YOUR GUIDE TO A

HEALTHIERLIFESTYLE

Table of Contents

Achieving a Healthy Lifestyle 8

Maintaining a Healthy Weight 8

TheEffectsofWeightonHealth 9

EffectiveDietingStrategiesforWeight Loss 12

EngaginginanExerciseRoutine 17

SurgicalOptionsforWeightLoss 19

MedicalConditionsandWeightLoss 23

Skin Conditions 28

Acne 28

Eczema 31

Rosacea 34

Psoriasis 36

SkinCancer 38

Melanoma 42

TheImportanceofEverydaySkinCare 43

Sleep Importance & Disorders 45

Insomnia 45

RestlessLegSyndrome 47

SleepApnea 48

Narcolepsy 52

SleepRecommendations 54

EffectsofPoorSleeponHealth 55

TipsforGettingaGoodNight’sSleep 57

Back Pain 61

CommonReasonsforBackPain 61

MuscleandLigamentStrains 62

BulgingandRupturedDiscs 65

SkeletalIrregularities 68

SpinalOsteoporosis 69

Diabetes 73

Whoismostatriskfordiabetes? 75

PreventingDiabetes 78

DiabetesDiagnosis&Treatment 79

Glaucoma 82

Whoismostatriskforglaucoma? 84

PreventingGlaucoma 85

GlaucomaDiagnosis&Treatment 85

Arthritis 88

WhoismostatriskforArthritis? 89

PreventingArthritis 90

ArthritisDiagnosis&Treatment 92

High Cholesterol 94

Whoismostatrisk? 94

PreventingHighCholesterol 96

HighCholesterolDiagnosis& TreatmentOptions 97

Hypertension 99

Whoismostatriskfor hypertension? 100

PreventingHypertension 103

HypertensionDiagnosis&Treatment 104

Depression 108

Whoismostatriskfordepression? 112

PreventingDepression 113

DepressionDiagnosis& TreatmentOptions 114

Heart Disease 116

Whoismostatriskfor heartdisease? 122

PreventingHeartDisease 126

HeartDiseaseDiagnosis& TreatmentOptions 127

Hearing Loss 130

TypesofHearingLoss 132

RiskFactorsforHearingLoss 134

PreventingHearingLoss 136

TipsforAvoidingLoudNoises 137

SymptomsofHearingLoss 138

HearingLossDiagnosis&Treatment 140

GettingHearingAids 141

CaringforHearingAids 144

Symptom Checker 146

Health Insurance 147

CommonHealthInsuranceTerms 148

PrivateInsuranceandEmployer Insurance 150

CHIP 151

Medicare 153

Medicaid 157

VA Health 160

TRICARE 162

8

Achievingandmaintainingahealthylifestylecanimprovequalifyoflifeandincreaselongevity.Youcantakestepstoreducethelikelihoodthatyouwilldevelopcertainconditions,evenifyoucan’tpreventthemall.

Bylearningmoreaboutpreventionmethods,riskfactorsandtreatmentoptions,youcanbettermonitorandimproveuponyourhealth,aswellasgainabetterunderstandingofanyconditionthatyoumayalreadyhave.

Maintaining a Healthy Weight

MorethanathirdofAmericanadultsareconsideredtobeobese.Tobeconsideredobese,youmustweighatleast20 percent ofwhatisconsideredtheidealweightforapersonofyourheight.Whenmeasuredusing

Achieving a Healthy Lifestyle

9

theBodyMassIndex(BMI),ascoreof30orhigherisconsideredtobeobese.

Obesitycanincreaseaperson’sriskofanumberofhealthconditions.Whilenoteverypersonwillexperiencehealthconditionsduetotheirobesity,thereisarealriskpresent,especiallyforthosewhoalsohaveagenetic-relatedriskortendtohavemostoftheirextraweightaroundtheirstomach.

Someconditionsthathavedevelopedduetoexcessweightcanalsoimproveorbeeliminatedalltogetherafterweightloss.

The Effects of Weight on Health

Havingextraweightincreasesyourlikelihoodofdevelopinghigh blood pressure and high cholesterol.Theseconditionscanincreaseyourlikelihoodofsufferingastrokeordevelopingheart

10

disease.

Ifyouareoverweight,youhaveasignificantriskofdevelopinggallbladder disease and gallstones.Itisalsoimportanttoavoidrapidweightloss,asitcansignificantlyincreaseyourriskofhavinggallstones.

Osteoarthritisisatypeofarthritisthataffectstheback,hipsorknees.Theextrapressurefromexcessiveweightcausesthecartilagewithinthejointstobecomeworndown,whichcanresultinosteoarthritis.Youcanreduceyourriskthroughweightlossandroutineexercise.Whilethereisnocureforosteoarthritis,youcanrelievesomeofthepainyoumayfeelfromthestressonyourjointsbylosingweight.

Goutisaformofarthritisthatoccurswhenthereistoomuchuricacidwithinaperson’sblood.Uricacidcausescrystal

11

depositsintothejoints.Themoreyouweigh,themorelikelyyouaretobeafflictedwithgout.

Obesitycanincreasetheriskforseriousbreathingconditions,includingCOPD, asthma and sleep apnea.Conditionslikesleepapneacanalsoincreaseaperson’sriskforothermedicalconditions,suchasheart disease or stroke.Weightlosscanoftenimproveandpotentiallyeliminatesomeofthesebreathingconditions,ifalreadydeveloped,aswellaspreventconditionsifoneisnotalreadypresent.

12

Effective Dieting Strategies for Weight Loss

Eatingawell-balanceddietisthemosteffectivewaytoachieveweightlossinasafemanner.Healthyeatinghabitshelpyouloseweightandmaintainweightloss.Expertssuggestthatyouaimtolosebetweenone and two poundsofweightperweek.Thereareanumberofpopulardietstoday,butsomeofthemosteffectivedietsinclude:

1. The Paleo Diet.Thepaleodietfocusesoneatingwholefoods, lean protein, fruits, nuts, vegetables and seeds. Dieterscutoutprocessedfoods,sugar,dairyandgrainproductsasmuchaspossible.Thereareafewvariationsthatpermitcertaindairyproducts.Weightlossstudiessurroundingthepaleodiethaveshownthatthisdietcanleadtosignificantweightloss,especiallyaround

13

aperson’swaist.Thepaleodiethasalsobeenlinkedtootherpotentialhealthbenefits,suchasareductioninbloodsugar,bloodpressureandcholesterol.

2. Vegan Diets.Avegandietexcludesmeat,dairy,eggsandotheranimal-derived products,suchaswhey,casein,gelatinandhoney.Thisdietcanbeaneffectiveweightlossdiet,andithasethicalandenvironmentalbenefitsformany.Thefoodsallowedareoftenlowinfatandhighinfiber,reducingtheneedtocountcalories.ThevegandiethasalsobeenshowntoreducetheriskofheartdiseaseandType2diabetes.However,thedietersmaynotreceiveseveralkeynutrients,includingvitaminD,vitaminB12,iron,iodine,calcium,zincandomega-3fattyacids.

3. Low-Carb Diets.Carbohydrateintakeisrestrictedtobetween20 and 150

14

grams per day.Thebodyisforcedtousefatstoresforenergyratherthancarbohydrates.Inadditiontoweightloss,low-carbdietsoftenreduce the risk of highcholesterol,highbloodsugar,highinsulinlevelsandhighbloodpressure.However,somedietersreportfeelingmiserableandnauseouswhenrestrictingcarbohydrates.Inveryrarecases,low-carbdietscanalsoleadtoaserioushealthconditioncalledketoacidosis,whichcanbefatalifleftuntreated.Ketoacidosisismorecommonamonglactatingwomen.

4. Intermittent Fasting.Intermittentfastingmeansyoucanonlyeatduringcertainperiodsofthedayonaconsistentbasisandyoumustfastduringotherperiodsoftheday.

a. Onemethodinvolvesskippingbreakfastandeatingonlywithinasetperiodofeight hours and

15

fastingfortheremaining16hoursoftheday.

b. Anothermethodinvolvesa24 hour fastthatisperformedonceortwiceperweekonnon-consecutivedays

c. Duetofasting,yougenerallyconsumefewercaloriesoverallthroughoutyourdayandstudieshaveshownthatmetabolicratescanbeincreasedby3.6to14percentonashort-termbasis,whichcanfurtherboostweightloss.Studieshaveshownthatapersonmaybeabletolosebetween3and8percentoftheirweightoveraperiodof3to24weeks.

d. Additionalhealthbenefitsofintermittentfastingdietsincludeareductionofinflammation,cholesterollevels,bloodtriglyceridesandbloodsugarlevels.However,thisdiethasbeenshowntobe

16

moreeffectiveandbeneficialformencomparedtowomen.Youshouldnotattemptanintermittentfastingdietifyouarepregnant,breastfeeding,malnourished,nutrientdeficientorateenagerorchild.

17

Engaging in an Exercise Routine

Whileabalanceddietisthemosteffectivewaytoloseweight,routine exercisecanhelppromoteandmaintainweightloss.Exercisecanbeespeciallybeneficialtoolderadultsandseniorcitizensinpreventinginjuriesandkeepingboththebodyandmindactive.

Ifyouwanttoloseweight,expertsrecommendthatyouengageinanaerobic(cardio)exerciseroutineforatleast200 minuteseachweek.Aerobicexercisesincludewalking,jogging,running,cyclingandswimming.However,anythingthatmakesyourheartandlungsworkharder,includingdancingandmowingyourlawn,canallcount.

Strength training exercisescanhelpyoureduceinjurieswhilehelpingwithmusclegrowth.Forstrengthtraining,youcanuseweight,bandsoryourownbodyweight.

18

However,whilestrengthtrainingdoesoffernumeroushealthbenefits,itisnotaneffectiveweightlossmeasure.

Youshouldstretch your musclesatleasttwiceaweekafterexercising.However,someexpertsrecommendthatyoutakethetimetostretchbothbeforeandaftereachexerciseinordertoreducethelikelihoodofaninjuryandimproveyourflexibility.

Regardlessofhowyouengageinexercise,itisimportanttoalternate between moderate and high intensity exercises,eitherinthesameworkoutoronalternativedays.Expertsalsorecommendthatyoualternatethetypeofexercisethatyouengagein.Doingsocanfurtherhelpyoutopreventinjuryandpreventyoufromgrowingboredwithyourworkoutroutine.

19

Surgical Options to Help with Weight Loss

Forsome,surgicaloptionscanbethebestcourseofactiontoachieveweightloss.Theseoptionsareonlyconsideredforthosewhoareobeseormorbidlyobese,especiallyifobesityiscausingadditionalmedicalconditionsorputtingtheindividualatgreatriskofdevelopingoneormoreconditions.

Restrictive surgeriesareaveryeffectivewaytoachieveweightlossasthesurgeryessentiallyshrinksthesizeofaperson’sstomachandslowsdigestion.Priortosurgery,aperson’sstomachcangenerallyholduptothreepintsoffood.Aftersurgery,thatindividual’sstomachwilllikelyonlyaslittleasanounceinitiallyanduptotwoorthreeounceslater.

Afewtypesofrestrictivesurgeriestakeremoveorbypasspartofaperson’sdigestive

20

tract,whichmakesitharderforthatperson’sbodytoabsorbcalories.However,thistypeofsurgeryisrarelyperformed,duetothepotentialsideeffectsofthesurgery.

Thereareanumberofdifferentoptionsforrestrictivesurgeriesthatcanbringaboutsignificantweightloss.Theseinclude:

Adjustable Gastric Banding.Duringsurgery,thesurgeonusesaninflatablebandtosqueezethepatient’sstomachintotwosections.Thesesectionsremainconnectedbyaverysmallchannel,whichallowsfoodtoslowlyemptyfromtheupperpouch.

a. Itisconsideredsimplerandsaferincomparisontomanyoftheothersurgeries.Thebandcanberemovedinasecondsurgery,shouldthepatientdesire.Themostcommon

21

sideeffectofagastricbandisvomitingaftereatingeithertoomuchortooquickly,althoughthebandcanslip,becometooloose,orleak.

Sleeve Gastrectomy.Thistypeofsurgeryisonlyavailabletothosewhoareveryobese,sickorwhereotherweightlosssurgeriesmaybetoorisky.Duringsurgery,thesurgeonremovesabout75 percentofapatient’sstomachandshapedintoanarrowtubeorsleeve.

a. Thissurgeryisirreversible,andthelong-termbenefitsandrisksofthisprocedurearestillbeingevaluated.

b. Themostprominentrisksaretypicallyinfection,leakingofthesleeveandbloodclots.Theintestinesarenotaffectedbytheprocedureandisnotlikelytoresultinmalabsorptionconditionsora

22

lackofnutrients.

Gastric Bypass.Thestomachisdividedintotwopartsandsealstheuppersectionfromthelowersection.Theuppersectionofthepatient’sstomachisconnecteddirectlytothelowersectionofthesmallintestine.Foodwillbypassasectionofboththestomachandsmallintestinesandreducecalorieabsorption.

a. Dumpingsyndromeisaconditionwherefoodpassesthroughtheintestinestooquickly,beforeithasbeenproperlydigested.Thiscancausebloating,pain,sweating,weakness,nauseaanddiarrhea.

Weightlosssurgerygenerallycausesrapidweightloss.Whilethiscanbebeneficial,itisalsoworthnotingthatacommonsideeffectofrapidweightlossisexcessskinthatisleftbehind.Excessskincanonlyberemovedthroughsurgicalmeans,whichmay

23

requireseveralproceduresdependingontheseverity.Thesesurgeriesareoftenconsideredcosmeticandnotgenerallycoveredbyhealthinsurance.

