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New to Diabetes FAQs: 5 in 5 with Gary Scheiner

Diabetes Alert Day

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By Katherine Plumhoff

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Everyone appreciates a useful list, so today I’m sharing with you Spry author Gary Scheiner’s answers to five questions for those who are newly diagnosed with T1 diabetes. Quick, concise, and full of advice, I hope his answers are helpful to you!

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KP: Who should be involved in a diabetes treatment team?

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GS: The patient (and his or her family) needs to “captain” the team. It’s best to include an endocrinologist and, ideally, a CDE, preferably one who lives with diabetes and can relate on a personal level.

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KP: What advice do you have for patients or parents of patients who may be dealing with difficult insurance companies?

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GS: Two things: (1) Solicit your doctor’s help. Your physician carries a lot more weight with insurance plans than you do as an individual member. (2) Talk with a case manager at the insurance company. Case managers can work on your behalf to help you get the most from your plan and work through some of the bureaucracy.

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KP: What’s the biggest dietary issue to watch out for when diabetes is onboard?

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GS: You have to be very careful about the timing of meals/snacks. Grazing will never allow you to control your blood sugar properly. It takes a disciplined approach to space meals/snacks appropriately.

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KP: What advice do you have for patients or parents worrying about A1c test results?

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GS: You can’t change what’s happened in the past, and that’s all that an A1c represents. I place much greater emphasis on day-to-day blood glucose (BG) values (or sensor data). I’d rather have an A1c that’s a little above target but with stable BGs than an A1c that’s tighter but with frequent highs and lows.

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KP: What tools do you most recommend for someone newly diagnosed?

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GS: Your brain remains your most powerful tool. Maybe get a copy of my book Think Like a Pancreas—it does a good job of teaching the ins and outs of self-managing your blood sugar levels. Beyond that, get a BG meter that is easy and accurate, an insulin pen that doses in small increments, a continuous glucose monitor, and a tool to help with accurate carb counting (such as a book or app). An insulin pump is beneficial to most type-1s as well, but only after some experience learning the basics.

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Gary’s latest book, Until There Is a Cure: The Latest and Greatest in Diabetes Self-Care is an essential resource for newly diagnosed people with diabetes as well as people who have been dealing with the disease for a long time. So if you’re looking for more information, check it out.

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As a Certified Diabetes Educator and person living with diabetes for more than 25 years, Gary Scheiner, MS, CDE, has received numerous awards for his work in the fields of diabetes care and self-management teaching. Scheiner has written six books and hundreds of articles on various topics in diabetes wellness. Additionally, he teaches the art and science of blood glucose balancing to people throughout the world from his private practice in Wynnewood, Pennsylvania, USA.

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Katherine Plumhoff joined the Spry Wellness Blog as a contributor in 2013. She is currently pursuing her undergraduate degree in English and Communication Studies at the University of Michigan and hopes to work in publishing after graduation.

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The Latest and Greatest Since Until There Is a Cure

GaryScheiner2008-1280

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By Katherine Plumhoff with Gary Scheiner, MS, CDE

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The world spins madly on, and that’s not just true in the 2006 song by The Weepies (a personal favorite of mine). It’s true for the world of diabetes management, too. Spry author Gary Scheiner, MS, CDE, tackles the evolving topic of diabetes care in his book Until There Is a Cure: The Latest and Greatest in Diabetes Self-Care.

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Published just a few months ago, Gary’s book addresses all that has changed in the world of diabetes in recent times, bringing readers up to date on changing technology, therapies, and approaches to diabetes management. He discusses the latest developments in pump technologies, diabetes medications, lifestyle considerations such as diet and exercise, and current attitudes about treatment and care.

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Each chapter includes “on the rise” and “on the decline” sections, helping readers learn what to keep an eye on and what to consider phasing out of their treatment plans. I checked in with Gary to talk about what’s been going on in the diabetes world since his book was published in February, and here’s what he has to share with you.

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KP: Gary, do you think that medications that try to prevent the disease will ultimately be successful? What about immune-system blocking drugs?

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GS: I’m somewhat skeptical about the immune system blockers, first because of the side effects and second because the human immune system is so darned complex and difficult to work around. Seems that every medication that has been developed either doesn’t work long-term or works too well, resulting in side effects that are worse than the diabetes was in the first place. A highly selective immune blocker that protects the beta cells would be the Holy Grail.

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KP: There’s been a lot in the news recently about adult stem cells and T1—how do you feel about the future of that research?

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GS: I’m a fan of any form of therapy that provides life-improving treatments … including stem cell research. Most people don’t realize that stem cell research almost never involves unborn fetuses; it’s received a lot of bad press by people who don’t understand the origin of the stem cells.

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KP: What about hardware? Anything new recently?

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GS: I don’t think there’s been much since the book came out. The Dexcom G4 has taken over as the continuous glucose monitor (CGM) we’ve all been waiting for, and insurance coverage has really improved. The new Asante Pearl pump has a lot going for it as it begins its rollout in the eastern part of the United States. There are a few new downloadable software programs and mobile device apps, but nothing that has revolutionized the industry.

