Saturday, June 29, 2019

Life with Chronic Disease: Complementary & Alternative Medicine

Recently I contracted a tick borne disease. While a number of my medical friends wanted to make sure I was on antibiotics, which I am, I’ve heard from many others advising “natural” remedies and alternative practices and practitioners.

Needless to say, I’ve been doing a lot of reading and talking to public health colleagues as I have a host of questions. Ultimately, there are not a lot of answers. Through this process, I’m reminded how certain aspects of this endemic are similar to what it was like during the first 15 years or so of the AIDS epidemic.  
• All sorts of home remedies being tried, including various combinations of vitamins and supplements, without any research to back them up.
• The belief that a cure is being withheld in order for pharmaceutical companies to make money
• Organizations rapidly formed by those affected.
• Scam artists abound to take advantage of those most desperate for help causing people to spend a lot of money unnecessarily.

When the effective treatment came for AIDS, it didn’t come from anything that had been developed in the “back alley.” It wasn’t an herbal remedy or some special combination of vitamins and supplements. Through clinical trials and the combined efforts of scientists, patients, medical providers, and advocates there are now a variety of medications that are keeping people healthy.

However, this is not to think the advocacy groups and AIDS service organizations didn’t make a significant contribution. They did in spades. Not only did they revolutionize how the FDA functions and how community can organize to take care of those who have such significant needs, they pioneered complementary practices to enhance quality of life and improve life expectancy.

“Complementary Medicine” refers to a range of disciplines that can be offered along with conventional treatments while “alternative” medicines are used in place of conventional treatments. Together these are often referred to as CAM (Complementary and Alternative Medicine). The term “Integrative Medicine” combines CAM with mainstream medical therapies in a coordinated approach.

I first learned about Qigong when I attended an AIDS conference in San Francisco. It’s a practice I do almost daily. Yoga, dance therapy, Reiki, meditation, mindfulness, support groups, acupuncture, acupressure, massage, nutrition, and mind/body connections were continually being discussed and tried.

Today, many of the “new” things we were exploring are now routine and most hospitals and medical centers offer them as integrative health services. For example, at NYU Langone their service of “holistic treatments and consultations” includes Acupuncture, Guided Imagery, Hypnosis, Massage Therapy, Mind-Body Relaxation Skills Training for Stress Management, Mindfulness Eating, Prenatal Massage, Reflexology, Reiki, Yoga and more.

Things to consider when exploring CAM options:
• Before starting any type of CAM, talk to your medical provider. Are there any reasons for or against? Possible complications?

• Check what works, what’s being tried, side effects etc. at the National Center for Complementary and Integrative Health, that is part of the National Institutes of Health.

• The Mayo Clinic offers a Diseases and Conditions website that includes “lifestyle and home remedies,” as well as “alternative medicine” that may be appropriate. It’s a good resource to check.

• Many condition specific organization,  e.g. American Cancer Society, offer information about CAM. Your local chapter can make recommendations about special classes and programs in your area and some chapters sponsor them.

• Connect with the “integrative services” program at your local hospital or health center for referrals, special programs for your condition etc.

• Before you enroll in a class or see a practitioner: check with your provider for a recommendation; find out about their credentials-do they meet your state’s requirements; do they work with people with your condition and/or have experience doing so; will your insurance cover the costs.

If you decide to use a dietary supplement, such as an herbal product, vitamins or an alternative medication, be aware of side effects, interactions with other medications you might be taking and whether it could impact your condition negatively.

Support groups are good places to discuss what’s worked and what hasn’t. However, they also lend themselves, particularly on-line groups, to practises that may turn out to be less than healthful.

