Experimental technology can ‘smell’ disease on your breath

(CNN)Smell is a primary human sense, key to our survival.

Like a super-sensitive human nose, an experimental technology can “smell” and identify the chemical composition of a person’s breath and then diagnose up to 17 potential diseases, according to the scientists who developed it.
These researchers, led by Hossam Haick of the Technion-Israel Institute of Technology, say their Na-Nose, which uses nanorays to analyze breath, can identify Parkinson’s disease, various cancers, kidney failure, multiple sclerosis and Crohn’s disease with 86% accuracy.
    “I would say our technology in many cases (is) equivalent to the accuracy of the currently available invasive technology,” Haick said, adding that for some diseases, including gastric cancer, Na-Nose has a “much higher” accuracy rate than currently available technologies. And, unlike most screenings, including standard blood tests, breath analysis technology is noninvasive — a benefit most patients would appreciate.
    The theory behind the technology is that each of us has a unique chemical “fingerprint.” Each disease also has a particular chemical signature, which can be detected on our breath. The Na-Nose technology, which consists of a sensor chamber with a breathing tube and software, is able to detect this precise chemistry of disease by interpreting the impact on our usual chemical fingerprint.
    Seven companies have licensed the underlying research for the technology from Technion in hopes of creating a commercial product, Haick said. He hopes that the companies, each specializing in a different application, will translate the science and technology from the lab to mass production.
    One application, for example, would turn smartphones into “sniffphones” that would monitor our health routinely.
    But with further testing and regulations to meet, neither the Na-nose device nor any variations will be available on the market — or in our doctor’s offices — for a number of years, said Haick.

    Dogs, flies and rats

    Though Na-Nose may seem revolutionary, smell was recognized as a potential diagnostic tool in antiquity.
    “The ancient Greeks used breath and urine scent to diagnose disease,” said Dr. Mangilal Agarwal, director of the Integrated Nanosystems Development Institute and an associate professor at Richard L. Roudebush VA Medical Center in Indianapolis. “Thucydides said there was a specific scent to plague victims in Athens, and Hippocrates cataloged a specific disease because it caused bad breath and bad-smelling sweat.”
    Agarwal, who is not involved with the Na-Nose technology, said he is working on a number of projects that analyze scents to diagnose diseases, including hypoglycemia (low blood sugar), prostate cancer and breast cancer.
    “Breath has the scents or volatile biomarkers necessary to identify many diseases,” he said. “We know this from canines who can detect hypoglycemia and epileptic seizures, fruit flies (and canines) that can detect cancer, and from giant rats that detect tuberculosis in Africa.”
    Similar research is being conducted in Spain, Latvia, Belgium, England, Italy and various corners of the United States.
    “Dr. Haick’s group is certainly ahead of our group in terms of getting close to doctor’s visit tests,” Agarwal said, adding that an important aspect to breath analysis is that it “excels at capturing changes in human health in a noninvasive manner.”
    “Quick diagnosis can help in identifying the most appropriate treatment response,” he said. He added that prostate cancer grows on a longer time-scale, but the prostate biopsy is such “a sufficiently unpleasant experience” that a noninvasive test would be beneficial and lower health-care costs.
    The high accuracy claims of Haick’s research group is “very reasonable, if the signal is not masked by environmental fluctuations in some manner,” Agarwal said, though he cautions that some “breath-based tests have had difficulty duplicating results in different regions, likely because the sensor has difficulty adjusting to different background air signals.”
    Other scientists raise additional concerns.

    Not ready for prime time?

    Dr. George Preti, a faculty researcher at Monell Chemical Senses Center, a nonprofit scientific institute in Philadelphia, said it’s hard to distinguish body chemicals from environmental chemicals in breath samples because “most of the compounds detected in breath are also detected in room air and their levels are similar to each other.”
    Until scientists “understand the origin and biochemical pathways leading to disease-related” markers in human breath, reliable results from a diagnostic breath test will be difficult to achieve, he stated in a recent review of studies.
    In fact, there are more than a few issues that must be addressed before effective technologies will be produced, according to Dr. Lisa Spacek, an adjunct assistant professor at Johns Hopkins School of Medicine, and Terence Risby, professor emeritus at the Johns Hopkins University Bloomberg School of Public Health.
    Using breath to diagnose disease first requires a profile of breath molecules for normal health to be established, Spacek and Risby say in a recently published paper. These must take into account variables such as age, gender, ethnicity and body mass index.
    Researchers also need to investigate the factors that might contaminate breath results, such as what someone ate within eight hours of breath collection or whether they used a mouth rinse, say Spacek and Risby. Another issue: How do you store breath that is not immediately analyzed?
    Advances in instrumentation, particularly portable monitors, is one factor inspiring and enabling the new research into breath analysis.
    Though the field is growing and results are promising, translation of the work into meaningful tests is another matter: “I take every claim by manufacturers … with a grain of salt,” Risby wrote in an email.

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    Today’s widespread interest in breath analysis stems from the relatively recent discovery — within the past 20 years or so — that nitric oxide, a common pollutant, works as a signaling molecule in the cardiovascular system, Risby observes. The three scientists who made the discovery won a Nobel Prize for their efforts in 1998.
    So despite ancient roots, Risby says, “clinical breath analysis remains in its infancy.”

    Read more: http://www.cnn.com/2017/11/07/health/na-nose-disease-smell-technology/index.html

    The non-alcoholic’s guide to drinking less alcohol

    (CNN)If you’re reading this, you may think you drink a little too much, yet you wouldn’t describe yourself as an “alcoholic.”

    Maybe you’re a parent who comes home after a stressful day at work and takes a drink to decompress and deal with the kids, another with dinner and then another to top off the evening before dozing off.
    Or maybe you’re a college student who studies hard all week and then downs a six-pack at the first post-exam opportunity. You might celebrate special occasions, like a big birthday or even weekend dinners, with a couple bottles of wine.
      Whether drinking is a celebratory ritual or serves to ease stress, you may be drinking an amount at which health risks outweigh potential benefits.
      “Alcohol use and its associated problems exist on a spectrum,” said Dr. John Mariani, associate professor of clinical psychiatry at Columbia University Medical Center and director of Columbia University’s Substance Treatment and Research Service. “There are people who don’t meet the criteria even for mild alcohol use disorder (a disorder characterized by a loss of control over drinking) but are drinking more than what would be considered healthy.”

      The problems with drinking too much

      Including some alcohol in your diet may lower your risk of a heart attack and type 2 diabetes. But even at low levels, alcohol may interfere with sleep, cloud judgment, contribute to weight gain and negatively interact with some medications.
      We’ve also known that just one drink per day slightly increases a woman’s risk of breast cancer.
      The more you drink, the greater the risks.
      According to the National Institute on Alcohol Abuse and Alcoholism, people who drink heavily — for men, that’s defined as more than four drinks on any day or more than 14 drinks per week, and for women more than three drinks on any day or more than seven drinks per week — have a greater risk of injuries, having children with birth defects and health problems including liver disease, heart disease, depression, stroke and several types of cancer.
      Drinking too much can also make it difficult to manage existing health conditions such as diabetes and high blood pressure.
      “Even in cases where one’s alcohol intake doesn’t necessarily meet the definition of what we colloquially refer to as an ‘alcoholic’ (i.e. someone who is considered ‘addicted’), excessive consumption can increase health risks,” Mariani said.

      How to know if you’re drinking too much

      Mariani stresses that rather than thinking about being “an alcoholic or not” — which he says is an imprecise term — it’s more important to consider how alcohol may be impacting your life.
      Red flags include situations in which you don’t remember where you parked the car after drinking, embarrassing yourself at a party or waking up unable to remember where you were.
      Other behaviors include sending inappropriate emails when drinking, having sex with people you wouldn’t otherwise choose, using other substances in conjunction with alcohol or getting a DWI. “These behaviors are objectionable to your value system, and you don’t like them,” he said.
      But even if you don’t engage in inappropriate behavior, you still might be drinking an unhealthy amount. One might use alcohol “almost medically — for anxiety, as an anesthetic,” Mariani explained. Here, the consequence is that you are missing beneficial opportunities to help manage the stress, such as going to the gym, reading a book or building a hobby. “The consequences are not bad things per se but an absence of good things that are not happening, because drinking is taking up that time. No one is going to lose their job if they have three drinks in a night, but it takes up time and space that doesn’t allow other things to happen.”
      For some, learning about a test result during a doctor’s visit or that you’ve gained an unhealthy amount of weight can be reason enough to cut back. “A person may go to the doctor one time and have elevated liver function tests, which is enough of a motivation,” Mariani said.

