More than 26 million Americans are living with asthma, including 6.2 million children. While there is no cure, asthma can be managed and treated so that those with the condition can live normal, healthy lives -- indoors as well as outdoors.
 It is important to learn more about common triggers -- which include respiratory infections, allergens, irritants, exercise and emotions -- as well as better understand what causes your symptoms. To get started, the American Lung Association is offering the following tips.

1.. combat indoor allergens.
Animal dander, dust mites and mold are common allergens found in-doors that can cause asthma symptoms. Keeping a clean home can help keep the presence of such allergens in check. For allergen-specific cleaning tips, as well as strategies for reducing the growth of mold and dust mites in your home, visit Lung.org/asthma-triggers. Be forewarned, cleaning supplies that have odors and fragrances can cause asthma symptoms to flare. Check the label and stick to safe, asthma-friendly products.

2.. void smoke and tobacco
Any kind of smoke, including to-bacco smoke as well as smoke from e-cigarettes or “vaping,” are known to irritate the airways of the lung. If you have asthma, don’t smoke and avoid being around people who do. If you need help quitting, visit Lung.org/ffs or call 1-800-LUNGUSA.

3.. stay weather-aware.
Climate change increases the risk that air pollution will worsen. Be aware that extreme weather events, such as drought, floods, wildfires and tornados, can create airborne irritants and allergens for individuals with asthma. Use the Air Quality Index found on the American Lung Association site to stay aware of current conditions and help protect yourself from outdoor air pol-lution. People with asthma will want to avoid being outside on days when the air quality index value is above 100, or in the orange, red, purple or maroon categories.

4.. Know your own triggers.
Avoiding and controlling your asthma triggers all begins with identifying them. Work with your doctor to find out what allergens or irritants may be causing your asthma symptoms; an allergy test can help. Together you and your doctor can create an Asthma Action Plan that includes finding simple solutions to reduce your exposure to your asthma triggers and make breathing easier. You can learn more about your asthma and how to manage triggers at Lung.org/asthma, and through a free one-hour, interactive online course at Lung.org/asthma-basics.
 If you suffer from asthma or love someone who does, take steps to better understand the condition and reduce the presence of common triggers in your everyday life.

 By Mary Gynn, RN, BSN, MSN/MS, MPH, Diabetes Educator  

The obvious secret to diabetes success is consistent blood sugar control. No ups and downs of blood sugar levels. Otherwise, the result, over time, is the inflammation that sugar, circulating in the blood, causes to all cells. This up and down blood sugar fluctuation causes irritation to all cells as sugar cir-culates in the blood. The goal for blood sugar is to control it over the years.  Otherwise, gradually, complications begin and the resistance of the cells to treatment persists.
 The answer is repeated, over and over, that lifestyle modification and changes must be the cornerstone of any management plan for patients with type 2 diabetes mellitus. The diabetic must attend to basic problems of obesity/overweight, nutrition, and exercise. These changes will dramatically increase the success of any long-term treatment plan and help to prevent or delay disease development for those with prediabetes. Otherwise, medications become less effective, and com-plications of hypertension, obesity, and high cholesterol levels increase, causing a stress reaction in the cells of the body. The health problems continue to worsen and the cost increases.
popular and available from stores and markets. You may have to pay slightly more, but the foods are usually fresher, more nutritious and less damaging to the environment than foods flown from thousands of miles away and kept in cold storage for months.
The answer to the above is a life-style change by the diabetic. Stopping smoking, getting adequate rest, and doing physical activity, whether sit-ting, standing, walking or running, are key. The biggest change is nutritional meal-planning education and portion control. The diabetic must learn about carbohydrate, protein, fat, and sugar intake and discuss with knowledgeable health professionals who have the time and expertise to discuss the foods that damage cell health. The responsibility remains with the diabetic.
Phytochemicals:
 Recent research has identified several natural plant compounds that could play a crucial role in preventing heart disease, arthritis, diabetes, and cancer. These compounds are known as phytochemicals and may, in the future, be classified as essential nutrients. Fruits, vegetables, whole grains, nuts, seeds, dried beans, and lentils contain a range of phytochemicals. These foods have a high number of vitamins and minerals in comparison to the calories they contain.  They are generally low in fat, rich in antioxidants, known to protect us from the most prevalent diseases, and a good source of fiber. Organic produce, which is grown with-out the use of chemical fertilizers and pesticides, is becoming increasingly 
Buying Tips:
1) Buy fresh foods from stores with a high turnover of goods. Avoid foods and vegetables that are displayed in the open air or in a hot, light window, since nutrients will be diminished.  Fluorescent lighting also depletes nutrients.
2) Remove fresh produce from plastic bags when storing. Loose fresh pro-duce is also much easier to check for quality.
3) Wild or organic salmon and trout
are preferable to farmed fish. Undyed smoked haddock and cod is better than the highly colored, bright-yellow alter-natives.
4) Check labels when buying pack-aged foods. Avoid those with high amounts of sugar, saturated and hydrogenated (trans) fat, colors, additives, flavoring, preservatives, and artificial sweeteners.
5) When buying eggs, look for organic, high-quality ones. Farm-fresh or boxes depicting attractive countryside scenes mean nothing: The eggs are usually from battery farms. Organic eggs
come from hens that have been better looked after and are not routinely fed antibiotics and yolk-enhancing dyes.
6) Refined sugars and those found in processed foods, including cookies, candy and cakes, have little or no nutritional value. Eating a sugary food gives a temporary surge in energy (and blood sugar elevation) that is promptly followed by a slump, but the blood sugar elevation remains.
7) Look out for sucrose, fructose, glucose, maltose, corn syrup, invert sugar, and dextrose on food labels, which are basically sugar by another name. Honey and maple syrup are marginally better, as they contain a few minerals, but they have the same effect on blood sugar levels.
More information will follow in my future articles about the need for diabetics to have ongoing food education. That education for the diabetic is No. 1 in the treatment of diabetes and can lead to eventual weight and blood sugar control. 
                                                                                                           Email  Nurse@SeniorVoiceAmerica.org

