Arm yourself against the flu for kids’ sake, says actress and mom Sarah Chalke. Photo by Eric Reed/AP Images on behalf of Faces of Influenza.

Flu is a big deal and it hit early and hard. But it’s not too late to get a flu shot: flu season can last as late as May. “Like all mothers, I do whatever I can to keep my son healthy—and that includes getting him immunized against the flu. I’ve learned that everyone is at risk of catching and transmitting this disease. So my family and I get annual vaccines to make sure we don’t spread the virus to him,” says actress Sarah Chalke, known for playing Dr. Elliot Reid on the hit TV series Scrubs and starring in the comedy series How to Live with Your Parents (for the Rest of Your Life) set to premiere in April.

The widely available vaccine is a good match for circulating flu bugs and immunity kicks in after two weeks. Federal health experts recommend that everyone 6 months of age and older be immunized annually, yet fewer than half of children ages 6 months to 17 years were immunized during the 2011-2012 flu season. Flu can lead to severe complications, even death, for patients or those with whom they come into contact. Each year in the U.S., influenza and its related complications result in an average of 226,000 hospitalizations and 3,000 to 49,000 deaths.

No vaccine is perfect. To boost your defense during outbreaks, avoid crowds and keep hands away from your face because pesky flu viruses can lurk for hours on hard surfaces. Six of the grimiest places you encounter through the day include: the kitchen sink, elevator controls (especially the first floor button), shopping cart handles, purses, playgrounds, gym equipment, and the office phone, according to leading commercial cleaning franchisor Coverall Health-Based Cleaning System®.

Learn more about the flu at facesofinfluenza.org.

Flu News with Scrubs Alum Sarah Chalke The Saturday Evening Post

Tricks (and treats) can help parents make sure that kids have fun, stay safe, and enjoy their Halloween candy—even when diabetes is a part of their lives.
To make the most of the upcoming festivities, here’s a checklist from experts at Fit4D, a personalized diabetes coaching service:

1. If your child is invited to a Halloween party, find out when it starts, how long it lasts, and what food will be served. Then adjust your child’s meal and medication plan accordingly.

2. Discuss the meal plan with your child. Also talk with the party hosts to address any of their questions or concerns.

3. Is your child going trick-or-treating? Do some homework. Review nutrition labels in stores, or go online to sites such as jdrf.org and calorieking.com to learn the carbohydrate amounts in pieces of popular candy treats. The information will help you appropriately include candy in your child’s meal plan.

4. Instead of taking away your child’s hard-earned candy, play “Let’s Make a Deal” for a nonfood item. For example, five small candy bars and four pieces of gum could “buy” a stuffed animal or music download.  

5. Should your child’s glucose level drop too low, consider letting them choose a safe piece of nonchocolate candy from their loot that you know is equal to 15 grams of carbohydrate. Retest your child’s blood sugar to ensure that it has come up to a safe range.

6. Most importantly, be safe and have fun! Children with diabetes can participate in the same activities as those without the diagnosis; it just takes a little more planning.

Here, Marc Wolf, pharmacist and CEO of Diabetic Care Services, offers more ways to make Halloween fun for children with diabetes.

Six Tricks for Kids with Diabetes The Saturday Evening Post

“You might not be able to manage your body the way you like, but you can manage your mind,” counsels Mims Cushing, who has been jotting down coping tips from patients and professionals since chronic nerve pain disrupted her life more than a decade ago. Those handwritten words of wisdom are now available in the new book, You Can Cope with Peripheral Neuropathy: 365 Ways for Living a Better Life (Demos, 2009, $18.95).

“In 1996 my feet were constantly burning and numb,” she tells the Post. “My lifelines to sanity were The Neuropathy Association and Dr. Norman Latov—the neurologist who co-authored the book with me.”

Cushing recently spoke at the annual meeting of the Neuropathy Action Foundation where she addressed the top ways to cope with neuropathy.

The Top Ten

When neuropathy gives you fits and you’ve done your best to seek medical advice:

1: Be excited about the buzz regarding neuropathy. People don’t say, “Never heard of it” as much as they used to. There’s a sea change out there that is making it easier for 20 million people to deal with, track, and understand their condition.

Today, The Neuropathy Association (neuropathy.org) can provide the name of a specialist near you. You can receive newsletters by mail and sign up with Google Alerts for updates. Experts recognize different types of the disease and dozens of reasons for having it.

2: Be grateful. It’s hard to be stressed when you are thankful and appreciative. Stress surely makes your neuropathy worse. To be less frazzled, keep a gratitude journal. (It doesn’t have to be a Pulitzer Prize winner.) At bedtime, think about what you’re grateful for—don’t groan about what you did wrong during the day or make to-do lists. Saying “I’m so grateful,” puts a different, healing spin on your feelings.

3: Be open to everything that might help you. Which technique seems out of place: acupuncture, meditation, tai chi, or drumming? Did you say drumming? Well, all of these methods (and others) are used for healing. I beat African drums at a senior center. Maintaining a powerful, constant rhythm is meditative. People in the class say their blood pressure and pulse rates go down. And on Tuesdays when I drum, my feet hurt less.

Dr. Jerome Groopman, renowned writer and physician, suffered an accident and was in pain for 19 years. Finally, he listened to a doctor’s advice to not give in to the god of pain. After one year of initially difficult exercise, he was pain free. I recommend Dr. Groopman’s books, including The Anatomy of Hope.
Consider new ideas you may have dismissed. And when you think about things you can’t do, remember that you now have the time to do things you may not have had time to do before your neuropathy: cook special recipes, research your genealogy, study a compelling topic, write in a journal, or create an indoor container garden.
And P.S.: Perhaps you must do some things differently, such as using a walker at the mall. But you can still do them.

4: Banish toxic people. You can wail about the curmudgeons in your life, slap ’em upside the head (which I don’t recommend), or ease yourself away—the best way to deal with them. Troublesome friends or relatives can make you sad or cause you angst, both of which make our illness worse. When my friend Madelyn heard someone was driving me nuts, she said, “Don’t let her rent space in your head!” Optimistic friends can help our spirit. Author Wayne Dyer says, “Your friends are God’s way of apologizing for your relatives.” Writer Judith Orloff calls the mean people in our lives “Energy Vampires.” Maybe you must be around difficult relatives during the holidays. Is it any wonder your neuropathy worsens then?

