DR SUGAR 's Medical Inspiration

Understanding Type 1 diabetes: part 3 - reversal
HELLO I AM DR. SUGAR, YOUR INTERNET DOCTOR, HERE TO continue our discussion on type 1 diabetes. I will go into a lot more detail on treatment and talk about what the future holds - perhaps even reversal of type 1 diabetes - - so if you are ready, let’s get started with a dose of MEDICAL INSPIRATION.

It is not yet possible to prevent Type 1 diabetes so instead, according to the Juvenile Diabetes Research Foundation, scientists hope to sustain and build upon recent momentum in the development of agents that can reverse type 1 diabetes after diagnosis.

We now know that patients retain more insulin-producing capacity in the beginning stages of disease than previously thought so early diagnosis is critically important. Clinical trials to reverse type 1 diabetes might be more successful if interventions were undertaken during the window of opportunity as close to diagnosis as possible, when the maximal number of functioning beta cells remain.

Researchers are now developing "combination" therapies that combine drugs that regulate the immune system with other drugs that activate beta cell regeneration to attempt to restore durable beta cell function. (Remember the beta cells are the cells in the pancreas that are responsible for making insulin and they are the cells that are destroyed in type 1 diabetes). If successful, this strategy could be used to reverse established, long-term type 1 diabetes.

Unfortunately, many drugs are simply too toxic for routine use in children or adolescents. New drugs to reverse type 1 diabetes must be developed that are effective for disease reversal, yet safe for use in the vulnerable pediatric population.

I am Doctor Sugar - - If you or your child has type 1 Diabetes , it is important to work with your health care team to make a plan that works for you and for your family’s lifestyle. Thanks for checking in and if you haven’t already done so be sure to read all of the medical inspiration blogs on Type 1 and Type 2 Diabetes. Thank you for your interest in Total Wellness. Simply click on my picture and go to my profile to see the latest medical blogs on a wide variety of topics. I’ll see you there.

Giving You Your Dose of MEDICAL INSPIRATION,
Dr. Sugar
TO YOUR TOTAL WELLNESS!!

American Diabetes Association: www.diabetes.org
Juvenile Diabetes Research Foundation: www.jdrf.org
Centers for Disease Control and Prevention: www.cdc.gov

The information contained in this blog is not medical advice.
Please consult your medical doctor before making any decisions
or taking any actions on your health or the health of your family.

Understanding Type 1 diabetes: part 2 - prevention
HELLO I AM DR. SUGAR, YOUR INTERNET DOCTOR, here to continue our discussion on Understanding Type 1 Diabetes. I will go into a lot more detail on the exciting research on preventing type 1 diabetes. - - so if you are ready, let’s get started with a dose of MEDICAL INSPIRATION.

The ultimate goal for type 1 diabetes prevention may involve the development of a vaccine against a diabetes-specific trigger that would provide universal protection from the disease. This would allow eradication of type 1 diabetes over time, similar to the concept of eradicating infectious diseases such as poliomyelitis.

Prevention is the only true means of eradicating type 1 diabetes in the entire U.S. population. Preventing the disease would free up to 30,000 individuals per year from a lifetime of difficult, daily disease management and the risk of long-term complications such as blindness, limb amputation, and kidney failure.

Over time, up to 5-10 percent of the total diabetes cases in the U.S. could be eliminated if a safe and effective type 1 diabetes vaccine were available. Society would benefit from the substantial savings in the healthcare costs treating type 1 diabetes and its complications, which can be more than twice as high as medical care for non-diabetic individuals. The CDC has estimated that the annual healthcare costs for an individual with diabetes is $13,243, compared with $2,560 for someone without diabetes.

Many multi-year research projects such as the Type 1 Diabetes Genetics Consortium and The Environmental Determinants of Diabetes in Youth (TEDDY) study are being done to carefully monitor and study children in order to identify environmental triggers associated with the development of type 1 diabetes.

It is not yet possible to prevent Type 1 diabetes so instead, according to the Juvenile Diabetes Research Foundation, scientists hope to sustain and build upon recent momentum in the development of agents that can reverse type 1 diabetes after diagnosis.

I am Doctor Sugar and I want to invite you to join me for part 3 of my blog series on Understanding Type 1 Diabetes. In the next section, I will go into a lot more detail on treatment, reversal of type 1 diabetes, and a look at what the future holds. Make sure to check it out. I’ll see you there!!

Giving You Your Dose of MEDICAL INSPIRATION,
Dr. Sugar
TO YOUR TOTAL WELLNESS!

American Diabetes Association: www.diabetes.org
Juvenile Diabetes Research Foundation: www.jdrf.org
Centers for Disease Control and Prevention: www.cdc.gov

The information contained in this blog is not medical advice.
Please consult your medical doctor before making any decisions
or taking any actions on your health or the health of your family.

Understanding Type 1 diabetes: part 1 - causes
HELLO I AM DR. SUGAR, YOUR INTERNET DOCTOR, HERE TO GIVE YOU YOUR DOSE OF MEDICAL INPIRATION FOR THE DAY. OUR TOPIC IS Understanding Type 1 Diabetes - - so let's get started shall we...

Many years ago the two types of diabetes were called juvenile diabetes and adult onset diabetes. However, the names have changed to type 1 which is the old juvenile diabetes and type 2, which is the old adult onset diabetes. Type 1 diabetes is the kind of diabetes that is primarily diagnosed in children. It is the kind that used to be called juvenile diabetes. However, adults can sometimes get it too.

The big reason for the name change however is that the other kind of diabetes, the one that is now called Type 2 diabetes is now being seen more and more in overweight and obese children. As the incidence of obesity rises in our country this is becoming more and more of an alarming trend. Type 2 diabetes can be caused by lifestyle and by being overweight.

So What exactly is Type 1 diabetes?
Type 1 diabetes accounts for about 5 to 10 percent of the total cases of diabetes in the United States, with type 2 diabetes making up the remaining cases. In type 1 diabetes the body’s own defense system (the immune system), whose function is to defend us against bacteria and viruses, by mistake attacks the cells in the pancreas that produce insulin. The exact causes for this attack are not well understood, but factors people are born with (which are called genetic factors) play together with things in your environment (which are called environmental triggers).

So if genetic factors play a role and you or your partner has Type 1 diabetes, you probably ask yourself will my children get it too? That depends on the environmental triggers, as even if one identical twin has Type 1 diabetes, the other one dose not necessarily get it. If scientist and doctors could understand better how these factors work together, it would be possible to predict everyone’s risk, and maybe even prevent the disease.

