The findings may help doctors identify more people at risk for the potentially deadly cancer. By Sheryl Huggins Salomon Medically Reviewed by Kacy Church, MD A type 2 diabetes diagnosis after age 50, called late-onset diabetes, is a known risk factor for pancreatic cancer, and in Latino and African-American people with diabetes who are diagnosed with pancreatic cancer within three years, pancreatic cancer itself may manifest as diabetes. That’s what a study published June 18 in the Journal of the National Cancer Institute suggests, and the findings may help doctors identify more individuals at risk for pancreatic cancer, which has poor survival rates because doctors often don’t catch the disease early enough for treatment to be effective. Pancreatic cancer has a five-year survival rate of only 8.5 percent, according to the National Cancer Institute (NCI). For the current study, authors studied the incidence of type 2 diabetes and pancreatic cancer in nearly 49,000 African-American and Latino people older than 50. From 1993 to 2013, about 32 percent, or about 15,800, of the study participants developed diabetes. During follow-up, researchers identified an additional 408 pancreatic cancer cases. Over the study period, about 20 years, they found that diabetes was associated with a twofold risk of pancreatic cancer. But when researchers stratified the data, they observed the risk for pancreatic cancer was even higher among participants diagnosed with diabetes in the previous three years (called recent-onset diabetes). Within that time period, Latinos were four times more likely to develop pancreatic cancer, and African-Americans were three times more likely. “Our results suggest that late-onset diabetes can be used as a marker to narrow down who is in a high-risk group for pancreatic cancer,” says the lead study author, V. Wendy Setiawan, PhD, an associate professor of preventive medicine at the Keck School of Medicine of the University of Southern California in Los Angeles. “Physicians should be aware that while the chance [of developing pancreatic cancer] is low, recent-onset diabetes could be an early sign of pancreatic cancer,” she adds. The Association Between Pancreatic Cancer and Type 2 Diabetes in Minorities The pancreas is a gland behind the stomach that secretes digestive enzymes and releases hormones, such as insulin and glucagon, that help to control blood glucose (sugar), according to Johns Hopkins University. According to the NCI, about 1.6 percent of people in the United States will be diagnosed with pancreatic cancer at some point in their lifetime. The incidence of pancreatic cancer among black people specifically is about 25 percent higher than it is in white people, according to the American Cancer Society. Yet, says Setiawan, “Blacks and Latinos are understudied, and thus very little is known about the relationship between diabetes and pancreatic cancer in these two populations.” Additionally, both black and Latino people have higher rates of type 2 diabetes than the general population, according to the American Diabetes Association. That’s why her team focused on those groups. Rahil Bandukwala, DO, an endocrinologist at MemorialCare Saddleback Medical Center in Laguna Hills, California, who wasn’t involved in the research, says the results seem to align with what he’s seen in his nearly 20 years of practicing medicine, but he would be interested in seeing more long-term data. He notes a limitation of the study that the authors acknowledge in their paper: The research relied on self-reporting when determining the diabetes diagnoses, Medicare claims, and hospital discharge records. And so the recorded onset dates may have been imprecise. “It would be good to better understand when the diabetes truly came about and follow the participants out from there — to see who gets pancreatic cancer and who doesn’t.” But previous research seems to support the current study’s findings. For example, nearly 40 percent of people with pancreatic cancer had also developed diabetes within the three years prior to their cancer diagnosis, according to the findings of a review of 500 medical records that was published in the March 2013 issue of Pancreas. A Need for Better Pancreatic Cancer Screening Tools Michael Choti, MD, a surgical oncologist at Banner MD Anderson Cancer Center in Gilbert, Arizona, who specializes in pancreatic cancer, says that study results so far, while interesting, aren’t cause for alarm. “Patients who develop late-onset diabetes shouldn’t panic and think Oh my God, that means I’m going to develop pancreatic cancer,” says Choti, who wasn’t involved in the current research. But he notes that pancreatic cancer rates are on the rise, and current screenings for the disease fall short. Given that pancreatic cancer can be aggressive and survival rates so poor, he argues that better tools are needed to screen for early signs. “We don’t really have any screening tools, and even imaging [methods] of the pancreas, such as a CAT scan or MRI of the pancreas, are not perfect,” Choti explains. According to the U.S. Preventive Services Task Force, there are no official guidelines for pancreatic cancer screening. Setiawan agrees with Choti. “There is an urgent need to find better ways to identify patients with early cancer in the group of patients who develop diabetes after age 50,” she says, adding that her team at the Consortium for the Study of Chronic Pancreatitis, Diabetes, and Pancreatic Cancer are “working diligently to develop tests that can better identify patients with recent onset diabetes who actually have pancreatic cancer at its earliest stage.” “Finding the cancer at an early stage and treating it with surgical removal provides the best chance for a cure of the disease,” she adds.
1. Have the courage to live a life true to yourself, not the life others expect of you.
2. Never attribute to malice that which can be adequately explained by stupidity.
3. “There is nothing noble in being superior to your fellow man; true nobility is being superior to your former self.” Ernest Hemingway
4. Don’t make decisions when you’re angry. Don’t make promises when you’re happy.
5. “Never argue with a stupid person, they’ll drag you down to their level and beat you with experience.” Mark twain
6. Only pack what you can carry yourself.
7. Remember you’ll always regret what you didn’t do rather than what you did.
8. “You’d worry less about what people think about you if you knew how seldom they do.” David Foster Wallace
9. If you blame it on someone else, don’t expect it to get better.
10. “You can be the ripest, juiciest peach in the world, but there will always be someone who hates peaches.” Dita von Teese
11. If the grass is greener on the other side, there’s probably more manure there.
12. Don’t give up what you want most for what you want now.
13. With regards to the opposite sex: If you look hungry, you’ll starve.
14. “Never let your sense of morals prevent you from doing what is right.” Isaac Asimov
15. Strive to be the man you want your daughter to marry.
16. “Remember only enemies speak the truth. Friends and lovers lie endlessly, caught in the web of duty.” Stephen King
17. Never forget your car keys will change your car from one tonne of inert metal into one of the most deadly killing machines that has been invented.
18. Wait 24 hours before getting mad and reacting about anything. If it doesn’t bother you in 24 hours time, it probably isn’t important enough to get mad over.