5: Focus on something greater than yourself—volunteer. I believe people quit volunteer jobs because they haven’t found the right one. A pianist in Ponte Vedra Beach, Florida, volunteered at a local hospital and was asked to change the sheets in the Emergency Room. After a few weeks, he asked if he could go to patients’ rooms and play music on a portable piano. He found the perfect job for him.

Sometimes volunteering means listening. It’s powerful to say: “You talk. I will listen.” A man I know got some bad news from a doctor. As he was leaving, the doctor put his hand on my friend’s shoulder. And my friend suddenly felt better. The church handout, Our Daily Bread, says, “When we forget about ourselves, we do things others will remember.” And, I add, we think less about our pain.

6: Love your cabbages and caviar equally. Consider chores to be as meaningful as creative hobbies and other diversions. Next time you are ironing or emptying the dishwasher, realize that it’s of value. Don’t rush around.

7: Let the good stuff in. Floridian Eugene Richardson, a retired Lt. Colonel and brilliant man who has had neuropathy for 41 years, watches for life’s little miracles (they are all around), and not for things to worry about. Do you have UFOs, Uninvited Foolish Observations, flying around in your head? Take a break from all the craziness in the world. When you have a crummy day, write about it or have a first-class pity party. Restrict the party to seven minutes, and do it when you are alone. You will carry on longer if you have an audience. Yes, your family may need to help you in a myriad of ways, but don’t dump your complaints on them. The less you fuss, the more they’ll want to help you.

8: Be kind to your body. This does not mean eating ice cream smothered with Chicken Alfredo. But you can hurt your neuropathy by jumping on hard surfaces, or doing certain kinds of Pilates, says Dr. Alan Berger, head of neurology at Shands, Jacksonville. I’ve figured out two perfect places where we can exercise without gravity being an issue: a swimming pool and a space shuttle. I’m buying a space shuttle. They cost around $50 billion, so I may have to get it on eBay.

Keep hunting for the exercise that’s right for you. Many fitness centers offer chair-based programs, even for yoga. Just as we can choose to not read a book we aren’t enjoying, or walk out of a movie, we can decide to change exercises.

9: Enjoy your own company. Now, a great spouse is a wonderful thing. So is a true friend, someone who will listen when you call at 3 a.m. But nurturing solitude is important, too. Find your own private place of peace: a park, a beach, the mountains, or the sea. Drive there or maybe just visit it in your dreams. Find stillness in solitude, and solitude will bring you peace.

Friends are not always available. YOU, on the other hand, are always available. Don’t beat yourself up because you have neuropathy. Treat yourself like gold. If you do that, you’ll treat others like gold, too.

One of my favorite sayings from writer Mary Gordon is, “I never feel so accompanied as when I am on my own. And I have figured it out. It is because God is beside me.” Another quote I love is, “You cannot see yourself in a rushing brook, only in a pond of still water” (Zen).

10: Embrace things that can embrace you back. Money can’t. A house can’t. Nor can a car or jewels. Friends and family can embrace you, and a dog can embrace you with a wagging tail. A cat’s purr is an embrace. Laugh along with what you embrace. Remember Norman Cousins’ book, Anatomy of an Illness, about the importance of belly laughs? Still a great read. Grandchildren can make you laugh, too. One grandchild said, “Grandma, your skin doesn’t fit your face.” Another commented, “Gram, you have curly skin.” If you don’t have a source for jokes, have someone send you a bunch from the Internet.

Courtesy of Mims Cushing

You Can Cope with Peripheral Neuropathy The Saturday Evening Post

LEEZA There are so many challenges in caregiving that have the potential to derail one’s own health and happiness during what may be a journey lasting many years. Imagine if your spouse of 30 years suddenly cannot remember who you are or where he lives. Or if you yourself suffer from a chronic illness and must now take care of a loved one on a full-time basis. What if you are the sole wage earner in your family and your loved one now needs round-the-clock care? You can see that the challenges of caregiving are as varied as life itself.

In my own experience and in the experience of my family, and also through meeting the many people who come to Leeza’s Place and share their stories with me, it is clear that the key challenge faced by caregivers is remembering to take care of oneself—physically, mentally, and spiritually—in order to give good care to a loved one.
When a person’s life is interrupted with a health challenge, it doesn’t seem to matter how much money you might have, how many people you might know, or how much education you might have … you are still very likely frustrated, isolated, stressed, and depressed. For me, when I learned of Mom’s diagnosis with Alzheimer’s disease, my first response was denial. For my dad, who spent many years as Mom’s primary caregiver, it was the isolation, being cut off from friends and family, which led to poor eating habits and self-medicating with alcohol. My sister Cammy became depressed, my brother Carlos put his head in the sand, and I got overbusy in order to avoid the harsh reality that we would lose Mom, memory by memory.

You can see that the key challenge facing all caregivers is to always “take your oxygen first.” It means put your physical health first, understand what depression is, take steps to overcome it, and feed your spiritual self. It makes so much sense—how can you take care of someone when you are so depressed that you can’t get yourself out of bed to face the day?

Caregivers do all kinds of things to numb their pain, deny their truth, and stuff their sadness with food, drink, shopping, and other behaviors that simply delay the inevitable. When you are a husband or wife, son or daughter, sister or brother and someone we love is suffering, we feel guilty and helpless on some level. When we tell our guests at Leeza’s Place to “take your oxygen first,” they find it counterintuitive and uncomfortable … somewhat embarrassing. It is only when we reveal that the best way to love and care for someone else is to first take care of YOU that we even begin to get their attention.

Q You write of harnessing the Three E’s: Education, Empowerment, and Energy. Can you give us an example? How did this three-pronged approach evolve?

LEEZA The Three E’s were designed by my friend, co-author, and co-founder and executive director of the Leeza Gibbons Memory Foundation, Dr. James Huysman. He is a psychologist and licensed clinical social worker and vastly knowledgeable about the kind of support this population of “family-first responders” needs. Creating Leeza’s Place enabled Dr. Huysman to put his knowledge to work.

