SUMMER 2020 NIHMedlinelus - NIH MedlinePlus Magazine

Back to school health:Vaccination checklistCommon vaccines and preventable diseasesDiseaseVaccinationAcellular pertussisTdap1ChickenpoxVaricellaDiphtheriaDTaP2; Tdap1Haemophilus influenzae type b (Hib)HibHelping our immune systems work betterHepatitis AHepAYour immune system is a complex network of cells,tissues, and organs that works together to protectyour body. A strong immune system will detect foreignsubstances—like harmful bacteria and viruses—andattack them. A person with a weak immune system hasa harder time fighting off these substances.When you get a vaccine, it sparks your immunesystem to create immune responses that help your bodyfight off infection. This also helps your body react morequickly the next time the bacteria invades.Hepatitis BHepBHuman papillomavirusHPVInfluenza CRMMeningococcal ococcal TetanusDTaP2; Tdap1Getting vaccinatedMost vaccines are given as a shot into muscle or theskin by a health care professional. Some are also giventhrough a liquid or spray in the mouth or nose.Some vaccines may cause mild reactions, such assoreness where the shot was given, a rash, or a fever.But serious reactions are rare. Your health careprovider should review your medical history beforegiving vaccines to you or a family member.Keeping kids and adults healthySome people with weakened immune systems or those whoare pregnant may not be able to get vaccines. This iswhy getting vaccinated not only helps you, but others inthe community too. This type of protection is known as“community immunity.” For this reason, proof of vaccination isoften needed before your child can enter school or child care.So, before you enroll your child in school or drop themoff at college, talk to your doctor to make sure theirimmunization schedule is up to date. T6 Summer 2020 NIH MedlinePlusTdap combines protection against tetanus, diphtheria, and acellularpertussis. Tdap is for children 7 and older, adolescents, and adults.1DTaP combines protection against diphtheria, tetanus, and pertussis.DTaP is for children under the age of 7.23MMR combines protection against measles, mumps, and rubella.SOURCES: MedlinePlus; National Institute of Allergy and InfectiousDiseases; NIH News in Health; Centers for Disease Control and PreventionI MAGE: AD OB E STOCKHEALTH TIPS August is National Immunization AwarenessMonth, which brings attention to the value of protectingyourself and your family from vaccine-preventable diseaseslike chickenpox and the flu.Vaccines help control and sometimes get rid of diseaseslike measles or polio that in years past sickened or killedmany people. They offer protection from viruses andbacteria that can make us very sick.Vaccine research is a priority for the National Instituteof Allergy and Infectious Diseases. It supports andconducts research to identify potential vaccines fora variety of emerging infectious diseases, includingCOVID-19, SARS, and Zika.

Q ATeen vaping research is a priority asmarijuana and nicotine use surgeRESEARCH Vaping hasled to a dramatic rise innicotine and marijuanause among young peoplein recent years. Marijuanavaping among 12th graders,for instance, nearly doubledfrom 2018 to 2019, accordingto the National Institute onDrug Abuse (NIDA).Vaping involves inhalingan aerosol, or vapor, thatmay contain addictive drugs,including nicotine or THC (achemical in marijuana thatcan affect behavior, mood,and thoughts). Because ofthe capacity of vaping todamage the lungs, it’s also amajor concern as COVID-19spreads. NIDA Director NoraVolkow, M.D., spoke aboutthese concerning trends andhow the institute is addressingthem head on.interfere with the developing brain.The data that has emerged indeedhas shown that teenagers who smokemarijuana are at much greater risk ofbecoming addicted to it. And becomingaddicted as teens increases the risk ofbecoming addicted to other drugs asyou age.How is NIDA researchresponding to these trends?Nora Volkow, M.D., is the director ofthe National Institute on Drug Abuse.I MAGE: MARY N OBEL OUR SWhat kind of story isthe latest data showing?There has been a very abrupt increase in vaping THC. Thiswas the second highest increase we’ve ever seen since theinception of the NIDA Monitoring the Future Survey in1975. The first was the increase in vaping nicotine in 2018.These both have worried us enormously. More teenagersare embracing vaping as a culture for taking drugs thatthey may not have taken otherwise.Why is vaping so concerning,especially with marijuana?Particularly among teenagers, one of the main concernsthat we have about the use of marijuana is that it canWe’re interested in treatments.And we’re interested in how vapingis influenced by social networks.Right now, there are no publishedstudies regarding the treatmentof teenagers who have becomeaddicted to vaping nicotine orvaping THC. So, we’re encouragingresearchers to do clinical trialsto see what interventions may bemost beneficial. That includes, forexample, testing other approachesthat have been useful, particularlyin teenagers, in helping them stopsmoking nicotine.What should teens, parents, and othersknow about vaping and COVID-19?We know that individuals who have conditions of thelung or the heart, like those who smoke or vape, are atgreater vulnerability of contracting the disease. That’sbecause smoking chemicals can produce severe lungdamage. We want people to be cautious and mindfulof the possibility of a negative interaction. TKEEP AN EYE OUT for more of our interviewwith Dr. Volkow in our feature article on vaping,publishing this fall.Summer 2020 magazine.medlineplus.gov 7

