When Care Goes Virtual: The Surprising Benefits of Video Visits

One thing Jillian Worth, MD, ABFP, can count on with teenage patients is their hesitancy to talk about serious subjects in the exam room. For teens coping with mood disorders, typical in-person appointments can feel artificial and discourage conversation. When the COVID-19 pandemic suddenly replaced office visits with video sessions, Dr. Worth noticed something remarkable: her young patients were opening up like never before.  

“What I’ve seen is kids on virtual visit in their bedrooms are more likely to talk about what they’re feeling, in the space where they have those feelings,” says Dr. Worth. “They’re willing to jump right into what they’re struggling with, instead of needing lots of warm-up.”

Another big benefit of video for young patients is flexible scheduling. Arranging an in-person appointment can delay care, when a quick video check-in has the power to turn things around for a teen. Adding a 15-minute virtual visit to the end of her day, says Dr. Worth, is much more doable than a regular visit, and takes care of the patient’s problem when it’s happening.

As a family medicine physician, Dr. Worth sees patients of all ages and backgrounds and surprisingly, video visits have proven beneficial across her diverse practice. Instead of having a patient seated in an exam room, video can offer a little window into their world, revealing the important objects, pictures and even people in their lives.    

“With longtime patients, at some point you stop asking social history questions, like who they live with,” says Dr. Worth. “But maybe you’ll see a grandkid running through the room on video and ask about them, and find out that family has moved in.”

Dr. Worth has discovered that asking her patients new questions that come up through video can lead to better patient care. Patients light up, she says, because they want to tell you more about who they are. They can also feel comfortable enough in their homes to admit problems they’ve never considered discussing in the office. If a patient reveals they feel unsafe in their relationship, for example, the care plan can include steps to address the situation.  

For elderly patients, occasional home visits can be a necessity, but before the pandemic they were usually limited to severely ill and homebound patients. Now that Dr. Worth sees most of her older patients on video, she looks out for them in new ways, such as noticing something in their environment that needs attention.

“I can have them pan around the room and see they have a loose area rug, or a dangerous step going down to their living room,” Dr. Worth says. “Maybe they use a walker and there’s a little dog running underfoot. Things I would never have known from an office visit.”

Then there are the patients who struggle more than others to even get to a provider’s office. Chronic conditions that involve regular appointments for care or medication management can be a challenge for those with debilitating illness, or for those who can’t get time off work. Visits using a patient’s smart phone can happen on a work break. People dealing with chronic pain can avoid a car trip and navigating a medical office building.

Another way virtual care boosts more equal access is the prevalence of smart phones across a diverse patient demographic. “It’s difficult for many working families to get themselves or their kids in for care, but most people have some version of a smart phone,” says Dr. Worth. “The flexibility and the capability of video on their device means they can hop on for a visit wherever they are.”

What’s clear is being able to see a patient when a visit might otherwise not have happened can change the course of illness and recovery. One elderly patient became bedridden and was considering hospice care. A family member held up her phone for a virtual visit with Dr. Worth from the patient’s bed.

“To see her in the office would have been impossible, but I was able to observe how it felt for her when she tried to move around,” says Dr. Worth. “I could see her pain and talk with her. Now we’ve got her in physical therapy at home and I see her sitting up in the living room.”  


Jillian Worth, MD, ABFP, is board-certified in Family Practice and currently practices at the Virginia Mason Bainbridge Island Medical Center. Dr. Worth specializes in family medicine, primary care, pediatrics, preventive medicine and transgender health.

Hit Me With Your Best Shot: 4 Reasons to Consider Getting Your Flu Shot This Year

**By Christopher Baliga, MD**

The flu is a contagious disease caused by influenza viruses that infect the nose, throat and lungs, causing mild to severe illness and, in extreme cases, can lead to death. Fortunately, there is a way to mitigate both your own risk from the flu and the risk of those around you, too – enter the annual flu shot. These influenza viruses tend to mutate year-after-year, meaning that every flu season is different and warrants a new vaccine each year.