      A guide to drinking less

      Whatever the motivation may be, there are ways to cut back on your alcohol consumption. Below are some tips worth trying, according to experts.
      1. Journal your drinks. Doing so can be a powerful tool in understanding how much you’re drinking and can bring awareness of patterns, according to Ginger Hultin, a registered dietitian and spokeswoman for the Academy of Nutrition and Dietetics.
      “A lot of my clients will say ‘Well, I don’t drink that much,’ but then when they track their intake on MyFitnessPal or another app, they start to see patterns like drinking many more days per week than they thought or having more drinks on a given night than they expected,” she said.
      The simple act of recording what you drink may help you naturally drink less. “It changes the behavior somewhat: Maybe you’ll have three drinks instead of five if you know you have to write it down,” Mariani said.
      It’s also important to know whether you are accurately estimating the amount of alcohol you consume. “A person may record three drinks, but is it three standard drinks — each containing 1.5 ounces of alcohol — or is it bigger?” Knowing what counts as “one standard drink” can help you accurately determine your intake.
      2. Set limits. Try slowly decreasing the number of drinks you consume, depending on where you are starting. “Cutting back means having two drinks instead of three or one instead of two,” Hultin said.
      Observe whether drinking less corrects any existing problems. The amount of alcohol that can disrupt sleep or lower inhibitions to eat unhealthy foods, for example, is different for each person, according to Hultin.
      3. Designate abstinence days. You might decide that Mondays and Fridays are “no alcohol” days. This can help to “prove that I can do it,” Mariani said.
      4. Keep alcohol out of the house. Out of sight often means out of mind. If this is unrealistic, try to keep a healthy physical distance from it, such as putting it on a high shelf.
      5. Alternate drinks in social settings. “Limit your quantity by alternating (alcoholic) drinks with sparkling water,” Hultin said. This can keep you hydrated and will help you pace yourself.
      Ordering a non-alcoholic cocktail in a restaurant or just adding a lime or other garnish can make a non-alcoholic drink feel more special. “It can also help mask the fact that you’re not drinking as much as others if you have social pressures,” Hultin added.
      6. Eat while you drink. “Eating before or with an alcoholic beverage can help slow the absorption of alcohol, and it can also make you feel more full, so you may drink less,” she said.
      7. Avoid temptations and triggers. “Some people find it better to avoid situations where they would typically drink,” Hultin said. Instead, spend time doing things you enjoy like going on a hike or attending events where alcohol isn’t the main attraction.
      If you can’t avoid a specific event or situation where you might feel the urge to drink, have a plan in place to prevent going back to old patterns. If a certain time of day triggers the urge, plan to do something else during that time, like calling a friend, going to the gym or taking a bath.

      When to seek additional help

      If these behavioral tips haven’t helped you achieve the desired result, you might consider seeking the help of a cognitive behavioral therapist with expertise in substance abuse problems.
      “Typically, these patterns have developed over a decade or two … and so it’s important to recognize these patterns and to try and create a new relationship with alcohol,” Mariani said. “A lot of this is about being more mindful about what is going on. It takes a lot of work and commitment.”

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      Medication is another option for some. For example, naltrexone or topiramate are medicines that people tend to drink less on, as they interfere with how rewarding the alcohol feels, Mariani said, though he cautions that they “work for some people and not for others.”
      Lastly, surround yourself with friends or family members who are supportive of your goals, and go easy on yourself if you slip. “When you have failures or don’t achieve your goals, the temptation is to give up,” Mariani said. “But it’s important to recognize that changing a behavior pattern takes time … and just being in the process of change is good.”

      Read more: http://www.cnn.com/2017/11/03/health/less-alcohol-food-drayer/index.html

      Finally there’s a way to find out the benefits of having a vagina

      Your rights, mapped out.
      Image: vagina benefits

      Having a vagina doesn’t feel like it comes with great perks these days, but there are still a few benefits available to those of us who have them, believe it or not.

      Thankfully there’s a new website to help us navigate what exactly theses benefits are. The helpfully named VaginaBenefits.com is put together by TIA, an app that provides women’s health advice, and is meant to help people who are trying to navigate our current insurance landscape.

      So what exactly are these benefits? They’re women’s health services that the Affordable Care Act mandated be 100 percent covered by insurance. They include birth control without a copay, UTI and STI tests, pap smears, breast cancer screenings, and wellness exams. 

      However, as efforts to undo pieces of the ACA — including the rollback of the birth control mandate — move forward in Washington, our federal access to these services are less and less secure. This leaves things in the hands of states, where it all gets very confusing.

      That’s where the interactive map comes in. You can explore which states offer what coverage, and see how they’re ranked on the Vagina Benefits Index.  

      This is especially relevant right now as the 2018 open enrollment period for ACA coverage has just started today. (It runs through December 15th.) But even if you have employer-based insurance, this is a great way to educate yourself on your rights and how to take full advantage of the available care. 

      Read more: http://mashable.com/2017/11/01/vagina-benefits-womens-health-map/

      Sugar and cancer: Is there a link?

      (CNN)Does sugar, which makes all things delicious, lead to cancer?

      A biologic mechanism in yeast cells may explain the relationship between sugar and malignant tumors, according to a recent study published in the journal Nature Communications.
      The nine-year research project may even influence personal medicine and diets for cancer patients, the authors concluded. The study begins by looking closely at cancer cells’ appetite for sugar.
        Scientists understand that cancer cells support their rapid reproduction by rewiring their metabolisms to take glucose, ferment it and produce lactate.
        Conversely, healthy cells continue with normal respiration, a process in which they take glucose and break it down into carbon dioxide and water.
        This “switch of cancer cells from respiration to fermentation is something that was discovered by Otto Warburg, a German biochemist, about 70 or 80 years ago,” said microbiologist Johan M. Thevelein, senior author of the study and a professor at KU Leuven in Belgium. It is known as “the Warburg effect.”
        Fermentation of sugar to lactic acid produces about 15 times less energy than respiration of sugar, Thevelein noted. Yet cancer cells “grow much more rapidly than normal cells, and yeast actually grows the fastest when they ferment,” he noted.
        “This is weird,” he said, and it raises an important question: Is the Warburg effect a symptom of cancer — or a cause of it?
        Searching for the answer, Thevelein and his colleagues experimented with yeast cells since, just like cancer cells, they are known to favor fermentation over respiration.
        The researchers found an intermediate compound that is a “potent activator” of the RAS protein. RAS is a proto-oncogene: a gene that codes for proteins that help to regulate cell growth and differentiation. Proto-oncogenes can become oncogenes or cancer-causing genes when mutations occur. Mutant forms of RAS proteins are present in many tumors, Thevelein said.
        The new study, then, reveals “a vicious cycle,” he said.
        As sugar is broken down in cells, the intermediate compound activates the RAS proteins, and this in turn stimulates cell proliferation, he said.
        This cycle seen in yeast cells might help explain the aggressiveness of cancer.
        “Very interesting,” said Dr. Jennifer Ligibel, chairwoman of the American Society of Clinical Oncology’s energy balance committee. Still, she urges caution in interpreting these findings.
        “It’s important to not make too many jumps into a patient message based on a study of yeast,” she said.

        Eating sugar or too much weight?

        Even though the researchers pinpointed some similarities between yeast and human cancer cells, Ligibel explained, “it’s important to recognize we’re a few steps away from even human cancer cells in a test tube.”
        The study showed only an increased rate of cell growth triggered by glucose, she said. Even though the team showed RAS pathways being activated, this “actually didn’t result in the cells replicating more quickly,” she said.
        Still, the data are “incredible,” said Ligibel, who is also an associate professor of medicine at Harvard Medical School. “This is really one of the first studies that’s provided a biologic mechanism that could explain a relationship between glucose itself and cancer progression.
        “When we think about the relationship between sugar and cancer — when we think about what drives the level of sugar in someone’s body — it’s primarily related to their weight,” Ligibel said.
        When people are heavier, their bodies manage sugar differently than those of people who are lighter. This sugar management is what leads to type 2 diabetes, a disease in which blood sugar is high and levels of insulin, the hormone the body uses to manage blood sugar, begins to rise because the body becomes resistant to its effects.
        “We’ve known for a while that having a higher blood sugar and having a higher level of insulin in your system are both linked to the risk of developing cancer,” Ligibel said.
        At the same time, studies that have tried to look at how eating sugar might be linked to cancer risk “have been much less consistent,” she said. One large study of older US adults, for instance, did not find a relationship between the amount of sugar people ate and the risk of developing cancer.
        Conversely, she noted, other studies show that people diagnosed with colon cancer who ate a higher proportion of their total calories in sugar had a higher risk of cancer recurrence — but only for people who were already overweight and obese. Once again, how the body manages sugar — and not the sweetener itself — may be key.
        Studies in breast cancer patients have compared low-carbohydrate diets to low-fat diets and found that the amount of weight people lost, not the diet itself, was important, Ligibel said. If it led to weight loss, either diet brought an identical lowering of sugar in the blood stream and an identical lowering of insulin.
        “Whether you achieved that through one diet versus another didn’t seem to be as important as the amount of weight you lost if you were overweight or obese,” she said. Translated into practical advice for cancer patients: “If you have someone who is obese or overweight, helping them to lose weight is going to be an important thing. We know that from a lot of different lines of study.
        “I think that sugar definitely contributes to weight gain. I think that sugar doesn’t have a lot of nutritional value,” Ligibel said. Still, cancer patients need to focus on maintaining a healthy weight by balancing exercise and the food they eat.

