10 things to know — Insurance status a factor in adolescent scoliosis surgery

How does insurance status impact scoliosis surgery outcomes and cost?

A group of researchers examined the Healthcare Cost and Utilization Project Kids’ Inpatient Database for 2000, 2003, 2006 and 2009 for patients under 18 years old who underwent surgery for idiopathic scoliosis. They included patients who had no underlying neurological disorders and underwent fusion procedures. Their results were published in Spine.

 

There were 19,439 surgical procedures estimated in the United States from 2000 to 2009 with 4,766 of those patients having Medicaid. The remaining 14,673 patients had private insurance. Here are 10 key notes from the study:

 

1. The number of spinal fusions for pediatric idiopathic scoliosis increased steadily from 2000 to 2009. In those nine years, spinal fusions for pediatric idiopathic scoliosis increased 18 percent.

 

2. The patients with private insurance were more likely to undergo surgery than Medicaid patient. There were 7.7 per 100,000 capita patients with private insurance, compared with 5.9 per 100,000 capita of Medicaid patients.

 

3. The patients with private insurance were slightly older on average than Medicaid patients — 13.9 years old versus 13.4 years old — at the time of surgery.

 

4. The Medicaid patient population who underwent spinal fusion for pediatric idiopathic scoliosis also tended to have a higher prevalence of other issues:

 

• Asthma: 10.8 percent vs. 7.4 percent
• Hypertension: 1.3 percent vs. 0.4 percent
• Hyperlipidemia: 0.3 percent vs. 0.1 percent
• Diabetes: 0.8 percent vs. 0.3 percent
• Obesity: 2.6 percent vs. 1.5 percent

 

5. The patients with Medicaid insurance were more likely to undergo more fusions involving nine or more vertebrae. There were 43 percent of the Medicaid patients who had nine or more levels fused, compared with 33.9 percent of private payer patients.

 

6. There were similar rates for in-hospital complications:

 

• Neurological: 1.8 percent for Medicaid vs. 1.7 percent for private
• Infections: 0.3 percent for Medicaid vs. 0.2 percent for private

 

7. The length of stay was longer for patients with Medicaid than private pay patients. The Medicaid patients stayed an average of 6.1 days in the hospital, versus 5.6 days for the private insurance patients.

 

8. The hospital costs were also higher for the Medicaid patients — $45,443 — compared with $41,635 for the private insurance patients.

 

9. There were several factors associated with lower rates of in-hospital neurologic complications, including:

 

• South and Midwest regions
• Older age
• Female sex

 

10. The factors associated with higher rate of in-hospital neurologic complications include:

 

• Cardiac disease
• Obesity
• Refusion

How to Deal with Social Anxiety: 5 Powerful Tips!

Do you fear that you will be judged by others in social situations? Do your fears cause you to avoid groups of people or group events because you think you might embarrass yourself? Do these fears sometimes overwhelm you? If you answered yes to these questions, you may have a condition called social anxiety disorder.

At its core, social anxiety (aka: social phobia) is all about a fear of being embarrassed or judged by others in small or large groups. These feelings can seemingly crop up without provocation and can strike at the most inopportune times; such as family events, concerts or even walking on a city street. Other examples include crowded shopping malls, nightclubs and birthday parties.

The good news is that social anxiety is treatable. Common treatment approaches includepsychotherapy,meditation and in some cases, prescription medications. By working closely with your medical doctor and counseling professional, you can move through your fears and move on to a place of greater happiness.

What follows are five tips for coping with social anxiety. Consider employing these are part of a comprehensive approach to anxiety management. Are you ready? Let’s jump right in!

social anxiety 5 tips

1. Know What You are Getting Into

A good rule for going into a social situation is to know what exactly you need to be prepared for at an event. This is not always possible, as gatherings tend to pop up unexpectedly, but you can still look ahead to that big party next month that you are required to attend. Access the situation at hand, find an estimate on the number of guests invited and attending, know the setting, and find ways to prepare for the evening. That way, you are able to go into a social event with previous knowledge of what to expect, giving you at least a little bit of peace on what is about to happen.