The CDC estimates that in the U.S., flu season can begin as early as October and as late as May, and is most rampant between December and February. The ideal time to get your flu shot is in the weeks leading up to the start of flu season but can still be effective if received later than this.

Whether we like it or not, flu season is right around the corner. Read on for four reasons why you should consider getting your flu shot this year.

It can lower your risk of contracting the flu

I’ll start with the obvious – getting your annual flu shot is your best defense against catching the dreaded flu as it allows your body to harbor and build up the necessary antibodies to protect against each new strain. According to the CDC, when the vaccine viruses are similar to the viruses going around, flu shots have proven to reduce the risk of flu-related doctor visits by 40-60%.

 It’s important to note that while the flu shot doesn’t guarantee full protection, it’s still worth getting.

It reduces the severity of flu-related illness

How your body responds to each flu shot varies from person to person. For example, it tends to be more effective for people under the age of 65, as older folks may develop less immunity after receiving it than their younger counterparts.

But, even if the shot doesn’t completely prevent the flu, it can still weaken the severity of illness if you do end up catching it. It can also lower your risk of developing serious complications that could eventually lead to hospitalization. And naturally, reducing the severity of flu-related illness can also lead to fewer hospitalizations on a macro level.

Getting vaccinated helps protect those around you, too

Receiving a flu shot allows you to play a role in protecting those around you who may be more vulnerable to serious flu-related illness, such as young children, older people and those with chronic medical conditions. It helps train your immune system to fight these nasty germs, which in turn diminishes your risk of transmitting them to those around you.

The flu is expected to have a nasty return post-COVID

Thanks to masks, social distancing and heightened hand hygiene across the U.S. amid COVID-19, other germs were kept at bay – including the flu. But, as these preventive measures begin to ease up, cold and flu viruses are expected to make a nasty return, making this year’s vaccine more important than ever before. Getting your flu vaccine at the same time as your COVID-19 vaccine? No problem – it is safe to get both.

Now that summer has come and gone, it’s time to shift attention to protecting ourselves, and those around us, from the flu’s return by receiving a flu shot. If you’re unsure of where to go for this, check out the HealthMap Vaccine Finder or talk to your doctor.


Christopher Baliga, MD is board-certified in Internal Medicine, with a subspecialty in infectious diseases, and currently practices at Virginia Mason Medical Center. He also specializes in travel health and HIV/AIDS care.

Boost Self-Care by Knowing Your Numbers

**By Teera Crawford, MD**

When you think about self-care, you might think of yoga, meditation and journaling – not measuring your blood pressure.

However, tracking your critical health numbers – blood pressure, cholesterol, hemoglobin A1C and waist circumference – goes a long way in ensuring both a healthy body and healthy life. Staying on top of these will help you take charge of your health, especially as we continue to navigate the pandemic.

Of course, this is easier said than done, and learning how to identify and keep your numbers in check requires a bit of work up front. However, it is advantageous to keep up to date with this practice in the long run. Read on to understand what these numbers mean, why they’re important and how to incorporate monitoring them into your self-care routine.

Blood PressureBlood pressure

Measuring your blood pressure consists of familiarizing yourself with two numbers: systolic and diastolic. Systolic tells you how much pressure your blood is exerting on the blood vessels with each heartbeat, and diastolic tells you how much pressure your blood is exerting when your heart is relaxing. For reference, an elevated blood pressure is one that is greater than 120/80. Measuring blood pressure can be done from the comfort of your home and is as easy as purchasing and using a quality blood pressure cuff. Pro tip: when you buy a new blood pressure cuff, it’s a good idea to have it checked against the blood pressure cuff used at your doctor’s office to ensure its accuracy.

