography (OCT): takes picture of optic nerves (Mayo, 2020)(Healthline, 2022)(NMSS, 2020).

There are several options for treatment of MS.  They include:

• Disease-Modifying Therapies (DMTs): slow progression and lower relapse rate.
• Corticosteroids: treat relapses.
• Diet and exercise: regular exercise and a well balanced diet can help manage overall health.
• H.P. Acthar Gel: treats relapses.
• Rehabilitation: include Physical Therapy, Occupational Therapy, and Speech Therapy.
• Muscle Relaxants: control muscle spasms.
• Rest (MNT, 2019)(Mayo, 2020)(Healthline, 2022)(NMSS, 2020).

To learn more about Multiple Sclerosis, watch our video:

UPDATED 4/23/23

For more information on Multiple Sclerosis, go to the National Multiple Sclerosis Society website at https://www.nationalmssociety.org/Treating-MS/Managing-Relapses

Healthline. (2022) Understanding Multiple Sclerosis.  Healthline.  Retrieved from https://www.healthline.com/health/multiple-sclerosis

Mayo Clinic. (2020) Multiple Sclerosis.  Mayo Clinic.  Retrieved from https://www.mayoclinic.org/diseases-conditions/multiple-sclerosis/diagnosis-treatment/drc-20350274

MNT. (2019) Multiple Sclerosis: What you need to know.  Medical News Today.  Retrieved from https://www.medicalnewstoday.com/articles/37556

NMSS. (2020) What is MS? National Multiple Sclerosis Society.  Retrieved from https://www.nationalmssociety.org/What-is-MS

Uterine Fibroids

Uterine Fibroids are growths within or on the uterus that are noncancerous.  Having fibroids does not increase risk of uterine cancer (OWH, 2019).  They can range in size from undetectable by the naked eye to bulky and large enough to distort the uterus (Mayo, 2020).  It is possible to have a single fibroid or multiple fibroids.  Other names for fibroids include:

• Leiomyoma
• Myoma
• Uterine Myoma
• Fibroma (Healthline, 2018).

Although fibroids can occur at any age, they most commonly occur between 30 and 40 years of age (ACOG, 2020).  Other risk factors for fibroids include:

• Family History - a woman with a mother who had fibroids has a 3 times greater risk of developing Fibroids.
• Race - Women of African descent are at higher risk of Fibroids than whites. 
• Obesity - can increase risk as much as 2 to 3 times.
• Eating habits - lots of red meat, ham and alcohol can increase risk.  Eating more green vegetables can be protective.
• Hormones - Estrogen and Progesterone may stimulate fibroid growth.
• Pregnancy - due to increased Estrogen and Progesterone production. (OWH, 2019)(Mayo, 2020)(Healthline, 2018).

It is possible to not have symptoms of Fibroids.  When symptoms do occur, they can include:

• Heavy bleeding between and during menses
• Blood clots
• Pelvic pain
• Low back pain
• Increased abdominal cramping with menses
• Increased urination
• Pain during intercourse
• Longer menses
• Abdominal pressure
• Abdominal swelling
• Anemia
• Constipation
• Rectal pain
• Infertility
• Complications during pregnancy and labor (ACOG, 2020)(Mayo, 2020)(Healthline, 2018)(OWH, 2019)

At times, Fibroids may be found during a physical exam.  Imaging tests can also be used to confirm Fibroids.  These tests include: 

• Ultrasound
• Magnetic Resonance Imaging
• X-ray
• Hysterosalpingogram - X-ray dye is inserted into uterus while X-rays are made
• Sonohysterogram - water is injected into uterus while ultrasound pictures are taken
• Hysteroscopy - scope is placed inside uterus
• Pelvic MRI.  (OWH, 2019)(Mayo, 2020)

There are several treatments that be used with Uterine Fibroids.  Things to consider when deciding on a treatment are:

• whether you are having symptoms
• if you want to become pregnant
• the location and size of fibroids
• age at time of treatment
• length of time until menopause (OWH, 2019).