• Know the warning signs of a scam-If it sounds too good to be true it probably is.
- The product promises a cure for a disease where there is none.
- The product is a quick cure for a wide range of ailments.
- The evidence given for its success is testimonials only.
- There are a number of products that claim “based on scientific study,” but the “study” will turn out to be designed by the manufacturer and will never appear in a peer reviewed medical journal. Further, the study may have only been done on animals. What works on animals doesn’t necessarily yield the same results in humans. In fact, there are questions being raised within the scientific community about the usefulness of animal testing.
- The term natural is often used to suggest that a product is safer than conventional medicine. Because many of these products are not under the Food and Drug Administration (FDA), you have no way of knowing what’s in the product or how much.
- Avoid products where the following key words are used in advertising miraculous cure, amazing breakthrough, foolproof, suppressed treatments,  secret ingredients, time-tested or new-found.
- Treatment is only available privately, for a short time or from only one source. Be even more skeptical if it requires payment in advance.
- The product is an experimental treatment only available if you pay to be part of study. Genuine clinical trials provide the treatment free of charge. 
- An “infomercial,”  newspaper, magazine or website promotion
- Satisfaction Guaranteed. Marketers of fraudulent products rarely stay in the same place for long.
- Lots of medical jargon. Terms and scientific explanations may sound impressive and may have an element of truth to them, but the public "has no way of discerning fact from fiction," says the FDA. Fanciful terms can cover up a lack of scientific proof.
- “The drug companies and medical providers don’t want you to know about this product because it would undercut their profits.” While drug companies may be profit driven, medical providers are in the business to heal and treat.

Wednesday, June 26, 2019

Take a Break: Fold a beach towel for multiple purposes

With beach season upon us, this is a great way to use your beach towel as a pillow and have it serve double duty to hold your sun screen, paper back or whatever else you like to have handy. Start by watching the video-Fold a beach towel into a pillow .

 While not shown in the video, all you have to do is place your items on the towel as you do your final roll, just before you tuck it in. Once you find the perfect spot, you can unfurl the towel, removing the various items.  I’ve found this is a great way to save space where I store my towels when not in use.

Not interested in today’s activity, go to the Take a Break Pinterest and pick out something else.

Saturday, June 22, 2019

Life with Chronic Disease: Ikigai (finding purpose)

Having  recently reread Viktor Frankl’s “Man’s Search for Meaning” for a book club, we had a lot of discussion about how one goes about finding their purpose.

I’m a Blue Zones  fan so I’m aware that having a sense of purpose was one of the “Power Nine,” those aspects of life that help people live longer and healthier.

There are various TED talks that relate to finding your purpose. Oprah has a new book “The Path Made Clear: Discovering Your Life’s Direction and Purpose,” and there are a variety of life and entrepreneurial coaches that have made careers out of teaching people how to do this.

What helped me understand the “how to,” but it’s also the basis for many of the books, Blue Zones, videos and life coaching, is the Japanese idea of “ikigai.” Dating back to at least 794, during the Japanese Heian period, there is no English equivalent to this word. However, it’s often used to describe why you get up in the morning.

The Japanese psychiatrist and author of What Makes Our Life Worth Living (ikigai nit suite) Mieko Kamiya explains, ikigai is similar to “happiness” but has a subtle difference in its nuance. ikigai is what allows you to look forward to the future whatever the way you feel right now. It is what gives you strength, resilience and hope when tragedy occurs. Whatever it may be, it is a source of energy and inner light. Japanese people believe that the sum of small joys in everyday life results in more fulfilling life as a whole. In short, ikigai is both about purpose as well as finding happiness.

The Venn diagram above shows how the convergence of four primary elements result in your ikigai. It’s not about achievement or what other people think, but rather finding the combination that works for you.

What you Love (your passion)
What the World Needs (your mission)
What you are Good at (your vocation)
What you can be rewarded for (your profession)

Unfortunately, most of the ikigai diagrams include what you can be paid for versus what you are rewarded for. If you are retired, or don’t work for other reasons, it’s important that you recognize rewards other than a paycheck.

Interestingly Richard Leider, an executive life coach, has based his practises on ikigai but looks at purpose as more of a calling. Are you using your gifts on things you are passionate about in environments that fit your values?  His “A Guide to Unlocking the Power of Purpose  can be a helpful tool. It’s free, but since it includes exercises, it’s probably best to print it out.. 

Saturday, June 15, 2019

Journal Watch June 2019

App helps improve pain control and reduce opiate use after surgery: Patients who underwent total knee replacement and used a smartphone app (PainCoach) at home after surgery consistently reduced opiate painkiller use and improved pain control. The more the study participants used the app, the more likely they were to lower pain scores and decrease their use of opioids.Euroanaesthesia Congress

Smartphone relaxation app helps some manage migraine: Migraine sufferers who used a smartphone-based relaxation technique at least twice a week experienced on average four fewer headache days per month, a new study shows. Developed in part by researchers at NYU School of Medicine, the app, called RELAXaHEAD, guides patients through progressive muscle relaxation, or PMR. In this form of behavioral therapy, patients alternately relax and tense different muscle groups to reduce stress. The study authors say their work, publishing in the journal Nature Digital Medicine online June 4, is the first to evaluate the clinical effectiveness of an app for treating migraine, and adding an app to standard therapies (such as oral medications) under the supervision of a doctor. 