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As a Certified Diabetes Educator and person living with diabetes for more than 25 years, Gary Scheiner, MS, CDE, has received numerous awards for his work in the fields of diabetes care and self-management teaching. Scheiner has written six books and hundreds of articles on various topics in diabetes wellness. Additionally, he teaches the art and science of blood glucose balancing to people throughout the world from his private practice in Wynnewood, Pennsylvania, USA.

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Katherine Plumhoff joined the Spry Wellness Blog as a contributor in 2013. She is currently pursuing her undergraduate degree in English and Communication Studies at the University of Michigan and hopes to work in publishing after graduation.

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First Peek at “Until There Is a Cure: The Latest and Greatest in Diabetes Self-Care”

by Jess Snyder

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Gary Scheiner BW Web

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Gary Scheiner MS, CDE , knows a thing or two about diabetes. Not only has he managed his own type 1 diabetes for more than 20 years, but he has also devoted his life and career as a Certified Diabetes Educator to educating and empowering others living with diabetes, helping them to truly understand their conditions and their treatment options. He is tremendously skilled at taking difficult medical concepts and communicating them in a way that virtually anyone can understand—an important, if not crucial, qualification in Gary’s line of work.

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Gary’s widely read books are staples in any serious diabetes library, with his Think Like a Pancreas frequently topping best-seller lists and adorning the bookshelves of both patients with diabetes and health-care professionals everywhere.

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In his newest book, Until There Is a Cure: The Latest and Greatest in Diabetes Self-Care , Gary shares insider information on forthcoming, groundbreaking advancements in diabetes research, technology, and treatments. The following excerpt captures Gary’s enthusiasm for helping people with diabetes and explains some of his overall concept behind writing the book.

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I never used to believe in that saying, “The more things change, the more they stay the same.” Then I entered the diabetes field.

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This book is all about keeping pace with the changes—changing technology, changing therapies, changing approaches to diabetes management. Basically, the information provided here will help you take advantage of what’s “new and improved,” and ultimately make your diabetes control a little bit better and living with this chronic condition a little bit easier.

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With changes taking place all around us, what exactly has stayed the same? For starters, the goal of diabetes management is roughly the same: to manage blood sugar as effectively as possible so that it does not keep us from enjoying life to the fullest. The emphasis on self-management hasn’t really changed. Experts recognize that diabetes is the type of condition that involves countless choices and decisions on the part of the patient on a daily basis. To expect your doctor or nurse to be there all the time is a pipedream. We, as people with diabetes, must educate ourselves and obtain and use the necessary tools to manage effectively.

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One other constant through the years is hope. We all hope that doing the right things will produce the desired results. We also hope for a cure. Back in 1985 when I was diagnosed with type 1 diabetes in a Texas town called Sugarland (God’s honest truth!), my endocrinologist tried to convince me how lucky I was to be diagnosed when I was.

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“We’ve come a long way in recent years,” he said. “The way research is going, in five or ten years, your diabetes will probably be cured.”

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That was more than 25 years ago. Still no cure, but people are still saying, “In 5 or 10 years … we’ll have a cure.” Although there is some very promising research taking place, I’m not one to put my eggs in that basket. My personal goal, and what I emphasize to my patients, is to take the best possible care of their diabetes here and now. When a cure does finally come along—and it will—I want to be in the best of health and have no regrets about the effort I put in.

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Today, I can look back at the way diabetes was treated when I was diagnosed and say, “Man, those were the Stone Ages!” But you know what? Five or ten years from now, I’ll probably look back to today and think the very same thing. At least I hope so.

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Gary Scheiner’s Until There Is a Cure: The Latest and Greatest in Diabetes Self-Care releases on February 26, 2013. Preorder your copy now!

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Jessica Snyder is a member of the Publicity and Marketing Department at Spry Publishing. In 2012, she contributed to the Spry Publishing blog while working part-time.

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The Flu

by Jess Snyder

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Several months ago, Dr. John Zettelmaier wrote a very helpful article about influenza and the flu. Given the particular vehemence of this year’s flu strains and the shortage of vaccine in some areas, we thought it would be useful to revisit some of Dr. Zettelmaier’s information and to update you on the current flu situation.

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The flu is caused by the influenza virus, which comes in three strains—A, B, and C. The A and B strains are responsible for many of what most people consider the standard flu symptoms, while the C strain usually causes a mild respiratory illness that is not currently prevented by flu shots. New flu shots have to be given every year, because when the A strain of the virus makes copies of itself, it frequently mutates. Influenza A viruses are classified based on antibody responses to the proteins HA and NA, and these different types of HA and NA form the basis of the H and N distinctions among viruses. For example, the swine flu is H1N1 while the bird flu is the H5N1.

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The rapid onset flu symptoms are fever and chills, headache, muscle aches (myalgia), joint aches (arthralgia), malaise (generalized body discomfort), nasal discharge or stuffiness, sore throat, cough, and sometimes vomiting and diarrhea. You may need medical attention if you have difficulty breathing or shortness of breath, chest pain, abdominal pain, sudden dizziness, confusion, persistent or severe vomiting, returning fever, worsening cough, or any of those symptoms combined with underlying health conditions, such as diabetes, asthma, etc. When in doubt, consult with your doctor.