The list of potential environmental triggers for type 1 diabetes is large and includes diverse agents such as cow's milk, timing of the introduction of cereal in an infant's diet, vitamin D, viral infection, and more. Definitive identification of environmental triggers for type 1 diabetes would aid in the discovery of new drugs or behavior modifications—such as delayed use of infant cereal—that could reduce disease risk.

I am Doctor Sugar and I want to invite you to join me for part 2 of my blog series on Understanding Type 1 Diabetes In the next section, I will go into a lot more detail on the exciting research on how to prevention type 1 diabetes. Make sure to check it out. I’ll see you there!!

Giving You Your Dose of MEDICAL INSPIRATION,
Dr. Sugar
TO YOUR TOTAL WELLNESS!

References:
American Diabetes Association: www.diabetes.org
Juvenile Diabetes Research Foundation: www.jdrf.org
Centers for Disease Control and Prevention: www.cdc.gov

The information contained in this blog is not medical advice.
Please consult your medical doctor before making any decisions
or taking any actions on your health or the health of your family.

Understanding Diabetes and pre-diabetes tests: part 4
HELLO I AM DR. SUGAR, YOUR INTERNET DOCTOR, HERE TO continue our discussion on UNDERSTANDING DIABETES AND PREDIABETES TESTING. In the last blog we talked about all the blood tests that should be done for people with diabetes but there are a lot of other tests that your doctor will do or he may even send you to a specialist to have checked out so lets take some time now so I can go into a lot more detail on those tests which are also very important for all diabetic patients. - - so if you are ready, let’s get started with a dose of MEDICAL INSPIRATION.

So you have diabetes – why does your doctor always want you to pee in a cup?

It is very important to Test for kidney disease: The American Diabetes Association recommends an annual urine test to detect small amounts of protein in the urine. We call this microalbuminuria. We do this annually to screen for diabetic nephropathy – or diabetic kidney disease. If we start to see small amounts of protein spilling into your urine, then your doctor will want to start you on a medicine that is protective for your kidneys if you are not already taking it.

At each visit your doctor will also Monitor height and weight. This is especially important in children with diabetes, as doctors will want to assure that the child is growing adequately. Checking the weight regularly is also very important for adults with Type 2 diabetes as gaining weight usually worsens the symptoms.

At each visit, the nurse will check your blood pressure and report this number to the doctor: Since elevated blood pressure can lead to complications, blood pressure should be tested at each doctor visit. Before diagnosing high blood pressure, doctors take readings on three separate days. Diabetic patients should keep their blood pressure less than 130 / 80 according to the latest Joint National Committee on prevention detection evaluation and treatment of high blood pressure JNC7 report. It is very important to keep your blood pressure within the levels appropriate for your age.

Another important preventive measure for people with diabetes is to make sure and Get an annual flu shot: A yearly flu shot is recommended for all people with chronic illnesses, including diabetes. At present, it is not recommended that people with diabetes take the live oral/nasal form of the flu vaccine. Instead, they should receive their flu vaccinations by injection. Flu shots are given in the fall months.

Your doctor will also recommend that you See your dentist regularly: Good oral health is essential for all people with diabetes. Schedule a thorough dental cleaning and examination every six months, informing your dentist and hygienist that you have diabetes.

You will also need to have your eyes tested: Your family doctor will probably look into your eyes with their ophthalmoscope at every visit but in addition, at least once a year, they will send you to an ophthalmologist – a doctor who specializes in diseases of the eye to do a special diabetic eye exam. This eye test involves dilating the eye and doing a thorough examination of the retina. An annual eye exam is recommended for everyone with diabetes, although some ophthalmologists may recommend testing less often in young children.

Lets talk a minute about the Diabetic Foot Exam: - Each time you go in to see your doctor, make sure to remove your shoes and socks as your doctor will want to examine your feet to screen for diabetic neuropathy (damage to the nerves)– they will also want to make sure you are not developing any worrisome blisters, corns, calluses, cracks or lesions that could become infected or a non healing ulcer. If there are any problems with your feet, you may be sent for an annual foot exam with a podiatrist or a doctor who specializes in disease of the feet.

And the last thing I should mentions is - - - the main reason we do all these test in our diabetic patients is to screen for complications and catch things early before they become a problem: Now that most doctors and most patients adhere to a treatment plan calling for tighter control, the incidence of long-term complications related to the eyes, kidneys, nerves, and cardiovascular system are lower than in the past and these complications are rare in children.

Your ultimate goal--and your doctor's--is not to see any long-term complications. Nevertheless, many doctors will take baseline kidney, liver function, and eye exams soon after diagnosis, and may repeat those tests at varying intervals. Such baseline tests help your doctor make sure that no underlying problem existed before diabetes occurred.

A lot of these test sound like a real drag, but keep in mind that diabetes increases your chances of developing a number of serious and sometimes life-threatening complications. If you haven’t already seen it, be sure to catch the entire blog series I did on diabetic complications for a lot more information. While this may sound very scary, your best bet for avoiding diabetic complications is to work together with your doctor as closely as possible with the goal of the whole team being to keep your diabetes well controlled.

Get your A1c less than 6.9 and keep it there. If you will do this consistently your chances of developing any long-term complications will go way way down. You are in the drivers seat and your healthcare team is here to help you. The better your control is, the less risk you have for complications. Keep up on the all the tests we’ve talked about today so that if you develop any complications they are detected early when they are much easier to treat.

I am Doctor Sugar - - If you have Diabetes or Pre-Diabetes, it is important to work with your health care team to make a plan that works for you and for your lifestyle. Thanks for checking in and if you haven’t already done so be sure to read all of the medical inspiration blogs on Understanding Diabetes. Thank you for your interest in Total Wellness. Simply click on my picture and go to my profile to see the latest medical blogs on a wide variety of topics. I’ll see you there.

Giving You Your Dose of MEDICAL INSPIRATION,
Dr. Sugar
TO YOUR TOTAL WELLNESS!!

References:
American Diabetes Association
www.diabetes.org
American Diabetes Foundation
New England Journal of Medicine, September 30, 1993
Gregg et al., Annals of Internal Medicine, 2007
Juvenile Diabetes Research Foundation

The information contained in this blog is not medical advice.
Please consult your medical doctor before making any decisions
or taking any actions on your health or the health of your family.

