The Exceptional Family Member Program (EFMP) provides care and services for military families with special needs – whether that is an adult or child. The program has served over 55,000 Army EFMP family members across a total of 32 locations within and outside of the continental U.S. In this Q&A with Magellan Federal senior program analyst Brandon Greenwood, we learn more about the important work with special needs families.

How does EFMP work?

Greenwood: There are three components to EFMP: Medical, Human Resource Command HRC(Assignments), and Family Support. Magellan System Navigators fall under the Family Support umbrella where we offer non-clinical case management to our clients. We provide support to soldiers and their dependents to make their transition to and from their duty stations as seamless as possible all the while providing support groups, educational workshops, Individualized Education Plans (IEP) assistance, and bringing exciting and inclusive special events to our population.

What are System Navigators?

Greenwood: System Navigators take the guesswork out of locating services in a brand-new environment for our clients, by forming relationships with community partners and service providers and connecting them to our service members and their families.

Clients are encouraged to collaborate with their Systems Navigator (SN) to create a service plan so that their individual goals are taken into account. A goal for our SNs is for them to empower our families to be the best advocate for their Exceptional Family Members as they can. We want to equip them with as many tools and as much knowledge about EFMP as possible so when they relocate, they are better prepared and informed for what may come.

How does this help families with children?

Greenwood: Our Systems Navigators also assist families with a dependent who has a special educational need with their Individualized Education Plans. SNs are trained in Wrightslaw Special Education and are able to educate parents and caregivers about their child’s IEP, point out inconsistencies, correct language that may not be beneficial to the child, and also attend the meeting with the family in a support role.

Wrightslaw is a training course that provides the knowledge build-up for Special Education Law and Advocacy.  It helps the System Navigator to better understand the challenges our EFMP families experience each day in the school system.

Our SNs play a large role in the planning and execution of special events. There are several events across all our military bases, however, most of those events aren’t inclusive for those with special needs. The EFMP family support program, along with the help of our SNs, create themed special events that are sensory-friendly and created with our EFMP families in mind. These events have become so popular that many sites have made them open to the entire base.

How can someone get connected to the EFMP?

Greenwood: To learn more about EFMP and the support available to your family, reach out to your local EFMP Family Support office. EFMP Family Support providers play a critical role in providing information, referral, family needs assessments, and family service plans to help you achieve the goals that are unique to your family.

Source: MilitaryOneSource

Within the fascinating experience that is life, change is a continual occurrence, and an example of ongoing change is that which is experienced through loss. Humans experience loss in many ways, commonly through the death of a loved one or the end of a relationship. A key component of loss is grief.

Grief is a personal process connecting the emotional, social, and physiological realms and is closely tied to overcoming the crisis that comes with loss. For some, grief may be a time involving self-acceptance and self-discovery, while for others, it may be a time of isolation and denial of reality. No matter how it is experienced, it is a journey of mental, emotional, and relational readjustment that may substantially alter a person’s daily life.

Professional counseling can help those experiencing loss and grief identify internal and external resources available to them promotes empowerment, a sense of community, and encourages grieving in healthful ways. Below are tips to support those struggling with loss while also incorporating self-care practices.

Grief Guidance

• Acknowledge grief is a personal experience and listen to the person without an agenda.
• Honor the grief someone is experiencing while being prepared to give the person space.
• Learn what spiritual practice or creative outlet allows the person to connect with their sense of meaning and purpose, then make recommendations accordingly. Not everyone will feel comfortable drawing or journaling.
• Observe how the person is moving through the grieving process and refer as needed. Some may seek a spiritual approach, while others may benefit from a grief counselor if they require more specialized care.
• Maintain self-awareness. Ask yourself, “How does dealing with someone grieving make me feel?” “Does it trigger any personal memories?” “To what extent can personal issues be distracting?”
• Be respectful of the person’s grieving and don’t turn encounters into interrogation sessions. Through self-awareness one may realize addressing someone’s grief can be anxiety provoking.
• It is okay to respond with, “I don’t know”.
• Grief counseling can trigger emotional reactions that may be new and uncomfortable. If this occurs, don’t hesitate to seek support from a trusted person.