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Analgesics such as Tylenol or Advil can help with the aches, pains, and fever. There are several medications the doctor may prescribe for the flu, including Symmetrel®, Flumadine®, Relenza®, or Tamiflu®. These medications need to be started at the onset of the flu, and most folks go to the doctor’s office after suffering with the viral infection several days—too late for most antiviral medications to work properly.

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If you are unlucky enough to get the flu, cover your nose and mouth when you cough or sneeze. Wash your hands often. Avoid touching your eyes, nose, or mouth, and, if possible, wear a facemask. Drink clear fluids, get lots of rest, and see a doctor if you’re pregnant, have diabetes, heart disease, or asthma, or if you have a compromised immune system. For more information, the CDC has a very helpful web page on this year’s flu virus.

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As you may well know, flu vaccine supplies have been running low. People who are still interested in receiving a vaccine can visit the flu vaccine locator to find out where there are vaccines in stock. Even though the flu season has started, it’s never too late to consider getting vaccinated. Flu season tends to be unpredictable and can last from as early as October to as late as May. It takes about two weeks for the vaccination to develop enough in your body to provide protection, so the sooner the better!

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Jessica Snyder is a member of the Publicity and Marketing Department at Spry Publishing. In 2012, she contributed to the Spry Publishing blog while working part-time.

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Ask the Doctor: The Holiday Cold

by Dr. John Zettelmaier

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As 2012 comes to an end, we at Spry wanted to share with you some tips on how to stay healthy throughout the holiday season. This post from Dr. John Zettelmaier was originally published on December 28, 2011.

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Woman with Cold

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Every winter, from Thanksgiving through New Year’s Day, I get a “Holiday” cold. We travel a lot at this time and I want my doctor to give me antibiotics, in case we need them on our trips. He says, “No.” Why?

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Common cold symptoms include a runny nose, sore throat, sneezing, coughing, and sinus headaches. Sinus headaches usually are in the area above the eyes, below the eyes, or in the cheek bone space. The symptoms may last for days or up to two weeks.

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The reason your doctor doesn’t give you antibiotics to prevent or “cure” your cold is that that antibiotics can neither cure nor prevent. Most colds are caused by the rhinovirus. However, over 200 other viruses can cause colds. Antibiotics only work against bacterial infections and NOT viruses.

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Taking antibiotics for viruses can be harmful. In fact, indiscriminate use of antibiotics can lead to antibiotic resistance. Resistance works as follows—at any given time there is a bacterial pool that reaches a high enough population to cause disease. Antibiotics kill most but not all of the bacteria in the pool. Those that remain may not have been dividing (duplicating themselves), and the antibiotic did not get incorporated into the cell walls of the bacteria (killing them). But, since the pool population has decreased, your symptoms are gone. These last few bacteria with enough antibiotic exposure develop changes and become resistant, that is, never to be killed by that antibiotic again. This antibiotic resistance develops because only the sensitive bacteria are killed and the resistant bacteria are left to grow and multiply. Decreasing the inappropriate use of antibiotics is the best way to control resistance. Antibiotic resistance is considered one of the world’s most pressing public health problems. The problem is that the infections that were easily treatable with antibiotics now are not. When the antibiotic doesn’t work, the illness lasts longer and requires stronger and stronger and sometimes more toxic replacement antibiotics. Some of these resistant infections even lead to death.

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Then, how should I treat my cold?

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Your initial treatment usually consists of rest and over-the-counter (OTC) medications for symptom relief. We are NOT talking about “chest colds,” which is the common terminology for bronchitis/pneumonia, which I’ll discuss in a later post. Since OTCs are for symptom relief, use the OTC that fits the symptom.

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1. FOR PAIN/FEVER: acetaminophen, ibuprofen, or naproxen
2. FOR SORE THROAT: ice chips, sore throat spray, or lozenges
3. FOR EARACHE: pain medications (listed above) and a warm moist cloth over the ear that hurts
4. FOR RUNNY NOSE: saline nasal spray or decongestants
5. FOR SINUS PRESSURE: warm compresses, decongestant, pain OTCs, or cool mist vaporizer/humidifier

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But remember, many OTCs are NOT recommended for children younger than a certain age, so be sure to read the label on the package. IT IS BEST TO CONSULT YOUR DOCTOR BEFORE MEDICATING SMALL CHILDREN.

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When your symptoms include a temperature of higher than 100.4 F, last more than 10 days, or are not relieved by the OTC medications, it is time to visit the doctor and find out if, in fact, you have a common cold or something more serious.

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Since you are visiting others during the holiday season, remember good hand hygiene. In other words, WASH YOUR HANDS A LOT! Have a safe and healthy trip.

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John Zettelmaier, MD is a graduate of the University of Michigan Medical School, a member of the Beta Beta Beta Biological Honor Society, an American Board of Family Practice Diplomate, an American Academy of Family Physicians Life Member and Fellow, and a Life Member of the Michigan Academy of Family Physicians.

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The Insider’s Info on Cholesterol

by Julie Feldman

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There is nothing exotic or romantic about cholesterol—a waxy, fat-based substance that determines our cardiovascular health risks. Then why is it that cholesterol is the topic of dinner conversations and long walks on the beach? I think it is because of the idea that cholesterol is something we can impact or change. As a dietitian, there is no greater thrill than to see the results of my clients’ hard work revealed in the lowering of their cholesterol. By focusing on four main areas of your diet, you can put the “les(s)” back in cholesterol and improve your complete health profile.