Understanding Diabetes and pre-diabetes tests: part 3
HELLO I AM DR. SUGAR, YOUR INTERNET DOCTOR, HERE TO continue our discussion on UNDERSTANDING DIABETES AND PREDIABETES TESTING. In the last blog we talked about some of the blood tests that should be done for people with diabetes but there are a lot more blood tests that your doctor will check so lets see what those are. - - if you are ready, let’s get started with a dose of MEDICAL INSPIRATION.

Another test we run on your blood is for cholesterol – we generally call this a lipid panel and we do this to Monitor blood fat levels - -the things that we look at are total cholesterol, LDL- the bad cholesterol, HDL – the good cholesterol and TRIGLYCERIDES: Lipid levels are important to monitor since high levels of cholesterol and triglycerides can contribute to such diabetic complications as heart disease. Everyone with diabetes should have his or her lipid levels tested at diagnosis. In younger children, testing at diagnosis should be done if there is a history of high cholesterol in the family or if a family member has had a cardiovascular problem before the age of 55. If the results are normal, the lipid screen should be repeated every 5 years. If abnormal, tests are repeated annually.

We will also check your blood to screen for thyroid disease: In patients with type 1 diabetes, thyroid disease is the most common additional autoimmune disease to develop. Some estimates put the rate of thyroid disease as high as one out of every three people with type 1 diabetes. Screening is done through simple blood tests and is recommended for all children and adults with type 1 diabetes at diagnosis and if normal, thyroid levels should be retested every 1-2 years.

And finally, many doctors will consider doing a Test for celiac disease: Celiac disease is the second most common autoimmune disease associated with type 1 diabetes. It occurs when the body is unable to digest gluten - which is a wheat protein. Screening is accomplished through a blood test, as well as a one-time test for gluten levels. Many physicians recommend screening at the time of diagnosis and every four years thereafter, or if you develop symptoms such as diarrhea, weight loss, abdominal pain, poor growth, or other gastrointestinal symptoms. Both thyroid and celiac disease can develop without obvious symptoms, which makes it even more important to consider doing screening tests.

I am Doctor Sugar and I want to invite you to join me for part 4 of my blog series on UNDERSTANDING DIABETES AND PREDIABETES TESTING. We just finished up talking about all the blood tests that should be done for people with diabetes but there are a lot of other tests that your doctor will do or he may even send you to a specialist to have checked out so In the next section, I will go into a lot more detail on those tests which are also very important for all diabetic patients. Make sure to check it out. I’ll see you there!!

Giving You Your Dose of MEDICAL INSPIRATION,
Dr. Sugar
TO YOUR TOTAL WELLNESS!

References:
American Diabetes Association
www.diabetes.org
American Diabetes Foundation
New England Journal of Medicine, September 30, 1993
Gregg et al., Annals of Internal Medicine, 2007
Juvenile Diabetes Research Foundation

The information contained in this blog is not medical advice.
Please consult your medical doctor before making any decisions
or taking any actions on your health or the health of your family.

Understanding Diabetes and pre-diabetes tests: part 2
HELLO I AM DR. SUGAR, YOUR INTERNET DOCTOR, HERE TO continue our discussion on UNDERSTANDING DIABETES AND PREDIABETES TESTING. I will go into a lot more detail on those tests that are very important for all diabetic patients - - so if you are ready, let’s get started with a dose of MEDICAL INSPIRATION.

According to the American Diabetes Association and the Juvenile Diabetes Research Foundation there are a number of important tests that should be done to care for diabetic patients to prevent and monitor for any complications. The most important tests that should be done for diabetic patients are monitoring of blood sugar levels, test A1c, check cholesterol, screen for thyroid and celiac disease, check blood pressure, check feet, eyes, urine, and teeth. So lets spend some time now talking about each of these tests and how they are done. I’ll begin by talking about the different tests that are done on your blood. I am sure if you have diabetes that you wonder why we take so much darn blood so lets see what is done with that.

Lets start with just the basic finger stick. If you have diabetes you should have some kind of a home glucose monitor to Monitor blood sugar levels: Daily blood sugar testing is one of the best ways you and your doctor can evaluate everyday management of diabetes and determine the effectiveness of the treatment plan. Your doctor should evaluate the blood sugar meter results you'll be keeping track of at each visit.

If you don’t already have one, make sure to get a blood sugar log and record your numbers in it daily. Many of my patients would also write comments – for example if they had a particularly high reading one day they might write in “my grandson’s birthday – ate cake” – to explain what was going on in their life at that particular time. I found this to be very helpful. Depending on how long you have had diabetes, and how good of control your diabetes is in will determine how many times a day you should be checking your sugars. Talk with your doctor about his or her recommendations.
Be sure to always take your log AND your personal blood glucose monitor in to the doctor with you for each of your visits. This makes it much quicker, easier and more effective for your doctor.

OK – so how about the actual blood draw that we do – one of the main tests that is done is called the Hemoglobin A1C test. It is a test that checks the amount of sugar stuck to your red blood cells – that is why the word hemoglobin is in the name: The "A1C" is a blood test that reflects the average blood sugar control over a 2 to 3 month period – or the average lifespan of a red blood cell - your A1C sample will include cells that are a few days, a few weeks and a few months old. That's how the test result covers a span of about three months. The A1c test allows doctors to evaluate the effectiveness of the treatment plan. The test should be repeated every three months.

For people without diabetes, the normal range for the A1C test is between 4 to 6 percent. In poorly controlled diabetics it can be above 8. The goal for people with diabetes is to have an A1C less than 6.9 percent, although glycemic goals may be modified somewhat with a young child. To give you an idea of what an A1c means - - An A1c of 7 correlates to an average blood sugar over the last 3 months of about 170. So our goal should be to make sure that the average sugar is less than 170.

Research studies have shown that the risks for diabetic complications decrease significantly for people with A1C levels less than 7 – so make sure to keep your sugars down to avoid the complications that can come from uncontrolled diabetes.

I am Doctor Sugar and I want to invite you to join me for part 3 of my blog series on UNDERSTANDING DIABETES AND PREDIABETES TESTING In the next section, we will talk about the other blood tests that we do and why they are very important so make sure to check it out. I’ll see you there!!

Giving You Your Dose of MEDICAL INSPIRATION,
Dr. Sugar
TO YOUR TOTAL WELLNESS!