Ifyouareconsideringaweightlosssurgery,itisimportantthatyoutalkwithyourdoctoraboutanyadditionalrisksthatyoumayface,baseduponanycurrentmedicalconditionsthatyoumayhave.

Medical Conditions and Weight Loss

Certainmedicalconditionsandprescriptionmedicationscancauseweightgainorpreventyoufromlosingweight,evenwhenyouaredoingalloftherightthings.Ifthisisthecase,youwillneedtotalktoadoctortocorrecttheproblembeforeyoucaneffectivelyworkonlosingweight.

Conditionsthatcouldinterferewithweight

24

lossorevencauseweightgain,include:

Chronic Stress.Chronicstress,anxietyorgriefcancauseyourbodytoproduceachemicalsubstancethatwillmakeyourbodymorelikelytostorefat,especiallyaroundthewaist.

Cushing’s Syndrome.Whenyouradrenalglandsatopofyourkidneysproducetoomuchcortisol,youmayexperiencefatbuildupintheface,upperbackandabdomen.

Hypothyroidism.Anunderactivethyroidcancauseyourbodytoproducelessofthethyroidhormone,whichessentiallyallowsyourbodytoeffectivelyburnstoredfat.Anunderactivethyroidcanalsoresultinaslowedmetabolism,soyoumaystoremorefatthanyoucanburn.

Polycystic Ovarian Syndrome(PCOS).

25

AffectingmorethanfivemillionwomenintheUnitedStates,thisconditionistheresultofahormonalimbalance.CommonsymptomsofPSOSinclude:

• Irregularorseveremenstrualbleeding,excessivefacialhair,thinninghair,weightgainthatisnotcausedbyexcessiveeating,acneanddifficultiesgettingpregnant.Whilethereiscurrentlynocure,therearemedicationsthatcanhelp.

Syndrome X.SyndromeXiscommonlyreferredtoasinsulinresistanceorhyperinsulinemia.Itisaclusterofhealthconditionsthatarethoughttoberootedininsulinresistance.Ifyourbodyisresistanttoinsulin,hormonesthataidinthecontrolofyourmetabolismwillnotworkastheyshould,potentiallyleadingtoweightgain.

Depression.Depressioncommonlyturns

26

theafflictedtoeatingtoeaseemotionaldistress.Additionally,somedepressionmedicationscancauseweightgain.

Expertssuggestthatthereareanumberofprescriptionmedicationsthatcarrypotentialsideeffectsforweightgain.Thesemedicationsinclude,butarenotlimitedto:

MedicationsthattreatType2diabetes.

Antipsychoticmedications,includingmedicationstotreatschizophrenia.

Beta-blockersthatareprescribedforhighbloodpressureorspecificheartconditions.

Antidepressants.

Hormonereplacementtherapydrugs.

Birthcontrolpillsandinjections.

Corticosteroidsthatareusedtotreat

27

conditionssuchasasthmaandlupus.

Shouldyoufindyourselfhavingsignificanttroublelosingweight,itisimportanttospeakwithyourdoctortoruleoutanycauserelatedtoprescriptiondrugsthatyoumaybetakingoranymedicalconditions.

28

Skin Conditions

ManyskinconditionsaffectmillionsofAmericanseachyear.Bylearningmoreabouttheseconditions,youcanfamiliarizeyourselfwiththepreventionmethodsandthetreatmentsavailableforcommonskinconditions.

Acne

Acneaffectsnearlyeverypersonatsomepointinlife.Acneoccurswhengreasysecretionsfromtheskin’soilglandsplugthesmallopeningsforhairfollicles.Theacnemaypresentintheformofablackhead,whicharesmallflatspotswithdarkcenters,orthecloggedporemaytaketheformofawhitehead,asmallflesh-coloredbump.

Inseverecasesofacne,firmbumpswillformbeneaththeskin’ssurface.Thesebumps,also

29

knownasnodules,canbecometenderand,attimes,infected.

Acneismostcommoninadolescence,startingduringpubertyyearsandgenerallygoingawayafterfiveto10years.Statistically,teenageboysaremorelikelytodevelopsevereacneincomparisontoteenagegirls.However,itisestimatedthat20percentofallacnecasesoccurinadults.Inadulthood,womenaremorelikelythanmentohavemildtomoderateacne.

Thereareanumberofstepsthatyoucantaketoreducethelikelihoodofdevelopingacne.Youmaybeabletoavoidacneby:

Washingyourfaceatleasttwiceadaytoremovedeadskincells,extraoilfromyourskin’ssurfaceandkeepyourfacegenerallycleaner.

Useover-the-countyacneproductsthat

30

aredesignedtocurbbacteriaandreduceoilyskin.

Usemakeupsparinglyandwashitoffattheendoftheday.Whenpossible,useoil-freecosmeticproductsthatdonotcontainaddeddyesandchemicals.

Avoidusinggels,pomades,oilsandfragrancesinyourhair.

Avoidtouchingyourfaceorusingyourhandstopropyourcheekorchinup.

Limittheamountoftimeyouspendinthesunorwearprotectiveclothing.

Ifacneisnotsevere,over-the-countercleanersandnonprescriptiondrugsthatcontainbenzoylperoxidemayhelp.Atopical retinol gel,whichcanpreventpimplestogrowasitaffectthegrowthofcellsandcanassistinunblockingpores.However,thisgelmustgenerallybeusedconsistentlyanditcan

31

takeupto12weekstobegintoseeresults.

Ifyouracneissevere,meetwithyourdoctortodiscusstreatmentoptions.Therearemanyprescriptionsforacne,manyofwhicharetopical.

Whentreatingacne,itisimportanttobeawareofpotentialsideeffectsandpotentialinteractions.Forexample,topicalretinoidsandbenzoylperoxidecancausedryandreddenedskin,aswellassunlightsensitivity.Oralantibioticscancausenauseaandsunlightsensitiveaswellasrenderwomenmoresusceptibletoyeastinfectionsiftakenmorethanafewweeks.

Eczema

Eczemaisagroupofconditionsrelatedtotheinflammationoftheskin:

32

Eczemacausesitchy,red,dryandcrackedskinduringflareups.Flareupscanaffectaperson’sskinonanypartofthebody.

Foradults,eczemaisoftenachronicproblem.However,theconditionismostcommonlyfoundininfants,manyofwhichwilloutgrowtheconditionbeforeadulthood.

Eczemacanbegenetic,butthosewithsensitiveskinoranoveractiveimmunesystemcarryahigherriskofdevelopingeczema.

Flareupscanbetriggedbyanumberofthings,includingasstress,heatandsweat,contactwithirritatingsubstancesandfabrics,coldanddryclimatesanddryskin.

Flareupscanalsooccurwhenotherconditionsarepresentthathaveaneffect

33

onaperson’simmunesystem,suchasthecommoncoldorabacterialinfection.

Goodskincarehabitscanreduceyourriskforeczemaand,inmildeczema,preventflaresinmildcases.Youcan:

Onlyusingmildsoapsorasoapsubstitutethatdoesnotcausedryskin.

Usemoisturizerappliedrightafterashowerorbathandforatotaloftwicedaily.

Takeshort,warmshowers.Longorveryhotshowersorbathsthatcanleadtodryskinandpotentialeczemaflares.

Humidifiershaveproventobebeneficialtothoseafflictedwitheczemathatsufferflaresduetodryair,particularlyincoldermonths.

Ifyouhavesevereeczema,youmustspeakwithyourdoctorabouttheconditionin

34

ordertodeterminethebestsolutionforyou.Thereareanumberofmedicationsthatareusedtotreateczema,includingcreams,oralmedicationsandultravioletlighttherapy.

Rosacea

Rosaceaisacommonskindisorderthatcausesrednessand,insomecases,maycausebloodvesselstobecomevisible.Thisconditioncanalsocausethedevelopmentofsolidredbumpsandpus-filledpimples.Thisdisordermainlyaffectstheskinontheface,includingthenose,chin,cheeksandforehead.However,inrarercases,rosaceacanappearonthecheck,backorneck.

Expertstheorizethatitmaybecausebyadisorder of the neurovascular system or the immune system.Statistically,iteffectsmorepeoplewhohavefairskinandwomen.However,menwhoareafflictedwiththe

35

conditiontendtoexperiencethemoreseveresymptoms.

Inmanycases,rosaceasuffersmaygointoremissionbyavoidingenvironmentalandlifestylefactorsthattriggertheirrosaceaflare-ups.Common triggers includesunandwindexposure,stress,hotorcoldweather,heavyexercise,spicyfoodsandalcoholconsumption.

Thereiscurrentlyno cureforrosacea,however,treatmentisavailabletocontrolorreversesomeofthesymptoms.Consultwithyourdoctoraboutthebesttreatmentoptionsforthesymptomsthatmaybepresentforyou.Treatmentoptionsrangefromoralandtopicalmedications,tosurgicalproceduresinrareandseverecases.

36

Psoriasis

Psoriasisisachronic skin disorder that causesaperson’sskincellstomultipleupto10timesfasterthanwhatisconsideredtobenormal.Duetoexcessskincells,apersonalafflictedwithpsoriasismayexperienceabuildupofbumpy,redpatchesthatappeartobecoveredwithwhite“scales”.Psoriasiscanaffecttheskinanywhereonaperson’sbody,butismorecommononthescalp,elbows,kneesandlowerback.

Whilethereareseveraltheories,expertsarenotdefinitelysureofthecauseofpsoriasis.However,therearehypothesisthatitcouldbecausedbyafaultimmunesystem,causinginflammation,whichresultsnewskincellsformingtooquickly.

Additionally,psoriasisisbelievedtohavegeneticcausesasittendstoruninfamilies,thoughitcanskipageneration.Generally,this

37

conditionusuallyappearsinearly adulthood.Itismostcommonforonlyafewareasofthebodytobeaffected,however,inseverecases,psoriasiscancoverlargeportionsofaperson’sbody.

Psoriasismaycomeandgo,dependingontheseverityofanindividual’scondition.Outbreakscanbetriggeredbyanumberofthings,includingcuts,scrapes,surgery,stress,strepinfectionsandsomemedications.

Youshouldtalktoyourdoctoraboutpsoriasisifyoufeelthatyoumayhavethiscondition.Generally,itiseasytodiagnosepsoriasisthroughaphysicalexam.Insomecases,asimplebiopsymaybenecessarytoruleoutskininfections.

Whilethereisno definitive cure forpsoriasis,avarietyoftreatmentsareavailablethatcanrelievediscomfortandslowthegrowth

38

ofnewskincells.Commontreatments includesteroidcreams,moisturizers,coaltar,prescriptioncreamsandointmentsandretinoidcreams.Formoderate to severe psoriasis,yourdoctormayrecommendlighttherapyorcertainoralmedications.

Skin Cancer

Skincancerhasbecomethemostcommoncancerintheworldtoday.Itisestimatedthathalfofallfair-skinnedpeoplewholivetoatleast65willhaveatleastoneskincancerwithintheirlifetime.Riskfactorsincludethefollowing:

Fair skin.Whileitispossiblefordark-skinnedpeopletodevelopskincancer,itisrareandgenerallyonlydevelopsonlighterareasofthebody,suchasunderneathfingernailsoronthesolesofthefeet.

39

Gender.Menarethreetimesmorelikelytodevelopskincancerthanwomen.

Age.Skincancertendstoappearbetweenthe45and54yearsofage.

Genetics.Yourriskforskincancerwillalsoriseifacloserelativehasskincancer,youarered-headed,youhaveblondhairandblueeyesoryouhaveapigmentdisorder,suchasalbinism.

Location.Skincancerdevelopsmorecommonlyinpeoplethatliveinareaswherethereisintensesunshine,suchasArizonaandHawaii.

Hazardous environment.Ifyouareregularlyaroundcertainchemicals,includingcoaltar,radiumandinsecticidesthatcontaininorganicarseniccompounds,yourlikelihoodofdevelopingskincancerwillincrease.

40

Youwillincreaseyourriskfactorsofdevelopingskincancerifyou:

Spendtoomuchtimeinthesun.

Usetanningboothsorsunlamps.

GetfrequentX-rays.Thisriskfactorhasmanycomponents,includingage,genderandtypeofX-ray.

Skincancersalwaysfallintooneoftwocategories:melanoma or nonmelanoma.Skincancerssuchasbasalcellcarcinomaandsquamouscellcarcinoma,themostcommonformsofskincancer,arenonmelanomasandarerarelylifethreatening.

Thesetypesofcancersgrowslowly,areusuallyeasilyfound,seldomspreadbeyondtheskinandcanusuallybecured.Basalcellcarcinomaaccountsfornearly75percentofallskincancers,butithastheslowestgrowthandistheleastlikelytospreadbeyondtheskin.

41

Ifyouarediagnosedwithskincancerquickly,youaremorelikelytobecured.Yourtreatmentoptionswilldependonthetypeofskincanceryouhave,whetherornotithasspread(andhowfar)aswellasanyotherhealthconditionsthatyoumaybeaffectedby.Treatment optionsmayincludesurgery,cryotherapy,radiation,chemotherapy,lasertherapy,biologicorimmunotherapyandtargetedtherapy.

Onceyouhavehadskincancer,youareatahigherriskforgettingskincanceragainwithinafewyears.Getyourskincheckedregularlytocatchanydevelopmentsearly.

Whilenonmelanomaskincancershaveanumberoftreatmentsthatarehighlyeffective,melanomaisafarmoreserioustypeofcancerthatisfarmoreaggressive,inclinedtospreadandmaynotbecurableinlaterstages.

42

Melanoma

Melanomaisamoreaggressivetypeofskincancerthatcanoftenbelifethreatening.Thistypeofcancergenerallybeginsindark skin tissue,suchasabirthmarkormole,butitcanstartinnormallypigmentedskin.Formen,melanomaismostcommononthehead,neckandback.Forwomen,canmostcommonlybefoundonthearmsorlegs.