In our experience, the path to caregiver success always begins with education. It has to. An unnamed enemy has way too much power over us. We have to name it and claim it before we can even think about thriving. For example, one must become educated about the disease that is taking your loved one. Understand that, while your loved one may no longer remember your name, even in the later stages of the disease they will still be able to enjoy hearing their favorite music. Become aware of your own nutritional requirements and the link between good eating habits and your ability to maintain a high energy level throughout the day. Learn about estate planning and health insurance and be ready for the day when you will no longer be able to take care of your loved one yourself.

To be able to face something with courage in spite of fear is real empowerment. Our goal is to help remind caregivers of their inherent strength and ability to take charge of their life and help others around them who are just as affected by chronic disease. The energy is also key … stress and depression are constant companions of most caregivers … they are depleted emotionally, spiritually, physically, and financially. At Leeza’s Place, we help nourish the empty energy banks through laughter therapy, reiki, dance, and art therapy along with many other programs—all offered free to extend help, hope, and healing to those who so desperately need it.

Q Your book speaks of the unique spiritual needs of caregivers. Specifically, you suggest seeking out a “spiritual companion”—someone close to you with whom you can share your thoughts. What are the potential benefits of forming such a relationship?

LEEZA In our opinion, caregiving presents an opportunity to learn to accept what we can’t change, to live and thrive in the present moment, and to let go of what we can’t control, which is most often the hope that our loved will “get better” over time. It’s an opportunity to stop wasting precious energy by resisting reality and instead embrace life, with all its pains and joys.

When we make the decision to actively choose what life has irrevocably chosen for us, we exercise our power. It can free up enormous amounts of energy needed for the day-to-day challenges of caregiving, and it presents the opportunity to live one’s life fully, instead of wasting time thinking “what if” or “things will get better.” But this takes work, and often those searching for this kind of spiritual relief seek out the help of a professional therapist to help explore one’s feelings about one’s loved one and about the situation one finds oneself in. But often it is not necessary. One can find a “spiritual companion,” who might be a close family member, a friend, one’s priest or rabbi, or someone with more experience giving care to another, with whom one can share one’s thoughts. Just talking can help us understand our own feelings about our special situation, push us to reevaluate our priorities, and force us to think about what really matters most to us. So, as we see it, caregiving can be an opportunity to learn and to grow, not despite the challenges and the trouble, but because of them.

Q Does caring for oneself actually improve the care of an ailing loved one?

LEEZA Of course! I will give you an example from my own family’s experience, but one that is very common place. My Dad, then in his early 70s, would often take Mom for a walk around the lake just behind their home in South Carolina. Dad had not been getting much exercise for a couple of years, since caring for Mom had become a full-time job. One day, while out for a walk, Mom slipped and fell, and he could barely lift her up, and in trying he wrenched his back pretty badly. So badly, in fact, that he couldn’t do the simplest tasks for Mom, or for himself for that matter, for a few weeks. But had he been taking care of himself, even by doing the simple exercises we describe in Take Your Oxygen First, he would have been able to help Mom and avoid his own injury.

Q What are your plans for the future? Do you have any projects in the works? Will you continue your work?

LEEZA I have so much passion for my role as a health advocate. It is a wonderful way for me to empower my audience to show up in their lives and navigate more effectively through whatever health crisis may enter their world. I have seen so many families unravel emotionally, spiritually, physically, and financially. I see so many families bury the caregiver before the diagnosed individual. We have to encourage each other to “take our oxygen first.” There is so much isolation and so much depression. I will continue to look for ways to offer help, healing, hope, and hugs for all those husbands and wives, sons and daughters, brothers and sisters who struggle to do the right thing.

I’m entering my seventh year with my mineral makeup line, Sheer Cover. It has given me a tremendous opportunity to communicate with an audience of women who sometimes put themselves last on the list. I always say as women, we need to know where we’re going and look good when we get there! That’s why, this year, I will introduce a new line of hair extensions! They are beautiful and will really help transform the lives of woman and boost their confidence. Add my Sheer Inspiration Life Coaching, and we can really make a difference. I find people who choose to access a coach have less stress and more peace of mind. Reaching out to another for help, insight, and another point of view is often the healthiest approach to a finding solutions. Our caregiver coaches have been the saving grace for many who have reached the end of their emotional roads. I love being the conduit through which stories of striving and surviving find their way into people’s hearts. That’s why my Hollywood Confidential radio show has been such a blessing in my life. Throughout the United States and Canada, we touch the hearts and minds of listeners who are seeking not only entertainment, but also what I call “life support.”

My professional life mission is simple: offer products, programs, and services to enhance the lives of women and their families. How lucky am I that I get so many ways to do that?

Leeza Gibbons’ Caregiving Advice The Saturday Evening Post

Psoriasis, an autoimmune disorder that occurs when skin cells grow too quickly, affects about 6 million Americans. And nearly 1 million adults might be candidates for the new treatment, which is not indicated for children. Stelara disables proteins released by the immune system that play a role in the overproduction of skin cells and inflammation.

At the close of a busy afternoon at his dermatology practice, Dr. Lebwohl, who was involved in the clinical testing of the new drug, discussed with us the promise (and potential drawbacks) of Stelara and other drugs that treat disease by targeting the immune system.

Q: What sets Stelara apart from conventional therapies for moderate-to-severe psoriasis?

Dr. Mark LebwohlCourtesy of Dr. Mark Lebwohl

Dr. Lebwohl: We have never had anything that works precisely this way. It is the first drug therapy that requires just four shots a year, and the overwhelming majority of patients improve dramatically. The approved treatment schedule is two injections four weeks apart, followed by maintenance injections every 12 weeks. Other injectable therapies are given weekly, twice a week, or every other week.

Q: What type of benefit have you observed with Stelara in your patients or study participants?

Dr. Lebwohl: We have seen benefit in many patients. In fact, it would be unusual for it not to work. On day one, people get the first injection. Four weeks later, there is a dramatic benefit. They get the second injection at that time and then return three months later for a third shot. At that visit, most patients are clear or close to clear.

Q: Has Stelara been tested for the type of psoriasis that affects people’s joints?