Grief Resources for Military Families

One very important component when addressing the process of loss with someone is that, similar to a crisis, the grieving individual may not have the frame of mind, the peace, or the support to address even the most essential basic needs. It may feel as if with the loss comes a loss of connection and where to look for help. Having an advocate who is attuned with the resources available within the military community can be a game changer. The Military & Family Life Counseling (MFLC) program is available to all service members and families for on-installation support with a number of life’s challenges through free, short-term, confidential non-medical counseling. MFLC counselors can help bridge the gap between the grieving person or family and the different agencies that can provide resources to aid during times of despair. Start by contacting your installation’s Military and Family Support Center for more information on the MFLC program. Reaching out for help and resources is an essential element in the process of healing and recovery from loss.

According to the National Institutes of Health’s (NIH) National Institute on Alcohol Abuse and Alcoholism, alcohol contributes to more than 200 health conditions and about 99,000 deaths in the U.S. each year.[1] According to the CDC, one in six adults in the U.S. binge drinks with 25% doing so at least weekly.[2]

April is National Alcohol Awareness Month, which is a time to increase your personal awareness about alcohol abuse and alcoholism and to recognize these disorders, which can be treated.

Magellan Federal’s Senior Manager in the Adolescent Support & Counseling Services (ASACS), Allison Welliver, LMHC, MCAP, shares her insights on why this month is important. Welliver is a licensed mental health counselor and a master’s level certified addiction professional.

Q: Why is National Alcohol Awareness Month important?

Allison Welliver: National Alcohol Awareness Month is important because it brings awareness to alcohol abuse and dependency and allows people to be screened to see where their use of alcohol falls (low, moderate, or high risk for alcohol abuse or dependence). It also allows people to see how their use of alcohol compares to alcohol use by other people of the same age and sex.

Since alcohol is a legal drug, and so often used in social situations and celebrations, it can be difficult to see when alcohol abuse is happening.

Q: What are signs that someone is addicted to alcohol?

AW: Signs of dependence on alcohol can be behavioral/social or physical. Behavioral/social signs include secretive use, heavy drinking, drinking alone, drinking at inappropriate times of the day (in the morning), and continuing to drink despite the negative impact it has on your relationships, job, and health. Physical signs may include developing a tolerance, developing the “shakes” when not drinking alcohol, disrupted sleep, lethargy, or headaches, and needing a drink to alleviate negative symptoms.

Q: What is the connection between this addiction and mental health?

AW: Addiction and mental health problems are frequently comorbid, meaning that they often occur at the same time. It is a question of which comes first – does the mental health problem cause the addiction or vice versa? Many times, people turn to alcohol or other drugs to cope with mental health concerns that they are having. They could use alcohol to cover up depression or other pain underneath.

Q: What are some steps someone should take if they recognize they need help and what does Magellan offer to support someone who is dealing with alcohol addiction?

AW: First, reach out to a therapist. A therapist can evaluate your use and determine what setting is best to treat your alcohol use. Surround yourself with a positive, supportive network who understands that you need help. You may identify support through connecting with your company’s Employee Assistance Program (EAP), if one is available to you. When contracted with an employer, Magellan offers EAP services to employees and their household members who may question if their use is abnormal, or if they have been having problems related to drinking. EAP services, including counseling, are free and confidential.

Q: Is there anything you would like to add or any resources you want to provide?

AW: There is a free online screening tool that anyone can use to gauge their level of alcohol use. https://alcoholscreening.org/

Additional Resources

• NIH Rethinking Drinking
• Work Stress and Drinking: A Vicious Cycle?
• How to say no to drugs and alcohol
• Maintain Your Recovery During the Pandemic

[1] Helping Your Patients with Alcohol-Related Problems: https://www.niaaa.nih.gov/health-professionals-communities/core-resource-on-alcohol?utm_source=twitter&utm_medium=social&utm_campaign=jul-2022

[2] Centers for Disease Control and Prevention: https://www.cdc.gov/alcohol/fact-sheets/binge-drinking.htm

Discussions about mental health in the Black community shouldn’t be limited to Black History Month in February and BIPOC Mental Health Awareness Month in July. The conversations and action steps geared toward providing education, support, and resources require a year-round effort.

A recent article published by the Kaiser Family Foundation, shares that although Black people have made great contributions and achievements in the United States, “they continue to face many health disparities that adversely impact their overall health and well-being,” which have been “exacerbated by impacts of the COVID-pandemic, ongoing racism and discrimination, and police violence against and killings of Black people.”