References:
American Diabetes Association
www.diabetes.org
American Diabetes Foundation
New England Journal of Medicine, September 30, 1993
Gregg et al., Annals of Internal Medicine, 2007
Juvenile Diabetes Research Foundation

The information contained in this blog is not medical advice.
Please consult your medical doctor before making any decisions
or taking any actions on your health or the health of your family.

Understanding Diabetes and pre-diabetes tests: part 1

HELLO I AM DR. SUGAR, YOUR INTERNET DOCTOR, HERE TO GIVE YOU YOUR DOSE OF MEDICAL INPIRATION FOR THE DAY. OUR TOPIC IS UNDERSTANDING DIABETES AND PREDIABETES TESTING- - SO LETS GET STARTED SHALL WE

According to the American Diabetes Association diabetes and pre-diabetes occur in people of all ages and races, but some groups have a higher risk for developing the disease than others. Diabetes is more common in African Americans, Latinos, Native Americans, and Asian Americans/Pacific Islanders, as well as the aged population. This means they are also at increased risk for developing pre-diabetes.

There are two different tests your doctor can use to determine whether you have pre-diabetes: the fasting plasma glucose test (FPG) or the oral glucose tolerance test (OGTT). The fasting plasma glucose test is just as the name implies – what the glucose level in your blood is when you are fasting – generally done first thing in the morning. If your blood glucose level is too high on the FPG, your doctor will say that you have impaired fasting glucose (IFG).

You doctor may also order an oral glucose tolerance test. For an OGTT you will be asked to come in fasting and then drink a beverage with a standardized amount of glucose (sugar) in it. Your blood will be tested before you start the drink and then 2 hours after drinking the glucose drink. The blood glucose levels measured after these tests determine whether you have a normal metabolism, or whether you have pre-diabetes or diabetes. If your blood glucose level is abnormal following the OGTT, you have impaired glucose tolerance (IGT).

To determine whether you have pre-diabetes or diabetes depends on your actual values: if your FPG level is 100mg/dl or above, but below 126mg/dl, and/or your blood glucose two hours after an OGTT is over 140mg/dl but below 200mg/dl you have prediabetes.

If your value for the FPG is above 126mg/dl and/or your 2h OGTT value is above 200mg/dl, you have diabetes. At this point the doctor does not yet know whether you have Type 1 or Type 2 diabetes, even though your overall appearance (Type 2 diabetics are usually older and overweight, while Type 1 diabetics usually have normal body weight and are younger) is a very good hint.

Once it is established that you have diabetes there are a number of tests that you and your doctor will perform on a regular basis to keep your health on track. Most of these tests are important for both Type 1 and Type 2 diabetics.

I am Doctor Sugar and I want to invite you to join me for part 2 of my blog series on UNDERSTANDING DIABETES AND PREDIABETES TESTING In the next section, I will go into a lot more detail on those tests that are very important for all diabetic patients. Make sure to check it out. I’ll see you there!!

Giving You Your Dose of MEDICAL INSPIRATION,
Dr. Sugar
TO YOUR TOTAL WELLNESS!

References:
American Diabetes Association
www.diabetes.org
American Diabetes Foundation
New England Journal of Medicine, September 30, 1993
Gregg et al., Annals of Internal Medicine, 2007

The information contained in this blog is not medical advice.
Please consult your medical doctor before making any decisions
or taking any actions on your health or the health of your family.

Understanding Type 2 diabetes: part 3 – lifestyle choices
HELLO I AM DR. SUGAR, YOUR INTERNET DOCTOR, HERE TO continue our discussion on Understanding Type 2 Diabetes I will go into a lot more detail on those exercise choices that are very important for all diabetic patients - - so if you are ready, let’s get started with a dose of MEDICAL INSPIRATION.

Ok in the last blog we talked a lot about healthy eating choices and how it really is Easier DONE than SAID once you set your mind to it. Now lets spend some time talking about another important lifestyle choice – EXERCISE.

If you don’t like the idea of joining a gym, walk your dog every day for 30 min. You don’t have a dog? Meet with a friend for a walk instead of for a blended, sugar-laden coffee-drink. Play with your kids outside. They’ll love to spend quality time with you, and you get a workout throwing balls, playing badminton, or just playing a good game of catch in the park. If you’re weight is keeping you off your hurting feet try swimming to build strength, but keep the goal of doing weight-bearing exercise in mind, as it will work better to prevent other conditions like osteoporosis.

Another great way to fit exercise into a busy schedule is using the bike to get to work, you have to get to work anyway, this way you use your commuting time to do something good for you and the environment. Many public transportation systems allow you to take you bike with you, if your commuting distance is too long to do it all on the bike. Playing team sports is also a good way to stay motivated. If you are unmotivated one day, don't worry, your teammates will kick you in the b*** and give you some motivation haha.

Try to pack some more activity into every-day living too: don’t use the elevator; take the stairs wherever you go. Take the farthest parking spot in the lot. If you need to see the results, carry a pedometer, one day with just your usual activities and the next day incorporating these simple tips. You can see the difference in steps with the pedometer. I bet you will be surprised how much of a difference you see. Try to reach 10,000 steps per day by slowly increasing your activity level steadily.

These are important changes to your lifestyle that may help to prevent or at least delay the onset of Type 2 diabetes. There is one more thing that is very important: know your risk: talk to your doctor about your risk during your yearly physical and have him or her check for signs of pre-diabetes especially if there are people with Type 2 diabetes in your family

I am Doctor Sugar - - If you have Type 2 Diabetes it is important to work with your health care team to make a plan that works for you and for your lifestyle. Thanks for checking in and if you haven’t already done so be sure to read all of the medical inspiration blogs on Understanding Diabetes. Thank you for your interest in Total Wellness. Simply click on my picture and go to my profile to see the latest medical blogs on a wide variety of topics. I’ll see you there.

Giving You Your Dose of MEDICAL INSPIRATION,
Dr. Sugar
TO YOUR TOTAL WELLNESS!!

References:
American Diabetes Association: www.diabetes.org
Centers for Disease Control and Prevention: www.cdc.gov
Diabetes Prevention Program (DPP) study
American Diabetes Foundation
New England Journal of Medicine, September 30, 1993
Gregg et al., Annals of Internal Medicine, 2007
Juvenile Diabetes Research Foundation

The information contained in this blog is not medical advice.
Please consult your medical doctor before making any decisions
or taking any actions on your health or the health of your family.

