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iStock/Thinkstock(NEW YORK) -- Thanksgiving is a time of turkey, mashed potatoes, casseroles, pies -- oh, and friends, family and giving thanks.

Our anticipation of and obsession with food can seem at times like it's the focus of the holiday.

"Thanksgiving is a holiday with so much emotion around food attached," said Dr. Alexis Conason, a clinical psychologist and the founder of The Anti-Diet Plan. "It's like there is this expectation to overeat on this day."

"Then the dam is let loose, and we often eat in ways that feel out of control or don't feel good in our body," she said.

Taking a few simple steps to be mindful before, during and after the Thanksgiving meal can help with not just enjoying the meal, but enjoying the holiday too, Conason said.

"If we're stuck in conflict, feeling like, 'Oh my gosh, I shouldn't eat any pie. I'm on a diet but the pie looks so good. I shouldn't have it, but maybe I'll have a small piece,' that's a tremendous amount of energy that's going into the pie," she said. "That's energy that is not going into catching up with friends and family or taking in the sights or anything else going on."

What is mindful eating?

Mindful eating is the "antidote to dieting," according to Dr. Susan Albers, a psychologist at the Cleveland Clinic and The New York Times' bestselling author of seven books on mindful eating.

"It's about eating the foods you love but in a mindful way, your awareness of hunger cues, your awareness of taste," Albers told ABC News' Good Morning America earlier this year. "When you tune into these cues, you enjoy food more and you're more in control of your eating."

Mindful eating can be done anywhere and with any meal. You are eating mindfully if you are focusing fully on the food you are eating and are aware and accepting of your thoughts, according to Albers.

Five steps for a mindful Thanksgiving meal

When it comes to Thanksgiving, a key part of being mindful is remembering that foods like pumpkin pie and sweet potato casserole are available year-round.

"The idea that these foods are unique and special to Thanksgiving leads to a panic feeling of eating everything you can in this one opportunity," Conason said. "We can have pumpkin pie in July. Try to take away the idea of scarcity of the food or of restriction."

Conason shared these five steps to try on Thanksgiving Day so you can savor every bite and not overindulge:

1. Check in with your body: See how hungry you feel and if there are any particular foods you're in the mood for.

2. Look at the food options: Observe all the different foods available and think about how hungry you feel, what foods are most appealing to you and how you want to feel afterward.

3: Take a moment before you eat: Look at the food and maybe bring it up to your nose and smell it.

4. Pay attention: When you do eat, make sure you're smelling, tasting and looking at the food and staying in touch and being present as you're eating.

5. Check in again with yourself: As you're eating, see if your desire changed at all, if your hunger changed and pay attention to that process.

How to be mindful if you overeat

"It's completely normal and OK to overeat sometimes," said Conason. "If you do overeat at Thanksgiving and feel uncomfortable, the best thing you can do is try to treat yourself with kindness and compassion and not beat up on yourself about it."

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ABC News(NEW YORK) -- There's a space-like pantsuit that claims it'll deliver slimming results through lymphatic drainage massage.

It's called the Ballancer Pro, and it uses patent-pending compression garments that apply a gentle or firm massage.

Basically, it's like a giant sleeping bag for the body that the makers say uses compression therapy to allegedly eliminate toxins, slim and tone the body and treat cellulite.

The celebrity laser facialist Teresa Tarmey currently offers the treatment at her new skin clinic in New York City.

Tarmey told ABC News' Good Morning America that the Ballancer Pro is great for preparing for red carpet events.

"The reason being is it's a bodysuit that you would actually climb into and then it would give you a really good lymphatic massage, which is amazing for athletes, anyone who is wanting to get rid of the water retention," Tarmey said.

Whether the claims check out or not, celebs have turned to the treatment to get ready for red carpets. Tarmey said she had even transported the suit to events to use on clients while they get their hair and makeup done.

"It's a really nice way to get the client really calm, but also see a result and feel a little bit slimmer," she explained.

Tarmey said the bodysuit has been used in London for a few months, and she's one of the few people who have it in New York.

Tarmey recommends a course of treatments to see the best results.

Here's what happened after one trial:

What it felt like having it on

The bodysuit was like getting a very strong hug. The suit inflates and deflates rhythmically with what felt like varying pressure throughout the whole session.

How long it took

The process felt really quick and took about 45 minutes in total.

The takeaway

There was no pain and it was a relaxing process. It's worth the splurge if a person wants to use it again before an event or a special occasion.

The price is $250 per treatment. To book an appointment visit teresatarmey.com.

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Courtesy Latiaa Stewart(NASHVILLE, Tenn.) -- A Tennessee mother of three who was once homeless now gives out care packages to homeless people, and it's all possible thanks to her couponing skills.

Latiaa Stewart, 37, spends the entire year coupon shopping so she can have extra personal care items — like toothpaste, deodorant and toilet paper — to hand out to homeless people each Christmas in the Nashville area, where she lives.

Stewart stores the products in every inch of the home that she shares with her husband and children. The family has made it a holiday tradition to assemble the products in festive Christmas bags and distribute the care packages to people on the street.

“I was homeless as a child myself and I remember going from shelter to shelter and sleeping in the car with my dad one night,” Stewart said. “I have to show my kids that even when you get on your feet in life, you don’t turn your back on the people who are still in need.”

Stewart, a drug and alcohol therapist, started couponing nearly five years ago out of a need to save money while raising three young children.

Inspired by the TV show “Extreme Couponing,” Stewart watched YouTube videos and joined Facebook groups to learn to coupon, and started buying multiple newspapers on Sundays in order to get as many coupons as possible.

The family’s house and garage quickly became overrun by piles of toilet paper, razors, shaving cream, deodorant, lotions and more.

"It really was overwhelming because the last house she was in was small," said Jovan Kearse, 37, Stewart's best friend since college. "They couldn’t even park their car in the garage."

Stewart said she wanted to give the items to homeless individuals who may not be willing, or able, to go to homeless shelters but still need help. She decided to hand out the bags around Christmas because she remembered the sadness of not receiving Christmas gifts every year as a child.

"One man said to me, ‘I’ve never had a Christmas gift,'" Stewart recalled. "Their faces just light up."

Stewart and her family distributed 93 bags the first year and hope to hand out more than 200 bags this year. Friends and strangers alike have also begun donating items, like blankets, coats and scarves, for Stewart to hand out as well.

Friends like Kearse also help by giving Stewart coupons so she can keep buying products.

"It definitely does not surprise me that she gives," Kearse said of her best friend's efforts to help others. "She’s always been a giver, even when she didn’t necessarily have the money."

Stewart said she spends around two hours collecting and organizing coupons and around three hours in the store shopping with them each week.

Last year was the only year since 2013 that Stewart did not hand out care packages because her family moved during the holiday season.

But she also recalled that the first thing she said when she walked into their larger new home: "I have so much space to receive donations for the homeless."

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iStock/Thinkstock(NEW YORK) -- November is National Diabetes Month, but for the more than a million children and adults in the U.S. living with Type 1 diabetes, every day and night is a constant reminder of a physically and emotionally tedious disorder that requires constant monitoring.

"I wear an insulin pump, a continuous glucose monitor, do several finger-sticks a day, count carbohydrates," said Bridget Kelly, a mother of two who was diagnosed in her 20s and is now in her 40s. "Type 1 diabetes is like a second job that you can’t quit."

People with Type 1 diabetes must work to keep their blood sugar in a normal range. High blood sugar over a long period of time can lead to devastating complications.

In the short term, blood sugars that are too high or too low can be deadly.

Kerri Sparling, from the blog SixUntilMe.com, also is a mother of two and was diagnosed in second grade. No one else in her family has Type 1 diabetes, and she remembers her parents being very upset with the diagnosis.

They tried to explain a chronic illness to her, to which she said, "So I'm gonna have it until Christmas?!”

Her parents gently replied, "No, honey -- all the Christmases."

Type 1 diabetes can strike people at any age and in any condition. Once called "juvenile diabetes," we now know people can be diagnosed as children or adults.