What impact do these factors have on the mental health of individuals in the BIPOC community? Magellan’s medical director Rakel Beall-Wilkins, M.D., MPH shares her perspectives on depression and suggestions on ways to be supportive.

What is depression and what are some signs or symptoms?

Dr. Beall-Wilkins: Depression is a clinical illness characterized by:

• Prolonged periods of low or sad mood.
• Loss of interest or pleasure in activities.
• Changes in appetite, sleep or energy levels.
• Feelings of worthlessness or hopelessness.
• Thoughts of death or suicide.

Depression can be caused by medical illness, substance abuse, and stressful social, academic, or occupational situations, but it can also develop more readily in individuals who have a family history of depression or other mental health conditions.

Other signs of depression may include:

• Withdrawing from social activities, relationships, or hobbies.
• Escalating drug or alcohol use.
• Declining self-care in the form of poor personal hygiene and grooming.
• Expressing feelings of hopelessness, worthlessness, and/or helplessness.
• Neglecting to attend to chronic medical conditions or maintain follow-up with healthcare providers.

How does depression impact individuals in the Black community?

Dr. Beall-Wilkins: As of 2020, the National Survey on Drug Use and Health found that 6% of Black American adults and 12.9% of Black American adolescents experienced a major depressive episode within the last year. Despite increasing levels of depression within the Black community, studies also show that Black Americans are less likely than their White counterparts to receive psychotherapy or medications for their depressive symptoms. This disparity is largely attributed to limited access to healthcare coverage and culturally competent behavioral health providers, as well as pervasive cultural stigma.

Is it possible for someone to experience depression that is triggered by external factors and societal issues, such as violence, police brutality, political unrest, and racism? If so, how?

Dr. Beall-Wilkins: Yes, it is possible for depression to develop as a result of exposure to sociopolitical strife. In fact, during the week following the highly publicized death of George Floyd in May 2020, rates of depression and anxiety spiked from 36 to 41% among Black American respondents to the Census Bureau’s 2020 Household Pulse Survey.

Likewise, a 2018 study published in The Lancet found that police killings of unarmed Black Americans resulted in an increase in poor mental health days among Black American respondents. Though they may not know the victims of these circumstances personally, it is very common for Black Americans to collectively internalize the trauma of these events and feel despair over the possibility that a similar fate could befall them or their close family members and friends. Moreover, the repeated nature of these events can elicit sadness, hopelessness, and fear that things will never change.

What are tips for an individual that recognizes they are showing signs of depression?

Dr. Beall-Wilkins:

• Visit your doctor and seek treatment: Regularly follow up with a primary care provider to ensure there are no untreated or undertreated medical conditions that may contribute to the development or worsening of depressive symptoms.
• Stay connected: Stay connected to close friends, family, and spiritual community for support.
• Diet and exercise play a role: Eat a balanced diet and engage in physical activity for at least 30 minutes a day, three times per week.

Resources:

• National Alliance on Mental Illness’s (NAMI) cultural dimensions website for BIPOC/AAPI communities.
• DSM-5 (American Psychiatric Publishing, Copyright 2013 (American Psychiatric Association) 
• Stanford University 
• Anxiety and Depression Association of America 

What is it and how to get started

Mindfulness has become a popular topic over the last decade, and for good reason. A growing body of research is showing incredible health, performance, and relationship benefits to adopting the practice. But what exactly is mindfulness and how does one practice it?

Mindfulness is a particular way of focusing on the present moment without judgment. It is a skill, a practice, and a state that helps counteract our brain’s natural tendency to time travel back into the past or ahead into the future. Being in the present moment more often is what enables us to build meaningful relationships and perform at our best.

Unfortunately, most of us are more familiar with not being in the present moment. Research suggests we spend nearly 50% of our time thinking about something other than what we are doing. It’s when you arrive home from work excited to see your family and just as you sit down at the dinner table you remember an email you forgot to reply to and suddenly you’ve missed your kid sharing the best part of their day. Or it’s the moment you’re at work trying to focus during a meeting and your mind wanders back to an argument you had with your spouse that morning. It can also be the moment when you are sitting down to finish a report, but you begin daydreaming about your upcoming vacation. And it’s a hundred moments in between.