Brain imaging, telehealthstudies promisebetterpreventionand recoveryNew research can extend stroketreatment window from 6 to 16 hoursHow has stroke research changed?It used to be that stroke victims could only come into thehospital within six hours of a stroke to get a brain clotremoved. Any longer and it was believed that you would havea brain hemorrhage. Now, with advanced brain-scanningsystems, someone can be treated within 16 hours of havinga stroke. The NIH-supported DEFUSE 3 trial helped changethe guidelines for treating strokes. We can identify at-riskbrain tissue and save many more lives much sooner.What other stroke research are you working on?Currently, we are funding several clinical trials comparingdifferent therapies and the effectiveness of acute treatmentand recovery. In addition to DEFUSE 3, here are twoimportant ones:8 Summer 2020 NIH MedlinePlusɠ Telerehab: NIH funded a study on deliveringpatient rehabilitation care via a computer or mobiledevice in the person’s home. A lot of people don’t getrehabilitation services because they’re very expensive.We still need to do more trials with more people, butso far, we have shown that telerehabilitation is noworse than getting rehab at a facility.ɠ Additional blood thinner: Another recent study, thePOINT trial, tested whether it was effective to givehigh-risk stroke patients two blood thinners insteadof one. This could be as simple as giving aspirin andanother blood thinner. Previous studies showed thattwo blood thinners could cause a bleeding problem.But the POINT trial found that two blood thinnerslowers the risk of recurring stroke. And though therewas a small increased risk of mostly gastrointestinalbleeding, the second blood thinner can be safelystopped after a few weeks when it is most needed.What does the future look like forpreventing and treating strokes?Now that we understand that most dementias aredue to multiple causes, researchers can stop thinkingabout these brain disorders [like stroke or Alzheimer’sdisease] in isolation. NINDS and the NationalInstitute on Aging fund a program called MarkVCID.This is a group of medical centers whose goal is tofind blood-based biomarkers in the brain that predictwho is at risk for vascular contributions to cognitiveimpairment and dementia, or VCID. With this type ofIMAG E: ADOBE STOCKSStroke research is a priority for the National Institutesof Health (NIH). Stroke, which often stops bloodfrom flowing to the brain or causes bleeding in oraround the brain, affects almost 800,000 people inthe U.S. each year and is the fourth leading cause of death.The National Institute of Neurological Disorders andStroke (NINDS) leads stroke research for NIH. ThroughStrokeNet, a network of 25 research centers across the U.S.,NINDS conducts clinical trials focused on prevention,treatment, and rehabilitation.Clinton B. Wright, M.D., M.S., director of the Divisionof Clinical Research at NINDS, shared some of the latestresearch updates and what they mean for stroke treatmentin the future.

STROKEFAST: How to spot a strokeand know when to call 911Numbness, tingling, slurred speechare warning signsClinton B. Wright, M.D., M.S., coordinatesresearch on stroke detection andtreatment at NIH.Acting fast and understanding telltale symptomsare key to improving stroke survival and outcomes.According to the National Institute of NeurologicalDisorders and Stroke (NINDS), the signs of a strokeinclude numbness, tingling, and slurred speech aswell as confusion, severe headache, and troublewalking or seeing.“Time is very important when dealing withthe brain and strokes,” says Clinton B. Wright,M.D., M.S., of NINDS. “The longer you wait to gettreatment, the more brain tissue is at risk.”Dr. Wright recommends memorizing the FASTsymptoms, like these provided by the AmericanStroke Association.“Now, with advanced brain-scanningsystems, someone can be treatedwithin 16 hours of having a stroke.”FI MAGE: COU RTESY OF THE NATIONAL IN STITU TE OF N EU ROLOG ICAL D ISORD ER S AND ST ROKE– Clinton B. Wright, M.D., M.S.imaging, researchers will be able to betterpredict who is at risk for stroke. Congresshas also funded the BRAIN Initiative, whichallows us to do neuroimaging [create picturesof the brain] and helps us understand normalbehavior and the disease process. So wewill have even better testing techniques andstrategies to help prevent stroke in the future.What should people knowabout common causes of stroke?People think that medicine takes care ofhypertension and high blood pressure, whichare the most common causes of stroke. Butmedicine doesn’t always take care of bloodpressure. Keep a diary of your numbers, andbe sure your health care provider is regularlymonitoring your blood pressure. Learn how totake your blood pressure at home. And if it’snot normal, get treated immediately. TFace DroopingIs one side of the facenumb or does it droop?AArm WeaknessSSpeech DifficultyTIs one arm weak or numb?Does one arm drift downward?Is speech slurred? Is theperson hard to understandor unable to speak?Time to Call 911If the person shows any of thesesymptoms, even if symptomsgo away, call 911 and go to thehospital immediately.SOURCE : American Stroke AssociationSummer 2020 magazine.medlineplus.gov 9