Total cholesterol

Cholesterol is a fat-like substance that your liver makes and is found throughout all of the cells in your body. Maintaining a certain level of cholesterol is important to keep your body functioning, but an elevated total cholesterol (a measure of the total amount of cholesterol in your blood) is more harmful than helpful. For reference, an elevated total cholesterol is one that clocks in at greater than 200. Obtaining this number requires blood tests done in a laboratory and should be checked at your doctor’s office every five years or so.

If your cholesterol errs on the higher side, or you have a family history of high cholesterol, you’ll want to get this checked a bit more frequently. Work with your doctor to set up the appropriate plan for you to keep this in check.

 Hemoglobin A1C

The hemoglobin A1C test measures the amount of blood sugar (glucose) attached to hemoglobin, or protein in your red blood cells. Hemoglobin A1C is a type of blood test typically used to screen for diabetes and can tell you your average blood sugar level over the three months prior. For reference, a measurement greater than 5.7% indicates a prediabetic range and means you’re at a higher risk for developing diabetes, while a measurement greater than 6.5% means you have diabetes. Check in with your doctor to help develop the right plan for you to stay on top of your hemoglobin A1C.

Waist circumference

Waist circumference is exactly what it sounds like – the measurement of your waist, which can fortunately be conducted at home with a flexible tape measure. Starting at the top of your hip bone, wrap the tape measurer around your body until it reaches the starting point. For reference, your waist circumference should typically be less than 40 inches for men and less than 35 inches for women. Pro tip: try to relax your body when measuring your waist to produce the most accurate reading.

Elevations in any of these numbers can lead to cardiac, vascular and other organ abnormalities over time, and Overweight Woman Measuring Waist in Gymmonitoring and staying on top of them is vital to healthy living. According to the CDC, heart disease is the leading cause of death in the U.S. and elevated numbers increase your risk of developing heart disease.

Frequent exercise is a surefire way to keep everything under control but unfortunately during the pandemic, going to the gym is not an option for all. Alternatives to the gym include online exercise videos that can be done at home or getting outside for a walk or run around your neighborhood.

In addition to exercise, it’s important to communicate about these measures openly, honestly and frequently with your doctor to set yourself up on the right path to healthier living. Pairing these efforts with your other self-care methods of choice will keep you living your best life.


Teera.CrawfordTeera Crawford, MD, is board-certified by the American Board of Internal Medicine and specializes in women’s health, preventive care, diabetes and weight management. Dr. Crawford practices at Virginia Mason Lynnwood Medical Center

 

Prioritizing Your Health During COVID-19

**By Donna L. Smith, MD**

Reports indicate nearly one-third of U.S. adults have avoided seeking medical care because they are worried about contracting COVID-19, and experts are concerned about deaths from non-COVID-19 illnesses that could be due to people not seeking treatment. This trend is alarming.

As a physician, I will always encourage people to be active participants in caring for their health. While staying healthy is understandably a top priority for all of us right now, it is also a time when many people might be tempted to minimize and deprioritize symptoms of serious illness. Although hand hygiene, social distancing and masking are key actions to avoid infectious diseases such as COVID-19, it is also important to seek prompt evaluation and treatment for any other health concerns. This includes care for yourself and for those you love.

Don’t ignore symptoms

A single symptom could be just that, or it could be an indication of a more systemic health condition. Though not always the case for every concern, it is often better to identify the cause of symptoms sooner rather than wait until they progress.Staying current with your health care is important, even during a pandemic.

Pay attention to changes in your body; you know your body best. An acute increase in symptoms, a new symptom that persists, or something that persists and then increases could all be causes for concern. Don’t hesitate to reach out to your health care provider when concerns arise.

Get it checked out now, for better future outcomes

Delayed care can result in a need for more involved treatment later. Diseases such as cancer are a prime example of this.  It is important to have routine, recommended screenings for diseases such as cancer, especially if you are at increased risk.  With regular screenings, diseases can be detected earlier and result in better health outcomes.