However,melanomacanappearinotherlocations,includingthepalmofthehands,solesofthefeet,underneathafingernailortoenail,inyoureyeandinmucusliningssuchasthevagina,anusormouth.

Whilemelanomacangenerallybecuredifcaughtearly,thistypeofskincancergrowsveryfastandcanspreadtootherpartsofthebody,includingbonesandthebrain.Shouldthishappen,themelanomawillbecomeverydifficulttotreatandcannotbecured.

43

Melanomatreatmentoptionsincludesurgery,radiationtreatment,chemotherapy,lasertherapy,cryotherapy,biologicalorimmunotherapyandtargetedtherapy.

The Importance of Everyday Skin Care

Adailyskincareroutinecanhavesignificantbenefitsonyourhealthasyouwillbelesslikelytobeafflictedbyskinrelatedconditions.

Expertsrecommendthatyouwashyourfacetwice dailyandfollowupwithatonerandmoisturizer.

Limityourtimeinthesun,especiallyduringthehoursof10AMand2PM,andalwayswearabroad-spectrumsunscreenthatcontainsa sun protection factor (SPF) of 30 orgreaterwheneveryouwillbeexposedtosunlight.

44

Bydoingso,youcansignificantlyreduceyourchancesofskincancers,freckles,growths,agespots,colorchangesandwrinkles.

Youshouldneverusetanningbedsorsunlamps,ifpossible,asyouwillsignificantlyincreaseyourchanceofdevelopinganumberofskinconditions,includingskincancer.

Finally,payattentiontoyourskinsothatyounoticeanychangesinpatchesofskinormolesthatmayindicateskincancer.Skincancer,ifcaughtearly,isgenerallytreatableandcurable.

45

Sleep,andlackthereof,canhaveasignificantimpactonyourhealthandincreaseyourriskfactorsforanumberofconditions.

Insomnia

Insomniaisaoneofthemostcommonsleepdisorderandonethatpreventspeoplefromeitherfallingorstayingasleep.

Therearetwotypesofinsomnia;primaryorsecondaryinsomnia.Primary insomnia isnotdirectlylinkedorcausedtoanothermedicalconditionwhilesecondary insomnia iscausedbyanothercondition,suchaspain,medication,heartburn,asthmaorcancer.

Insomniacanbepresentasacute,lastingup

Sleep Importance & Disorders

46

tothree monthsandoftenlinkedtostress,orchronic,inwhichsymptomscanlastforyearsifleftuntreated.Insomniaisconsideredchronicwhenapersonhastroublefallingasleeporstayingasleepforatleastthreenightsaweekforafullmonthorlonger.

Adiagnosiscansometimesbemadeafteradiscussionaboutyourhealthandsleepproblems.Insomecases,youmaybeaskedtokeepasleepdiaryoryoumaybereferredtoasleepcenterforadditionaltesting.

Treatment for insomniavariesbaseduponthecauseandseverityofthecondition.Inmoremildcases,itcanoftenbecuredbyformingbettersleepinghabits.

However,incasesofmoderatetosevereinsomnia,sleepingpillsmaybeprescribedforalimitedperiodoftime.

47

Restless Leg Syndrome

Restless legs syndrome (RLS)isadisorderofthenervoussystemthatcancauseanurgeforapersontomovetheirlegsand/orarms.

Thesymptomsgenerallyincludeuncomfortablesensationsinaperson’slegsorarms.Thissensationhasbeendescribedas“itchy”or“pinsandneedles”.Symptomscanappearduringdaytimehoursbutaregenerallyattheirworstduringperiodsofrest,especiallywhenlyingorsittingdown.TheseverityofRLSsymptomsrangefrommildtointolerable.

Whilethereisno medical testthatcandiagnoserestlesslegsyndrome,doctorsutilizebloodtestsandothertestingmethodsinordertoruleoutotherconditionsthatpresentsimilarsymptoms.Thereisno cure for RLS,buttreatmentcaneasethesymptoms.Treatmentoptionsincludelifestyle

48

changes,theestablishmentofmoreregularsleeppatterns,theeliminationofcaffeineortheeliminationofalcohol.ThereareafewmedicationsthatareusedtotreatthemoreseverecasesofRLS. Sleep Apnea

Sleep apneaisconsideredtobeaserioussleepdisorderthatcandramaticallyimpactaperson’ssleepandoverallhealthassleepapnearaisesaperson’sriskforothermedicalconditions.

Sleepapneaoccurswhenaperson’sbreathingisinterruptedduringsleep.Thisprocesscontinuesthroughoutthenight,sometimesuptohundredsoftimes.Asaresult,apersonnotonlydoesnotgetenoughsleep,buttheymaynotgetenoughoxygen.

Themostcommonformofsleepapneais

49

referredtoasobstructive sleep apnea(OSA).IncasesofOSA,aperson’sairwayisblockedwhenthesofttissueatthebackofthethroatcollapsesduringsleep.Theothertypeofsleepapnea,central sleep apnea,occurswhenthebrainfailstosignalaperson’smusclestobreatheduetoinstabilityintherespiratorycontrolcenter.

Anyonecandevelopsleepapnea,buttherearesomefactorsthatwillputyouatahigherriskforthecondition.Youwillbeathigherriskforsleepapneaifyou:

Aremale.

Areoverweight.

Are40yearsofageorolder.

Haveafamilyhistoryofsleepapnea.

Havealargernecksize,tonsilsortongue.

Havenasalobstructionsduetoa

50

deviatedseptum,sinusproblemsorallergies.

Ifleftuntreated,youmaybeatahigherriskforconditionslikehighbloodpressure,strokeandvariousheartconditions.

Themostcommonsymptomsofsleepapneaincludewakingupwithaverysore or dry throat,loudsnoring,wakingupgaspingorchoking,fatigue,morningheadaches,forgetfulnessandmoodchanges.

Ifyouthinkthatyoumayhavesleepapnea,itisimportanttotalktoyourdoctor.Insomecases,youmaybeabletocompleteasleepapneatestathome.Thesleepstudytestisdonetorecordspecificphysicalactivitieswhileyousleep.Insomecases,furthertestingmaybeneededwhensleepapneaisdetermined.

In mild casesofsleepapnea,ordependingonthecauseofyoursleepapnea,youmay

51

beabletocureyoursymptomsbylosingweight,avoidingalcohol,avoidingsleepingpills,alteringyoursleepingpositionsandbyeliminatingnicotine.

In moderate to severesleepapnea,devicessuchasacontinuouspositiveairwaypressure(CPAP)arecommonlyused.ACPAPdevicehasamaskthatiswornoverthenoseandmouthduringsleep.Thismaskishookeduptoamachinethatdeliversacontinuousflowofairintothenosetoregulatebreathingandoxygenaccess.

Incertaincasesofsleepapnea,surgerymayberequiredtocorrectthecondition.Surgeryisoftenrequiredifyoursleepapneaiscausedbyadeviatednasalseptum,enlargedtonsilsorasmalllowerjawwithanoverbite.Surgeryisdonetocorrectthesefacialproblemsandthroatobstructionsinordertoreduceoreliminatesleepapneasymptoms.

52

Narcolepsy

Narcolepsyisatypeofneurologicaldisorderthataffectsthemind’scontrolofsleepandwakefulness.Individualswhoareafflictedwiththisdisordermaynotbeabletooperateavehicleorheavymachineryduetoexcessivedaytimesleepinessandintermittent,uncontrollableepisodesresultinginsuddensleepduringtheday.Episodescanoccuratanytimeofthedayduringanytypeofactivity.

Inanormalsleepcycle,initialstagesofsleeparefollowedbydeepersleepstagesandfinallyrapideyemovement(REM)sleep.REMnormallyoccursafterabout90minutes,butfornarcolepsysufferers,REMoccursalmostimmediatelyinthesleepcycleaswellasperiodicallyduringthewakinghours.REMsleepisthetypeofsleepthatmayincludedreamsandmuscleparalysis.

Expertshypothesizethatthedisordercould

53

begenetic,duetobrainabnormalitiesorduetoachemicaldeficiencyinthebrain.

Themostcommonsymptomsofnarcolepsyincludeexcessivedaytimesleepiness,lackofenergyandconcentration,extremeexhaustion,thesuddenlossofmuscletone,hallucinationsandsleepparalysis.

Ifyoubelievethatyoumayhavenarcolepsy,yourhealthcareprovidercanperformaphysicalexamorreferyoutoasleepdisorderclinictohaveadditionaltests.

Thereiscurrentlyno curefornarcolepsy.However,someofthemostdisablingsymptomsofthedisordercanbecontrolledusingavarietyofmedications.Thetypeofmedicationsthatareprescribeddependonthesymptomsthatarepresentintheafflictedindividual.

54

Sleep Recommendations

Theamountofsleepthatisrecommendedtoapersondependsonhisorherage.Thecurrentrecommendedsleepamountsare:

Infants (0-3 months) –14-17hoursofsleepperday.

Infants (4-11 months) –12-15hoursofsleepperday.

Toddlers (1-2 years of age) – 11-14hoursofsleepperday.

Pre-School Children (3-5 years) – 10-13hoursofsleepperday.

School-Age Children (6-13 years) –9-11hoursofsleepperday.

Teenagers (14-17) –8-10hoursofsleepperday.

Adults (18-64) –Generally,adultsneed

55

between7and9hoursofsleepperday.

Seniors (65 years of age and older) – 7-8hoursofsleepperday.

Inadditiontoagegroups,pregnant women willneedseveralmorehoursofsleepeachdaythanusualduringthefirst3monthsofpregnancy.

Effects of Poor Sleep on Overall Health

Poorsleepinghabitsandfailingtogetenoughsleepeachnightcanhavebothshort-andlong-termeffectsonthebodyandmind.

Withoutenoughsleepoverashortperiodoftime,youmayexperience:

Adecreaseinalertnessandperformance.

Cognitiveabilityandmemory

56

impairment.

Agreaterrisktoreceiveanoccupationalinjury,especiallyifyouworkaroundpotentiallydangerousenvironments.

Changesinmood,includingmoodiness,anxietyanddepression.

Asignificantlyhigherrisktobeinvolvedinanautomobileaccident.

Failingtogetenoughsleepforalongperiodoftimecanresultinanincreasedriskofseriousmedicalconditions,including:

Highbloodpressure.

Heartattack.

Heartfailure.

Stroke.

Obesity.

57

Depressionandothermoodrelateddisorders.

Mentalimpairment.

Poorqualityoflife.

Studieshaveshownthatindividualswhohavereportedgettinglessthansix or seven hoursofsleepeachnighthaveanincreasedmortalityrisk.Oneofthesenotablestudiesshowedthatfailingtogetenoughsleepforalongperiodoftimeheldagreatermortalityriskthansmoking,heartdiseaseandhighbloodpressure.

Tips for Getting a Good Night’s Sleep

Thereareanumberofprecautionsthatyoucantakebeforegoingtobedthatcanhelpyoufallasleepquicklyandsleepthroughthenight.Youshouldstillspeakwithyourdoctor

58

andfollowanyrecommendationsthattheymayhavetotreatyoursleepdisorder.Togetabetternight’srest,avoid:

Caffeine.Caffeineisastimulantthatcanstayinyoursystemfor12hours.Caffeineisfoundinmanythings,includingcoffee,soda,tea,chocolateandsomeover-the-countermedications.Avoidcaffeinefourtosixhoursbeforebedtime.

Nicotine.Avoiditfourhourspriortobedtimeinordertopreventwakingduringthenight.

Alcohol.Drinkingalcoholbeforebedcancausenighttimeawakeningsandnightmares,interruptingyoursleepcycles.

Heavy meals before bed.Beforebed,avoidprotein-basedsnacksandchoseacarbohydrate-basedsnackinstead.Studiesshowthatsmallsnacksthathave

59

alargeamountofcarbsmayimprovesleep.Numerousstudieshaveshownthatasmallportionofmilkordairyproductsbeforebedcanhelpinducesleep.

WatchingTV,listeningtomusic,eatingorreadinginbed.

Minimizethelight and noiseinyourbedroomandmakesuretheroomisnot too hot or too coldduringsleep.Generally,aroomthatisabove75degreesorbelow54degreesFahrenheitcanaffectsleep.

Whileyoushouldwakeupatthesametimeeachday,itisimportanttoonlygotobedwhensleepy.Ifyoufindyourselfunabletofallasleep,getoutofbedanddoadifferentactivitybeforetryingagainin10 to 15 minutes.Dothisasoftenasnecessary.Ifyoufeeldrowsythenextday,avoidnappingifyoucan.Ifyoudotakeanap,donotnapfor

60

longerthan20 minutes.

Ifyouhavetrouble falling asleepeachnight,trytoallowyourselfmoretimetounwindbeforebed.Expertsrecommendthatyoucommittorelaxingactivitiesuptoonehourbeforebed.Thisperiodoftimeshouldnotbeaboutrushingnighttimeactivities,suchasbrushingyourteeth,anditshouldnotbeatimewhereyouplaneventsforthefollowingdays.

61

Back Pain

Backpainisacommonafflictionthatcanhaveanumberofcauses.Manyofthesecausesmaybepreventable.Otherformsofbackpaincancomeaboutafteraninjuryorduetoamedicalcondition.

Common Reasons for Back Pain

Thereareanumberofcommonlifestyletriggersthatcancausebackpain,including:

Poorposture.

Liftingheavyobjects.

Beingoverweightorobese.

Smoking.

Failingtomaintainanexerciseroutine.

Wearinghighheelsorill-fittedshoes.

62

Additionally,studieshaveshownthatstress canleadtomuscletensioninbackmuscles.