There are also medications that are used to treat fibroids.  These medications include:

• Ibuprofen, - pain
• Tylenol - pain
• Iron - anemia
• Low dose birth control pills - helps control bleeding
• progesterone like injections (Depo Provera) - helps control bleeding
• Mirena IUD  - helps control bleeding
• GnRHa (Gonadotropin Releasing Progesterone Agonists) - shrink fibroids

Surgical options are also available to treat fibroids.  These options include:

• Myomectomy - fibroids are removed through laproscopic, hysterscopic or open abdominal surgery
• Hysterectomy - uterus is removed
• Hysteroscopy - fibroids destroyed through electricity or laser
• Uterine Artery Embolization - particles are injected into arteries leading to uterus which cut off blood flow to fibroids and they shrink.
• Magnetic Resonance Imaging - guided Ultrasound surgery - MRI directed where to use Ultrasound to destroy fibroids.

For more information, watch Youtube video below.  Subscribe and like.  Also, click follow to the right to follow blog and get updates on new articles.  Also watch the second video to hear a personal experience with Uterine Fibroids.

ACOG. (2020) Uterine Fibroids.  American College of Obstetricians and Gynecologists.  Retrieved from https://www.acog.org/womens-health/faqs/uterine-fibroids

Healthline. (2018)  What are Fibroids.  Healthline.  Retrieved from https://www.healthline.com/health/uterine-fibroids#_noHeaderPrefixedContent

Mayo clinic. (2020) Uterine Fibroids.  May Clinic.  Retrieved from https://www.mayoclinic.org/diseases-conditions/uterine-fibroids/symptoms-causes/syc-20354288

OWH. (2019) Uterine Fibroids.  Office on Women's Health.  Retrieved from https://www.womenshealth.gov/a-z-topics/uterine-fibroids

Diabetes

Although there are several types of Diabetes, Diabetes is a metabolic disorder that involves the release of insulin from the pancreas and its use in the body in order to process and store Glucose (sugar) within the body.  Glucose is an important source of energy, however, too much can negatively impact health.

Types of Diabetes include:

• Type 1
• Type 2
• Gestational
• Prediabetes (Mayo, 2018)

In Type 1 Diabetes, an individual's immune system destroys the cells of the pancreas that produce insulin.  This greatly reduces the amount of insulin being produced.  Without insulin or very little insulin, the amount of blood sugar in the body increases (Mayo, 2018).There is a genetic proponent to Type 1 Diabetes.  Prediabetes is a step to developing Type 2 Diabetes.  In Prediabetes, cells within the body become increasingly resistant to insulin.  Regardless of how hard the pancreas works, it cannot make enough insulin to counteract the insulin resistance (Mayo, 2018).  This leads to blood glucose increasing instead of being used by cells for energy.  At this point, someone has developed Type 2 Diabetes.  There is also a genetic aspect to  Type 2 Diabetes.  Increased weight is also linked to developing Type 2 Diabetes (Mayo, 2018).  Gestational Diabetes occurs due to hormones, produced by the placenta, causing cells to be resistant to insulin.  There are instances where the pancreas is unable to produce enough insulin to counteract the resistance (Mayo, 2018).  Typically, Type 1 Diabetes is diagnosed in children and younger adults, but can be diagnosed at any age.  Type 2 Diabetes is typically diagnosed in adulthood, but  can be also diagnosed in children as well.  Gestational Diabetes is diagnosed during pregnancy (NIH, 2016).

There are approximately 50.2 million people, 18 years or older, in the United States with Diabetes, either diagnosed or undiagnosed (MNT, 2020).  This equates to almost 10% of the population.  More than 25% do not know that they have Diabetes (NIH, 2016).

Symptoms of Diabetes (including Gestational) include:

• Extreme hunger
• Fatigue
• Increased urination
• Increased thirst
• Dry mouth
• Itchy skin
• Blurred vision
• Impotence/Erectile dysfunction

Symptoms of Type 1 Diabetes include:

• Unexplained weight loss
• Nausea
• Vomiting
• Velvety dark skin changes of neck, armpits, and groin (Acanthosis Nigricans)
• Decreased vision

Symptoms of Type 2 Diabetes include:

• Yeast infections
• Slow healing sores or cuts
• Pain or numbness (Mayo, 2018)(WebMD, 2019)

Complications from Diabetes can arise.  Diabetes can play a part in developing conditions such as:

• Heart disease
• Stroke
• Kidney disease
• Eye problems
• Dental disease
• Nerve disease
• Foot problems
• Hearing impairment
• Alzheimer's disease
• Depression (Mayo, 2018)(NIH, 2016)

With Gestational Diabetes, complications that can occur include:

• Excess growth (Large baby)
• Baby more likely to develop Type 2 Diabetes later in life
• Low blood sugar
• Death (Mayo, 2018).