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Cholesterol is manufactured in your liver, so it makes sense that when we eat animal-based foods there is going to be cholesterol in them—because those animals’ livers make cholesterol too! Our own livers make up to 4,000 mg of cholesterol per day, so it is important that we limit the amount of cholesterol we get in our diets. The American Heart Association recommends that cholesterol intakes be limited to less than 300 mg per day. To put that number in perspective, 1 egg has 213 mg of cholesterol (all of which is in the yolk), and one 4-ounce hamburger has about 100 mg of cholesterol. To see a complete list of the cholesterol content in common foods visit this link. A great way to decrease your daily cholesterol intake is to change a couple of meals each week from animal-based meals to vegetable-based ones. Several studies have confirmed that following a vegetarian or vegan diet helps to keep cholesterol levels in a desirable range.

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Total caloric intake impacts our cholesterol more than most people think. Overconsumption leads to weight gain, and we know being overweight increases our cholesterol and risk for heart disease. Most adults require between 1500 and 2500 calories per day, depending on gender, height, weight, age and activity level. Great websites including calorieking.com and myfitnesspal.com allow you to determine and track your target daily caloric intake, thus helping you to keep calories in check each and every day.
Fitting in fiber is essential to keeping cholesterol levels low. Fiber is helpful in this area in two main ways. First, fiber plays a unique role in the small intestine where it literally binds to cholesterol in the food that we have eaten and helps to excrete that cholesterol before it ever enters our blood stream. The fiber content in foods like Cheerios and Quaker Oatmeal is what allows them to boast about their ability to lower your cholesterol. Secondly, fiber helps to keep us feeling fuller for longer, thus reducing our daily intake and cravings for sweets. Adults need 25-35 mg of cholesterol each day. Children need 5 plus their age in grams of fiber each day. Fiber intake should be spread throughout the day and be included in part of each meal. Fiber is found naturally in foods like whole grain breads, cereals, pastas, rice, fruits, vegetables, beans, lentils and popcorn.

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Last but certainly not least is the requirement to change the types of fats you include in your daily diet. There are fats that are actually good for us. Those are the ones that help to keep your HDL (happy cholesterol) high, while keeping your LDL (lousy cholesterol) low. The types of magical fats that I am referring to are monounsaturated fats and a certain type of polyunsaturated fats called omega-3 fats. These fats, found in olive oil, canola oil, avocados, nuts, fish and flaxseed, should be included in small servings two to three times each day. Other fats, including saturated fat (butter, high-fat dairy, and meats), and trans-fats (margarine and processed liquid vegetable oils) negatively impact our cholesterol by making our total cholesterol and our LDL cholesterol go up. Many Americans were raised putting butter on everything. While removing butter from your daily routine may seem like a daunting task, rest assured that your taste buds will adapt. In fact, it only takes your body about three weeks to adjust to a new way of eating.

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There are very few things in life that we actually have control over. While some people have a genetic predisposition toward high cholesterol, the majority of us can control our cholesterol and should feel empowered to do so. After all, the only thing less romantic than cholesterol to talk about is a heart attack.

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When Should You Get a Mammogram?

by Jess Snyder

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Many women begin to receive mammograms at age 40, however, new research is causing a controversy within the medical community over when women should begin to receive annual or biannual mammograms. There are two opinions: one group is continuing to recommend that annual mammograms begin at 40, while the other group is advocating for an initial assessment at 40 which will then direct a personalized assessment of how often the woman should receive mammograms. Both sides are attempting to provide the most complete care for women by focusing on two different aspects of the diagnosis process.

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The first group of doctors is continuing to encourage an annual mammogram, preferring to err on the side of health versus harm. Even though the risk of developing cancer between the age of 40 and 49 is about 1%, women with a family history of breast cancer are at a much more significant risk of developing cancer. The time between when a cancerous growth begins and when it shows symptoms is called the sojourn time. For women in their 40s, that time is 2-2.4 years. So, if a woman does not receive annual mammograms and does have a cancerous growth, she may not have symptoms until it has been growing for 2 years. Since the 5-year survival rate is 98% for breast cancer that is caught early enough, doctors think that the few women who do develop breast cancer in their 40s may discover it early enough to experience the highest possible 5-year survival rate, if they receive annual screening. By screening all women over 40 annually, the one percent of women who do have breast cancer is given a much higher chance of survival.

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However, most women in their 40s who are told that they have a suspicious lump end up having a “false positive,” a growth that is not cancerous. Some healthcare providers think that the emotional stress of a false positive and the radiation from the x-ray are not worth the cost of an annual screening until the women are 50.

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Many who feel that the emotional stress and financial cost of annual mammograms at 40 are more damaging than previously indicated are now advocating that women should have an initial assessment at 40 to determine a personalized recommendation. This recommendation would be based on factors such as breast tissue density and family history. The breast has both glandular and fatty tissue, and women with more glandular tissue (or more dense tissue) exhibit growths that are more difficult to see on the x-ray. A woman with higher-density tissue and a family history where a first-degree relative, such as mother or sister, has had breast cancer may be recommended to have annual exams due to greater risk factors. However, a woman with low breast density and no family history of breast cancer may only need a mammogram every 3-4 years until she turns 50.