Understanding Mindfulness
Mindfulness is the practice of catching our minds when they wander and intentionally bringing them back to where we are—put simply: it’s the practice of being present. The more we practice, the more quickly we’re able to reestablish our mind in the present moment before it impacts relationships or performance.

To be truly mindful is to be able to recognize as your mind wanders away from the here and now, accept the wandering, and recenter your mind back to the present to be where your feet are.

Mindfulness has a long and rich history dating back more than 2,500 years. While this may activate images of ancient monks in stillness and solitude, in the last 15 years, an enormous amount of rigorous research has been conducted supporting the benefits of a mindfulness practice—many that are particularly relevant to thriving in our fast-paced, always-on culture.

Mindfulness Benefits
Mindfulness has been shown to act as a buffer against cognitive anxiety, improve memory and learning, improve sleep, and reduce fatigue. It is also associated with increased frequency in optimal performance states, improved performance in high-intensity contexts, and better regulation of emotion and stress. Importantly, these benefits can be realized without spending hours upon hours a day in silent meditation. Mindfulness training research suggests that 8-20 minutes a day is all you need to see meaningful benefits. If you want a more exact prescription, Dr. Amishi Jha, one of the leading mindfulness researchers, has determined that 12 minutes a day, five days a week is the most effective “dose.” It balances what time-pressed people will actually commit to and it benefits their attention.

Getting Started
Magellan Federal is the world’s largest single employer of professionals with specialized training in performance psychology coaching. Our cognitive performance coaches have delivered education and training to more than 2.7 million within the Army population in the past five years. Here are some simple exercises our coaches teach to help build positive mindfulness habits:

• Practice 1 minute of mindful breathing. Set a timer for one minute and simply turn your attention to your breath. What does it feel like to inhale? What does it feel like to exhale? Try pausing at the top and bottom of each breath. If you find 1 minute too easy, aim for 3 minutes or more.
• Practice mindfulness during everyday activities. For example, while washing the dishes focus on the temperature of the water, the slipperiness of the soap, the sound of the dishes. Every time your mind wanders to something else (as it naturally will), gently guide it back to the dishes. Surprisingly, even for menial tasks like dishes, people who focus on the task, instead of daydreaming, report greater levels of happiness.
• Conduct a brief body scan. Find a quiet place to sit, start with a few mindful breaths, and then turn your attention to your body. Start at the top of your head and work downward, just noting what your body feels like. Don’t get stuck in any particular place; just notice comfort or discomfort and move on until you get to your toes. Finish with a few mindful breaths.

Know that as you try any of these activities, your mind will wander; it is completely natural. Mindfulness is the practice of gently bringing your mind back to your target. Each time your mind wanders, think of it as a repetition to strengthen the skill of returning to the present moment.

Making it Stick — Find or Build a Community of Support
Like most new habits, developing a mindfulness practice can be tricky. Research has shown that learning with and from others on a similar path has a staggering effect on success.

Magellan Federal believes in a human-centered approach when building new habits like mindfulness. We are currently developing a solution that models the success we have found through our work with the Army, which will incorporate live coaching sessions and a community of support to further enhance successful habit change. Finding or building a group or partnership that supports your mindfulness goals and offers encouragement and motivation along the way will make you more likely to succeed in creating mindfulness habits that stick. You might consider adding a mindful minute with your family before dinner, starting a team meeting with a mindfulness practice, or finding your own unique way to build community around mindfulness practice.

Learn More
Magellan Federal’s holistic approach seeks to help people not only improve performance, but health, relationships, and culture—and mindfulness is a key piece of the puzzle for many people. If you are Interested in starting a mindfulness practice or connecting to a community of support, contact us today.

Article originally published on MFed Inform.

In 2019, Time magazine listed virtual reality (VR) as one of the 12 innovations that will change health care and medicine in the 2020s. With this projection, the probability that you will use VR sometime in your life is high! VR is currently being used in a variety of fields, including

• Mental health
• Pain management
• Rehabilitation
• Training and education

VR is not a fad, as studies are underway for its potential efficacy to treat Alzheimer’s disease, depression, addiction, and other illnesses. This new field of medicine collectively referred to as medical extended reality (MXR), encompasses VR and augmented reality (AR). There are many aspects in the VR landscape including safety, regulations, and value to name a few. Let’s dive in and explore some of the clinical uses of this emerging trend.