2. Step Back from the Situation As Needed

If you find yourself in a situation where it is hard to breathe, give yourself permission to step away for a moment. Do not try to tough it out; this will only make matters worse. A little bit of alone time and some fresh air can do wonders for the brain and for your anxiety disorder. You can avoid being flustered and feeling stressed by simply making time for yourself while at the event.

3. Keep a Journal

Journaling helps with many things, but one of the tremendous attributes of it is being able to ease your social anxiety. When you journal, you are able to write down everything that you feel and anything that concerns you. This can be done on a daily basis, an occasional basis, or even just right before an event to relieve your worries onto a piece of paper. The satisfaction of getting out your feelings helps to take away those thoughts from your mind, thus giving you more peace on the issue and preventing you from over thinking your anxiety.

4. Know Your Limits

Along with stepping back from the situation comes knowing your limits. Part of preparation for an event involves evaluating where your weak points are and working to overcome them. While at an event, be careful of your limits and know when you are overstepping your own boundaries. It is better to step away from the scene for a moment than to continue and walk away from the event disappointed in your actions.

5. Find a Therapist

One of the best ways to deal with social anxiety is to work with a therapist that is trained in helping people with this common anxiety disorder. Research suggests that cognitive behavioral therapy is one of the most effective treatment approaches. Therapy can help you learn a variety of concrete approaches used to help reduce the symptoms and in many cases prevent the onset of a panic attack.

Social Anxiety Final Thoughts

The current research suggests that somewhere between 5 – 13% of the population will deal with social anxiety disorder at some point during their lifetime. Studies suggest thatwomen tend to suffer more from social anxiety than men by a number of 3 to 1 however, it is believed that men underreport incidence of anxiety for cultural reasons. Social phobias are usually triggered by certain thoughts and events and can be traced back to adolescence or early adulthood. Social anxiety can also be related to past traumas

Thanks for stopping by! If you found this post helpful, please Like on Facebook. Circle on Google+ and share with others.

