Struggling to bring your high blood pressure under control, even with the help of medications?
Open your mouth and say “aha!” if you see tooth decay or gums that are sore, bleeding or receding. You may have found the culprit.
Researchers reported that in adults whose hypertension was being treated with medications, systolic blood pressure – which measures pressure in the vessels when the heart beats – got higher as the health of their teeth and gums declined.
Compared to hypertensive patients who had no signs of periodontal disease, those with inflamed gums were 20% less likely to have gotten their blood pressure within healthy limits.
In addition, patients whose dental health was poor, had systolic blood pressure readings that were 3mmHg higher, on average, than similar patients with healthy gums.
The findings were published in the journal Hypertension.
An estimated one in three adults in the United States are thought to have high blood pressure, putting them at greater risk of heart attacks and strokes.
Hypertension is a primary or contributing cause of more than 1,000 deaths a day in the US. Yet, only 54% of those with the condition have brought their blood pressure readings under control with some combination of medication, diet and exercise.
The new study is in line with a mountain of research linking gum disease with higher rates of heart, blood vessel and kidney disease – all organs that are affected by high blood pressure. And it breaks new ground by detailing how poor dental health upends efforts to bring hypertension under control.
Indeed, the study found that people with untreated hypertension and healthy gums had blood pressure readings roughly equal to those of people who took medication for their hypertension, but also suffered from gum disease.
In other words, poor dental health largely negated the effects of taking blood pressure medication.
The new research doesn’t establish that gum disease causes hypertension and its negative health effects. Many researchers suspect that, like stiff blood vessels, sore and bleeding gums are just one more manifestation of inflammation throughout the body.
Nor does the study show that treating periodontitis will reduce high blood pressure.
But it does suggest that, when dental health is poor, the challenge of bringing blood pressure under control will be more expensive and is more likely to fail.
Researchers from Italy scoured the records of 11,753 people who participated in the US National Health and Nutrition Examination Survey between 2009 and 2014, and were screened for periodontal disease.
Some 4,095 of the participants had been diagnosed with hypertension, of whom 88.5% were taking medication for the condition and 11.5% were not.
Rates of moderate and severe periodontal disease tended to be higher among study participants who were men, older, Latino, smokers, and those with less income and education.
Participants who were 65 or older and had evidence of long-standing periodontal disease, were much more likely than those with less severe and long-standing gum disease to have unchecked high blood pressure.
Both hypertension and periodontitis are more common among African Americans and Latinos in the US. Those patient populations also have strikingly higher rates of the diseases linked to both, including heart disease, kidney failure and cerebrovascular diseases such as stroke and certain forms of dementia.
There’s little doubt that access to healthcare differs by race and ethnicity, and that impediments to good medical and dental care play a key role in racial and ethnic health disparities.
Dental care especially, is expensive and far less likely than medical care to be fully covered by insurance. As a result, economic factors likely play a powerful role in influencing the health of a patient’s gums.
Moreover, many primary care physicians and cardiologists fail to ask their patients about their dental health, or to refer them to dentists unless they are undergoing cardiac procedures and have clear signs of tooth decay. And dentists don’t necessarily check their patients’ blood pressure.
The study authors wrote that patients with high blood pressure should have their gum health taken into account when they consider their treatment options.
“Our data suggest that all racial/ethnic subgroups, especially Hispanics, might benefit of such approach,” they wrote.
“Conversely, ignoring the additional burden of poor periodontal status on blood pressure might translate into a higher cardiovascular risk in the long term.”
Charlene Niemi, director of health literacy for Care Harbor, a California-based nonprofit charity that provides free medical, dental and vision care in massive “pop-up” health clinics across the state, said it’s “imperative that individuals are informed that good oral care and treatment of gum disease does play a role in blood pressure”.
While everyone needs regular dental checkups, “those with hypertension should understand the importance of having a dental home, seeking routine follow-up, and practising good oral care,” she said.
Patients with hypertension should make every effort to improve their oral health, and those with poor gum health should be vigilant for hypertension. – Los Angeles Times/Tribune News Service
Overshadowed by the cloud of lousy news is a ray of hope for transgender kids and the people who love them in the United States.
The American Academy of Pediatrics (AAP) announced its first-ever policy statement for parents and clinicians caring for transgender and gender-diverse children and adolescents.
The statement, which is now available online, will be published in the journal Pediatrics.
“In its dedication to the health of all children, the American Academy of Pediatrics strives to improve healthcare access and eliminate disparities for children and teenagers who identify as lesbian, gay, bisexual, transgender or questioning (LGBTQ) of their sexual or gender identity,” the statement reads.
“Despite some advances in public awareness and legal protections, youth who identify as LGBTQ continue to face disparities that stem from multiple sources, including inequitable laws and policies, societal discrimination, and a lack of access to quality healthcare, including mental health care.
“Such challenges are often more intense for youth who do not conform to social expectations and norms regarding gender.”
