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Coronavirus Resource Center

The Latest Numbers (as of May 18, 2020, at 6:58 p.m. EDT)

U.S. cases have surpassed 1.5 million and the country’s death toll is more than 90,000. The Johns Hopkins Coronavirus Resource Center maintains an ongoing count of the COVID-19 cases and deaths in the United States and worldwide. As of May 18, the tally is:

  • Total cases worldwide: 4,786,672 (up from 4,516,360 Friday)

  • Total deaths worldwide: 317,695 (up from 306,051 Friday)

  • Total recoveries: 1,776,641 (up from 1,622,354 Friday)

  • Total cases in the United States: 1,506,732 (up from 1,432,045 Friday)

  • Total deaths in the United States: 90,236 (up from 86,851 Friday)

New York has added another region to reopen Tuesday, with many beaches set to reopen Memorial Day weekend. On Monday, New York State Governor Andrew Cuomo told the media that the region around Buffalo could reopen on Tuesday, making it the sixth of 10 regions in New York State to meet the criteria to lift lockdown measures, according to CBS News. The Finger Lakes, the North Country, the Southern Tier, the Mohawk Valley, and Central New York reopened last week. Cuomo said that these areas have met the required benchmarks, including declines in infections, deaths, and hospitalizations, and having sufficient numbers of hospital beds to handle a surge.

The governor also announced Friday that state beaches in New York, New Jersey, Connecticut, and Delaware will reopen the Friday before Memorial Day. As of June 1, horse racing tracks statewide can resume races without fans.

New York City Mayor Bill de Blasio, however, said Sunday that city beaches will not reopen Memorial Day weekend or in the near term, and that fences will be built if people start gathering on beaches, according to CBS New York. On Monday, he said that if the current downward trending of infections and hospitalizations continues, the city could ease social distancing restrictions and permit nonessential businesses to reopen by June, according to Newsday.

Texas recorded its highest single-day rise in cases as the state continues to reopen. Over the weekend, Texas reported its biggest daily case count to date of 1,801, according to Newsweek. The surge may be partially due to outbreaks at meat plants and increased testing capacity. The state allowed stores and restaurants to resume business on May 1; gyms are set to reopen today.

More than two-thirds of states have begun to reopen. According to The New York Times, this week Minnesota is set to reopen stores and malls, Kentucky is looking to lift restrictions on restaurants and stores, and Connecticut is allowing salons, museums, and office buildings to resume activities.

More than 11.8 million Americans have been tested so far. A total of 11,834,508 individuals have been tested in the United States for the detection of SARS-CoV-2 as of May 18, according to the Johns Hopkins Coronavirus Resource Center.

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New Developments

Initial human trials of a vaccine have yielded encouraging results. Phase 1 results of Moderna’s mRNA vaccine trial show that all participants who received varying dose amounts of the potential treatment produced antibodies for the novel coronavirus, according to data released on Monday by the biotechnology company.

In the study, led by the National Institute of Allergy and Infectious Diseases (NIAID), three groups of 15 healthy participants ages 18 to 55 received dosing at either a low-level amount (25 micrograms), a medium level (50 micrograms), or a high level (100 micrograms). Low- and medium-level doses were shown to be safe, but those in the high dose group had significant “systemic symptoms.”

Moderna will discontinue the high dosing in its Phase 2 trials and expects to move to Phase 3 trials in July. If those trials go well, The New York Times reported that a vaccine could become available for widespread use by the end of this year or early 2021, according to Tal Zaks, MD, Moderna’s chief medical officer.

David Bernstein, MD, vice chairman of medicine for clinical trials at Northwell Health in Manhasset, New York, who is not involved in the research, told Everyday Health: “It is important for the public and researchers to have realistic expectations, and I would estimate that at best we are looking at a possible vaccine 12 to 18 months from now, assuming current trials are successful.”

The Federal Reserve chair said the economic downturn could go through end of next year. On 60 Minutes on Sunday, Federal Reserve Chairman Jerome Powell said that the economic slump “could stretch through the end of next year.” He added, however, that the country will get through the recession. “In the long run, and even in the medium run, you wouldn’t want to bet against the American economy,” he said. “This economy will recover.”

Vitamin D may help beat the virus. recent statistical analysis published in MedRXiv of coronavirus patient data from hospitals and clinics across China, France, Germany, Iran, Italy, South Korea, Spain, Switzerland, the United Kingdom, and the United States found a strong link between severe vitamin D deficiency and mortality rates. An article in Forbes reviewing the latest research regarding vitamin and COVID-19 concluded that the “jury’s still out on its effects.”

Trump announced that he is taking hydroxychloroquine. President Trump said he is taking daily doses of the antimalarial drug hydroxychloroquine, according to CNN. The president has touted the drug as a potential coronavirus treatment amid questions about its effectiveness and potential side effects.

A study suggests summer weather could help slow virus spread. A working paper posted last week from researchers at Harvard Medical School and the Massachusetts Institute of Technology indicates that the warmer summer months could have some positive effects in blocking COVID-19. Temperatures above 77 degrees were linked to a reduction in transmission. The authors found a “negative association between temperature and humidity and transmission.” They warned, however, that the “estimated effects of summer weather are not strong enough to seasonally control the epidemic in most locations.”

Japan’s economy fell into a recession in the first quarter. The Wall Street Journal on Sunday reported that Japan’s economy, the third largest in the world, contracted by 3.4 percent in the first three months of the year. The economy minister, Yasutoshi Nishimura, warned on Monday that data for the second quarter is expected to be worse, and he expects the economy to “shrink substantially for the time being.”

China supports a WHO investigation of the outbreak’s origin. Chinese leader Xi Jinping on Monday told the World Health Organization’s annual assembly that he backs an international review of the pandemic led by the WHO once the emergency has ended, reported The Guardian. Jinping also announced that China would donate $2 billion to the international fight against COVID-19 and offered to help establish hospitals and health infrastructure in Africa.