19. Never make someone a priority who only makes you an option.
20. Try not to take anything personally. No one thinks about you as much as you do.
21. “If you want to know what a man’s like, take a good look at how he treats his inferiors, not his equals.” Sirius Black
22. Figure out what you love to do, and then figure out how to get someone to pay you to do it.
23. If you treat a woman like a queen, and she treats you like a jester, your princess is in another castle.
24. Whenever something happens that makes you sad, ask yourself whether you’d still care about it when you’re ninety.
25. Be persistent. When knowledge and ability aren’t enough, be persistent.
26. “Life is scary. Get used to it. There are no magical fixes. It’s all up to you. So get up off your keister, get out of here, and go start doin’ the work. Nothing in this world that’s worth having comes easy.” Bob Kelso
27. Smart girls like to hear they’re pretty, pretty girls like to hear that they’re smart.
28. Happiness is a choice and everything else is a matter of perspective.
BY PATRICK SULLIVAN Clear as urine. That’s not the expression, but perhaps it should be, at least when urine is healthy. Perfectly normal urine tends to be a pale, straw color or a clear yellow. “A lot of people don’t realize that when you’re well-hydrated, your urine should be close to running water,” explains urologist Arthur Crowley, MD. “People are confused about that. They’ll say it looks great but it’ll be dark.” Urine gets its yellow color from a pigment called urochrome. “It has to do with the way the kidneys break things down,” says Dr. Crowley. In addition, healthy urine has a slight, mild smell. But what if your pee has a strong odor, or isn’t a mellow yellow? What if it’s pink? Or red? Chances are the cause is innocuous, but there are times when your body may be telling you something about an underlying medical condition. What’s that smell? Normal urine should smell unobtrusive, but there are several reasons why you might notice a stronger odor wafting up from the bowl. Dehydration can cast a distinct aroma if your urine isn’t as diluted as usual, signaling that you need to drink up. Vitamins—namely vitamin B6—and certain foods are other common suspects. “Vitamin B6 has a strong odor, almost like old urine,” says Crowley. “It’s more a nitrogen-type smell.” Garlic can make your pee as stinky as your breath, and asparagus is well known for scenting your urine, giving off a sulfur-like smell. Sometimes, though, the smell may be a sign of trouble. Diabetics often have sweet-smelling urine due to the presence of sugar. A urinary tract infection (UTI) is another condition that brings along a strong smell, “almost like gunpowder,” says Crowley. “The bacteria that causes a UTI will split the urea molecules in urine apart, releasing the smell.” (Not so) pretty in pink Red or pink urine could indicate the presence of blood, but don’t panic just yet. Blueberries and rhubarb (did you overindulge in pie recently?) can do it. So can beets. Certain medications, such as senna laxatives or even ibuprofen, can cause blood in the urine. Crowley says if a lab analysis reveals no red blood cells in your urine sample, it’s probably something you ate. If it’s not your diet, blood in the urine may be a symptom of UTIs, bladder stones and cancer of the kidneys or bladder. It may also be due to long-distance running (joggers’ hematuria) or other strenuous exercise. If you haven’t recently chowed down on veggies that may be behind the color change, see your primary care physician and have a sample taken. Very dark urine If you’ve thought all along that dark-colored urine is the norm, think again. Severe dehydration is the best-case scenario for urine that’s amber or orange in color. Fortunately, it’s the most common diagnosis, according to Crowley. The fix is easy enough: Drink more water. If your urine is still dark, you might need to replenish your electrolytes as well. Sports drinks and Pedialyte can help. But if dehydration isn’t causing the dark hue, it could be something more serious. “Cirrhosis of the liver and hepatitis are possibilities,” says Crowley. With liver issues, a pigment called bilirubin is turning the urine dark. “Bilirubin results from the breakdown of old red blood cells and normally can be converted to a water soluble substance by the liver,” Crowley says. If the liver is damaged, the bilirubin does not get broken down and passes through the bladder as a dark discoloration.
Burning, itching, and an unpleasant odor are just some of the common symptoms of vaginal infections. But treatments vary by condition, so it's important to know which type of vaginal infection you have. By Beth W. Orenstein Medically Reviewed by Lindsey Marcellin, MD, MPH Vaginal infections, or vaginitis, are very common — so much so that most women will experience some form of vaginal infection or inflammation during their lifetime. “To the gynecologist, vaginitis is a vaginal discharge with or without itching and burning, with or without an odor,” says Gregory R. Moore, MD, MPH, an obstetrician-gynecologist and director of the University Health Service at the University of Kentucky in Lexington. Some women seem to be more prone to vaginal infections than others for reasons that are not entirely obvious, Dr. Moore says. What Upsets the Normal Vaginal Balance A healthy vagina has many bacteria and yeast. However, some things can disturb that healthy balance. These include: Douches Hormone level changes Antibiotics Vaginal intercourse Pregnancy and breastfeeding The Most Common Types of Vaginal Infections There are three very common types of vaginal infections, says Cynthia Krause, MD, assistant clinical professor of obstetrics and gynecology at Mount Sinai School of Medicine in New York City. Yeast infections. The most common type of vaginitis, a yeast infection is caused by one of the many species of fungus known as Candida. Candida live naturally in your body in small numbers, including in the vagina, and usually don't cause any harm. However, Candida thrive in a warm, moist, airless environment and, under those conditions, can grow in number, causing a vaginal infection. Dr. Krause says, “There are many species of yeast or Candida — Candida albicans is the most common.” Symptoms of a vaginal yeast infection include a thick, white discharge that some women describe as resembling cottage cheese. Yeast infections also can cause vaginal itching and redness of the vulva (the lips of the external female genital area) and vagina. Bacterial vaginosis. Along with yeast, “friendly” bacteria called lactobacilli live in the vagina. When the number of lactobacilli gets too low, it can trigger a condition called bacterial vaginosis (BV). Why bacteria levels change is not known, but the normal lactobacilli can be replaced by other infection-causing bacteria. “Gardnerella is the bacteria most often associated with bacterial vaginosis,” Krause says. “It is the lack of lactobacilli and overgrowth with these other bacteria that cause the symptoms of infection.” With bacterial vaginosis, a woman may see a thick or whitish discharge or one that is slippery and clear. It is not likely to itch or burn. A fishy odor may be noticeable, especially during intercourse. Trichomonas. “Of the three most common vaginal infections, trichomonas vaginitis is the only one that is a true sexually transmitted infection,” Krause says. Commonly called “trich,” it is caused by a single-celled parasite, trichomonas vaginalis, and is passed from partner to partner during intercourse. The symptoms of trichomonas vaginitis are similar to other vaginal infections: burning, irritation, redness, and swelling of the vulva, with a yellow-gray or greenish vaginal discharge, possibly with a fishy odor. Some women also experience pain during urination. Other common vaginal infections and causes of vaginal itching include: Chlamydia vaginitis. Chlamydia is a sexually transmitted disease that can cause inflammation of the vagina. Some women will have a discharge with chlamydia and some will not. A more common symptom is bleeding, especially after intercourse. “Sexually active women up to age 26 should be tested annually for chlamydia because it so often comes without symptoms and can linger and do a fair amount of damage to fertility,” Moore says. Noninfectious vaginitis. Noninfectious vaginitis is when the skin around the vagina becomes sensitive to an irritant such as scented tampons, perfumed soaps, or fabric softeners. This is not an infection, and the solution is simple: “Not to be exposed to whatever you are having a reaction to,” Moore says. Vulvodynia. This is a condition in which women have chronic pain or discomfort of the vulva without a known cause. The symptoms are similar to vaginal infections: burning, stinging, rawness, soreness, and swelling. Symptoms may be constant or occasional. Viral vaginosis. Viruses also can cause vaginal infections. Most viruses are spread through sexual contact. “The herpes simplex virus is a common cause of viral vaginosis,” Moore says. Symptoms include pain in the genital area from lesions or sores. Most of the time, you can see the sores on the vulva or vagina, but they can also be hidden and seen only during an examination by your gynecologist. Treatment for Vaginal Infections All of these infections can be treated, but it is important to know which infection you have so that the right medication is prescribed. “Yeast medication is available over the counter if you are certain that it is a yeast infection,” Krause says. “Sometimes women think they have a yeast infection and it is actually something else. If you try over-the-counter medications and they don’t work, you should see a doctor.”