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Dr. Diana Petitti who has worked on the US preventative Services Task Force study says, “Personalized breast screening recommendations are better.” Talk with your doctor about your family history and your wishes in order to form the best healthcare plan for you.

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Jessica Snyder is a member of the Publicity and Marketing Department at Spry Publishing. In 2012, she contributed to the Spry Publishing blog while working part-time.

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9 Things to Tell Your Physician about Your Headaches

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Dr. Gary Ruoff has worked with pain and headache management for much of his career as a family care physician. His new book, Knock Out Headaches, details his extensive knowledge about how to communicate with your physician about your situation, manage your headaches, and find a way to “get your life back.” In the following excerpt, Dr. Ruoff is back with more information about how to communicate with your doctor about your headache by keeping a headache diary.

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The first step in treating your head¬aches is to understand them. By keeping a thorough diary of your headaches, you and your physician will be able to identify triggers and recognize patterns, which will lead to a more successful treatment plan.

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Use a scale of 0 to 10 to indicate the level of pain you experience: 0 being no headache, and 10 being the most severe head¬ache you’ve ever had. Use these general guidelines for pain: severe headaches keep you home from work and in bed; mod¬erate headaches allow you to stick it out, but you are suffering quite a bit; and mild headaches are noticeable but do not interfere with your tasks.

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When keeping a diary, you should:
1. Record the date and time the headache began.
2. Indicate the intensity of the pain, using the 0 to 10 scale, as well as what part of the head is affected, including your neck and shoulders.
3. Notice what you were doing when the headache began—exercising, working, resting, or reading, for example.
4. List any associated symptoms, such as phonopho¬bia (sensitivity to sound), photophobia (sensitiv¬ity to light), nausea, or vomiting.
5. Note what you ate or drank in the 24-hour period prior to the onset of your headache, par-ticularly known dietary migraine triggers.
6. Jot down what you were feeling before the head¬ache occurred—were you angry, sad, stressed out, or feeling depressed?
7. Explain what you did to make yourself feel bet¬ter, such as resting in a dark room, or taking OTC painkillers or migraine medications. Did these help? Did anything make you feel worse—physical activity, bright lights, or loud noises?
8. For women, note whether you are on your men¬strual period or what day of the cycle you are on.
9. Record when the headache subsided.

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Be sure to put your headache diary somewhere handy and noticeable, such as the refrigera¬tor or next to your bed, so you don’t forget to use it. Fill out the diary for at least a month before you bring it to your physician. Sometimes, certain patterns or triggers are readily apparent, and other times, it may take months. Be patient and hang in there.

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Jessica Snyder is a member of the Publicity and Marketing Department at Spry Publishing. In 2012, she contributed to the Spry Publishing blog while working part-time.

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Read other articles by Jess Snyder

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Knock Out Headaches Releases, Available for Review

Knock Out Headaches Cover

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Knock Out Headaches Releases, Available for Review

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October 2, 2012, Ann Arbor

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Spry Publishing and headache expert Gary E. Ruoff, MD, today released Knock Out Headaches, a book that provides education, support, and inspiration to sufferers of chronic pain from headaches.

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Knock Out Headaches helps patients identify the warning signs that indicate they need to be treated, educates them on the different types of headaches and available treatment options, suggests strategies to enable optimal doctor-patient partnerships, and provides support stories from other patients who have succeeded in managing their headache symptoms. Covered within the book are the most recent advancements in headache research, diagnosis and treatment, from traditional medications to progressive, alternative techniques.

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The book also features a foreword by Seymour Diamond, MD, Executive Chairman and Co-Founder of the National Headache Foundation.

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Review copies of Knock Out Headaches are currently available to interested media. Dr. Gary Ruoff is available for interviews for print, radio, or television. His area of expertise is pain management and he is qualified to comment on a wide variety of topics in that subject area.

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Read the entire release.

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Dr. Gary E. Ruoff is a founder of the Westside Family Medical Center in Kalamazoo, Michigan, and presently serves as Director of Clinical Research at that facility. His main research interest is pain therapy and management, including headache and acute and chronic pain. Dr. Ruoff serves on several advisory boards for pain and pain therapy and has received numerous awards for his research work.

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Meet Dr. Gary Ruoff

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Dr. Gary Ruoff, MD, is a family practitioner in Kalamazoo, Michigan, and he has devoted much of his career to headache and pain management. In his new book, Knock Out Headaches, Dr. Ruoff shares his knowledge on how to manage your headaches so that you can move beyond just dulling the pain to being able to function fully. I talked to Dr. Ruoff to learn more about him and what motivates him to keep practicing and learning about headache management.

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Can you tell us a little bit about yourself?
I have been married for 47 years with two children. My son is a physician in primary care and sports medicine, and my wife and daughter work in education. When I’m not working, I’m playing piano, collecting stamps, and doing other interesting things I think are necessary to keep a focus in life.

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What made you want to do what you’re doing?
Headaches are a situation that I have a lot of respect and empathy for, and the willingness to help patients take care of headache and pain problems. That’s probably the real reason why I’m doing what I’m doing.