If you have chronic disease, regular check-ins are essential

For those living with and managing chronic disease, a change in daily life patterns, including eating habits, exercise routines and social activities, can leave you stressed and vulnerable to developing new or increased symptoms. Make sure to keep up your regular check-ins with your health care team to ensure you are taking the best actions to optimize your health.

Health care facilities have COVID-19 prevention top of mind. Here at Virginia Mason, we rigorously screen patients for symptoms, and have a separate entrance for those with respiratory illness. We provide masks to all patients and visitors upon arrival. We’ve arranged our waiting areas to provide at least six feet of distance between patients. And of course, we always have intensive cleaning processes in place including disinfecting all surfaces and handles in exam rooms after each patient visit.

There are virtual options for care available as well. Call or send portal messages to talk with care team members and determine if virtual care or in-person is optimal for you. And, if you prefer in-person visits, be certain to tell the team member of this preference, and they will advise accordingly.

We encourage you to continue seeking medical care even in the time of COVID-19 to protect your health and the health of your family, whether it’s virtually or in-person. When you do seek care, Virginia Mason providers are ready and able to help.


Dr. SmithDonna Smith, M.D., MBA, is Executive Medical Director and Associate Chief Medical Officer of Virginia Mason Medical Center. Previously serving in multiple medical leadership roles at Virginia Mason, she is responsible for oversight of the health care system’s hospital and clinics. Dr. Smith is board-certified by the American Board of Pediatrics and also specializes in primary care. She practices at Virginia Mason University Village.

When COVID-19 Comes Home: How to Protect Healthy Family Members

**By Gabrielle Worzella, DO**

Let’s say someone in your household shows symptoms of COVID-19 or tests positive for the virus. It’s a reality that many of us have now experienced personally or know of a family who has.

If your loved one is confirmed positive with COVID-19, what you can do to ensure the virus doesn’t spread to other family members may follow what you do when someone in your household has the flu. It may even seem like common sense. However, because this virus is so contagious, it’s important to take extra precautions to give your family the best chance of avoiding other members getting sick, while supporting the recovery of those infected.

Here are some steps you can take to minimize the spread of COVID-19 in your home:

Maintain separation from the infected family member entirely, or as much as possible.
This can be hard as the infected family member will likely need help from family to monitor their temperature, help with meals and other needs. However, it is best to at least confine the ill individual to one room in the house while they recover. If possible, this should include access to their own bathroom as well. Since that’s not always feasible, all high-touch bathroom surfaces like the toilet, doorknob, light switch and sink should be disinfected after every use.

Designate one caregiver.
Preferably only one person should have direct contact with the infected family member. Discuss this as a family and determine who will be best suited to meet these demands. When caring for the individual, the designated caregiver should protect themselves by following recommended guidelines by the CDC like wearing gloves and a mask. Wearing gloves is also recommended when washing the ill individual’s dishes or handling anything they have touched.

Virus concept. Protection and isolationWash your hands!
Sound familiar? Everyone in the household should be washing their hands frequently to avoid the spread of disease, especially after going to the bathroom, handling commonly used objects like the television remote and after sneezing or coughing.

Maintain cleanliness of the household.
Members of the household should disinfect and clean high-touch surfaces such as kitchen counters, doorknobs and light switches frequently to avoid the spread of the virus, which experts have said could live on hard surfaces for hours, even days depending the type of surface material.

Take extra precautions for immune-compromised individuals.
If there is an immune-compromised person living in the home, consider isolating that individual as much as possible from all common areas in the home and from the infected family member at all times. If both family members are sharing the same space, both should wear masks.

Be there for your ill family member, safely.
It can be difficult mentally and emotionally for your family member to be in isolation, while they’re feeling sick and may be frightened by their diagnosis. It’s important to check in on them regularly and using virtual means is a great way to do that safely. You can use video chat to communicate when in separate rooms; send encouraging text messages; and ask friends and family members to reach out.