Symptoms often include extreme thirst, frequent urination and sudden weight loss, leading to a medical visit during which a person is given a blood test -- the only way to identify Type 1 diabetes. For those at risk, their blood sugar is dangerously high.

Type 1 diabetes is an autoimmune condition in which a person’s immune system attacks the insulin-producing cells of the pancreas, and it can no longer make insulin. Insulin is essential for life because it delivers glucose, aka blood sugar, which all cells in the body need to function.

There may be instant relief after diagnosis, knowing that there is a name for what is happening and that there are monitoring systems -- and that insulin that will be available for daily treatment. But for a person with Type 1 diabetes, life is never the same.

"After my diagnosis, I was ready to do whatever was necessary to take care of this disorder, but it's unimaginable the amount of work that is required to keep your blood sugar within a safe range when your pancreas stops making its own insulin," Kelly said.

This is different from the more common Type 2 diabetes, most often seen in adults with obesity, high blood pressure and high cholesterol. Both types are believed to have a genetic component, and both are linked to the pancreas.

In Type 2 diabetes, however, the pancreas still makes some insulin and it can be controlled with oral medication, exercise and diet.

There is currently no way to prevent Type 1 diabetes, typically referred to as T1DM, and there is no cure.

ABC News' Medical Unit has previously reported on the technology available now to make managing diabetes easier and the solutions on the horizon.

For now, it's a very difficult disorder to manage, surrounded by second-guessing by the individual and the well-meaning people around them who may offer dietary advice without understanding Type 1 diabetes.

"I choose when I eat my carbohydrates carefully," Kelly said. "So if I want to have pizza or chocolate cake I can. ... but I need to know how many carbohydrates are in that food and take the necessary insulin through my pump, so my blood sugar doesn't skyrocket. And I can't take too much insulin or my blood sugar will plummet and I can go into a coma and worse."

"I'm also considering variables like whether I’ll be exercising soon or sleeping soon and what my current blood sugar is," Kelly added. "I have to think of all those things before I eat and make insulin dosing decisions. So it's not helpful if other people are commenting on my meal choices."

New daily life

Every day, a person with T1DM needs to make many decisions: They need to check their blood sugar levels with a finger-stick test regularly, especially before they eat; inject themselves with insulin, as no pills are available to treat T1DM, or use an insulin pump device; and actively think about what they're eating -- how many carbohydrates every meal or snack contains.

If they're sick, more active than usual, gained or lost weight, they need to adjust the insulin doses; these variables are difficult to manage.

And finally, they need to watch out for dangerous signs of blood sugar being too low or too high. They may begin to learn to care for their own body better than any health care professional can.

And they need to do this every hour, of every day, of every year. There is no quitting or putting diabetes on hold.

Carl Armato, CEO of Novant Health, recently published A Future With Hope. He was diagnosed with T1DM as a toddler. In the book, he shares important lessons about his 50 years of experience.

"The disease is the disease, but it's how people deal with diabetes and adapt to it that is critical to the quality of life they have -- more importantly, to whether they even have a life to live," he said.

He admits it's difficult to manage, but advises from his experience that it's more than possible to have a successful and fulfilling life.

"Diabetes is a marathon, not a sprint," Armato said. "Stuff happens. You lose. You fail. Then you have to get back up and fight."

Kelly, the mother of two diagnosed in her 20s, works with her endocrinologist, certified diabetes nurse educator and, at times, a specialized nutritionist.

She looks at dealing with the disorder as "going into battle."

"I always have my diabetes devices with me. I always need to think, 'If I have a hypoglycemia, how am I going to get fast acting sugar to raise it?'" she said. "I keep Gatorade by my bedside and glucose tablets in my purse" to help regular blood sugar.

A Day in the life

Doctors who treat people with T1DM are endocrinologists. They can prescribe insulin and talk to a person with diabetes about their health, and check blood tests that measure their average blood sugar level over the past three months to see how well they are controlling their blood sugar.

Kelly said: "For me, the diabetes online community has been so important. Emotionally and practically, it helps so much to share information and experiences with other people with Type 1 diabetes."

"This is a lot to deal with, and most people in my life have very little understanding of what I'm really doing to take care of myself," she added. "Well-meaning people want to suggest 'alternative' treatments involving cinnamon or a special herb, and I have to say, 'Thanks, but I'll always need insulin.'"

"It's good to connect with other PWDs who really get it," she added, referring to persons with diabetes.

One of the first people to share experiences online was Kerri Sparling, who said that when she started blogging she was one of four or five T1 bloggers she knew about.

Today, she regularly speaks on panels at diabetes conferences.

"I started Six Until Me in May of 2005 because I was tired of Googling 'diabetes' and coming up with little more than a list of complications and frightening stories," she said. "Where were all the people who were living with this disease, like I have been since I was a little girl? Was I the only person with diabetes out there who felt alone?"

She shares her daily experiences online in a very transparent way under titles like, "Love Poem for my Stupid Pancreas," "World's Okayest Diabetic" and "Um, can you eat that? A Halloween Poem."

She's written a book called Balancing Diabetes but points out she isn't a medical professional and joked, "I can't even drive a stick."

But her openness about her experience is invaluable to a large community of people living with Type 1 diabetes who gather online in Facebook groups, at conferences and monthly meet-ups in their own community to avoid the isolation.

"For much of my life, I was the only diabetic I knew," Sparling said. "Thankfully, that's not the case anymore."

"When you're diagnosed so young, every life event has included diabetes," she continued. "I went to prom with diabetes. I got my license with diabetes. I graduated high school with diabetes. I had a special pocket sewn into my wedding dress for my insulin pump."

In her day-to-day life, she thinks about diabetes every few minutes. From the moment she opens her eyes in the morning until she closes her eyes at night, there are hundreds of small decisions she needs to make to keep herself safe.

There is a "variable to everything that you do -- how to get dressed, how far is the drive," she said. "It all becomes automatic after a few decades."

If people with Type 1 diabetes don't use newer technologies, like an insulin pump or a continuous glucose monitor, they may need to inject themselves with insulin four to eight times a day and check finger-sticks at least six to eight times a day.

Sometimes, they need to check more. They must always be aware of how their body feels when blood sugar level is too high or too low. If it's too high, some people describe feeling anxious, a stomachache, very thirsty or not themselves. If it's too low, which can be very dangerous, they may feel a headache, tremors, heart palpitations, confused, slur speech or even be unresponsive.

"We tiptoe that line all the time, between I'm sick and I'm fine," she said.

But she doesn’t let that stop her from living her life.

"You can do everything everyone else can do, except make insulin," Sparling said.

Speaking of insulin, diabetes is one of the most expensive chronic conditions -- insulin prices has tripled in the past 15 years.

From 2001 to 2015, the price of Novolog, a commonly used insulin, went from $100 per vial to $336 per vial in the United States. People have been known to ration their insulin, which can be deadly for someone with T1DM.

There are generic versions, or alternative types of insulin, as well as patient-assistance programs, which can help to decrease the cost of insulin. The Endocrine Society and other physician and patient advocacy groups are calling on the government to pursue initiatives on insulin affordability.

In the meantime, diabetes are their own best advocates.

What about these things I read online about pumps and sensors, and the 'artificial pancreas?' Is that a cure?

Technology in diabetes is evolving at the fastest pace in history and working to improve the lives of people with T1DM. There are insulin pumps that can automatically decrease the amount of insulin you get if your blood sugar numbers are too low or heading low.

There are continuous glucose monitors, or CGMs, which sense your blood sugar levels every five minutes without requiring a finger-stick prick.

And now, there are systems whereby the CGM can communicate with the insulin pump in a "hybrid closed-loop system." At Boston University and various start-ups across the country, there's ongoing research to build a "closed-loop system," or artificial pancreas, that does not require any human input.

We are so close, and yet so far. Even the most advanced systems on the market now still require human input. If the blood sugar is too low or too high, the sensors or pumps will beep, and ask for a confirmatory finger-stick test. People still need to input the amount of food they’re going to eat, or make adjustments if they’re going to exercise or not eat for a long period of time.