Pediatric Intervention
Children are often under-treated and under-recognized when it comes to managing pain, fear, and anxiety. Thus, VR is utilized in children’s hospitals, such as Stanford Children’s Health, to engage and distract children during painful procedures. At the Lucile Packard Children’s Hospital Stanford, VR is used in several ways to reduce pain and stress, including the use of AR goggles for patients in the pre-op so they can watch movies and play games prior to surgery, and the use of VR games in the intensive care unit (ICU).

Mental Health Treatment
With an estimated 52.9 million adults suffering from mental illness in 2020 according to the Substance Abuse and Mental Health Services Administration (SAMHSA), one of the biggest challenges today is the rising demand for mental health treatment and a shortage of available providers. As another tool to tackle mental health conditions, VR now contributes to the availability of additional resources.

The use of VR software simulates real-world settings that closely resemble the surroundings of daily life so that triggering stimuli such as anxiety, paranoia, fear, and cravings can be assessed and treated. Anxiety disorders are already being treated using virtual reality exposure therapy (VRET) as a potentially scalable tool. In addition to anxiety-like disorders, VR is being studied for several other disorders.

There is evidence that VRET reduces post-traumatic stress disorder (PTSD) symptoms, with sustained improvements at six and twelve months after treatment. Among children with autism spectrum disorder (ASD), a recent research initiative demonstrated that VR combined with cognitive behavioral therapy (CBT) improved specific phobias. For seniors who suffer from social isolation, Rendever has developed a VR platform designed to reduce depression and loneliness.

Chronic Pain Treatment
A Centers for Disease Control and Prevention (CDC) survey in 2019 found that 20.4% of US adults have experienced chronic pain. Persistent pain is linked to depression and anxiety and can become an overlapping symptom.

In a study conducted by Cedars Sinai, VR reduced hospitalized patients’ pain scores by 24% and was most effective for patients with severe pain. In November 2021, a prescription medical device (RelieVRx) was authorized by the US Food and Drug Administration (FDA) as the first at-home VR therapeutic as an adjunct to treat chronic lower back pain.

Virtual Rehabilitation
While the benefits of physical therapy have long been established, some patients who would benefit from PT do not have access to it. In recent years, VR rehabilitation has been gaining traction with a host of conditions from chronic pain, stroke, and Parkinson’s disease to multiple sclerosis, dementia, and cerebral palsy. VR-assisted rehab may offer advantages for patients such as improved patient engagement and motivation, poststroke functional recovery, and improved mobility in Parkinson’s patients.

Training and Education
It can be challenging for educators to meet learning objectives through standardized medical training, especially as healthcare systems evolve. VR training and education, allow personnel, students, and residents to learn in a controlled environment while minimizing risks to real patients. As a result, VR systems are increasingly used in hospitals to train residents, assist surgeons with surgical planning, and educate patients. In a UCLA study, participants using the Osso VR platform significantly improved their overall surgical performance compared to conventional training methods.

Health Inequities
The healthcare system continues to be affected by structural racism, affecting the well-being of all people, especially those who have historically been marginalized. The use of VR as a training tool is currently being explored for a better understanding of the cultural needs of patients, with the possibility of VR becoming a tool for increasing empathy and giving people a broader perspective when interacting with individuals of different racial and economic backgrounds.

With VR technology developing at record speed and its potential to transform healthcare, we are keeping VR on our radar. We encourage you to learn more about VR and the world of MXR by visiting our website to explore our latest white paper: Virtual Reality – An Emerging Paradigm in Healthcare

This is just the beginning!

Written by Noushin Izadifar Hart, MD

As the second leading cause of death among U.S. women, most of us know someone who has or have experienced breast cancer ourselves. One in eight of us will develop it in our lifetime, and every 13 minutes one of us dies from it. Understanding breast cancer and early screening can increase survival and help us all live happier, healthier lives, including men, who have a 1 in 833 lifetime risk.

What factors increase my breast cancer risk?

In women, the risk of breast cancer increases with age, with the average woman being diagnosed at age 63. Other contributing factors are:

• Personal and family history of breast cancer, including ductal cancer in situ

• Benign (non-cancerous) breast conditions, including lobular cancer in situ

• Radiation treatments to the chest before age 30

• Physical inactivity, alcohol use and obesity

• Inherited gene mutations

• Risk factors for men are similar, and also include liver disease, Klinefelter’s syndrome, estrogen treatment and testicular conditions.