Backpaincancommonlybeassociatedwithinjuriesand,insomecases,mayrequiremedicaltreatmenttorepair.Spine-relatedproblemssuchasherniated,slippedorbulgingdiscscanalsocausepersistentpain.

Thereareanumberofmedicalconditionsthatcausebackpain,includingarthritis,tumorsandosteoarthritis.Othermedicalconditionsthatmaycausebackpainincludekidneystones,kidneyinfections,fibromyalgiaandendometriosis.

Muscle and Ligament Strains

Beneathyourskin,aseriesofmusclesandligamentsholdthebonesofyourspineinplace.Thesemusclesandligamentscanbestrainedwhentheyarestretchedbeyondtheir

63

means,causingsmalltearsinmuscleandligamenttissues.

Astraincancauseageneralpainthroughoutyourbackorinalocalizedspotthatisnotnecessarilywherethestrainislocated,duetonervepain.

Muscleandligamentback pain symptoms canincludepainandstiffnessintheback,paininthebuttocksandlegs(oftenthebackofthethigh)andpainthatworsenswhenstretching,coughing,sneezingandbending.

Ifyouhaveanysymptomsofnumbness,weaknessinyourlegs,bowelorbladderproblems,orpersistentorseverebackpain,youshouldconsultwithyourdoctorimmediately.Severalligamentandmusclestrainsymptomsarealsosymptomsformoreseriousconditions.

64

Ifyouareexperiencingbackpainthatmaybecausedbyamuscleorligamentstrain,consider:

Applyicetoyourbackafteraninitialinjuryforaperiodof20 to 30 minutes.Repeatthisprocessafterthreetofourhoursfortwotothreedays.

Applyheattoyourbackafter 2-3 daysoficingoroncetheswellinghasgonedown.

Takeover-the-counterpainkillersorothernon-steroidalanti-inflammatorydrugs,suchAdvilorAleve.

Participateinphysical therapy,ifsymptomsaresevereorifrecommendedbyyourdoctor.

Youcanreducethelikelihoodofamuscleorligamentstrainbyutilizingpreventativemeasuressuchas:

65

Ifpainoccursduringaphysicalactivity,stopimmediately.

Loseweightifyouarecurrentlyoverweightorobese.

Sleeponyourbackorsidewithawedgeorpillowunderorbeneathyourlegsandavoidsleepingonyourstomach.

Striveforabetterposture.

Bulging and Ruptured Discs

Whileitisestimatedthat80percentofAmericanswillexperiencesomeformofbackpainatleastoncewithintheirlifetime,backpainisusuallyshortlivedwithanumberofcauses.

Insomecases,backpainiscausedbyaherniated disk.Thevertebraeofyourspinearecushionedbyrubberydisksthatcanbreak

66

downorteartheinner“jelly-like”materialpressingoutofthediskandcompressingnervesintheprocess.

This“slipped disk”isreferredtoasaherniated disk.Notonlycanslippeddiskscausepain,butifpresseduponthesciaticnerve,paincanescalateandrunfromyourlowerbackorbuttocksallthewaydownyourleg.

Thelevelofpaincanvarybetweenpatientsandtheseverityoftheinjury.Approximately80to85percentofherniateddiskswillhealovertimeusingvarioustreatmentoptions.

Doctorscommonlyprescribeanti-inflammatorydrugs,steroidinjectionsandphysicaltherapytotreatherniateddisks.Restisstronglyencouragedtoallowthebodytohealandavoidfurtherinjury.Generally,aherniateddiskcanhealwithinsix to 12

67

weeks.

Inrarecases,surgerymaybenecessary.Microdiscectomyinvolvestheremovaloftheportionoftheslippeddiskthatispushingonanerve.Traditionally,surgeonscompletedthisprocedurewithinch-lingincisionsthatweremoreinvasive.

However,amoreminimallyinvasiveprocedurerequiressmallerincisionsanddoesnotrequiremusclestobedetachedandreattached.Insteadofcuttingintoapatient’smuscle,surgeonsuseatoolcalledadilatorinordertocleartheaffectednerveofherniateddiskfragments.

Microdiscectomiesaregenerallyanoutpatientprocedureandmostpatient’sgohomethesameday.Whiletheprocedureisconsideredtobeofalowerrisk,theprocedurefailsinabout10percentofpatients

68

whowillrequireanadditionalsurgery.

Insomecases,physical therapyisrequiredaftertheprocedure.Aftersurgery,apatientcangenerallywalkwithinafewdays,butmostavoidanyvigorousactivityforfour to six weeks.

Skeletal Irregularities

Skeletalirregularities,alsoreferredtoascongenitaldeformities,aredefectsofthespinethataregenerallyidentifiedatbirth.However,somediagnosesmaynotbemadeuntillaterinchildhood.

Thereisnodefinitivecauseforskeletalirregularities.However,expertsbelievethatthecausemaybegenetic and environmental.Manyabnormalitiesareprogressiveandresultinsignificantspinaldeformity,whichcanleadtootherserious

69

healthconditions.Congenital deformities includescoliosis,kyphosis,torticollis,lordosisandothervertebraldefects.

Thesymptomsofskeletalirregularlydiseasescanvarybythedisease.However,whensevere,theyareoftenvisibleintheformofadeformedorcurvedspine.Painmaybepresent,andthesedeformitiescanleadtoproblemswithmobility.

Treatmentoptionsareoftenlimitedandbasedupontheseverityofthedisease.Inlessseverecases,exercise,physicaltherapyandbracesmayhelp.However,inmoderatetoseverecases,surgeryisoftennecessaryandmaynotbeabletocorrectaprobleminitsentirety.

Spinal Osteoporosis

Spinalosteoporosisisadegenerativejoint

70

diseasethatgraduallybreaksdowntheprotectivecartilagethatcushionsthejointsanddiscsintheneckandlowerback.

Insomecases,spurscandevelopandputpressureonthenervesleavingthespinalcolumn,resultinginweaknessandpainwithinthearmsand/orlegs.

Spinalosteoarthritisismostcommonlyseenin womenwhoareatleast45 years of age.Obesityandemploymentoractivitiesthatputsrepetitivestressonthejointsintheneckandspineincreasetheriskofdevelopingspinalosteoarthritis.

However,thediseasecandevelopinyoungeradultsfollowinganinjuryortraumatoajointorduetoageneticdefect.Incasessuchasthese,menaremorelikelytodevelopthecondition.

71

Spinalosteoarthritispresentsnumeroussymptoms,includingchronic stiffness or painintheneckorback.Ifanerveisalsocompressed,theconditioncancauseweakness and even numbnessinthelegsorthearms.Generally,discomfortandpainarerelievedwhenlyingdown.

SpinalosteoarthritiscanonlybediagnosedbyuseofanX-ray.However,aphysicalexamisusuallyperformedbyaphysiciantodeterminewhetherornottotestforthecondition.Whilebloodtestscannotconfirmthiscondition,bloodtestscanruleoutotherdiseasesthatpresentsimilarsymptoms.

Ifyouhavebeendiagnosedwithspinalosteoarthritis,treatmentmaybeabletorelieveyoursymptomsorincreaseyourabilitytofunction.However,thereisnocureforspinalosteoarthritis.

72

Dependingonsymptoms,yourhealthandtheseverity,yourdoctormayrecommendweightlossandregularexerciseinorderstrengthenmusclesaroundyourjoints.

Yourdoctormayalsoprescribepainmedication,anti-inflammatorydrugsandotherprescriptions.Surgerymayberecommendedincaseswherebowelandbladderfunctionareimpaired,thenervoussystemisdamagedorifyouhavegreatdifficultywalking.

73

Diabetes

Diabetesisalifetimediseasethataffectsapproximately18.2millionAmericanswithanestimated5.2millionAmericansunawarethattheyhavethecondition.Diabetesoccurswhenoneofthefollowingconditionsispresent:

Whenaperson’spancreasdoesnotproduceany(orverylittle)insulin.

Whenthebodydoesnotrespondappropriatelytoinsulinanddevelopsandinsulinresistance.

Therearethree typesofdiabetes.Type 1 diabetesoccursaftertheinsulin-producingcellswithinthepancreasaredestroyedbyaperson’simmunesystem.InType1cases,theafflictedperson’sbodyproducesnoinsulinandthepersonmustuseinsulininjectionsinordertocontrolbloodsugarlevels.

74

Type 1 diabeteshasoftensymptomsthatcanbesevereandappearsuddenly,including:

Increasedhunger.

Increasedthirst.

Frequenturination.

Unexplainedweightloss.

Fatigue.

Blurredvision.

Labored,heavybreathing.

Type 2 diabetes,themostcommonformofdiabetes,occurswhenthepancreasdoesnotsecreteenoughinsulinorwhenthebodyhasbecomeresistanttoinsulin.Symptomsoftype2diabetesincludethesymptomsoftype1,butmayalsoincludesymptomssuchas:

Slow-healingsoresorcuts.

75

Itchiness.

Yeastinfections.

Weightgain.

Numbnessortinglingofthehandsandfeet.

Finally,gestational diabetesistheonly(usually)temporaryformofdiabetesthatistriggeredbypregnancy.Ararecondition,thoseaffectedbythisdisorderhaveahigherchanceofdevelopingtype2diabeteslaterinlife.Leftuntreated,amother’shighbloodsugarcanaffectthebloodsugarlevelsoftheunbornbaby,whichcanleadtogrowthanddevelopmentproblems.

Who is most at risk for diabetes?

ForType1diabetes,youwillhaveanincreasedriskofthisconditionif:

76

YouhaveafamilyhistoryofType1diabetes,particularlyifyouhaveamother,fatherorsiblingthatisafflicted.

Youareafflictedbycertaindiseasesofthepancreas.

An infection or illnesscausesdamagetoyourpancreas.

Type1diabetesgenerallybeginsinchildhoodwiththemajorityofdiagnosesmadebeforeadulthood.

While Type 2diabetesprimarilybeginsinadulthood,itcanbeginatanytimeofaperson’slife.Riskfactorsinclude:

Obesityorbeingoverweight(thehighestriskfactorforthiscondition).

Impaired glucosetolerance.

Insulinresistance.

77

EthnicbackgroundssuchasHispanic/LatinoAmericans,AfricanAmericans,NativeAmericans,AsianAmericans,PacificIslandersandAlaskaNatives.

Apreviousgestational diabetes diagnosis.

Sedentarylifestyles.

Afamilyhistoryofdiabetes,particularlyinaparentorsibling.

AdiagnosisofPolycysticOvarianSyndrome(PCOS).

GestationaldiabetesisarareconditionthataffectsaroundfourpercentofallU.S.pregnancies.However,youmayhaveahigherriskforgestationaldiabetesifyou:

Areoverweightorobese.

Haveaglucoseintolerance.

78

Haveafamilyhistoryofgestationaldiabetes.

Additionally,theolderthatyouarewhenyoubecomepregnant,thehighertherisk.

Preventing Diabetes

Ifyouareatriskofdevelopingdiabetes,itisimportanttotakethenecessarystepstopreventordelaytheonsetofthislifelongdisease.Regardlessofyourriskfactors,youmaybeabletosignificantlyreduceyourriskofdiabetesby:

Managingyourbloodpressure.

Keepingyourweightwithinahealthyrangeforyourheight.

Gettingatleast30minutesofexerciseonmostdays.

Eatingabalanceddietonaregularbasis.

79

Diabetes Diagnosis and Treatment Options

Inmostcases,diabetesisdiagnosedwithasimplebloodtest.Multiplebloodtestsareavailable,includingafastingglucosetestoranA1C test.

Notonlycanabloodtestdeterminewhetherornotapatienthasdiabetes,butdoctorsareabletodeterminethelikelihoodthatapatientwilldevelopType2diabetesinthenearfuture,aconditioncommonlyreferredtoaspre-diabetes.Thosediagnosedwithpre-diabeteshaveahigherthannormalbloodsugarlevel,butonethatisnothighenoughforadiabetesdiagnosis.

Thereiscurrentlyno curefordiabetes,butdiabetescanbemanagedandcontrolled.Treatmentwillrequireyoutocloselymonitoryourbloodsugarlevelsaswellascombinediet,exerciseandmedication.

80

InsomecasesofType2diabetes,theconditioncanbecontrolledthroughappropriatediet and exercisealone.Shouldmedicationberequired,thetypeofdiabetesmedicationthatisprescribedwillvaryonanumberoffactors,includingtheseverityofthecondition.

Whilegestationaldiabetesistreatedinmuchthesameway,bloodsugarlevelsoftenreturntonormalwithinsixweeksofchildbirth.

Ifyouarediagnosedwithanytypeofdiabetes,followyourdoctor’srecommendationsformedication, diet and exercise.Uncontrolleddiabetescancontributetothedevelopmentofanumberofmedicalconditions,includingcardiovasculardisease,nervedamage,kidneydamage,blindness,fooddamage,hearingimpairmentandAlzheimer’sdisease.

Inthecaseofgestationaldiabetes,notonly

81

canuncontrolleddiabetesleadtoyourownmedicalconditions,butalsocomplicationsinyourbaby,includingexcessgrowth,lowbloodsugar,deathandthedevelopmentofType2diabeteslaterinlife.

82

Glaucomaisaseriousconditionthatcausesprogressivedamagetotheeye’sopticnerve,resultinginsignificantvisionlossorblindness.Glaucomaoccurswhentheaqueoushumorchannelisblockedwithintheeye.Outsideofrarecaseswherethedamageiscausedbyachemicalorbluntinjurytotheeye,thecauseofthisblockageisunknown,thoughexperts’hypothesisthatismaybegenetic.Leftuntreated,glaucomacancausetotalandpermanentblindnesswithinafewyears.

