A: In addition to basic pill sorters, there are medication reminder products and services that can help. For example, there are pharmacy services that can sort medications into individual packets. It is similar to a pill sorter, but you don’t have to sort the medications yourself. The packs include the name of the medication and when to take them. For example, if you take three pills in the morning and two at night, you will receive two packets for each day, sorted into a.m. and p.m. Most major pharmacies offer this service, usually at no extra cost. For some people, simple alarms set throughout the day can be enough. There are pocket-sized alarms that are easy to put in a purse or suitcase, or you can set cell phone alarms to perform that function. If you are tech savvy, there are many cell phone apps that can send medication reminders, keep track of refills, and more. Look for those that are HIPAA-compliant, which helps protect privacy. Ask your doctor or pharmacist to recommend an app.

It is helpful to have all your medications filled at one pharmacy. Specialty pharmacies, such as the one at UCLA, help patients understand complicated treatment plans and work closely with your doctors and specialists to coordinate your care. All pharmacists can provide a list of all medications as well as review them for potential negative drug-to-drug interactions and answer questions you may have about how and when to take medications. Many older adults are understandably frustrated by what we physicians call “pill burden.” That’s why it’s important to understand why you are taking a medication, what it can and can’t do, and possible side effects. Review your medications and your health goals annually with all your physicians. It’s possible there may be newer combination medications, or long-acting medications that are taken only once a day. When it comes to cancer treatments, some people might want something that has fewer side effects, even if it may not prolong life as much as another medication. It comes down to your goals of care and what it most important to you. Understanding the risk and benefits of treatments is essential, as is understanding if there are any non-medication options that may ease your condition. Discuss these subjects with your physician. Never stop taking a medication without talking with your doctor first. Some medications can be stopped abruptly, but others need to be tapered down.

The post Medication Management appeared first on University Health News.

A:  A migraine headache is a neurological condition (i.e., it’s a disease of the nervous system) and unlike other kinds of headaches, a migraine has other symptoms, such as nausea, vomiting, and dizziness. The pain is intense and can last four to 72 hours, it can affect one or both sides of your head, and the pain usually gets worse with activity. Other symptoms include being sensitive to light, sounds, and smells, and feeling weak. Some people with migraines have different triggers, such as stress and anxiety, certain foods/beverages, changes in hormone levels, inadequate sleep, sudden weather changes, and medication overuse, which can happen from long-term use of some prescription and over-the-counter medications. To help your physician diagnose yoru headache, keep track of what might be triggering your symptoms, when they started, what the pain feels like, how long it lasted and anything that might have helped relieve it. Try to recall any subtle changes prior to the commencement of the pain (e.g., mood changes, food cravings, frequent yawning, increased urination, or fluid retention). After the pain passes, some people feel drained, while others might feel elated. There are some prescription medications that can help prevent migraine symptoms as well as nonpharmaceutical remedies that may be helpful. Digestive conditions such as irritable bowel syndrome and celiac disease might be linked to migraines. Treating these conditions may help reduce or eliminate migraine occurrence.

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A: Both gallstones and kidney stones are common and can exist without causing any pain or problems, unless they move or become large enough to block the normal flow of fluids in their associated organs. Kidney stones develop in the kidneys and can affect any part of your urinary tract. Key culprits to kidney stone formation include a diet high in sodium, red meat, oxalates (compounds found in such foods as leafy greens, some fruits, and nuts), and inadequate hydration. Symptoms include painful urination and sharp pain in the lower back or side that can travel down to your groin. Nausea and vomiting also may occur. Kidney stones may pass through the urinary tract (which can be quite painful). Treatments include medications to dissolve the stones, shockwave therapy, and surgical removal.