        Sugar can cause obesity which leads to cancer

        Asked whether he believes that eating more sugar leads to more cancer, Thevelein immediately answered, “No! definitely not.” He and his co-authors do not state that in the paper; instead, they explain how normal, healthy cells can handle sugar in a controlled way.
        “On the other hand, we all know that when you eat a lot of sugar, you have a tendency — that has been clearly shown — to become more obese,” Thevelein said. “And obesity is linked to a higher risk of cancer.”
        Though it’s “too early to say,” Thevelein said that when you eat too much sugar over a long time, “maybe this can also lead in some way to dysregulation of the RAS protein in the normal cells,” and possibly it is this “dysregulation” that triggers RAS genes into becoming mutants.
        “It’s better not to eat too much sugar so that you don’t become obese,” he said. “And if at the same time, you also decrease your risk of cancer, the better — but this is something we cannot make a statement about at this moment.”

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        If anything, he would suggest that cancer patients eat less simple sugars and more complex sugars, such as those found in starch and whole grains. Complex sugars are released more slowly and are taken up by the body more slowly, and this might be helpful to cancer patients.
        “That would be our message,” Thevelein said: “Try to look for alternative ways of providing sugar and energy to cancer patients rather than rapidly metabolized simple sugars.”

        Read more: http://www.cnn.com/2017/10/27/health/sugar-cancer-relationship-study/index.html

        Breast cancer genetics revealed: 72 new mutations discovered in global study

        (CNN)The genetic causes of breast cancer just got clearer.

        Researchers from 300 institutions around the world combined forces to discover 72 previously unknown gene mutations that lead to the development of breast cancer. Two studies describing their work published Monday in the journals Nature and Nature Genetics.
        The teams found that 65 of the newly identified genetic variants are common among women with breast cancer.
          The remaining seven mutations predispose women to developing a type of breast cancer known as estrogen-receptor-negative breast cancer, which doesn’t respond to hormonal therapies, such as the drug tamoxifen.
          The new discoveries add to previous research bringing the total number of known variants associated with breast cancer to nearly 180.

          Beyond BRCA1 and BRCA2

          The international team of 550 researchers across six continents, known as the OncoArray Consortium, included professor Doug Easton of the University of Cambridge, who led the investigation.
          “Essentially, we used blood samples from a very large number of women (nearly 300,000), about half of whom had had breast cancer,” Easton explained in an email. Next, the researchers used the DNA from the samples to look for genetic mutations.
          “Think of a gene as a very long strand of DNA,” said Dr. Otis Brawley, chief medical officer of the American Cancer Society, who was not involved in the research. DNA is made up of nucleic acids, and when a nucleic acid is incorrectly placed along the strand, this is referred to as a genetic mutation, noted Brawley.
          Take BRCA1 and BRCA2, two well-known genes that confer a high risk of breast cancer when they contain mutations.
          There are 125,950 base pairs in the BRCA 1 mutation, noted Brawley.
          “Think of it as a 125,950 letter word,” said Brawley. “A mutation is a misspelling such that the gene cannot code the proper protein.” A gene that cannot code the proper protein leads to disease.
          According to the National Cancer Institute, 55% to 65% of women who inherit a BRCA1 mutation and around 45% of women who inherit a BRCA2 mutation will develop breast cancer by age 70.
          However, the BRCA1 and BRCA2 risk mutations, which are present in less than 1% of women, explain only a fraction of all inherited breast cancers.
          The consortium came together, then, to discover the other causes of breast cancer susceptibility — the additional genetic mutationsthat can lead to this form of cancer.

          Finding the other mutations

          The researchers measured DNA at over 10 million sites across the genome, said professor Peter Kraft of Harvard T.H. Chan School of Public Health, a study author.
          “At each of these sites, we asked whether the DNA sequence in women with breast cancer was different than that in women without,” said Kraft. “Because our study was so large, we could detect subtle differences between these two groups of women and be sure these differences were not due to chance.”
          According to Jacques Simard, a study author and professor and researcher at Université Laval, Quebec City, the newly discovered mutations only slightly — by anywhere from 5% to 10% — increase a woman’s risk of developing breast cancer.
          But even though, individually, these mutations don’t have as big as an effect as BRCA1 and BRCA2 defects, there are many of them, so their “overall contribution is larger,” said Easton. An individual woman, then, may have two or more of these common smaller risk gene mutations, and so her risk for developing breast cancer increases due to their combined effects.
          Kraft noted that “taken together, these risk variants may identify a small proportion of women who are at 3-times increased risk of breast cancer.” Women found to have a number of these smaller risk genetic mutations, then, would likely benefit from earlier mammography screening.
          Simard agreed, noting that it may be time to “adapt” breast cancer screening guidelines based on this information instead of basing mammography guidelines on age alone. By doing so, Simard said, “we will detect a higher number of breast cancers.”

          Quantifying cancer risk

          Brawley described the new research as “not earth-shattering.” It is “most important for us nerds,” he said, but less so for the general public.
          These types of studies help experts identify mutations that “help us quantify the risk,” said Brawley. “It helps us figure out that a non-patient, often a relative of a cancer patient, is at risk and helps us quantify that risk.” Normal lifetime risk of breast cancer is 12.5% for women in the US, said Brawley.
          Lisa Schlager, vice president of community affairs & public policy for the nonprofit FORCE (Facing Our Risk of Cancer Empowered), said past studies and evidence indicate that about 10% of breast cancers are hereditary.
          “This new information may mean that that estimate is low,” said Schlager.
          It is important for patients to know whether their cancer is due to an inherited genetic mutation because they may be at increased risk of other cancers or their treatment recommendations may differ based on that fact, said Schlager.
          “And their family members may be affected with the same mutation,” said Schlager.

          Enabling personalized medicine

          For the promise of personalized medicine to be realized, our government and health system need to “embrace the ability to use genetic information to tailor health care by providing affordable access to the needed screening and preventive interventions,” said Schlager. As it stands now, men with BRCA mutations as well as some women may not be covered for screening by their insurancein the US.
          Brawley said “this type of genome wide screening has and is being used to identify genes that are associated with increased risk of a number of diseases, including diabetes, Alzheimer’s disease, stroke and heart disease.”
          “The same methodology can be used for other cancers,” said Easton. Thescreening method used by the consortium, the OncoArray, was designed to be used in many other cancer types, including prostate, ovary, colorectal and lung cancer, he said.
          Simard added that the cost of the genetic screen is “quite cheap,” at less than $50 per individual. “We can use just a blood sample or saliva sample. It’s not difficult to obtain the material for a genetic analysis,” he added.
          Kraft said it was important to keep in mind that the study was conducted primarily among women of European ancestry.

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          “For sure we have missed some variants associated with cancers that are common in some non-European populations but rare in Europeans,” said Kraft. To find these, cancer genetic studies in Africans, African Americans, Latinas, Chinese and other populations are ongoing, he added.
          Easton commented that most of the newly identified variants “are in regions of the genome that regulate nearby genes.” These may someday serve as targets for new therapies or drugs to cure the disease.
          In the end, the most important lesson here is the fact that this research has been a collaborative effort, said Simard.
          “Scientists are not in competition against each other,” he said. “We are really working together to expedite and to accelerate the discovery.”

          Read more: http://www.cnn.com/2017/10/23/health/72-new-breast-cancer-mutations-study/index.html

          Benefits of water: Are you getting enough fluids to stay healthy?

          (CNN)Water is known as the elixir of life, with good reason. Every system in your body needs it to survive.

          This feature is part of CNN Parallels, an interactive series exploring ways you can improve your health by making small changes to your daily habits.
          “Water regulates our body temperature, keeps our joints lubricated, helps prevent infections and delivers nutrients to our cells,” said registered US dietitian and CNN contributor Lisa Drayer. “Additionally, our kidneys and liver work hard to get rid of toxins in our bodies, and they depend on water to do their job.”
          Water makes up about 60% of your body’s weight, and although you can survive without food for weeks, dehydration can kill you within days or even hours, depending on the temperature and your environment.
            Dehydration means more water is moving out of your body’s cells than into them. And as this happens, it’s not just water that you lose. Small amounts of electrolytes critical to cell function and energy, such as sodium and potassium, are lost along with the water.
            You’re constantly losing water and electrolytes throughout the day via breath, sweat, urine and bowel movements, so even mild dehydration can exhaust you and affect many of your body’s daily functions.