By Joseph Bennington-Castro Medically Reviewed by Sanjai Sinha, MD Yeast infections frequently occur in men, even though they're most common in women. Men over 40 who have Type 2 diabetes may face an increased risk for developing penile yeast infections.Robert Nicholas/Getty Images Yeast infections are usually associated with women, but men aren't safe from these infections, either. The term "yeast infection" generally refers to a vaginal infection caused by the yeast Candida albicans, and less commonly other Candida species, including C. glabrata, C. parapsilosis, C. tropicalis, and C. krusei. (1) But yeast infections, or candidiasis, can affect other areas of the body. For instance, a yeast infection of the mouth is called thrush, or oral candidiasis, and a yeast infection of the skin (such as the armpits and groin) is called cutaneous candidiasis. (2,3) A yeast infection of the penis is called candidal (or candida) balanitis, or balanitis thrush. The term "balanitis" refers to an infection of the glans penis, which is the head of the penis. Candida infects the glans penis more often than any other infectious agent. If the yeast infection also affects the foreskin, it is known as candidal balanoposthitis. (4) Prevalence of Candidal Balanitis, a Yeast Infection of the Penis Candida yeasts are responsible for 30 to 35 percent of all cases of balanitis, according to a report published in the journal Clinical Microbiology Reviews. (4) Other infectious sources of balanitis include streptococci and staphylococci bacteria, Herpes simplex virus and human papillomavirus, and a sexually transmitted bacterium called Mycoplasma genitalium. (5) But candida balanitis is not well studied, so it's unclear how many men the illness affects each year (though it's thought to be a rare condition). Various Candida species, most notably C. albicans, live in the gastrointestinal tract and other warm areas of the body without causing illness (they only cause issues when they're present in large numbers). (4) In fact, about 20 percent of women have Candida living in their vagina and don't experience any yeast infection symptoms, according to a report published in the journal The Lancet. (1) Candida is commonly found on the penis, with studies suggesting that 16 to 26 percent of men carry the yeast. About 37 percent of men with Candida experience no symptoms, while 27 percent of them develop balanitis, according to a study of new attendees to a clinic for sexually transmitted diseases. (6) Causes and Risk Factors of Candidal Balanitis or Penile Yeast Infection Unlike with vaginal yeast infections, penile yeast infections are usually sexually acquired — when a man has sex with someone who has a yeast infection. But candidal balanitis isn't considered a sexually transmitted disease (STD) because men can get the infection without having sex. There are several risk factors that increase a man's risk of getting a penile yeast infection, including: Antibiotics, which kill the "good" bacteria that keep Candida's numbers in check Immune-suppressing illnesses, particularly HIV Diabetes mellitus (aka diabetes) Corticosteroids Additionally, Candida yeast colonization and infection are more common among men with uncircumcised penises than men with circumcised penises (the warm, moist environment underneath the foreskin promotes yeast growth). (6) A study published in the Journal of European Academy of Dermatology and Venereology found that candidal balanitis was strongly associated with age over 40 years and diabetes mellitus. And men older than 60 years were more likely to have Candida colonization. (7) Hygiene may also play a role in candidal balanitis development. Washing with perfumed shower gels and soaps can irritate the skin, potentially helping Candida multiply. (8) Symptoms of Male Yeast Infections (Candidal Balanitis) Common symptoms of candidal balanitis include: Burning and itching around the head of the penis, which worsens after having sex Redness and swelling Small, rash-like bumps called papules, which may have pus Pain during urination or sex If you have candidal balanoposthitis, you may also have: A thick, lumpy discharge under the foreskin An unpleasant odor of the foreskin Difficulty pulling back your foreskin Men with diabetes may experience more severe symptoms, including fluid buildup and ulceration of the penis, as well as fissuring of the foreskin. Complications with balanitis are rare, but may include an inability to retract the foreskin, cellulitis (inflammation of connective tissue beneath the skin), and a narrowing of the urethra that makes urinating difficult. (6,9) Treating Penile Yeast Infections (Yeast Infection in Men) Like vaginal yeast infections, penile yeast infections are easily treated with antifungal drugs called azoles. There are a number of over-the-counter and prescription-based topical medicines available, including: Lotrimin (clotrimazole) Monistat (miconazole) Spectazole (econazole) In some cases, these drugs may be combined with hydrocortisone to reduce marked inflammation. Importantly, topical oil-based medication cannot be used with latex condoms. Alternatively, an oral azole medication called Diflucan (fluconazole) is effective for yeast infections. If the topical or oral treatments don't work, make sure to see your doctor, as you may have another kind of balanitis or an infection by a Candida species resistant to azole antifungals.