Gallstones form in the gallbladder, which is a small bag-like organ connected to the liver and intestines through tiny tubes called bile ducts. The gallbladder stores bile, a liquid produced by the liver that helps you digest fat. Most gallstones are composed of cholesterol. When the stones cause blockages, the most common symptoms occur suddenly after a fatty meal and include severe pain in the upper-right side of the abdomen that can last from 30 minutes to several hours, waxing and waning. Pain may radiate to the back or under the right shoulder; and nausea and vomiting may occur. If the pain is mild and intermittent, avoiding fatty foods and pain medications may prevent or reduce it. Small gallstones that don’t get stuck in the ducts can be passed through the stool. There are several nonsurgical treatments for dissolving and breaking apart the stones. If those aren’t an option, your doctor may recommend gallbladder removal, which is typically done through minimally invasive laparoscopic surgery. After removal the gallbladder is not missed because its function is basically as a storage bag. Without it, the bile flows directly from the liver to the small intestine. A high-fat diet can contribute to the formation of gallstones. A plant-based diet rich in fiber and magnesium may reduce the risk of formation.

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A: There have been many studies that show that light at night, particularly blue light emitted from digital devices, disrupts sleep. Over the long term, poor sleep has been linked to many health problems, including diabetes, reduced immune function, obesity, and high blood pressure. Last year, a small study published in Sleep Medicine investigated the effects of pre-bedtime blue-light exposure on the ratio of deep sleep and sleep quality. In this study, 11 healthy young men were exposed to three conditions for one hour before bedtime: 1) incandescent light, 2) blue light, or 3) use of blue light-blocking glasses. The following morning, subjective sleep quality was assessed by measuring sleep time, ratio of sleep, ratio of deep sleep, and body movements during sleep. The researchers found that deep sleep was significantly decreased in the blue-light exposure group compared with the groups with incandescent light and blue light-blocking glasses. There were no differences noted in sleep time or body movements among the three groups. These results suggest that blue-light exposure affects sleep quality by reducing the ratio of deep sleep. Deep sleep is important to many aspects of health, including cognitive function, replenishing energy stores, and repairing muscles and tissues. Though blue light at night appears to be the most powerful robber of restorative sleep, any kind of light can suppress melatonin, the hormone your brain releases in response to darkness. Compared to blue, green light has far less impact, and red has been found to have a very modest impact on sleep. It can be tough to avoid blue light. For example, even though the light appears to be white, energy-efficient LED light, such as that from spiral-shaped bulbs, contains more blue light than incandescent bulbs. LEDs are also used in TVs, computers, smartphones, and tablets. For better sleep, avoid using those devices in bed, and keep the room cool (60 to 70 degrees Fahrenheit) and quiet.

Q: I am a 72-year-old woman, and I lost my life partner to COVID in 2020. I stress out around the holidays and may be drinking more than I should. How do I know when I’ve crossed the line?

A: The holidays can be especially difficult when you lose a loved one. Many people turn to alcohol to help them cope during difficult times. Don’t be too hard on yourself, but do try to seek some support and know when to seek professional help. Red flags include not being interested in activities that were pleasurable, not socializing with friends and drinking instead and feeling like you need alcohol to cope. Alcohol has a powerful effect on the brain, producing pleasurable feelings and blunting negative feelings. These feelings can motivate some people to drink alcohol again and again, despite possible risks to health and well-being. Research shows that over time, drinking to cope with stress—while it may provide temporary relief from emotional discomfort—tends to enhance negative emotional states between bouts of alcohol consumption. These changes can motivate further drinking and cause you to become stuck in an unhealthy cycle of alcohol consumption. Signs that you’re drinking too much also include frequently drinking more than you should or for longer than you planned; spending a lot of time thinking about getting more alcohol and recovering from it; and your tolerance has gone up (e.g., drinking several glasses of wine whereas before you only drank one). Sometimes just asking the question is a clue that you need to seek support. You don’t need to hit rock bottom. It’s best to talk to someone sooner rather than later. That can be a mental health provider, your primary care physician, or talking to a trusted advisor, such as a friend or member of the clergy. Find nearby treatment centers by doing a ZIP code search at findtreatment.gov. Telehealth providers that may be able to help you. Be leery of those who over-promise. The newly launched national 9-8-8 Suicide & Crisis Lifeline provides 24/7 service to anyone in suicidal crisis or emotional distress.

The post Ask the Doctor December 2022 appeared first on University Health News.