Struggle To live- Sarcoidosis – Carla Malcoms Story

I started having “weird” symptoms in March of 2006, with swelling of the face being the worst, so I went to my family doctor. He put me on an anti-inflammatory and sent me on my way. The symptoms got worse. My symptoms included: swelling in my eyes, face and neck; muscle cramps and twitching; dry eyes; night sweats; and fever. I went back to the doctor. He sent me to a specialist (I can’t remember what kind) who took a biopsy of the “fluid” in my face. It came back inconclusive. After many more back and forths with the doctor, he told me he wanted to admit me to the hospital to have them perform tests to determine what was going on. I went to the hospital, but they wouldn’t admit me because they said all I had was edema. I went back to the doctor. He referred me to a rheumatologist who took many vials of blood. 
media_xll_5313062
Several days later, the rheumatologist told me that they ruled out Mumps, Mono, Sjogren’s Syndrome, and a slew of others that I can’t recall. And the best diagnosis they could come up with was Sarcoidosis. I was told that this would be something I would have forever but that I may never have another symptom with it. So he put me on a 60-day prescription of Prednisone. After that 60 days, all my symptoms were gone, and I felt as well as I had before all the symptoms appeared. All was well … or so I thought.
Fast forward to April 9, 2013. I was chasing my puppy so she wouldn’t run out in the street (maybe 15 yards of running), and I was so out of air that I didn’t think I could WALK back to my house. I dismissed the notion that maybe it was because I was out of shape because I know my body, and this was different. So I went in to see my family doctor (I have a different one that the one I had in 2006). I asked her to test me for asthma. She took a chest X-Ray and had me breathe into a spirometer. The chest X-Ray had to be sent off, but she saw the results immediately from the spirometer, which confirmed asthma. She prescribed an inhaler and sent me on my way.
On April 18, 2013, my doctor called with the results of my chest X-ray, which revealed enlarged lymph nodes in my lungs and chest. She wanted me to have a CT scan the next morning, which I did. She called me the following Monday morning, April 22, 2013, and said that the CT scan confirmed the existence of the enlarged lymph nodes and wanted me to see a pulmomary specialist the same day, which I did. (Little did I know at the time that she suspected lung cancer.) 
After reviewing my CT scan, the lung doctor wanted me to have a bronchoscopy to biopsy some of the lung tissue, so that was scheduled for April 25, 2013. As I was still in the recovery room, he explained to my husband that whatever was going on with my lungs had been there for quite some time as there was some damage to my lower left lobe. And the airway leading into my left lung was only open about the size of a pencil head. We had to wait a week before we got the results.
In the meantime, the lung doctor wanted to give me a breathing test, which I did on May 1, 2013. Another confirmation that my airway was constricted, and he put me on Advair and Albuterol.
The following day, my husband and I met with the lung doctor to go over the results. He said, “The good news is it isn’t cancer; the bad news is it’s Sarcoidosis.” There’s that dreaded word again! He said at that time he wanted to treat it with a 12 day taper prescription of Prednisone and scheduled me to come back in four months for another breathing test and chest X-Ray. He also scheduled me to have blood work to see if it showed up in any other organs and told me to see an ophthalmologist to make sure it hadn’t gotten in my eyes. Both of those came back normal, thank God!
On Monday, May 13, 2013, (day 11 of the Prednisone), I noticed a burning, tingling sensation on the left side of my face that would come and go, sometimes mild, sometimes painful. So on  May 15, 2013, I went back to my family doctor. She ordered a Brain MRI and also wanted me to have another CT Scan (of my abdomen and pelvic area this time) as the previous CT scan showed enlarged lymph nodes in my stomach, which she never told me about. 
That same day, I had the Brain MRI (and I pray to God that I never have to have one of those again!). And the following day on May 16, 2013, I had the CT Scan. The brain MRI came back normal; the CT scan confirmed the existence of enlarged lymph nodes in my abdomen. At this point, my family doctor wants me to follow up with a rheumatologist, and I’m in the process of trying to find a doctor in the Dallas area (or even in the Texas area) who KNOWS about this disease, not just one who TREATS it.
The latest episode occurred last night while at the movies with my friends. Out of nowhere, I had an asthma attack where I couldn’t get any breath. That was my first such episode and hopefully my last. It scared all of us. 
The most frustrating part of this disease for me, as I’m sure it is for others suffering, is the unknown. It seems like after being fairly healthy all my life, all of a sudden, an onset of symptoms just appear out of nowhere. And although I appear fine, I feel like there’s a battle raging on the inside of me, and there’s not much I can do about it.
I empathize with the Sarcoidosis sufferer who has little to no symptoms, and I empathize with those who have many. And I pray for a cure. I’m thankful that my faith is strong.  God has carried me these last several weeks during all this testing, and I know without Him, I would be a basket case. But instead, I have had incredible peace. This peace and hope I send out to all of the other Sarcoidosis sufferers. Blessings to all!

Thank you,s

DOES HILLARY CLINTON HAVE AIDS? DONALD TRUMP SUPPORTERS SEEM TO THINK SO

It is certainly no secret that Donald Trump supporters are not the biggest fans of Hillary Clinton. The host of The Daily Show on Comedy Central decided to blend into a Donald Trump rally to see what Donald Trump supports had to say about Hillary Clinton’s health, body double, and all the other conspiracy theories that have been floating around as of late.

What is the latest Hillary Clinton conspiracy theory, you wonder? Well, one Donald Trump supporter seems to think Hillary Clinton’s health issues may be because she is actually sick with AIDS. This Donald Trump supporter goes on to speculate that Bill Clinton gave his wife AIDS. The supporter also believed Magic Johnson had something to do with it. Did one (or both) of the Clintons have an intimate relationship with Magic Johnson? This Donald Trump supporter seems to think so!

