The Doctor Is In

By Peter Hanna, M.D., Special to The Explorer

Until recently, type 2 diabetes was also known as adult-onset diabetes. Now, it is no longer called adult-onset diabetes because so many children are developing the condition.

According to the National Institutes of Health, the prevalence of obesity has nearly tripled in adolescents in the past 20 years. About 3,700 youth under 20 years old are diagnosed with type 2 diabetes each year, and the disease is particularly prevalent in minority youth.

The racial and ethnic groups at higher risk for developing type 2 diabetes include African Americans, American Indians, Hispanic Americans, and some Americans with Asian or Pacific Island backgrounds.

What is type 2 diabetes?

In general, those with type 2 diabetes have abnormally high blood sugar levels because their pancreas either produces too little insulin, or their bodies are resistant to the insulin that is produced. (Insulin is the hormone that transports the glucose into the body’s cells.)

Like adults with type 2 diabetes, children with the condition are at increased risk for serious health problems such as heart disease, kidney disease, and blindness later in life.

Type 2 diabetes has an inherited component. Still, biology isn’t destiny.

Obesity is a big trigger for diabetes. Weight gain, or fat, especially in the abdomen, increases the body’s demand for insulin and interferes with the body’s ability to use it properly. To prevent type 2 diabetes, help your children stay at a healthy weight.

Be a role model

Helping kids stay lean and fit is a tall order. The message kids get on television is to eat junk food and drink sugar-containing beverages such as soda. Schools often have unhealthy choices for children in the vending machines.

Still, you can help your kids keep their weight in check. In fact, your encouragement and actions may be the only thing they’ve got to counteract societal messages that promote weight gain.

As a parent, you set a huge example for your children. Your example carries a lot of importance, so make sure you practice what you preach. To get your kids into the exercise habit, for example, do what you want your kids to do rather than just urging them to go outside and play.

Participating as a family in lifestyle kinds of exercise, such as bike riding, hiking, walking, running, basketball, and tennis—fun activities that can carry over into adulthood—or even just playing in the park sends a strong message.

Eat dinner together

Likewise, to expand your children’s palates and help them learn to make healthy food choices, which, in turn, can help them avoid obesity, make family meal time a priority.

Why is this so important? Family dinners can promote healthy eating habits and encourage the consumption of a wide variety of healthy foods.

Not only will they eat by example, but new foods also will become less foreign when everyone has some. Of course, you may have to serve a new food 10 times before your children will try it. But don’t give up, or make an issue out of eating it.

To increase the likelihood your children will try a new food, have them help you select it in the supermarket and prepare it at home. If they don’t like a new food, experiment with different preparations. Don’t force your child to eat anything.

Don’t serve family style

To help your children get in touch with their hunger cues so they learn to stop eating when they’re full, don’t serve meals family style. It may encourage overeating. Portion out food in the kitchen and bring it to the table.

Also, model proper portion sizes yourself and let your kids know if they want more, they can have some if they’re still hungry.

Temper TV watching and eating

When it comes to weight gain, watching TV has a bad reputation—and for good reason. Eating in front of the television promotes mindless eating, and often overeating. Restrict food, including snacks, to the kitchen.

(Editor’s Note: Peter Hanna, M.D., is a Family Medicine physician practicing with Northwest Allied Physicians. His office can be reached at 825-0300.)

By Jyotsna Sahni, M.D., Special to The Explorer

The link between sufficient sleep and good health is well established. A growing body of research gives added weight to the argument that shorting yourself on sleep may shorten your life – by significantly raising your risk of heart problems.

More than 40 million people in America suffer from chronic sleep problems. Insomnia, the most common sleep problem, affects 30 percent of adults – around 60 million individuals – in America. Another 18 million Americans have sleep apnea and, of these, 80 to 90 percent are undiagnosed.

Insomnia involves the inability to fall asleep and remain asleep, all night. Sleep apnea is the interruption of sleep due to reduced air intake when the muscles of the throat weaken and the windpipe fails to stay open during breathing.

Sleep disorders can have serious effects on heart health, by raising the risk of heart disease, heart attack, heart failure, and stroke. Individuals with sleep difficulties may have as much as a 45 percent higher risk of a heart attack, according to the American Heart Association.

While studies have demonstrated the detrimental effects of insufficient sleep on the heart, the relationship between the two is not clearly defined. Studies show that insufficient sleep does not directly cause heart disease, but increases the risk factors for heart disease: weight gain, stress hormone production, and high blood pressure, to name a few.