A: The most common cause of difficult or painful swallowing is called dysphagia. It can be caused by a problem with the muscles or nerves involved in the swallowing process or by a physical problem that impedes food from going down. There are two main types of dysphagia.Esophageal dysphagia feels like there is something caught in your throat. It’s usually a structural problem rather than a neuromuscular disorder. Possible causes are gastroesophageal reflux disease (GERD), a condition in which acid from the stomach flows backward into the esophagus, irritating the esophageal lining; and an abnormally shaped esophagus that sometimes occurs in older adults. Oropharyngeal dysphagia makes it difficult to maneuver food toward the back of the throat. This condition usually has a neurological cause, but can also result from cancer or Zenker’s diverticulum, a condition where small pouches develop in the upper throat and prevent the esophagus from relaxing. This inhibits solid food and liquids from moving down the throat.

There are several tests that can diagnose dysphagia types. For example, an x-ray can reveal changes in the shape of the esophagus. A pH test can measure acid reflux. Treatment depends on the cause and can include medications (antacids, or drugs like Tagamet or Pepcid AC that decrease stomach acid), endoscopic interventions, or surgery might also be indicated. A speech therapist can teach you exercises that might help coordinate your swallowing muscles or restimulate the nerves that trigger swallowing. Changing the consistency of food and liquids to make them safer to swallow might be necessary. A 2019 study showed that peppermint oil tablets taken before a meal may be helpful for people who have trouble swallowing and noncardiac-related chest pain. Peppermint oil is believed to soothe the muscles in the lower esophagus, making swallowing easier. Peppermint oil tablets are generally considered safe when taken in recommended dosages. Nonetheless, you should talk with your doctor about your swallowing issues to rule out any serious conditions and find the best treatment options for your situation.

Q: My eyes often feel dry and itchy. What can I do about this?

A: Many people describe dry eye as you do—gritty, dry, and itchy. Other typical symptoms include sensitivity to light, excessive tearing, redness, and burning. Many people ignore these symptoms. You’re wise not to. Dry eye disease is not always a passing nuisance. In some people, it may lead to impaired vision or vision loss. Persistent dry eye is a treatable medical condition. You can try over-the-counter (OTC) artificial tears. Ask your doctor for a recommendation. There are liquid drops, gels, and ointments. You may have to try a few different products before you find the one that is right for you. Preservative-free drops cost more but can be used more frequently (preservatives can be irritating). Some products contain omega-3 fatty acids because of their known anti-inflammatory effects. The FDA recently approved an OTC eye drop, Keto fumarate ophthalmic (brand name Alaway Preservative Free), which is an antihistamine designed to soothe itchiness due to allergies from pet dander, grass, and pollen. It may provide up to 12 hours of relief. If OTC products don’t work, there are also prescription medications. Also, pay attention to your environment. For example, drier indoor air in winter can irritate eyes. Using a humidifier to increase moisture can be useful. Ceiling fans, however, can make matters worse. When it’s windy outdoors, use eyeglasses that wrap around your face or have side shields. When using the computer, reading, or focusing on close work such as crossword puzzles or needlepoint, take breaks by looking away periodically, and use reading glasses, if needed, to reduce eye strain. Dry eye affects more women than men because postmenopausal declines in hormone levels can reduce tear production and subtly increase inflammation.

The post Ask the Doctor November 2022 appeared first on University Health News.