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Why did you feel you had to share the information in your new book?
Too many of my patients were living with the idea that just having something to take the edge off is enough. It’s not enough. Patients should be headache free or be able to conduct themselves on a daily basis without disability. They should able to do everything that they want to do without worrying about their headaches.

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What is your favorite piece of information that you share in your book and why?
What I like about the information in Knock Out Headaches is that it empowers the patient to direct the care of their headache through non-pharmacological means and through questions to take to their doctor in order to properly make a diagnosis and develop appropriate treatment.

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What tips or advice would you share with your readers?
Lifestyle change is essential! They must go to bed and wake up at same time, eliminate caffeine, chocolate, MSG, and things like NutraSweet. “Oh, there’s nothing I can eat! I can’t do this!” they may say. But the patient has to stick to some lifestyle changes in order to take care of their headaches.

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How does your family feel about the book?
Two members of my family suffer from migraines so they are looking forward to it. My family feels it’s fantastic that there will be more resources to help the patients who suffer so greatly from their headaches.

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What do you wish people would ask you about more?
I would hope that they would ask me more about the etiology of headaches and how they come about. Patients have to realize that it’s not their fault. It’s not that they have so much stress and anxiety; it’s actually inherited. Headaches are in the genes. If the patient is extremely sensitive to sensory stimuli—such as light, sound touch and taste—all of these may affect the patient when given the correct circumstances, forming a migraine.

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Jessica Snyder is a member of the Publicity and Marketing Department at Spry Publishing. In 2012, she contributed to the Spry Publishing blog while working part-time.

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How to Talk to Your Doctor about Your Headaches

by Jess Snyder

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Do you often experience headaches?

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Are you frustrated because nothing will fix your migraines and you are ready to give up?

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Dr. Gary Ruoff has spent his life helping headache sufferers to receive an accurate diagnosis and find a way to reduce or even alleviate their migraines. In his upcoming book, Knock Out Headaches, Dr. Ruoff offers this information on how to talk to your physician:

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“It sounds easy enough: you go to the doctor because you want to get better, and your doctor prescribes some type of treatment to help you do just that. But the process is far from simple.

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The first time you meet with a physician you may undergo a headache consultation which should delve into your medical history, all of your medications and treatments, and your dietary and sleeping habits. You may also be asked to submit to certain lab tests.

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It may seem like information overload, but gathering this data helps the doctor form a complete picture of you and your condition. This data gathering serves two purposes:
• For your physician to get to know you and for you to get to know him or her.
• To establish a baseline, or level of “wellness,” which will later be used as a comparison.
The more prepared you are, the more productive your visit will be. Don’t rely on your memory; write your answers down and bring them with you. If you have been keeping a headache diary, bring that along. List any specific concerns or questions you may have.

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Think about lifestyle issues. How much caffeine or how many alcoholic beverages do you drink each week, particularly red wine and champagne? How much MSG, and artificial sweeteners do you consume? Have an honest discussion with yourself regarding these issues.

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Before you go to this initial appointment, take some time to answer the following questions:
1. When did the headaches start?
2. How often does the headache occur?
3. What does the pain feel like?
4. Where is the pain located?
5. Are your present headaches becoming more severe or more frequent?
6. Is there anything you can identify that makes the headache worse, such as certain foods, drinks, activities, situations, etc.?
7. Do you have any other symptoms along with your headache, such as nausea, vomiting, dizziness, sensitivity to light or sound, or tingling of the extremities?
8. What do you think is causing your headaches?

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Being prepared with as much information as possible prior to seeing your doctor will help him/her to make a more accurate diagnosis. Also, don’t be afraid to voice your fears. Remember, honest communication is essential in this partnership.

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It is, most often, the headache sufferer who comes back to thank me for “giving me my life back.” Why are headache patients so grateful? Because many of them have reached a point of surrender. Perhaps you have also reached that point. If so, I urge you not to give up.”

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Do you feel like your doctor understands you? What is the best way that you have found to talk with him or her?

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Read other articles by Jess Snyder
What Triggers a Headache?
Five Things to Remember in Your Child’s 504 Plan
5 Ways to Avoid Phishing Scams
Internet Bullying
Pancreatic Hope

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Jessica Snyder is a member of the Publicity and Marketing Department at Spry Publishing. In 2012, she contributed to the Spry Publishing blog while working part-time.

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What Triggers a Headache?

by Jess Snyder

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Coffee and Chocolate

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Are you running out of patience with your migraines? Have you tried everything and the headaches still keep coming?

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Dr. Gary Ruoff understands the pain of a migraine. In his upcoming book, Knock Out Headaches, he details many tips and strategies to help with migraine management. In the following excerpt, Dr. Ruoff discusses headache management and what triggers to look out for.

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Two of the most important concepts in headache management are thresholds and triggers. Each headache patient has a threshold for particular triggers, and when that threshold is exceeded a headache will occur. Let’s use the example of a glass of water—the threshold is the top of the glass and the water represents potential migraine triggers. If you keep pouring “water” into the glass, you will eventually reach the point of overflowing, causing a headache.