Check out the video The Daily Show shared on Facebook below to see what other Hillary Clinton conspiracy theories the host of the Comedy Central television show was able to uncover:

According to The Political Insider, while the theory that the Clintons had an intimate relationship with Magic Johnson might be a bit of a stretch, there may actually be some merit to the Trump supporters’ theory that Hillary Clinton is sick with AIDS. Authors Darwin Porter and Danforth Prince released a new book titled Bill & Hillary: So This is That Thing Called Love. The book features interviews from sources close to the Clintons.

One of the sources reveal that Hillary repeatedly has Bill get HIV tests from doctors because of how many women he has been intimate with. The source goes on to reveal this is a decision Hillary made because her husband preferred to be intimate with all of these women without protection.

While the sources went on to reveal that the very first tests came back negative, there is no public information about the rest of the tests as both Hillary and Bill have done a pretty good job keeping their medical records and history out of the public eye. The Political Insider speculates that Bill Clinton having AIDS would explain the rapid change in his appearance, his heart surgery, his new diet, and the fact that he looks dramatically thin and weak at all of his wife’s campaign rallies.

The Political Insider goes on to point out that George W. Bush and Bill Clinton are roughly the same age, and while Bush continues to look healthy, Clinton continues to look older and frailer. Furthermore, it goes without saying that AIDS would also explain the recent bout of medical episodes and issues Hillary Clinton continues to suffer from as well.

Dick Morris, Bill Clinton’s former advisor, has even come forward to say Clinton isn’t looking too great these days and is hard to recognize as he looks washed out and appears to be having a hard time thinking or speaking.

Pink News reports former basketball star Earvin “Magic” Johnson, Jr. has been living with HIV since the year 1991. So, while it is a stretch, he could have had something to do with the Clintons getting AIDS – if they have AIDS.

It goes without saying that some of the questions the host of The Daily Show on Comedy Central asked the supporters at the Trump rally were intended to mock them for believing Hillary Clinton conspiracy theories. For example, the host admitted to printing out two identical pictures of Hillary Clinton before asking supporters if they looked different or which one was the body double.

Could there, however, be any merit to the conspiracy theory that Hillary Clinton has AIDS? Share your thoughts in the comments section.
Read more at http://www.inquisitr.com/3536699/does-hillary-clinton-have-aids/#y1pFxOKMFJcHmxxi.99

Why Your Rheumatoid Arthritis Remission Didn’t Last

RA can relapse — even after years of remission. Learn why and what you can do about it.

Thanks to newer medications and more aggressive treatment strategies, remission has become increasingly possible for people with rheumatoid arthritis. In fact, about 50 percent can now achieve remission, according to a study published in Arthritis Research & Therapy in January 2014.

For some people, though, remission doesn’t last, and there are a number of reasons why. Although some factors may be out of your control, there are ways you can help prevent am RA relapse, says Grant Louie, MD, MHS, an assistant professor of medicine in the Division of Rheumatology at Johns Hopkins Medicine.

What Is RA Remission?

Remission doesn’t mean you are cured. A good way to think of it is that your disease is under the radar, or that you have little or no disease activity. Although there’s no one clear definition, there is a set of criteria that doctors use to determine when a patient with RA achieves remission, explains Dr. Louie.

Overall, to achieve remission there must be a significant reduction in your symptoms, such as less than 30 minutes of morning stiffness and pain. But, Louie adds, your doctor must also consider a number of other factors, including:

  • Physical findings. Your doctor will examine your joints for tenderness, swelling, and loss of mobility.
  • Blood tests. The erythrocyte sedimentation rate (ESR) test and the C-reactive protein (CRP) test measure overall levels of inflammation in the body. The rheumatoid factor (RF) test can also measures levels of an antibody associated with rheumatoid arthritis (RA).
  • Imaging tests. X-rays and MRIs can also reveal how RA has affected cartilage, bone, and joints.

Many people with RA who achieve remission experience a relapse at some point, according to a study published in 2012 in Arthritis Research & Therapy. The researchers followed 394 people with RA for two years, starting at the time they achieved remission. Over the course of the study, 50 percent of them experienced a relapse.

The researchers noted that even after many years of remission, RA could become more active.