A: Metabolic syndrome is a combination of risk factors that greatly multiply your chances for heart disease, diabetes, and stroke. It is diagnosed when you have three or more of the following conditions: abdominal obesity (waist circumference 40 inches or greater [men] or 35 inches or greater [women]); triglyceride level of 150 mg/dL or greater; HDL cholesterol of less than 40 mg/dL in men or less than 50 mg/dL in women; systolic blood pressure (top number) of 130 mmHg or greater, or diastolic blood pressure (bottom number) of 85 mmHg or greater; fasting glucose of 100 mg/dL or greater; insulin resistance or glucose intolerance (the body can’t properly use insulin or blood sugar). When you have these risk factors together, your chances for cardiovascular problems are greater than if you have any one factor presenting alone. For example, having high blood pressure alone is serious, but high blood pressure along with high blood sugar levels and abdominal obesity, a common characteristic of metabolic syndrome, means there is a much greater chance of cardiovascular problems and diabetes because of the combination of risk factors. The underlying causes of metabolic syndrome are poor diet, being overweight or obese, physical inactivity, and genetic factors. Switching to a healthier diet, losing weight, and getting more exercise are the cornerstone treatments. While virtually any healthy diet that helps a person lose weight can improve some features of the metabolic syndrome, researchers are working to sort out which diet works best. The Mediterranean-style diet combined with low-glycemic load foods is often recommended. The Mediterranean diet consists of minimally processed foods, lots of vegetables, fruits, unrefined grains, olive oil, legumes, seafood, fish, and poultry with moderate consumption of red wine, dairy, eggs, and rarely, red, and processed meats. Low-glycemic-index (GI) foods are those that minimize sharp spikes in blood sugar. Generally, the idea is to avoid starchy foods, highly processed foods, and sugary baked goods. Low-GI foods include apples, grapefruits, carrots, broccoli, peppers, whole grains, unsweetened Greek yogurt, and legumes. A registered dietitian can devise the ideal eating plan and behavioral strategies that meet a person’s health needs and dietary preferences.

Q: We recently moved to a new city. Can you provide us with some tips for finding a good hospital?

A: There are several free online grading systems that can help pinpoint specialties valuable to your health-care needs. A 2019 report in the New England Journal of Medicine (NEJM) recommended the U.S. News & World Report (health.usnews.com/best-hospitals). The website provides overviews on national rankings of specialties and performance. For example, UCLA Medical Center in Los Angeles is ranked #3 on the Best Hospitals Honor Roll, the #1 hospital in California & Los Angeles metro area, and nationally ranked in the top 5 in Diabetes & Endocrinology, Gastroenterology & GI Surgery, Geriatrics, Ophthalmology, Orthopedics, Psychiatry, and Pulmonology & Lung Surgery. The NEJM also called out the Centers for Medicare and Medicaid Services (medicare.gov/care-compare), which has a star rating comparison and lots of details on how to find the best hospitals for your needs. The report includes an overall star rating based on how well a hospital performs across different areas of quality, such as treating heart attacks and pneumonia, readmission rates, and safety of care; and a patient survey rating that includes ratings on nurse/physician communications, responsiveness, cleanliness, and noise. Make sure that preferred hospitals as well as physicians are covered by Medicare and your supplement plans. The new federal “No Suprised Act” shields consumers against unexpected bills from out-of-network providers and facilities. For details on the No Surprises Act, go to www.cms.gov/nosurprises.

Finally, let your voice be heard by filling out patient surveys. At UCLA Health PFAC members are a visible and valued part of our care team. 

The post Ask the Experts: October 2022 appeared first on University Health News.

A: Memory care and assisted living facilities provide many of the same services, but there are important distinctions. Assisted living facilities offer “levels of care.” For example, level one may include verbal reminders for bathing and dressing, whereas level two includes hands-on help with the same activities. The more services offered, the greater the monthly fee. In contrast, memory care facilities are typically all-inclusive. However, many assisted living facilities offer levels of care that are suited for residents who have dementia and those who do not. For example, music and art therapy programs can be enjoyable and relaxing for everyone. Medication management and dressing assistance are common options as well. Depending on the degree of dementia symptoms, it’s possible that a person can start off in an assisted living and then transition to a memory care unit, if needed. For people with mild dementia, it can be more inspiring to be with a mixed population.

If a person wanders (typically a later-stage symptom), facilities require placement in a memory care unit. These units provide security so that a person can’t just walk out and get lost. Entrances and exits are locked, doorways may be obscured, require keys or codes to enter, and doorbells typically signal entering and exiting the unit. The layout in memory care units is designed to help minimize confusion and orient residents. Memory care units also include round-the-clock care and supervision. This is useful for people who need a lot of direction throughout the day, frequently lose things, and those with combative and inappropriate behaviors. All residential care facilities have their own evaluation processes that help pinpoint whether their assisted living or memory care offering is best for a particular person. Facilities that offer transitions of care can make moving into memory care less stressful. It also enables residents to maintain continuity of care with staff and healthcare providers.