Dr. Lebwohl: It has been studied for joint disease, and it was beneficial. The study dose was higher than the one used for skin disease, and given once a week for four weeks.

Q: Do people inject themselves with Stelara or come to the doctor’s office?

Dr. Lebwohl: It is approved for administration in the doctor’s office. If you review the FDA deliberations on this approval, it seems their conclusion is based on the fact that Stelara is a systemic drug, it affects the immune system, and patients ought to be seen by doctors at least four times a year.

Q: Any word yet on insurance coverage?

Dr. Lebwohl: We expect approval from federal insurers, and the drugmaker, Centocor Ortho Biotech, has set up a phone line for physicians to check with the other insurances. However, the insurers have not yet had time to respond.

Q: What do people considering treatment with Stelara need to know?

Dr. Lebwohl: Clinical trials of Stelara were conducted in more than 2,000 patients. Some have taken the drug for longer than three years, and many for a shorter period of time. No clear side effect that emerged.

Stelara is an antibody that blocks a component of two chemicals: IL (interleukin) 12 and IL 23. It turns out that some people are born without that target component. In other words, they are born as though they had Stelara on board. Research on 41 of these people shows that their main problem has been susceptibility to Salmonella infections and also mycobacterial infections, such as tuberculosis.

In the studies of Stelara, there were no cases of either kind of infection–perhaps because we are giving the drug intermittently as opposed to having a lifelong genetic abnormality.

Nonetheless, people should be tested for tuberculosis prior to initiating Stelara therapy. In addition, they should never receive BCG (bacille Calmette-Guérin) vaccines, a type of vaccine used in other countries (but not in the United States) that contains mycobacteria. The usually harmless bacteria caused serious infections in those 41 people; that’s how their genetic abnormality was discovered. People on Stelara should get flu vaccines, but not one containing the live virus. For example, patients on this treatment should not get the seasonal flu vaccine in the inhaled form that has a live virus. They should instead get the shot that contains inactive virus and has no chance of infecting them.

Q: Are you involved in clinical trials of other dermatologic treatments or promising research projects?

Dr. Lebwohl: Yes. At least two experimental biologic agents for psoriasis act upon newly identified molecular targets and appear to be effective. We will be seeing more biologics as time goes on.

Highly targeted biologic therapies are very effective and safe. The drawback, however, is they are very expensive to make. The same is true for biologics to treat diseases other than psoriasis. For example, some cancer drugs target the tumor and spare normal cells that are nearby. Biologics are very costly but have the potential of significantly changing our lives for the better. It’s important that we figure out better ways to develop and manufacture these promising therapies.

Dr. Mark Lebwohl is president of the New York State Society of Dermatology and has served as chairman of the Section on Dermatology of the New York Academy of Medicine. Dr. Lebwohl is a member of the medical advisory board of the National Psoriasis Foundation and editor of Psoriasis Forum as well as medical editor of The Bulletin of the National Psoriasis Foundation.

New & Effective Psoriasis Drug The Saturday Evening Post

Not to be confused with osteoarthritis, which is caused by wear and tear on aging joints, RA is an autoimmune disease that may also affect the eyes, skin, or lungs. Here, Krieger shares with the Post some foods that may reduce inflammation in the body and help relieve the painful swelling and stiffness that is often associated with RA.

“Inflammation is the main thing. And there are foods I find so interesting, particularly spices like turmeric, which is one of the main ingredients in curry. Try curry on cauliflower or use ginger in an Asian-flavored stir-fry. These spices have been linked with having an anti-inflammatory effect,” says Krieger.

Although mainly developed for patients of RA, Krieger’s campaign recipes are beneficial to anyone trying to eat a healthier diet. “It’s about spicing up your life with wonderful flavors. I have a recipe for a Blueberry Blast Smoothie, which is milk blended with a little honey and some fresh (or frozen) blueberries. You’re getting antioxidants, and you’re getting your Vitamin D in essentially what I think tastes like a milkshake.” Additionally, Krieger shares her Chickpea and Spinach Salad with Cumin Dressing, an excellent source of fiber, vitamin C, vitamin K, and a good source of iron and vitamin A.

Blueberry Blast Smoothie

Blueberry Blast Smoothie

(Makes 1 smoothie)

• 1/2 cup nonfat milk
• 1/2 cup plain nonfat yogurt
• 1 cup frozen unsweetened blueberries
• 1 teaspoon honey

Put all ingredients into a blender and process until smooth.

Nutrition Facts

Nutrition Information
Per serving:

• Calories: 195
• Total fat: 1 g (sat fat 0 g, mono fat 0 g, poly fat 0 g)
• Protein: 10 g
• Carbohydrates: 40 g
• Fiber: 4 g
• Cholesterol: 5 mg
• Sodium: 134 mg

Chickpea and Spinach Salad with Cumin Dressing

Chickpea Spinach Salad with Cumin Dressing. Photo courtesy of Ellie Krieger.

(Makes 4 servings)

• One 15.5-ounce can of chickpeas, preferably low-sodium, drained and rinsed
• 2 tablespoons fresh chopped flat-leaf parsley
• 1/4 cup diced red onion
• 2 tablespoons olive oil
• 2 tablespoons fresh lemon juice
• 1/4 teaspoon finely grated lemon zest
• 3/4 teaspoon ground cumin
• Pinch of cayenne pepper
• Salt and freshly ground black pepper to taste
• 3 tablespoons plain nonfat yogurt
• 1 tablespoon orange juice
• 1/4 teaspoon finely grated orange zest
• 1/4 teaspoon honey
• 2 ounces baby spinach leaves (about 2 cups lightly packed)
• 1 tablespoon coarsely chopped fresh mint

In medium bowl, combine chickpeas, parsley, and onion. In small bowl, whisk together oil, lemon juice and zest, cumin, cayenne, salt, and black pepper. Pour dressing over the chickpea mixture and toss to coat evenly. In small bowl, stir together yogurt, orange juice and zest, and honey. Serve chickpea salad over bed of spinach leaves. Top with yogurt sauce and garnish with mint.