Reasons for Relapse

When remission ends and symptoms return, several factors may be involved. One of the first things doctors usually consider is their patients’ medication.

“Sometimes patients are lulled into a false sense of security once they achieve remission,” Louie says. “They may feel that they no longer need to take their medication.” Because of that, “probably one of the highest risk factors for relapse is medical noncompliance,” he says. “Patients will self-taper or stop taking their medication altogether; then they experience a flare.”

Even if you are taking your medication correctly, however, a relapse can occur, according to a study published in the journal Rheumatology in 2012. Although biologic medications, including tumor-necrosis factor (TNF) inhibitors like adalimumab (Humira) and infliximab (Remicade), have enabled more people with RA to achieve remission, these drugs may become less effective for those who develop antibodies to them.

Also, if your doctor decreases your dosage or discontinues your medication because of a planned surgery or another illness, such as an infection, relapse can occur, according to Apostolos Kontzias, MD, a rheumatologist at the Cleveland Clinic.

 

Louie points out there are other factors that may reduce RA patients’ chances of achieving successful remission, including smoking, being obese, and having other health problems, all of which complicate RA treatment.

Preventing Relapse

If your RA is in remission, there are ways you can help prevent a relapse. First, take your medication as directed by your doctor — even if you are feeling well, advises Louie. If you need help keeping track of your medication, he recommends using tools like a pillbox, calendar, or smartphone app.

Next, follow up with your doctor regularly. You must be closely monitored, even in remission. Let your doctor know if you notice any changes in your symptoms. He says that this could be a sign that your medication needs to be adjusted.

Some lifestyle changes also could help prevent relapse, including:

  • Exercise. “Maintaining a regular exercise program is critical,” Louie says. Look for low-impact activities, like yoga, tai chi and swimming, and avoid high-impact exercises, like running, Louie says. “The stress of some repetitive activities can affect the joints and trigger a flare-up,” he explains.
  • Get Immunized. Infections can lead to a flare-up of your RA symptoms, Louie says.
  • Relax. Physical and emotional stress has been shown to influence RA activity, and avoiding these triggers could help prevent relapse, says Dr. Kontzias. Yoga and medication are great ways to de-stress, adds Louie. “Even though I do not like to remind patients that they have RA, it’s also mind over matter,” he says. “Patients need to pace themselves and not overdo it. Do things in small doses.”

Autoimmune Hemolytic Anemia in Sarcoidosis Patient Successfully Treated with Rituxan, CellCept Combo

Patients with sarcoidosis may develop a condition known as autoimmune hemolytic anemia, in which the red blood cells are prematurely destroyed by the immune system. Although this is not well documented, researchers at Warwick Hospital in England have reported the case of a patient who exhibited both illnesses.

Their study, “Steroid Refractory Autoimmune Haemolytic Anaemia Secondary to Sarcoidosis Successfully Treated with Rituximab and Mycophenolate Mofetil,” published in the journal Case Reports of Hematology, shows that these patients may be effectively treated with B-cell depletion therapies such as Rituxan (rituximab) and CellCept (mycophenolate mofetil).

Autoimmune hemolytic anemia is a condition that develops in 3 out of 100,000 people per year, and it is associated with poor outcomes. It is characterized by the production of antibodies that target proteins in the red blood cells, resulting in their premature degradation with the development of severe anemia. These patients often require blood transfusions; however, these can be problematic because the donor red blood cells are consumed rapidly and are difficult to match to the patient’s blood type.

Although its symptoms are not well-recognized in sarcoidosis patients, the authors of the study report the case of a 30-year-old women who had both diseases.

The patient had a two-day history of progressive dizziness, shortness of breath, jaundice, and abdominal pain. Clinical observation revealed lymphadenopathy, a common symptom of sarcoidosis, and splenomegaly, or enlarged spleen. Further analysis also revealed severe hemolytic anemia.

The patient received blood transfusions to treat her severe anemia, and then started on immunosuppressive steroid treatment with high-dose Prelone (prednisolone), which was reduced after two weeks when hemolysis (red blood cell destruction) was no longer observed and the patient did not require more blood transfusions.