Q: I took an online quiz for personalized supplements that are supposed be specific to my health needs. Are they worth the cost?

A: The cost of personalized supplements can range from $30 to $100 per month, depending on how many supplements are recommended. Companies typically offer a deep discount on the first month and then make their money on ongoing subscriptions. The supplements typically include those that can be purchased for less in stores (e.g., vitamins, minerals, probiotics, omega-3s, protein powder, collagen and electrolytes). Though companies promote that their supplements will be personalized, how they make that determination varies widely and is questionable. Recommendations may be based on a few quiz questions, such asking about whether you exercise on a regular basis, sleep well, and if you have any digestive issues. DNA tests may be recommended, but research does not show that DNA tests are reliable for creating customized dietary supplements. Some companies offer the support of a dietitian, but most do not. The better option would be to consult with a registered dietitian who can create a custom eating plan and behavior-change strategies that can help you meet your specific goals. Your physician can conduct blood tests to determine vitamin levels and recommend what may be needed.

What these companies are capitalizing on is an emerging field of science called nutrigenomics, which is still evolving. It’s a fascinating field based on genetic testing to assess the interplay between genes, nutrition, and health. The field is exploring how nutrients influence the behavior of a person’s genes and which dietary choices might be best given your genetic makeup. But the field is new and not quite ready for a broad mass market approach. Studies show that foods, not supplements, are the optimal way to obtain needed nutrients. Supplements have their place, but they don’t replace a nutritious diet and they are not without risk. Talk with your doctor or pharmacist before taking supplements, especially if you’re taking any medications. 

The post Ask the Doctor: September 2022 appeared first on University Health News.

A. As of 2020, the Centers for Disease Control and Prevention (CDC) says hepatitis C screenings are recommended for all adults ages 18 and older at least once in a lifetime. According to the CDC, four in 10 people don’t even know they have it, which is why screenings remain important. Heavy alcohol use, toxins, some medications, and certain medical conditions can all cause hepatitis. However, hepatitis is often caused by a virus, and in the U. S., the most common hepatitis viruses are known as hepatitis A, B, and C. Although each type can cause similar symptoms, they are spread in different ways and can affect the liver differently.

Hepatitis A is usually a short-term infection. Hepatitis B and hepatitis C also can begin as short-term infections, but in some people, the virus remains in the body and causes chronic infection. There are vaccines to prevent hepatitis A and hepatitis B, but there is no vaccine for hepatitis C. Many people newly infected with the hepatitis C virus don’t have symptoms, don’t look or feel sick, and therefore don’t know they are infected. For people who develop symptoms, they usually happen two to 12 weeks after exposure to the hepatitis C virus and can include yellow skin or eyes, poor appetite, joint pain, and fatigue. Some people clear the virus, but more than 50% will develop a chronic infection. Left untreated, chronic hepatitis C can cause severe liver damage, liver cancer, and even death. But hepatitis C is curable. The first step is to be screened, which involves a blood test.

Q. My eyelids are starting to droop. What might be causing this?

A. There are two common medical conditions related to droopy eyelids: blepharoptosis (ptosis for short) and dermatochalasis. Ptosis is caused by muscle weakness or paralysis. It can affect one or both eyes. In adults, ptosis is usually caused by aging, eye surgery, or disease affecting the levator eye muscle or its nerve. For example, a stroke that affects the eye can cause ptosis. In addition to a drooping eyelid, people may experience eye fatigue and difficultly completely closing the affected eye. Ptosis is usually corrected with surgery to tighten the levator muscle. Surgery to remove excess eyelid tissue (blepharoplasty) may also be done at the same time. The other condition, dermatochalasis, refers to droopy eyelids due to excessive and lax eyelid skin, usually due to gravity and age-related weakening of connective tissue. Some diseases, such as thyroid-related eye disease and Ehlers-Danlos syndrome (a connective tissue disorder), also may cause dermatochalasis. Both ptosis and dermatochalasis can be much more than just a cosmetic concern because they can interfere with your vision. Untreated, these conditions can compromise safety, making everyday activities dangerous, including driving, cutting vegetables, and using the stairs. The most effective treatment for both conditions is surgical removal of the excessive skin and tightening of the levator muscle. Insurance generally covers the procedure, if the lid is affecting your vision.