            Hydration and your health

            You could quickly become constipated as your colon steals water from your stool to keep your digestive system moving. Urine will become darker; prolonged dehydration can also crystallize salts and minerals in urine, possibly leading to the formation of painful kidney stones.
            Because dehydration can often be mistaken for hunger, you might gain weight as you try to satisfy your body’s needs. Fortunately, the opposite is also true if you’re hydrated.
            “If you are looking to lose weight, water can help you shed pounds,” Drayer said. “Drinking a glass of water before a meal can fill you up a bit and help you eat fewer calories at a meal.”
            If you suffer from migraines, studies show that a lack of fluids might easily trigger an episode. Headaches are also likely to last longer if you’re low on fluids. In addition, dehydration can leave you unable to concentrate, cause short-term memory problems and leave you feeling moody and anxious.
            “When you’re well-hydrated, your sleep quality is better, your cognition is better, you function better, your mood is better, the list goes on,” said Douglas Casa, CEO of the University of Connecticut’s Korey Stringer Institute, which studies athletic performance — another area that benefits from drinking enough fluids.
            “We did a study on people who were mildly dehydrated, which can happen within just 30 minutes of exercise,” Casa said, “and we found mood was compromised in both men and women.”

            Signs of dehydration

            The signs of dehydration differ by age group. Infants and young children may not be able to recognize their need for fluids, so it’s critical to provide frequent fluid intake and keep an eye out for symptoms of dehydration: irritability or lethargy, no tears when crying, no wet diapers for as little as three hours, a dry mouth and tongue, sunken eyes and cheeks, and a shrinking of the soft spot on top of head.
            Adults show much different signs of dehydration, including fatigue, dizziness, confusion, less-frequent urination and extreme thirst, but the latter has one exception: the elderly. Older adults may not feel thirsty but can still be dehydrated.
            That’s why one of the best ways to tell whether you’re lacking fluids is by the color of your urine.
            “The morning is the best time to get a global sense of your hydration status,” Casa advised. “If your urine looks more like apple juice instead of lemonade, then you’re dehydrated. On the flip side, the need to urinate throughout the day is a sign that you’re well-hydrated.”

            Additional causes of dehydration

            A lack of fluids is not the only cause of dehydration. Certain blood pressure and diuretic medications can increase urination, as can diabetes that has not been diagnosed or isn’t well controlled.
            A sudden and extreme episode of diarrhea or vomiting can remove a large amount of fluids in a short amount of time. Add a high fever, and you could be in trouble quickly. Upping fluid intake, preferably fluids fortified with electrolytes, is critical.
            Sweating due to hot, humid conditions or extreme physical activity is another sure way to become quickly dehydrated. Athletes and those who work outside have to be especially careful to avoid heat injuries including muscle cramps, heat exhaustion and seizures.
            Hypovolemic shock, in which low blood volume causes a drop in oxygen and blood pressure, is the most serious form of dehydration and can be life threatening.

            The many sources of water

            What’s the best way to stay hydrated? Drinking plain water, of course, can’t be beat. It’s readily available and has zero calories.
            But what if, like many Americans, you don’t like the taste of water? Drayer suggests adding fruit or vegetables, such as lemons, berries and orange or cucumber slices, to enhance the flavor.
            The National Academies of Medicine recommends a little over 11 cups (2.7 liters) of fluids a day for the average woman and 15 1/2 cups (3.7 liters) for men. Though that may sound difficult to achieve, the fluids can come from many sources besides water, including food.
            “I often remind people that broth-based soup, as well as other beverages including tea, coffee and milk, count towards your daily fluid intake,” Drayer added. “Also vegetables including cucumbers, lettuce, celery and tomatoes and fruits including watermelon, cantaloupe and strawberries.”
            “Why don’t Americans like to drink water? Because we are conditioned to expect high levels of sweetness in everything,” said renowned nutritionist Dr. Walter Willett, professor of nutrition and epidemiology at Harvard T.H. Chan School of Public Health.
            “And that has led to a lot of problems,” he added. “High levels of sugar have adverse metabolic effects, and the amounts we get in beverages today is so huge that it is one of our major health issues.”
            Willett, who is also a professor of medicine at Harvard Medical School, has published over 1,700 research papers and reviews on lifestyle risk factors for chronic disease.
            “You might say we are malhydrated, because we drink so much soda and fruit juice and other sugar-sweetened beverages, and by that I mean we drink beverages that harm our health,” he said. “Even energy drinks and vitamin waters, most are loaded with sugar and not worth the use.”

            Calculate your fluids

            To help people make better choices about their fluid intake, the American Society for Clinical Nutrition’s Beverage Guidance Counsel created a “pitcher” of liquids to illustrate at a glance how much of each fluid is considered best for optimal health. Though it was created in 2006, Willett, who served on the council, said the guidance holds true today.

            The vast majority of your daily fluid intake should come from water. In this illustration, a person on a 2,200-calorie diet would drink about 50 fluid ounces of water a day, which is just over 6 cups (1.4 liters). Another 28 fluid ounces, which is 3½ cups or just over 700 milliliters, could come from coffee or tea.
            “There are health benefits to coffee. Studies show it can help with diabetes and has some modest cardiovascular benefits,” Willett said. “It’s a mild antidepressant. In fact, studies show about a 50% lower risk of suicide of with three to four cups of coffee a day.
            “Tea has about a third the amount of caffeine as coffee, so you’re much less likely to have sleep problems,” he added, “but we don’t see as many health benefits for tea as coffee.”
            The next choice in the fluid pyramid is skim milk, also sold as 1% milk, as well as soy or other unsweetened alternatives such as almond milk. For adults who wish to add that beverage to their diet, the maximum amount per day would be two cups (almost 500 milliliters).
            “Milk is really complicated area because it comes along with saturated fat,” Willett said, “and even low-fat milk is high in calories. Up to two servings a day is fine, but going beyond that is excessive.”
            Level four in the diagram includes diet sodas, teas and other beverages with non-calorie artificial or natural sweeteners such as aspartame, sucralose and stevia. Because there is growing evidence that these drinks might contribute to weight gain, Willett says they should be seen as an “occasional treat.” They are listed in the pitcher as no more than 16 ounces a day (2 cups or almost 500 milliliters); keep in mind that a typical can of soda is 12 ounces.
            Then come alcohol, whole fat milk, sports drinks, vitamin enhanced waters and fruit and vegetable juices. Yes, even fruit and veggie drinks are capped at 4 ounces a day.
            “Fruit juices are cautionary because they contain about the same amount of sugar as soda,” Willett said. “Orange juice has nutritional value, apple juice much less, so we recommend choosing orange over apple juice.”
            Alcoholic beverages are complicated, he added. “There are definite protective health benefits against heart disease for both sexes, but for women, even a half a drink a day can raise the risk of breast cancer. So if you’re not at risk for heart disease, there’s no benefit in preventing it, so there’s no reason to drink,” he said. That’s why alcohol is listed on Willet’s diagram as zero fluid ounces toward your daily amount.
            The last category is reserved for sugar- or high fructose corn syrup sweetened beverages such as regular soda, lemonade and fruit drinks. Willett says those get a ‘”thumbs down” because they provide no nutritional value and plenty of calories.

            See the latest news and share your comments with CNN Health on Facebook and Twitter.

            Taken as a whole, Willett said, the pitcher recommendations should come as a wake up call for anyone looking to quench their thirst.
            “The most important message is the source of the hydration,” he said. “Beverages can cause real harm. People are not dying of dehydration in America, so choosing beverages other than water and other healthy sources has major health implications.”

            Read more: http://www.cnn.com/2017/09/27/health/benefits-of-water-and-fluids/index.html

            More than 25 million people dying in agony without morphine every year

            Concern over illicit use and addiction is putting morphine out of reach for millions of patients globally who need it for pain relief

            More than 25 million people, including 2.5 million children, die in agony every year around the world, for want of morphine or other palliative care, according to a major investigation.

            Poor people cannot get pain relief in many countries of the world because their needs are overlooked or the authorities are so worried about the potential illicit use of addictive opioids that they will not allow their importation.

            Staring into this access abyss, one sees the depth of extreme suffering in the cruel face of poverty and inequity, says a special report from a commission set up by the Lancet medical journal.

            In Haiti, for instance, says the report, there are no nursing homes or hospices for the dying and most have to suffer without pain relief at home.

            Patients in pain from trauma or malignancy are treated with medications like ibuprofen and acetaminophen, says testimony from Antonia P Eyssallenne of the University of Miami School of Medicine. Moreover, nurses are uncomfortable giving high doses of narcotics even if ordered to do so for fear of being responsible for the patients death, even if the patient is terminal.