Understanding Type 2 diabetes: part 2 – healthy eating
HELLO I AM DR. SUGAR, YOUR INTERNET DOCTOR, HERE TO continue our discussion on Understanding Type 2 Diabetes I will go into a lot more detail on those healthy eating choices that are very important for all diabetic patients - - so if you are ready, let’s get started with a dose of MEDICAL INSPIRATION.

The American Diabetes Association (ADA) has a wealth of resources for people with diabetes or at risk for diabetes that can be of use to people interested in pre-diabetes.

One way to turn the tide on diabetes when you are already showing sign of pre-diabetes is good nutrition. This is an easy meal planning guide that is great if you already have diabetes and also may help to decrease your risk for getting type 2 diabetes or preventing a host of other diseases like heart disease and even certain cancers.

Try these 6 simple steps to get started:
1. Using your dinner plate, put a line down the middle of the plate.

2. Then on one side, cut it again so you will have 3 sections on your plate.

3. Fill the largest section with non-starchy vegetables such as: spinach, carrots, lettuce, greens, cabbage, bok choy, green beans, broccoli, cauliflower, tomatoes, vegetable juice, salsa, onion, cucumber, beets, okra, mushrooms, peppers, or turnip - - - these are all NON STARCHY Veggies.

4. Now in one of the small sections, put starchy foods such as: whole grain breads like whole wheat or rye whole grain, high-fiber cereal, cooked cereal such as oatmeal, grits, hominy, or cream of wheat, rice, pasta, dal, tortillas, cooked beans and peas such as pinto beans or black-eyed peas, potatoes, green peas, corn, lima beans, sweet potatoes, winter squash, low-fat crackers, snack chips, pretzels, or fat-free popcorn
these are all considered STARCHY Foods.

5. And then on the other small section, put your meat or meat substitutes such as: chicken or turkey without the skin, fish such as tuna, salmon, cod, or catfish , other seafood such as shrimp, clams, oysters, crab, or mussels, lean cuts of beef and pork such as sirloin or pork loin, tofu, eggs, low-fat cheese

One suggestion for general good health is to choose fish at least twice a week and then for at least 2 other meals a week try to substitute a soy related protein for an animal protein. Soybeans have much more protein than other beans and they can be made into a lot of different products including many that look like animal foods. The next time you are in the grocery store look in the refrigerator cases and do some experimentation to see what you like. You will often find a bigger selection at a health food store or even an oriental market. There are now many forms of TOFU and TEMPEH as well as burgers, wieners and lunchmeats made from soy protein. So consider eating more soy protein and more fish and less animal protein.

6. In addition to your meal which is now divided in to a large section of a non starchy food, a small section of a starchy food and a small section of a protein, you can add an 8 oz glass of non-fat or low-fat milk or unsweetened soy milk (you can add a splash of sugar-free syrup to make it more tasty). If you don’t drink milk or soy milk, you can add another small serving of carb such as a 6 oz. container of light yogurt or a small multi grain roll.

7. Then add a piece of fruit or a 1/2 cup fruit salad and you have your meal planned. You can choose fresh fruit, frozen fruit, or fruit canned in juice or fruit frozen in light syrup.

Now that you know what to eat add daily exercise. I am Doctor Sugar and I want to invite you to join me for part 3 of my blog series on Understanding Type 2 Diabetes In the next section, I will go into a lot more detail on exercise choices that are very important for all diabetic patients. Make sure to check it out. I’ll see you there!!

Giving You Your Dose of MEDICAL INSPIRATION,
Dr. Sugar
TO YOUR TOTAL WELLNESS!

References:
American Diabetes Association: www.diabetes.org
Centers for Disease Control and Prevention: www.cdc.gov
Diabetes Prevention Program (DPP) study
American Diabetes Foundation
New England Journal of Medicine, September 30, 1993
Gregg et al., Annals of Internal Medicine, 2007
Juvenile Diabetes Research Foundation

The information contained in this blog is not medical advice.
Please consult your medical doctor before making any decisions
or taking any actions on your health or the health of your family.

Understanding Type 2 diabetes: part 1 - causes and prevention
HELLO I AM DR. SUGAR, YOUR INTERNET DOCTOR, HERE TO GIVE YOU YOUR DOSE OF MEDICAL INPIRATION FOR THE DAY. OUR TOPIC IS Understanding Type 2 Diabetes- - so let's get started shall we...

Type 2 diabetes accounts for more than 90% of the cases of diabetes in this country. It is the kind that used to be called adult onset diabetes, as it was only seen in adults, and usually in people 50 or older. Nowadays, it is even seen in children, so it’s no longer accurate to call it adult-onset diabetes.

What are the causes of Type 2 diabetes and is there a way to prevent it? Some people are born with insulin-producing cells in the pancreas that are very sensitive while other people have very robust insulin-producing cells. In general, a person who eats lots of white carbohydrates like sugar, white flour (including white bread or tortillas) as well as white pasta and white rice will need more insulin – especially if they do not exercise regularly and are overweight. Lets compare this to a person who exercises regularly, is lean and eats a healthy diet with lots of fruit, vegetables, and whole grains - - this type of person will need much less insulin.

However, if you are born with very robust insulin producing cells lifestyle choices alone will most likely not make you diabetic. Similar to how some people who smoke cigarettes every day never develop lung cancer. Unfortunately it is a little like Russian roulette because nobody knows who has robust and who has sensitive insulin-producing cells until the first symptoms develop. So it is a great idea to maintain a healthy lifestyle now instead of taking your health for granted and just hoping for the best.

Family history of Type 2 diabetes is usually a good hint that you should be careful, and in general it is always better to err on the side of caution. Type 2 diabetes is preventable; the best way would be to always live a healthy lifestyle. Now some of you may think as you are listening that is easier said than done, and for some people the idea of preventing diabetes becomes only urgent when their Doctor diagnoses prediabetes. Prediabetes is the diagnosis we make when somebody develops subtle symptoms that their insulin-producing cells are severely stressed, but before they have actually developed diabetes.

According to the American Diabetes Association the recently completed Diabetes Prevention Program (DPP) study conclusively showed that people with pre-diabetes can prevent the development of type 2 diabetes by making changes in their diet and increasing their level of physical activity. They may even be able to return their blood glucose levels to the normal range. And I believe that this is EASIER DONE than SAID.