STROKEStroke: What youneed to knowThrombosisHemorrhageQuick facts about types,risk factors, and recoveryA stroke happens when blood stops flowing to the brain.A person’s brain cells start to die within a few minutesbecause they can’t get the oxygen and nutrients theyneed from the blood.This can cause brain damage, long-term healthproblems, or death if it’s not treated in time.Understanding strokes better and keeping an eye onrisk factors and warning signs, like those described inthe FAST guidelines, can improve stroke outcomes andhelp prevent them.Ischemic stroke: This type makes up 87% of strokes andhappens because of a blocked blood vessel in the brain orneck. There are three kinds of blockages that can causean ischemic stroke:ɠ Thrombosis—A clot in a blood vesselin the brain or neck.ɠ Embolism—A clot that moves fromanother part of the body, such as the heart,to the brain.ɠ Stenosis—A severe narrowing of anartery that leads to the brain.Hemorrhagic stroke: This type causes bleeding in thebrain or the spaces surrounding the brain.Mini-stroke or transient ischemic attack (TIA):Mini-strokes, or TIAs, happen when the blood supply tothe brain is blocked for a short time. Damage to braincells is not permanent, but if you have a TIA, you aremore likely to have a stroke in the future.Treatable risk factorsSome risk factors for stroke can be reduced with lifestylechanges—like quitting smoking and losing weight—ormedical treatment.Treatable risk factors include high blood pressure(also called hypertension), cigarette smoking, limitedphysical activity, obesity, high cholesterol or cholesterolimbalance, an unhealthy diet, and excessive alcohol useor illicit drug use.10 Summer 2020 NIH MedlinePlusStenosisEach type of stroke can affect the bloodvessels (shown here) in the brain differently.Other risk factorsɠ Age. Stroke can happen at any age. However,studies show that the risk of stroke doubles ineach decade between the ages of 55 and 85.ɠ Gender. Men have a higher risk for stroke inyoung and middle age. But in older age, morewomen than men die from stroke.ɠ Race and ethnicity. African Americans havea higher risk for stroke.ɠ Family history. Based on genetics, familymembers may be at risk for conditions likediabetes or high blood pressure, which canincrease the risk of stroke.TreatmentTreatment depends on what type of stroke you haveand when you are seen by a health care professional.That’s why quick action is important. Treatmentoptions include blood-thinning medicine to helpwith clots, as well as various types of surgery to openblocked arteries or control bleeding.Long-term stroke treatment depends on theperson and can take weeks, months, or even years.Some people recover fully, while others have longterm disabilities. Ongoing care, rehabilitation, andemotional support can help you recover and may evenhelp prevent another stroke. TSOURCE: National Institute of Neurological Disordersand StrokeIMAG E: ADOBE STOCKTypes of strokeEmbolism