            Death in Haiti is cruel, raw, and devastatingly premature. There is often no explanation, no sympathy, and no peace, especially for the poor.

            A doctor in Kerala, India, which has a palliative care service, told of the arrival of a man in agony from lung cancer. We put Mr S on morphine, among other things. A couple of hours later, he surveyed himself with disbelief. He had neither hoped nor conceived of the possibility that this kind of relief was possible, said Dr M R Rajagopal.

            But when he returned, morphine stocks were out. Mr S told us with outward calm, I shall come again next Wednesday. I will bring a piece of rope with me. If the tablets are still not here, I am going to hang myself from that tree. He pointed to the window. I believed he meant what he said.

            The commissions three-year inquiry found that nearly half of all deaths globally 25.5 million a year involve serious suffering for want of pain relief and palliative care. A further 35.5 million people live with chronic pain and distress. Of the 61 million total, 5.3 million are children. More than 80% of the suffering takes place in low and middle-income countries.

            Jim Yong Kim, president of the World Bank, said things had to change. Failure of health systems in poor countries is a major reason that patients need palliative care in the first place. More than 90% of these child deaths are from avoidable causes. We can and will change both these dire situations.

            Morphine is hard to obtain in some countries and virtually unobtainable in others. Mexico meets 36% of its need, China meets 16%, India 4% and Nigeria 0.2%. In some of the worlds poorest countries, such as Haiti, Afghanistan and many countries in Africa, oral morphine in palliative care is virtually non-existent.

            Oral and injectable morphine is out of patent, but costs vary widely and it is cheaper in affluent countries like the USA than in poor countries. A second issue is opiophobia the fear that allowing the drugs to be used in hospitals will lead to addiction and crime in the community.

            The world suffers a deplorable pain crisis: little to no access to morphine for tens of millions of adults and children in poor countries who live and die in horrendous and preventable pain, says Professor Felicia Knaul, co-chair of the commission from the University of Miami, calling it one of the worlds most striking injustices.

            Knaul says she only realised that many people suffered without pain relief when she was working to improve access to cancer treatment in low-income countries. I was shocked. I had no idea. When people were showing me the data I thought it cant be in this world, she told the Guardian.

            She had also experienced the need for morphine herself after a mastectomy for breast cancer. When I woke up I couldnt breathe because the pain was so bad. If they hadnt arrived with the morphine I dont know how I would have got through it. And as a young girl in Mexico, she had to watch her father suffer as he died without pain relief.

            I dont think that we have cared enough about poor people who have pain, she said. It doesnt make them live any longer. It doesnt make them more productive. It is simply the human right of not suffering any more pain and we dont care about that for people who are poor.

            The commission recommends that all countries put in place a relatively inexpensive package of effective palliative care for end of life conditions that cause suffering, including HIV, cancers, heart disease, injuries and dementia.

            One of their most emphatic recommendations, says Knaul, is that immediate-release, off-patent, morphine that can cost just pennies should be made available in both oral and injectable formulations for any patient with medical need. The disparity and access abyss between the haves and have-nots is a medical, public health and moral injustice that can be effectively addressed by the commissions recommendations.

            Read more: https://www.theguardian.com/science/2017/oct/12/more-than-25-million-people-dying-in-agony-without-morphine-every-year

            Joe Biden supports Julia Louis-Dreyfus after her breast cancer announcement like only a veep could

            The "veeps" got this.
            Image: HBO/Kobal/REX/Shutterstock

            After Julia Louis-Dreyfus’ breast cancer diagnosis announcement Thursday, former Vice President Joe Biden voiced his support to the acclaimed actress who has played a fictional vice president on HBO’s Veep.

            Biden assured Louis-Dreyfus that he was there for her during her cancer fight. “We Veeps stick together,” he wrote. He included a photo from a 2014 spot the two did together before the White House Correspondents’ Dinner in 2014. Aviators are obviously involved.

            Louis-Dreyfus, who plays vice president-turned-president (briefly) Selina Meyer on the show, had produced a spoof video in character with the then-real-life veep. The two had an adventurous day in the White House and bumped into Michelle Obama, Rep. Nancy Pelosi, and called former Speaker of the House John Boehner.

            Julia liked Joe’s tweet, and posted her own response shortly after.

            Like Biden tweeted, we’re with you, Julia.

            Read more: http://mashable.com/2017/09/28/joe-biden-julia-louis-dreyfus-veep-breast-cancer/

            Julia Louis-Dreyfus shares breast cancer diagnosis

            The star of Seinfeld and Veep tweeted a note to praise her glorious support network and fantastic insurance but added that not many women were so lucky

            Julia Louis-Dreyfus has revealed that she has been diagnosed with breast cancer.

            The Emmy-winning star of Seinfeld and Veep shared a note on Twitter on Thursday to inform her followers while also reminding them of the importance of universal healthcare.

            The good news is that I have the most glorious group of supportive and caring family and friends, and fantastic insurance through my union, she wrote. The bad news is that not all women are so lucky, so lets fight all cancers and make universal health care a reality.

            The 56-year-old has received support on Twitter from fellow actors Sarah Silverman, Debra Messing, Veep star Tony Hale, Christina Applegate and Michael McKean. According to a statement from HBO, she received the news the day after she won her record-breaking sixth Emmy for playing the lead in HBOs hit comedy Veep. The show is set to finish at the end of next season. That decision was not influenced by the diagnosis.

            Our love and support go out to Julia and her family at this time, a statement from HBO reads. We have every confidence she will get through this with her usual tenacity and undaunted spirit, and look forward to her return to health and to HBO for the final season ofVeep.

            Louis-Dreyfuss plea for universal healthcare comes after other political statements criticizing the decisions being made by the Republican party. My father fled religious persecution in Nazi-occupied France, Dreyfus said at the SAG awards earlier this tear. Im an American patriot, and I love this country. Because I love this country, I am horrified by its blemishes, and this immigrant ban is a blemish and its un-American.

            Read more: https://www.theguardian.com/culture/2017/sep/28/julia-louis-dreyfus-breast-cancer-diagnosis

            The most common pre-existing medical conditions

            (CNN)By the numbers, it looks like Americans are one unhealthy nation and could therefore have a lot to lose, depending on how the health care debate concludes.

            As many as one in two Americans has some kind of illness or condition that was, at one time, considered a pre-existing condition by insurance companies before Obamacare. For older Americans, that percentage is even higher: About 86% of your aging parents and grandparents, Americans between the ages of 55 and 64, have one, according to government estimates.
            Before the Affordable Care Act, Americans could be denied health insurance if they had one of several of common health conditions like diabetes, asthma and even acne. Obamacare generally stopped that practice. The law, in most cases, made it illegal for insurers to deny coverage or to charge people more because they’d been sick. It also put an end to most of the lifetime and annual benefit payment caps carried by some insurance policies, even the typically more generous employer-provided ones.
              The debate about repealing Obamacare is ongoing, which means it is unclear what a final replacement law would look like. The latest Graham-Cassidy bill would eliminate federal funding for the Medicaid expansion. It would remove the subsidies that lower premiums for people on Obamacare and eliminate subsidies that help with deductibles and co-pays.
              Instead, states would get a lump sum annually through 2026, and the state would decide what to do with that money. Insurers would still have to cover everyone, regardless of pre-existing conditions, but insurance companies could charge people more based on their medical history. The 10 essential health benefits all plans must carry under Obamacare would also be eliminated.
              The last bill to make it through the House would leave 23 million uninsured by 2026, compared with who gets coverage under the current law, according to a Congressional Budget Office analysis. Polls show that this news worries many Americans, particularly the half who have had a condition once considered pre-existing.
              But who are these people who live with these pre-existing conditions? Have they failed to “lead good lives,” as Alabama Republican Rep. Mo Brooks said in May of healthy people, who he believes should pay less for coverage? Will they really be able to buy a policy as Republicans are promising, or will the costs make coverage prohibitive?
                CNN analyzed the top 10 most common conditions for Americans. People with these conditions come from all walks of life, but they each must cope with the illness they have or once had.