What are the signs and symptoms of breast cancer?

Breast cancer is caused by a growth of abnormal cells in the breast, which should die but don’t. It is often found when a new lump or mass is discovered. Signs and symptoms of breast cancer include:

• Lump or mass in the breast area

• Persistent changes to the breast, including:

Skin thickening
Nipple abnormalities/discharge
Skin redness or swelling

While most early-stage breast cancer does not have symptoms, it is important to quickly identify any changes to your breasts.

How do I screen for breast cancer?

Monthly self-breast exams are one way you can detect any breast changes that may need to be reported to or discussed with your healthcare provider. Self-screening is easy to do and can be incorporated into a regular routine. Learn how here.

Yearly mammograms are another way to identify any abnormalities. These low-dose breast X-rays are used to set a baseline and determine if changes have occurred. From 1989 to 2019, mammograms decreased breast cancer death rates in the U.S. by 42%. The American Cancer Society recommends the following mammography screening guidelines for women:

• 40-44 years old—Option of yearly mammograms
• 45-54 years old—Yearly
• 55 years and older—Yearly or every other year, and continue with overall good health and a life expectancy of 10 or more years

If you have a higher risk of developing breast cancer, you should create a screening plan based on your family history and risk level with your doctor, regardless of your age. This may include adding magnetic resonance imaging as part of regular screening.

What advancements are being made in breast cancer screening?

The FDA recently approved, iSono Health wearable 3D breast ultrasound, an automated whole-breast ultrasound system and intuitive software for image acquisition and analysis. The 3D breast ultrasound unit can automatically scan and analyze your entire breast in under two minutes. This unique system does not require a trained sonographer (someone who uses imaging equipment and soundwaves to form images of parts of the body) and allows for 3D visualization of the breast tissue. Breast ultrasound is a useful supplement to mammography to improve breast cancer detection in women with dense breasts. This system has the potential to improve breast cancer screening worldwide, especially in countries with limited resources.

Currently, iSono Health is conducting prospective case studies to validate the deep learning software that aids clinicians in localization and classification of breast lesions. This up-and-coming technology made for point-of-care physicians should be monitored by healthcare professionals as it could potentially be performed during an in-office visit by a breast surgeon or gynecologist.

What treatment options are available if I am diagnosed with breast cancer?

The earlier a diagnosis is made, the greater the options for treatment. This is another reason why self-screening and yearly mammograms are so important. Healthcare providers review each case for individual factors that assist in selecting the best treatment plan for each patient. Treatment options include the following, or a combination of them.

• Surgery to remove breast cancer involves two main types:

Breast-conserving surgery, also known as a lumpectomy, quadrantectomy, partial mastectomy or segmental mastectomy, is used to remove the part of the breast containing the cancer. It depends on where and how large the tumor is, as well as other factors, how much breast is removed. Sometimes surrounding normal tissue may also be removed as a precaution.

Mastectomy involves removing the entire breast, including the breast tissue and sometimes adjacent tissues. Some individuals may have both breasts removed. This is called a double mastectomy.

• Chemotherapy is the use of drugs to target and destroy breast cancer cells. The drugs can be administered intravenously or taken orally in the form of a pill. Chemotherapy can help those with breast cancer live longer and have a better quality of life, including increasing the chances of a cure, decreasing the risk of breast cancer returning and alleviating symptoms. Depending on the type and dose of chemotherapy drugs given, and the length of treatment, chemo drugs may cause side effects. Some of the most common side effects include hair loss, nail changes, mouth sores, loss of appetite or weight changes, nausea and vomiting, diarrhea, fatigue and nerve damage.

• Radiation therapy is a localized treatment that destroys cancer cells with high-energy rays delivered directly to the cancer. Potential side effects include skin changes and feeling tired, which can be managed with skincare techniques and creams, and rest and hydration to aid in the body’s repair and recovery process. Three types of radiation therapy utilized to treat breast cancer are:

External beam radiation therapy uses a machine called a linear accelerator that produces a radiation beam administered to the cancerous region outside of the body. The machine has parts that shield the normal organs from exposure, and others that target and focus the beam on the treatment site. Depending on the breast cancer’s stage and other factors, 5-36 treatments could be prescribed and are usually given five days a week.