The hemolysis recurred after four weeks and the patient was started on Rituxan and Imuran (azathioprine), but Imuran caused severe side effects and was replaced by CellCept. The patient responded well to the therapy, showing decreased lymphadenopathy and splenomegaly after three months on CellCept and Rituxan therapy, which allowed clinicians to reduce the dose of steroids that were being administered.

Although more studies are required to understand the relationship between these diseases, researchers believe that the same subsets of immune cells are involved in the development of both sarcoidosis and hemolytic anemia, which may explain why some patients get both illnesses at the same time.

This means that therapeutic agents such as Rituxan, which target the immune cells known to be involved in both diseases, are promising approaches for the treatment of these patients. But given that Rituxan often takes 8 to 16 weeks to induce a clinical response, other agents that inhibit the proliferation of immune cells, such as CellCept, may be used in combination with Rituxan to help reduce the dose of steroids in a timely manner.

The authors caution, however, that “effective treatment of autoimmune hemolysis in sarcoid patients is dependent on a better understanding of the pathophysiological link between sarcoidosis and hemolytic anaemia.”

How Can People With Narcolepsy Drive Safely?

It takes treatment and a dose of self-awareness.

For many people, avoiding fatigued driving means staying off the roads after pulling an all-nighter. But imagine driving when you have narcolepsy, a brain disorder that causes people to suffer from chronic daytime drowsiness and fall asleep suddenly. With narcolepsy, the dangers of drowsy driving become a perennial threat.

What can a person with narcolepsy do ― never drive?

Well, no, but there are some important caveats.

Joyce Scannell, an office manager at the Narcolepsy Network nonprofit who has had narcolepsy her whole life, says she never drives more than 20 minutes at a time.

“Luckily I work from home and my kids have moved out. So it’s just: Go to the doctor, go to the store, go home,” she said. “Because if I get into an accident, the state will make it really tough to get back my license.”

Each state has its own laws about the health conditions that can prevent resident from getting a license, as well as whether those conditions must be disclosed on the license itself.

Scannell, who lives in Rhode Island, was able to get a driver’s license, and doesn’t have to disclose on it that she has narcolepsy. Other states require narcoleptic drivers to be medicated and symptom-free for a certain period of time before they can obtain a license: For example, that period is a whole year in New York, but it’s just 90 days in Kentucky.

Treatment is the key to people with narcolepsy driving safely, sleep experts say. People with narcolepsy usually take a combination of stimulants and antidepressants to combat daytime sleepiness. The prescriptions are customized to the patient, Scannell said.

“Treated narcoleptic patients can drive safely,” said Dr. Emmanuel Mignot, a sleep researcher at Stanford University. “They have to take precautions, like napping before driving, not taking long drives that require stops, pulling over if sleepy, avoiding driving alone, and having emergency medication on hand for an emergency.”

“Of course,” he added, “we don’t let them do things like drive fuel-loaded trucks or fly commercial airplanes.”

People with narcolepsy are susceptible to the same high-risk periods as regular drivers, said Ohio State University sleep expert Dr. Meena Khan.

“The natural times that people tend to be sleepy are mid-afternoon (1 to 3 p.m.) and early morning (2 to 5 a.m.),” she told The Huffington Post. “This is when we have a natural drop in our circadian rhythm, which regulates alertness. Narcoleptics may be more susceptible to this given their condition.”

Napping for 15 to 20 minutes can help alertness, as can taking stimulant medication right before a long drive, Khan said.

“A sleepy driver can be dangerous no matter what the reason,” she said.

Scannell was diagnosed with narcolepsy 20 years ago, and said she has since become highly aware of when her body wants to sleep.

“Most of the time I know when an attack is coming on, so if that’s the case, I will pull over at a rest stop or, preferably, not even get behind the wheel,” Scannell said.

“If you don’t take a nap, your body will make you take one anyway,” she said about narcoleptic people who ignore the urge the nap.