Under-detected "mini-strokes" cause brain damage, result in cognitive impairment, and dementia, says a new study. Chances are if you're a senior managing your health, you've already had a conversation with your doctor about stroke risk. While many patients know the warning signs of stroke — slurred speech, weakness on one side of the body, coordination problems, double vision, and headaches — health care providers often fail to educate patients about their risk for silent or "mini-strokes," which can cause progressive, permanent damage and lead to dementia. A new study published in the Journal of Neuroscience, examined the effects of these so-called mini-strokes. They frequently are not diagnosed or detected by a doctor because a patient does not immediately present with stroke signs. Mini-strokes may lead to permanent neurological damage and increase risk for full blown stroke. Experiencing a Chronic Condition? Find a Gastroenterologist Now. Maiken Nedergaard, MD, lead author of the study and professor of neurosurgery at the University of Rochester Medical Center, says at least half of individuals over the age of 60 will experience one mini-stroke in their lifetime. She calls the prevalence of mini-strokes "an epidemic." "Often you don't have symptoms. That's the scary thing about them, you don't know they're occurring," says Dr. Nedergaard. "If you are elderly and something doesn't work quite right, you think, I should take a nap. You don't go to the hospital unless you have big stroke." Mini-strokes often are detected well after the damage has been done, she says, and quite possibly by the time a patient has had several of them. A typical scenario, says Nedergaard, may be a patient who visits her doctor for chronic migraines. The doctor may order an MRI to rule out brain tumors, only to discover the patient has had several mini-strokes, which appear on a scan as "little dots where the tissue has grown," she says. "When you have a stroke, there's an area of the brain that dies rapidly almost at the epicenter of the injury, but there are neurons around it that die slowly," says Larry Goldstein, MD, professor of medicine, director of the Stroke Center at Duke University and a spokesperson for the American Heart Association. The study authors say mini-strokes are similar in nature to ischemic strokes, which are full blown episodes provoked by a loss of blood supply, depriving an area of the brain from oxygen. Ischemic stroke effects, including blurry vision, numbness, and slurred speech, are usually present immediately after the event. "A big stroke is caused by a clot in the artery. We assume that's the same that happens in the mini-stroke, but it's not clear," says Nedergaard. "What we do know is they cause this very delayed loss of cells in the brain." Nedergaard and her colleagues used rodents to examine the impact of small strokes. Strokes were provoked by injecting mice with cholesterol crystals, she says. The researchers put the mice who had mini-stroke through a series of tasks, such as recalling objects and responding to audio cues. They found the mice who suffered strokes were more likely to fail these tasks. "Silent strokes are really common but their effects are not silent," says Philip B. Gorelick, MD, MPH, medical director of the Hauenstein Neuroscience Center of Saint Mary's Health Care in Grand Rapids, Mich. He says one in three patients who have a mini-stroke will sustain permanent damage. According to the Centers for Disease Control, stroke is the third leading cause of death in the United States. They typically occur in people over the age of 65, and cause more than 140,000 deaths each year. Around 795,000 people suffer a stroke annually. About 600,000 of these are first attacks and 185,000 are recurrent attacks. Strokes are common among people with atrial fibrillation, high blood pressure, and smokers. Nedergaard says currently there's no treatment available to reverse brain damage caused by a stroke or to lower a patient's chances for having recurring episodes or developing dementia. This is why preventative medicine is crucial. To lower one's risk for having a stroke, doctors advocate for preventive medicine and a healthy lifestyle, which includes a low sodium and low cholesterol diet, a regular exercise program, only moderate amounts of alcohol, and not smoking cigarettes. Some doctors may recommend cholesterol-busting medications such as Plavix and anticoagulants such as aspirin.
Under-detected "mini-strokes" cause brain damage, result in cognitive impairment, and dementia, says a new study. By Jessica Firger Chances are if you're a senior managing your health, you've already had a conversation with your doctor about stroke risk. While many patients know the warning signs of stroke — slurred speech, weakness on one side of the body, coordination problems, double vision, and headaches — health care providers often fail to educate patients about their risk for silent or "mini-strokes," which can cause progressive, permanent damage and lead to dementia. A new study published in the Journal of Neuroscience, examined the effects of these so-called mini-strokes. They frequently are not diagnosed or detected by a doctor because a patient does not immediately present with stroke signs. Mini-strokes may lead to permanent neurological damage and increase risk for full blown stroke. Maiken Nedergaard, MD, lead author of the study and professor of neurosurgery at the University of Rochester Medical Center, says at least half of individuals over the age of 60 will experience one mini-stroke in their lifetime. She calls the prevalence of mini-strokes "an epidemic." "Often you don't have symptoms. That's the scary thing about them, you don't know they're occurring," says Dr. Nedergaard. "If you are elderly and something doesn't work quite right, you think, I should take a nap. You don't go to the hospital unless you have big stroke." Mini-strokes often are detected well after the damage has been done, she says, and quite possibly by the time a patient has had several of them. A typical scenario, says Nedergaard, may be a patient who visits her doctor for chronic migraines. The doctor may order an MRI to rule out brain tumors, only to discover the patient has had several mini-strokes, which appear on a scan as "little dots where the tissue has grown," she says. "When you have a stroke, there's an area of the brain that dies rapidly almost at the epicenter of the injury, but there are neurons around it that die slowly," says Larry Goldstein, MD, professor of medicine, director of the Stroke Center at Duke University and a spokesperson for the American Heart Association. The study authors say mini-strokes are similar in nature to ischemic strokes, which are full blown episodes provoked by a loss of blood supply, depriving an area of the brain from oxygen. Ischemic stroke effects, including blurry vision, numbness, and slurred speech, are usually present immediately after the event. "A big stroke is caused by a clot in the artery. We assume that's the same that happens in the mini-stroke, but it's not clear," says Nedergaard. "What we do know is they cause this very delayed loss of cells in the brain." Nedergaard and her colleagues used rodents to examine the impact of small strokes. Strokes were provoked by injecting mice with cholesterol crystals, she says. The researchers put the mice who had mini-stroke through a series of tasks, such as recalling objects and responding to audio cues. They found the mice who suffered strokes were more likely to fail these tasks. "Silent strokes are really common but their effects are not silent," says Philip B. Gorelick, MD, MPH, medical director of the Hauenstein Neuroscience Center of Saint Mary's Health Care in Grand Rapids, Mich. He says one in three patients who have a mini-stroke will sustain permanent damage. According to the Centers for Disease Control, stroke is the third leading cause of death in the United States. They typically occur in people over the age of 65, and cause more than 140,000 deaths each year. Around 795,000 people suffer a stroke annually. About 600,000 of these are first attacks and 185,000 are recurrent attacks. Strokes are common among people with atrial fibrillation, high blood pressure, and smokers. Nedergaard says currently there's no treatment available to reverse brain damage caused by a stroke or to lower a patient's chances for having recurring episodes or developing dementia. This is why preventative medicine is crucial. To lower one's risk for having a stroke, doctors advocate for preventive medicine and a healthy lifestyle, which includes a low sodium and low cholesterol diet, a regular exercise program, only moderate amounts of alcohol, and not smoking cigarettes. Some doctors may recommend cholesterol-busting medications such as Plavix and anticoagulants such as aspirin.