Trump officially unveiled Operation Warp Speed. On Friday, President Trump announced that Moncef Slaoui, the ex-head of GlaxoSmithKline’s vaccines division, and four-star Army General Gustave Perna will lead Operation Warp Speed, the administration’s effort to have a coronavirus vaccine ready by the end of the year, acccording to CNN. “Operation Warp Speed means big and it means fast,” Trump said.

Retail sales and industrial production dropped dramatically in April. The Census Bureau released data on Friday showing that retail sales fell 16.4 percent from a month earlier. This plunge comes on the heels of an 8.3 percent drop in retail sales in March. The Federal Reserve also reported that industrial production plunged a record 11.2 percent in April, according to the Associated Press.

A Gallup poll shows social distancing has dropped significantly. A Gallup poll released Friday revealed that 58 percent of U.S. adults report completely (17 percent) or mostly (41 percent) isolating themselves, continuing a decline from a high of 75 percent the week of March 30 through April 5. The results come as more states are taking steps to reopen their economies.

Tens of thousands of autoworkers are returning to jobs. The Associated Press estimated that 133,000 autoworkers are due to pour back into auto plants that are reopening next week. Ford is predicting stronger sales in the future in Europe, China, and the United States as the lockdowns ease.

Loud talking may leave viral droplets in the air up to 14 minutes, a study found. A single minute of loud speaking generates at least 1,000 virus-containing droplets, according to a study published this week in the Proceedings of the National Academy of Sciences of the Unites States of America. Researchers found that infectious droplets may hang in the air for 8 to 14 minutes. “These observations confirm that there is a substantial probability that normal speaking causes airborne virus transmission in confined environments,” write the study authors.

At 108, she may be country’s oldest coronavirus survivor. Sylvia Goldsholl, who is 108 years old, may be the nation’s oldest COVID-19 survivor, according to USA Today on Friday. The resident of the Allendale Community for Senior Living in New Jersey had the virus but made a full recovery. Goldsholl has also lived through the Spanish Flu Pandemic of 1918, which struck when she was 6 years old.

Almost three million people filed jobless claims, and the unemployment rate has hit 15.7 percent. The Department of Labor released data last Thursday showing that 2.9 million new claims for unemployment insurance were filed in the previous week. About 36.5 million Americans have filed applications in the past eight weeks. CNBC called it the biggest job loss in U.S. history. The unemployment rate has now rocketed to 15.7 percent, up from about 3.5 percent in February.

The ousted vaccine director warned lawmakers that the country lacks a vaccine plan. In testimony before the House Energy and Commerce Committee last Thursday, Rick Bright, PhD, former director of the Biomedical Advanced Research and Development Authority, told representatives that the United States lacks a plan to produce and fairly distribute a coronavirus vaccine when it becomes available, according to the Associated Press. He warned that the nation could face “the darkest day in history” unless decisive action is taken.

Dr. Bright was removed from his post last month after pushing for rigorous vetting of hydroxychloroquine, an anti-malaria drug embraced by President Trump as a coronavirus treatment. He filed a whistleblower complaint saying he was reassigned because he tried to “prioritize science and safety over political expediency.”

The CDC has confirmed the link between a mysterious syndrome in kids and COVID-19. New York City Mayor Bill de Blasio announced that the Centers for Disease Control and Prevention (CDC) has confirmed the link between a rare syndrome in children with COVID-19, according to NBC New York. New York City has found at least 145 cases of children sickened by the illness.

The CDC issued a health advisory regarding multisystem inflammatory syndrome in children (MIS-C). The condition has been seen in several U.S. states and European countries.

“Healthcare providers who have cared or are caring for patients younger than 21 years of age meeting MIS-C criteria should report suspected cases to their local, state, or territorial health department,” according to the CDC advisory.

According to the American Heart Association (AHA), children with this syndrome have symptoms resembling Kawasaki disease, including “persistent fever, inflammation, and evidence of single or multi-organ dysfunction (shock, cardiac, respiratory, renal, gastrointestinal, or neurological disorder), and may or may not test positive for COVID-19.”

How to Help

Blood Donors Needed

The American Red Cross is seeking people who have fully recovered from the coronavirus to sign up to donate plasma to help current COVID-19 patients. You may qualify to donate plasma if you meet specific convalescent plasma and regular blood donation requirements. The FDA offers more information about plasma donations on its website.

Help the Hungry

As the result of job losses, school closures, and health concerns related to the COVID-19 pandemic, many communities and individuals are in need across America. Feeding America is seeking donations to support food banks nationwide.

Consumer’s Guide to Drug Discounts

A Consumer’s Guide to Drug Discounts

Have you ever had to choose between buying groceries or paying the rent and filling a drug prescription? Have you or has someone you know ever skipped taking medication because of the cost? You’re not alone. Millions of Americans are feeling the burden of increasingly costly prescription drugs, and they’re making choices that could jeopardize their health.

Today, the amount consumers have to pay out of pocket for prescribed drugs is rapidly escalating, from about $25 billion in 2000 to a projected $67 billion in 2025. To make matters worse, more than 8.8 percent of American adults, or roughly 28.5 million people, do not have health insurance and must pay for all prescription medications themselves.

But there are ways that you can minimize the effect that the accelerating prescription drug crisis has on your healthcare. This guide to drug pricing and discounts provides the answers to common questions and offers practical information that every consumer needs to know.

Why Are Prescription Drug Prices So High?

Did you know that Americans pay the highest costs for prescription medications in the world? You can partly attribute the exorbitant prices to an intricate and extensive drug research and development (R&D) and approval process, along with an equally complex healthcare system.