Therearetwotypesofglaucoma;open-angle and open-closure.Open-angleglaucomaisthemostcommontypeofglaucomaasitisoccurswhenthedrainstructurewithintheeyeappearstobenormal,butthefluidwithindoesnotflowoutasitshould.

Incasessuchasangle-closureglaucoma,

Glaucoma

83

whichismorecommonlyseeninAsia,theeyedoesnotdraincorrectlyduetothedrainspacebetweentheirisandcorneabecomingtoonarrow.

Thoseafflictedwithglaucomamaynotshowanyinitialsymptoms.However,thefirstsymptomthatisexperiencedisgenerally a loss of peripheral vision.Insomecases,thelosscanbesosmallthatitisunnoticeableuntillateinthedisease.Additionalglaucomasymptomsinclude:

Seeing“halos”aroundlights.

Generalvisionloss.

Rednessoftheeye.

Eyesthatappearhazy.

Nauseaorvomiting.

Alingeringpainwithintheeye.

84

Narrowedvision.

Who is most at risk for glaucoma?

Glaucomaismostcommoninadultswhoareatleast40 years of age.Whilemostcommoninmiddleagedandolderadults,thediseasecanaffectyoungadults,childrenandinfants.Otherincreasedriskfactorsforglaucomainclude:

AfricanAmerican,Irish,Russian,Hispanic,Scandinavian,JapaneseorInuitethnicities.

Afamilyhistoryofglaucoma.

Poorvision.

Adiagnosisofdiabetes,especiallyifdiabetesisuncontrolled.

Takingcertainsteroidmedications,includingprednisone.

85

Aneventresultingintraumatotheeyeoreyes.

Preventing Glaucoma

Unfortunately,thereiscurrentlynowaytopreventglaucoma.However,catchingthediseaseearlyallowsittobetreatableandcontrolled.Therefore,expertsrecommendthatyougetacompleteeyeexamfromaneyedoctoreveryonetotwoyears.Ifyouhaveahigherriskforglaucoma,orifyouhavediabetes,youmayneedtohaveaneyeexammoreoften.

Glaucoma Diagnosis & Treatment Options

Theonlywaytodiagnosisglaucomaisthroughaneyeexam.Theexaminerusesdropsthatwilldilateyourpupilsandallowanexaminationofyouropticnerve.Ifglaucoma

86

issuspected,atestcalltonometryisgenerallycompletedinordertocheckyoureyepressure.

Ifyouarediagnosedwithglaucoma,treatmentoptionsmayvarydependingonhowfarthediseasehasprogressed.Lostvisioncannotberegained,however,treatmentcanhalttheprogressionofthediseaseandfurthervisionloss.

Themostnon-invasiveoptionavailableistheuseofmedicaleyedropsthatcanreducetheformationoffluidwithintheeyesorincreaseitsoutflow,resultinginareductionofeyepressure.

Inmanycases,lasersurgeryormicrosurgerymaybeneeded.Lasersurgeryisaprocedurethatcanincreasetheflowoffluidfromtheeyeorstockfluidblockage,dependingonthetypeofglaucomapresent.Lastersurgerymay

87

includeproceduressuchas:

Trabeculoplasty,whichfurtheropensthedrainagearea.

Iridotomy,whichinvolvestinyholesintheiristhatallowthefluidwithintheeyetoflowmorefreely.

Cyclophotocoagulation,whichinvolvestreatingareasofthemiddlelayeroftheeyeinordertoreducetheproductionoffluid

Ifmicrosurgeryisrecommended,aprocedurecalledtrabeculectomywillbeperformed.Thisprocedureallowsdoctorstocreateanewchanneltodrainthefluidwithintheeyeandeasepressure.Insomecases,atubemaybeimplantedinordertohelpthefluiddrain.Withmicrosurgery,thereisariskoffailure,temporaryvisionloss,permanentvisionlossandinfection.

88

Arthritis

Arthritisisaninflammationofoneormorejoints,causingjointpainandstiffenthattypicallyworsenovertime.Themostcommonformsofarthritisarerheumatoidarthritisandosteoarthritis.

Osteoarthritisaffectsthecartilage,aprotectivetissuethatcoverstheendsofboneswherejointsareformed,tobreakdown.Rheumatoidarthritisisanautoimmunedisorderthattargetstheliningofjoints.Whilethesecommontypesofarthritisaffectthebodydifferently,symptomscanbesimilarandinclude:

Pain.

Stiffness.

Swellingofjoints.

Rednessaroundjointareas.

89

Adecreasedrangeofmotion.

Osteoarthritismostcommonlyaffectsjointsintheknees,hands,hipsandspine.Rheumatoidarthritiswillgenerallybegininsmallerjointareas,suchasinyourfingers,hands,toesandfeet.However,itcanandoftendoesprogressandspreadtootherareas,suchasthewrists,knees,ankles,elbows,hipsandshoulders.Inmostcases,rheumatoidarthritissimultaneouslyaffectsbothsidesofthebodyinthesamejoints(bothknees,bothwrists,etc.).

Who is most at risk for arthritis?

Anyonecanbeafflictedbyaformofarthritis,however,therearesomewhoareataconsiderablyhigherrisktodevelopthedisease.Riskfactorsforarthritisinclude:

A family history.Manytypesofarthritiscanruninfamiliesandthistypeofrisk

90

isconsideredhighestwhenaparentorsiblinghasthedisorder.

Age.Riskbeginstoincreasetheolderapersonisasthediseaseprimarilybeginsinmiddletolateadulthood.

Gender.Womenarefarmorelikelythanmentodevelopsometypesofarthritis,includingrheumatoidarthritis.

Previousinjuries to joints,suchasaninjurysustainedinasport.

Obesity.Excessweightputsadditionalstressonjoints,especiallythespine,hipsandknees.

Preventing Arthritis

Whilethereisnowaythatyoucanguaranteeyourselfagainstbecomingafflictedwitharthritis,youcanreduceyourriskfactorsbytakingafewpreventativemeasures.

91

Studieshaveshownthatadding more fish toadietmaylowerriskforcertaintypesofarthritis,suchasrheumatoidarthritis,duetotheomega-3fattyacidsthatarefoundinfish.Omega-3shaveseveralhealthbenefits,mostnotablythereductionofinflammationwithinthebody.

Asobesityandbeingoverweightcancausesignificantrisktothedevelopmentofarthritis,youcanreduceyourriskfactorsbyreducing your weightandgettingdowntoahealthierrangeforyourheight.

Notonlycanaroutineexerciseroutineassistinweightloss,butregularexercisecanreduceyourriskforarthritisbystrengthening the musclesaroundyourjoints,thusprotectingthemfromaddedwearandtear.

Avoid injury and protect your joints wheneverpossible.Usepropertysafety

92

equipmentwhenplayinganytypeofsportandusetherighttechniqueswheneversitting,liftingorworkinginordertoprotectyourjointsfromstrainrelatedinjuries.

Arthritis Diagnosis & Treatment Options

Generally,aphysicalexamisthefirststeptoadiagnosisasswelling,redness,warmthorlimitedmotionmaybepresent.Imagingtests,includingx-raysandultrasounds,arethemostcommonandaccuratewaytodiagnosisarthritis.

Thereisno cureforarthritis,buttreatmentcanalleviatesomeofthesymptomsorslowtheprogressionofthedisorder.Insomecases,youmayneedtotrymorethanonetreatmentoruseacombinationoftreatments.

93

Anumberofprescriptionmedicationsarecommonlyusedtotreatarthritis.However,manysuffererscanalsobenefitgreatlyfromcertainexercisesandphysicaltherapy.

Ifnon-invasivetreatmentoptionsdonotproviderelief,youmaybenefitfromsurgery.Thereareseveralsurgicalproceduresthatcanbeperformedforarthritis,includingjointrepair,jointreplacementandjointfusion.

94

Whilecholesterolisneededtobuildhealthycells,havingtoohighalevelofcholesterolcanincreaseyourriskforanumberofmedicalconditions,includingheartdisease.Highcholesterolcancausethedevelopmentoffattydepositsinsideofyourbloodvessels,whichcanleadtoalifethreateningclotthatcausesaheartattackorstroke.

Highcholesteroldoesnotpresentanytypeofsymptomsanditcanonlybedetectedthroughabloodtest.

Who is most at risk for high cholesterol?

Highcholesterolisfairlycommonwhereafamilyhistoryispresent,however,themajorityofriskfactorsinvolvelifestylechoices,makinghighcholesterolpreventable.

High Cholesterol

95

Yourriskfactorsforhighcholesterolmaybeincreaseddueto:

Poor diet,especiallyincasesofadietthathashighsaturatedandtransfatoradietthatishighinsalt.

Obesity,especiallyinbodymaxindexes(BMIs)of30orgreater.

Lack of exercise.

A diabetesdiagnosis.

Smoking.

Highlevelsofstress.

Additionally,youaremorelikelytohavehighbloodpressuretheolderthatyouare.Thisisduetothefactthatyourliverbecomeslesscapableofremovingbadcholesterolfromyourbloodstream.

96

Preventing High Cholesterol

Highcholesterolisverypreventablethroughahealthy,well-balanceddietandroutineexercise,evenifyoumaybedispositionedtowardshavinghighcholesterolduetoafamilyhistory.Topreventhighcholesterol,try:

Eatingalow-saltdietthatincludesanabundanceoffruits,vegetablesandwholegrains.

Limittheamountoffoodscontaininganimalfatsthatyouingest.

Getdowntoahealthyweightifyouarecurrentlyoverweightorobese.

Quitsmoking.

Learnhowtobettermanageandreduceyourstress.

Ifyoudrinkalcohol,drinkonlyinmoderation.

97

Strivetoexerciseonmostdaysoftheweekforatleast30minuteseachday.

High Cholesterol Diagnosis & Treatment Options

Highcholesterolisdiagnosedthroughablood test.Inordertoensurethatyourbloodtestresultsareaccurate,itiscrucialthatyouavoideatingordrinkinganythingotherthanwaterforatleastninehoursbeforeyourbloodtest.

Whilehighcholesterolismostcommoninolderadults,itcandevelopatanyage,includinginchildren.Formostchildren,theNationalHeart,LungandBloodinstituterecommendscholesterolscreeningbetweentheagesof9and11andbetweentheagesof17and21.

Ifyouarediagnosedwithhighcholesterol,

98

lifestylechangescanhaveasignificanteffectinreducingyourcholesterollevelsandreducingyourriskforheartdisease.Therefore,yourdoctormayrecommendweight loss, exercise or a change to your diet.

Additionally,prescriptionmedicationsareusuallyusedtotreathighcholesterollevels,dependingonaperson’sriskfactors,ageandoverallhealth.

99

High blood pressureiscommonlyreferredtoashypertension,whichcanseriouslyimpactyouroverallhealthandputyouatgreatriskforotherhealthconditions,includingheartdisease,heartattack,strokeanddementia.

Yourbloodpressureisdeterminedbythesizeofyourarteriesandtheamountofbloodthatyourheartpumpswitheachbeat.Thenarroweryourartiesandthemorebloodthatispumpedbyyourheart,thehigheryourbloodpressurelevel.

Hypertensiongenerallydevelopsoverseveralyearsanddoesnotalwayspresentsymptoms.Infact,mostofthoseafflictedwithhypertensionwillnevershowasignorsymptomuntilbloodpressurereachesdangerously high levels.However,someofthesymptomsthatmaybepresentonce

Hypertension

100

bloodpressurereachesthoselevelsinclude:

Frequentheadaches.

Shortnessofbreath.

Nosebleeds.

Fortunately,highbloodpressureiseasilydetectedandroutinelycheckedaspartofregulardoctor’sappointments.

Who is most at risk for hypertension?

Therearetwo types of hypertension,eachwithdifferentriskfactorsforthecondition.Themostcommontypeofhypertensionisprimaryhypertension.

Thistypeofhighbloodpressuredevelopsgraduallyoverseveralyearsanddoesnotusuallyhaveanidentifiablecause.However,

101

expertssuggestthatriskfactorsforprimaryhypertensioninclude:

Age.Theriskofhighbloodpressureincreasestheolderthatyouget.

Gender.Highbloodpressureismorecommoninmenbelow64yearsofageandmorecommoninwomenatages65yearsofageandolder.

Race.ThoseofAfricanheritagearemorelikelytodevelophypertension,oftendevelopitatyoungeragesandaremorelikelytosuffercomplications.

Family history.

Beingoverweight or obese,asexcessweightrequiresthehearttopumpmorebloodtosupplytissueswithoxygenandnutrients.

A lack of physical activity.

102

Useoftobacco.

High sodiumdiets.

Dietsthatlack potassium.

Drinkingtoomuchalcoholonaregularbasis.

Highlevelsofstress.

Certainchronic conditions,suchaskidneydisease,diabetesandsleepapnea.

Secondaryhypertensioniscausedbyanunderlyingmedicalcondition.Incasesofsecondaryhypertension,highbloodpressureappearssuddenlyratherthangraduallyoverseveralyears.Thereareanumberofmedicalconditionsthatcancausesecondaryhypertension,including:

Obstructivesleepapnea.

103

Kidneyproblems.

Thyroidproblems.

Adrenalglandtumors.

Congenitaldefectsinbloodvessels.

Illegaldrugs,includingamphetaminesandcocaine.

Certainmedications,includingover-the-counterpainrelievers,certainprescriptiondrugs,birthcontrolanddecongestants.

Preventing Hypertension

Regardlessofyourriskfactors,youcanreduceyourlikelihoodofdevelopinghypertensionbymaintainingahealthyweight,engaginginroutineexerciseandeatingawell-balanceddiet.