BPT) - Habits that support a healthy lifestyle come in many forms, like eating a balanced diet, exercising regularly and keeping an eye on blood pressure and cholesterol levels. But did you know these and other healthy habits can also protect you from vision loss?
Some of the leading causes of blindness and vision loss in the U.S. are retinal diseases, including conditions such as diabetic retinopathy and age-related macular degeneration, often referred to as AMD. There are steps everyone can take to prevent vision loss and support retina health, especially those at a higher risk for retinal diseases.
"With state-of-the-art technologies that allow for early detection and advanced treatments, vision loss and blindness from retinal conditions can be treated effectively, but acting as early as possible is critical to maintaining healthy vision," said American Society of Retina Specialists (ASRS) President Dr. Philip J. Ferrone, MD, FASRS. "To safeguard sight, it's important that everyone know the signs and symptoms of retinal conditions, adopt some simple lifestyle habits that bolster retina health, and seek care immediately if sudden vision changes occur."
America's retina specialists urge the public to adopt the following healthy habits to preserve healthy retinas and encourage family and friends to also take these steps to protect their sight.
1. Get regular dilated retina exams
Many retinal diseases have few noticeable symptoms in the early stages. With regular dilated retina exams, your eye physician can help preserve your sight by detecting symptoms of a retinal condition early, before extensive damage occurs. After your exam, encourage friends and family to schedule their dilated retina exam.
2. Eat nutritious foods including dark, leafy greens and fish
Research shows that consuming a diet high in Omega-3 fatty acids, lutein and zeaxanthin has been associated with a lower incidence of AMD.
3. Quit smoking
Smoking can also lead to vision loss and blindness. In fact, research shows that people who smoke are significantly more likely than non-smokers to develop AMD. To access information and help for quitting smoking, call 800-QUIT-NOW (800-784-8669) or visit SmokeFree.gov.
4. Control your blood sugar, blood pressure and cholesterol
If you have diabetes, one of the best ways of lowering your risk of vision loss and preventing diabetic eye disease is to closely monitor and manage your blood sugar, blood pressure and cholesterol levels. 
​5. Stay active and maintain a healthy weight
Studies have shown that people who walk for exercise are less likely to develop AMD. Exercise also helps control obesity, high blood pressure and cholesterol which benefits eye health. Make staying active a family affair by adding a walk or bike ride to your next family get-together.
6. Know your family history
Ask family members if they have had vision issues. Retinal conditions including AMD, diabetic retinopathy and even retinal detachments may have a genetic component that runs in families.
7. Protect your eyes from the sun
Ultraviolet (UV) rays from the sun can damage not only our skin but also our eyes. Wear a pair of sunglasses that provide 100% UV absorption or block both UVA and UVB rays and a wide-brimmed hat when outdoors.
In addition to family history, common risk factors for retinal disease include older age, smoking and high blood pressure and cholesterol. Pay close attention to your vision and find a retina specialist if you experience common adult symptoms of retinal disease, including blurred central vision, loss of color vision, distortion or straight lines appearing wavy, and new or worsening floaters or flashes of light.
For more information about retina health visit SeeforaLifetime.org.