Shortened sleep duration – less than six hours – can have a variety of negative effects on heart health. Researchers theorize that, because blood pressure and heart rate fall at night, sleeping for shorter durations does not allow sufficient time for this restorative cycle of lowered heart rate and blood pressure to take place. Therefore, the heart has to work harder, and blood pressure remains elevated, which can damage the heart, long-term.

Adults who sleep fewer than six hours per night also produce more of a protein that is usually released during stress or when inflammation is present in the body. High levels of stress hormone and inflammation are also risk factors for heart disease.

Insufficient sleep can also lead to calcium deposits in the arteries, narrowing the pathway for blood flow and raising heart attack risk, according to a 2008 study at the University of Chicago. This landmark study of 495 men and women ages 35 to 47 documented the exact risk of shortened sleep: one hour less on average each night can increase coronary calcium by 16 percent. Among this group, 27 percent of patients who got less than five hours of sleep each night developed plaque in their heart vessels; compared to just 11 percent among those sleeping five to seven hours and only 6 percent of people who slept more than seven hours nightly.

A 2011 European Heart Journal review of 15 medical studies involving almost 475,000 people found that short sleepers had a 48 percent increased risk of developing or dying from heart disease in a seven to 25-year follow-up period (depending on the study) and a 15 percent greater risk of developing or dying from a stroke during this same time.

If you suffer from excessive sleepiness during the day, or have other symptoms of sleep deprivation or a sleep disorder (see sidebar), talk with your doctor about undergoing an assessment to determine your sleeping habits.

Sleep disorders can be diagnosed through some simple tests, including a sleep study, in which the patient is observed during sleep to detect patterns of interrupted sleep, abnormal heart rate and rhythm, and much more. Treatments may include a continuous positive airway pressure device, weight loss, surgery on the windpipe, sleep aids to promote optimal body positioning while sleeping, and dental devices to promote good airflow.

(Editor’s Note: Jyotsna Sahni, M.D., is a board-certified Sleep Medicine physician practicing with Northwest Allied Physicians.  Her office may be reached at 742-1565)

Symptoms of Sleep Trouble

Having trouble catching enough ZZZ’s? Symptoms of sleep deprivation or sleep disorder can include:

• Daytime fatigue

• Decreased alertness or concentration capabilities

• Inability to stay asleep at night (irregular sleep patterns)

• Morning headaches, or waking and feeling not well rested

• Snoring, snorting or gasping for breath during sleep (often first noticed by a sleeping partner)

By Michael Yim, M.D., Special to The Explorer

Attention-Deficit, Hyperactivity Disorder (ADHD) affects an estimated five to eight percent of school-aged children throughout the United States. Every day, millions of students attend class suffering from key symptoms of the disorder including inattention, distraction, over-activity and impulsivity. While each of these symptoms can be a part of normal childhood behavior, children with a diagnosis of ADHD suffer from multiple symptoms beyond what is normal given a child’s age and development.

Currently, treatment for ADHD focuses on reducing the symptoms and improving functioning. Treatments include medication, which is not a cure, but effective only as long as it is being taken. Other treatments include various types of psychotherapy, education or training for parents, teachers and children, or a combination of treatments.

ADHD and the Classroom

Often, teachers are the first to notice the symptoms of ADHD, when a child has trouble following rules, or frequently “spaces out” in the classroom or on the playground. Although the medical condition of ADHD can only be diagnosed by a qualified, licensed medical or mental health professional trained in the diagnosis and treatment of ADHD, the school is most likely seeing the impact of ADHD symptoms on your child’s education or behaviors at school. 

While they cannot formally diagnose ADHD, teachers and other school personnel can play an important role by evaluating your child’s learning ability and determining educational deficits. This information should be part of the comprehensive evaluation done by the medical or mental health professional. 

It is also important for teachers to have the needed skills to help children manage their ADHD. Since the majority of children with ADHD are not enrolled in special education classes, their teachers will likely have some techniques like:

• Use a homework folder for parent-teacher communications

• Make assignments clear

• Give positive reinforcement

• Be sensitive to self-esteem issues

• Involve the school counselor or psychologist

To Medicate, or Not to Medicate?

Parents of kids with ADHD face a tough choice: whether to medicate their children or not. It’s a touchy subject, and it got even thornier after recent reports linked popular ADHD drugs to increased health risks, including heart problems, and over-use.

But the top experts at the American Academy of Pediatrics, as well as at other professional groups for ADHD and cardiology experts, say the drugs are safe.  Medications to treat ADHD are 80 to 90 percent effective, and reports of major problems are extremely rare.