There are many risk factors for Diabetes.  They include:

• For Type 1:
• Family history
• Environmental factors
• Presence of damaging immune system cells (autoantibodies)
• Geography
• For Prediabetes/Type 2:
• Family history
• Weight
• Physical inactivity
• Race
• Age
• Gestational diabetes
• Polycystic Ovary Syndrome
• Hypertension
• High Cholesterol
• Gestational
• Age
• Family history
• Personal history
• Weight
• Race (Mayo, 2018).

With the symptoms occurring rapidly with Type 1 Diabetes, screening tests for Diabetes are often warranted.  With Type 2 Diabetes and Prediabetes, there are guidelines set forth by the American Diabetic Association to prompt screening for Diabetes including:

• BMI >25, regardless of age
• 45 years old or older
• Any woman that had Gestational Diabetes during a pregnancy
• Diagnosis of Prediabetes (Mayo, Diagnosis, 2018).

Tests used to diagnose Diabetes include:

• Glycated Hemoglobin (A1C) test
• Random blood sugar
• Fasting blood sugar
• Oral glucose tolerance test
• Urine checked for ketones, if Type 1 is suspected 
• Glucose challenge test, used to diagnose Gestational Diabetes

There are several treatments that can be used with Diabetes.  These treatments include:

• For Type 1
• Insulin
• Injections
• Insulin pump
• Blood sugar checks
• Carbohydrate Counting
• For Type 2
• Lifestyle changes
• Exercise
• Weight loss
• Well-balanced diet
• Minimal alcohol 
• Medications
• Metformin
• SGLT2 inhibitors
• GLP-1 receptor agonists
• Bariatric surgery (Mayo, 2018).

With all types of Diabetes, an individual should be aware of the symptoms of hypoglycemia, hyperglycemia, Diabetic Ketoacidosis, and Hyperglycemic Hyperosmolar Nonketotic Syndrome as they all can constitute an emergency. Individuals with Diabetes should be aware of the symptoms of each of these conditions.   Hypoglycemia, or low blood sugar, occurs when someone's blood sugar falls below a target level.  Hyperglycemia occurs when blood sugar raises above a target level.  Diabetic ketoacidosis occurs when the body breaks down fat for energy producing ketones.  Hyperglycemic Hyperosmolar Nonketotic Syndrome occurs with Type 2 Diabetes when the blood sugar level becomes so high that an individuals' blood thickens (Mayo, 2018).

Symptoms of Hypoglycemia include:

• Sweating
• Shakiness
• Weakness
• Hunger
• Dizziness
• Headaches
• Blurred vision

Symptoms of Hyperglycemia include:

• Frequent urination
• Increased thirst
• Dry mouth
• Blurred vision
• Fatigue
• Nausea

Symptoms of Diabetic Ketoacidosis include:

• Loss of appetite
• Weakness
• Fever
• Numbness
• Stomach pain
• Sweat, fruity breath

Symptoms of Hyperglycemic Hyperosmolar Nonketotic Syndrome include:

• Blood sugar 600 mg/dL or higher
• Fever
• Dry Mouth
• Extreme thirst
• Drowsiness
• Confusion
• Vision loss
• Hallucinations (Mayo, 2018).

Watch Youtube video below.  Click like, share and subscribe.  Also, in blog, at right of articles, click follow for updates on articles.

For more resources on Diabetes, visit the American Diabetic Association website at https://www.diabetes.org/resources

Mayo Clinic. (2018)  Diabetes.  Mayo Clinic.  Retrieved from https://www.diabetes.org/resources

Medical News Today. (2020) Diabetes: Symptoms, treatment and early diagnosis.  Medical New Today.  Retrieved from https://www.medicalnewstoday.com/articles/323627

NIH. (2016) What is Diabetes?  National Institute of Diabetes and Digestive and Kidney Diseases.  Retrieved from https://www.niddk.nih.gov/health-information/diabetes/overview/what-is-diabetes

WebMD. (2018) Early Signs and Symptoms of Diabetes: How To Tell If You Have It.  WebMD.  Retrieved from https://www.webmd.com/diabetes/guide/understanding-diabetes-symptoms

Depression

Depression is a mood disorder that is also known as Major Depressive Disorder or Clinical Depression.  Because depression is comprised of a persistent feeling of sadness and a loss of interest in activities it is more than feeling sad for a couple days (Mayo, 2020).  The symptoms of depression can affect and individual's feelings, thoughts, and daily activities (NIH, 2020).