While the DPP showed that some medications may delay the development of diabetes, diet and exercise worked better. Just 30 minutes a day of moderate physical activity, coupled with a 5-10% reduction in body weight, produced a 58% reduction in diabetes. Now lets look at this 30 minutes of moderate physical exercise – that could mean brisk walking out in the neighborhood or even at your local park, or you could go to the gym if that is more your style, how about riding a bike or swimming, or joining a yoga or Pilates class – these are all activities that could definitely be fun in addition to being very good for you. And how about that weight loss recommendation – lets say you weigh 150 pounds – a 5-10% reduction in weight is only 7 to 14 pounds. Or if you weigh 180 pounds a 5-10% reduction in weight is only 9-18 pounds. With moderate exercise and cutting back on carbs, incorporating more fruits and veggies in the diet and choosing water instead of soda, this is easily accomplished. Why don’t you start today and incorporate a healthier way of living. Think about lowering your risk of diabetes by almost 60% - that is definitely a great reason to get moving today! You can do it, I know you can.

I am Doctor Sugar and I want to invite you to join me for part 2 of my blog series on Understanding Type 2 Diabetes. In the next section, I will go into a lot more detail on those healthy eating choices that are very important for all diabetic patients. Make sure to check it out. I’ll see you there!!

Giving You Your Dose of MEDICAL INSPIRATION,
Dr. Sugar
TO YOUR TOTAL WELLNESS!

References:
American Diabetes Association: www.diabetes.org
Centers for Disease Control and Prevention: www.cdc.gov
Diabetes Prevention Program (DPP) study
American Diabetes Foundation
New England Journal of Medicine, September 30, 1993
Gregg et al., Annals of Internal Medicine, 2007
Juvenile Diabetes Research Foundation

The information contained in this blog is not medical advice.
Please consult your medical doctor before making any decisions
or taking any actions on your health or the health of your family.

Rheumatoid arthritis part 1
HELLO I AM DR. SUGAR, YOUR INTERNET DOCTOR, HERE TO GIVE YOU YOUR DOSE OF MEDICAL INPIRATION FOR THE DAY. OUR TOPIC IS rheumatoid arthritis - SO LETS GET STARTED SHALL WE

Have you ever thought of the impact caused by rheumatoid arthritis? If you are affected by rheumatoid arthritis (RA), then you are one among the 1-2% of the population affected by the very same disease. Anyone can develop RA. For most people, it begins between the ages of 25 and 50. The prevalence increases with age and up to 5% of women over age 55 are affected by it.

Interestingly, some recent studies have suggested that although the number of new cases of rheumatoid arthritis for older people is increasing, the OVERALL number of new cases may actually be going down. This disease affects people worldwide. And it occurs in all races and all ethnic groups. Like some other forms of arthritis, it occurs much more frequently in women than in men. According to The John Hopkins Arthritis Center the average annual incidence in the United States is about 70 per 100,000 annually.

Since RA is an inflammatory condition affecting the joints, you may have symptoms like swelling, pain, stiffness and loss of junction in the joints. Of the most important features is the presence of morning stiffness in the joints, which may persist for hours.

Most often RA affects the wrist joints and finger joints close to the hand. You can expect the involvement to be symmetrical meaning if it is affecting your right wrist it will also affect your left wrist. It is much less likely to affect your left elbow and your right wrist for example. But remember, it may affect other joints as well. Rheumatoid arthritis can also cause other health problems. Your hands may become bent or twisted (deformed). Doctors generally refer to this as ulnar deviation because your fingers may start pointing towards the outer bone in your arm called the ulna. In addition, lung and heart problems may also occur.

You may also feel tired, develop fever at times and have a general sense of not feeling well. For some people, the fatigue, fever and general poor sense of feeling only lasts a few months or a year or two and goes away without causing any noticeable damage. Other people have mild or moderate forms of the disease, with periods of worsening symptoms, called flares, and periods in which they feel better, called remissions. Still others have a severe form of the disease that is active most of the time, lasts for many years or a lifetime, and leads to serious joint damage and disability.

I am Doctor Sugar and I want to invite you to join me for part 2 of my blog series on Understanding Rheumatoid Arthritis. I will go into a lot more detail on the causes of rheumatoid arthritis. Make sure to check it out. I’ll see you there!!

Giving You Your Dose of MEDICAL INSPIRATION,
Dr. Sugar
TO YOUR TOTAL WELLNESS!

References:
1.http://www.niams.nih.gov/Health_Info/Rheumatic_Disease/default.asp
2.http://www.hopkins-arthritis.org/arthritis-info/rheumatoid-arthritis/index.html
3.The John Hopkins Arthritis Center
4.National Institutes of Health

The information contained in this blog is not medical advice.
Please consult your medical doctor before making any decisions
or taking any actions on your health or the health of your family.

Rheumatoid arthritis part 2

HELLO I AM DR. SUGAR, YOUR INTERNET DOCTOR, HERE TO continue our discussion on rheumatoid arthritis. I will go into a lot more detail on the causes of rheumatoid arthritis. - - so if you are ready, let’s get started with a dose of MEDICAL INSPIRATION.

RA is an autoimmune disease, which means the arthritis results from your immune system attacking your body's own tissues. Scientists still do not know exactly what causes the immune system to turn against itself in rheumatoid arthritis, but research over the last few years has begun to piece together the factors involved.

According to the National Institutes of Health, Scientists have discovered that certain genes known to play a role in the immune system are associated with a tendency to develop rheumatoid arthritis. The confusing part is that some people with rheumatoid arthritis do not have these particular genes; still others have these genes but never develop the disease. These somewhat contradictory data suggest that a person's genetic makeup plays an important role in determining if he or she will develop rheumatoid arthritis, but it is not the only factor.

What is clear, however, is that more than one gene is involved in determining whether a person develops rheumatoid arthritis and how severe the disease will become. Many scientists think that something must occur to trigger the disease process in people whose genetic makeup makes them susceptible to rheumatoid arthritis. Some believe that a viral or bacterial infection appears likely, but the exact agent is not yet known. Keep in mind however that this does not mean that rheumatoid arthritis is contagious: a person certainly cannot catch it from someone else.

Some scientists also think that a variety of hormonal factors may be involved. Women are more likely to develop rheumatoid arthritis than men, pregnancy may improve the disease, and the disease may flare after a pregnancy. Breastfeeding may also aggravate the disease. While contraceptive use may alter a person's likelihood of developing rheumatoid arthritis. The hormonal changes, or possibly deficiencies or changes in certain hormones, may promote the development of rheumatoid arthritis in a genetically susceptible person who has been exposed to a triggering agent from the environment.