Q. Is it true that eating certain foods can ease chronic pain?

A. Pain results from inflammation, and what you eat can either stimulate or quell inflammation. So, yes, diet can play a role. Eating a lot of fried, sugary, and highly processed foods negatively affects the immune system, triggers inflammation, and can contribute to pain. A diet rich in plants has been found to reduce inflammation. A recent study in The Journal of Clinical Medicine linked the Mediterranean diet to lower levels of inflammatory markers in the body. This diet is rich in whole grains, dark green leafy vegetables, nuts, fruits, olive oil, and fatty fish, such as salmon and sardines, which is high in omega-3 fatty acids, a fat known to reduce inflammation. In contrast, sugary foods such as cookies and sweetened drinks, and highly processed foods such as bacon and hot dogs can increase inflammation and should be limited or avoided.   

The post Ask the Doctor: August 2022 appeared first on University Health News.

Q. I understand that ticks can carry Lyme disease. What are the symptoms?

A. Lyme disease is an infection caused by the bacterium Borrelia burgdorferi, commonly spread by the blacklegged tick. The symptoms of Lyme disease are many and varied and can take weeks or longer to manifest. Flu-like symptoms are common in the early stages. You may, or may not, get or even see the classic bullseye rash following the tick bite. The rash is commonly missed because it can be on the calf or somewhere on the body that can’t be easily seen. Early-stage symptoms of Lyme disease include a rash, fever, chills, body aches, and sometimes facial paralysis. Later-stage complications of the disease include arthritis. A single inflamed joint is most indicative of Lyme arthritis. Very rarely, the disease can affect the heart, a condition called Lyme carditis. In the majority of cases, it is successfully treated with oral antibiotics. In some patients, symptoms such as fatigue, pain, and joint and muscle aches, persist even after treatment, a condition termed post-treatment lyme disease syndrome (PTLDS). In people who have nonspecific symptoms after being treated for Lyme disease and who have no evidence of active infection, studies have shown that more antibiotic therapy is not helpful and can be dangerous. Along with a thorough physician’s exam, blood tests are used to diagnose Lyme disease. If you know you have been bitten, take note of when your symptoms began, and tell your doctor about all the medications and supplements you are taking. When hiking in areas known for ticks, wear long sleeves, tuck your pants into your socks, and use repellent that contains 20 percent or more DEET, picaridin, or IR3535 on exposed skin for protection that lasts several hours. Afterwards, tumble dry clothes in the dryer on high heat for at least 10 minutes to kill any ticks that may be on clothing. Ticks can attach to any part of the human body but are often found in hard-to-see areas such as the groin, armpits, and scalp. In most cases, the tick must be attached for at least 36 to 48 hours or more before the Lyme disease bacterium can be transmitted. Remove the tick as soon as possible and avoid leaving any pieces by carefully removing the whole tick with tweezers. The bullseye rash develops in about seven days following a bite. Regardless, if you feel sick a few weeks after a tick bite, see your doctor.

Q. I am hosting a picnic in a park and want to keep it healthy and safe. Can you recommend some picnic-friendly foods?

A. When planning your menu, think simple foods that travel well, won’t get soggy, and taste great at room temperature. For shared foods, those that are easy to pick up with a fork are best. Hearty salads are also ideal for picnics. Flavorful grains combined with summer fruits create a dish bursting with the season’s best flavors. Potato salad is a picnic favorite, which can also be made without mayo (try mustard or nondairy mayo), which holds up better in the heat. In general, any food that has mayonnaise, garlic, or animal product should be kept cold (< 40F) until it is time to eat and needs to be re-packaged and stored within one to two hours to be the most food safe. Peanut butter and jelly sandwiches are an excellent picnic choice for kids, and kids at heart. Mix it up by using different nut butters (e.g., sesame, cashew, almond), hearty breads and crackers, and sugar-free jams (e.g., strawberry, blueberry, peach).