No doubt, we have benefited from innovations in the management of diseases for which there were few or no treatment options before. But opponents of the pharmaceutical companies argue that just a small percentage of the drug companies’ costs are used for R&D, with most of the money spent on administration and brand-name drug marketing.

Drug companies don’t tell the whole story behind the rising cost of prescriptions. There are third-party administrators known as pharmacy benefit managers (PBMs), who are paid to negotiate prices between pharmacies and large insurers. These PBMs charge pharmacy providers either a percentage or a flat fee for every prescription filled, which contributes to higher drug prices.

How Can You Save Money on Medication?

Consumers have options when it comes to getting the lowest prices on prescription drugs.

First, if you aren’t shopping around for medications at local pharmacies, using online coupons, or joining buyers’ clubs at drugstores, you’re probably paying way too much.

Just because your pharmacist quotes you a price does not mean that’s the lowest price for that prescription. Comparison shopping for prescription medications can be as quick and easy as following the helpful tips below, reviewing a few websites, and printing some money-saving coupons.

12 Ways You Can Cut Your Drug Costs

These 12 surefire tips will help you save on prescription medications so that you can put the extra funds to other important uses.

1. Try Generic Drug Options

More than 80 percent of all drugs today are generics, which use the same active ingredients as brand-name medicines and work the same way but tend to cost a lot less than their pricey brand-name counterparts.

The cost-saving news is that manufacturers of generic drugs do not have to repeat the animal and clinical (human) studies that were required of the brand-name medicines to demonstrate safety and effectiveness. Also, the competition among multiple companies producing a generic version of a drug helps keep the prices low for consumers.

According to the Food and Drug Administration (FDA), to gain approval a generic drug must be the same as the brand-name product in the following ways:

  1. Able to reach the required level in the bloodstream at the correct time and to the same extent

  2. Manner in which it is taken (whether inhaler, liquid, or pill)

  3. Strength

  4. Testing standards

  5. Use and effects

  6. Working ingredients

Generics may differ from brand-name counterparts in terms of other characteristics that don’t affect the drug’s performance or safety, like flavorings.

What you should do Talk to your physician and pharmacist about generic equivalents of your brand-name drugs and consider switching.

2. Search for Discount Coupons Online

A simple Google search of your prescription drug, over-the-counter medicine, or healthcare supplies will bring up pages of websites offering money-saving coupons.

Drug coupons cannot lower your copay, but your pharmacist may apply the coupon to your drug purchase to lower the price.

What you should do Before you head to the pharmacy to fill a prescription, do a quick Google search to check for money-saving coupons and rebates.

3. Use an App to Compare Local Drug Prices

There are several websites and mobile applications that can help you find the best price available for a prescription drug.

One of the most widely used is GoodRx, which allows you to comparison shop and get coupons toward medications. GoodRx collects and compares prices and discounts that you didn’t know existed from more than 70,000 U.S. pharmacies, including CVS, Rite Aid, and Walgreens. It allows you to print free discounted coupons or send them to your phone by email or text message. You can then use a GoodRx discount instead of your health insurance or Medicare Part D or Advantage plan if the cost is lower than your copay.

When you go to GoodRx.com, they will ask for the name of the drug, the dosage, the number of pills, and your zip code. Click the “Find the Lowest Price” button. You will see what you might pay at different chain pharmacies with a GoodRx discount coupon or voucher. You can then print or download the generated coupons and vouchers to your smartphone and show your pharmacist to get savings on your drug purchase.

Similarly, Blink Health lets users browse local prices by simply searching for a prescription drug’s name. It also offers the option of having your medication delivered or ready for pickup. Another online and mobile service is OneRx, which lists drug prices in your area and offers discounts to consumers using the OneRx card.

RetailMeNot Rx Saver is a popular and easy-to-use app and program. Here you can search for prices on brand-name and generic drugs. Their coupons can be used an unlimited number of times at retail pharmacies such as Walgreens and CVS.

Other websites and mobile apps that offer drug coupons and rebates include ScriptSave WellRxEasy Drug Card, and Search Rx.

What you should do Check out these and other no-cost prescription pricing services to see what pharmacies in your area charge for your medications.

4. Join Your Pharmacy’s Prescription Club

No insurance or not enough coverage? You can find in-store pharmacy prescription clubs at many drugstores. These money-saving programs can lower drug and supply prices.

Also, the in-store programs provide up to an 85 percent savings on thousands of prescriptions, including commonly prescribed generic medications for heart health, diabetesasthmamental health issues, women’s health, gastrointestinal health, and other conditions.

While these savings clubs are not health insurance, they can save you money at the pharmacy.

What you should do Compare different in-store pharmacy prescription clubs to get the best prices when checking out. In-store pharmacies at retailers like Walgreens and Kmart also offer prescription clubs.

5. Shop Local or a Preferred Pharmacy Network

Independent pharmacies may beat major chain drugstores, supermarkets, and big box discounters on price — and by an impressive margin. Independents can also easily beat membership warehouses and clubs.

In contrast, the preferred pharmacy network is a group of chain pharmacies that likely give insurance plans a larger discount than other pharmacies.

The point is that drugstores have different prices — they can vary by hundreds of dollars — so be sure to ask ahead before you pick a specific pharmacy.

What you should do Call your local and preferred retail pharmacies before filling your prescription to find the lowest prices.

6. Use a Verified Internet Pharmacy

Verified internet pharmacies are those that have passed stringent reviews by the National Association of Boards of Pharmacy (NABP). These pharmacies often include “.pharmacy” in their URLs to show that they are in compliance with the NABP, although some verified pharmacies are .coms or .orgs. They also carry the designation VIPPS, for Verified Internet Pharmacy Practice Site.

While verified internet pharmacies have passed inspection and are deemed safe, be careful not to use a rogue internet pharmacy that is not verified. Check your internet pharmacy against the Find a Safe Site list to buy safely.