Machines can experience technical errors or malfunction, however; tubing may kink or get clogged, the sensor or pump can fall off or the battery may run out.

You can't turn your brain "off" no matter how good the technology is.

Sparling, the blogger, said she has "hope for a cure," but "I have to live today."

There are many famous and successful athletes and professionals with T1DM who never let their disease define their careers. Mountain climber Will Cross climbed Mount Everest, professional football player Mark Andrews and Supreme Court Justice Sonia Sotomayor, to name a few, continue to achieve their dreams while living with T1DM.

My loved one was just diagnosed with T1DM. What can I do to help?

"What anyone with diabetes soon learns is that you can't do this alone," said Armato, the CEO of Novant Health. "A good steady support system ... is like the breath of life."

Here are some key tips for family and friends of people with T1DM:

-- Understand this is a disease that requires nearly 24/7 attention. Have empathy. Be positive, not critical and judgmental.

-- Learn about T1DM from trustworthy sources instead of passing on things you've heard.

-- Recognize the signs and symptoms of low blood sugar.

-- Know where your loved one keeps their glucometer, insulin supplies and glucose tabs.

-- Know the phone number of your loved one's doctors.

"You can do the absolute best," Sparling said, "and things can still happen."

Online resources

There are some good, reliable online resources and meetings for people with T1DM and their family and friends.

Armato and Sparling emphasized the importance of having support.

"Find your support community, someone who can say 'me too' and be there for you -- it's very powerful -- someone who won't judget you and will hold you when you're down," Sparling said.

Here are some trusted organizations for whose living with Type 1 diabetes:

-- American Diabetes Association

-- JDRF (Juvenile Diabetes Research Foundation)

-- College Diabetes Network

-- SixUntilMe

-- BeyondType1

-- DiaTribe

-- Children With Diabetes

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Justin Sullivan/Getty Images(NEW YORK) -- The state of Florida has sued the two largest pharmacy chains in the country over the sale of opioids -- an epidemic that has killed thousands in the state in just the past few years.

Attorney General Pam Bondi announced the state had amended an original lawsuit, filed in May, to include both CVS Pharmacy and Walgreens. Insys Therapeutics, the specialty pharmaceutical company that produces Subsys, the brand name for a type of fentanyl, was also added to the complaint.

CVS and Walgreens are the two largest pharmacy chains in the country, according to health care marketing firm SK&A, with about 18,000 stores between the two brands. Walgreens operates 820 stores and CVS operates 754 stores in Florida, according to the lawsuit.

"We will continue to pursue those companies that played a role in creating the opioid crisis," Bondi said in a statement. "Thousands of Floridians have suffered as a result of the actions of the defendants."

The lawsuit filed in May included Purdue Pharma, the maker of OxyContin; Endo Pharmaceuticals, the maker of Percocet and Opana; Janssen Pharmaceuticals, the maker of fentanyl drug Duragesic; and Teva Pharmaceutical, one of the largest generic drug manufacturers in the world.

"Opioid use has had tragic consequences for communities across Florida, and the State has been forced to expend enormous sums as a result of the opioid crisis," the introduction to the lawsuit reads. "The crisis has a cause: Defendants cooperated to sell and ship ever-increasing quantities of opioids into Florida."

Florida has been hit hard by the country's opioid crisis.

In 2016, the latest data available, 2,798 people died from opioid overdoses, according to the National Institute on Drug Abuse. The rate of 14.4 deaths per 100,000 people is 1.1 deaths above the national average.

The rate of opioid overdose deaths in Florida in 1999 was just 2.6 per 100,000 people, according to the NIH. That number jumped to 8.7 per 100,000 a decade later and 9.4 in 2015.

According to the Centers for Disease Control, the nationwide number of overdose deaths involving prescription opioids was five times higher in 2016 than 1999.

"Defendants reaped billions of dollars in revenues while they knew, or should reasonably have known, that they were causing immense harm to the State and its citizens," according to the lawsuit.

CVS distributed 700 million dosages of opioids in Florida from 2006 to 2014, according to the suit. The lawsuit says one Florida town of just 3,000 people was supplied with 285,800 orders of oxycodone in one month by a Walgreens distribution center.

The state is seeking a jury trial in the civil case.

Bondi has been mentioned as a possible replacement for U.S. Attorney General Jeff Sessions, which President Donald Trump confirmed on Saturday. 

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iStock/Thinkstock(NEW YORK) -- With suicide rates rising across the country, a new report from the Centers for Disease Control and Prevention (CDC) finds that certain occupations are associated with a higher risk of suicide.

Suicide rates were highest among men who worked in construction or extraction (oil rigging, mining) jobs and women who worked in arts, design, entertainment, sports and media, the report found.

Following construction and extraction jobs, the jobs with the highest risk of suicide for men were those in the arts, design, entertainment, sports and media, as well as installation, maintenance and repair. For women, arts, design, entertainment, sports and media were followed by protective service and health care support.

The study, published in the CDC’s Morbidity and Mortality Weekly, looked at suicide rates by occupation within a group of 22,053 people, ages 16 to 64, in 17 participating states between 2012 and 2015. The authors note in their summary that the results are not nationally representative.

During that time, suicide rates rose the sharpest among men working in arts, design, entertainment, sports and media, and among women working in food preparation and service-related occupations, the CDC study found.

“Increasing suicide rates in the U.S. are a concerning trend that represent a tragedy for families and communities, and impact the American workforce,” said Dr. Deb Houry, director of the CDC's National Center for Injury Prevention and Control, in a press release.

The study noted that suicide rates increased across many occupational groups in the four years that were studied, and said that factors that contribute to suicide aren’t limited exclusively to problems a person may have with his or her job.

“Usually stressful situations converge with decreased ability to tolerate distress, which leads a person to feel hopeless,” psychiatrist Dr. Colette Poole-Boykin told ABC News.

The relationship between suicide and occupation might also be “confounded by access to lethal means on the job and socioeconomic factors such as lower income and education,” the study's authors reported. The study did not, however, look deeper into these factors.

The CDC said that the new information may help workplace leaders better focus their prevention programs and policies. For high-stress jobs, these efforts may already be in place, Poole-Boykin said, noting that “it would be wise to seek professional help when discontentment causes problems with [someone’s] mood.”

“People who are contemplating suicide often have changes in their mood, as well as the way they talk and behave,” Poole-Boykin said.

Common signs, in addition to verbally expressing suicidal thoughts, include a person expressing feelings of being trapped or of being a burden to others, Poole-Boykin said. A person might also feel depressed, anxious, irritable -- or all three at once. He or she may lose interest in their usual hobbies or isolate themselves.

“When these warning signs are present, a person should seek mental health care as soon as possible,” Poole-Boykin said, “as it may be too difficult for the person to will themselves into a better mental state.”

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ABC News(NEW YORK) -- Since receiving his face transplant 10 months ago, Cameron Underwood has slowly but surely gotten comfortable being out and about in public.

But he was riddled with anxiety before a certain meeting that the now-26-year-old and his mother went to recently.

Waiting for them on a Manhattan apartment patio was Sally Fisher, the mother of Underwood’s donor.

Fisher would once again be looking into the face of her late son, Will Fisher, but that face now belonged to someone else.

"I know how my heart feels…I’m scared because it brings back the loss of my son," she told ABC News' 20/20.

Others had come along to the Manhattan reunion to give the trio moral support, including Will Fisher’s family, and Cam Underwood’s brother Aaron Underwood.

Dr. Eduardo Rodriguez, who had performed Underwood’s face transplant surgery, was also there for the reunion he had made possible. Rodriguez is a renowned reconstructive surgeon who is the chair of NYU Langone Health's Hansjörg Wyss Department of Plastic Surgery in New York. He lead a team of more than 100 medical staff who worked in side-by-side operating rooms at NYU Langone to complete the transplant this past January.

