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Thursday, January 31, 2019

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This is the time of year when it’s important to think about flu vaccinations. And there’s good reason for that! The flu causes thousands of preventable hospitalizations and deaths each year.

But what about other vaccinations? Do you think of them as something for kids? You aren’t alone. And it’s true, a number of vaccinations are recommended for young children as well as preteens and teenagers. These vaccinations have provided an enormous benefit to public health by preventing diseases that were common and sometimes deadly in the past, including polio, rubella, and whooping cough.

But there are several vaccinations recommended for healthy adults as well. And over time, these recommendations change. Here is a quick rundown.
Vaccinations for adults

In addition, adults should have vaccinations to prevent a number of infections if they were not received during childhood. Examples include the MMR vaccine (for measles, mumps, and rubella), HPV (human papilloma virus), chickenpox, and hepatitis.

Additional or earlier vaccinations may be recommended if you have certain medical problems, such as having an immune system weakened by illness or medications.
New recommendations

Mumps

In recent years, cases of mumps have spiked in the US. In 2015, there were about 1,300 cases reported. In 2016, the number jumped to more than 6,300. And as of November 2017, more than 4,600 cases were diagnosed. College campuses have been particularly prone to outbreaks. Mumps threatened to disrupt graduation at Harvard University in 2016, and recently Syracuse University, the University of Missouri, SUNY New Paltz, and Tufts University have reported outbreaks. We haven’t seen numbers like this since routine measles-mumps-rubella (MMR) immunizations began in the 1970s.

Although mumps is usually more of an annoyance than a serious illness, in some cases it may cause hearing loss, encephalitis (inflammation of the brain), and even death.

The rise in cases of mumps is not necessarily due to people not getting recommended vaccinations. The fact is, protection provided by vaccinations tends to wane over time. As a result, an expert panel has recommended that those at high risk for mumps get a booster shot. This includes anyone who has been in contact with someone who developed mumps. Others at higher than average risk include young adults ages 17 to 21 who spend time in close quarters, such as college students, church groups, and sports teams.

Shingles

Shingles is a re-activation of chickenpox, so anyone who had chickenpox in the past is at risk. Many who don’t recall having chickenpox have been exposed to the virus that causes it and are at risk as well.

Symptoms of shingles include an itchy, burning rash over a patch of skin lasting up to 10 days. Complications include vision loss (if the skin near the eye is affected), pneumonia, and chronic pain in the area of the rash (called post-herpetic neuralgia). Shingles tends to occur in older adults, affecting an estimated one in three people over a lifetime.

Since 1995 a vaccination has been available for chickenpox, so the incidence of shingles should fall dramatically in future generations. But in 2006, a vaccine was approved to prevent shingles for those who already had chickenpox. More than 20 million people have received this vaccine.

In October 2017, a new and more effective shingles vaccine called Shingrix was approved, leading an expert panel to recommend that people over age 50 get this new shingles vaccine even if they’ve already had the old one. As a next step, the CDC will review this recommendation and issue its own guidelines. Health insurance coverage for this new vaccine may vary, so it’s worth checking on that before getting it.
How to keep track of your vaccinations

It can be hard to remember which vaccinations you’ve had and when. Your primary care doctor should keep a running list in your medical record. But it’s a good idea to keep your own list. Each time you get a vaccination, put it in your smartphone or keep an updated record on your computer. There are apps and programs that can make it easy, but I just enter each vaccination I receive in my cellphone’s Contacts list under “Health Information.”

Keep in mind that no matter how hard you try to follow recommendations regarding adult vaccinations, the recommendations may change over time. So, at your routine checkups, ask your doctor if you should receive any vaccinations. It might be the most important thing you can do for your health.
I got a new doctor last year and at my first exam, he asked the standard, “What do you like to do for fun?” I laughed at him. I said that I have a 6-year-old and 3-year-old, mumbled something about poker games, and then my answer stopped. I’m not complaining, at least not much. I like my family and they require time. I don’t mind giving it, though I also work at home, a personal choice that comes with great benefits. But I can’t completely disappear, so sometimes, it just feels like an unending amount of time. My friends with older kids try to be supportive, saying that my wife, Jenny, and I are in the deepest part of the hole and it will soon get better, but they said that last year, and maybe the year before — I don’t really remember.

I know that I should squeeze in something like listening to music, reading, or doing nothing. It just never tops the priority list. I feel guilty spending time or money on anything that isn’t family-related. Jenny feels the same. We’re not pioneers with this mindset. As Dr. Beth Frates, assistant professor of physical medicine and rehabilitation at Harvard Medical School, says, it’s almost a default. “If you’re not working or taking care of another relative, you’re giving kids 100% of your attention.”
Why taking a break is important (and why it’s so hard)

The problem, she explains (and which isn’t surprising), is that parenting is a drain. It requires CEO-like thinking that happens in the prefrontal cortex, the place for self-control and rational decisions. That takes stamina, and if — check that — when you’re exhausted, you’ll shift into the amygdala, the emotional part of the brain that fights or flights, which is good against a bear attack, not so much against your child. Point is, a break every so often isn’t the worst thing.

Great. I’m still all for it. One question: when and how exactly does this magic happen?

The first step, Frates says, and it’s a big one, is acknowledging that personal time isn’t a luxury. The airplane oxygen mask analogy — put on yours first so you can better help your child — is the classic, but she prefers the idea that you can’t pour from an empty cup; with nothing there, there’s nothing to give.
The practical realities of “me time” — even a little bit can help a lot

If you can accept the concept, it becomes about identifying the daily possibilities. Ideally, she says, it’s a range, from 30 minutes to the occasional 24 hours. At minimum, it’s taking five. Even that might feel undoable, but any type of screen time is a good place to look for time that can be better spent. And if it’s just the five, Frates likes deep breathing. She did it when her kids were young. She’d be in a chair with them in the room. They eventually understood not to bother her. She got her break and they got to witness the habit.