In a revealing 2018 study, Consumer Reports sent secret shoppers to 150 pharmacies in six cities across the country to ask for the retail cash prices for a one-month supply of five commonly prescribed drugs — essentially the prices someone without insurance might pay. The widespread range in prices they uncovered was shocking. While the five-drug “basket” cost was just $66 at the verified internet pharmacy HealthWarehouse.com, two national chain retailers had prices closer to $900 for the five drugs. (7)

What you should do It pays to shop around, and don’t forget to check internet pharmacies like HealthWarehouse.com for greater savings.

7. Use Mail Order for Medications and Supplies

Many pharmacies offer online ordering for drugs, diabetic supplies, over-the-counter medicines, hair supplies, and even pet medications. And you don’t have to have insurance. After placing your order, you will receive the drugs and supplies in the mail. Make sure the pharmacy is VIPPS accredited and certified. Your doctor will send the Rx by e-prescription to the proper phone number.

What you should do Generally, it will take one to five business days to process your mail order prescription, so it’s important to plan ahead.

8. Get Free or Low-Cost Birth Control Online

Not only can you get great prices on medications online, several newer websites offer free or low-cost birth control to women in many states. Planned Parenthood DirectNurxPrjkt Ruby, and Maven Clinic offer telehealth services, virtual clinics, and prescription drugs delivered right to your door — and no insurance is needed.

What you should do Explore telehealth services and virtual specialty clinics that can save you time and money on birth control and other necessary medications.

9. Talk Openly With Your Doctor

Be vocal with your doctor about any financial issues you may have, and be sure to try one or more of the following five things at your next office visit:

  • Ask your doctor for free samples or coupons. Doctors usually have samples and coupons given to them by drug reps. It doesn’t hurt to try a free sample pack before filling a pricey prescription to make sure this drug will work for you.

  • Ask your doctor for a 90-day supply. This gives you one copay every three months instead of one every month.

  • Ask about mail order. If your drug plan has a mail-order option, you may be able to get the 90-day supply of medications at an even lower cost.

  • Ask about pill-splitting. Your doctor can prescribe a higher dose of medicine at the same price of the lower dose. You can split the drug in half or fourths to save. Scored pills are easier to split, but use a pill splitter (usually between $3 and $9 at most pharmacies) to avoid crushing the medication.

  • Ask for an exception. If you and your doctor can’t find an affordable option together, speak with your insurer about making a formulary exception and providing coverage for your drug. The formulary is a list of prescription drugs covered by a prescription drug plan or another insurance plan offering prescription drug benefits. Your doctor will most likely need to submit a supporting statement, detailing that your drug is medically necessary and that any alternatives would have an adverse effect.

What you should do Be open and persistent. If your insurer denies your request for an exception, file an appeal. This requires that you work with your doctor to submit an application or letter of appeal.

10. Consider Patient Assistance Programs

Patient assistance programs (PAPs) are typically offered by pharmaceutical companies to provide free or low-cost prescription drugs to patients who lack health insurance or prescription drug coverage. You will need to fill out an application on the drug company’s website with your financial information. Your doctor may need to provide information about your prescribed medications.

The drug company will review the application and tell you if you’re eligible for assistance. If approved, many companies will ship a supply of the drug to your home or your doctor’s office. Your doctor will need to place a new order several weeks before the supply runs out.

What you should do Check out RxAssist.org, an online database of drug companies offering patient assistant programs that provide free or affordable drugs and copay assistance.

11. Learn More About Medicare Part D

If you are 65 years or older and on Medicare Part D or Medicare Advantage, it’s important to understand how to get discounts on drugs. Medicare Part D is an optional program to help Medicare beneficiaries pay for prescription drugs. Medicare Advantage Plan is a type of Medicare health plan offered by a private company that contracts with Medicare.

The insurer’s formulary of drugs that they cover can change at any time, so be sure to check the prescription medications you take on the Medicare.gov site to find the best Part D plan that works for you.

While some people are able to use discounted coupons with Medicare Part D, most cannot unless they’re paying cash only. Of course, if you have a coupon for a drug not covered by your prescription drug plan, you can use this to lower your costs.

What you should do Take advantage of online education such as the Drugs.com Medicare Support Group to ask questions, share opinions, and stay up with the latest news. Also, check the Medicare.gov site for more understanding on how Part D works with other insurance.

12. Get It for Free, if You Can

Some large supermarket chains, including Publix, Harris Teeter, Schnucks, Price Chopper, Walmart, Sam’s Club, Costco, and ShopRite, will fill basic antibiotic prescriptions like amoxicillin for free. Supermarket pharmacies may give prenatal vitamins, metformin, antibiotics, children’s vitamins, and other commonly taken medications and supplements for free if you have a valid prescription. These meds and antibiotics are free for as long your doctor prescribes them. You just have to ask.

What you should do You never know until you ask at the pharmacy to find out what drugs they provide customers for free. So be vocal!

Nutrients for Bone Health

A Guide to Nutrients for Bone Health

Bones are active, living tissues that are grown, broken down, and remodeled throughout our lives. Loss of overall bone mass can occur when bone resorption (breakdown) and bone remodeling are imbalanced. This process is associated with osteoporosis, a condition characterized by low bone mineral density, impaired bone structure, and an increased risk of bone fractures.

The risk of bone loss and osteoporosis increases with age; however, various lifestyle factors may reduce your risk and promote bone health. Continue reading to find out how to prevent bone loss by incorporating nutrients important for bone health.

Strengthen your bones by limiting alcohol consumption, avoiding smoking, exercising regularly, and consuming a healthy diet.