Nutrition Facts

Nutrition Information
Serving size: 1/2 cup chickpea salad, 1/2 cup spinach, and 1 tablespoon yogurt sauce
Per serving:

• Calories 175
• Total fat: 9 g (sat fat 1 g, mono fat 5.5 g, poly fat 1.5 g)
• Protein: 6 g
• Carbohydrates: 20 g
• Fiber: 5 g
• Cholesterol: 0 mg
• Sodium: 147 mg

Ellie Krieger

Krieger recently teamed up with Emmy winner Deborah Norville and a panel of experts to discuss and share information important to people with RA. Proper nutrition, fitness, relationships, career management—it’s all part of an online talk show to educate the public on a disease affecting more than 1.3 million Americans, most of which are women. For more information, visit newwayra.com/newwayra/home.html.

Recipes courtesy of Ellie Krieger.

Foods to Reduce Inflammation The Saturday Evening Post

What would Ben Franklin say about individuals who decline inoculation?

Here is what he did say about the subject: “As the practice of Inoculation always divided people into parties, some contending warmly for it, and others as strongly against it. …” It was necessary to have a strict and impartial enquiry into the inoculation and death rates during epidemics.

Few people alive today are old enough to remember the 1918 influenza pandemic, an event that killed tens of millions of people. Ben Franklin, however, lived in an era where contagious epidemics—yellow fever, malaria, smallpox, typhus, influenza—were common. Since the germ theory of disease had not yet been proposed during Franklin’s lifetime, people had no idea about what caused such deadly assaults on the population. The most commonly accepted explanation involved divine visitation, presumably as punishment to an entire population for sinful conduct.

Edward Jenner’s discovery of the smallpox vaccine did not occur until several years after Franklin died. During Franklin’s lifetime, inoculation against smallpox was performed by exposing a person to scabs taken from the skin of somebody with the disease. Usually, the inoculation process produced a mild smallpox infection; survival meant lifetime immunity. Occasionally, however, the inoculation would lead to a progressive form of the disease, which would kill the patient. For this reason, many feared inoculation, although Franklin favored it.

When Ben Franklin was a young printer in Philadelphia, he lost the only son he had with his wife to a smallpox epidemic. The lad was 4 years old at the time. Franklin had planned to have the boy inoculated, but never got around to it.

Ben Franklin never forgave himself for the loss. Like many parents who nowadays create a foundation in the memory of a child who died so that others might benefit from research into the illness that took away their loved one, Franklin started collecting smallpox inoculation statistics. He soon realized that the risk of inoculation was small compared to the risk of acquiring a smallpox infection in what he referred to as the “usual way.”

When Franklin was in England in 1759, he persuaded a famous physician to write a pamphlet for distribution in British North America favoring the smallpox inoculation. Franklin himself penned the pamphlet’s preface. In it, he presented his statistical results, hoping to persuade parents that their children would benefit from inoculation. Likewise, he found it necessary to overcome theological resistance to inoculation. Certain men of the cloth, it turns out, were convinced that any attempt to reduce the impact of a divinely ordained plague would go against God’s will. Franklin found it necessary, therefore, to point out that God gave mankind the capacity to discover a method that reduced the impact of a contagious illness.

Here’s how Franklin combined his analysis of smallpox statistics with his response to those who found inoculation somehow unholy:

“If the chance were only as two to one in favour of the practice [of inoculation] among children, would it not be sufficient to induce a tender parent to lay hold of the advantage? But when it’s so much greater, as it appears to be by these accounts (in some even as thirty to one) surely parents will no longer refuse to accept and thankfully use a discovery GOD in his mercy has been pleased to bless mankind with.”

Influenza Pandemic The Saturday Evening Post

Schools across the country are reporting their first cases of the newly identified H1N1 flu (earlier called the “swine flu”). And every state will likely see sporadic to widespread cases before the typical flu season winds down sometime next spring.

How can you minimize your risk? Leading experts from the Centers for Disease Control and Prevention, the National Institutes of Health, and the Food and Drug Administration offer the following advice for fighting H1N1 and seasonal flus.

Avoid flu viruses.
DO keep your hands away from your eyes, nose, and mouth. If you are ill, this helps prevent infecting others. If you’re healthy, it helps you stay that way. H1N1 and seasonal flu viruses may live for hours on hard surfaces such as doorknobs, phones, and computer keyboards.

DON’T depend on wearing a facemask for complete flu protection. In general, the use of facemasks is not recommended in community and home settings.

Follow vaccine recommendations.
DO consider flu shots. Nearly everyone is advised to get the seasonal flu shot. Exceptions may include those with an egg allergy or a history of Guillain-Barre Syndrome. People who are ill should usually delay vaccination until they recover. About 45 million doses of the H1N1 vaccine (from five manufacturers) are expected by mid-October, with up to 195 million doses by year’s end. Target groups for vaccination focus on those at most risk of infection and severe disease, including pregnant women, children and young adults ages 6 months through 24 years, and people 25 to 64 with medical conditions that predispose them to complications of the flu. Health care workers and emergency medical service workers, as well as those who care for infants not yet old enough to be vaccinated, are also encouraged to receive the H1N1 vaccine.

DON’T assume that flu vaccines provide immediate and full protection. Remember to wash hands frequently with soap and water, cover your cough, and stay home if you are sick. When possible, avoid being within about six feet of a person with influenza-like illness.

Stay informed.
DO watch for new reports about emerging trends and prevention strategies. Study findings expected in mid-September will indicate whether one or two doses of the H1N1 vaccine provide adequate immunity against the novel virus.

DON’T let your guard down. Influenza is unpredictable. Current levels of flu activity in the United States are low. But any influenza at this time of year is unusual—and most of the confirmed cases are the H1N1 flu.

H1N1: Can You Minimize Your Risk? The Saturday Evening Post

1. Protect your supplies. Pack glucose meters, test strips, and insulin in a dark protective carrying case with a gel cooling pack. Always bring an extra set of supplies in a separate case. When flying, keep supplies and medicines in your carry-on luggage.

2. Bring premeasured snacks from home to help you manage unusual meal times and menus. Special travel bars for diabetics are also available. Two popular brands are Glucerna and Extend.