Understandably however, many parents are reluctant to medicate their young children, and so there’s lots of interest in alternative treatments. Alternatives to the stimulants used to treat ADHD include ongoing counseling for the child, educational support in the form of smaller classes and individualized attention, tutoring, and training in social skills. Some parents have turned to such different treatments as biofeedback, megavitamins, and blue-green algae. Any alternative treatments should be discussed with your health care provider before trying them.

What’s a parent to do in choosing the right treatment for their child with ADHD?  Have careful discussions with your child’s doctor.

Here’s what to cover:

• Is it possible that medications might help? How likely is it?

• If your child uses medication, what is the right dose to start with?

• How closely should your child be monitored? How often should you see or call the doctor?

• What is the role of diet, counseling, or behavioral therapy? They may offer help with or without medication.

• How can you get teachers and other school officials to help?

(Editor’s Note: Michael Yim, M.D., is a Family Medicine physician practicing with Northwest Allied Physicians.  His office may be reached at 825-5719 or www.mytucsondoc.com)

By Joel Moncivaiz, M.D., Special to The Explorer

We’ve all had days when we’ve felt down and nothing seems to go right. However, if those bad days outnumber the good and you can’t seem to shake the “blahs,” don’t minimize these feelings as just a “blue” period. Feelings of intense sadness, helplessness or hopelessness enduring for more than a few days and as long as several weeks — and begin to interfere with your ability to function on a daily basis — may be clinical depression.

Clinical depression is a common condition, affecting more than 19 million Americans each year – and it can happen to anyone, regardless of age, race, gender, or health status. Despite this, only half of Americans diagnosed with clinical depression receive treatment for it, according to the National Institute for Mental Health (NIMH). Many people tend to explain away their symptoms, dismiss them as a personal weakness rather than a legitimate medical condition, or try to treat symptoms on their own. This can actually make the condition worse, because most people who experience depression need treatment to get better – and early treatment is more effective and decreases the likelihood of a recurrence down the road.

Causes

Depression has many causes: biological (internal factors in our biological make-up), cognitive (mental issues), genetic (relating to one’s family background or development), and situational (based on one or more external life events). Often, depression is the result of a combination of these factors. While there is no single cause, here are a few common factors:

Women are more likely to develop depression than men – possibly due to hormonal changes associated with the menstrual cycle, pregnancy, childbirth, and aging.

Some medications can cause depression.

Depression is more likely to occur with certain illnesses: heart disease, stroke, cancer, diabetes, hormonal disorders, Parkinson’s disease and Alzheimer’s disease.

Studies have also linked depression with early stages of multiple sclerosis, or brain changes that result after a significant health event such as heart attack or traumatic brain injury.

Recent research links depression with a broad variety of health conditions, with depression serving either as a trigger or an outcome of the condition. Studies have also shown that depression can develop from causes as far-ranging as allergies to inadequate B-vitamin intake in the diet; and that depression itself can contribute to conditions weight gain or greater pain sensitivity.

Side Effects

Depression can increase your risk for certain chronic conditions, or make the symptoms of existing conditions worse. Individuals with Type 2 diabetes and major depression are more likely to experience life-threatening diabetes-related complications, according to an NIMH study. Depression has been linked to thinning bones in pre-menopausal women. And one in four cases of obesity has been linked with depression or anxiety disorders, according to research.

Signs, Triggers & Symptoms

Symptoms of depression are not the same for everyone. The specific symptoms of depression, their severity and duration, differ from one individual to another. Many people experience a combination of symptoms. Health experts consider a patient to have a diagnosis of depression when at least five of these symptoms occur nearly every day for at least two weeks. Other chronic health conditions that either contribute to, or develop as a consequence of, depression must also be treated.

If you’re struggling with symptoms of depression, talk first with your family physician. Your doctor can conduct a physical exam, psychological evaluation and tests to rule out other possible causes, such as a medication, virus, or other health issue that can mimic symptoms of depression, such as a thyroid disorder. Your doctor may also use a simple questionnaire to determine the severity of your symptoms. You may be referred to a mental health professional for a complete diagnosis, evaluation and treatment. An initial evaluation typically will encompass any family history of depression, a complete list of symptoms, including duration and severity, any prior treatment, thoughts about death or suicide, and any alcohol or drug use. Depression is often treated with medication, therapy or a combination of the two.

 If you feel that you’re experiencing some symptoms of depression, talk to your doctor and schedule an appointment for an evaluation. Your symptoms may be caused by an unrelated health condition that can be simply resolved, or, if depression is the diagnosis, early detection and prompt treatment are most effective.

(Editor’s note: Joel Moncivaiz, M.D., is a Family Medicine physician practicing with Northwest Allied Physicians.  His office may be reached at 818-0300 or www.mytucsondoc.com)