104

Topreventhypertension,itiscrucialthatyouappropriatelymanageanyotherhealthconditionthatyoumayhavethatcanleadtohypertension.Additionally,itisimportanttohaveroutineannualcheckupswithyourprimarycarephysician.Ifyouareatriskforhypertension,yourdoctormayrecommendmorefrequentbloodpressurechecks.

Incasesofprimaryhypertension,yourdoctorwillmorethanlikelybeabletoseethewarningsignsofhighbloodpressure.Shouldthishappen,correctivemeasures,suchasweightloss,exerciseandabalanceddietcanpreventelevatedbloodpressurefrombecominghypertension.

Hypertension Diagnosis & Treatment Options

Hypertensioniseasilydiagnosedasbloodpressurechecksareacommonandroutine

105

checkthatisdonewitheachvisittoadoctor’soffice.Bloodpressureismeasuredusingabloodpressuremachine.Themachineisabletomeasureyourbloodpressurethroughaninflatablecuffthatisplaceduponyourarm.

Abloodpressurereadingcontainstwonumbers.Theuppernumbermeasuresthepressureinyourarterieseachtimeyourheartbeats.Thelowernumbermeasuresthepressurewithinyourarteriesbetweenbeats.Theresultingmeasurementswillfallwithinoneofthefollowingcategories:

Normal blood pressure–Below120/80.

Elevated blood pressure–anuppernumberbetween120to129andalowernumberthatisbelow80.

Stage 1 hypertension–Anuppernumberof130to139withalowernumberbetween80and89.

106

Stage 2 hypertension–Anuppernumberof140orhigherandalowernumberof90orhigher.

Ifyourbloodpressuretestresultsinhighbloodpressure,yourdoctorwilllikelyreviewyourmedicalhistorywithyouandconductaphysicalexam.Yourbloodpressurewillmostlikelybecheckedmorethanonce.Yourdoctormayalsorecommendfurthertests,includingaurine,bloodandcholesteroltestbeforegivingadiagnosis.

Dependingontheseverityofyourhypertensionandyourotherhealthconditions,yourdoctormayrecommendseveraldifferenttreatmentoptions.Inalmostallcases,lifestylechangescanhaveasignificantimpactoncontrollingyourhighbloodpressure.Importantrecommendedlifestylechangesmayincludediet,regularexercise,weightlossandlimitingalcohol.

107

Inadditiontolifestylechanges,thereareanumberoftypesofprescriptionmedicationsavailablethatcanhelplowerandcontrolyourhighbloodpressure.Thetypeofmedicationthatmayberecommendwillvarybaseduponanumberoffactors,includingthecauseofyourhighbloodpressure,theseverityofyourhypertensionandothermedicalconditionsthatyoumayhave.

108

Depressionisacommonmooddisorderthatcancauseanumberofsymptomsintheafflicted,includingpresidentfeelingsofsadnessandalossofinterest.Symptomsvaryinseverityandseverecasesofdepressioncandrasticallyaffectday-to-dayactivitiesandaperson’squalityoflife.

Thereareanumberoftypesofdepressionoutsideofthestandarddisorder.Eachofthesevariationsofmajordepressionaddsoneormorespecifiers,orspecificfeature.Someofthemostcommontypesofdepressioninclude:

Anxious distress,whichisdepressionthatalsopresentsitselfasunusualrestlessnessorworry.

Mixed features,whichisatypeofdepressionthatalternatesbetween

Depression

109

depressionandmania,anelevatedself-esteemandincreasedenergy.

Melancholic features,whichisaseveredepressionthatincludesalackofresponsetothingsthatoncebroughtpleasure.Melancholicfeaturesmayalsobeaccompaniedbyworsenedmoodinthemorning,seriouschangesinappetite,guilt,agitationorsluggishness.

Atypical features,atypeofdepressionthatincludestheabilitytobetemporarilyhappyduringcertainevents.Atypicalfeaturesdepressioncanalsoincludeanexcessiveneedforsleep,sensitivitytorejectionandaheavyfeelinginthelegsorarms.

Psychotic features,whichisdepressionthatisaccompaniedbydelusionsorhallucinations.

Peripartum onset,atypeofdepression

110

thatoccursduringpregnancyorintheweeksormonthsfollowingpregnancy.

Seasonal pattern,atypeofdepressionthatisrelatedtothechangesinseasonsandareductioninexposuretosunlight.

Depressioncanbepresentedasanumberofsymptoms.Thosewhohavedepressionwilltypicallyhavemultipleepisodesthroughouttheirlifetimewhilesomehavechronicdepressionthat,leftuntreated,couldlastforyears.Someofthemostcommonsymptomsofdepressioninclude:

Feelingsofsadness,hopelessness,emptinessortearfulness.

Angryoutbursts,frequentfrustrationandirritability.

Sleepdisturbances,includingsleepingtoomuchorinsomnia.

111

Lackofenergy.

Slowedthinking,bodymovementsandspeech.

Reducedorincreasedappetite,resultinginweightlossorgain.

Anxiety,restlessnessandagitation.

Feelingsofguilt,worthlessnessorself-blame.

Troubleconcentrating,rememberingthingsormakingdecisions.

Frequentorrecurrentthoughtsofdeath,suicide,orsuicideattempts.

Depressionsymptomscanpresent in different waysforyoungchildren,teensandolderadults.Inyoungchildrenandteens,refusingtogotoschoolcanalsobeasignofdepression.Forteens,poorschoolperformance,theuseofrecreationaldrugsor

112

alcoholandavoidanceofsocialinteractionsarealsosymptomsofdepression.

Inolderadults,depressionmayalsopresentitselfaspersonalitychanges,physicalachesandpains,wantingtostayhomeandareluctancetotrynewthings.

Who is most at risk for depression?

Aswithmostmentaldisorders,therearemanypotentialfactorsthatcouldincreaseaperson’sriskfordepression.Expertsdonotknowtheexactcauseofdepression.Increaseddepressionriskfactorsmayinclude:

Biologicaldifferences,specificallyinthebrain.

Brainchemistrychangesinfunctionandeffect.

Hormonalchangesorimbalances.

113

Geneticsandfamilyhistory.

Certainpersonalitytraits,includingbeingtoodependentorhavingalowself-esteem.

Abuseofalcoholorrecreationaldrugs.

Certainmedications,includingsomesleepaidsandhighbloodpressuremedications.

Depressionismostcommonlyseeninteensaswellasinadultsintheir20s and 30s,butdepressioncanoccuratanyage.Statistically,morewomenhavebeendiagnosedwithdepressionthenmen.However,expertscautionthatthismaybe,inpart,duetothefactthatwomenaremorelikelytoseektreatmentandthusreceiveadiagnosis.

Preventing Depression

Whilethereisnoguaranteedwaytoprevent

114

depression,youmaybeabletoreduceyourriskofdevelopingthedisorderby:

Takingstepstocontrolstress.

Reachingouttofamilyandfriendsintimesofcrisis.

Gettreatmentrightawaywhenexperiencinganypotentialsymptomsofdepression.

Considergettinglong-termmaintenancetreatmenttopreventarelapseofsymptomsfollowinganepisodeofdepression.

Depression Diagnosis & Treatment Options

Depressioncanbediagnosedbyreviewingsymptoms,thoughts,feelingsandbehaviorpatternswithamentalhealthprofessional.Yourprimarycareprovidermayalsocomplete

115

aphysicalexamororderlabtestsinordertoruleoutotherconditionsthatmaypresentdepressionsymptoms,suchasthyroiddisorders.

Formostpeoplewithdepression,medication,therapyoracombinationofthetwocanbebeneficialinreducingthesymptomsofdepression.Incasesofseveredepressionorsymptomsthatincludethoughtsofsuicide,ahospitalstaymaybewarranted.

116

Heartdisease,alsoreferredtoascardiovasculardisease,describesmanyheartconditions,includingbloodvesseldisorders,heartdefectsandheartrhythmconditions.

Manyheartdiseaseconditionscanbepreventedwithhealthylifestylechoicesandaretreatablethroughanumberofmethods.

Heartdiseasethataffectsyourbloodvesselsiscalledatherosclerotic disease.Themostcommonsymptomsofatheroscleroticdiseaseinclude:

Chestpain,tightness,pressureordiscomfort.

Shortnessofbreath.

Pain,numbness,coldnessorweaknessinalimb.

Heart Disease

117

Painintheneck,throat,upperabdomen,backorjaw.

Nausea.

Extremefatigue.

Likemanyformsofheartdisease,atheroscleroticdiseasecanleadtoastrokeorheartattack.

Abnormalheartbeats,knownasheartarrhythmias,isanotherformofheartdisease.Thisconditioncausesthehearttobeattooquickly,tooslowlyorirregularly.Symptomscaninclude:

Aflutteringfeelinginyourchest.

Aracingorslowedheartbeat.

Chestpainordiscomfort.

Lightheadedness.

118

Shortnessofbreath.

Dizziness.

Fainting.

Infantscanbebornwithsevere congenital heart defects.Whileusuallyevidentshortlyafterbirth,thesedefectsaresometimesdiscoveredinyoungchildrenorlaterinlife.

Symptoms of a heartdefectinclude:

Palegrayorblueishskincolor.

Swellingthatoccursinthelegs,abdomenortheareaaroundtheeyes.

Ininfants,symptomscanbepresentedasshortnessofbreathduringfeedingorpoorweightgain.

Thedefectsthatarenotdiscoveredshortlyafterbirtharegenerallylessseriousand,whilenotimmediatelylife-threatening,can

119

leadtoseriouscomplicationslaterinlife.Symptomsoflessseriouscongenitalheartdefectsinclude:

Shortnessofbreaththatisbroughtoneasilyduringactivityorexercise.

Tiringeasilyduringactivityorexercise.

Swellingthatoccursinthehands,anklesorfeet.

Dilated cardiomyopathyisaformofheartdiseasethatiscausedbyweakenedheartmuscles.Intheearlystagesofthisdisorder,anafflictedpersonmaynotexperienceanysymptoms.However,astheconditionworsens,symptomsmayappear,including:

Breathlessnesseitherwithexertionorwhenatrest.

Swellingthatoccursinthelegs,anklesandfeet.

120

Persistentfatigue.

Irregularheartbeatsthatarefluttering,rapidorpounding.

Dizziness,faintingandlightheadedness.

Heartdiseasecanbecausedbyaninfectionknownasendocarditis,whichaffectstheinnermembranethatseparatesthevariouschambersandvalveswithintheheart.Symptomsofaheartinfectioninclude:

Fever.

Shortnessofbreath.

Skinrashesorunusualspots.

Dryorpersistentcough.

Changesinyourheartrhythm.

Weaknessorfatigue.

Swellingthatoccursinthelegsor

121

abdomen.

Heartdiseasecanalsobecausedbyvalvularheartdisease,inwhichvalveswithintheheartbecomedamagedduetoanumberofconditions.Thedamagetodamagetothevalvesresultinthenarrowing,leakingorimproperclosingofthevalves.Symptomsofvalvular heart diseasemayvarybaseduponthevalvethatisnotworkedproperly,howevergeneralsymptomsinclude:

Fatigue.

Shortnessofbreath.

Fainting.

Chestpain.

Irregularheartbeat.

Swellingthatoccursinthefeetorankles.

122

Who is most at risk for heart disease?

AtherosclerosisisthemostcommoncauseofheartdiseaseinAmerica.Whilefamilyhistorycanplayarole,asisthecasewithmanyformsofheartdisease,thosewhoareatahigherriskforatherosclerosisarethosewhohaveanunhealthy diet or lack of exercise.Smokingorbeingoverweight canalsoincreasetheriskofthisconditionconsiderably.

Thereareanumberofcausesofheartarrhythmias,includingheartdefectsthatapersonisbornwith,highbloodpressure,diabetes,coronaryarterydisease,stress,certainmedicationsandvalvularheartdisease.

Congenital heart defectsgenerallydevelopwhileababyisstillinthewomb.Defectscandevelopasearlyasonemonthafter

123

conception.Whileanexactcauseofthesedefectsarenotknown,itisbelievedthatsomemedicalconditions,geneticsandmedicationscanplayaroleinthedevelopmentofcongenitalheartdefects.

Cardiomyopathycandevelopforanumberofreasons,dependingonthetypeofcardiomyopathythatapersonisafflictedwith:

Dilated cardiomyopathycausesarerelativelyunknown,howeveritmaybecausedbyareducedbloodflowtotheheart,infections,toxins,certainmedicationsanddamagefollowingaheartattack.

Hypertrophic cardiomyopathyisusuallyinherited.Insomecases,itcanalsodevelopovertimeduetohighbloodpressureoraging.

Restrictive cardiomyopathycan

124

occurfornoknowreason.Itcanalsobecausedbyotherconditions,suchasconnectivetissuedisorders,abuildupofabnormalproteinsandbycertaincancertreatments.

Aheartinfectioncanoccurwhenabacterium,chemical,parasitesorvirusreachesyourheart.

Valvular heart diseaseisgenerallyaconditionthatyouareeitherbornwithorthatdevelopsduetodamagecausedbyconditionssuchasrheumaticfever,infectionsorconnectivetissuedisorders.

Inadditiontothespecificriskfactorsrelatedtoeachofthespecifictypesofheartdisease,therearegeneralriskfactorsthatcanapplytomostformsofheartdiseases,including:

Age.Thereisanincreasedrisktoheartdiseasetheolderyouare.

125

Gender.Menaregenerallyatagreaterriskofheartdiseasebycomparisontowomen.

A family history of heart disease,especiallyifaparentdevelopedheartdiseaseatanearlyage.

Smoking.

Certain chemotherapy drugs and radiationtherapyforcancertreatment.

Poor diet,especiallydietsthatarehighinfat,salt,sugarandcholesterol.

High blood cholesterol levels.

High blood pressure.

Diabetes.

Obesity and excess weight.

Lack of exercise.