BY WILL ASHTON Princess Charlotte is only three years old, and she already knows how to handle herself around pesky photographers. Before attending a christening for her younger brother, Prince Louis, on Monday, the young member of British royalty had some stern words for the photographers and videographers surrounding the Chapel Royal in St. James's Place. Holding her father Prince Williams' hand, the little princess wasn't afraid to let the photographers know they weren't invited inside, and while she's not even close to being in the double digits yet, she's totally ready to handle herself as a princess. As it was reported by CBS News yesterday, before attending her youngest brother's christening, Princess Charlotte had the following words to say. You're not coming. It was an adorably blunt response that instantly won her over with fans of the royal family everywhere. We're used to princes and princesses being polite and considerate with the media, so this sweet little moment of sass from Princess Charlotte was a very cute instance of breaking the mold a bit. If her cutely cutting words weren't enough, Princess Charlotte added to the moment by continuing to stare down the photographers until she entered the religious building with the rest of her famous family, which also includes her duchess mother, Kate Middleton and her older brother, Prince George. This video wasn't the only one of Princess Charlotte from her brother's christening. There is also another video of Charlotte and the rest of the royal family greeting a priest at the Chapel Royal. Additionally, it should be noted that the newlyweds Meghan Markle and Prince Harry were also in attendance for Prince Louis's big day, although Queen Elizabeth II and her husband, Prince Philip, were not able to make it to the christening event. In a statement released by the Buckingham Palace, Elizabeth and Philip claimed their absence was due to a scheduling mishap, and that it didn't relate to their health. So we can seemingly put any such concerns to rest. It should also be noted that this is not the first time Princess Charlotte has thrown some sass around. She was recently recorded having a temper tantrum while boarding a helicopter. Naturally, such emotions are to be expected from a toddler, although it's unusual to see such sassinZess from a member of royalty. At the time of the tantrum, Princess Charlotte was a mere two years old, so such behavior is pretty common for someone her age. It has been an eventful year for the Royal Family. Prince Louis was welcomed into the world back on April 23rd, shortly before Prince Harry and Meghan Markle were married on the world stage a little less than a month later. And it's not going to be slowing down for the most famous family in Britain anytime soon, as there is word of another Royal Wedding in the midst. Yep, as it was reported last month, Princess Eugenie is now engaged to her previously long-distance boyfriend, Jack Brooksbank. Their wedding is expected to take place later this year in the fall, presumably in September. Hahahaha!!! Awesome , love it , no one will ever walk over this young lady as Dad would say , she has spunk .
Whether you're sweating or shivering, always take precautions to avoid temperature-related blood sugar spikes. By Beth W. Orenstein Medically Reviewed by Pat F. Bass III, MD, MPH When temperatures start to get out of control, so can your blood sugar. Both hot and cold weather extremes can affect your testing equipment and your medications, and have a negative impact on your body’s ability to produce and use insulin. Research shows that when it’s hot out, more people with diabetes end up in the ER and are hospitalized because of heat illness. The number of deaths in diabetes patients due to heat illness also increases in summer. Low temperatures can be an issue for people with diabetes as well. But you don’t have to let the environment have the upper hand. Taking a few smart precautions can help you outsmart Mother Nature. Here are the adjustments to make depending on where you live and the weather forecast. 6 Tips to Survive the Summer Heat Take these steps to keep your diabetes under control when the temperature soars: Stay hydrated. Lori Roust, MD, an endocrinologist at the Mayo Clinic in Arizona, explains, “The problem is that in the heat, people tend to get dehydrated easily. When you’re dehydrated, you have higher concentrations of blood sugar because less blood flows through your kidneys. With less blood, your kidneys don’t work as efficiently to clear out any excess glucose (blood sugar) from your urine.” When it’s hot, be sure to drink plenty of water or sugar-free drinks. Don’t wait until you are thirsty to replenish fluids. Store your medications properly. High summer temps can affect your diabetes medications, glucose meter, and diabetes test strips. “When it’s hot out, it’s easy for insulin and other drugs to become degraded,” Dr. Roust says. Be sure to store your medications properly — out of the extreme heat. Never leave them in your car on a sweltering summer day, for instance. “It could get up to 150 degrees inside your car,” warns Roust. If you’re traveling, don’t forget to take your type 2 diabetes medicines with you. You may need to carry them in a cooler with an ice pack. Just be sure they’re not sitting directly on ice or the ice pack. Stay out of the heat of the day. Exercise is an important part of diabetes management and blood sugar control. But you don’t want to be outside exercising during the hottest part of the day. “Get in your exercise first thing in the morning or once the sun goes down,” advises Angela Ginn, RD, a diabetes educator at the University of Maryland Center for Diabetes and Endocrinology and a spokeswoman for the Academy of Nutrition and Dietetics. Another option is to work out in an air-conditioned gym. Know signs of low blood sugar. Some of the symptoms of heat exhaustion are similar to those of low blood sugar, or hypoglycemia. These include sweating, light-headedness, shakiness, and confusion. “You may think it’s the heat and not recognize that your blood sugar levels have fallen to dangerous lows,” Roust warns. Be aware of the warning signs of low blood sugar and keep some carbohydrates with you to eat if you need to raise your blood sugar. Have a plan for a medical emergency. Test more often. You may need to test your blood sugar levels more frequently so that you can adjust your insulin and your diet as necessary. Talk with your diabetes educator about guidelines if you're unsure of the best schedule, Ginn says. Mind your feet. People with diabetes are susceptible to problems with their feet. In the summer you face the temptation to go barefoot or wear open sandals that expose your toes … to trouble. Always wear shoes that fit well — even in warmer months — and at the end of the day, check your feet for any cuts, scrapes, blisters, or bruises. Don’t ignore injuries to your feet. Get medical treatment right away. 6 Ways to Winter-Proof Your Diabetes Care Plan Freezing temps and inclement weather can make it more challenging to stay on top of diabetes. Here’s what to watch for during the colder months: Keep your supplies out of the cold. Just like extreme heat, extreme cold can affect your insulin and cause your glucose monitor to stop working. Don’t leave supplies in a car when