Brachytherapy, or radiation inside the body, usually consists of 1-10 treatments administered over a couple of days.

Intraoperative radiation therapy is a less common treatment type consisting of a dose of radiation delivered at the time of breast cancer surgery.

What are the survival rates for breast cancer?

Survival rates are directly correlated with the stage of the disease. While the five-year survival rates for localized breast cancer (i.e., no cancer has spread outside of the breast) and regional (i.e., cancer has spread to nearby structures or lymph nodes) are 99% and 89%, respectively, the survival rate drops dramatically to 29% for distant disease (i.e., cancer has traveled to the bones, liver, lungs, etc.). Therefore, early screening, detection and diagnosis are extremely important and greatly improve your chances of breast cancer survival.

This article was co-authored by Toby Shutters, CMD, R.T.(R)(T) and Carrie Carter, RT (T).

Resources:

• Breast Cancer Statistics | How Common Is Breast Cancer?
• Breast Cancer | Breast Cancer Information & Overview
• Cancer Facts & Figures 2022| American Cancer Society
• Chemotherapy for Breast Cancer | Breast Cancer Treatment
• Chemotherapy for breast cancer – Mayo Clinic
• Get Involved to Stop Breast Cancer – National Breast Cancer Coalition
• Radiation Therapy | Radiation Treatment for Cancer
• Stop the Clock! – National Breast Cancer Coalition (stopbreastcancer.org)
• Surgery for Breast Cancer | Breast Cancer Treatment
• What Is Breast Cancer? | American Cancer Society

November is National Diabetes Awareness Month. Perhaps you, a family member, or a friend has diabetes. By reading this article, you can share this information and/or use it yourself to help manage diabetes. The first step to effective management is a good understanding of the diabetes disease process. From there, you can build upon that foundation to know signs or symptoms, how to monitor, knowing when to call your provider before symptoms worsen, importance of provider follow up, and most importantly adhering to the non-pharmacological (diet and exercise) and pharmacological prescribed regimens. This article will focus on four key questions surrounding diabetes and diabetes management.

1) How does diabetes affect Americans?
In 2019, 37.3 million Americans, or 11.3% of the population, had diabetes. Nearly 1.9 million Americans have type 1 diabetes, including about 244,000 children and adolescents.1 1.4 million Americans are diagnosed with diabetes every year, making the U.S. #3 in countries with the highest rate of Diabetes.2

2) What are the different types of diabetes?

Type 1 Diabetes:
Type 1 diabetes is a disease that starts when the pancreas stops making enough of a hormone called insulin. Insulin helps the body use sugar from food as energy or store it for later use. If there isn’t any insulin, too much sugar stays in the blood. Over time, high blood sugar can harm many parts of the body. These include the eyes, heart, blood vessels, nerves, and kidneys.
Type 1 diabetes can occur at any age, but it usually starts in children or young adults. It’s a lifelong disease. But with treatment and a healthy lifestyle, people can live a long and healthy life.3

Gestational Diabetes:
Gestational diabetes is high blood sugar that first occurs during pregnancy. High blood sugar can cause problems for you and your baby. But with treatment, most women can control their blood sugar and have healthy babies. Blood sugar levels usually go back to normal after the baby is born.4

Prediabetes:
Prediabetes is a warning sign that you are at risk for getting type 2 diabetes. It means that your blood sugar is higher than it should be, but not high enough to be diabetes. Prediabetes is also called impaired glucose tolerance or impaired fasting glucose. Most people who get type 2 diabetes have prediabetes first.5

Type 2 Diabetes:
Type 2 diabetes is a condition in which you have too much sugar (glucose) in your blood. Glucose is a type of sugar produced in your body when carbohydrates and other foods are digested. It provides energy to cells throughout the body. Normally, blood sugar levels increase after you eat a meal. When blood sugar rises, cells in the pancreas release insulin, which causes the body to absorb sugar from the blood and lowers the blood sugar level to normal.When you have type 2 diabetes, sugar stays in the blood rather than entering the body’s cells to be used for energy. This results in high blood sugar. It happens when your body can’t use insulin the right way. Over time, high blood sugar can harm many parts of the body, such as your eyes, heart, blood vessels, nerves, and kidneys. It can also increase your risk for other health problems (complications).6