Emotional Awareness and Expression Therapy for Chronic Pain: Patients with chronic pain, especially primary or centralized pain, have elevated rates of psychosocial trauma and intrapersonal or intrapsychic conflict. To address these risk factors and potentially reduce pain, the authors developed emotional awareness and expression therapy (EAET). This article presents the rationale for EAET, describes its principles and techniques, reviews its development and early testing as well as recent clinical trials, and critically analyzes the evidence base. Four initial trials (between 2006 and 2011) demonstrated the efficacy of earlier versions of EAET. Four recent randomized, controlled trials of different EAET durations (1 to 8 sessions) and formats (individual or group) in patients with fibromyalgia, irritable bowel syndrome, pelvic pain, or medically unexplained symptoms support the earlier findings. EAET reliably reduces pain and interference, although improvements in anxiety and depression are less reliably achieved and may be delayed. The largest and best conducted trial found superiority of EAET over cognitive-behavioral therapy for fibromyalgia. Patient retention in EAET is high, and adverse events are rare. EAET merits inclusion as a treatment option for primary pain conditions, and it may be the preferred treatment for some patients. Research is needed on EAET with other pain conditions and samples, using better controls and comparison conditions, and on additional ways to motivate and help patients engage in successful emotional processing. Current Rheumatology Reports

Vagus nerve stimulation study shows significant reduction in rheumatoid arthritis symptoms: Initial pilot data support the use of new neurostimulation treatment in a larger study in patients who have failed current standard of care. Science Daily

Growing up high: Neurobiological consequences of adolescent cannabis use: Cannabis use was linked to impairments in working memory and inhibitory control, which is required for self-control. Cannabis use was also linked to deficits in memory recall and perceptual reasoning. Alcohol use was not linked to impairments in these cognitive functions, suggesting cannabis could have more long-term effects than alcohol. Preliminary data indicates that cannabis use had a stronger effect on the memory functions of male students than female students. Both sexes were however, equally affected by cannabis on inhibitory control. Canadian Neuroscience Meeting

• Approved NovoTTF-100L, which uses electric fields to stop solid tumors from mesothelioma from dividing.
Seized more than 300,000 containers of dietary supplements, including tablets, capsules, and teas from Life Rising Corporation due to poor manufacturing practices

• Finalizes guidance for premarket tobacco product applications for electronic nicotine delivery systems as part of commitment to continuing a strong oversight of e-cigarettes

Approves first chemoimmunotherapy regimen, Polivy,  for patients with relapsed or refractory diffuse large B-cell lymphoma

Permits marketing of first medical device for relief of pain associated with irritable bowel syndrome in patients 11-18 years of age

Approves first treatment, Emgality, for episodic cluster headache that reduces the frequency of attacks

Approves new treatment, Zerbaxa, for hospital-acquired and ventilator-associated bacterial pneumonia

• Issued warning for women of childbearing age about possible safety risks of dietary supplements containing vinpocetine

Announces Project Facilitate to assist physicians seeking access to unapproved therapies for patients with cancer

Puts R3 Stem Cell, LLC on notice for marketing unapproved stem cell products for treating serious conditions

Approves first PI3K inhibitor for breast cancer

Approves innovative gene therapy, Zolgensma, to treat pediatric patients with spinal muscular atrophy, a rare disease and leading genetic cause of infant mortality

Permits marketing of first diagnostic test, Synovasure, to aid in detecting prosthetic joint infections

Clears first diagnostic tests for extragenital testing for chlamydia and gonorrhea

• Warns of fecal transplants after one death

Blood pressure and glucose control may prevent common arrhythmia: Blood-pressure and glucose control may be effective in preventing heart block, a common form of arrhythmia, and the subsequent need for a pacemaker. JAMA Network Open 

High-intensity exercise may restore heart function in people with type 2 diabetes: The study found that three months of high-intensity interval training (HIIT) improved heart function in adults with type 2 diabetes, without any change in medications or diet. University of Otago

Seniors who feel their life has purpose may live longer: Seniors who feel their life has purpose may be less likely to die from heart, circulatory and digestive diseases and more likely to live longer, new data suggest. In a study that followed nearly 7,000 people over age 50 for more than a decade, researchers determined that people were more likely to die at a younger age if they felt their lives had little purpose, according to the report published in JAMA Network Open. 