temperatures outside are below freezing. Do your best to avoid getting sick. Winter is cold and flu season. When you’re sick, you’re stressed, and being under stress can raise your blood sugar. Also, when you don’t feel good, you’re likely to not eat properly. Wash your hands with soap and water often so that you don’t spread germs. Ginn recommends "diabetes patients have a sick-day kit at home and fill it with soup, sugar-free cough drops, tea — things that will make you feel better and that you can access easily.” Also, be sure to get vaccinated against the flu. Avoid packing on the pounds. Managing type 2 diabetes during the holidays can be tricky. Many seasonal treats are loaded with carbohydrates that cause your blood sugar to rise. Plan your meals and pace your special treats so that you don’t greet spring a few pounds heavier. Even a small weight gain makes it more difficult to control your diabetes and blood sugar levels. Keep an eye on your feet. Diabetes can cause a loss of feeling in your toes and feet. Protect them with the right winter footwear, especially in snow. Apply moisturizer to your feet to keep your skin healthy. Inspect them regularly, and if you notice an injury that doesn’t heal, seek medical attention. Don’t wait. Warm your hands. “If your hands are cold, you may have to warm them up to get a good blood sugar reading,” Roust says. Wash them in warm water before testing. Your meter will work best when it’s kept in a room where the temperature is between 50 and 104 degrees Fahrenheit.
Don’t skip your workouts. It can be hard to get motivated to exercise in winter. But exercise is an important part of keeping blood sugar in check. It helps if you dress in layers when you’re exercising outdoors in the cold. Or join a gym where you can work out indoors. Another option: Work in exercise at home by taking the stairs, lifting weights, and exercising to videos.
Diana RodriguezBy Diana Rodriguez Reviewed by Rosalyn Carson-DeWitt, MD A Sometimes Silent Danger When you have type 2 diabetes, your main goal should be controlling your blood glucose (sugar). If you don’t do this and glucose levels swing up and down, you run the risk of developing serious health problems such as stroke, heart disease, and nerve damage (neuropathy). The tricky part is that with type 2 diabetes you might not feel it when blood sugar levels are too high; hyperglycemia feels different for everyone. “Not everyone will have the same symptoms, and some individuals have no symptoms at all,” says Lori Zanini, RD, CDE, a diabetes educator and former spokesperson for the Academy of Nutrition and Dietetics. Because blood sugar management is so important to your overall health with type 2 diabetes, you need to take action if you think your levels may be out of control. “Symptoms of uncontrolled diabetes may not appear until prolonged hyperglycemia has been present, explains Mary Ann Emanuele, MD, an endocrinologist, professor, and medical director of inpatient diabetes at Loyola University Medical Center in Maywood, Illinois. “It’s important for individuals with diabetes to monitor their glucose and adjust their medication based on the results.” Keep an eye out for these seven key warning signs and symptoms that blood sugar is too high — and talk to your doctor about whether you need to adjust your management plan. Being Extra Thirsty and Having to Urinate More than Usual This is a common but not so obvious sign of blood sugar that is too high: feeling really thirsty and needing to drink more than usual. “Excessive urination, known as polyuria, occurs when glucose builds up in your blood, and your kidneys begin working harder to get rid of the extra glucose,” Zanini says. If your kidneys can’t keep up and adjust blood sugar so that it returns to a normal level, the excess sugar is flushed out of your body through urine, she adds. You may become dehydrated and get dizzy. You’re Hungrier than Usual, but Losing Weight Many people with uncontrolled high blood sugar find that they’re particularly hungry — a symptom known as polyphagia, according to the Nemours Foundation, a nation-wide nonprofit organization dedicated to children’s healthcare. And even though you’re eating more, you may be losing weight for no apparent reason, if your blood sugar levels are too high. “Since your body is not getting energy from the preferred source, glucose, it has to turn to muscle and fat,” Zanini explains. “When your body starts breaking down muscle and fat for energy, you experience unintentional and unhealthy weight loss.” In addition to these changes in weight and appetite, you may notice weakness in your muscles and experience more frequent falls, Emanuele adds. Tiredness and Fatigue Fatigue and extreme tiredness are symptoms of uncontrolled blood sugar that you might not think are being caused by type 2 diabetes, the American Diabetes Association (ADA) says. “Simply put, when your body is not processing insulin properly or it doesn’t have sufficient amounts of insulin, the sugar is staying in our blood rather than getting into our cells to be used for energy,” Zanini says. Blurry Vision You may notice that your vision isn’t as clear as it used to be and that things may appear a bit blurry. High blood sugar levels can lead to swollen lenses in your eye from fluid leaking in, according to the Joslin Diabetes Center in Boston. This changes the shape of the lens, which makes it unable to properly focus, causing blurred vision. You may also find yourself having difficulty driving, struggling at work, and suffering from frequent headaches, Emanuele notes. Sores That Heal Slowly Cuts, scrapes, bruises, and other wounds heal more slowly because of uncontrolled blood sugar, according to the University of Maryland Medical Center. Diabetes causes nerve damage and affects circulation, especially in the lower legs and feet, which can slow down healing because there isn’t enough blood flow to the area, according to the American College of Foot and Ankle Surgeons. Even minor wounds are more prone to infections, which can become very serious and even result in amputations of the foot. You may notice drainage seeping onto your socks or an unpleasant smell if you develop a foot ulcer, notes the American Podiatric Medical Association. Unusual Changes in Your Skin Small pieces of extra skin, called skin tags, may form in the creases of skin, especially if you have diabetes and you’re trying to find ways to manage your weight, notes the American Diabetes Association (ADA). Dark, thick areas of soft skin (called acanthosis nigricans) may form on the back of the neck or hands, armpits, face, or other areas. These can be a sign of insulin resistance, Zanini says. Blisters, infections, and other discolorations and abnormalities of the skin can all be warning signs of high blood sugar. Check with your doctor if these skin changes develop. Tingling and Numbness in Your Hands or Feet Uncontrolled blood sugar can cause nerve damage called diabetic neuropathy. What you may notice is a tingling sensation or even numbness in your hands and feet, according to the National Institute of Diabetes and Digestive and Kidney Diseases. Some people experience pain in their hands and feet as well. Though neuropathy is most common in people who have had diabetes for a long time, it can occur in anyone with poorly controlled diabetes.