                Eric Brod may be a confident professional in the world of finance today, but when he was a freshman in high school, something made him self-conscious.
                Like a lot of high school freshmen, he had acne.
                “I was probablymore aware of it than my peers,” Brod said. “I was definitely thinking about it.”
                Acne is one of the most common chronic pre-existing conditions and is the most common skin condition in the United States. At least 50 million people have acne, according to a 2006 national study of skin disease, the latest data available.
                Acne happens when a pore in your skin gets clogged. Your body is constantly shedding dead skin cells. Sometimes, it over-produces the oil needed to keep your skin from drying out, and when that happens, dead cells can stick together and clog your pores. The bacteria that naturally live on your skin can also get caught in your pores and cause your skin to get inflamed and red. When the bacteria get deep into your skin, they can create an acne cyst.
                  Acne can appear on your face, your back, your chest — essentially anywhere on your skin. When your hormones are out of whack with puberty, it increases your chance of having acne, but adults can get it, too.
                  Prior to Obamacare, insurance companies could turn down your request for a policy or charge you more if you had this condition, even if you had it under control.
                  In Brod’s case, his acne wasn’t too bad, but it was persistent, and he said it wasn’t being contained with the usual antibiotics or topical medications he tried throughout his high school years.
                  “I was self-conscious about it and would nervously pick at it if it lingered,” Brod said. Running track and cross-country kept him fit, but it did not help his skin. He’d break out if practice was held on cold or hot days, and the sweat and dust didn’t help.
                    He had breakouts throughout his high school years, but the summer before freshman year of college, he had a breakthrough. His father, a dermatologist, recommended a different treatment to get it under control once and for all.
                    “I felt really lucky because, living with my dad, he saw how it looked from day to day and had an idea about what would help,” Brod said.
                    Brod got a prescription for isotretinoin, better known as Accutane, which has since beenpulled from the market. It was a form of vitamin A that reduced the amount of oil released in your skin and helped the skin recover quickly. For Brod, it did the trick. He didn’t have any side effects, and the help came just in time.
                    “When you are going to college and you don’t know anyone, you do want to look your best,” Brod said. “Acne is more than a cosmetic concern, though. I knew it could lead to permanent scarring. And while this was a relatively mild case, I didn’t want that and was glad we found something that worked.”


                    Kat Kinsman has what she calls a kind of “autoimmune disease of the soul.” She struggles with anxiety and “came out” about it in a first-person story on CNN in 2014. She said it “freed me in so many ways that I felt really lucky that I had an employer and a husband who supported me through this and it didn’t blow back on me.”
                    More than 39 million American adults struggle with anxiety. It’s the second-most common pre-existing condition in the country, according to a 2005 study.
                    Kinsman now works as a senior food and drinks editor at Time Inc.’s all-breakfast site Extra Crispy, and she is the author of the book “Hi, Anxiety: Life with a Bad Case of Nerves,” published in November. However, it is something Kinsman has struggled with since kindergarten, long before she had words to describe it. In fact, when her parents first noticed something was wrong, they took her to a doctor, who tested her for such conditions as cancer and mono. It got so bad that she missed a part of her freshman year of high school.
                    “Your parents can love you and take care of you the best they can,” Kinsman said. “Anxiety is not necessarily something that first comes to mind when you are looking at what is wrong.”
                    When doctors did finally figure it out, her parents found Kinsman the counseling she needed. “At an early age of 13 or 14, I was given this gift of openness,” she said. “Talking about my anxiety saved my life.” Though medication was not for her, she said therapy helps. She sees a nutritionist. She does a lot of deep breathing. Kinsman is not cured, but she’s better at managing it.
                    “I have almost 45 years of practice,” she said. “People tell me I have a real good poker face.” However, when her close friends suspect something is up, they ask to see her thumbs. She admits to a bad habit of picking at them when her anxiety is triggered. “I have sometimes picked them raw,” she said.
                    Her anxiety can manifest itself in other physical ways. It makes her heart pound, her body tense; it can make her sick to her stomach. “My body can decide to be a real jackass,” she said. She also gets restless and cannot sleep, and then a lack of sleep exacerbates her anxiety. Not telling people about it also compounded the problem.
                    “You find it so exhausting to put on your normal person suit every day and go out,” Kinsman said. “You don’t want people worried about you, and you get afraid of being thought of as crazy, or you are worried you would lose your job.”
                    Over the years, it has clouded her judgment, and before she talked about it, it hurt some of her relationships. A few boyfriends never understood, an employer told her not to talk about it at the office, and some friends thought she was blowing them off when she really stayed home because something had triggered her anxiety.
                    When she finally could talk about her anxiety, life got better. She learned that she wasn’t alone. After her essay ran, friends and even strangers would tell her about the mental illness in their own lives or within their own families.
                    “It was an extraordinary time,” Kinsman said. “It’s like when you look out at a meadow and you see that first firefly, and then another lights up in response and then another and another, and finally the whole meadow looks like it is on fire. People started talking to me about their own struggles, and it made me feel less of a freak and opened up the possibility for conversation.”
                    She hopes her talking about it can help end the stigma of mental illness. “Too many people are self-medicating or even dying because they can’t talk about it,” she said. She volunteers in the community and got certified to work on a crisis line. “I am well aware that I am in an incredible place of luxury to work where I do and to be so open and supported,” she said. “I feel like I can take this hit, and my goal is to make it easier for someone who, for whatever reason, cannot get help.”


                    Peter Richardson, an avid biker in Spokane, Washington, said he nearly jumped into a river when the test strips used to monitor his diabetes fell out of his pocket and into the water. “I was on a 30-mile bike ride, and about 30 dropped in. It was awful,” Richardson said.
                    Richardson is fit, but he’s a self-employed real estate broker who buys his own insurance, and his policy has its limits. When he went to the pharmacy to get more test strips, the pharmacist said Richardson would either have to wait four days for his insurance autorenewal to kick in or need to pay the full retail price. Unable to manage his disease without test strips, he paid. It cost him $338.
                    “Luckily, I can afford it, but it could easily have been a whole different scenario,” Richardson said. “I’ve got a 3-year-old daughter and a wife who stays up late at night worrying about our finances. I was blown away when the pharmacy called.” Richardson couldn’t believe insurance couldn’t cover something he regularly uses to manage his care.
                    Richardson is one of 30.3 million people with diabetes, according to the latest numbers from the US Centers for Disease Control and Prevention. It’s a pre-existing condition that left people uninsured prior to Obamacare. Luckily for Richardson, he had coverage when he was diagnosed, but his insurance didn’t cover much. He had what was known as a catastrophic policy that had high deductibles and limited benefits. His first vial of insulin cost almost $500.
                    “When they told me that at the pharmacy, I nearly walked out without filling it,” Richardson said. But diabetics need insulin to live.
                    With type 1 diabetes, the pancreases doesn’t create much, if any, insulin. Your body needs insulin to balance the glucose in your bloodstream. Glucose is what your body uses for energy. If your blood sugar is too high, it can lead to blindness or kidney or nerve damage. If your blood sugar gets too low, you could faint or even slip into a coma.
                    Fortunately, Richardson found a medical study to volunteer for that gave him insulin for free. That held him over until he could get better insurance.
                    “That really scared me,” he said. His policy is generally better now, but he can afford it. Business is doing well now. That could change if there’s another downturn in the real estate market or interest rates go up. That’s why he’s watched the health care debate with trepidation.
                    “That’s what keeps me up at night, because you can’t control what they are going to decide, and some of what they are considering, especially for someone like me with diabetes, is scary.”
                    Though he wants to stay an independent business owner, he’s been tempted to take jobs that provide benefits. “If I don’t have a sale, that may be what I’m faced with if they don’t provide coverage for people like me on the marketplace. What are you going to do?” he asked.
                    In the meantime, he will continue to watch what he eats. He’ll keep biking to stay fit, and he’ll monitor his health with modern tools like a program called One Drop that gives him more up-to-date data about his daily health.
                    Richardson hopes lawmakers will listen to the diabetic community. “Talk to the kids at the diabetic camps. Go talk to a group of people living with the condition to give you a real-life perspective,” he said. He hopes that motivates Congress to make the system better. “It has to get better.”