What causes bone loss: diet and bone health

Several dietary factors may impair bone health. One review investigated the effect of dietary patterns on bone strength and resilience, including its effect on bone mineral status, fracture risk, osteoporosis, and bone biomarkers (measurable indicators of disease). The researchers found that a poor quality Western-style dietary pattern and certain unhealthy dietary components were associated with poor bone health. You can reduce bone loss risk factors in your diet, by avoiding:

  • Fried foods

  • Meat, particularly processed meat products

  • Processed foods

  • Refined grains

  • Soft drinks

  • Sweets and desserts

Further, specific nutrient deficiencies may be associated with an increased risk of bone diseases, reduced growth of bone mass in children and adolescents, as well as increased bone loss in the elderly, including:

The best diet for bone health

Consuming a nutritious diet may support bone health in various ways, such as improving bone density and bone mineral content, reducing the risk of fractures, and decreasing bone resorption. The best foods for bone health include:

  • Fish and seafood

  • Fruit

  • Legumes

  • Low-fat dairy products

  • Nuts and seeds

  • Olive oil

  • Poultry

  • Vegetables

  • Whole grains

Adhering to an overall healthy dietary pattern, such as the Mediterranean diet, may protect your bone health. There has been some concern linking higher protein consumption with increased calcium excretion from the body. However, a systematic review concluded that higher protein intake isn’t associated with adverse effects on bone health and may, in fact, support bone mineral density and help protect the spine.

Which nutrients help build strong bones?

We outline five of the key nutrients for bone health below. If you’re a patient, speak with your integrative healthcare practitioner to determine which diet and supplements are best for your individual needs.

Calcium is found in a variety of animal- and plant-based foods, as well as in supplements.

Calcium

An essential mineral (cannot be produced by the body) and the most abundant mineral in the body, calcium is a key structural component of bones and teeth. Calcium is naturally found in high amounts in dairy products, canned fish such as sardines and salmon, chia seeds, and leafy greens such as kale, turnip greens, and bok choy. The daily recommended dietary allowance (RDA) for calcium is 1,000 mg for adults, 1,200 mg for females 51 and older, and 1,200 mg for males 71 and older.

Certain individuals have an increased risk of calcium deficiency, including postmenopausal women, women with amenorrhea (absence of menstruation), vegetarians, and individuals who restrict dairy, such as those with lactose intolerance. Research suggests that calcium supplementation may benefit individuals with osteoporosis by reducing the rate of bone loss.

Did you know?
99% of your body’s calcium is present in bones and teeth.

With adequate calcium intake, vitamin D may reduce the risk of bone fractures from falls and improve balance and muscle function.

Vitamin D

Vitamin D, also known as cholecalciferol, is one of the necessary vitamins for bone health. It enables the absorption of calcium from the gut, maintains blood calcium and phosphorus levels, and supports bone growth and remodeling. The body produces vitamin D from sun exposure, and precursors to the active form can be obtained from fatty fish, mushrooms, beef liver, eggs, and dietary supplements.

Vitamin D deficiency has been associated with osteoporosis and osteomalacia. Osteomalacia is a condition characterized by impaired mineralization of the bone matrix and bone softening. Research suggests that certain factors increase the risk of vitamin D deficiency, such as being postmenopausal, being over 70 years old, and having limited sun exposure.

Vitamin K2

Vitamin K2 is a form of vitamin K that assists in bone mineralization and helps prevent calcium from accumulating in blood vessels. Studies have shown that vitamin K2 improves bone mineral density and decreases the risk of fractures.

You can find vitamin K2 in eggs, cheeses, meats, natto (fermented soybeans), and some bone health supplements. Vitamin K1, found in high amounts in green leafy vegetables, is considered to be less active than the K2 form. Research suggests that vitamin K2 supplementation may prevent bone density loss and bone strength decline in certain individuals, such as postmenopausal women.

Did you know?
Bone mass peaks around the age of 30. Childhood, adolescence, and early adulthood are the time periods when we can significantly increase our peak bone mass through diet, lifestyle choices, and physical activity.

Consuming adequate amounts of magnesium can help maintain bone integrity.

Magnesium

Magnesium is an essential macromineral (needed in relatively large amounts) that is required for healthy bone structure and is essential to the function of osteoblasts and osteoclasts, cells that build and break down bones. Magnesium is also involved in mineral homeostasis, helping to maintain balance of other minerals, such as calcium and potassium.

One four-year study in elderly adults found that increased magnesium intake was associated with higher bone mineral density in the forearm for men and in one hip site for both women and men. You can increase magnesium in your diet by consuming a variety of plant foods, including green vegetables, nuts, seeds, legumes, and whole grains.

Did you know?
Approximately 50 to 60% of the magnesium in your body is found in bones.

Potassium

Potassium is an essential mineral that helps maintain fluid balance, making it necessary for all body tissues. One theory that promotes an alkaline diet for bone health is based on the hypothesis that a highly acidic diet affects acid-base balance, leading to increased use of calcium as an acid-buffering agent and subsequent bone loss. As an alkaline substance, potassium is said to protect against this process, although this theory is debated.

Observational studies of dietary potassium intake support its role in bone health, and clinical trials of potassium supplementation show that the mineral may increase bone formation and decrease bone resorption. On the other hand, potassium deficiency may increase the risk of bone turnover. Potassium is found in high amounts in dried fruit, lentils, squash, potatoes, beans, bananas, dairy products, and spinach.

Additional nutrients for bone health

Keep in mind that, in addition to the nutrients highlighted above, bone formation relies on many different nutrients that can be obtained from the diet or dietary supplements, including:

  • B vitamins

  • Boron

  • Calcium

  • Copper

  • Fluoride

  • Iron

  • Magnesium

  • Manganese

  • Protein

  • Potassium

  • Phosphorus

  • Silicon

  • Vitamin A

  • Vitamin C

  • Vitamin D

  • Vitamin K2

  • Zinc

The bottom line

Certain lifestyle modifications, including food for healthy bones and bone supplements, may promote bone health and prevent the risk of osteoporosis. If you’re a patient, consult with your healthcare practitioner for individual guidance on your wellness regime before trying bone health supplements.