For optimum heart health, the American Heart Association recommends 30 minutes of moderate to vigorous aerobic exercise on most days of the week. If you can't get in 30 minutes all at once, you can divide your exercise routine into 10- or 15-minute segments. "Aerobic exercise improves heart and lung fitness and can impact many of the risk factors for heart disease," says Deb Sampson, RN, BC, clinical coordinator for cardiac rehabilitation at the Nebraska Medical Center in Omaha.
Walk It Out for Heart Health Number one on the top 10 for aerobic exercise is walking. Walking is enjoyable, safe, inexpensive, and easy to fit into almost anyone's busy day. You can get in walking time by walking to work, walking to the grocery store, and walking around your neighborhood. Aerobic exercises are those that use large muscles in a continuous, rhythmical manner over time, and walking is a great example of that, says Sampson.
Exercise at Home by Climbing Stairs To get the maximum heart health benefit from any aerobic exercise, aim to reach between 50 and 85 percent of your maximum heart rate. Climbing stairs is an easy way to get into that target range, whether you do it at home or at the gym on a stair machine. To find your maximum heart rate, subtract your age from 220. If you don’t want to stop to count heartbeats, you can assume that you’re in your target rate if you can carry on a conversation while exercising without being too out of breath.
Go for a Bike Ride The pumping motion of the large muscles in your legs is a great aerobic exercise for your heart. Either a road bike or a stationary bike will work for this exercise routine. Pedaling at home on a stationary bike can get you on the road to heart health when it’s too cold or too wet to cycle outside. The position of the seat and pedals are important to prevent injury when biking, so make sure your bike is properly adjusted for your body.
Take a Swim Swimming is one of the best aerobic exercises around and the third-most popular sports activity in the United States, according to the U.S. Centers for Disease Control and Prevention. Two and a half hours of swimming per week will give you all the aerobic heart health benefits you need. Another advantage of this exercise routine is that swimming puts less stress on your bones and joints. That can be especially beneficial if you’re starting out a little overweight or have a joint condition such as arthritis.
Go for a Spin on the Elliptical Machine Elliptical training machines are one of the fastest-growing aerobic exercise options. These machines are found in most fitness centers and are increasingly being purchased for exercise at home. The advantage of an elliptical machine for heart health is that it gives you both an upper- and lower-body workout at once. The elliptical leg motion mimics running with the lower impact of cycling. At the same time, the rhythmic arm movements get blood flowing to your back and shoulder muscles.
Dance to Your Heart's Content Dancing your way to heart health makes for a rhythmic and aerobic exercise routine. All you need is good footwear, some space, and music that motivates you. A good aerobic beat is about 120 to 135 beats per minute. Dancing can range from high impact to low impact depending on your ability and preference, and you can dance with others in a class such as Zumba or exercise at home by yourself.
Chill Out With Tai Chi According to a recent survey from the National Institutes of Health, 2.3 million adults in America used tai chi as a low-impact aerobic exercise routine in the prior year. Tai chi is an ancient Chinese form of exercise based on the martial arts. It uses slow rhythmic body movements combined with deep breathing and concentration, which is why it’s also called a "moving meditation." This exercise routine is great for both mind and body, including heart health.
Stay Fit at Home With Wii Fit Playing interactive video games is a great option for exercise at home. Studies show that Wii Fit boxing, tennis, and bowling could increase your heart rate enough to qualify as aerobic exercise. "The American College of Sports Medicine states that Wii Fit does provide an effective form of exercise," says Sampson. Remember that to meet physical activity guidelines, you will need to play for about 30 minutes five days a week.
Make a Splash With Water Aerobics Like swimming, water aerobics offers the heart-health benefits of a good aerobic exercise workout without causing as much stress on the joints as other exercise routines might. If you have conditions such as arthritis, knee pain, or are overweight, water aerobics may be the perfect exercise for you. Water exercises have been shown to improve the use of joints in people with arthritis without worsening symptoms, according to the Centers for Disease Control and Prevention.
Other Great Benefits of Aerobic Exercise It’s hard to find any other lifestyle habit that offers as many benefits as aerobic exercise. “Regular aerobic exercise helps control blood pressure, reduces stress and depression, improves cholesterol levels, helps weight loss and maintenance, decreases diabetic blood sugars, increases muscle and bone strength, and helps prevent blood clots,” says Sampson. Pick an aerobic exercise you can enjoy and stick with, and you’ll reap the benefits in more ways than you can imagine.
Keeping blood sugar within healthy ranges is important with diabetes. Here's how to watch for and manage both high and low blood sugar levels. By Karen Appold Medically Reviewed by Bhargavi Patham, MD, PhD One of the challenges of managing diabetes is maintaining consistent blood sugar (glucose) levels. Even with diligence, some situations can cause high blood sugar, or hyperglycemia, while others can bring on low blood sugar, or hypoglycemia. So it’s important to know the signs of both high and low levels, and what actions to take to bring them back within a desired range. Monitoring your blood sugar levels with a glucose meter will do a lot to help you keep those levels steady and avoid the complications that can come with diabetes. According to the Mayo Clinic, how often you check your blood sugar level depends on many factors, including your age, the type and severity of your diabetes, the length of time that you've had the condition, and the presence of any diabetes-related complications. About High Blood Sugar (Hyperglycemia) Common signs of high blood sugar include frequent urination, fatigue, dry or itchy skin, feeling thirsty, more frequent infections, and eating more food but not gaining as much weight as usual, says Athena Philis-Tsimikas, MD of the Scripps Whittier Diabetes Institute in San Diego, California. A blood sugar reading above 180 milligrams per deciliter (mg/dL) is considered above normal and can bring on these symptoms, although it’s possible to have high blood sugar without any symptoms, Dr. Philis-Tsimikas says. A reading above 300 mg/dL is considered severe. If your blood sugar is above 250 mg/dL for two days, Philis-Tsimikas advises informing your doctor and asking for specific treatment recommendations. Blood sugar levels above 300 mg/dL can cause nausea, drowsiness, blurred vision, confusion, and dizziness, especially when standing up from a sitting or lying position. Ways to treat high blood sugar include: Taking your prescribed medications as directed Eating fewer carbohydrates with your meals Exercising regularly with your doctor’s guidance About Low Blood Sugar (Hypoglycemia) When your blood sugar drops rapidly, or when the reading is 70 mg/dL or below if you take medications for diabetes, you may experience symptoms of low blood sugar such as shaking, sweating, rapid heartbeat, headache, hunger, weakness, fatigue, impaired vision, anxiety, irritability, and dizziness. Blood sugar values that drop below 70 mg/dL are considered severe and can lead to more significant and dangerous issues such as difficulty concentrating, confusion, loss of consciousness, seizures, and even death. If you experience more than two blood sugar readings below 70 mg/dL in a week, notify your doctor and go over your treatment plan. To treat blood sugar below 70 mg/dL, Philis-Tsimikas recommends one of these options (only one at a time): Drink 1/2 to 1 cup of juice, skim milk, or regular soda OR Chew five to six hard candies OR Take four glucose tablets OR Swallow one tube of glucose gel Then, check your blood sugar in 15 minutes. If it’s still below 70 mg/dL, consume more sugar. If your symptoms don’t stop, call your doctor or seek medical attention. If your blood sugar returns to normal, be sure to eat at your next scheduled meal or snack .