Roundup Linked to Human Liver Damage: A group of patients suffering from liver disease had elevated urine levels of glyphosate, the primary weed-killing ingredient in Roundup, according to researchers at the University of California, San Diego (UCSD).

Brush your teeth --postpone Alzheimer's: Researchers have determined that gum disease (gingivitis) plays a decisive role in whether a person developes Alzheimer´s or not. the bacteria is not causing Alzheimer´s alone, but the presence of these bacteria raise the risk for developing the disease substantially and are also implicated in a more rapid progression of the disease. However, the good news is that this study shows that there are some things you can do yourself to slow down Alzheimer´s. "Brush your teeth and use floss". Mydel adds that it is important, if you have established gingivitis and have Alzheimer´s in your family, to go to your dentist regularly and clean your teeth properly. 

10,000 Steps A Day? How Many You Really Need To Boost Longevity: A study of 17,000 older women (average age 72), women who took 4,400 steps per day, on average, were about 40 percent less likely to die during the follow-up period of about four years compared with women who took 2,700 steps. The benefits of walking maxed out at about 7,500 steps. In other words, women who walked more than 7,500 steps per day saw no additional boost in longevity. This study only measures walking. It didn't measure things that many of us do that don't require steps, things like gardening, swimming or biking. And it's safe to assume some women in the study were doing these other things that can influence health as well. JAMA International Medicine

Two-Hour Weekly Dose of Nature May Aid Health, Well-Being: Spending at least two hours a week in nature may promote health and well-being, according to a study published online June 13 in Scientific Reports

Irregular Sleep Patterns May Increase Risk for Metabolic Syndrome: Variability in sleep duration and timing is associated with higher odds of metabolic syndrome, according to a study published online June 5 in Diabetes Care. 

Exercise, Therapy May Improve Depression, Diabetes Outcomes: Exercise and cognitive behavioral therapy can improve depression outcomes in adults with type 2 diabetes. Diabetes Care

Intracranial Hemorrhage Risk Up With Low-Dose Aspirin: For individuals without symptomatic cardiovascular disease, the use of low-dose aspirin for primary prevention of cardiovascular events is associated with an increased risk for intracranial hemorrhage, according to a review and meta-analysis published online May 13 in JAMA Neurology. 

Coffee not as bad for heart and circulatory system as previously thought: The research from Queen Mary University of London has shown that drinking coffee, including in people who drink up to 25 cups a day, is not associated with having stiffer arteries. British Cardiovascular Society (BCS) Conference 

• Millions of Cardiovascular Deaths Attributed to Not Eating Enough Fruits and Vegetables.
Do Policies Targeting Sugary Drinks Pay Off? New research suggests that taxes and health warnings could bring significant health and economic benefits by cutting consumption of sugar-sweetened beverages
• Eating More Vitamin K Found to Help, Not Harm, Patients on Warfarin: Contrary to common wisdom, increasing vitamin K intake helps stabilize anticoagulation
• Sun-Exposed Oyster Mushrooms Help Patients Fight Tuberculosis: Bread containing the low-cost mushrooms increased vitamin D levels and boosted immune response of TB patients
In a study of 2,717 young adults in the U.S. with long-term follow-up, people who increased the amount of fruits, vegetables, whole grains, nuts and vegetable oils in their diet over 20 years had a 60 percent lower risk of type 2 diabetes compared to those with a small decrease in plant foods.
• Findings from a study examining three large cohorts of U.S. health professionals suggest that people with higher intakes of vitamins B2 and B6 from food or supplements have a lower risk for type 2 diabetes. The study, which included more than 200,000 people, also revealed that consuming higher levels of vitamin B12 from foods was associated with a higher type 2 diabetes risk, which may be due to consumption of animal products.
• A new study reveals that changing the order in which food is eaten could reduce post-meal blood sugar spikes. The researchers found that eating rice first and then a vegetable and meat caused significantly higher blood sugar levels after eating compared to other sequences. The results point to a simple but effective way to lower blood sugar levels after eating, which could prevent the transition from prediabetes to diabetes.
• Fewer new type 2 diabetes (T2D) cases are seen in adults who eat more plant-based foods, and intake of vitamins B2 and B6 is also associated with a reduced risk for T2D, according to two studies

Red and white meats are equally bad for cholesterol: Contrary to popular belief, consuming red meat and white meat such as poultry, have equal effects on blood cholesterol levels, according to a study published today in the American Journal of Clinical Nutrition.