3. Closely monitor your glucose level. When crossing time zones, carry a second watch set to the time at home for a few days until you adjust to the new schedule. Consider more frequent testing, as travel inevitably disrupts daily routines.

4. Plan ahead for insulin injections in flight: Contact your insulin manufacturer for any special instructions to accommodate the plane’s cabin pressure.

5. Pack for walking. To avoid foot soreness and blisters, change socks often and wear comfortable, closed-toe shoes. Bring an extra pair of shoes. Consider purchasing socks for diabetics that are designed to keep feet cool and dry.

6. Carry or wear medical identification that indicates you have diabetes.

7. Take your pick at the buffet table. Opt for colorful vegetables, whole grains, chicken, and fish. Veggie burgers and edamame beans are nutritious choices, too. Select fresh fruit or use a small plate for desserts.

8. Stay hydrated by drinking water or unsweetened iced tea. Or fill a thermos with lemonade made with water, fresh squeezed lemons, and mint. Dehydration may lead to false high glucose readings.

9. Limit diet soda consumption to one serving per day. Drink alcohol only with a meal and no more than one serving per day for women; two for men.

9 Travel Tips: On the Road with Diabetes The Saturday Evening Post

In May one of the study participants, Edwin McClure, walked across the stage to receive his degree after completing a rigorous graduate program at Virginia Commonwealth University. The young man appeared strong, healthy, and confident.

The scene was in stark contrast to four years earlier when the high school star football player was battling a severe cold, fatigue, and inexplicable visual changes.

“It was like someone turned down a dimmer switch,” he recalls. “My mom thought the problems were due to sinus pressure and would eventually go away, but when I got over the cold and still had difficulty seeing, she took me to an optometrist.”

When nothing surfaced during visits to an optometrist and an ophthalmologist, McClure was referred to a neurologist for follow-up.

After a series of tests and an MRI scan, the doctor delivered the diagnosis — multiple sclerosis (MS). The visual changes the young man was experiencing were due to optic neuritis, an inflammation of the optic nerve that occurs in approximately 50 percent of patients with the disease.

McClure was placed on steroids and interferon injections — a regimen that successfully controlled symptoms for two years. But when the MS started to break through, his physician switched to another medication.

“Over the course of four months, I started to develop an allergic reaction to the drug,” McClure says. “Meanwhile, my disease was still progressing.”

McClure was at a crossroads: begin medications with significantly greater risk of side effects or, as his neurologist suggested, investigate a promising clinical trial underway at Northwestern University in Chicago.

He chose the latter, qualified, and enrolled in Dr. Burt’s study. McClure was one of the 21 patients in the trial, ages 20 to 53, who had relapsing-remitting MS for an average of five years and had not responded to at least six months of treatment with interferon beta. After an average follow-up of three years posttreatment, 17 patients (81 percent) improved and none got worse, according to Dr. Burt, whose findings were published in the March issue of The Lancet Neurology.

Resetting the Immune System

Dr. Richard Burt, M.D.
Courtesy Dr. Richard Burt, M.D.

“The concept is that your immune stem cells — your blood stem cells — could be used to regenerate a new immune system in virtually any autoimmune disease,” Dr. Burt tells the Post. “If we treated patients in the early relapsing-remitting phase of MS who were experiencing frequent acute attacks despite the use of interferon, patients got better. Six months after the procedure, they were even better. By two years, they seemed to have reached their peak improvement in neurological function. Most people tend to be early- to mid-range in their disability, and that’s when this therapy is really effective. But if you treat MS in a later stage, called secondary progressive MS, it doesn’t really help. In this stage, patients experience a steady worsening of irreversible neurological damage.”

In the procedure, Dr. Burt and colleagues first push immune stem cells from the bone marrow into the blood by using a growth factor and a drug called Cytoxan (cyclophosphamide). Ten days later, they harvest cells from the blood via catheter. The cells are then separated, frozen, and cultured to ensure that none are contaminated with bacteria during the process. Next, the patients are treated with drugs to inhibit the old immune system, and then the frozen stem cells are thawed and infused back into the patients to make a new immune system.

Reversing the Tide

“I started to feel improvement while I was in the hospital,” McClure says. “I realized that I didn’t need my glasses to see. At home my parents noticed that my balance was improving and that I didn’t seem as fatigued as before. Honestly, these changes started within the first month after coming home. My life continued to improve. By the third month, I was actually going to the YMCA to exercise.”

Three years after treatment, McClure remains off medication and now experiences no symptoms of MS.

Like McClure, the majority of trial participants experienced benefits.

“We’ve seen patients who have had marked improvement in symptoms,” notes Dr. Burt, principal investigator of the clinical trial. “Your nervous system controls everything, so the part of the brain attacked by MS determines where you have a problem. Some patients had trouble walking — falling down and having to hold on to things — but after the procedure, they had marked improvement. Others had issues with incontinence, and that’s gone away. If you’re worried about incontinence, that’s quite remarkable. Numbness, tingling, inability to feel things, visual problems — blurred and double vision — can all reverse. Basically, any type of deficit can reverse. In some patients, we actually had complete reversal — everything went away, and they were completely normal in all functional exams.
In others, symptoms never completely reversed, but improved dramatically.”

The study participants are also off all conventional disease-modifying medications now used to slow the rate of disease progression.

While the small trial is only a first step, the results offer a completely new way to treat MS. “This is the first time in the history of any therapy used to treat MS where it actually reverses neurological deficit,” stresses Dr. Burt.

“All other therapies were studied or approved for their ability to slow the rate of progression — in terms of clinical deficits or MRI load of lesion burden — but nothing has, up to this time, reversed deficit. That’s what’s exciting. However, I want to stress that we cannot say it is a cure and current results with three years of follow-up are encouraging.”

Dr. Burt and colleagues are enrolling patients in a larger trial to test the procedure in a randomized setting. “If the results of the trial hold up, I believe it will help open the door for it to be accepted as standard therapy,” adds Dr. Burt.

At present, clinical trials are underway at the University of Calgary in Canada, the University of São Paulo in Brazil, and at Northwestern University. If interested in learning more about the trial, e-mail d-spahovic@northwester.edu.