The symptoms of depression can fluctuate in severity.  An individual can have episodes of symptoms.  The episodes last at least two weeks but can last for months or years (MNT, 2020).  Symptoms of depression include:

• Persistent feelings of sadness, anxiety, hopelessness, worthlessness.
• Feelings of irritability or angry outbursts.
• Loss of interest in activities.
• Decreased energy or fatigue.
• Difficulty concentrating, remembering or making decisions.
• Sleep disturbances such as difficulty sleeping, early morning awakening, oversleeping.
• Appetite and/or weight changes (increased or decreased).
• Aches or pains not explained by other conditions.
• Increase in purposeless physical activity (pacing back and forth, etc).
• Slowed movements and speech.
• Suicidal ideations or suicide attempts (Mayo Clinic, 2020)(APA, 2017)(NIH, 2018).

About 6.7% of adults are affected by depression in any given year and 16.6% of people experience depression during their lifetime.  (APA, 2017).  Also in any given year, 16.1 million people in the United States are affected by depression (MNT, 2020).  Women are about twice as likely  to experience depression than men and about one third of women experience an episode of depression in their lifetime (APA, 2017)(MNT, 2020).

Risk factors of depression include:

• Genetics
• Brain chemistry
• Environmental factors
• Psychological and social factors
• Hormones
• Personality
• Acute stress
• Lack of coping strategies
• Some medications
• Recreational drugs
• Head injury
• Chronic condition
• Persistent pain (MNT, 2020)(APA, 2017)(Mayo Clinic, 2020).

Depression is most often first seen in adulthood, although depression can occur at all ages.  In adults, depression can occur along with other medical conditions.  Medications for these conditions may impact depression (NIH, 2018).

In order to diagnose depression, several things should be done including:

• Physical exam
• Lab tests
• Psychiatric evaluation
• The Hamilton Depression Rating Scale
• The Beck Depression Inventory
• Use of DSM-V (Diagnostic & Statistical Manual of Mental Disorders, 5th edition) (MNT, 2020)

According to the DSM-V, five or more symptoms must be present during a two week period, as well as be a change in prior functioning with one of the symptoms being either a depressed mood or loss of interest in activities or pleasure (FMHI, 2018).

Treatments for depression include:

• Support
• Psychotherapy
• Medications
• Selective Serotonin Reuptake Inhibitors (SSRIs)
• Monoamine Oxidase Inhibitors (MAOIs)
• Tricyclic antidepressants
• Atypical antidepressants
• Selective Serotonin & Norepinephrine Reuptake Inhibitors (SSNRIs) 
• Electroconvulsive therapy  
• Transcranial Magnetic Stimulation (MNT, 2020)(APA, 2017)(Mayo Clinic, 2020)-.

There are forms of depression that are somewhat different from Major Depressive Disorder.

• Persistent Depressive Disorder:  also known as Dysthymia and is less severe and more chronic as it lasts for at least two years.
• Postpartum Depression: occurs during pregnancy or after childbirth.
• Psychotic Depression: consists of severe depression and a form of psychosis (delusions or hallucinations).
• Major Depressive Disorder with Seasonal Pattern:  onset is during winter months with less natural sunlight.
• Bipolar Depression:  Depression fluctuates with mania (extreme high euphoria).
• Cyclothymic Disorder:  involves symptoms that are milder than Bipolar Depression.

If you are experiencing depression, find support and seek medical attention.  If you are considering suicide, find support, seek medical attention, or contact the National Suicide Hotline at 1-800-273-8255.

Watch the Youtube video below.  Click like, share, and subscribe.  Also, in the blog, at right of articles, click follow for updates on articles.