Cholesterol in eggs tied to cardiac disease, death: Research that tracked the diets, health and lifestyle habits of nearly 30,000 adults across the country for as long as 31 years has found that cholesterol in eggs, when consumed in large quantities, is associated with ill health effects. One large egg contains nearly 200 milligrams of cholesterol, roughly the same amount as an 8-ounce steak, according to the USDA. Other foods that contain high levels of cholesterol include processed meats, cheese and high-fat dairy products. While the new research does not offer specific recommendations on egg or cholesterol consumption, it found that each additional 300 milligrams of cholesterol consumed beyond a baseline of 300 milligrams per day was associated with a 17 percent higher risk of cardiovascular disease and an 18 percent higher risk of death.  Journal of the American Medical Association.

Mediterranean diet linked with improved cognition in people with diabetes: Analyzing two years’ worth of data from 913 participants in the Boston Puerto Rico Health Study, researchers found that people with diabetes who followed a Mediterranean diet had bigger gains in memory and other types of cognitive function than those who didn’t eat that way. Reuters

Vitamin D does not prevent type 2 diabetes in people at high risk : Taking a daily vitamin D supplement does not prevent type 2 diabetes according to a study of 2,423 adults. NEJM 

Eating blueberries every day improves heart health: Eating a cup of blueberries a day reduces risk factors for cardiovascular disease -- according to a new study. Eating 150g of blueberries daily reduces the risk of cardiovascular disease by up to 15 per cent. The research team say that blueberries and other berries should be included in dietary strategies to reduce the risk of cardiovascular disease -- particularly among at risk groups. American Journal of Clinical Nutrition 

Vitamin D and estradiol help guard against heart disease, stroke, and diabetes: Vitamin D and estrogen have already shown well-documented results in improving bone health in women. A new study from China suggests that this same combination could help prevent metabolic syndrome, a constellation of conditions that increases the risk of heart disease, stroke, and diabetes in postmenopausal women. Menopause

Increases in Red Meat Intake Linked to Increased Mortality: Increases in red meat consumption over eight years are associated with an increased mortality risk during the subsequent eight years, according to a study published online June 12 in The BMJ.

Dietary Supplements May Up Risk for Severe Medical Events: Consumption of dietary supplements, specifically those sold for muscle building, energy, and weight loss, is associated with an increased risk for severe medical events among individuals aged 0 to 25 years, according to a study published online June 5 in the Journal of Adolescent Health. 

Low vitamin K levels linked to mobility limitation and disability in older adults: Low levels of circulating vitamin K are linked to increased risk of mobility limitation and disability in older adults, identifying a new factor to consider for maintaining mobility and independence in older age. The Journals of Gerontology: Series A

Diuretic withdrawal is safe for stable heart failure patients: Drug therapy for patients with stable heart failure can be simplified by stopping diuretics, according to late breaking results from the ReBIC-1 trial. European Society of Cardiology 

Nerve stimulation could provide new treatment option for most common type of stroke: A study of 1,000 patients found evidence that the technique, called active nerve cell cluster stimulation, reduced the patients' degree of disability three months after they suffered an acute cortical ischemic stroke, which affects the surface of the brain and is the most common type of stroke. UCLA

Statin Use With Colorectal Cancer Lowers Risk for Early Death: Use of statins before or after colorectal cancer (CRC) diagnosis is linked to a lower risk for premature death, from either cancer or other causes, according to a review published online May 8 in Cancer Medicine. 

International clinical trial of new drug for men with advanced prostate cancer yields strong result: The New England Journal of Medicine published the first results of a phase III international clinical study called TITAN (National Clinical Trials Number 02489318), which evaluated the effectiveness and safety of a new drug, apalutamide, to treat advanced prostate cancers. This publication accompanies a presentation today that outlines the study results at the American Society for Clinical Oncology (ASCO). Researchers found that treatment with apalutamide significantly improved overall survival, with a 33% reduction in risk of death compared to standard-of-care therapy. Additionally, this study showed apalutamide significantly delayed disease progression and increased the amount of time until a patient has to receive chemotherapy.