126

Chronic stress.

Poor hygiene.

Preventing Heart Disease

Whilecertainformsofheartdiseasecannotbeprevented,mostformsofheartdiseasearemorelikelytooccurduetocertainlifestylechoices.

Youcanimproveyouroverallhearthealthby:

Notsmokingorquittingifyoudo.

Controlling other health conditions thatyoumayhave,includingdiabetes,highbloodpressureandhighcholesterol.

Exercisingforatleast30minutesadayonmostdaysoftheweek.

Eating a dietthatislowinsaltandsaturatedinfat.

127

Losing weightifoverweightandmaintainingahealthyweightforyourheight.

Reducingandmanagingstress.

Practicinggoodhygiene.

Heart Disease Diagnosis & Treatment Options

Thereareanumberoftestsforheartdisease.However,beforerecommendingatest,yourprimarycarephysicianwilllikelyperformaphysicalexamandgooveryourpersonalandfamilymedicalhistory.WhilebloodtestsandchestX-raysarecommontestsusedtodeterminethepresenceofheartdisease,othercommontestsinclude:

Electrocardiogram (ECG).AnECGmonitorsandrecordselectricalsignalsinordertodetectirregularitieswithinaheart’sstructure

128

andrhythm.

Holter monitoring.AHoltermonitorworkssimilarlytoanECG,butitisaportabledevicethatisworntorecordECGreadingsforaperiodthatisusuallybetween24and72hours.

Echocardiogram.Anechocardiograminvolvesanultrasoundofthechestinorderforaphysiciantoseedetailedimageryofaheart’sfunctionandstructure.

Stress Test.AstresstestIperformedafterraisingtheheartratethroughmedicineorexerciseinordertodeterminehowwelltheheartresponds.

Cardiac computerized tomography (CT) scan.Acommontestusedtocheckforheartdisease,thepatientliesonatableinsideofamachinethatproducesamagnetic

129

field,creatingpicturesoftheheartthatareevaluated.

Heartdiseasetreatmentsoftenvarywidelydependingontheconditionapatientsuffersfrom.Insomecases,lifestylechangesmaybenecessarytocontrolandtreatheartdisease..

Sometimes,lifestylechangesarenotenoughtoeffectivelytreatheartdisease.Inthesecases,medicationmaybeprescribedtohelpcontroltheheartdiseasecondition.Thetypeofmedicationprescribedwilldependonthetypeofheartdiseasepresent.Inrarecase,suchaswhenmedicationisnotenoughorineffective,surgerymayberequired.

130

Hearinglossisextremelycommon,especiallyasyouage.One-thirdofpeoplebetween65and75yearsofageexperiencehearingloss,whilehalfofthepopulationover75yearsofagehassomedegreeofhearingloss.Whilethisconditionismorecommonintheolderpopulation,anyonecanexperiencehearinglossatanyage.

Knowingwhatcauseshearingproblemscanhelpyouavoid risk factorsandseekmedicaltreatmentearlyon.Whilesometypesofhearingproblemscannotbereversedorcured,otherscan.Evennon-reversablehearing loss can be managedwithvarioustreatmentsanddevices,suchashearingaids.

Hearinglossiscausedbyanumberoffactors.Someofthesefactorscanbeavoided,whileotherscannot.Knowingthereasonbehind

Hearing Loss

131

hearinglosscanhelpyoutakepreventativemeasureswheneverpossible.Mosttypesofhearinglosscanbeattributedtothefollowing:

Aging

Damagetotheinnerear

Buildupofearwax

Infectionsandabnormalgrowths

Rupturedeardrums

Dependingonthecauseofhearingloss,thisconditionmaydevelopslowlyovertimeorhappensuddenly.Forexample,arupturedeardrumcanimmediatelyaffectyourhearing.Earwaxbuildup,ontheotherhand,usuallycausesamoregraduallossofhearing.

132

Types of Hearing Loss

Tounderstandthetypesofhearingloss,ithelpstoknowhowtheearisstructured.Yourearismadeupofthreemainparts:

The outer earincludesthevisiblecartilageandopeningoftheearcanal.Itpicksupsoundwavesandfunnelsthemtoyourinnerear.

The middle earisacavityinsideyourearthatcontainsyoureardrum,severaltinybonesandotherimportantstructuresthatamplifyandtransmitsoundwaves.

The inner earismadeupoftinyhairsandseveralchambersthatreceivevibrationsfromthemiddleear,thenconvertthatinformationintoelectricalimpulsesthataresenttothebrain.

Hearinglosscanaffectany part of the

133

ear.Thetypeofhearinglossapersonexperiencesdependsonthepartoftheearthatisaffected.Therearethreemaintypesofhearingloss.

Conductive hearing lossoccurswhentheouterormiddleearisdamaged,infectedorotherwiseaffected.Thistypeofhearinglosscanoccursuddenlyorgraduallyovertime.Inmostcases,itiscausedbyamechanicalproblemoranobstruction,suchasearwaxbuildup.

Sensorineural hearing losshappenswhenthetinyhairsorchambersoftheinnerearbecomedamaged.Whenthesepartsoftheeararedamaged,itbecomesdifficultfortheeartotransmitimportantinformationtothebrain.Asaresult,theloudness,pitchormeaningofsoundsmaynotbeproperlyinterpreted.Thistypeofhearinglossisthemostcommon.

134

Mixed hearing lossisacombinationofsensorineuralandconductivehearingloss.Itispossibletoexperienceacertaindegreeofdamagetoeachpartoftheearallatonce,whichresultsinamorecomplexhearingproblem.

Risk Factors for Hearing Loss

Therearemanycausesandriskfactorsforhearingloss.Whilesomeriskscanbeavoided,otherscannot.Themostcommonrisksofhearinglossinclude:

Reaching an older age,whichcausestheearstructurestodegradeovertime.

Prolonged exposure to loud noises fromexplosives,gunfire,carpentryorloudmusic.

Working in certain industries,includingfarming,factorywork,constructionwork

135

orbeingamusician.

Taking certain medications,suchasViagra,chemotherapydrugsortheantibioticdruggentamicin.Largedosesofpainrelieversoranti-malarialdrugscantemporarilyaffecthearingaswell.

Having certain diseases or illnesses,suchasahighfever,meningitis,someautoimmunediseases,mumpsorMeniere’sdisease.

Having a hereditary condition thatmakesyoumoresusceptibletodegenerationordamageasyouage.

Mostpeopleareatriskforhavinghearingloss,asthisconditionhasahighchanceofdevelopinginorderage.However,someindividualsareatagreaterriskthanothers.Inanycase,itisimportantforeveryonetobeawareoftheirriskfordevelopingahearingcondition.

136

Preventing Hearing Loss

Knowingyourriskforhearinglosscanhelpyoutakepreventative measures,suchasavoidingloudactivitieswhenpossibleorprotectingyourears.Ifyouworkincertainindustriesorfrequentlyengageinactivitiesthatexposeyoutoloudnoises,itisevenmorecrucialthatyouthinkaboutyourearhealth.

Youcanhelpprotectyourselffrompermanent ear damagebytakingthesepreventativemeasures:

Wear ear plugswhenattendingconcertsorparticipatinginotherloudactivities,suchasracingeventsorgoingtoashootingrange.

Wear ear protectionwhenusingloudequipmentsuchassnowblowers,lawnmowers,woodchippers,leafblowersorweedwhackers.

137

Lower the volumewhenlisteningtomusiconheadphonesorspeakers.

Avoid exposure to loud noisesaroundyourhome,suchasnearbyconstructionwork.Wearearprotectionortrytoblockthesoundinyourhomeifyoucannotavoidthesenoises.

Get your hearing checkedonaregularbasis,suchaswhenyougotothedoctorforacheck-up.

Tips for Avoiding Loud Noises

Sometimes,itishardtoknowwhatnoiselevelcancausehearingdamage.Ingeneral,anynoisethatfallsbelow70 decibels is considered safe.Ifasoundislouderthan70decibels,yourriskofhearingdamageincreasesthelongeryouareexposedtoitandthehigherthedecibelsare.

138

Forcontext,anormal conversation is about 60 decibels.Arunningrefrigeratorhasproduces40decibels,whileadishwashercausesabout75decibels.Itdoesnottakemuchtoreachadangeroussoundlevel.Evensomethingascommonasheavycitytrafficorabusyrestaurantcanproducemorethan85decibels.

Symptoms of Hearing Loss

Hearinglossmaybegradual or sudden.Itisoftentimeseasiertoidentifythesymptomsofsudden-onsethearinglossbecauseyouwillimmediatelynoticeadifferenceinyourhearing.Incaseswherehearingfadesmoreslowly,youwillwanttopayattentiontothesesymptoms:

Askingpeopletorepeatthemselves.

Difficultycatchingeverywordinaconversation.

139

Thinkingthatothersaremumblingallthetime.

HavingtoturnupthevolumeontheTVorradio.

Hearingringingorhissingnoisesthatcannotbeexplained.

Frequentlymisunderstandingwhatotherpeoplesay.

Onaverage,peopleexperiencinggradualhearinglosswaitseven yearsbeforefinallytalkingtoadoctor.However,seeking medical treatment earlyisyourbestoption.Itcanbedifficulttonoticesymptomsrightaway,ortotakeyoursymptomsseriously.Manypeoplebrushoffhearinglossasjustanothersignofaginganddonotrealizethattreatmentsareavailable.

140

Diagnosis and Treatment of Hearing Loss

Ifyouareworriedthatyoumightbelosingyourhearing,itisimportanttotalktoadoctor.Hearinglossissometimesdiagnosedwithaphysical exam,inwhichadoctorwilllookatyourearsforsignsofinfection,inflammationorexcessearwax.

Doctorsmayalsoconductnoise-basedteststhatevaluatewhatlevelofsoundyoucanhear.Forexample,averysimpletestcanbeperformedbystrikingatuningforkinordertodetectwhichlevelyoucanhear.Anaudiometer testprovidesamoreaccurateassessment.Withthistypeoftest,youwearapairofheadphoneswhileanaudiologistplaysvariouswords,tonesorsoundstodetectthelowestdecibellevelyoucanhear.

Treatmentsforhearinglossvarydependingonthereasonbehindyourcondition.The

141

mostcommontreatmentsinclude:

Removingblockagesifyouhaveexcessearwax.

Treatinginfectionsorgrowths.

Surgicallycorrectingabnormalitiesorinsertingtubes.

Usingahearingaid,whichhelpsamplifysound.

Gettingacochlearimplant,whichbypassesdamagedpartsofyourear.

Getting Hearing Aids

Mosttypesofhearingdamageareirreversible.Withtheexceptionofearwaxbuilduporearabnormalities,youcannotusuallycurehearingloss.However,therearemanywaystotreatandmanagepermanenthearingloss.Oneofthebestmethodsisusing

142

hearingaids.Anaudiologistwillhelpyoudecideifthistreatmentoptionisagoodideaforyou.

Thereareseveral types of hearing aidstochoosefrom.Ahearingaidisnotmeanttobeaone-size-fits-allsolution.Instead,thetypeofhearingaidyoushouldusedependsonyourindividualneeds.

Completely in the canal (CIC) hearing aids aredesignedtogoentirelyinsideyourearcanalforacomfortablefit.Thesearebestformoderatehearingloss,andaretheleastvisibletype.However,theirsmallsizealsomeansthattheyusetinybatterieswithashorterlifespan.Furthermore,thisstyledoesnotusuallyhavecustomizablecontrols.

In the canal (ITC) hearing aidsarebestformildtomoderatehearingloss.Theyaresmallenoughtofitmostlyinsideyourearcanal,

143

whichmakesthemlessvisiblethansomevarieties.Theirsmallsizemeansthattheydonotincludeeveryfeatureofalargerhearingaid.However,theyaremorecustomizablethanCICvarieties.

In the ear (ITE) hearing aidsusuallyhaveanexternalcomponentthatsitsinyourouterear.Theyhaveavarietyoffeaturesduetotheirslightlylargersize.Asaresult,theyalsocanholdalargerbatterywithalongerlife.However,theyaremorevisiblethanCICandITCoptions.Theirpositioningcanalsopickupmoreunwantednoises,suchaswindnoise.

Behind the ear (BTE) hearing aidsareanoptionforjustaboutanytypeofhearingloss.Thesedeviceshaveacomponentthatsitsbehindtheear,whichisconnectedbyatubetoanotherpiecesittingintheearcanal.BTEdevicesaresometimeslargerthanotherstyles,buttendtohavethemostoptions.A

144

similartypeofdesignisthereceiver in canal (RIC) hearing aid,whichusesawireratherthanatubetotransmitsoundtotheearcanal.

Open fit hearing aidsaresimilartoBTEdevices,buttheydonotconnecttoapiecethatfillstheearcanal.Instead,thetubeorwireitselfsitsinthecanal.Thisallowsforothersoundstoentertheearcanalnaturally.

Caring for Hearing Aids

Hearingaidsrequiresomecareandmaintenanceinordertoensuretheyworkproperly.Thewayyoutakecareofyourdevicewilldependonthetypeofhearingaidsyouhave.However,youcanmakesureanytypeofhearingaidisworkingwellbydoingthesethingsdaily:

Checkthebatteries.

145

Carrysparebatteriesjustincase.

Removedirtandearwaxwithasoft,drycloth.

Keepyourdevicesdry.

Keepdebrisfromtheinnercomponentstoavoidgettingfeedbackinthemicrophone.

146

Ifyouareexperiencinganytypeofsymptomsthatmaybelinkedtoamedicalcondition,itcanbebeneficialtoutilizeasymptomcheckerfromareputablesource.Symptomcheckersmatchthesymptomsimputedaswellasotherfactors,suchasyourage,gender,medicationsandotherconditions,tomedicalconditionsthatfityoursymptoms.