When the emotional moment unfolded and Cam Underwood met Sally Fisher, there were embraces and expressions of deep gratitude.

"I’m so glad you’re here," Fisher said to Underwood as the two hugged. "I’m so glad."

"Oh, Sally. Oh, my goodness," Bailey-Potter said as the two women embraced. "You’re the courageous one and giving my son the chance to be normal again. I mean, he looks so fantastic."

"I know, you look beautiful," Fisher told Underwood. "I guess I’m a little biased. I think you’re drop-dead gorgeous."

Watch the full story on "20/20" this Friday, Nov. 16 at 10 p.m. ET


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iStock/Thinkstock(NEW YORK) -- Once kids reach a certain age, they're expected to address adults as something other than "so-and-so's mommy" and "so-and-so's daddy."

In school, the rules are clear. The teacher indicates on day one what the students should call him or her -- and that's that.

But outside of school, when addressing their friends' parents and their parents' friends, the rules for what children should call adults are totally unclear.

Good Morning America
posed the question of whether or not kids should call adults by their first names in a 30,000 member Facebook group for moms. The responses were varied, but there does seem to be one trend: the days of addressing adults as Mr. or Ms. Last Name are definitely on the decline.

Popular alternatives for a hypothetical person named Mary Jones: Miss Mary, Ms. Mary, Aunty Mary (depending both on culture and degree of closeness to the family) and Ma'am.

Several people who were teaching their children to call adults by their first names mentioned that this had nothing to do with respect level.

"Personally, I grew up calling my parents' friends their names and I do the same for my son," said Jessica Borow Zuckerman. "To me, respect is not in a name -- it is in your behavior and attitude."

I don’t think my children calling their teachers/superiors/adults by their first names impacted their level of respect. In fact, I think the use of first names made my children feel more secure and comfortable with their teachers and their environment.

Lyn Fay grew up using the hypothetical "Mrs. Jones" to address adults but her children do not.

"When I was growing up in Ohio my mom insisted we call adults Mr/Mrs," she wrote. "As a parent in [New York City], my kids' friends called me by my first name... and teachers/principal were also on a first name basis (e.g. Susie, Doreen, Amy)."

"A year ago we moved to northern VA/DC suburbs and everyone here calls me Mrs. Fay," she continued. "To be honest, I don’t like it at all and half the time I don’t respond immediately because it doesn’t register that someone is talking to me! People use titles to show respect, but to me the formality is cold and impersonal."

"I don’t think my children calling their teachers/superiors/adults by their first names impacted their level of respect," Fay wrote. "In fact, I think the use of first names made my children feel more secure and comfortable with their teachers and their environment."

"I think respect is best shown by calling someone whatever he or she prefers so I wish my kids’ friends would call me Lyn! At this point I'd even prefer 'Margot's mom' or 'Edward's mom,' but 'ma'am' puts me over the edge."

In fact, there were multiple respondents who preferred to be called anything other than "ma'am."

One respondent said she heard outside of the South, where she grew up using "ma'am" and "sir" to address adults, it might be considered offensive to do so.

In fact, Lisa Tyler O'Leary said, "I'd be insulted if someone called be "ma'm".

So, what do the experts say?


Lizzie Post, co-president of the Emily Post Institute and an etiquette expert told Good Morning America that kids should call people what they want to be called.

"Defaulting to the formal is always appropriate until told otherwise," Post said. "So, if you're unsure, use 'Mrs.' or 'Ms.' Jones. If 'Ms. Jones,' then says, 'call me Cara.' Then you respond, 'of course, thank you.'"

It's more awkward to go from less formal to more formal, Post said.

Defaulting to the formal is always appropriate until told otherwise. So, if you're unsure, use 'Mrs.' or 'Ms.' Jones. If 'Ms. Jones,' then says, 'call me Cara.' Then you respond, 'of course, thank you.'

"How things have developed is that it's a 'call me by first name society' but not everyone is like that," she said. "Starting informal and then being requested more formal makes it seem as if the person is distancing themselves from you."

Simply asking an adult what they prefer your child to call them is not only respectful, but teaches the child confidence.

"Children eat plenty of foods that don't require a fork and knife but we still teach them to use utensils," Post told GMA. "That way when they encounter a situation that requires it, they know what to do."

One pitfall?

Don't let a person's marital status dictate the level of formality with which your child addresses a person. Post recalled a situation when a child was introduced to her as "Lizzie" but to the married friend she was with as "Mrs. Jones."

"Try to point out equality in terms in seniority and not marriage and relationships," Post said.

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iStock/Thinkstock(NEW YORK) -- The murder of 12 people at a bar in Thousand Oaks, California, earlier this month is the latest example of a veteran perpetrating a mass shooting, adding another complicated addition to a growing list of incidents of gun violence in the U.S.

Some see the discussion of veteran-involved shootings as promulgating of an inaccurate narrative that service members are prone to violence when they come home from war.

This is particularly sensitive after recent comments from President Trump that drew a connection between veterans, mental health issues, and violence.

“He was a war veteran. He was a Marine. He was in the war. He served time. He saw some pretty bad things, and a lot of people say he had PTSD, and that’s a tough deal,” Trump said on Nov. 9, referring to alleged shooter Ian David Long, two days after the shooting at Borderline Bar and Grill in Thousand Oaks, California. Long has been identified as a Marine Corps veteran, but it is unclear if Long was ever formally diagnosed with PTSD.

“People come back -- that’s why it’s a horrible thing -- they come back, they’re never the same,” Trump added.

Paul Rieckhoff, the CEO and founder of the non-profit group Iraq and Afghanistan Veterans of America, called Trump’s comments “extremely unhelpful.”

“They perpetuate a false and damaging narrative that veterans are broken and dangerous. Most people who suffer from PTSD, when able to access effective treatment, are able to live healthy, happy, meaningful lives,” Rieckhoff said in a statement.

Barbara Van Dahlen, the founder and president of the non-profit Give an Hour, which works to provide counseling help and other support to veterans, said that Trump’s comments spoke to an incorrect stereotype.

“People who go through war absolutely come back changed. You won't find a veteran or a family member of a veteran [who] won’t say that’s not true,” Van Dahlen said. “But what that means and how people take that to mean that... all of them are broken [or] more likely to go off, that is false,” she said.

That said, the shooting in Thousand Oaks is the latest addition to a list of U.S. mass shootings involving a veteran.

Three of the 10 deadliest mass shootings in modern U.S. history were at the hands of veterans: the Sutherland Springs shooting in 2017 that left 26 people dead, the shooting at Luby’s Cafeteria in California in 1991 where 23 people were killed, and the U.T.-Austin tower shooting during which a former U.S. marine sniper killed 14 people.

The military sometimes also factors into the location of these attacks, like in the case of the Washington Navy Yard shooting in 2012 in which a Navy veteran killed 12 people, or when an Army psychologist killed 13 people at Fort Hood in 2009.

But as the list of deadly shootings in America increases, so does the number and variety of shooters. The remaining seven of the 10 deadliest mass shooters didn’t have any known military ties. Neither did other high-profile shooters, like the perpetrators of Columbine, or the man who shot 11 people at a Pittsburgh synagogue in October.

Various studies point to links between post-traumatic stress disorder and anger or aggression, a theme that percolates around veteran-involved shootings because of PTSD rates among veterans.

According to statistics from the Department of Veterans Affairs, the levels of PTSD in veterans varies by their service area. Between 11 and 20 percent of veterans of Operations Iraqi Freedom and Enduring Freedom, which largely focused on the wars in Iraq and Afghanistan respectively, have PTSD in a given year. By contrast, 12 percent of Gulf War veterans have PTSD in a given year, and an estimated 30 percent of Vietnam War veterans had PTSD in their lifetime, according to the VA.

By comparison, the VA reports that 7 to 8 percent of the general U.S. population develops PTSD at some point in their lives.

Van Dahlen said that post-traumatic stress “creates a risk factor” but doesn’t necessarily a determinate as to whether or not a veteran will become a deadly shooter.