I am Doctor Sugar and I want to invite you to join me for part 3 of my blog series on Understanding rheumatoid arthritis. In the next section, I will go into a lot more detail on what may happen when you go to the doctor and the kinds of tests that are done for rheumatoid arthritis. Make sure to check it out. I’ll see you there!!

Giving You Your Dose of MEDICAL INSPIRATION,
Dr. Sugar
TO YOUR TOTAL WELLNESS!

References:
1. http://www.niams.nih.gov/Health_Info/Rheumatic_Disease/default.asp
2. http://www.hopkins-arthritis.org/arthritis-info/rheumatoid-arthritis/index.html
3.The John Hopkins Arthritis Center
4.National Institutes of Health

The information contained in this blog is not medical advice.
Please consult your medical doctor before making any decisions
or taking any actions on your health or the health of your family.

Rheumatoid arthritis part 3
HELLO I AM DR. SUGAR, YOUR INTERNET DOCTOR, HERE TO continue our discussion on rheumatoid arthritis. I will go into a lot more detail on what may happen when you go to the doctor and the kinds of tests that are done for rheumatoid arthritis. - - so if you are ready, let’s get started with a dose of MEDICAL INSPIRATION.

How do you know whether the symptoms you suffer from is due to RA? While your family doctor may begin the work up of your symptoms, and start ordering tests, he or she may refer you to a rheumatologist who usually diagnoses RA. A rheumatologist is a doctor who specializes in arthritis and other diseases of the joints, bones, and muscles. Rheumatoid arthritis can be difficult to diagnose in its early stages for several reasons. First, there is no single test for the disease. In addition, symptoms differ from person to person. Also, symptoms can be similar to those of other types of arthritis and it may take some time for other conditions to be ruled out. Finally, the full range of symptoms develops over time, and only a few symptoms may be present in the early stages.

As a result, doctors use a variety of the tools to diagnose the disease and to rule out other conditions. After obtaining your full medical history and performing a physical examination, your doctor may order for a few laboratory tests like a complete blood count, an erythrocyte sedimentation rate (SED rate or ESR), a C-reactive protein (CRP), and also a blood test for rheumatoid factor. Depending on your symptoms, a test called ANA which is usually associated with Lupus may also be checked. You will then probably be sent for x-rays. Complete blood count may show an increased white blood cell count or a low red blood cell count, which is more commonly referred to as anemia. You may also have a high Sed rate and a high CRP.
Rheumatoid factor is an ANTIBODY that is present eventually in the blood of most people with rheumatoid arthritis. An antibody is a special protein, which is made by the immune system. Under normal circumstances the antibodies that your immune system makes helps you to fight foreign substances in the body. Unfortunately in rheumatoid arthritis, your own antibodies start attacking your joints. Rheumatoid factor is the test that tests for this antibody but unfortunately for your doctor, who is attempting to diagnose your symptoms, Not ALL people with rheumatoid arthritis test positive for rheumatoid factor - - this is true especially early in the disease. Also, just to confuse things, some people test positive for rheumatoid factor, yet never develop the disease. X rays are used to determine the degree of joint destruction. They too are not useful in the early stages of rheumatoid arthritis before bone damage is evident, but they can be used later to monitor the progression of the disease.

I am Doctor Sugar and I want to invite you to join me for part 4 of my blog series on Understanding rheumatoid arthritis. In the next section, I will go into a lot more detail on treatment and prognosis for rheumatoid arthritis. Make sure to check it out. I’ll see you there!!

Giving You Your Dose of MEDICAL INSPIRATION,
Dr. Sugar
TO YOUR TOTAL WELLNESS!

References:
1.http://www.niams.nih.gov/Health_Info/Rheumatic_Disease/default.asp
2.http://www.hopkins-arthritis.org/arthritis-info/rheumatoid-arthritis/index.html
3.The John Hopkins Arthritis Center
4.National Institutes of Health

The information contained in this blog is not medical advice.
Please consult your medical doctor before making any decisions
or taking any actions on your health or the health of your family.

Rheumatoid arthritis part 4
HELLO I AM DR. SUGAR, YOUR INTERNET DOCTOR, HERE TO continue our discussion on rheumatoid arthritis. I will go into a lot more detail on lifestyle modification for rheumatoid arthritis. - - so if you are ready, let’s get started with a dose of MEDICAL INSPIRATION.

Doctors use a variety of approaches to treat rheumatoid arthritis. These are used in different combinations and at different times during the course of the disease and are chosen according to the patient's individual situation. The treatment goals are to relieve pain, reduce inflammation, slow down or stop joint damage, and improve the person's sense of well-being and ability to function.

Good communication between the patient and doctor is necessary for effective treatment. Talking to your doctor at regularly scheduled visits can help ensure that exercise and pain management programs are provided as needed, and that drugs are prescribed appropriately.

Certain activities can help improve a person's ability to function independently and maintain a positive outlook.
•People with rheumatoid arthritis need a good balance between rest and exercise, with more rest when the disease is active and more exercise when it is not.
•Some people find using a splint for a short time around a painful joint reduces pain and swelling by supporting the joint and letting it rest. Splints are used mostly on wrists and hands, but occasionally also on ankles and feet.
•People with rheumatoid arthritis face emotional challenges as well as physical ones. The emotions they feel because of the disease- - fear, anger, and frustration-combined with any pain and physical limitations can increase their stress level. Although there is no evidence that stress plays a role in causing rheumatoid arthritis, it can make living with the disease difficult at times. And I think it is pretty clear that Stress can affect the amount of pain a person feels.

There are a number of successful techniques for coping with stress. Regular rest periods can help, as can relaxation techniques, distraction techniques, deep breathing techniques,
or visualization exercises. Exercise programs, participation in support groups, and good communication with the health care team are other ways to reduce stress.

•With the exception of several specific types of oils, there is no scientific evidence that any specific food or nutrient helps or harms people with rheumatoid arthritis. However, an overall nutritious diet with enough-but not an excess of-calories, protein, and calcium is important.

I am Doctor Sugar and I want to invite you to join me for part 5 of my blog series on Understanding rheumatoid arthritis. In the next section, I will go into a lot more detail on treatment and prognosis for rheumatoid arthritis. Make sure to check it out. I’ll see you there!!

Giving You Your Dose of MEDICAL INSPIRATION,
Dr. Sugar
TO YOUR TOTAL WELLNESS!