The AAP recommends a “gender-affirming” approach that calls for the following:
• Access to family-based therapy and support for parents, caregivers and siblings of youth who identify as transgender.
• Electronic health records, billing systems and other notifications that respect the asserted gender identity of each patient.
• Insurance plans that offer coverage specific to the needs of youth who identify as transgender, including coverage for medical, psychological, and when appropriate, surgical interventions.
• Advocacy by paediatricians for policies and laws that promote acceptance of all children without fear of harassment, exclusion or bullying because of gender expression.
“As a parent, even when you struggle to understand and may not see eye-to-eye, your most important role is to offer understanding, respect and unconditional love for your child,” said Dr Jason Rafferty, lead author of the policy statement.
“This builds trust and puts you in a better position to help them through difficult times.
“Research has shown that if a transgender teen has even just one supportive person in their life they can go to, it greatly reduces their risk of suicide.”
Population-based surveys estimate that 0.7% of teens ages 13 to 17 in the US identify as transgender, according to the AAP.
Studies indicate roughly 50% of teens who identify as transgender have attempted suicide.
Dr Rafferty, a Rhode Island-based paediatrician and child psychologist, added: “There is increasing recognition that gender and sexual development is a normal process for all children starting at an early age, and that some children will exhibit variations, similar to all areas of human health and behaviour.
“Having a vocabulary around gender and sexual diversity facilitates conversations with parents, families and providers, allowing children to label some of their complicated feelings that otherwise may have been suppressed or hidden.”
When asked if he expects pushback from paediatricians about the policy statement, he replied, “No.
“The messages of this policy statement are very much in line with the core principles of paediatrics, including the importance of using a non-judgmental, family-based, developmentally appropriate approach.
“It emphasises that transgender and gender-diverse children – like all children – need support, love and care from family, school and society. When supported and loved as they grow and develop, kids mature into happy and healthy adults.”
Some parents will have an easier time accepting gender differences than others, of course.
“Some transgender youth expect immediate acceptance, but often, family members proceed through a process of becoming more comfortable and understanding of the youth’s gender,” Dr Rafferty said.
“The process often resembles the stages of grieving as it may require letting go of strongly-held expectations for their child.”
Paediatricians can help, he said, by promoting open dialogue and perspective-taking between young people and their parents.
“Gender affirmative care,” he said, “is based on the belief that all children benefit from love and support – a principle that is almost always a place where providers can meet parents to start a discussion.” – Chicago Tribune/Tribune News Service
You can certainly feel like death warmed over when you get the flu, which often lasts for a dreadfully feverish, snotty and cough-wracked week.
But in some rare cases, the flu can actually be fatal. Last year, influenza killed about 80,000 people, including 180 children, according to the US Centers for Disease Control and Prevention (CDC).
Just what happens in the body when the flu turns fatal? How does a relatively common illness actually end your life?
The sad truth is that when the flu virus enters your body, it triggers your immune response – and in some lethal cases, that response pummels not just the virus but the body too.
The influenza virus hijacks human cells in the nose and throat to make copies of itself. This hoard of viral beasties triggers the immune system to send battalions of white blood cells, antibodies and inflammatory molecules to eliminate the threat.
Usually, that process works to heal the body. But sometimes the immune system’s reaction is so strong, destroying so much tissue in the lungs that they can no longer deliver enough oxygen to the blood, which in turn causes hypoxia and death.
It’s also possible to die from a secondary bacterial infection, such as pneumonia. Death from such secondary infections usually occurs about a week or so after a person first gets sick, because it takes time for the secondary infection to set in.
The flu can lead to death in other ways as well. In a particularly gruesome way to go, people with the flu can experience “multiple organ failure” throughout their bodies.
Other serious complications can set in, such as inflammation of the heart, brain or muscle tissues, or sepsis, all of which can be life-threatening, according to the CDC.
Perhaps the most terrifying part is that the flu likes to break its own rules. During the infamous 1918 epidemic, an estimated 500 million people, one-third of the world’s population, became infected, notes the CDC. There were about 50 million deaths worldwide.
The deaths were even more shocking because they tended to occur not in children or the elderly, whom we usually think of as most vulnerable, but in healthy people from ages 20-40, people in the prime of their life. – The Mercury News/Tribune News Service
It’s normal for both adults and children to feel nervous once in a while. A little anxiety prior to an event like a presentation or test is common – and normal.
“For some, a little nervousness can actually be helpful,” says Dr Tina Ardon, a Mayo Clinic family medicine specialist. “But, for others, they struggle a bit more with what we call ‘test anxiety’.”
Test anxiety can affect anyone from primary and secondary school students to college students. While symptoms are varied, and can include trouble concentrating and sleeping the night before a test, Dr Ardon says some individuals struggle significantly.
Some even experience physical symptoms. “There are people who have trouble focusing during a test, but others who experience trouble breathing, stomachache, headache, elevated heart rate,” she says.