Whilesymptomcheckerscanbebeneficial,thesecheckersdonotoverrideanyrecommendations,treatmentoptionsordiagnosisthatyourprimarycarephysicianmayhave.

Sourcesofreliableandreputablesymptomcheckersinclude:

WebMD

MayoClinic

Health Line

Symptom Checker

147

MedicalbillsarethenumberonecauseofbankruptcyinAmerica.Withoutadequatehealthinsurance,thecostofhealthcarecanquicklyaddup.

Healthinsurancecansignificantlyreducetheamountofmoneyyouwouldotherwiseneedtopayforhealthcare.Typically,youareresponsibleforacertainamountofthecostsofyourhealthinsuranceandyourinsurancewillpayfortheremainingamount,solongasthemedicalserviceiscoveredunderyourinsuranceplan.

Mostinsurerswillalsoincludeamaximumamountthatbeneficiariesmayberequiredtopayineachbeneficiaryperiod.Aftermeetingamaximumamount,theinsurerpays100percentofthecostfortheremainderofthebeneficiaryperiodforanycoveredservices.

Health Insurance

148

Common Health Insurance Terms

Byfamiliarizingyourselfwithcommonhealthinsuranceterms,youwillbebetterpreparedforthecostofyourmedicalbillsandgainabetterunderstandingofwhatyourhealthinsurancewillandwillnotcover.

Covered Costs–Coveredcostreferstothemedicalservices,treatment,suppliesandprescriptiondrugsthatyourhealthinsuranceplanwillprovidepaymentfor.

Premiums–Premiumsrefertotheamountthatyoupaytoyourhealthinsurancecompanyeachmonth(oronaquarterlybasis,dependingontheinsurer)tomaintainyourhealthinsurancecoverage.Whenreviewingplansthatmaybeavailabletoyou,thiscostisusuallythefirstonethatyouseeandhavetheopportunitytoconsider.

Deductible–Adeductibleisaflatdollar

149

amountofmoneythatyoumustpayforyourcoveredmedicalservicesbeforeyourhealthinsurancebeginstopayforyourhealthcare.

Copayment–Acopaymentisaflatdollaramountthatyouwillbeexpectedtopaytoyourhealthcareproviderforaservicethatiscoveredbyyourhealthinsurance.Thisisusuallyasmallamount,suchasbetween$10and$50,dependingonyourhealthinsuranceplan.

Co-Insurance–Co-insurancereferstoanamountthatyoumustpayyourhealthinsurancecompanyafteryourdeductiblehasbeenmet,uptoyourmaximumout-of-pocketcosts.Thisamountisgenerallyasetpercentageofthetotalchargesthatyouarebillingtoyourinsuranceforacoveredservice.

Maximum out-of-pocket costs–Yourmaximumout-of-pocketcostisthemaximum

150

amountofmoneythatyoumustpayforcoveredmedicalservicesduringasinglebenefitperiod(typicallyoneyear).Thisamountdoesnotincludeyourpremiumoranymedicalservicesthatyoupaidthatyourinsurancedidnotcover.

Private Insurance and Employer Insurance

PrivateandemployerhealthinsuranceplansaresomeofthemostcommontypesofhealthinsuranceinAmerica.Ifyouremployeroffershealthinsurancepackages,youwilllikelybeabletoenrollaftertheminimumperiodoftimehaspassed(90daysofemploymentiscommon).

Whileemployerofferedhealthcareplansmaybecheaperthanobtainingprivateinsurance,youdonotgenerallyhavealotofplanstochoosefromandyoucannotselectadifferent

151

insuranceprovider.Therefore,itisimportanttoreviewtheofferedhealthinsurance,includingcostsandcoverageoptions,beforemakingadecision.

PrivatehealthinsuranceplanscanbepurchasedfromHealthcare.gov.Onceyouhavecompletedanapplication,youwillbeprovidedwithanyhealthinsuranceoptionsthatareavailablewithinyourarea.Thewebsiteallowsforside-by-sidecomparisonsofpremiumcosts,coverageoptions,deductiblesandmore.Healthcare.govwillalsoinformyouofanyadditionalassistancethatyouoryourfamilymaybeeligiblefor,suchasMedicaidorCHIP,baseduponyourapplicationinformation.

CHIP

TheChildren’sHealthInsuranceProgram(CHIP)offershealthinsurancecoverageto

152

childrenwithfamilieswithtoohighofanincometoqualifyforMedicaid,butnothighenoughincometobeabletoreasonablyaffordprivatehealthinsurance.

LikeMedicaid,CHIPisadministeredbystates,accordingtofederalrequirements.Therefore,coveredservices,costsandeligibilityrequirementshavesomevariationbetweenstateprograms.

CHIPeligibilityisprimarilybaseduponageandincome.Insomecases,pregnantwomenmayalsobeeligiblefortheprogramduringapregnancy.YoucandiscovermoreaboutCHIPeligibilityrequirementsbyclickinghere.

SomeCHIPcoveragebenefitsaremandatedbythefederalgovernment.Othertypesofcareareconsideredoptionalandyouwillneedtocheckwithyourstateprograminordertodetermineadditionalcoverage

153

optionsthatmaybeavailable.Youcanlearnmoreaboutmandatedcoveragehere.

YoucanlearnmoreabouttheCHIPprogramthatisavailableinyourstate,includingeligibilityrequirements,benefitsandcostsbycontactingyourstate.YourstatemayallowyoutoapplyforCHIPinperson,online,bymailoroverthephone,dependingonyourstate.

Medicare

Medicareisafederalhealthinsuranceprogramthatprovideshealthinsurancebenefitstoseniorcitizenswhoare65 years of age or olderaswellthoseyoungerthan65whoareafflictedwithcertaindisabilities,permanentkidneyfailureoramyotrophiclateralsclerosis.

Whiletheprogramdoesassistbeneficiaries

154

withthecostofhealthcare,itdoesnotprovidecoverageforallmedicalexpensesorforthecostofmostlong-termcare.WhenenrollinginMedicare,applicantswillbeabletobuildtheirownMedicarehealthinsuranceplanbyselectingthepartsofMedicarethattheywishtoenrollinto.

Original MedicareismadeupofMedicarePartAandPartB.Medicare Part Aisprimarilyconsideredhospitalinsuranceandisavailabletomostbeneficiarieswithoutapremium.YoucanlearnmoreaboutMedicarePartAcoverageoptionshere.

Medicare Part Boffersanumberofmedicallynecessaryservicesandsupplies,includingvisitswithaphysician,mentalhealthcareandservicesanddurablemedicalequipment(DME).YoucanlearnmoreaboutMedicarePartBcoverageoptionshere.

155

Medicare Part C,alsoreferredtoasaMedicareAdvantagePlan,offersavarietyofcostandcoverageoptionsbasedupontheareathatyoulivewithin.CoveragegenerallyincludescoverageoptionsofferedwithinMedicarePartAandPartB,butmayalsoincludeadditionalservices.YoucanlearnmoreaboutMedicarePartCandreviewtheplansavailablewithinyourareabyclickinghere.

Medicare Part Donlyprovidesprescriptiondrugcoverage,butitcanbecombinedwithanumberofdifferenthealthinsuranceplans,includingMedicarePartAandPartB.YoucanlearnhowMedicarePartDworkswithotherhealthinsurancepolicieshere.

DependingontheMedicareplanthatyouenrollin,youmayhaveamonthlypremiumtoretaincoverageaswellasdeductibles,copaymentsandcoinsurance.Youcanlearn

156

moreabout2019Medicarecostshere.

YoushouldapplyforMedicareassoonasyoubecomeeligibleforbenefitsinordertoavoidmonetarypenaltieswhenyoudoenroll.Forseniorcitizens,theinitialenrollmentperiodforMedicarebeginsthreemonthspriortoyour 65th birthdayandendsthreemonthsfollowingyourbirthdaymonth.

Ifyoumissyourinitialenrollmentperiod,youwillnotbeabletoenrollforcoverageuntilthegeneralenrollmentperiod,unlessyouqualifyforaspecial enrollment period.TheMedicaregeneralenrollmentperiodtakesplacefromJanuary1sttoMarch31steachyear.CoveragebeginsonJuly1stoftheyearthatyouenroll.

Youwillbeeligibleforaspecialenrollmentperiodifyoucurrentlyhavemedicalinsurancecoverageunderagrouphealthplanthatis

157

baseduponeitheryouroryourspouse’scurrentemployment.

Incasessuchasthese,youcanenrollintoMedicarewithoutapenaltyanymonththatyouremaincoveredunderthegrouphealthplanandyouroryourspouse’scurrentemploymentcontinuesorwithintheeightmonthperiodthatbeginsthemonthafteryourgrouphealthcareplancoverageoremploymentthatitisbaseduponends,whichevercomesfirst.

YoucanapplyforMedicareonline,byvisitingyourlocalSocialSecurityofficeorbycallingtheSocialSecurityAdministrationat: (800) 772-1213.

Medicaid

Medicaidisastateandfederalprogramthatprovidescomprehensivehealthcoverage

158

tomillionsofAmericanseachyearthatmeeteligibilityrequirements.Medicaidisadministeredbyeachstateinaccordancetofederalrequirements.Therefore,eligibilityrequirementsandcoveredservicescanvarybetweenstates.

ToqualifyforMedicaid,youmustmeetincomerelatedeligibilityrequirements.Incomelimitsdovaryforsomecoveredgroups,suchasseniorcitizens(ages65andolder)andindividualswithcertaindisabilities.

Notonlymustyoulivewithinthestatethatyouareapplyingforbenefitsthrough,butyoumustalsobeeitheraU.S. citizenorholda lawful, qualifying non-citizen status.Dependingonthestatethatyoulivein,youmayberequiredtomeetadditionalnon-financialbasedeligibilityrequirements.Theserequirementsaregenerallycategorical.Forexample,somestatesdonotofferMedicaid

159

coveragetoresidentswhodonothavechildrenwithinthehome,unlesstheapplicantisdisabled,pregnantoraqualifyingseniorcitizen.YoucanlearnmoreaboutMedicaideligibilityrequirementsbyclickinghere.

Thefederalgovernmentmandatessomeofthe covered servicesthatmustbeincludedineachstate’sMedicaidprogram.Theseservicesincludehospitalservices,physicianservices,laboratoryservicesandhomehealthservices.Certaincoverageoptions,referredtoasoptional benefits,aredeterminedbythestate.Youcanlearnmoreaboutmandatoryandoptionalcoveragebenefitshere.

The cost of Medicaidisdeterminedbyanumberoffactors,includingyourincome, categorical qualifications and the state that youlivewithin.WhilestatesdohavesomesayoverMedicaidcosts,thesecostsmustfallwithinfederalguidelines.Costsmayinclude

160

monthlypremiums,copayments,coinsurance,deductiblesandsimilarcharges.YoucanlearnmoreaboutcostsharingwithMedicaidhere.

ToapplyforMedicaid,youmustcontactyourstateMedicaidoffice.Applicationmethodsvarybystate.Dependingonthestatethatyoulivewithin,youmaybeabletoapplyonline,overthephone,bymailorinperson.

VA Health

VAhealthcareofferscomprehensivehealthcaretocurrentandretiredactivemilitary,navalorairservicemembersthatdonotreceiveadishonorabledischarge.Generally,minimumdutyrequirementsapply,however,theserequirementsarewaivedforthosewhomeetadditionalqualifications.YoucanlearnmoreaboutVA health eligibility requirementsbyclickinghere.

161

OnceapprovedforVAhealth,veteransgainaccesstocomprehensivemedicalbenefitspackages.However,notallpackagesarealikeandcoveredservicesmayvary.Generally,medicalservicesincludedinbenefitspackageincludeservicestotreatillnesses and injuries and preventative care.Somebeneficiariescanreceiveadditionalcoverageoptions,includingbenefitssuchasdental care.

AnumberofveteransqualifyforVAhealthatnocost,dependingonincomeandwhetherornottheapplicanthasaservice-connected disability.Ifcost-freehealthcareservicesarenotavailable,applicantscanbeexpectedtopaysmallcopaysandco-insurancecosts.TolearnmoreaboutVAhealthcosts,clickhere.

YoucanapplyforVAhealthonline,byvisitingyourstate’sDepartmentofVeteransAffairsoffice,bysubmittinganapplicationby-mailor

162

bycallingtheVAat(877) 222-8387.Youmayneedtoprovidespecificdocumentsinorderforyourapplicationtobeprocessed,suchasyourmostrecenttaxreturn.

TRICARE

TRICAREisahealthinsuranceprogramthatisavailabletoU.SArmedForcespersonnel,veteransandtheirdependentsandspouses.Theprogramfeaturesanumberofdifferentplans,eachwithvaryingcostsandcoveredmedicalservicesinordertoprovideawiderangeofoptionstoqualifyingapplicants.

YoumustmeeteligibilityrequirementsinordertoenrollinTRICARE.Eligibilityrequirementsarecategoricalandnotonlydeterminewhetherornotyouareeligibleforbenefits,buttheTRICAREplansthatareavailabletoyou.

163

CoveredservicebenefitsandthecoststhatyoucanexpectforservicescanbereviewedbycomparingTRICAREplans.Plansmayincludepremiums,deductibles,copayments,coinsuranceandmaximumout-of-pocketcosts.SomeTRICAREenrolleeswillnotbeexpectedtopayforcoveredservices,baseduponcategoricalqualifications.

ToapplyforTRICAREbenefits,youmustselecttheplanthatyouwishtoenrollin.Youcanbeginyourenrollmentprocesshere.OnceyouhaveselectedtheTRICAREplanthatisrightforyou,youcansubmitanapplicationforTRICAREonline,bymailoroverthephone.

164