“That risk factor is then one within a whole collection of other factors, and some of those factors decrease the likelihood of violence or dysfunction and others exacerbate,” Van Dahlen said.

“Some of the people who come back with post-traumatic stress will be at risk for a number of either dysfunctional [or] destructive painful experiences that they themselves either are the recipient of or the initiator of,” she added, noting that is particularly the case if they have other contributing factors like substance abuse, brain injuries or other traumas.

Van Dahlen was quick to point to the fact that veterans who become mass shooters are anomalies -- as are mass shooters within the larger population -- and not the rule.

Veterans with PTSD can get treatment that can help reduce the risk factor presented by PTSD, and mediating factors like a supportive social network or a meaningful job are also important. Van Dahlen said that Give an Hour has “seen an increase in the last couple of years” in the number of requests for help that they’ve received.

“Our society is just not good with dealing with these issues,” she said. “We do not deal with mental health and mental health challenges.”

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iStock/Thinkstock(NEW YORK) -- Hey, guys: If you want to look more attractive to women, ditch the razor.

A survey of more than 8,500 women shows that clean-shaven men don't cut it, and men sporting 10 days of beard growth are the most attractive.

The results of the study, which were published in the Journal of Evolutionary Biology, show that men with that much growth were the most desirable, followed by men with full beards, men sporting stubble, and in last place, men who had no facial hair.

It seems that it all comes down to hard-wired evolution.

"Beards may be more attractive to women when considering long-term than short-term relationships," the study out of the University of Queensland said, "as they indicate a male’s ability to successfully compete socially with other males for resources."

Facial hair is associated with masculine social dominance, and age, the researchers said.

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iStock/ThinkstockBy Dr. Sumir Shah

(NEW YORK) -- Seven years ago, Matt Wilson went to the emergency room. He had stomach pain, which he assumed was a kidney stone. It was not. His CT scan showed an abnormal spot, later diagnosed as early pancreatic cancer.

That chance discovery may have saved his life. Pancreatic cancer usually grows silently, without symptoms, and successful treatment is rare.

Thursday was World Pancreatic Cancer Day, in the hope that awareness about the disease can help save lives.

What is Pancreatic Cancer?

The pancreas, an organ in the abdomen, is responsible for the secretion of digestive enzymes and hormones which regulate metabolism. Pancreatic cancer is the third leading cause of cancer deaths in the U.S. -- it may even surpass lung and colorectal by 2020. The lifetime risk of developing this cancer is 1 in 63 for men and 1 in 65 for women; the risk increases with age. Almost 90 percent of people diagnosed are over 55 years old. Other risk factors include a family history of cancer, obesity, smoking, diabetes and a diet high in red and processed meats. A diet that includes plenty of fruits and vegetables may work to decrease risks.

Why is it so deadly?

Most people who are diagnosed, including Matt Wilson, only display vague symptoms at first: abdominal or upper back pain, unintentional weight loss, fatigue, a recent diabetes diagnosis, or jaundice (yellowing of the skin and eyes). Because these symptoms apply to lots of diseases, the cancer is often times diagnosed too late for meaningful treatment. There’s a frightening 9 percent survival rate five years after diagnosis. This year alone 55,440 people will be diagnosed, and 44,330 will die.

Are there different types?

There are two major types of pancreatic cancer: endocrine and exocrine tumors.

The most common and most aggressive form is the exocrine tumor. That is an adenocarcinoma that begins in the pancreatic ducts and gland cells, which produce enzymes. These cells have a thick coat to protect them from the digestive enzymes they produce. But that thick coat also reduces the effects of chemotherapy.

Just a few cases of pancreatic cancer -- about 1 percent -- are endocrine tumors. They affect the cells that produce insulin and glucagon, the hormones that manage our blood sugar. These cancers have a significantly increased survival rate five years after diagnosis of about 50 to 80 percent.

Treatment options

The gold standard treatment option is a surgical procedure known as the Whipple. This technique was coined by Dr. Allen Whipple back in 1935 at Columbia-Presbyterian Hospital in New York City. Doctors remove many of the digestive organs: the gall bladder, common bile duct, part of the stomach, and the pancreatic head. Unfortunately, that procedure is only possible in about 20 percent of patients; it can’t work with patients who are diagnosed with cancer in a later stage. Other treatment options include chemotherapy, a host of medicines designed to kill cancer cells. This may be done after the Whipple or along with radiation for those who aren’t eligible for the surgery. Treatment is difficult because it’s so hard to diagnose pancreatic cancer when the tumor is small. When it enlarges and obstructs pancreatic ducts or produces abnormal levels of hormones, it is often too late for surgery.

Pancreatic transplants, another treatment option, has also caught on recently. That’s what Steve Jobs used, in part, to battle his disease. However, doctors warn that steps taken to stop the body from rejecting the new pancreas can allow remaining cancer cells to grow, and that means a high risk of the cancer coming back.

“An oncologist will likely have to rely on both the science and the art of medicine to help a patient determine the treatment that is the best choice for them,” Lynn Matrisian Ph.D., chief science officer for the Pancreatic Cancer Action Network, told ABC News.

Can’t we screen for pancreatic cancer the way we do for breast cancer?

The International Cancer of Pancreas Screening Consortium recommends that people with hereditary pancreatitis, those with first-degree relatives who have been diagnosed, or those with BRCA1/2 mutations should be screened by doctors more closely when they come into the office with vague stomach pain. Unfortunately, no other specific guidelines exist.

What is on the horizon?

Matt, the ER patient, had surgery that removed part of his pancreas, spleen and more than 20 lymph nodes. A challenging recovery and discovering a new cause means that Matt now splits his time as a university professor and advocate for others with the same diagnosis. He’s now part of the Pancreatic Cancer Action Network.

Organizations like the Pancreatic Cancer Action Network are constantly working to urge further funding to find out what may work against this aggressive cancer. They’re also researching biomarkers for a blood test that could help diagnose it early. At this point the tests remain unreliable, but perhaps further research can open new doors. Drug therapy targeting specific DNA mutations may help create drugs that better penetrate the tumor cells. But sadly, those screening tools will take years to develop.

Dr. Sumir Shah, M.D. is an emergency medicine physician at NewYork-Presbyterian Queens/Weill Cornell Medical Center in New York City, and a member of the ABC News Medical Unit.

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iStock/ThinkstockBY: DR. JOHANNA KREAFLE

(NEW YORK) -- Thanksgiving is only a week away, and with more than 46 million turkeys landing on 46 million dining room tables, there’s a lot of room for food preparation mistakes. If you have questions about preparing turkey, the U.S. Department of Agriculture has put together some handy tips for preventing your celebration from becoming a food poisoning disaster. Here they are.

How far in advance can I buy a turkey?

You can buy a frozen turkey anytime, even a year in advance. A turkey will keep its top quality for a full year in the freezer.

But be sure to thaw the turkey properly before you’re ready to cook it. Keep it in the fridge — one with a thermometer — at a safe temperature of 40 degrees Fahrenheit or slightly lower. Allow it to thaw one day for every five pounds of its weight, and then give it an extra day or two after that. So, if it’s a 15-pound turkey, allow four to five days for it to thaw. After it’s thawed, it’s safe for another two days.

If you prefer a fresh turkey, be sure to buy it no more than two days before you plan to cook it.

What are the most important steps before preparing the turkey and other dishes?

Hand washing and clean preparation and cooking spaces are two of the most important steps. A study from the USDA showed that people fail to properly clean their hands 97 percent of the time before and during meals.

The same study also found that more than 80 percent of people inadvertently contaminate other food they’re serving. This usually happens when germs from the raw turkey aren’t properly washed off a person’s hands and are able to reach other surfaces, such as soap dispensers, cutting boards and spice containers.

When you wash your hands, continuously scrub them with soap for at least 20 seconds, and remember to get between the fingers and under the nails. This will help you to avoid spreading bacteria that can increase the risk of foodborne illness.

How do I properly prepare the turkey for the oven?