A Different Approach

Sergeant Preston WalkerCourtesy Sergeant Preston Walker

After undergoing conventional therapy for MS for several years, Fort Worth police sergeant Preston Walker learned about a new treatment for autoimmune disorders. Researchers were utilizing adult stem cells derived from cord blood at The Institute of Cellular Medicine in Costa Rica. Walker inquired about the potential of the treatment for multiple sclerosis.

“We knew that if the treatment worked, the potential benefits for multiple sclerosis patients could be limitless,” says Walker.

Dr. Neil Riordan, CEO of the Institute, suggested a therapy under consideration — using stem cells derived from a patient’s fat tissue. In May 2008, Walker flew to the clinic where doctors removed samples of his abdominal fat through a mini-liposuction, drawing out stem cells, which were later re-injected. According to Dr. Riordan, Walker and a colleague were the first to undergo this treatment protocol. “My quality of life has improved significantly,” Walker told the Post. “The problems with depression, fatigue, and balance have been corrected. I feel really good.”

In June 2009, Walker, who continues to take Avonex as a maintenance drug, plans a return trip to Costa Rica for a “tune-up,” as he puts it. “I’m curious to see if they can further improve my cognitive abilities.”

Breakthroughs on the Brink: Turning the Tide on MS The Saturday Evening Post

“It’s a fascinating time in MS research,” says Patricia O’Looney, Ph.D., vice president of biomedical research at the National Multiple Sclerosis Society. “The knowledge is so great now.”

Multiple sclerosis is an unpredictable and often disabling disease of the central nervous system. It is believed to be an autoimmune disease, which means that the immune system reacts against itself. One of its quirks is that its progress, severity, and symptoms are different in everybody.

An estimated 400,000 people in the United States are affected by MS. Someone is diagnosed with MS every hour, every day of the year.

Symptoms that might send someone to a neurologist for tests include: loss of mobility; numbness, tingling, or pain; and sudden, often temporary, blindness. People may have mysterious, erratic symptoms for years before diagnosis. Most people — two to four times as many women as men — are diagnosed between ages 20 and 50.

Not surprisingly, genetics plays a major role in current research. “So far, researchers have found as many as 12 genes (out of about 20,000 in the human genome) that are linked to MS. Most of these are connected to the regulation of the immune system, which is inherited from our parents. In the end, we may find as many as 80 MS genes,” says Dr. O’Looney. “Identifying these genetic markers will help us understand why there’s such variability and unpredictability in the disease. There might even be some genes linked to particular types of MS. When you identify genes, it may lead to targets for new therapies.”

By eating away myelin - the protective nerve coating - MS shorts out the flow of information within the brain and between the brain and body, similar to how a stripped electrical wire can short out an appliance.
Image © 2009 RelayHealth and/or its affiliates

Even with genetic susceptibility, something has to trigger the disease, and researchers are looking for these catalysts. One hypothesis is that a lack of sunlight and vitamin D — which, in part, regulates the immune system — might play that role. One bit of evidence is a higher prevalence of MS the farther you live from the equator in your early years. What complicates this research is that there may be different triggers in different people. If a virus is the culprit, as many suspect, it likely has vanished from the body years before the onset of symptoms.

With more than 130 clinical trials under way around the world, including more than a dozen phase 3 (late-stage) trials in process, nearing completion, or finished, MS research is making huge strides toward solving these unknowns. Many of these trials focus on treatment. The vast majority of people with MS have a type called relapsing-remitting and take one of the FDA-approved disease-modifying therapies. Fifteen years of data demonstrate their effectiveness. “What research has told us is that the disease is much more active than originally thought,” Dr. O’Looney explains. “Even if a person is aware of one or two flareups a year, the disease could still be active, although asymptomatic, particularly in the brain. There are times when a person feels OK, but damage is taking place. That’s why the National MS Society advocates so strongly that people diagnosed with MS should be on drug therapy.” Not everyone responds the same to these medications, so having several to choose among is important. One option we can expect to see within a year or so is an oral medication, which may be offered alongside or as a replacement for the injectable medications.

Another promising line of inquiry is understanding how sex hormones may regulate the immune system in people with MS. For example, levels of the hormone estriol typically rise significantly during late pregnancy. This is also when most women’s MS activity declines, leading some scientists to suspect that estriol may be responsible for the easing of symptoms during pregnancy. Preliminary results in a small pilot trial showed that oral estriol treatment decreased disease activity in women with relapsing-remitting MS. To further explore this, a larger trial has begun at the University of California at Los Angeles and several sites throughout the United States.
“Five or 10 years from now, it is certainly our hope that more and increasingly effective MS therapies will be available,” Dr. O’Looney concludes. “Our goal is to find a cure for everyone, and we will, eventually.”

To learn more, call 800-344-4867 or visit www.nationalmssociety.org.

Terri Garr

Courtesy: National Multiple Sclerosis Society

Garr takes one of the MS disease-modifying therapies, which has slowed the progression, she says. She also exercises for an hour a day on a recumbent bicycle. “It helps strengthen both my arms and legs and is aerobic as well. Plus, I can read or watch TV while I’m on it. In the summer, I swim, which I really love. It’s vital to keep moving.” She eats healthy, balanced meals and “was blessed with a dancer’s metabolism. I eat pretty much what I like, but in moderation.

“I decided to go public with my diagnosis partly because rumors had begun circulating about my health, and I wanted to be the one to set the record straight. Besides, what’s worse? Being disabled or being a woman over 50 in Hollywood? Once I went public about my MS, I quickly realized that I would be able to help people in the same condition, and there was nothing to be ashamed of. If people could relate to me through my work, why not in my real life? I became a spokesperson for MS Lifelines, a patient education program, and traveled the country speaking to people with MS, trying to encourage them to find out everything they could about the available therapies and how they could move forward with their lives. I still receive e-mails and fan letters that thank me for sharing my story and helping take the stigma and mystery away from MS.

“The most important thing I tell people with MS is to have a positive mental attitude and keep moving! I also advise anyone
recently diagnosed to relax. The status of MS research has never been more exciting. People talk about the ‘war’ against MS; this isn’t a war, but a movement by and for people with MS.

“Together we will create a world free of multiple sclerosis.”