New Breast Cancer Drug Boosts Patients’ Survival Rates by 30%: Researchers say a new form of drug improves survival rates of patients with the most common form of breast cancer. The findings, presented at the annual meeting of the American Society of Clinical Oncology in Chicago, showed that the addition of a drug known as a cyclin inhibitor increased survival rates to 70 percent. The mortality rate was 29 percent less than when patients were given a placebo.

Beta blockers reduce stress-induced irregular heart rhythm: Taking beta blockers -- medications that reduce blood pressure and treat many heart conditions -- can blunt the negative effects of stress and anger on people with a history of atrial fibrillation, or irregular heart rhythm, said Yale researchers. This strategy could potentially improve quality of life for many of the 2 million Americans with the condition, according to a new study. HeartRhythm

Long-term islet transplant recipients show near-normal glucose control: Continuous glucose monitoring (CGM) evaluations in islet transplant recipients who have been insulin independent for an average of 10 years show near-normal glycemic profiles and time-in-range metrics, according to data presented by the Diabetes Research Institute at the University of Miami Miller School of Medicine. The findings, which were accepted as a late-breaking poster at the American Diabetes Association (ADA) 79th Scientific Sessions, June 7 - 11, 2019 in San Francisco, CA, demonstrate that islet transplantation can be a successful long-term cell therapy for select patients with type 1 diabetes.


Combo Injectable Controls Blood Glucose Longer in T2DM: Compared with insulin glargine, initial injectable therapy with a combination of insulin degludec and liraglutide aids achievement of blood glucose goals for a longer period of time in patients with uncontrolled type 2 diabetes on oral antidiabetic drugs, according to a study published online June 9 in The Lancet Diabetes & Endocrinology


Weight Loss Surgery May Not Relieve Acid Reflux: Reflux symptoms return in about half of patients who undergo gastric bypass, according to a study published online June 4 in Alimentary Pharmacology & Therapeutics.

Hot Water Therapy Aids Patients With Peripheral Arterial Disease: Heat therapy can improve functional ability and also has potential to be an effective cardiovascular conditioning tool for people with peripheral arterial disease (PAD), according to a small study published online June 5 in the American Journal of Physiology-Heart and Circulatory Physiology.

Antibiotic Prophylaxis Before Dental Work Often Unnecessary: Antibiotic prophylaxis before dental procedures is unnecessary more than 80 percent of the time, according to a study published online May 31 in JAMA Network Open.


Excess Cause-Specific Mortality Tied to Chronic Proton Pump Inhibitor Use: Taking proton pump inhibitors (PPIs) is associated with an excess of cause-specific mortality, according to a study published online May 30 in The BMJ.

Women's Facial Moisturizers Cost More Per Ounce Than Men's: Facial moisturizers marketed to women are more than $3 more per ounce, despite similar ingredients. Journal of Cosmetic Dermatology 

Industry uses non profit organizations to campaign against public Health policies: A new study shows how a non-profit research organization has been deployed by its backers from major food and beverage corporations to push industry-favourable positions to policy makers and international bodies under the guise of neutral scientific endeavour. Globalization and Health

Most Older Adults Would Have to Liquidate Assets for Home Care: Researchers found that 74 percent of adults (nationally representative sample of non-Medicaid, community-dwelling adults age 65 years and older) could fund at least two years of a moderate amount of paid home care if they liquidated all their assets, and 58 percent could fund at least two years of an extensive amount of paid home care. However, among older adults with significant disabilities, only 57 percent could fund at least two years of moderate paid home care and 40 percent could fund at least two years of extensive paid home care by liquidating all their assets. "Home care is less affordable, however, for those most likely to need it, including older adults with significant long-term services and support needs, single adults, and those ages eighty-five and older," the authors write.

Wednesday, June 12, 2019

Take a Break: Make Non Alcoholic Cocktails

 Summer is finally here in Vermont so time to think about BBQs, being outside, and sipping something cold and delicious. More and more people are forgoing the alcohol but they like the look of a cocktail and all the cool glasses just made for them. Truth be told, in the 802 (Vermont’s area code) Mason Jars are the glass of choice. Even the restaurants offer them.