Fevers - All you need to know

Fevers: See what you should know

Overview

A fever is a temporary increase in your body temperature, often due to an illness. Having a fever is a sign that something out of the ordinary is going on in your body.

For an adult, a fever may be uncomfortable, but usually isn’t a cause for concern unless it reaches 103 F (39.4 C) or higher. For infants and toddlers, a slightly elevated temperature may indicate a serious infection.

Fevers generally go away within a few days. A number of over-the-counter medications lower a fever, but sometimes it’s better left untreated. Fever seems to play a key role in helping your body fight off a number of infections.

Symptoms

You have a fever when your temperature rises above its normal range. What’s normal for you may be a little higher or lower than the average normal temperature of 98.6 F (37 C).

Depending on what’s causing your fever, additional fever signs and symptoms may include:

  • Sweating

  • Chills and shivering

  • Headache

  • Muscle aches

  • Loss of appetite

  • Irritability

  • Dehydration

  • General weakness

Children between the ages of 6 months and 5 years might experience febrile seizures. About a third of the children who have one febrile seizure will have another one, most commonly within the next 12 months.

Taking a temperature

To check your or your child’s temperature, you can choose from several types of thermometers, including oral, rectal, ear (tympanic) and forehead (temporal artery) thermometers.

Although it’s not the most accurate way to take a temperature, you can use an oral thermometer for an armpit (axillary) reading:

  1. Place the thermometer in the armpit and cross your arms or your child’s arms over the chest.

  2. Wait four to five minutes. The axillary temperature is slightly lower than an oral temperature.

  3. If you call your doctor, report the actual number on the thermometer and where on the body you took the temperature.

Use a rectal thermometer for infants:

  1. Place a dab of petroleum jelly on the bulb.

  2. Lay your baby on his or her tummy.

  3. Carefully insert the bulb 1/2 to 1 inch (1.3 to 2.5 centimeters) into your baby’s rectum.

  4. Hold the bulb and your baby still for three minutes.

  5. Don’t let go of the thermometer while it’s inside your baby. If your baby squirms, the thermometer could go deeper and cause an injury.

When to see a doctor

Fevers by themselves may not be a cause for alarm — or a reason to call a doctor. Yet there are some circumstances when you should seek medical advice for your baby, your child or yourself.

Infants

An unexplained fever is greater cause for concern in infants and in children than in adults. Call your baby’s doctor if your child is:

  • Younger than age 3 months and has a rectal temperature of 100.4 F (38 C) or higher.

  • Between ages 3 and 6 months and has a rectal temperature up to 102 F (38.9 C) and seems unusually irritable, lethargic or uncomfortable or has a temperature higher than 102 F (38.9 C).

  • Between ages 6 and 24 months and has a rectal temperature higher than 102 F (38.9 C) that lasts longer than one day but shows no other symptoms. If your child also has other signs and symptoms, such as a cold, cough or diarrhea, you might call your child’s doctor sooner based on severity.

Children

There’s probably no cause for alarm if your child has a fever but is responsive — making eye contact with you and responding to your facial expressions and to your voice — and is drinking fluids and playing.

Call your child’s doctor if your child:

  • Is listless or irritable, vomits repeatedly, has a severe headache or stomachache, or has any other symptoms causing significant discomfort.

  • Has a fever after being left in a hot car. Seek medical care immediately.

  • Has a fever that lasts longer than three days.

  • Appears listless and has poor eye contact with you.

Ask your child’s doctor for guidance in special circumstances, such as a child with immune system problems or with a pre-existing illness.

Adults

Call your doctor if your temperature is 103 F (39.4 C) or higher. Seek immediate medical attention if any of these signs or symptoms accompanies a fever:

  • Severe headache

  • Unusual skin rash, especially if the rash rapidly worsens

  • Unusual sensitivity to bright light

  • Stiff neck and pain when you bend your head forward

  • Mental confusion

  • Persistent vomiting

  • Difficulty breathing or chest pain

  • Abdominal pain or pain when urinating

  • Convulsions or seizures

Urgent Care vs. Emergency Room

Urgent Care vs. Emergency Room: What’s the Difference?

When a patient is feeling pain in their chest, they’re likely unsure about where to go: do they call 911, go to the emergency department, go to an urgent care center, or make an appointment with a primary care physician?

It’s not an easy decision and it’s not easy to explain.

Urgency or Emergency?

Some conditions are considered absolute emergencies: heart attacks, strokes, sepsis, anaphylaxis, and gunshot wounds are just some of the medical conditions that are universally considered emergencies. They must be evaluated and treated in the emergency department. If a patient goes to an urgent care center with a true medical emergency, the urgent care staff should send them to the emergency department anyway, often by ambulance and often at a substantial cost.

That’s just a small sample of what constitutes an emergency. The list is a lot longer and it always includes a diagnosis. In other words, one almost has to know they’re having a heart attack in order for it to be a real emergency.

Isn’t it the responsibility of the emergency department to tell patients if the symptoms they’re experiencing are signs of an emergency? I’d say it is and the American College of Emergency Physicians agrees with me, but not all medical insurances do. More on that below.

Urgent Care Centers

So, when should patients go to the urgent care center? That’s not an easy question to answer.

One might hear the term “urgent care center” and assume that “urgent” means this is a place where serious medical conditions can be treated in a similar, if not identical, manner as in an emergency department. The truth is: every state is different. Some states consider urgent care centers nothing more than glorified physician offices. Other states treat them like stand-alone emergency departments (a third option that we’ll cover below) regardless if stand-alone emergency centers are even an option in that state.

Urgent care centers might be staffed with physicians or they might be staffed with nurse practitioners or physician’s assistants, depending on the state. As individual state legislatures address the needs of their populations, the rules change quickly.