If you have new symptoms that sound like they might be COVID-19, such as fever, body aches, cough, loss of taste and smell, consult your health care provider as soon as possible. He or she may recommend a virtual visit or in-person evaluation, depending on your symptoms. Your provider can also give you additional advice on caring for yourself while at home to reduce potential spread of the virus.


Dr. WorzellaGabrielle Worzella, DO specializes in women’s health, preventive medicine, osteopathic manipulative treatment and integrative medicine. She is board-certified by the American Board of Family Medicine. She practices at Virginia Mason’s Edmonds Family Medicine clinic.

 

 

 

 

 

Tips to Keep Your Immune System Healthy During COVID-19

**Medically Reviewed by Amy Portacci, DO**

Keeping your immune system healthy is important anytime, but even more so during the current COVID-19 pandemic. That’s because our bodies have never met this year’s coronavirus, which means we have no idea how to fight it off. Some of us are being hit harder than others with the infection, undermining our sense of control.

While we can’t simply eat “this food” or take “that vitamin” to ensure a healthy immune system, we can take simple steps to optimize its functionality and give our body its best fighting chance at a healthy defense.

Practice good hygieneWashing hands helps prevent the spread of viruses like COVID-19.

In general, washing your hands helps reduce viruses and bacteria transferring to surfaces, yourself and others. Thoroughly washing your hands for at least 20 seconds with warm water breaks up the fatty, outside layer of viruses and bacteria, including COVID-19, which effectively kills all or most of the contagion.

During this pandemic, the Centers for Disease Control and Prevention advises that we should be extra careful about handwashing after being in a public place.

By upholding good hygiene, we significantly reduce our chances of coming in contact with germs, keeping our immune systems healthy.

Get sleep

We need good sleep to keep our immune systems at peak performance. Studies show that chronic sleep deprivation suppresses the immune system and reduces the release of infection-fighting antibodies into the body.

If you’re finding yourself out of your normal routine due to changes in work or school schedules, kids or other responsibilities, do your best to still prioritize your nighttime routine. Keeping this regular helps keep your circadian rhythm, or internal clock, on track, resulting in balanced sleep and energy levels throughout the day.

Quit smoking

The World Health Organization advises that smokers could be more vulnerable to COVID-19 because the actual act of smoking increases the possibility of transmission from hand to mouth.

Research also shows that the risk of flu, another respiratory virus, among smokers is several times higher, and is much more severe than in nonsmokers. Although the exact mechanism of how smoking affects the risk of infection isn’t fully understood, there is a clear connection between inhaling smoke into the lungs and a lowered immune response.

Find ways to de-stress

Stress is known to lower the immune system’s response, making us more prone to infection. While stress might feel inevitable right now, proactively exercise ways to Pets can help people de-stress, which may beneift the immune system. reduce it through new habits like meditation, mindfulness, journaling, exercising or even getting a pet. Find connection with others, even virtually, through video calls and chat.

If you are immunocompromised, the same advice applies – however, it is even more important to take precautions including practicing physical distance and limiting visits to public places. Always seek the guidance of your physician to ensure you are doing everything you can to protect yourself and optimize your health.


Amy Z. Portacci, DO, is a Family Medicine doctor who practices at Virginia Mason Edmonds Family Medicine. She specializes in women’s health, pediatrics, osteopathic manipulation and sports medicine. She is board certified by the American Board of Family Medicine and the American Board of Osteopathic Family Physicians.

Make Stretching Your Fitness Strategy: Tips from Tyler Lockett and David Belfie, MD

When is the best time to stretch, before or after exercise? What types of stretches have the most benefit? Why does stretching become more important as we age? These are just a few of the questions Tyler Lockett of the Seattle Seahawks and orthopedic surgeon David Belfie, MD, answered for viewers of King 5’s Take 5 show last week. Watch the video, then discover your own favorite stretch.