Ultimately, there’s no list of best things to do. The main requirement is that you look forward to whatever it is to get the reward of being fully absorbed, of losing your sense of time, and forgetting that you actually have bills, deadlines, or even children. It sounds simple, and it is to a degree, but if kids are involved, few things are simple. It takes teamwork to pull off. As a supportive partner, “What can I do to help?” is never a bad opening question. Often the person knows; now there’s an opening to brainstorm and strategize. Sometimes, if you know it’s not overstepping, you can take the initiative and buy something like a prepaid yoga classes card. The free time now almost has to happen.
“Me time” done just right

My wife took that route. I recently turned 50 on a Monday, and she woke me the morning before, holding a bottle of sports drink and telling me that this was my present. Where my head was at, I thought, “I have to get another colonoscopy?” She told me that at noon, I was playing tennis with a buddy.

I got to do something that I love — I think I stammered tennis out to the doc as well — with the person I like to hit with the most. But where Jenny crushed it was setting the whole thing up. She knew that if she gave me an open-ended coupon, it wouldn’t have happened. She just told me to go and enjoy myself.

I listened to my wife on this one. For two hours, I didn’t have to watch my language or answer the same question 10 times. My biggest responsibility was hitting a ball back over a net and breaking a sweat. It was great. I felt unburdened. I felt more energized and positive, and, at some point on the drive back, I remembered that I had two children. If you think that there’s a lot of flu going around this winter, you’re absolutely right. Every state except Hawaii is reporting widespread influenza activity, making for a lot of miserable people suffering from classic flu symptoms of cough, fever, headache, stuffy nose, and achy muscles. Hospitals across the United States have been flooded with flu patients. Matters have been made worse by national shortages of IV fluids in the wake of Hurricane Maria.

Are we headed toward a historically bad flu season? It’s too early to tell. This year, it could just be that flu season, which is usually at its worst in February, is peaking early. Even an average flu season is a public health disaster, leading to between 12,000 and 56,000 excess deaths in American adults. There have been several tragic and widely publicized deaths of children this flu season, with at least 30 such cases so far. Unfortunately, this is not that unusual. In the United States, 98 kids died of flu-related complications in the most recent flu season. In recent years, deaths of children from flu in the US have ranged from 35 in 2011–2012, to a peak of 282 in the 2009–2010 flu season. Most children who die after influenza have a high-risk underlying medical problem, such as asthma, cerebral palsy, or heart disease, but 43% were previously healthy.

So far this year, the major flu type is H3N2, a strain of influenza A virus. Last year, the flu vaccine was only around 32% effective against H3N2, while providing much better protection against the other two major flu strains. It’s not too late to get a flu vaccine if you haven’t already. Some protection against flu is better than none. Even if the flu vaccine is not completely protective against H3N2, it can reduce the risk of a life-threatening case. It’s also common for other varieties of virus, such as influenza B, to emerge late in flu season, and the vaccine usually provides better coverage for these other strains. Just as we’ve finished welcoming the new year, sports fans are getting ready to celebrate the Super Bowl. This event marks the single most active gambling-related activity in the world. For most gamblers, betting on the outcome of a sporting event, lottery drawing, casino table game, or any event with an outcome determined by chance represents an entertaining recreational activity. However, for some, gambling can become an addiction.
Excessive gambling recognized as an addiction

Gambling disorder is now a part of the American Psychiatric Association’s latest version of its diagnostic manual (DSM-5). Gambling is the first “behavioral” addiction included in the substance-related and addictive disorders section of the manual. For the first time, the APA recognizes that substance-related addiction and difficult-to-control behavioral addiction are similar enough to be grouped as comparable expressions of addiction.

Now, clinicians, scientists, policy makers, gambling purveyors, and the public alike recognize that addiction can emerge from patterns of excessive behavior that derive from either using a substance, such as tobacco or alcohol, or engaging in activities like gambling, video game playing, or sex. This might come as a surprise, but it’s true. You can become addicted to gambling just like you can become addicted to alcohol or other drugs.
History and causes of gambling problems

Historically, opinions about gambling have tended to mirror the social and moral climate of the day. Gambling problems aren’t anything new; there were scientific papers written about excessive gambling as far back as 1798 and, reaching even further back into history, there are cave drawings depicting gambling-related behaviors. However, the concept that problem gambling is not a moral defect but instead a disorder is relatively new. Most experts and clinicians now consider gambling addiction as a legitimate biological, cognitive, and behavioral disorder. Further, although mental disorders can lead to problem gambling, gambling to excess also can lead to other problems.

Gambling problems have many potential causes: genetics, erroneous thought patterns, impulse control disorders, poverty, and personal experiences, for example. An estimated 2% to 3% of the US population has experienced some kind of gambling-related problem during the past 12 months. That means about 5.5 million people currently have a gambling disorder, or gambling-related problems that don’t quite rise to the level of a disorder.
If you answered yes to any of these questions, you should evaluate your gambling and how it fits into your life. There are many resources to help, and my colleagues and I have published an easily accessible book that can help you to evaluate your gambling and decide whether you might be a candidate for treatment. Some people need treatment to recover from addiction, while others recover on their own with no help from anyone.

To figure out whether you might benefit from a change, you need to take stock. A variety of mental health issues often accompany excessive gambling. You might have some of these symptoms even if they don’t reflect a full-blown disorder. It’s worth it to figure out whether gambling and associated activities are adversely influencing your life. Understanding how gambling works for you is a worthwhile exercise, even if you choose to continue gambling.

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