Sturdy baskets, canvas bags and coolers are must-haves for any picnic outing. VIP nonfood items for your list include sunglasses, sunscreen, plenty of water, cloth napkins, hand sanitizer, dish towel, reusable or recyclable plates, cutlery, shatter proof BPA-free glasses, trash bags, extra containers for packing up dirty dishes and utensils, insulated beverage bags, and a large heavy blanket (ideally waterproof on the bottom). Be sure to have plenty of ice packs for perishables. Pack the heaviest items at the bottom of your basket or bag, with the lighter more fragile fare on top. As for leftovers, three days in the fridge is the limit. In the freezer, items can last up to six months, if well-sealed to prevent freezer burn. Once thawed, an item should not be refrozen.

The post Ask the Doctor: July 2022 appeared first on University Health News.

Passing exams and continuing education programs are customary for healthcare and medical degrees, though state requirements do vary. These are the general requirements. A medical doctor, MD, requires a pre-med bachelor’s degree (four years), and four years of medical school followed by a residency/internship hospital program that includes from three to seven years of education, depending on the area of specialty. For example, a geriatrician is a MD who has completed four years of medical school plus a three-year residency program and a one-to-two-year geriatric fellowship. Along with the required bachelor’s degree, that’s a minimum 12 years of intensive study/training. A registered nurse (RN) must earn a degree from an accredited nursing institution and pass a national exam. The amount of schooling varies depending on where a person lives and where they hope to practice. For example, an associate’s degree in nursing takes about two years to complete, but more employers prefer applicants who have completed their bachelor’s degree in nursing (BSN), which takes about four years. A nurse practitioner, NP, is a registered nurse with additional graduate school education and clinical training. He or she is nationally certified in one of several specialties, such as acute care or women’s health. It can take six to eight years to become a NP. In contrast, a licensed practical nurse, LPN, program takes about a year. Programs are typically available at community and technical colleges. LPNs provide basic nursing care, such as checking blood pressure and inserting catheters. CNAs, certified nursing assistants, are commonly employed by assisted living facilities to help with activities of daily living such as dressing, bathing, and other healthcare needs under the supervision of an RN or LPN. Physician assistants certified (PAC) are not physicians, but they do earn their master’s degrees at medical schools. PAs/PACs provide primary care services and can diagnose and treat illnesses, prescribe medications, and interpret lab work and imaging. PAs/PACs are licensed to practice medicine under a physician’s supervision, but that does not mean the physician has to be present. Most physician assistants take between seven and nine years to complete training.

I frequently feel tired, and a friend suggested I might be low in vitamin B₁₂. I’ve seen offers at stores in the mall for vitamin B₁₂ shots. Is it OK to try these?

Your friend is correct in that vitamin B₁₂ deficiency is known for causing fatigue, but being tired can have many causes, such as sleep apnea, insomnia, dehydration, and some medications can also make you feel tired, too. It may seem like there’s no harm in getting these shots at your local mall, but I advise caution. Vitamin injections, and vitamin supplements for that matter, are best prescribed by a doctor after your blood levels have been checked. The shots are typically prescribed for people who have difficulty absorbing vitamin B_12, and that does occur in older adults. The reason is that after age 50 we tend to produce less stomach acid and are less able to efficiently absorb B₁₂ from the diet. Thus, a B₁₂ deficiency becomes more common as the decades pass. The main food sources of vitamin B₁₂ are animal products such as eggs, fish, meat, and dairy. So, people following a vegan or vegetarian diet may be low in the vitamin and need to supplement or look for foods that contain added B vitamins. Other people who may need supplemental shots include those who have had gastrointestinal surgery. Vitamin B₁₂ plays crucial roles in maintaining the health of blood cells, the digestive system, brain, and nervous system. While fatigue is sometimes a symptom, recent research shows that many people have vitamin B₁₂ deficiency without anemia or significant fatigue. Instead, they may have numbness and/or tingling in the hands and feet and dizziness.

The post Ask the Doctor: June 2022 appeared first on University Health News.