STROKEA personal approachto stroke treatmentAfter 5 mini-strokes and long-term rehabilitation,chiropractor Gregory Symko helps other survivorsGREGORY SYMKO, D.C., isa chiropractor who specializesin helping people with brainissues related to stroke. He helps themimprove their hand-eye coordinationand balance issues, working with theirarms, legs, or hands.Dr. Symko also brings a uniqueperspective to his work: He is astroke survivor.“I realized that if I could dobrain-based therapy formyself, I could help otherstroke victims recover.”– Gregory Symko, D.C.IMAG E: JOYCE CHU TCHIANFirst-hand experienceWhen he was 40 years old, Dr. Symkohad a stroke, which he later learnedhad been a series of five mini-strokes.Dr. Symko’s strokes left him unableto see, eat, or walk. Something assimple as raindropsP E R S O N A L or wind on his handS T O R Y would cause severepain, and he had towear gloves to help prevent it.“It was terrible,” he recalls. “I hadextreme burning in my arm, leg,and face.”His symptoms became worseover time. In addition to pain andnumbness, he also had vertigo,which makes you feel like you arespinning. This caused severe balanceissues. He also couldn’t focus hiseyes on anything.“When you have a stroke, yourbrain gets confused,” he says.“Parts of your brain that deal withyour sense of touch can get messedup.” For example, his left arm wasnumb, but he experienced extremepain in his right arm.Hard work pays offFor a few years, Dr. Symko couldn’tdo anything on his own and had toget help from his wife, family, andhealth care professionals.But after three years of hardwork with physical therapistsand occupational therapists,and on his own, Dr. Symko wasable to go back to work—just notas a chiropractor. He worked ata pharmaceutical company andcontinued to take care of himselfby eating well, exercising daily,and using brain-based therapy. Hehad to reteach his brain to focusand gain use of his limbs again.“Brain-based therapy is all aboutteaching your brain to do newthings,” Dr. Symko says. “I realizedthat if I could do brain-basedtherapy for myself, I could helpother stroke victims recover.”Helping othersFour years after returning to work,Dr. Symko felt strong enough toreopen his chiropractic business inConcord, Massachusetts.Now 61, he says that he treatspatients from a different perspective.“A stroke changes you,” he says.“It put my life on pause for sevenyears, but now I’m healthier thanever.” He eats healthier foods andunderstands the impact that exercisehas on his brain.Stroke survivor Gregory Symko, D.C.,demonstrates a tool that helps patientsimprove their balance and coordination.Pushing harderWhile Dr. Symko occasionally hasvision issues at night and troublewalking due to balance problems, hesays he doesn’t get discouraged.“I view these issues as a message topush even harder to remain healthy,”he says.Dr. Symko advises those who havesuffered a stroke or who care forstroke victims to be patient and notgive up.“Eat well, get lots of sleep, andexercise regularly to keep your brainactive,” he says. “Strokes aren’t theend of the world. You have to work atrecovery all the time.” TFind Out Moreɖ MedlinePlus: Strokehttps://medlineplus.gov/stroke.htmlɖ The National Institute ofNeurological Disorders andStroke: Know Strokehttps://www.stroke.nih.govɖ ClinicalTrials.gov: Strokehttps://clinicaltrials.gov/ct2/results?cond StrokeSummer 2020 magazine.medlineplus.gov 11

SJÖGREN’S SYNDROMECarrie Ann Inaba‘Dancing with the Stars’judge creates communityof positivity, self-care,and strength12 Summer 2020 NIH MedlinePlusCarrie Ann Inaba is a familiar face in millions of American homes.A lifelong dancer, she has become well-known as a judge on ABC’scompetition show “Dancing with the Stars.” Last year, she becameco-host of the CBS daytime talk show “The Talk.”Outside of her on-camera career, Inaba is a self-described warriorfor those with Sjögren’s syndrome, a difficult and often painfulautoimmune disease she has herself. As an Awareness Ambassadorfor the Sjögren’s Syndrome Foundation, she spreads hope andcomfort to others with the condition. In this exclusive interview,she describes how meditation, yoga, and a sense of communityhave helped her thrive despite her diagnosis.IMAG E: COU RTESY OF ABCdoesn’t let Sjögren’s syndrome stand in her way

SJÖGREN’S SYNDROME“Sjögren’s has made me standup and set limits and boundariesso I can take care of myself.”– Carrie Ann InabaTell us about your diagnosis.Like with many autoimmune diseases,my Sjögren’s diagnosis was not easyto come by. I remember telling mydoctor that my eyes had been dry foryears. I asked him if I had Sjögren’sand he said I didn’t. It wasn’t untilmany years later that I was diagnosedby a rheumatologist [a doctor whotreats musculoskeletal disease andautoimmune conditions]. And that’sbecause I was going through a lot ofpain and fatigue.You have other autoimmunediseases as well.Yes. Sjögren’s and other autoimmuneconditions often come in pairs. I alsohave fibromyalgia and rheumatoidarthritis. And just last year I foundout that I also had lupus.I MAGE: COU RTESY OF CARRIE ANN INABAHow do you cope withyour conditions and leadsuch a busy life?Autoimmune conditions are verychallenging. It is no joke when theycall us Sjögren’s warriors. We haveto be our own warriors becauseeach one of us struggles differentlyand there are so many differentcombinations of autoimmuneconditions. It is really important tokeep track of your symptoms and tonotice what each does to you.How important is it tokeep a positive attitude?Having a realistic attitude isimportant. My natural tendencyis to be a Type A personality.So I feel badly when I’m not ableto accomplish much on a downday. But I have learned to be morerelaxed and I’m much happier for it.I also have an online projectcalled Carrie Ann Conversations. Ishare my insights on how to live agood life in general and for thosewith conditions like Sj

and muscle tone. Many people practice yoga to ease feelings of anxiety, like worry or fear. Yoga’s combination of physical poses, breathing exercises, and meditation may help quiet the mind as the body builds strength. Research studies suggest that yoga may also improve slee