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What are those triggers? Just as the symptoms, duration, and severity of headaches are different for everyone, so are the triggers or combination of triggers. Potential migraine triggers come in many forms, including:
• Environmental factors, such as changes in weather or altitude
• Hormonal fluctuations
• Sensory stimuli, such as perfume, tobacco smoke, flickering lights, and loud noises
• Changes in habits, such as sleep patterns and work schedule
• Stress or other emotional crisis
• Some medications, including painkillers
• Certain foods and drinks

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However, the most common triggers are dietary. The four main dietary triggers I see in migraine patients are caffeine, chocolate, MSG, and certain artificial sweeteners.

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Now, you may be saying, I don’t get a headache every time I eat chocolate or drink coffee. On any given day, you may have a glass of water that is already half full due to unavoidable factors such as rising heat and humidity, the lack of sleep, or increased stress over a big project at work. Then, you add more “water” to that glass in the form of a soda with caffeine, or a diet soda loaded with artificial sweetener. This combination of triggers cause the water to reach the top of the glass and spill over the sides, and you end up with a headache.

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The whole idea here, and I can’t stress this point enough, is that you must decrease the number of triggers or risk factors in order to successfully manage migraines. A patient who identifies and decreases his or her potential triggers can often manage migraines without medication, or with minimal use of medication. There are many triggers that are unavoidable or difficult to avoid, so the trick becomes steering clear of the triggers you can control. You don’t want to indulge in your favorite chocolate treat or a large latte on a day when there is a thunderstorm, because the change in barometric pressure is already a potential trigger. You can’t control the weather, but you can control what you eat or drink.

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If you can’t escape the situation, make sure you don’t make it worse.

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What headache management techniques have worked for you? Would you be able to give up caffeine if it meant your headaches would improve?

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Read other articles by Jess Snyder
Five Things to Remember in Your Child’s 504 Plan
5 Ways to Avoid Phishing Scams
Internet Bullying
Pancreatic Hope
Sweet Treats

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Jessica Snyder is a member of the Publicity and Marketing Department at Spry Publishing. In 2012, she contributed to the Spry Publishing blog while working part-time.

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Pancreatic Hope

by Jess Snyder

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Insulin

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The U.S. Food and Drug Administration recently approved outpatient trials as part of an Artificial Pancreas Project (APP) for the first time in the United States. This study, which is funded in part by the Juvenile Diabetes Research Foundation (JDRF), is the first APP test in the United States where patients do not stay in a hospital setting; instead, they carry out the requirements of the study while continuing their normal lives at home. The new artificial pancreas device imitates the behaviors of a real pancreas, the organ which does not function properly in individuals who have diabetes. The device would both monitor and control high and low blood sugar by using a continuous glucose monitor and an insulin pump. It would automatically monitor blood sugar levels and then emit the appropriate dose of insulin when needed, alleviating the need for users to perform the tasks manually. The FDAs approval indicates an important step towards developing guidelines and technologies that can assist in regulating and maintaining the health of individuals with type 1 diabetes.

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Moira McCarthy, the National Chair of Outreach for the JDRF and the mother of a daughter with type 1 diabetes, is enthusiastic about these developments, especially what they could mean for teenagers with type 1 diabetes.

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“I have great hope for the APP,” says Moira. “The artificial pancreas is a continuous glucose monitor combined with a pump that’s smart enough to do that work the teens do not want to do. Recent studies of the APP have found that teens benefit from it greatly. I have hope that in the near future we will have a tool that will help teens through their rough years.

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“I know a young woman who was diagnosed with type 1 as a small child who went into an inpatient APP trial during her college spring break. During the trial’s one-week in-hospital stay she was told to eat and drink as she pleased and live her life without thinking about diabetes while the artificial pancreas did that job for her. I wondered if she’d resent missing a spring break trip so I called her afterward and said, ‘So, how was it?’ She replied, ‘It was the best vacation I’ve ever taken in my life.’ That’s how much teens see diabetes as a burden. I will never forget that response, and it is part of the reason I understand the desperate need for better tools for the teens with diabetes. Until the cure is found, I really hope for better tools for these teens.”

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The type 1 diabetes community remains optimistic as further outpatient tests are scheduled for the summer of 2013 and as far into the future as 2015.

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Read other articles by Jess Snyder
Green Machines: How to Turn Fruits and Veggies into Summer Snacks
Teenie Weenie Size Ten to Fourteenie?
Exploding Safely
Sweet Treats: Cool Snacks for Children with Diabetes

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Jessica Snyder is a member of the Publicity and Marketing Department at Spry Publishing. In 2012, she contributed to the Spry Publishing blog while working part-time.

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Spry Publishing’s Expanding Diabetes List

by Jeremy Sterling

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Spry Publishing’s list of diabetes books continues to grow. One of our top objectives this year is to expand our presence within the diabetes community, and to that end, we have some very exciting recent developments to report.

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Kids First Diabetes Second Cover

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Our first printing of Kids First, Diabetes Second by Leighann Calentine arrived in our warehouse this week. We’re truly elated about the way that this book has come together and can’t wait to release it! Our official book launch will take place at the Friends for Life conference for children with diabetes, July 3¬–8. Leighann will appear in the OmniPod booth on July 6th and 7th, signing a special excerpt from the book that will only be available at the event. Visit Leighann at the conference to receive your FREE, autographed excerpt!