APA. (2017) What is Depression?  American Psychiatric Association.  Retrieved from https://www.psychiatry.org/patients-families/depression/what-is-depression

FMHI. (2018) DSM-5 Criteria: Major Depressive Disorder.  Florida Mental Health Institute. Retrieved from  http://www.medicaidmentalhealth.org/_assets/file/Guidelines/2017-
2018%20Treatment%20of%20Adult%20Major%20Depressive%20Disorder.pdf

Mayo Clinic. (2020) Depression (Major Depressive Disorder)  Mayo Clinic
https://www.mayoclinic.org/diseases-conditions/depression/diagnosis-treatment/drc-20356013

MNT. (2020) What is Depression and What Can I Do About It?  Medical News Today.  Retrieved from https://www.medicalnewstoday.com/articles/8933#triggers

NIH. (2018) Depression.  National Institue of Health.  Retrieved from https://www.nimh.nih.gov/health/topics/depression/index.shtml

Opioid Use Disorder

Opioids can occur naturally or be made in laboratories (synthetic).  Opioids, when ingested, interact with opioid receptors that are located on neurons in both the brain and the body.  Due to the interaction between the opioid and the neurons, any pain is reduced (APA, 2018).  Opioids have both analgesic (pain relief) and Central Nervous System depressant effects (Strain, 2020).  Naturally occuring opiates (Heroin, Opium, Morphine, Codeine) and Synthetic Opiates (Oxycodone, Hydrocodone, Fentanyl, Tramadol, and Methadone) are  both classified as opioids (Strain, 2020).  Some opioids are stronger than others.  Fentanyl is 50 - 100 times more potent than other opioids (Strain, 2020).

There are medical uses for opioid use such as treatment of acute pain, cancer treatment, palliative care, and end of life care (APA, 2018).  When used at increased amounts, for an increased amount of time, for reasons other than being prescribed by a medical professional or longer than what it was prescribed to be, a person can develop an addiction to opioids.  Taking opioids in increased amounts activated the reward system in the brain which is what causes the "high" that people feel when taking opioids.  When opioids are abused, they "high-jack" the reward system in a way that normal activities of the reward system are foregone in favor of the "high" obtained with opioid use.  With continued use, a person becomes physically dependent fairly quickly and develops tolerance.  This tolerance causes higher doses to be needed in order to create the same ¨high¨ as lower doses had previously created.  Withdrawal occurs when use of the drug is either reduced or stopped (PCSS, 2017).

In 2015, 3.8 million people aged 12 and older in the United States reported past month use of prescribed pain medication with 2 million having Opioid Use Disorder or dependence diagnosable according to the DSM-IV (Diagnostic and Statistical Manual of Mental Disorder)(Strain, 2020).  Seventy two thousand people died from drug overdoses in 2017 in the United States (APA, 2018).

Risk Factors include:

• Prior history of Substance Use Disorder
• Younger age
• More severe pain
• Co-morbid mental disorders
• Genetic factors
• Environmental factors 
• Ease if access (PCSS, 2017)(Strain, 2020)

Diagnosis of Opioid Use Disorder consists of using criterion in the DSM-V.  Two or more criterion should be present within a 12-month period including:

• taking opioids longer than prescribed
• desire and/or trying to control use
• spending a lot of time obtaining, using, and recovering from use
• craving for opioid use
• failure to meet obligations due to opioid use
• persistent or recurrent social or interpersonal interactions due to opioid use
• giving up previous activities due to opioid use
• Tolerance
• Withdrawl (Strain, 2020) 

Several tests can be done to assist in diagnosing Opioid Use Disorder.  Diagnosis tools:

• Substance use history
• Physical Exam
• Drug screen
• Complete Blood Count (Strain, 2020)

Treatments include:

• Medically Assisted Treatment (MAT)
• Methadone
• Buprenorphine
• Naltrexone
• Opioid Treatment Centers
• Coordinated Care
• Recovery support system
• Behavioral interventions (PCSS, 2017)(SAMSA, 2020)

Prevention efforts:

• Naloxone - opioid reversal medication
• Individuals should lock up all medications to remove them from reach of others. (PCSS, 2017)

If you, a family member, friend or neighbor are dealing with Opioid Use Disorder:

• please seek assistance in your local area, 
• call SAMHSA´s National Hotline, 1-800-622-HELP
• Go to SAMHSA website, https://www.samhsa.gov/find-treatment

APA. (2018) Opioid Use Disorder.  American Psychiatric Association.  Retrieved from https://www.psychiatry.org/patients-families/addiction/opioid-use-disorder/opioid-use-disorder

PCSS (2017) Opioid Use Disorder: What is Opioid Addiction? Providers Clinical Support System.  Retrieved from https://pcssnow.org/resource/opioid-use-disorder-opioid-addiction/

SAMHSA.(2020)  Medication and Counseling Treatment.  Substance Abuse and Mental Health Service Administration.  Retrieved from https://www.samhsa.gov/medication-assisted-treatment/treatment