​By Mary Gynn - Diabetes Educator ​
Let me start with the reminder that Diabetes affects 25.8 million people. Those diagnosed are 18.8 million people and undiagnosed total 7.0 mil-lion people. Unfortunately, both Type 1 and Type 2 diabetes are affecting the younger generation, as well, the numbers being a staggering 215,000. (Center for Disease Control and Prevention in Atlantic, GA. www,cdc.com). Prediabetes and diabetes are now officially listed as an epidemic in the US. And, the numbers are growing.
An epidemic? This is 2018. Ironically, diabetes was first described in an Egyptian manuscript from 1500 BC and the first cases were described by Indian physicians in 400-500 AD identified as Type 1 and Type 2. Then in 1776, a Dr. Matthew Dobson con-firmed an excess of a kind of sugar in the urine. (Dobson,M. 1776, Medical Observations and Inquiries 5:298-3Is it the 10). And in 1889, it was found that dogs whose pancreas was removed developed all the signs and symptoms of diabetes.
So, considering these very early discoveries, why are we dealing today with Diabetes now an epidemic? Shouldn't the disease have been either controlled or eliminated all these years later?
Does "It", the epidemic, have some-thing to do with the following questions? I ask:
• Is it lack of community health and diabetes education?
• Is it the abundance available and consumption of processed foods?
• Is it lack of Americans knowing the existence of a gene somewhere in their ancestry that they may have inherited predisposing them to diabetes? Do most Americans have any idea of what a genetic inheritance (aka genome sequence) is? And all the variety of genes we all have predisposing us to health issues?
• Is it because the majority of Americans are addicted to sugar and sugar is present in practically all our food? And, why is sugar in all of our food?
• Is it the growing numbers of people who don't want to adapt a healthy life-style either early on or when diagnosed with a blood test they have prediabetes?
• Is it because people aren't aware of their predisposition to the disease and have no knowledge of the metabolic syndrome?
• Is it because Americans who if they do have some pre-diabetes symptoms just want a quick-fix pill to avoid facing reality and say nothing to or deny any symptoms to their physician?
• Is it due to the insidious development of overweight and/or the obesity epidemic?
• Is it in anyway connected to the in-activity or a "sitting" population in to-day's America?
• Is it connected to stress in our lives in today's stressful world that we do nothing about?
• Is it the multitude of pills or insulin pre-diabetics and diabetics ingest and inject and think they are the "cure"?
• Is it the lack of diabetics not knowing how to self-manage their own dis-ease resulting in permanent sugar control?
• Is it pre-diabetics and diabetics have no desire to self-manage or fearful of taking control of their disease?
In my years of being a registered nurse and diabetes educator, I could go on and on identifying the multitude of questions. They help me arrange my diabetes self-management education programs and discuss your answers to the above questions. Your answers assist my effort to understanding why we now have a diabetes epidemic.
Mary Gynn, RN, MSN/MS, MPH, CDE


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​​Choosing the right doctor is one of the most important decisions people can make for their health. If you are unsure who to turn to for your general care, experts point out that internal medicine specialists, or internists, specialize in the prevention, diagnosis and treatment of a broad spectrum of illnesses that affect adults through-out their lives, making them the right choice for many adults.
 Before selecting an internal medicine doctor, it’s helpful to learn a little bit more about their training and specialties. Trained to care for adults, many general internal medicine doctors, or general internists, practice in an office-based setting as primary care physicians for adults, following patients from their teens through their senior years for ongoing medical care. Other general internists spend the majority of their time caring for hospitalized patients in the role of a hospitalist.
 Due to the broad, intensive nature of core internal medicine training, which requires a three-year residency program after graduating from medical school, general internists aren’t limited to one type of medical problem or organ system, making them especially well-qualified to care for patients with complex conditions or multi-system diseases.
 “Comprehensive education and training make the internist particularly suited to care for the whole per-son,” says American College of Physicians (ACP) President Dr. Robert M. McLean. “Many patients appreciate the tailored prevention and treatment plans that internists can provide. From the internist’s perspective, we value long-term relationships with patients and working closely with them to pro-
vide compassionate, quality care.”
While training of general internists does not include pediatrics, obstetrics, or major surgery, patients requiring those services can turn to their general internist for recommendations and referrals.
 Internal medicine is a wide-ranging field, as many subspecialty areas of medicine require internal medicine training as a foundation, including allergists and immunologists, cardiologists, critical care doctors, endocrinologists, gastroenterologists, geriatricians, hematologists, hepatologists, infectious disease doctors, nephrologists, oncologists, pulmonologists, rheumatologists, and sleep medicine physicians.
 Training to become an internal medicine subspecialist is both broad and deep, and includes a three-year residency program plus one to three years of fellowship training, depending on the subspecialty. General internists even receive some training in each internal medicine subspecialty during their three-year residency program.
 To learn more about internal medicine, visit acponline.org, the website of ACP, a membership organization rep-resenting internal medicine doctors, and the largest medical specialty organization in the U.S.
 “With such in-depth training in the complete care of adults, internal medicine specialists and subspecialists are excellent choices to help patients navigate the increasingly complex world of medical care,” says Dr. McLean, a rheumatologist. “Whether you are healthy or have a chronic illness such as diabetes, cancer or heart disease, an internist can provide comprehensive, coordinated care.”