Diabetes Registry Enables Safer, More Thorough Care for Patients

**By Nicholas Moy, MD**

MD PatientAccording to a landmark study published in 2016 in The Lancet, 422 million adults worldwide have diabetes. In the United States alone, diabetes statistics are staggering. According to the Centers for Disease Control and Prevention, in 2015:

  • More than 100 million Americans have diabetes or prediabetes, which if not treated can lead to type 2 diabetes within five years.
  • The percentage of adults with diabetes increased with age, reaching a high of 25.2 percent among those aged 65 years or older.
  • An estimated 1.5 million new cases of diabetes were diagnosed among U.S. adults, with more than half between the ages of 45 and 64.
Understanding diabetes by type

In type 1 diabetes, the body does not produce insulin. Insulin is a hormone the body needs to get glucose (sugar) from the bloodstream into cells. Type 1 is usually diagnosed in children and younger people. However, it can develop at any age. Only about 5 percent of people with diabetes have type 1. Currently, there is no known way to prevent type 1. People with it must inject or pump insulin to survive.

In type 2 diabetes, sometimes called “adult onset,” the body does not use insulin properly, which is called insulin resistance. At first, the pancreas makes extra insulin to make up for it. But, over time, it isn’t able to keep up and can’t make enough insulin to keep blood glucose at normal levels. People with type 2 can manage the disease with diet, exercise and medications. In some cases, insulin is needed for management.

Preventing type 2 diabetes

Before people develop type 2 diabetes, they almost always have prediabetes – blood glucose levels that are higher than normal, but not yet high enough to be diagnosed as diabetes. This condition puts you at a higher risk for developing type 2 diabetes and cardiovascular disease.

While there is still no cure for diabetes, there is good news: The progression from prediabetes to type 2 diabetes is not inevitable. The National Institutes of Health clinical trial, the Diabetes Prevention Program, found that for people with prediabetes, modest lifestyle changes led to weight loss of 5 to 7 percent in participants and reduced the risk of type 2 diabetes by 58 percent in individuals at high risk.

Diabetes Registry

This is why primary care physicians with Virginia Mason, including myself, developed a Diabetes Registry, which does three important things to help ensure the right care is delivered to the right patients at the right time. First, it identifies patients with diabetes. Second, it identifies how well they are doing. And third, it pulls them back into care when needed.

Although the American Diabetes Association recommends that people with diabetes see a primary care or endocrinology provider every three to six months, life doesn’t always allow that to happen. This is why Virginia Mason’s  Diabetes Registry software is so helpful. It uses algorithms to regularly analyze electronic medical records and alert care teams about who may need follow-up, whether through an appointment or a report to their care team on recent changes, such as with blood pressure, weight loss, etc.

Virginia Mason team members, including medical assistants and nurses, then know to check in with these patients to make sure they are on track. This ensures the care they receive is aligned with their current needs.

“Recently, I was able to get several out-of-care patients in for an appointment and labs with one of our providers,” said Certified Medical Assistant Courtney Yates. “Patients are responding well to the simple reminders we’re sending them, whether they are messages though the patient portal, calls, or mailed letters. Our goal is to get 100 percent of our out-of-care patients back in care.”


Dr Nicholas MoyNicholas Moy, MD, is board certified in Internal Medicine and practices Primary Care at Virginia Mason Hospital and Seattle Medical Center. His special interests include quality improvement and geriatrics.

 

Medical Referral to Community Program Can Fight Obesity, Prevent Disease

**By Brandon Auerbach, MD, MPH**

Plus Size Woman Meeting With Doctor In SurgeryAccording to the Centers for Disease Control and Prevention, more than one third of American adults are obese. Among American teenagers, 21 percent are obese, which is up from only 5 percent in 1980.

Obesity directly contributes to the development of more than 25 chronic diseases, such as high blood pressure, diabetes, high cholesterol and heart disease. Obesity also increases the risk of many cancers (e.g., colon, breast, pancreatic, thyroid, esophageal, kidney and gallbladder). This year, the direct medical cost of obesity in the U.S. is estimated to exceed $150 billion.

What is obesity?