Strain, E. (2020) Opioid Use Disorder: Epidemiology, pharmacology, clinical manifestations, course, screening, assessment and diagnosis. UpToDate.  Retreived from https://www.uptodate.com/contents/opioid-use-disorder-epidemiology-pharmacology-clinical-manifestations-course-screening-assessment-and-diagnosis

Ovarian Cancer

The female reproductive system consists of the uterus, two Fallopian Tubes, and two ovaries.  The ovaries.  The ovaries are small and produce eggs (ovum) and the hormones estrogen and progesterone (Mayo, 2020).  As with other parts of the body, cancer can develop in the ovaries.  Although deaths from ovarian cancer has declined over the past twenty years, it is still the fifth leading cause of cancer deaths in women in this county (MNT, 2020).

Because, most often, cancer starts in the outer lining of the ovary, also called the epithelium, there are few or no early symptoms.  Because of the types of symptoms that do occur, the condition is often misdiagnosed as conditions such as Pre-Menstrual Syndrome, Irritable Bowel Syndrome, or a temporary bladder problem (MNT).   Symptoms of ovarian cancer include:

• abdominal bloating or swelling
• quickly feeling full when eating
• weight loss
• pelvic discomfort
• changes in bowel habits
• frequent urination
• pelvic pain
• pelvic pressure
• unexpected vaginal bleeding
• gas
• nausea
• vomiting
• loss of appetite (Mayo)(MNT)(Medline, 2019).

Risk factors include:

• family history: having a close relative with ovarian or breast cancer
• reproductive history
• dietary factors
• use of Talcum powder 
• gene mutations
• using fertility treatment
• smoking (ACS, 2020)(MNT)(Mayo).

There are three types of ovarian cancer.  They include:

• Epithelial:  occurs in the outside layer of the ovary (90% of ovarian cancers)
• Stromal:  occurs in the ovarian tissue (7% of ovarian cancers)
• Germ cell: occurs in egg producing cells.  Are often benign, but when malignant, treatment is effective in 90% of cases. (MNT)(Mayo).

Along with history and physical exam, there are several tests that can be done to diagnose ovarian cancer including:

• imaging tests
• ultrasound
• MRI
• CT scan
• laparoscopy
• biopsy
• barium enema xray
• chest xray
• PET scan
• colonoscopy (ACA, 2018)(MNT).

Staging, how far the cancer has progressed, is determined after testing is done.

Treatments used depend on the type and stage of the cancer, the patient's age, the patient's general health, patient preference, and the accessibility and affordability of treatment (MNT).  Treatments include:

• surgery
• chemotherapy
• targeted therapy
• palliative care
• radiation therapy
• immunotherapy (Mayo)(MNT).

Genetic testing can be done to search for gene mutations that make some individuals more susceptible to certain cancers such as ovarian, breast in both men and women, prostate, pancreatic and melanoma cancers (Mayo, 2020).  The BRCA1 and BRCA2 genes are the genes where mutations can increase someone's likelihood of certain cancers.  Finding out that someone has the mutation of one or both of those genes does not mean that the individual will indeed develop cancer, however, there is an increased susceptibility.

If you have a family history of breast cancer and/or ovarian cancer, please consider speaking with your doctor and getting genetic testing done.

Watch Youtube video below.  Click like, share and subscribe.  Also, in blog, at right of articles, click follow for updates on articles.

https://www.youtube.com/watch?v=hs1X4uYYDGk&t=21s


ACS. (2020) Ovarian Cancer Risk Factors.  American Cancer Society.  Retrieved from https://www.cancer.org/cancer/ovarian-cancer/causes-risks-prevention/risk-factors.html

Mayo Clinic. (2020) Ovarian Cancer.  Mayo Clinic.  Retrieved from https://www.mayoclinic.org/diseases-conditions/ovarian-cancer/symptoms-causes/syc-20375941

Mayo Clinic. (2020) BRCA gene test for breast and ovarian cancer risk.  Retrieved from https://www.mayoclinic.org/tests-procedures/brca-gene-test/about/pac-20384815

Medical News Today. (2020) What is Ovarian Cancer?  Medical News Today.  Retrieved from https://www.medicalnewstoday.com/articles/159675#symptoms

Medline Plus. (2020) Ovarian Cancer.  Medline Plus.  Retrieved from https://medlineplus.gov/ovariancancer.html

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