How Can People With Narcolepsy Drive Safely?

It takes treatment and a dose of self-awareness.

For many people, avoiding fatigued driving means staying off the roads after pulling an all-nighter. But imagine driving when you have narcolepsy, a brain disorder that causes people to suffer from chronic daytime drowsiness and fall asleep suddenly. With narcolepsy, the dangers of drowsy driving become a perennial threat.

What can a person with narcolepsy do ― never drive?

Well, no, but there are some important caveats.

Joyce Scannell, an office manager at the Narcolepsy Network nonprofit who has had narcolepsy her whole life, says she never drives more than 20 minutes at a time.

“Luckily I work from home and my kids have moved out. So it’s just: Go to the doctor, go to the store, go home,” she said. “Because if I get into an accident, the state will make it really tough to get back my license.”

Each state has its own laws about the health conditions that can prevent resident from getting a license, as well as whether those conditions must be disclosed on the license itself.

Scannell, who lives in Rhode Island, was able to get a driver’s license, and doesn’t have to disclose on it that she has narcolepsy. Other states require narcoleptic drivers to be medicated and symptom-free for a certain period of time before they can obtain a license: For example, that period is a whole year in New York, but it’s just 90 days in Kentucky.

Treatment is the key to people with narcolepsy driving safely, sleep experts say. People with narcolepsy usually take a combination of stimulants and antidepressants to combat daytime sleepiness. The prescriptions are customized to the patient, Scannell said.

“Treated narcoleptic patients can drive safely,” said Dr. Emmanuel Mignot, a sleep researcher at Stanford University. “They have to take precautions, like napping before driving, not taking long drives that require stops, pulling over if sleepy, avoiding driving alone, and having emergency medication on hand for an emergency.”

“Of course,” he added, “we don’t let them do things like drive fuel-loaded trucks or fly commercial airplanes.”

People with narcolepsy are susceptible to the same high-risk periods as regular drivers, said Ohio State University sleep expert Dr. Meena Khan.

“The natural times that people tend to be sleepy are mid-afternoon (1 to 3 p.m.) and early morning (2 to 5 a.m.),” she told The Huffington Post. “This is when we have a natural drop in our circadian rhythm, which regulates alertness. Narcoleptics may be more susceptible to this given their condition.”

Napping for 15 to 20 minutes can help alertness, as can taking stimulant medication right before a long drive, Khan said.

“A sleepy driver can be dangerous no matter what the reason,” she said.

Scannell was diagnosed with narcolepsy 20 years ago, and said she has since become highly aware of when her body wants to sleep.

“Most of the time I know when an attack is coming on, so if that’s the case, I will pull over at a rest stop or, preferably, not even get behind the wheel,” Scannell said.

“If you don’t take a nap, your body will make you take one anyway,” she said about narcoleptic people who ignore the urge the nap.

The 5 Stages Of Parkinson’s Disease

There are five Parkinson’s disease stages.  This helps healthcare providers decide what treatment to recommend and to help families better understand how the condition progresses.  These categories include stages I through V, and can also be described as early, moderate, and advanced Parkinson’s disease.  The effects and severity of symptoms increases with each of these five stages.

Stage I (Beginning or Early Stage of Parkinson’s)

  • Signs and symptoms are only on one side of the body
  • Symptoms are mild
  • Symptoms are inconvenient but not disabling
  • Usually has tremors in one limb
  • Friends have noticed changes in posture, locomotion, and facial expression.

Stage II

  • Symptoms occur on both sides of the body
  • Minimal disability
  • Posture and gait are affected.
  • Medication may be started during stage I or II and typically involves one of the less powerful Parkinson’s disease medications.  This includes such drugs as:  Selegiline (Eldepryl, Zelapar, Emsam); an anticholinergic;  or a dopamine agonist, such as pramipexoleMirapex®) or ropinirole (Requip®).

Using these medicines first allows the healthcare provider to save the most powerful treatment (specifically, levodopa) for the time when people need it most.