References:
1.http://www.niams.nih.gov/Health_Info/Rheumatic_Disease/default.asp
2.http://www.hopkins-arthritis.org/arthritis-info/rheumatoid-arthritis/index.html
3.The John Hopkins Arthritis Center
4.National Institutes of Health

The information contained in this blog is not medical advice.
Please consult your medical doctor before making any decisions
or taking any actions on your health or the health of your family.

Rheumatoid arthritis part 5
HELLO I AM DR. SUGAR, YOUR INTERNET DOCTOR, HERE TO continue our discussion on rheumatoid arthritis. I will go into a lot more detail on treatment and prognosis for rheumatoid arthritis. - - so if you are ready, let’s get started with a dose of MEDICAL INSPIRATION.


Most people who have rheumatoid arthritis take medications. Some medications are used only for pain relief; others are used to reduce inflammation. Still others, often called disease-modifying antirheumatic drugs (DMARDs), are used to try to slow the course of the disease. Biologic response modifiers are new drugs used for the treatment of rheumatoid arthritis.

Several things must be taken into consideration when choosing a treatment for rheumatoid arthritis. For example, the person's general condition, the current and predicted severity of the illness, the length of time he or she will take the drug, and the drug's effectiveness as well as the potential side effects of the medication are all important considerations in prescribing drugs for rheumatoid arthritis.

The various medications used to treat RA are NSAIDs, Corticosteroids, DMARDS disease-modifying antirheumatic drugs like Azathioprine, Cyclosporine, Hydroxychloroquine, Gold sodium thiomalate, Leflunomide, Methotrexate, & Sulfasalazine
and biologic response modifiers like Etanercept, Infliximab, Adalimumab. IF you haven’t already done so, be sure to check out the entire series on rheumatoid arthritis new and emerging treatments, which goes into much more detail on each of these treatment options. If you or a loved one has rheumatoid arthritis, you will definitely want to see it.

Several types of surgery are also available to patients with severe joint damage. The primary purpose of these procedures is to reduce pain, improve the affected joint's function, and improve the patient's ability to perform daily activities. Surgery is not for everyone, however, and the decision should be made only after careful consideration by patient and doctor. The surgeries that are currently available are Joint replacement, Tendon reconstruction and Synovectomy. In synovectomy, the doctor actually removes the inflamed synovial tissue.

RA is a lifelong disease. Sometimes, if it's treated, it will go away for a little while, but it usually comes back. It is important to see your doctor as soon as you begin to experience symptoms. If not treated early in the disease course, it may cause disability. If your disease is treated with these new treatment options early and aggressively, you have a very good chance of going into complete remission.

This does not mean your Rheumatoid Arthritis is cured, as it is a chronic disease for which no cure exists today, but it means that your symptoms could go away completely as long as your medication is working for you. These treatments have also been shown to reduce or even avoid long-term joint destruction and lower the risk of disability.

I am Doctor Sugar - - If you have rheumatoid arthritis, it is important to work with your health care team to make a plan that works for your lifestyle. Thanks for checking in and if you haven’t already done so be sure to read all of the medical inspiration blogs on rheumatoid arthritis. Thank you for your interest in Total Wellness. Simply click on my picture and go to my profile to see the latest medical blogs on a wide variety of topics. I’ll see you there.

Giving You Your Dose of MEDICAL INSPIRATION,
Dr. Sugar
TO YOUR TOTAL WELLNESS!!

References:
1.http://www.niams.nih.gov/Health_Info/Rheumatic_Disease/default.asp
2.http://www.hopkins-arthritis.org/arthritis-info/rheumatoid-arthritis/index.html
3.The John Hopkins Arthritis Center
4.National Institutes of Health

The information contained in this blog is not medical advice.
Please consult your medical doctor before making any decisions
or taking any actions on your health or the health of your family.

Osteoarthritis part 4
HELLO I AM DR. SUGAR, YOUR INTERNET DOCTOR, HERE TO continue our discussion on Osteoarthritis. I will go into a lot more detail on other treatments for osteoarthritis. - - so if you are ready, let’s get started with a dose of MEDICAL INSPIRATION.

Transcutaneous electrical nerve stimulation which is referred to as a TENS unit is another technique used to relieve pain. It uses a small electronic device to direct mild electric pulses to nerve endings that lie beneath the skin in the painful area. It seems to work by blocking pain messages to the brain and by modifying pain perception.

Massaging is also helpful in relieving pain. In this approach to pain relief, a massage therapist will lightly stroke or knead the painful muscles. This may increase blood flow and bring warmth to a stressed area. However, arthritis-stressed joints are sensitive, so the therapist must be familiar with the problems of the disease.

Medications like acetaminophen, NSAIDs (like ibuprophen, motrin, or aspirin) and Tramadol may help to relieve pain. These are available as oral medications. Some of these are also available as injections and topical agents, which can be applied directly over the affected joints. In severe cases, you doctor may inject steroids in to the affected joint, which may provide short term but significant relief from symptoms.

Hyaluronic acid substitutes (visco-supplements) are sometimes used by your doctor to treat osteoarthritis involving the knee joints. These products are designed to replace a normal component of the joint involved in joint lubrication and nutrition. These are injected right into the joint space.

For many people, surgery helps relieve the pain and disability of osteoarthritis. Surgery may be performed to remove loose pieces of bone and cartilage from the joint if the joint is buckling or locking, for repositioning of bones and to resurface or smooth out bones. Surgeons may also replace affected joints with artificial joints called prostheses. Artificial joints can last 10 to 15 years or longer.
Osteoarthritis may be considered a life long disease, but many options are available for safe and effective treatment.

I am Doctor Sugar - - If you have osteoarthritis, it is important to work with your health care team to make a plan that works for your lifestyle. Thanks for checking in and If you haven’t already done so be sure to read all of the medical inspiration blogs on osteoarthritis. Thank you for your interest in Total Wellness. Simply click on my picture and go to my profile to see the latest medical blogs on a wide variety of topics. I’ll see you there.

Giving You Your Dose of MEDICAL INSPIRATION,
Dr. Sugar
TO YOUR TOTAL WELLNESS!!

Reference
1.http://www.niams.nih.gov/Health_Info/Osteoarthritis/default.asp
2.http://www.cdc.gov/arthritis/arthritis/osteoarthritis.htm
3.National Institute of Arthritis and Musculoskeletal and Skin Diseases

The information contained in this blog is not medical advice.
Please consult your medical doctor before making any decisions
or taking any actions on your health or the health of your family.