Many illnesses sometimes present with symptoms that are so subtle those experiencing them don't immediately suspect a problem, and diabetes is no exception. In fact, complications can outpace the appearance of symptoms, which is why it's important to detect and treat it quickly.
A Burgeoning Medical Reality : Diabetes is a metabolic disorder affecting nearly 10 percent of Americans. Costs related to the condition reached $245 billion in 2012 compared to $174 billion spent in 2007. Matt Petersen, the American Diabetes Association's managing director of medical information and professional engagement, attributes this rise partially to an aging population and obesity currently at epidemic levels. "I know of no other disease that's increasing at (about) 8 percent per year." Complications from diabetes may be serious and range from kidney failure to leg and foot amputation from infections in those areas. Keeping your blood glucose (blood sugar levels stable and under control, along with healthy eating habits, is key to preventing these and other problems such as heart disease, blindness, and arm and leg neuropathies from nerve damage caused by cells receiving insufficient amounts of oxygen. Diabetes occurs in two different primary forms. Normally, the pancreas, a gland found behind the stomach, secretes insulin, a hormone that moves glucose into the cells. In Type I diabetes, an autoimmune condition, develops when the body attacks the only cells in the body that produce insulin, pancreatic beta cells. The primary risk factor for Type 1 is a parent or sibling with the disease. In Type II diabetes, insulin is present, but the body does not respond to or process it efficiently. An analogy to illustrate the two types of diabetes: Imagine a gas pump with no gasoline supply or a pump that has gasoline but a malfunctioning delivery system. Neither can effectively fuel your car. Here are 10 significant diabetes symptoms to be aware of: If you experience any of these, see your doctor: Frequent Urination : Excess sugar buildup in your bloodstream forces your kidneys to work harder to filter and absorb the overload. When it begins accumulating faster than the kidneys can filter it, that sugar, along with fluid from tissues gets excreted into urine, triggering more frequent trips to the restroom. Another Gallon of Water, Please : Excessive thirst is a secondary accompanying reaction to dehydration brought on by excessive urination. This can turn into a troublesome, self-perpetuating pathology cycle. As dehydration from tissue fluid loss increases thirst and volume of liquid consumed, the more fluid lost through increased urine output. Can 't See Straight? See An M.D.: Blurry vision can occur when excess sugar pulls fluid from the lenses of your eyes. This process can adversely affect the ability to focus and trigger retina-damaging new blood vessels. Floaters also can appear. Although experiencing vision changes at an early stage of diabetes is unusual, vision loss and blindness are possible but usually avoidable outcomes unless the condition goes undetected. Gum Pain, Soreness and Swelling : Diabetes may impair or weaken the ability to fight off infection, and this can manifest in gums and the bones that secure the teeth. Loosened teeth, receding gums and pus can form in pockets created by periodontal recession. Feeling Fatigued? Dehydration from increased urination can cause sufferers to feel tired. When the body is less able to use sugar for energy, fatigue is often the result. Losing weight without trying? Always hungry? : Urinating frequently carries sugar out of the body, and malfunctions related to diabetes may block the cells' ability to access the sugar in what is eaten, causing constant hunger. Rapid weight loss can result from this combination, particularly if Type 2 diabetes is the diagnosis. Slow sore and wound healing may indicate the body's ability to fight off infection is weakened. Patches of Darkened Skin : Occurring in the body's creases and folds such as the armpits and neck, the condition acanthos nigricans manifests as patches of velvety, darkened skin and can be a sign of insulin resistance. Hyperglycemia or High Blood Sugar: Early symptoms can present as a bundle of the diabetes signs mentioned earlier, including increased thirst, frequent urination, fatigue, blurred vision and headache. When farther along, some hypoglycemia signs include shortness of breath, nausea and vomiting, dry mouth, fruity-smelling breath, abdominal pain, weakness, confusion and coma. Other Indicators Tingling/numbness in hands or feet : Frequent yeast infections ; Irritability or mood changes : Facing a disease that needs constant management and vigilance is an arduous feat for the staunchest of souls. But exciting discoveries that more effectively treat this tough condition are well underway. Currently, UK researchers are studying advances in the use of an artificial pancreas in treating Type 1 diabetes. There's no question diabetes requires significant lifestyle adjustments and increased attention to health, but understanding how effectively it can be controlled can go a long and encouraging way. Two examples in particular stand out. Actor Tom Hanks was recently diagnosed with Type 2 diabetes. He told Yahoo Movies, “I have high blood sugars, and Type 2 diabetes is not going to kill me. But I just have to eat right, and exercise, and lose weight, and watch what I eat, and I will be fine for the rest of my life.” Television personality Sherri Shepherd also calls attention to the beneficial effects of nutrition and getting fit in treating diabetes. “I am a type-2 diabetic, and they took me off medication simply because I ate right and exercised. Diabetes is not like a cancer, where you go in for chemo and radiation. You can change a lot through a basic changing of habits,” Shepherd said in an interview with Essence.