3) What are some potential complications associated with diabetes?
There is no cure for diabetes. Management of diabetes is important to prevent and/or delay long term complications (risk for getting other health problems). This is especially true if your blood sugar levels stay high. Over time, high blood sugar can damage many parts of your body. It can lead to a variety of problems, including problems with your:

Eyes: High blood sugar levels may cause temporary blurred vision. Blurry vision, floaters, or flashes of light may be a sign of diabetic retinopathy, which can lead to severe vision loss. Having diabetes also puts you at risk for cataracts and glaucoma.
Heart and blood vessels: High blood sugar damages the lining of blood vessels. This is called hardening of the arteries, or atherosclerosis. It can lead to stroke, heart attack, peripheral arterial disease, or heart failure. Erection problems can be an early warning sign of blood vessel disease and may mean a higher risk of heart disease.

Nerves: High blood sugar levels can damage nerves throughout your body. This damage is called diabetic neuropathy. There are different types of neuropathy. They may be caused by damage to nerves that sense things like pain or touch or that control things like your heartbeat, digestion, or blood pressure. Nerve damage can be painful, especially in the feet.
Feet and skin: You may have less feeling in your feet. This means that you can injure your feet and not know it. Common infections from blisters, ingrown toenails, small cuts, or other problems can quickly become more serious when you have diabetes.

Kidneys: High blood sugar can damage tiny blood vessels in your kidneys that help filter waste from your blood. This kidney damage is called diabetic kidney disease (sometimes called diabetic nephropathy). You may not have any symptoms until the damage is severe. Then you may notice swelling in your feet or legs or all over your body.

Infections related to diabetes: High blood sugar from diabetes can affect the body’s immune system. The immune system is the body’s natural defense system that helps fight infections.
People with high blood sugar from diabetes can be more severely affected by common infections, such as influenza and pneumonia. They also are more likely to be infected with unusual organisms, such as Gram-negative bacteria or fungi.7

4) What can you or someone you know do to help prevent and/or manage diabetes?

Prevention – You can help prevent or delay complications by keeping your blood sugar in a target range. You also need regular medical checkups to look for early signs of complications. If complications are treated early, the damage may be stopped, slowed, or reversed. 7

Management of diabetes –
• Follow up with your physician. Your physician will monitor lab values (hemoglobin A1C) (defined below), kidney function tests, and others as needed/warranted] on a routine basis. Eye and foot exams are also recommended to be performed every year.
• Stay up to date with recommended vaccinations.
• Keep up on latest education, treatments for diabetes. Diabetic educators are available to assist and educate with diabetes. The ADA (American Diabetic Association) is a great resource.
• Monitor your blood sugar based on your physician’s treatment plan.
• Understand the signs and/or symptoms of low and/or high blood sugar.
• Diet, nutrition, exercise – follow your physician’s suggestions. Coaches, Dieticians, Care managers, and/or Diabetic educators are available to assist, check with your health plan for benefit coverage.
• Take your medications/insulin as prescribed by your physician.
• Utilize your smart phone application(s) that help with managing Diabetes.
• Joining a support Group (online and/or in person sessions) may be beneficial in connecting with others that are affected by Diabetes.

• List of Sources:
  1) American Diabetes Association. Website url: https://diabetes.org/about-us/statistics/about-diabetes. Accessed 10/19/22
  2) Medical News Today. Website url: https://www.medicalnewstoday.com/articles/diabetes-rates-by-country#type-2. Accessed 10/23/22
  3) Healthwise: Website url link: Type 1 Diabetes (healthwise.net). Accessed 10/19/22
  4) Healthwise: Website url link: Gestational Diabetes (healthwise.net). Accessed 10/19/22
  5) Healthwise: Website url link: Prediabetes (healthwise.net). Accessed 10/19/22
  6) Healthwise: Website url link: Type 2 Diabetes (healthwise.net). Accessed 10/19/22
  7) Healthwise: Website url link: Diabetes Complications (healthwise.net). Accessed 10/19/22
  List of additional Resources:
  1) https://www.heart.org/en/health-topics/diabetes/diabetes-tools–resources
  2) https://professional.diabetes.org/search/site?f%5B0%5D=im_field_dbp_ct%3A32&retain-filters=1