                    When Cathy Stephens completed her first triathlon, she proudly held up a sign that said “Dear asthma, I win.”
                    The endurance athlete who thinks nothing of a 100-mile bike ride has such bad asthma, there are days when she cannot breathe enough to speak and she can forget about walking across the collegecampus where she works.
                    People with asthma have inflamed airways. Your lungs use airways to bring oxygen into and out of your body. When someone experiences asthma symptoms, the muscles around these airways tighten and narrow, making it hard to breathe. The cells that create mucus can also overproduce it, causing the airways to tighten more. This happens when an asthmatic encounters something that triggers an attack. It could be something they are allergic to — In Stephens’ case, it’s mold and dust — or it could be a virus. “When people are sick around me, I run screaming the other way,” she joked.
                    Sometimes, asthma symptoms can be mild and make a person wheeze or cough. Sometimes, attacks can kill.
                    Stephens is one of 25.2 million asthmatics in the United States, according 2015 numbers from theCenters for Disease Control and Prevention.
                    Stephens said shewasn’t breathing when she was born, and doctors had to revive her. And asthma has troubled Stephens all her life. She’s the only one of her siblings to have it. “I tell them I took one for the team,” she said. Her mom also had asthma and died of related complications in August 2016.
                    Despite having to raise five children by herself in small-town Idaho, Stephens said, hermother was the “real hero” who would get her through her attacks. She’d put her daughter in a hot shower so the steam could open her airways. She’d pin a towel with ice around her throat. Sometimes, she’d even sit up all night with her daughter, holding her upright.
                    “I have vivid memories of my mom in that rocking chair, holding me up when I was too little to prop myself up, since you can’t lay down when your asthma is bad like that,” Stephens said. Doctors also put Stephens on massive doses of prednisone, which worked but packed on the pounds.
                    “I was always the girl with the note for PE saying I couldn’t run, but if you looked at me, I looked fine, so I would always have to fight off that stigma that I was lazy or something,” she said.
                    As an adult, she feels like she has a good handle on her disease. She avoids her triggers. She watches her diet and has eliminatedfoods that cause inflammation. She exercises, since excess pounds can exacerbate asthma symptoms.
                    It’s paid off. She hasn’t been hospitalized in 20 years. She still needs to see the doctor regularly to get prescriptions for her rescue inhalers, and she’s got a nebulizer to use if her symptoms are bad. “Sometimes I’ll have to bring it to work,” said Stephens, who certifies teachers and principals and helps them find jobs. “When I have to do, that I’ll just close my door, and if someone comes in when I’m on what I call my peace pipe, no one seems to mind.”
                    She feels fortunate to have good insurance through her work, but she didn’t always. When she was waitressing to put herself through college, those jobs didn’t always come with benefits. Even when they did, prior to Obamacare, sometimes insurance wasn’t an option. Companies could turn her down because of her pre-existing condition, or they would make her wait a certain amount of time before they’d cover her care. That meant she’d often put off going to the doctor or getting prescriptions filled even though she’d need to.
                    “I muddled my way through and mostly was lucky, but there were times when a trip to the hospital was devastating to my budget,” she said. Even now, with good insurance, her $2,000 deductibleprompts her to use her inhaler — an Advair bronchodilator — sparingly. She’s been OK, but it’s not ideal.
                    She hopes Congress doesn’t decide to “take 10 steps back to the past,” when coverage was not as affordable as it iswith the current health care bill. “It was scary when I’d have to make a choice between paying for college and paying for insurance,” Stephens said. “What bothers me about the current debate is that they talk about those of us with pre-existing conditions as being the sickest, but other than that one thing, I am much healthier than most.” She said she’d love to take a long bike ride with any legislator who says people don’t die from a lack of insurance and see whether they see can keep up.
                    “They need to stop beating people up for having an illness,” Stephens said. “They should instead see what we can do when we have an environment in which we can stay healthy and live up to our full potential.”

                    Sleep apnea

                    Wendy Solon always described herself as an “active sleeper.” It never woke her up, nor did she remember any of it, but her husband told her that she’d toss and turn and snore. As she got older, her snoring got louder. She felt fine but remembered vivid dreams. After her husband continued to have problems sleeping, she talked to her doctor and asked for a recommendation to see a sleep specialist.
                    “I went because I thought it would help me sleep calmer and I wouldn’t be bothering my husband as much,” said Solon, 47.
                    She went to Emory University’s sleep clinic, where doctors “basically asked me a million questions” and suggested an overnight sleep study.
                    When she went in, they hooked her up to a bunch of sensors on her legs and arms, and then she went to sleep.
                    “I woke up, and I remember thinking, ‘Well, that’s not going to be a very interesting sleep study. I think I got a very good night’s sleep,’ and I thought for sure the doctor would tell me that he didn’t find anything,” she said.
                    Instead, her doctor told Solon that she wokean “astronomical number of times,” she said. The doctor recommended that she get a continuous positive airway pressure machine, or CPAP machine, to help her breathe. He diagnosed her with sleep apnea.
                    “I had no idea I had sleep apnea,” she said. “I wouldn’t have guessed that, ever.”
                    More than 25 million American adults have sleep apnea, according to the Sleep Foundation. People with the condition pause when they breathe in their sleep. The pauses can last for seconds or minutes and may happen as many as 30 times an hour. People with sleep apnea don’t often breathe deeply when they sleep. Because they stop breathing, they go in and out of deep sleep, and that can leave them feeling tired during the day. It can have serious health consequences such as high blood pressure, stroke, obesity, diabetes and heart problems. It can cause accidents at work. It’s the No. 1 cause of sleepiness during the day, according to the National Institutes of Health.
                    Solon feels like using a CPAP machine is a bit like needing braces: “medically necessary but not a big deal.”
                    She said she doesn’t feel any more rested yet, but it helps. The CPAP machine gives her a constant stream of air pressure so her throat and airways don’t constrict and she keeps breathing during sleep. Insurance, which she gets through her husband’s company, covers the machine.
                    “We were blessed that we have the insurance we do, but we know we are lucky,” she said. She hopes Congress will continue to help people like her with pre-existing conditions. “For me, the sleep apnea is not a big thing compared to the other health issues in my life, but treatment does matter. It’s not like these medical situations are your fault, and they should never every be treated that way.”


                    The health care debate drove Mike Babb to write a highly public letter about a deeply personal issue.
                    “For me keeping Obamacare is a matter of life or death,” the father of two wrote in his local newspaper in Pennsylvania..
                    To Babb, this isn’t merely rhetoric. He is one of more than 20.8 million American adults who struggle with major depressive disorder.
                    “I was constantly overwhelmed with suicidal thoughts,” he said. “When you have really bad depression, this is not laziness. This is not something easy to get over. You learn you have it, and it gets even worse, because you beat yourself up for having it.”
                    Depression is a mental health disorder in which people have a constant feeling of despondency. It can cause them to lose interest in everyday activities and make them feel bad about themselves and others. It’s an intense sadness and feeling of hopelessness that, if not treated, can lead people to suicide.
                    Doctors put Babb on nearly every medication available, but none seemed to work. They then suggested a treatment that sounded more radical: electroconvulsive therapy. Once a month, he would go under general anesthesia, and doctors would send small electric currents through his brain. The currents trigger a brief seizure, changing his brain chemistry. The treatment, he said, saved his life.
                    “This really took a cross off my back,” he said. “It was amazing to find something that worked.”
                    In addition to the electroconvulsive therapy, he sees a therapist weekly. He also sees an additional psychiatrist and takes three drugs. He pays about $675 a month for COBRA — employer-based insurance for people who lose or leave their jobs –plus at least $1,500 a year with various co-pays. It’s expensive, especially since he had to quit his teaching job due to his depression, but even when he got insurance through work, it was limited.
                    When he started teaching chemistry 22 years ago, he noticed that his policy carried a $50,000 lifetime cap on mental health care. Quickly, he could have surpassed that and would have had to pay for his treatment out of his savings, he said.
                    “Obamacare changed that,” Babb said. “Parity of service means they can’t exclude you because you suffer from something that is something mental, not physical. That has been a lifesaver for me.”
                    He said Obamacare gave him his life back. Though he can’t work, he still feels he has something to offer his community in Fleetwood, Pennsylvania. He’s a regular volunteer, driving for the blind, and he stays active with his hometown Lions Club. He’s there for his teenage sons. And he promises to continue speaking up to urge congress to keep Obamacare, rather than merely repeal it. As someone who is about to get coverage through Medicaid, he worries about those proposed cuts.
                    “I remain very concerned with what’s going on,” he said. “I know when to speak up when stuff seems rotten. I can’t believe these politicians would take hundreds of millions out of health care for people who really need it to give tax cuts to the rich. I hope they come to their senses soon.”


                    In 2001, when Karen Deitemeyer was 55, she started having trouble walking up the stairs. She had been a smoker, but with the help of two visits to a psychologist who used hypnotherapy, she had kicked the habit about a decade before.
                    Initially, she chalked it up to aging. “I was a little overweight at the time, and while I exercise, I probably don’t exercise nearly as much as I should,” she thought, but the problem continued.
                    She went to see her primary care doctor, who sent her to a pulmonologist. Tests showed that it wasn’t normal aging. She had chronic obstructive pulmonary disease, known as COPD. It’s an umbrella term used to describe lung diseases that block airflow and make it difficult to breathe. More than 15.7 million Americans have it, according to a clinical review from 2013. Though many with COPD smoked at one point in their lives, it can also be genetic, and it can be caused by a person’s environment.
                    COPD is the third leading cause of death in the United States, and yet Deitemeyer, who is a volunteer in the COPD community, regularly gets asked what it is. “It’s a relatively newer umbrella term, so when I ask them ‘did you have an older relative with chronic bronchitis or emphysema? That’s what we call COPD now,’ and then they start to recognize it,” she said.
                    By the time she was diagnosed with COPD, it was considered severe, she said. “It comes on gradually. It’s not like one day you are fine and the next you can’t do anything,” she said.
                    Despite the severity, Deitemeyer continued to work. She had a decent job with good insurance with the Oceolo County tax collector’s office. “I was determined to make it work and just brought my oxygen tanks to the office,” she said.
                    She went to pulmonary rehabilitation and lost weight. Both helped her breathe better. She retired when she turned 62. “Then I finally thought it was time,” but she stays active. The 55-and-older community where she lives with her husband has an activity every day, she said. “You would not believe the calendar here. There is so much going on,” she said. She also travels the country raising awareness about COPD.
                    Now, 16 years after her diagnosis, she uses a stationary oxygen tank when she sleeps anda portable oxygen concentrator when she exercises or travels, but “otherwise, I don’t have to drag it around with me, so I’m fortunate in that sense,” she said.
                    Though she is old enough to be covered my Medicare, she is 71, she knows others with COPD who are not so lucky and she follows the health care debate closely and worries for others with pre-existing conditions.
                    “Who exactly is exempt from that. I mean, If you think about it, essentially life is a pre-existing condition.”