After washing your hands, it’s time to prepare your turkey for cooking in the oven. Keep raw turkey separated from all other foods at all times and use separate cutting boards, plates, and utensils when handling the raw turkey.

Even if your mother did it this way, do not wash the turkey, since the splashing can get bacteria onto the aforementioned kitchen surfaces and prep materials.

Once you’re done prepping, place the turkey in the oven — recommendations from the USDA for safe cooking can be found here, but the main thing to remember is that bacteria that cause foodborne illnesses are completely killed by heat, so you should cook the turkey fully.

How do I know if my turkey is cooked properly before serving it?

Buy a food thermometer if you don’t already have one. Test the turkey in three spots to make sure the internal temperature is at least 165 degrees: the thickest part of the breast, the innermost part of the thigh and the innermost part of the wing.

How do I properly store the leftovers?

Place leftovers in the refrigerator within two hours of the meal; this will prevent bacteria from growing on the food. It’s best to place the leftovers in shallow containers — this reduces the cooling time and therefore the amount of time that the food spends at unsafe temperatures (between 40 and 140 degrees).

If you stuff your turkey, always remove the stuffing and store it separately from the meat. Leftovers are good for three to four days in the refrigerator, so if you don’t think you’ll eat them until the Tuesday after Thanksgiving or later, place them in the freezer.

Dr. Johanna Kreafle is an emergency medicine physician at the Carolinas Medical Center in Charlotte, North Carolina, and a member of the ABC News Medical Unit.


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ABC News(NEW YORK) -- Cameron Underwood was 24 years old when the course of his life changed forever, resulting in his undergoing a state-of-the-art face transplant procedure. Through this extensive surgery, Underwood's face is now connected to the face of another young adult who was able to give him a second chance at life.

Underwood, the son of a California pastor, told ABC News’ Amy Robach in an interview for "20/20" that he still has the face he was born with from the cheekbones up, but almost everything below that belongs to the donor -- a 23-year-old aspiring New York filmmaker and writer named Will Fisher.

But when he looks at himself now, "I see me," he said.

Underwood grew up in a close-knit family, grounded in its faith. His grandfather founded the United Pentecostal Church in the Northern California agricultural community of Yuba City.

"Faith is the essence of everything in our family," Underwood's older sister Julie Jones said. "Without that foundation, I think this journey would've been a lot more difficult."

Underwood’s mother, Bev Bailey-Potter said her greatest joy is her children – Julie, Aaron, Brad and her youngest, Cam.

"They were just so close and I always took pride in that." Bailey-Potter said, and Cam "was just easy. He was always quiet, a little on the shy side... but just a wonderful spirit about him... easy going."

She said he was "just a handsome boy," and "His smile would light up his face and it was so evident in his eyes."

Underwood had just started his career working in his stepfather’s business of heavy equipment repair. With that money, he was able to buy his own house at the age of 19. Hunting was also a family pastime.

“We’re really an outdoors family,” his father Randy Underwood said. “He [Cam] grew up on the lake… He was just a natural athlete, he was good, he enjoyed it.”

Even with everything going for him, his mom said the bright light that always shone in his eyes began to fade.

"You know, I have a clear memory in my mind," Bailey-Potter said. "I saw him walk across the parking lot... and he just looked so sad and empty. I just thought... what is he going through? Is he unhappy?"

The family says Underwood became a workaholic and was pushing himself too hard. He began struggling with depression, they said, but kept this to himself, rarely expressing his emotions. After Underwood went through a breakup, his brother Aaron Underwood remembered, "He started going out more... and you know, partying a little more at that time."

Over the next few years, Underwood’s family said he and his closest friend and brothers drifted apart – the friend started a family and his older brothers started new jobs and moved out-of-state. His struggle with alcohol was apparent, but less obvious to his family, they said, was Underwood’s underlying depression. It was a shock to them when Underwood not-so-subtly hinted one day that he was thinking of taking his own life.

"I thought well, you know, he’s just going through a rough time... we all do," his mother said.

His family decided to remove all of the guns in his home. But there was one they couldn’t get to: Underwood had put a shotgun in his safe.

On a Sunday night in June 2016, Underwood’s uncle Lonnie said he received a text from his nephew asking him to come over and stay the night.

"I got to his house and all the lights were on, which I expected," Lonnie said. "Door was unlocked, I walked in... nobody in the living room."

Lonnie walked into the bedroom and into a nightmare. He saw blood everywhere, and Underwood staggering against the wall.

"I think that is probably the point where I went into shock," Lonnie said.

Underwood had placed the shotgun under his chin and fired, in an attempt to take his own life. He was immediately rushed to a nearby hospital.

At the hospital, "They told us he had … no teeth, no chin, no cheekbones, no facial structure… nothing," Randy Underwood said.

"It really wasn’t a face... it was pretty horrific," Aaron Underwood added.

Underwood was transferred to University of California-Davis Medical Center, where renowned plastic surgeon Dr Lee L.Q. Pu implanted 12 titanium plates to keep what was left of his shattered skull intact.

Underwood survived the ordeal but underwent eight surgeries to restore the bare minimum function to his face. To cover his face, doctors used skin from his thigh and tissue from his shoulder. His nose was lost in the blast and he only had a tiny hole to breathe through. Even then, the results from his surgeries were difficult to endure.

"What kind of quality of life would he have?" Bailey-Potter wondered. "If he didn’t want to live with all that he had going for him, then why would he want to continue on now?"

"I cried every day for a year... every single day," she continued.

Randy Underwood said, "I would’ve changed places with him any day. I would’ve taken his pain any day, but I couldn’t."

It was six months before Underwood could leave the hospital – even then, he wore a mask wherever he went.

"I would see people stare at him and he would notice that," Randy Underwood said. "The worst part was the little kids... stare at him and hang onto mom and dad because he looked so pitiful."

But then Dr. Pu suggested that a face transplant might be possible and could give him a chance at a better life.

Coincidentally, Bailey-Potter found herself at the checkout counter of her local grocery, thumbing through a magazine that highlighted the story of firefighter Patrick Hardison.

Hardison was a fireman in Mississippi who was horribly burned trying to rescue a woman from her burning home. His face was so badly burned that his fellow firemen didn’t know it was him at first when they got to him.

Hardison survived -- but his scalp, ears, nose, eyelids and lips were gone.

Hardison underwent multiple surgeries to try to repair his face. He suffered years in isolation, hiding himself as much as possible from the outside world. Then he met Dr. Eduardo Rodriguez, a renown reconstructive surgeon who is the chair of NYU Langone Health's Hansjörg Wyss Department of Plastic Surgery in New York.

In 2015, Dr. Rodriguez agreed to perform what was at the time the most extensive face transplant ever done.

The operation took 26 hours and replaced Hardison’s entire face and scalp with skin, tissue and nerves of a donor. Since his surgery, Hardison, whose story was also profiled by ABC News' “Nightline,” has had a better quality of life.

So Underwood’s mother thought Dr. Rodriguez might be able to help her son as well.

"I decided I that I would go ahead and on my own, you know... send an email to Dr. Rodriguez," Bailey-Potter said.

"Cam’s mom sent me an email. Her story was very moving," Rodriguez said. "Looking at him with that injury, right away, I knew there was no way this kid, I could ever make him normal with conventional surgery."

Because Underwood’s brain wasn’t affected in the blast, Dr. Rodriguez’s thought he could be a potential candidate to be his third face transplant patient.

Each face transplant surgery is incredibly complicated and has its own particular, unique challenges in every case. The procedure costs over $1 million and though that’s usually paid for by a grant, Rodriguez said "everybody was worried" about the possibility that Underwood could try to end his life again after the transplant.

So, Rodriguez went up to Yuba City, California, to meet Underwood and his family in person and discuss the risks and concerns, including Underwood’s struggle with depression and his attempted suicide.

But according to Rodriguez, “I think these individuals all deserve a second chance … we shouldn’t give up on them.”