Montel Williams

© Montel Media Group

Without a trace of self-pity, Williams admits he has 24-hour pain in his feet and side, and that it has recently migrated to his face. He’s tried many remedies, from over-the-counter painkillers to opiates, and from acupuncture to biofeedback. He deals with his condition by raising awareness and funds for MS research through the Montel Williams MS Foundation. “MS is a lifelong battle. There’s no wonder drug that arrests it with true efficacy,” he says. “We’re in a battle of time.” He also actively supports the Partnership for Prescription Assistance (pparx.org), which matches patients with free or nearly free prescriptions.

“The most important thing you can do as a patient, no matter the illness, is educate yourself,” he adds. “There is nothing more profoundly assuring and calming than knowledge.”

Unraveling Clues to Multiple Sclerosis The Saturday Evening Post

A surprising observation by friends on a tandem bike is now an active focus of research: Can forcing someone with Parkinson’s to exercise harder than (s)he normally would somehow counteract the uncontrollable leg and arm movements that are characteristics of the disease?

Preliminary research says yes—and ongoing studies are teasing out the specifics of how much exercise is best. Discovery of why it works awaits future investigation.

In a study presented at the June 11-17 conference in Paris, France, researchers at Cleveland Clinic report that forced-exercise helps relieve symptoms as well taking levodopa, a standard drug prescribed for PD.

Participants showed a 35 percent to 40 percent improvement after a single ride on a stationary tandem bicycle with a healthy partner pedaling at a steady pace of 80 to 90 revolutions per minute (rpm). PD patients typically perform about 40 to 60 rpm on their own.

Researchers think that exceeding the nervous system’s usual limits may lead to chemical changes in the body that help improve motor functioning.

“Exercise is part of a healthy lifestyle in general, and, if it has specific effects in PD, that is all for the better,” commented Dr. Mark Hallet of the National Institute of Neurological Disorders and Stroke. “The current abstract deals with the mechanism of a short-term benefit. Using neuroimaging, the authors find a similar pattern of changes as are induced with levodopa. This is certainly interesting and may indicate that exercise, in the short run, causes dopa release. Whether this effect is relevant to more long-term effects remain to be demonstrated.”

Dr. Angela Ridgel and her team at Kent State University are testing a motorized stationary bike that has been customized by its German manufacturers to reach speeds of 90 rpm. In the recently completed study, 21 people with Parkinson’s disease strapped themselves to the bike’s pedals for three 40-minute sessions.

“First we had study participants perform a basic fitness test,” Dr. Ridgel explained to the Post. “Then they came for sessions at 60, 70, or 80 rpm, and we compared their ability to move between each workout. This is passive exercise—we asked them not to help, but to let the motor do the work. We’re analyzing the data right now, but really seems as if we are getting an effect.”

The next step is to compare the benefit of passive versus active exercise.

“The same bike allows active exercise,” Ridgel says. “We will continue to look at specific rates, but we’re going to see if we get an even more dramatic effect when people are helping.

“The goal of our current research is not to make specific recommendations,” she concludes. “Of course, exercise is good for everyone. For people with Parkinson’s who want to exercise by cycling, I suggest lightening the resistance and maximizing the speed of their leg movement. Having Parkinson’s makes it somewhat more tricky for them, but that is what I’m suggesting to people who ask me.”

For more information about the research and to receive the study upon publication, e-mail Dr. Ridgel at aridgel@kent.edu.

Gene Research

Investigators say that variations within one gene may play a role in developing Parkinson’s disease and essential tremor (ET). Data presented at the Movement Disorder Society’s 13th International Congress reveal that the LINGO1 gene may be the “missing link” between the two most common movement disorders. PD and ET are characterized by different types of tremors and treatments. The finding provides the first firm evidence that connects these disorders and offers hope for new therapies in the future.

Parkinson’s Research Update The Saturday Evening Post

The Insight Foot Care Scale allows for thorough and safe observation of the soles and heels of the feet. For more information, visit focusonyourfeet.com or call 1-866-321-2406.

Diabetes: Foot Care The Saturday Evening Post

Vagal nerve stimulation (VNS) therapy, approved in 1997, does not involve brain therapy. The pulse generator is implanted under the skin in the upper chest and delivers intermittent signals to the brain via one or two wires attached to the left vagus nerve in the neck. Studies show that VNS therapy may also benefit some people with chronic depression.

For more information about VNS therapy, visit vnstherapy.com.

Treating Epilepsy with New Technology The Saturday Evening Post

Grandma Eileen and Grandpa Jim were in Indianapolis for the summer. I felt that Grandma needed to get out of the house for a little while, so I took her with me to run a few errands. Because her knees often hurt due to surgeries after falling off a horse in her youth, it was quite a battle getting her into my SUV. But after what seemed like hours of maneuvering and adjusting, we were buckled up and off to the bank.

To avoid the grueling process of getting in and out of the car, I decided to opt for drive-thru banking. As I was explaining my transaction to the teller, I heard the ding sound that signals a car door ajar. I looked over to my passenger, and yes, she was making a break for it! I inquired as to where she was going, and with an “isn’t it obvious” tone in her voice, Grandma replied: “I’m going to the bank.” Now, far be it from me to hold her back from doing her imaginary personal banking, as I’m pretty sure she did not hold an account at that banking institution, nor any other one for that matter. But I explained that I was working with the teller, and we didn’t even need to get out of the car; how convenient! She was delighted with the concept and closed the car door.

After the bank, I stopped to get a bagel and told Grandma that she could sit in the car while I went inside. I asked if she was hungry and she responded, “Sure.” Always so agreeable when it comes to food or drink, I thought. It must run in the family. But then I asked what kind of bagel she wanted. Blueberry? Salt? Plain? With light cream cheese? Butter? Or toasted? I waited for at least three minutes. Finally, she asked politely for “a round one.” As opposed to the ever popular, but far less tasty, triangular shaped bagels? I did hear that the octagonal bagel was making a comeback, and quite a treat, I thought. But she decided to stick with the original round bagel! You have to appreciate that kind of answer after so much consideration!

Have you ever been able to appreciate a light-hearted moment while coping with ongoing grief?

Running Errands … The Saturday Evening Post