With such irregular regulation, going to an urgent care center for a true medical emergency is a gamble unless the patient is very clear in advance what a particular urgent care center can handle. In most cases, people should treat the urgent care center the same as the doctor’s office. It just has more flexible hours.

Would you visit the doctor for a sore throat? Sure, and that is a decent option for an urgent care center. A spider bite or skin infection? Perfect for the urgent care doc, too.

Who Pays the Tab?

The whole concept of urgent care centers was born out of runaway healthcare costs. Folks regularly go to the ER when they could’ve gone to their private doctor for substantially less cost. Compare the bills for an emergency department and an urgent care center side by side, and you’ll see that urgent care centers are almost always substantially less expensive when the medical condition is something they can treat.

That doesn’t mean it’s always cheaper for the patient to go to an urgent care center. Even taking away the possibility of a serious medical emergency—one that requires ambulance transport from the urgent care center to the ER—comparing cost is really not apples to apples.

Insurance companies (also known as payors) usually contract with facilities and physicians (and sometimes ambulance companies) to get the best prices. There are networks of facilities and physicians that might be cheaper options for payors. The patient’s portion of the bill (co-payments, deductibles, or co-insurance) vary greatly depending on their insurance company, their coverage plan, and whether the facility or the doctor is in the network or not. It’s one of the most complicated financial processes that many consumers will ever face.

If an urgent care is not in the network, but the emergency department is, it could end up costing the patient less to visit the more expensive option.

Let’s break it down: If both the emergency department and the urgent care center are in (or out) of the network, payors night not want to pay for the ER if it isn’t an emergency. Payors often feel it’s an unnecessary expense to pay for an emergency physician to examine and diagnose a complaint, unless it turns out that the complaint is truly worthy of the emergency department.

How do patients know if their medical condition is a worthy emergency? The payor determines whether the patient’s judgment is correct using the doctor’s diagnosis, something they don’t know until they get there.

Some emergency departments have urgent care areas built-in, and the patient is easily moved from one area to the other based on medical condition. These are my favorite. The patient (or the insurance) is charged based on which path the patient needed to take. That way, patients who get a lower deductible for visiting the ER only if the diagnosis is a real emergency won’t get charged the extra cash if they’re wrong. They’ll only be charged the more expensive emergency department bill when it’s appropriate, and when the insurance will pick up a larger chunk of the tab.

Many times, payors will use hospital admission as a litmus test to determine if the patient was truly sick enough to go to the ER. If the patient is admitted to the hospital, the payor might reduce or waive any co-pays or deductibles. On the other hand, if the patient is not admitted, they’re on the hook for the entire deductible or co-pay. It’s the benefit of hindsight and it only helps the insurers.

Payors do the sliding-scale deductibles as a disincentive for choosing the emergency department as first-line medical care. Most patients, however, don’t have a choice. Physician visits might not be available same-day. Patients don’t plan to get sick, and ERs are usually open 24 hours a day. Urgent care centers were meant to close that gap. It’s a doctor’s office that caters to last-minute appointments and walk-ins. Unfortunately, not all things that look like clinics are the same.

Freestanding Emergency Rooms

A freestanding or stand-alone ER is a relatively new invention cropping up all over the country. A 2017 NBC News story reported that 35 states allowed freestanding emergency centers. These aren’t emergency departments necessarily, because they aren’t always associated with actual hospitals. In many states, these emergency centers are allowed to be owned by physicians.

Stand-alone emergency centers might look very similar to an urgent care center. They often open in the same places: malls and retail districts. They won’t be adjacent to a hospital—at least not in the same building—and they may or may not have an ambulance entrance.

Most of these facilities advertise a full range of services, but the reality is that any patient who needs admission to the hospital will probably have to be taken there by ambulance. Show up with a stroke or a heart attack and true definitive treatment might have to wait until the ambulance responds and transports to the actual emergency department.

The Bottom Line

The ER, also known as the emergency department, is the definitive immediate-need healthcare option. This is the place patients can go for any level of medical condition, regardless of how severe or benign. Emergency departments are also the most expensive option.

An ER visit bill will almost always be north of a grand. A trip to the urgent care center or to a doctor’s office, on the other hand, is likely to be two or three hundred bucks, tops. It’s important to understand the differences—and educate patients on the difference—so that they can make a better decision.

parasitic fish to help us fight brain cancer and stroke

How a parasitic fish could help us fight brain cancer and stroke

Researchers turn to an ancient species of fish in a bid to find a better way of delivering therapeutic drugs into the brain to treat conditions and events ranging from cancer to stroke.

Lampreys are one of the oldest surviving species of eel-like jawless fish. They populate both rivers and coastal sea waters in temperate regions around the world.

These strange-looking fish are rendered particularly uncanny by their boneless, tooth-lined mouth. They are also parasitic, feeding on the blood of other fish.

New research suggests that these aquatic-dwellers may provide an adaptable vehicle for drugs that treat the biological effects of conditions or health events affecting the brain.

A recent study, conducted by a team of scientists from University of Wisconsin-Madison and the University of Texas at Austin, has looked at a type of molecule from the immune system of lampreys, called “variable lymphocyte receptors” (VLRs).

The researchers explain that what makes VLRs interesting is their ability to target the extracellular matrix (ECM), a network of macromolecules that provide structure to the cells they surround.

This network makes up a large part of the central nervous system, so the research team believes that VLRs can help carry drugs to the brain, boosting the effectiveness of treatments for brain cancer, brain trauma, or stroke.

“This set of targeting molecules appears somewhat agnostic to the disease. We believe it could be applied as a platform technology across multiple conditions.”

The researchers tested their hypothesis on mouse models of aggressive brain cancer, and they report their results in the journal Science Advances.