“I don’t think anybody knew it was a test per se,” Aaron Underwood said. “I think we did understand that… he had to be sure that their investment in Cameron was secure, that he was not the kind of patient that would take this amazing miraculous gift and throw it away.”

Rodriguez said this was something that they only offer to select individuals.

"And we have to be sure we have chosen the right person,” he continued. “I need to know that I have a fighter on my hands... and this person’s willing to do whatever it takes to have this operation be successful."

"We want to hear that we’re going to get this fixed and we’re moving on with our life, but it’s not that simple,” Rodriguez added “There could be serious complications from something like this. It’s very important that people understand the severity of undergoing this operation."

For starters, a face transplant means a lifetime of treatments with harsh side effects to prevent rejection – and doctors say they just don’t know enough yet to predict survival beyond 10 years.

Bailey-Potter said, "it did" give her pause, "but it was Cam’s decision to make."

"That was hard to swallow... but I would rather have 10 years of great life than 100 years of miserable life," Aaron Underwood said.

By the end of the visit, both doctor and patient were on board.

“Being accepted into this program is very much like winning the lottery,” Rodriguez said. “But instead of $500 million… Cameron wins a second chance at life.”

But "the most difficult part," Rodriguez said, was still ahead – the search for a perfect donor: "It’s like a needle in a haystack."

It was about seven months after Rodriguez accepted Underwood as a patient that a donor became available. It was a young man who had registered with New York state to be an organ donor, as well as signed up with the non-profit organ and tissue donation service, LiveOnNY.

But Dr. Rodriguez, who rushed from NYU Langone to another hospital in New York where the donor was, said the request for a face donation is a very special one – handled with the utmost sensitivity: "That’s asked at a separate time... a separate consent." After speaking with the donor’s mother, she consented to the request.

Miraculously, the donor had all the prerequisites to be a match for Underwood – skin tone, hair color, skull size plus a matching blood type. Rodriguez said the match felt "absolutely" fated to be.

A team of more than 100 medical staff worked in side-by-side operating rooms at NYU Langone to complete the transplant.

Doctors removed the lower portion of the donor’s face, preserving the muscles, tissues and blood vessels -- eventually taking his teeth, along with the bones that make up his cheeks, nose, chin and jaw.

The damaged portions of Underwood’s face were also surgically removed. This preparation alone took more than 12 hours – the actual facial reconstruction would take just as long.

"Often people think it’s just like putting on a mask... it’s not that simple," Rodriguez said. "The face needs to fit like a puzzle -- and that’s a tricky thing because we hit the point of no return."

Rodriguez started the actual transplantation by aligning the bones perfectly. Once they were connected, he moved on to the painstaking work of attaching muscles, nerves and blood vessels.

"We prayed for those doctors through the night," Bailey-Potter said. "They were pulling an all-nighter. None of them were leaving."

"I had prayed for that miracle every day for a year.... and my son had a nose, he had a mouth, he had teeth," Bailey-Potter said. "It was just a happy moment."

Underwood reflected on the first time he saw himself after the transplant: "Wow... that was breathtaking. And I was just blown away, relieved... and excited all at the same time."

Ten months later, he can breathe through his new mouth and nose – and smile.

"I can smile, I’m working on closing my lips all the way, they don’t close all the way... but they’re getting there," Underwood said. "They’re a lot better than they were."

Part of the recovery has been extensive dental work – and he says one of the biggest things he missed was "being able to actually eat."

"Just to let it sit in your mouth and taste it," he said. "All those little things that we take for granted that you know, you miss and you want back."

Underwood, now 26, said over the last year it’s been a lot of work to teach himself "how to talk again with a new mouth and new teeth and lips": "It’s just like a baby learning to talk."

"I have a strong son, and I’m grateful for that," Randy Underwood said. "He’s got a lot of tenacity, and he’s got a lot of determination... he’s going to come out of this."

Months after Underwood’s surgery, Dr. Rodriguez arranged for Underwood to meet his donor’s mother for the first time. “20/20” was there and captured the emotional meeting.

Back home, Underwood has been able to get other pieces of his old life back – playing golf, even skydiving. Though as great as getting back into his life is, he admits there are still tough days.

"Occasionally, it’s not a daily fight anymore... but yeah, there are still days when I am depressed," Underwood said.

His mother said they wanted to share his story to “give someone else hope” and show that “This ailment of depression it’s treatable.”

But he says he knows to ask for help now when he needs it – whether that means at church or at home.

“I just want people to know that it can happen, you know? That if you’re in the same kind of situation that I was in… there’s people out there that can help you and will. You just have to reach out,” Cam Underwood said.

He added that he was "very grateful" to have a full life ahead of him. His goal from here, he said, is "that I can get back to work... and you know, eventually I want a family and kids... you know, the American dream."

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iStock/Thinkstock(NEW YORK) -- Type 1 diabetes is one of the most common, chronic conditions in the U.S. -- the seventh leading cause of death and the top leading cause of kidney failure, lower limb amputation and adult-onset blindness.

Almost 30.3 million Americans suffer from diabetes and of those, 1.25 million have type 1 diabetes (T1DM).

The Egyptians discovered symptoms of diabetes in 1552 and life-saving insulin has been around in syringe form since 1949.

Type 1 diabetes is an autoimmune condition, where the pancreas is destroyed and can’t make any insulin to help process sugar and carbohydrates. In type 2 diabetes (T2DM), either the pancreas is not making enough insulin, or the body has become resistant and needs more insulin to process sugar.

Both types are still difficult disorders to control physically as well as emotionally, and there is no cure.

Yet in the past decades, there has been a rapid acceleration of new research and technology to help to make the lives of people with diabetes easier to manage.

Insulin pumps


Patients with type 1 or type 2 insulin-dependent diabetes need the medication insulin to regulate their blood sugar. It can only be administered with a needle, and needs to be delivered into the body throughout the day. This can mean an average of four to six injections a day in the thigh or abdomen, which can be difficult to manage in busy, everyday life.

But, insulin pumps are devices that can help provide continuous insulin without requiring multiple injections throughout the day. There is a small controller device that can clip on to clothing, connected with tubing to a thin plastic tube under the skin. It provides a constant rate of insulin -- called a basel rate -- over 24 hours, to keep blood sugars in range when a person is not eating or overnight.

When patients eat, they can enter into the pump how much they’re going to eat, what their blood sugar level is, and administer additional insulin to cover the meal.

Newer insulin pump algorithms can even calculate when the blood sugar is trending lower, and automatically reduce the amount of delivered basal insulin.

Using an insulin pump takes training. A person needs to check their finger stick glucose frequently, input any carbohydrates they are going to eat, and learn to understand the different alerts that can pop up on the device. The pump is not permanent, and the insertion site does need to be replaced every few days. The freedom from injections that an insulin pump offers is quite significant. Studies have shown that use of pumps results in improved average glucose values (called hemoglobin A1cs) over 3 months, as well as fewer episodes of dangerous hypoglycemia, or low blood sugar.

People can decide when they want to eat, and how much they want to eat, with tighter control of how much insulin they administer to themselves.

CGMs


The other half of diabetes technology focuses on monitoring blood sugars. Normally, a person would prick their finger and use a machine called a glucometer to measure the blood sugar.

For someone with T1DM, this could mean pricking themselves between 4 and 20 times a day -- including before each meal and before bedtime. Most people check more frequently: before snacks, after they eat, when they feel their blood sugar is off, and sometimes in the middle of the night.

Not only is this painful and disruptive, but finger sticks generally only provide a snapshot of glucose at a specific point in time. They do not provide glucose level trends (falling lower, climbing higher, or staying stable), or an accurate representation of how much time someone spends in a normal glucose range.

Enter continuous blood glucose monitors, CGMs for short. These are devices, first created in 2006, that can be attached to the body with a small sensor under the skin to measure glucose levels as frequently as every 5 minutes, 24 hours a day, for up to 10 days (depending on the device).