Simply put, obesity means having too much body fat. It is different from being overweight, which means weighing too much. The weight may come from muscle, bone, fat or water. Both terms mean that a person’s extra body weight is greater than what is considered healthy for his or her height.

Obesity happens over time when you eat more calories than you burn. The balance between calories-in and calories-out differs for everyone, influenced by diet, level of physical activity and genetics.

Thankfully, if you are obese, losing 5 to 10 percent of your weight can prevent the development of chronic diseases like diabetes, or substantially improve existing disease.

Calculating whether you are overweight or obese

Body Mass Index (BMI) is used as a screening tool for determining whether someone is overweight or obese. Click here to access an adult BMI calculator. A high BMI can be an indicator of high body fat.

  • If your BMI is less than 18.5, it falls within the underweight range
  • If your BMI is 18.5 to <25, it falls within the normal
  • If your BMI is 25 to <30, it falls within the overweight range
  • And if your BMI is 30 or higher, it falls within the obese range

At Virginia Mason Primary Care practices, team members weigh and electronically track all patients’ weight so that customized care plans, supported by automated follow-up tools, can be made during primary care visits.

Weight management care plans are different for every person. Virginia Mason has partnered with the YMCA to refer patients with obesity or chronic conditions – like  diabetes or prediabetes – to lifestyle change programs shown in randomized, controlled trials to help patients lose weight, maintain weight loss, and prevent or reverse diabetes and prediabetes.

The YMCA Diabetes Prevention Program

The YMCA’s evidence-based Diabetes Prevention Program helps people at high risk of developing type 2 diabetes adopt and maintain healthy lifestyles by eating healthier, increasing physical activity and losing a modest amount of weight to reduce their risk of developing this disease.

In a classroom setting, a trained lifestyle coach helps small groups learn about healthier eating, physical activity and other behavior changes over 25 sessions. The year-long program consists of 16 weekly sessions and two sessions every other week during the first five months, followed by seven monthly sessions. It also includes a three-month membership to the YMCA.

A perspective on the Diabetes Prevention Program

For one Virginia Mason patient, participating in the YMCA Diabetes Prevention Program has been key to his weight loss and better overall health.

“In the past few years my weight crept up to the 230-pound range, my cholesterol kept going up and my physician told me I was prediabetic,” remembers Ray. “At my annual physical last year, I said I was planning to join the YMCA because exercise was something that had been missing in my life over the last few years. My physician told me about the YMCA’s Diabetes Prevention Program and asked if I would be interested. I said yes.”

After going to the first meeting in February 2017, Ray, who is 59 years old, decided this was something he needed to do for himself to get healthier. Since then, he has lost 15 pounds. According to Ray, other benefits of the program include the support from his lifestyle coach, consistent meetings throughout the year and the camaraderie among participants.

“Steps like keeping a daily journal, tracking my weight, trying to keep certain foods at bay and listening to other people’s stories were all very helpful and motivating,” says Ray.


Dr Brandon AuerbachBrandon Auerbach, MD, MPH, practices at Virginia Mason Hospital and Seattle Medical Center. He is board certified in internal medicine and specializes in primary care.
To learn more about the YMCA program and find a location near you, pleas visit: SeattleYMCA.org/DiabetesPreventionProgram 

 

 

 

Actinic Keratosis: Get the Facts About this Common Pre-Cancer

**By Eric Brumwell, MD**

The name may be unfamiliar, but the appearance is common.

apply-sunscreenAlthough you may not have heard of actinic keratosis, if you’re someone who spends time in the sun, you run a high risk of developing one or more in your lifetime. In fact, since people often have more than one, it is common for dermatologists to refer to them in the plural, “keratoses.”

According to the Society for Investigative Dermatology and The American Academy of Dermatology, actinic keratosis is the most common pre-cancer in the United States. It affects more than 58 million Americans.

What are they? And what do they look like?