A promising experiment

Normally, drugs will not easily penetrate the brain because it is protected by the brain-blood barrier, which stops potentially harmful agents leaking into the brain. However, this barrier also prevents the medication from reaching its target.

In the case of some health events that affect the brain, the brain-blood barrier “loosens up,” which can expose the brain to further problems but also allows drugs to get in.

In the current research, the investigators were interested in testing the effectiveness of VLRs, taking advantage of the disruption of the brain-blood barrier in the case of glioblastoma, an aggressive form of brain cancer.

“Molecules like this [VLRs] normally couldn’t ferry cargo into the brain, but anywhere there’s a blood-brain barrier disruption, they can deliver drugs right to the site of pathology,” explains Prof. Shusta.

The research team worked with mouse models of glioblastoma, treating them with VLRs bound to doxorubicin, a drug used to treat this form of cancer in humans.

Prof. Shusta and colleagues report that this approach was promising, prolonging survival in the rodents treated with this experimental combination.

The investigators note that binding VLRs to various drugs may have another important benefit — it could allow specialists to deliver significantly higher doses of those drugs to the brain ECM.

“Similar to water soaking into a sponge, the lamprey molecules will potentially accumulate much more of the drug in the abundant matrix around cells compared to specific delivery to cells,” illustrates coauthor Prof. John Kuo.

And this binding “trick” could help solve yet another problem. The researchers explain that brain cells can be their own enemy when it comes to receiving treatment since they “disgorge” chemicals that reach them.

However, since VLRs target the ECM that surrounds brain cells, this could allow the drugs to act on the cells for more extended periods.

“This could be a way to hold therapies in place that don’t otherwise accumulate well in the brain so they can be more effective,” says coauthor Ben Umlauf, Ph.D.

‘Trying this strategy in different models’

Finally, the researchers note that the VLRs freely circulated through the body in the mouse models, but they did not accumulate in healthy tissue. This suggests that these molecules would not disrupt healthy, functioning organs.

Going forward, the investigators want to try combining VLRs with other types of anti-cancer drugs, including those used in immunotherapy, to see how well the molecules would work with a more diverse array of therapies.

Another possibility that the researchers would like to investigate is that of using VLRs to detect any disruptions of the blood-brain barrier, which might indicate the onset of a health event. They propose to do this by binding VLRs to sophisticated probes compatible with brain imaging technologies.

For the time being, however, “I’m excited about trying this strategy in different disease model systems,” declares Kuo, adding that “[t]here are several disease processes that disrupt the blood-brain barrier and we could conceive of delivering a variety of different therapies with these molecules.”

Doctors Give Better Care in the Morning

Do Doctors Give Better Care in the Morning?

FRIDAY, May 10, 2019 (HealthDay News) — Many people do their best work in the morning, and new research suggests the same may hold true for doctors.

The study, of nearly 53,000 primary care patients, found that doctors were more likely to order cancer screenings for patients seen early in the day, versus late afternoon.

During 8 a.m. appointments, doctors ordered breast cancer screenings for 64% of women who were eligible for them. That figure declined over the next few hours, rebounded around lunchtime, then fell again as the afternoon wore on: During 5 p.m. appointments, doctors ordered screening for just under 48% of eligible patients.

A similar pattern was seen with colon cancer screening. About 36% of patients with 8 a.m. appointments received a screening order, versus only 23% of those with 5 p.m. appointments.

What’s going on? Senior researcher Dr. Mitesh Patel speculated on one explanation: As the day goes on, doctors often fall behind schedule, and may run out of time for cancer screening discussions.

There’s “a lot to get done” during a standard appointment, Patel noted — from routine health checks, to flu shots, to whatever concerns the patient is bringing up.

“So the doctor might think, ‘I have limited time. I’ll talk about this [screening test] the next time,'” said Patel, an assistant professor of medicine at the University of Pennsylvania.

It’s also possible “decision fatigue” is a factor, he said.

If a doctor has spent much of the day talking to patients about cancer screening — and often hearing “no” — he or she might let it slide by day’s end.

“This is a reminder that doctors are human, too,” said Dr. Jeffrey Linder, a professor of medicine at Northwestern University Feinberg School of Medicine in Chicago. “They’re laboring under the same psychological and fatigue constraints as everyone else.”

Linder wrote an editorial accompanying the study, published May 10 in the journal JAMA Network Open.

“Not everyone can get an 8 a.m. appointment,” Linder pointed out. But, he said, it’s good for doctors and patients to be aware that time of day might affect their care.

The study is not the first to suggest doctors practice differently as the day wears on.

In an earlier study, Patel’s team found the pattern held true with flu shots: Patients seen late in the day were less likely to get them.

Other researchers have found that toward the end of the day, primary care doctors are more likely to inappropriately prescribe antibiotics or opioid painkillers.

It’s possible, Patel said, that patients are also in a rush toward day’s end, or dealing with their own decision fatigue.

“At the end of a workday,” he said, “you might not want to have a conversation about cancer screening.”

The findings are based on records from patients in the University of Pennsylvania health system who had primary care appointments between 2014 and 2016. Over 19,000 were eligible for breast cancer screening, while over 33,000 were eligible for colon cancer screening.

Patel and his team looked at whether patients received a screening order at their first appointment during the study period — and whether they actually went for screening over the next year.

They found that patients with late-day appointments were substantially less likely to be screened: One-third of women with an 8 a.m. appointment underwent breast cancer screening in the next year, versus 18% of those with 5 p.m. appointments. The figures for colon cancer screening were 28% and 18%, respectively.

What to do? Patel said there’s a “great opportunity” for technology to help. Patients’ electronic health records could be cued to remind doctors to order cancer screenings, for example.

Linder agreed. He also pointed to the low screening rates among these study patients overall. That, he said, suggests that patients need similar nudges, to encourage them to follow up on screening orders.