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Leighann’s Book Signings in the OmniPod Booth
Friends for Life Conference, Orlando, FL
Friday July 6th, 3:00pm–4:00pm
Saturday, July 7th, 11:00am–12:00pm

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In addition, we’ve recently signed with three heavy-hitters in the world of diabetes to produce books that will release in 2013.

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- Gary Scheiner, MS, CDE, Owner of Integrated Diabetes Services, is writing a book about the hottest new trends in diabetes management. This publication will serve to educate patients and health-care professionals alike, covering a wide range of topics, including lifestyle approaches, medication innovations, monitoring and measurement, preventing and treating complications, and the Web movement.

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- Respected diabetes activist, author, and journalist Moira McCarthy has signed with us to produce a book for parents of teenagers with diabetes. Moira is not only a tremendous writer who has successfully parented a teen with type 1 diabetes; she is also a seasoned author on the subject, having written four previous books, including The Everything Parent’s Guide To Children With Juvenile Diabetes.

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- Scott Benner, author of Arden’s Day, is currently writing a book of life lessons from a stay-at-home dad. The book will address a variety of topics from the perspective of a hard-working father who has overcome significant challenges by maintaining a positive attitude and a relentless sense of humor. Scott’s writing is hysterical, honest, poignant, and true. A perfect Father’s Day gift, it’s scheduled to release June 2013.

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Stay tuned here for more information about these and other great diabetes books from Spry Publishing!

Ask the Doctor: Concussions

by John Zettelmaier, MD

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Goats Butting Heads

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My child was “knocked silly” in football practice today. He wasn’t knocked out. Should I be worried about a concussion?

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Yes. In most cases, a person with a concussion never loses consciousness. Generally, a concussion is an injury to the brain presenting as a temporary loss of normal brain function. Being “knocked silly” and not unconscious is a concussion by definition. This means that your child’s brain function was disturbed. The child doesn’t have to “pass out” in order to have received a concussion. Brain function disturbance, CONCUSSION, is called by many names. Athletes frequently refer to being “dinged” or having had their “bell rung.”

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Concussion symptoms include any of the following after a blow to the head:

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- memory loss (amnesia—the best predictor of severity)
- prolonged headache
- visual disturbance (example, blurred vision)
- dizziness
- impaired balance
- confusion (foggy thinking or appears dazed or stunned)
- ringing in the ears
- difficulty concentrating
- sensitivity to light
- loss of smell
- loss of taste
- having trouble following a conversation
- trouble studying or forgetting instructions
- grogginess
- shows mood, personality, or behavior changes
- can’t recall events prior to the injury
- can’t recall events after the head trauma

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The brain is a soft organ that is protected by the hard boney skull. The skull protects the brain from trauma just as boney ribs protect the delicate lungs. The impact of a violent force to the head bounces the soft brain around and it hits the inside of the hard skull. The blow can make microscopic brain cell changes that are so tiny even a head CT scan (computed tomography scan) or an MRI (magnetic resonance imaging) can’t find the tiny brain cell changes. The CT scan and MRI are usually normal in concussions, because concussion is a functional rather than structural injury. But the small brain cell changes nonetheless may impact the thinking (cognitive) functions of the brain. Frequently after a concussion, the person may not even remember the causative event or the immediately following events. The doctor examines brain function by history questions (who is the President?), by thinking questions (count backward from 100 by 7s), and by examination of the cranial nerves (follow my finger, checking the pupils, etc.).

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Robert Cantu, MD, devised a set of guidelines that was adopted by the American College of Sports Medicine. Roughly, they are as follows:

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Grade I Concussion:
no loss of consciousness; athlete may return to play if no symptoms are present in one week.


Grade II Concussion:
brief loss of consciousness; athlete may return to play in one week if athlete has no symptoms.


Grade III Concussion:
slightly longer loss of consciousness or significant symptoms. Athlete is sidelined for one month and then, if no symptoms for a week after the one-month vacation, he/she may play.

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There are several scales or tests that physicians or sideline assessors use, including the SAC (Standardized Assessment of Concussions), the SCAT (Sport Concussion Assessment Tool), and the Glasgow Coma Scale, to name a few. They measure and rank thinking and motor functions of the brain, such as time, date, place, and motor responses to verbal stimuli or painful stimuli.

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Treatment for concussion is rest (the brain needs time to heal) and acetaminophen (Tylenol®).

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Athletes should always wear helmets or appropriate headgear when participating in football, batting, hockey, cycling, skiing, horseback riding, skateboarding, wrestling, or any other activity that presents opportunities for head injury. There are about 300,000 concussions each year from sports-related activity.

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So, if your child’s cognitive (thinking) process is ok and he/she doesn’t have any of the symptoms listed above, it is OK continuing the sport but, if you have any doubts, have the child checked over by a doctor.

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To learn more about preventing sports-related injuries, read The Awakening of a Surgeon by David H. Janda, MD.

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John Zettelmaier, MD is a graduate of the University of Michigan Medical School, a member of the Beta Beta Beta Biological Honor Society, an American Board of Family Practice Diplomate, an American Academy of Family Physicians Life Member and Fellow, and a Life Member of the Michigan Academy of Family Physicians.

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