Actinic keratosis, also known as a solar keratosis, is a scaly or crusty bump that forms on the skin surface and may look like warts. Interestingly, it tends to lie flat against skin on the head and neck and be elevated on arms and hands.

As with other skin conditions, there are some tell-tale signs of actinic keratosis, including:

  • The base may be the same color as your skin. It might also be light, dark, tan, brown, pink, red or a combination
  • The crust is dry and rough or scaly
  • It can be tender, itch or cause a pricking sensation
  • They can also become inflamed and surrounded by redness
  • In rare cases, they can even bleed

Causes

An actinic keratosis is most likely to appear on parts of the body that have received more exposure to real or artificial sunlight – mainly through the use of tanning beds – and through the damaging effects of ultraviolet (UV) radiation. In rare cases, extensive exposure to X-rays can also cause them.

Where do they form?

The most common locations on the body where keratoses form include:

  • Face
  • Lips
  • Ears
  • Scalp
  • Neck
  • Backs of hands and forearms

They can also appear on shins and other parts of the legs.

Risk factors

Anyone can develop actinic keratosis, but you may be more likely to develop the condition if you:

  • Are 40 or older
  • Live in a sunny location
  • Have a history of frequent or intense sun exposure or sunburn
  • Have red or blond hair, and blue or light-colored eyes
  • Tend to freckle or burn when exposed to sunlight
  • Have a personal history of actinic keratosis or skin cancer
  • Have a weak immune system from chemotherapy, leukemia, AIDS or organ transplant medications

Development and diagnosis

Actinic keratoses take years to develop. These skin lesions develop slowly and usually range from an eighth to a quarter of an inch in size.

In the beginning, an actinic keratosis is often so small that it is recognized by touch rather than sight. It feels like you are running a finger over sandpaper. Many times, patients may have more invisible – or “subclinical” – lesions than those that are visible on the surface of the skin.

A dermatologist will likely be able to determine whether you have an actinic keratosis simply by examining your skin. If there is any doubt, he or she may do other tests, such as a skin biopsy.

Treatments

An actinic keratosis sometimes disappears on its own, but it typically returns after more sun exposure. Because it’s impossible to tell which lesions will become skin cancer, actinic keratoses are usually removed as a precaution.

If you have several actinic keratoses, dermatologists often recommend treating the entire affected area.

Treatment options include:

  • Various prescription creams
  • Photodynamic therapy – chemical solution is applied to a keratosis to make it sensitive to light. The affected area is then exposed to artificial light to destroy the damaged skin cells
  • If you have only a few actinic keratoses, your doctor may recommend removing them by freezing (cryotherapy) or scraping (curettage)

The good news

If treated early, almost all actinic keratoses can be cleared up or removed before they develop into skin cancer.

Even after treatment for actinic keratosis, your doctor will likely suggest that you have your skin checked at least once a year for signs of skin cancer.

If not treated

Actinic keratosis is considered a pre-cancer because, if left alone, it could develop into a skin cancer – most often the second most common form of the disease, squamous cell carcinoma. According to the American Cancer Society, more than 1 million cases of squamous cell carcinoma are diagnosed in the United States each year.

Prevention

People can reduce their risk of actinic keratoses by simply minimizing exposure to sunlight and protecting skin from UV rays. The best approach to do that is to cover your body when in the sun. Clothes with built-in UV protection are helpful, but so is covering exposed skin with sunscreen containing a higher Sun Protection Factor (SPF) rating.

Dermatologists recommend using a sunscreen with an SPF of at least 30, which blocks 97 percent of the sun’s harmful UV rays. Higher-number SPFs block a bit more, but no sunscreen can block 100 percent of the sun’s rays.

I will leave you with a quote from a fellow physician, Howard Murad, MD. Its beauty is in its simplicity: “Healthy skin is a reflection of overall wellness.”


Eric Brumwell, MD, is a board certified dermatologist with special interests in skin cancer prevention and treatment. He practices at Virginia Mason Bainbridge Island Medical Center.