Pina Coladas: This can be as simple as 1 cup cream of coconut (be sure to mix before measuring), ¾ cup pineapple juice, and 2 cups of ice  Put the ice in a blender or food processor and process until ice is crumbly. Add the juice and coconut milk and blend until is a slushy consistency.

Can’t find coconut milk?  Pick up a can of frozen Pina Colada mix in the freezer section where they sell juice. Use a lot more ice  and less water (usually it’s a can of water for the virgin variety) and let the blender work its magic.

 Not interested in today’s activity, go to the Take a Break Pinterest and pick out something else.

Saturday, June 8, 2019

Life with Chronic Disease: Internet Safety


A few weeks ago, we held a "Tech Cafe" in my town,  which began with a presentation on Internet safety. No matter how tech savvy you are, there is always something new to learn and/or benefit from a reminder. 

Living in a “wired” society is a double-edged sword. Many things are a lot easier because of it, and we’ve become very dependent on it.  We text, call, book appointments, bank, share files, pay bills, surf the web for the best deals and the list goes on. At the same time these various devices-computers, tablets and phones-are vulnerable to security threats.

Don’t despair. Some very practical steps will help minimize your exposure

1. Check sites for SSL Certification (Secure Sockets Layer): Does it start with “http://” or “https://”? If you notice an s at the end, that means your connection is encrypted and secure, so any data you enter is safely sent to the website. Not all sites have SSL certification. While they may be fine to browse, avoid sharing any financial or personal information on websites without this added layer of security.

2. Passwords
• Create unique passwords: Make your password a sentence: A strong password is a sentence that is at least 12 characters long. Focus on positive sentences or phrases that you like to think about and are easy to remember. On many sites, you can even use spaces. Read How to Create a Strong Password (and Remember it).

• Do Not use the same password for multiple accounts. Why You Should Use a Password Manager and How to Get Started.

• Use biometric features, such as fingerprint authenticators. This makes unauthorized access nearly impossible.

3. Change the default password of your internet router and IOT devices. Make it harder for hackers or even snoopy neighbors. Most router manufacturers configure their new routers with the same default username and password. The default usernames and passwords for popular models of wireless network gear are well known to hackers and often posted on the internet. Why You Should Change the Default Password on a Wi-Fi Router.

4. Connect to the Right Wi-Fi: Many free Wi-Fi points are not encrypted. These open networks allow malicious people to eavesdrop on the network traffic and easily get your passwords, usernames and other sensitive information. To protect against Wi-Fi hacking, use applications that secure your connection or at least tell you the status of the Wi-Fi to which you are connected. WPA (Wi-Fi Protected Access) is more secure compared to WEP (Wired Equivalent Privacy). Consider investing in a Virtual Private Network (VPN). A VPN is a piece of software that creates a secure connection over the internet, so you can safely connect from anywhere.

5. Click Smart: Don’t invite danger with careless clicking. Many of today’s online threats are based on phishing or social engineering. This is when you are tricked into revealing personal or sensitive information for fraudulent purposes. Spam emails, phony “free” offers, click bait, online quizzes, texts from people you don’t know, and more all use these tactics to entice you to click on dangerous links or give up your personal information. If it sounds too good to be true, it probably is. Avoid links asking for personal information and Do Not Click on Website Ads!
10Ways to Avoid Phishing Scams

6. Be a Safe Shopper
• Remember to follow Step 1 and only use sites whose address starts with “https.”

• Don’t Save Financial Information on Shopping Sites: Even sites with SSL certification can be hacked. Many shopping sites let you save your credit card information in your online account. This setup makes it easier to make purchases in the future and it also makes it easier for hackers to access your information. Spend the extra minute to enter your information each time you make a purchase.

7. Know your “friends:” Whether it’s on Facebook, other social media sites or texts via your mobile device, if you don’t know the person sending you a text, e-mail or a friend request, don’t respond. Use your spam filter.

8. There’s an App for That: Only download apps from official app stores after reading other users’ reviews first.

9. Stay current and be alert: Keep all your software updated so you have the latest security patches. Online threats are evolving all the time, so make sure you know what to look out for. Make sure that your security software is enabled on your mobile, just like your computers and other devices.

10. Careful What You Post : There are no “take backs” with what you post, or even what’s posted about you. Don’t put anything on line you wouldn’t want your current or prospective employer to see.