Some can notify the wearer if their glucose level is too high or too low, or even if it’s heading in that direction, allowing them more control over their diabetes management. Many devices connect to smartphones, and can be shared with loved ones, so that they can help keep an eye out of dangerous glucose situations.

The CGM sensor needs to be replaced every few days.

There’s another option called a flash glucose monitor that can be worn for up to 14 days, and provide a glucose reading when the wearer scans over it. It doesn’t provide a constant stream of data, which can more desirable and less stressful.

What about the “artificial pancreas”?


People suffering from T1DM have a pancreas that has completely stopped making insulin. A potential solution may be an artificial pancreas. This promising technology would take the need for carb-counting, finger-sticking and manual entry of data out of the hands of the user -- the device could do all of that.

Certain insulin pumps can communicate wirelessly with CGMs, and even have an algorithm that automatically adjusts the basal insulin rate depending on the trend of glucose from the CGM. We are still not yet at the point of

Still, a completely hands-off T1DM management remains elusive, at least for now.

These “hybrid closed-loop” systems still require user input for when and what they are going to eat, and do not have glucagon, which is a hormone made in the pancreas that helps to raise blood sugar if needed.

A Boston medical technology company called Beta Bionics is conducting research devoted to developing “the world’s first fully autonomous bionic pancreas”, according to a press release from earlier this year.

The firm has created the iLet Bionic Pancreas System, which is a “dual-chamber, autonomous, infusion pump that mimics a biological pancreas”, including both insulin and glucagon, and communicates with a CGM.

Utilizing a machine-learning algorithm, the system will autonomously calculate and dose insulin and/or glucagon as needed, without requiring blousing or input from the user. This summer, they received Food and Drug Administration (FDA) approval to begin clinical testing in a home setting of adults and children with T1DM. The company aims to finalize the design in 2019, and potentially launch their first product in 2020.

Can I get a new pancreas?


Technology is not for everyone, and sometimes people wonder if it would be easier to just get a new pancreas. Not everyone can qualify for a pancreas transplant: currently it is only considered in people with serious complications of diabetes, such as end stage renal disease, or frequent severe low or high blood sugars.

A full pancreas transplant is often done along with a kidney transplant in someone with both diabetes and end stage renal disease. It is a major abdominal surgery, and comes with the risks of such an extensive procedure.

After the transplant, they will need to be on lifelong medications to suppress their immune system to avoid rejection of the new organ. Even after a successful surgery, rejection can still occur days to years after the surgery in up to 30 percent of people.

The goal of transplant is to allow people with T1DM the opportunity to no longer be dependent on insulin, and decrease complications from having diabetes over their lifetime. For those who have been able to get a pancreas transplant, most were able to stay off of insulin, maintain normal glucose levels, and avoid hypoglycemia for many years. Some studies show improvement for up to 15 years!

A promising, less-invasive alternative is currently being developed: islet cell transplant.

What is an islet cell transplant?


Islet cell transplant is a minimally-invasive procedure that replaces specific cells of the pancreas that are destroyed by the autoimmune process in a person with T1DM.

With the gradual destruction over time, “it becomes more and more difficult to control the lability in glucose levels, [which] leads to unstable glycemic control”, according to Dr Michael Rickels, the medical director for Pancreatic Islet Cell Transplantation Program at the Hospital of the University of Pennsylvania.

They can develop hypoglycemia, or low blood sugar, “which can be severe, resulting in coma, seizure, [or] loss of consciousness that can be life threatening or even result in death.”

The program at the Hospital of the University of Pennsylvania started in 2000, with the goal that islet cell transplant “can provide both insulin and glucagon secretion to maintain near normal levels of glycemia, [in an] appropriately regulated manner.”

Insulin production should turn off when it’s supposed to, and glucagon can be made by the transplanted cells to prevent low blood sugars, or hypoglycemia.

The islet cells are collected from a deceased donor pancreas, purified, and delivered via a noninvasive procedure into the liver of the patient with T1DM.

After a few weeks, the islet cells grow a blood supply and can start to make their own insulin and glucagon hormones.

In 2004, Hospital of the University of Pennsylvania was named one of five NIH-sponsored centers to proceed with transplantation as part of an FDA registered clinical trial.

From 2008 to 2012, they successfully transplanted 11 individuals with T1DM and severe, frequent hypoglycemia. Of those, seven were able to stop insulin after the first transplant, and the remaining 4 were able to stop insulin after a second transplant.

More than half have remained off insulin for five or more years; the first transplant patient has been insulin-free for 10 years. One person did develop a recurrence of autoimmune diabetes, and three have required low doses of insulin, but not to the level of what they had previously required, and without hypoglycemia.

After transplant, the recipient does need to be on lifelong, low dose immunosuppression to prevent both rejection of the transplanted islet cells and potential autoimmune destruction from the T1DM antibodies.

Islet cell transplant has great potential for long term insulin independence, and Rickels’ team is currently pursuing the biologic licensure process with the FDA, in hopes of having this available for patients with T1DM and severe hypoglycemia.

“Patients tell us they feel like they’ve been cured,” he said.

“For patients having the hardest time with T1DM, and who have become extremely debilitated by glycemic lability and frequent, severe hypoglycemia, this therapy has been life-changing and really transformative. To hear ... what they’ve been able to accomplish in their lives, from what they never thought they could do before, has been the most incredible part of this.”

Type 1 and type 2 diabetes affect millions of people, and the science and technology required to make their lives better is making incremental improvements.

All medical devices and insulin requires prescriptions and since each person with diabetes is a unique case a discussion with medical professionals is appropriate.

But for those who suffer from diabetes, the potential to make their lives better and longer can’t come soon enough.

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iStock/Thinkstock(WASHINGTON) -- The Food and Drug Administration announced Thursday it will pursue a ban on menthol cigarettes and take new steps to keep youth from using flavored e-cigarette devices.

FDA Commissioner Scott Gottlieb has publically highlighted what he described as an “epidemic” of addiction.

“The actions #FDA announced today are a response to our deep concern over the epidemic growth in kids use of e-cigarettes,” Gottlieb said in a tweet.

THREAD: The actions #FDA announced today are a response to our deep concern over the epidemic growth in kids use of e-cigarettes. The data released by the #CDC shows a trend in use that simply cannot stand. We must reverse this trajectory of youth use and addiction....

— Scott Gottlieb, M.D. (@SGottliebFDA) November 15, 2018

The announcement comes with a new report which finds more than three million high school students use e-cigarettes. That’s up 20 percent since 2011.

At the same time, the number of middle school students using the nicotine products shot up by almost a factor of 10 to more than half a million using the devices in 2018, according to the Centers for Disease Control.

“The data released by the #CDC shows a trend in use that simply cannot stand,” Gottlieb tweeted. “We must reverse this trajectory of youth use and addiction.”

The U.S. Department of Health and Human Services identified the growing trend in 2016 and called e-cigarettes dangerous for young people.

Juul, a leading e-cigarette maker, tried to preempt additional regulation this week when the company announced it would rein in sales of flavored vaping devices popular with younger consumers, including mango, creme and cucumber.

The company rolled out what it calls an age verification system to help ensure only adults are purchasing the flavors online.

In the summer of 2018, the FDA used undercover investigators to crack down on more than 1,300 retailers illegally selling e-cigarettes like those made by Juul. It was the largest enforcement action of its kind in the agency’s history.

Last month, the FDA raided the San Francisco headquarters of Juul Labs, looking for documents related to the company's marketing practices. The federal regulator had been investigating whether Juul violated the law by targeting minors through its advertising and flavored products.

The new regulations come on the same day the FDA promotes its anti-smoking campaign which it calls the “Great American Smokeout.” The use of e-cigarettes has been left out of their primary list of tobacco-free alternatives promoted to help adults quit.

Gottlieb has continued to highlight the need for regulating e-cigs while acknowledging their use as a way of getting adult smokers to quit.

“I won’t allow policy accommodation we take to promote innovation to come at the expense of an epidemic of use of tobacco products by children,” Gottlieb said in a tweet. “We are now witnessing that epidemic.”

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