                    Extreme obesity

                    Akilah Monifa Monifa had worked as the director of communications and public affairs for the San Francisco CBS affiliate for nearly 14 years but wanted to be an entrepreneur so she could make sure more voices were heard, and down the road, she hoped to employ others.
                    She usedseverance and unemployment checks to co-found Arise 2.0 in November. It’s a multimedia publication by LGBTQ people of color created to fill a gap in coverage of that community.
                    She’s excited about it, but this busy Oakland mother is uncertain about her future.
                    “As I’ve been doing this, I’ve noticed most people who create online publications keep their day job for at least a couple of years, particularly when they have families,” Monifa said. “My big concern is health insurance.”
                    Monifa is covered through COBRA — employer-based insurance for people who lose or leave their jobs — but she’ll have to buy her own plan soon. That’s got her watching the health care debate with concern.
                    “It is something I worry about, because with the reality of this new law and what it might do with pre-existing conditions, I may not be able to afford what I need to stay healthy,” she said. “And I certainly can’t afford to go without.”
                    Monifa has had three of the most common pre-existing conditions. She had sleep apnea and for decades had to use a CPAP machine to help her breathe as she slept. Asthma slowed her down when she walked, and both were exacerbated by her weight.
                    Like more than 18.5 million American adults, she struggled with extreme obesity and has been doing everything she can to fight it.
                    Starting around age 15, she’d gain about 10 to 15 pounds a year. “I wasn’t mindful about what I ate,” she said, and it became a problem. At her greatestweight, her 5’11” frame carried more than 400 pounds. Over the years, she tried to lose it.
                    “I tried everything that I could, but I would lose 75 and then gain 100, and my weight would yo-yo back and forth, and it caused serious health problems,” she said. In addition to the asthma and sleep apnea, she had borderline high blood pressure. Her knees and back hurt. “I knew my overall life expectancy was not great,” she said
                    In 2012, she elected to have gastric bypass surgery. She weighed 330 pounds at the time. She made several life changes, joining group therapy and signing up for two gyms, where she continues to exercise daily. She plans meals ahead, and instead of meeting friends for dinner, they go for walks.
                    The effort paid off. She lost more than 222 pounds and feels great.She doesn’t even need her CPAP machine any more, and her asthma doesn’t bother her. But the fight isn’t over. She’ll need regular checkups so doctors can monitor her health and nutrition intake becauseshe physically can’t eat as much now. She’ll also continue to see a counselor to manage the emotional side of her eating, and she’ll stay devoted to exercise.
                    Even with an ankle cast for arecent injury, she is signing up for races. She recently got a medal for walking the Bay to Breakers event. “I only walked 4½ miles because the ankle was bothering me, but I was determined to do it,” she said. “You don’t lose hundreds of pounds and give up.”


                    Mika Leah did everything she could to have a healthy heart, but it didn’t work, which is why she’s concerned about the possibility that insurance guarantees for those with pre-existing conditions may be dropped if Obamacare is replaced.
                    She’s been eating a healthy diet all her life. She developed a taste for healthy fare after her mom removed sugar and salt from the family meals when Leah’s father had his first heart attack at age 32. She’d been playing soccer since she was 5. She exercises about four to five times a week and enjoyed the gym so much, she started teaching a cycling class for fun. But when she started having trouble running, she wondered whether something was wrong. She had run a half-marathon fine, but when she started running short distances, she felt “horrible.”
                    “I was extremely breathless, and when I came home, I threw up,” she said.
                    At first, she thought she’d push through. But when her breathing didn’t get easier and she started getting headaches, she went to the doctor, who chalked it up to stress. When the doctor summed up her life — she had an intense job and two children under the age of 2 and was going through a divorce — she replied, “Well, when you put it that way, I guess I am.”
                    So she kept exercising, but the symptoms got worse. The doctors continued to tell her it was stress. An EKG didn’t show any problems. It wasn’t until her 33rd birthday that they realized something else was wrong.
                    She and a friend went on a hike thatwas supposed to be easy. Leah had completed itwithout trouble when she was nine months pregnant. But on the first mile, she had to sit down not once but twice, and she couldn’t catch her breath.
                    “It felt like a 200-pound man was standing on my chest,” she said. She looked at her hiking partner, who she says could stand to lose a good 80 pounds and was a pack-a-day smoker, and realized he hadn’t broken a sweat. “I knew something was really wrong with me, and I was terrified,” she said.
                    She went to the cardiologist who had looked at her EKG. He too thought it was stress, but she refused to accept that answer. She demanded a stress test.
                    A couple weeks later, doctors put her on a treadmill to run. She stepped off, and a doctor came in to tell her she needed surgery right away, she said: Her left artery was 98% blocked. The blockage was extremely close to her heart.
                    She’s since had threeprocedures and fivestents put in her heart.
                    Heart disease is the No. 1 killer of women, and atherosclerosis,or clogged arteries, which can lead to heart problems, are one of the top 10 most common health conditions for Americans. About 16 million American adults struggle with it, according to a 2008 study.
                    As she recovered, Leah became reflective and decided the job that brought her true joy, her cycling class, was what she wanted to do full-time. She founded Goomi, a wellness company that brings fitness and cooking and meditation classes to workplaces and schools across the country. Goomi means rubber band in Hebrew and is meant to symbolize bouncing back and flexibility.
                    Leah said she is deeply concerned about insurance and tries not to get political, but as a new business owner, she watches the health care debate closely and remains concerned about the cost of care. She hopes her company and her volunteer work for the American Heart Association will help keep people healthy and especially empower patients. Though she knows it may sound cheesy, she hopes someday, it will save lives.
                    “Had I not spoken up, I could easily have been one of those athletes that goes for a run and drops dead because of my heart,” she said. “It makes a difference if you speak up on behalf of your health.”


                    Lori Dorn, a writer for Laughing Squid, an online site that covers arts, culture and technology, said she’s become a kind of “medical sherpa” over the years, trying to help friends and acquaintances navigate the medical system when they are diagnosed with cancer.
                    “I tell friends, if you or someone you know who has been diagnosed with cancer and need someone to talk to or to get you through that void and darkness or someone who can help you navigate the health care system, I am there for you,” Dorn said. That’s because she has been there, too.
                    Diagnosed with breast cancer in 2011, she meets the five-year definition of cancer-free but still goes in every three months for a checkup, and she’s still on medication.
                    When she was diagnosed with cancer, she had surgery, chemotherapy and radiation and got through it without too much trouble. “I’ve been told I’m a tough cookie,” she said.
                    She also has another condition: asthma. Her asthma symptoms were much worse when she was living in San Francisco, where there were a lot of old buildings with mold and dust, to which she is highly allergic, she says. “Thankfully, I haven’t had a serious attack in eight or nine years,” although she usesa rescue inhaler if neededbut hasn’t been to the hospital in years.
                    Still, the medication for both are expensive. She is on her husband’s insurance, but without it, she says, the drugs would cost her about $20,000 a month.
                    “It’s expensive without it, or what would happen if I was unemployed, which has happened in the past? I don’t know what I would do,” she said. “I can’t go without them, but you see where people can’t afford their medication and have to go without. Politicians keep saying people can have their choice with health care reform, but when health care is too expensive, there are not great options in the market. That is not a choice.”
                    Dorn is particularly concerned that annual or lifetime limit caps could come back. She said her treatments could have easily put her over those limits.
                    Dorn also has questions for politicians and insurance companies that talk about pre-existing conditions as if they were something they brought on themselves. She has a gene that makes her predisposed to breast cancer. “A lot of people like myself with the genetic marker,” Dorn said. “We were born with this. Does this mean I’ve always had a pre-existing condition? Does this mean that they want to punish people for being born with a proclivity toward a pre-existing condition? Legislation like this seems very cruel.”

                    Read more: http://www.cnn.com/2017/09/20/health/most-common-pre-existing-conditions/index.html