The challenge for many parents, especially of younger children, is confirming whether a complaint of headache, stomachache or other ailments is related to an actual illness or anxiety.
“For younger students, it may be hard to determine if they are struggling due to test anxiety or other issues.
“I always suggest parents talk to their child first,” she says.
Dr Ardon also advises reaching out to your child’s teacher.
“It’s helpful to get insight into what they see in the classroom, if the student is having trouble taking tests in the moment,” she says.
She offers these tips for helping to prepare children for tests and alleviate mild test anxiety:
• Be prepared. “Having ample time to prepare and study is important to reduce stress,” says Dr Ardon.
• Create a consistent routine before a test.
• Try relaxation techniques. Before the big day, try different techniques to help your child ease nervousness.
• Be familiar with the test format. “Is it multiple choice, short answer, an essay? Knowing that can help alleviate some of that anxiety as well, and help students prepare.”
• Get plenty of rest and eat well. “It’s really important to get a good night’s sleep every day, but especially the night before a test. And make sure you have a really good breakfast the day of, as well,” she says, adding it’s best to avoid sugary foods and drinks, as well as caffeine.
• Seek professional guidance. If your child’s anxiety is not improving or your child seems to be struggling with learning overall, Dr Ardon recommends talking to your healthcare provider.
“Ask them about their symptoms to make sure it’s not something else that needs to be addressed.” – Mayo Clinic News Network/Tribune News Service
Imagine a weekday morning when, instead of rushing into the office huffing and puffing, you were calm. Confident. Even looking forward to your workday.
Wellness experts think such a thing is possible, part of a movement that prizes self-awareness and making small, conscious steps toward a healthier, fulfilling life – like adjusting your morning commute routine.
Judy Manisco, a registered nutritionist and dietitian in Chicago, United States, believes that slight meal adjustments could drastically improve commuters’ well-being before work.
“The key is to wake up early enough where you’re not running around, stressed about getting to work on time, but pacing yourself and eating a healthy breakfast before work,” she says.
Manisco suggests a balance of protein and carbohydrates to keep you full and energised until lunch.
Her favourite breakfast? “A protein shake made from organic soy milk, raw, unsalted walnuts (they’re high in nutrient-dense omega-3 fatty acids), a variety of seeds, oat bran, and either a stalk of celery or a handful of spinach,” she says.
For sweetness, she recommends adding natural cocoa or a date.
If you skip the protein shake, Manisco recommends whole grain toast, a handful of nuts or seeds, and a cup of fruit.
She warns against coffee. “Caffeine will get your heart and adrenals pumping artificially, and thus could have you feeling unnecessarily anxious or depressed,” she says.
Diet isn’t the only trick to incorporating wellness into your morning commute. Paying attention to posture and movement can also help.
Jason Kart, a practising physical therapist for 10 years and the owner of Core Physical Therapy in Chicago, says lower back and neck pain are the most “common ailments” among his working patients.
“When you sit for a while, you turn your postural muscles off and you start using passive structures like cartilage, which breaks down easier,” he says. “Humans are built to walk around and look for food, so when you’re sitting, you’re not activating those important spinal muscles, but instead causing a steady breakdown of muscle tissue.”
Kart takes the train to work each morning and notices the same behaviour causing neck pain among commuters: “text neck”.
“Text neck” occurs when you lean your head over your phone, straining your neck muscles and thus causing joint pain.
To alleviate this, he recommends a simple fix: “If you’re standing, the movement of the train helps you practise stability and balance, and work your postural muscles,” he says.
And for car drivers who can’t stand during their commute?
Consider the headrest. “Bad posture is so common among drivers… they should practise keeping their head lightly against the headrest and avoid a slouch position,” he says. “This will gradually alleviate back and neck pain while driving.”
At work, Kart suggests periodically moving around to engage the postural muscles most commonly associated with neck and back pain.
After considering your stomach and your spine, think of your brain. One of the most popular sectors of wellness is mindfulness.
Darrell Jones, a meditation instructor, meditates on the train during his commute and recommends the practice to anyone who wants to feel “calmer and happier” entering their workspace.
Annoyed by the loud chatter or the loudspeaker on the train?
“Incorporate those sounds and how they make you feel into your meditation,” he says.
He recommends the guided meditation on apps like Calm, or finding a piece of instrumental classical, jazz, world or new age music, and taking deep breaths while asking yourself questions such as: “Who do I want to be, regardless of what does or doesn’t happen today? Do I want to be a jerk, or a kind soul? Do I want to embody possibility, or show up exuding impossibility?
“An easy meditation game you can play is taking a deep breath, with your eyes closed, each time the train door opens, and exhaling when it closes,” Jones says.
The most important thing, according to him, is cultivating a calm, positive mindset before launching into a routine.
“If we can prioritise our wellness in small ways, or create a mindset of possibility before reading a horrible piece of news or a frustrating work email… that could improve your whole day,” he says. – Chicago Tribune/Tribune News Service