Stage III (Moderate Parkinson’s Disease)

  • Significant slowing of body movements
  • Early impairment of equilibrium when walking or standing
  • Generalized dysfunction that is moderately severe

Stage III is when levodopa is usually first prescribed.  Stages III, IV, and V are when a person develops significant disability from Parkinson’s disease.  A person in stage III is considered to have moderate Parkinson’s disease.

Stage IV (Advanced Parkinson’s Disease)

  • Severe symptoms
  • The person can still walk to a limited extent
  • Rigidity and bradykinesia are present
  • Person is no longer able to live alone
  • Tremor may be less than earlier stagesStage V
    • Cachectic stage (general reduction in vitality and strength of body and mind)
    • Invalidism complete
    • Person cannot stand or walk
    • Requires constant nursing care

5 Warning Signs That Rheumatoid Arthritis Is Getting Worse

These signs and symptoms may offer clues to the seriousness of your rheumatoid arthritis.

One of the tricky things about treating rheumatoid arthritis is that this inflammatory autoimmune disease doesn’t progress the same in everyone who has it.

“I don’t know when I see someone over the first two or three visits how serious it will be,” says John J. Cush, MD, director of clinical rheumatology for Baylor Scott & White Research Institute and a professor of medicine and rheumatology at Baylor University Medical Center at Dallas.

Despite all the research that’s been done, who may develop severe RA and joint damage and whose joint damage will slow over time still remains somewhat of a medical mystery.

Guidelines from the American College of Rheumatology suggest that certain measurements, along with other tests, can help give you and your doctor a map as to how your rheumatoid arthritis disease may progress. Here are five things doctors look for:

1. The Number of Swollen, Painful Joints You Have

The more joints that are painful and swollen, the more severe the disease may be, says Dr. Cush. Joint pain and swelling are characteristic symptoms of rheumatoid arthritis. Rheumatologists consider this a very important way to measure disease severity.

Your doctor should examine joints in your hands, feet, shoulders, hips, elbows, and other spots to see how many are causing problems. Symmetrical symptoms, such as having the same swollen joints on both sides of the body, are also hallmark signs of RA, Cush says.

2. Rheumatoid Factor Blood Test Results

Rheumatoid factor (RF) is an antibody found in the blood that can trigger inflammation that may cause joint damage. While it’s a historic marker of the disease, new research shows that the presence of rheumatoid factor in the blood is not required for a doctor to make a rheumatoid arthritis diagnosis.

People whose blood tests don’t indicate RF or ACPA (some patients have ACPA positive and negative RF) have the seronegative form of the disease. As many as 80 percent of all people who have RA are considered seropositive because of their rheumatoid factor blood levels. The conventional wisdom is that those who have seronegative RA have milder symptoms, but a June 2016 article in BMC Musculoskeletal Disorders found that further research is needed to better understand the long-term outcomes of patients with seronegative rheumatoid arthritis.

3. ACPA Blood Test Results

This blood test checks for antibodies to a protein called citrulline. A positive anti-citrullinated peptide antibody (ACPA) test is a more specific marker for RA than rheumatoid factor, and is found in 70 to 80 percent of patients with the disease.

“ACPA testing detects peptides that are involved in key elements of the onset of the disease, and it is part of an association with a genetic risk factor for the disease,” says Cush. High levels of this antibody appear to be associated with more serious disease progression, but as with RF, the presence of those antibodies are not necessary for a doctor to make an RA diagnosis.

4. Imaging Test Results

X-rays, CT scans, MRIs, and ultrasounds are all tests that can help track and detect the severity of joint and cartilage damage. Bone erosion and destruction of cartilage can happen quickly within the first two years you have rheumatoid arthritis, and they may continue to develop over time.

5. Your Perception of Your Quality of Life

Rheumatoid arthritis is one of the few diseases where subjective measures of how a patient feels are among the best predictors of how well a person will respond to treatment and how much the disease will progress. Doctors may measure severity of symptoms using both the Health Assessment Questionnaire Disability Index (HAQ) and the Rheumatoid Arthritis Quality of Life (RAQoL) questionnaire.