What is leprosy?

Leprosy is a bacterial disease of the skin and nervous system caused by Mycobacterium leprae. The two main types of leprosy are called lepromatous and tuberculoid. Tuberculoid leprosy is not related to tuberculosis.

Who gets leprosy?

Leprosy is usually found in South Asia, Southeast Asia, tropical Africa and some areas of Latin America. Although it is occasionally found in the southern part of the United States, most persons diagnosed with leprosy in this country are immigrants or refugees who were infected in their native countries.

What are the symptoms of leprosy?

In lepromatous leprosy, the skin lesions are many and widespread. Infection in the nose may cause crusting, bleeding and blockage; infection in the eye may cause inflammation of the iris and cornea. In tuberculoid leprosy, the skin lesions are fewer and have little or no feeling. There may also be numbness in the hands, feet or other parts of the body. Lepromatous leprosy is much more contagious than tuberculoid leprosy.

How soon after exposure do symptoms appear?

The range is from 9 months to 20 years. It usually takes 4 years from the time of exposure for symptoms of tuberculoid leprosy to appear and 8 years for symptoms of lepromatous leprosy to appear.

How is leprosy spread?

Although not clearly understood, leprosy is thought to spread through prolonged close contact (as may occur in a household) with an untreated lepromatous patient. The bacteria enter the air from the patient's nose (by nose blowing, for example) and probably spread to others by being breathed in or coming into contact with broken skin. Untreated mothers may pass the infection to their unborn children.

When and for how long is a person able to spread leprosy?

Usually, after three months of treatment with dapsone or clofazimine, or after three days of treatment with rifampin, a person will no longer be infectious to others. No restrictions in employment or school attendance are indicated for persons whose disease is determined to be noninfectious.

How can leprosy be prevented?

Household contacts of persons with leprosy, especially children, should be examined yearly for at least five years after their last contact with an infectious person. Household contacts of patients with lepromatous leprosy who are less than 25 years old may be considered for preventive treatment.

Information provided by the
Wisconsin Department of Health and Family Services

How to set up a healthy sleep environment

How to set up a healthy sleep environment

Insomnia is a common condition. Most people will have an occasional bout of sleeplessness due to temporary stress, worry, or irregular schedule. However, when the inability to sleep well continues for weeks or months, it can become a health problem.

If you have chronic insomnia, it may be caused by an underlying factor such as depression, anxiety, or pain. Your insomnia will probably improve or disappear when the cause is treated successfully. Sometimes poor sleep becomes a problem of its own. Dwelling on it only makes it worse. Simply changing your beliefs about sleep and your everyday behaviors can improve your sleep dramatically.

"Sleep hygiene" measures include commonsense health practices and setting up an environment that promotes sleep.



Insomnia is the perception or complaint of inadequate or poor-quality sleep because of one or more of the following:

  • difficulty falling asleep
  • waking up frequently during the night with difficulty returning to sleep
  • waking up too early in the morning
  • unrefreshing sleep

Insomnia is not defined by the number of hours of sleep a person gets or how long it takes to fall asleep. Individuals vary normally in their need for, and their satisfaction with, sleep. Insomnia may cause problems during the day, such as tiredness, a lack of energy, difficulty concentrating, and irritability.

Insomnia can be classified as transient (short term), intermittent (on and off), and chronic (constant). Insomnia lasting from a single night to a few weeks is referred to as transient. If episodes of transient insomnia occur from time to time, the insomnia is said to be intermittent. Insomnia is considered to be chronic if it occurs on most nights and lasts a month or more.

Certain conditions seem to make individuals more likely to experience insomnia. Examples of these conditions include:

  • advanced age (insomnia occurs more frequently in those over age 60)
  • female gender
  • a history of depression

If other conditions (such as stress, anxiety, a medical problem, or the use of certain medications) occur along with the above conditions, insomnia is more likely.

There are many causes of insomnia. Transient and intermittent insomnia generally occur in people who are temporarily experiencing one or more of the following:

  • stress
  • environmental noise
  • temperatures
  • in the surrounding environment
  • wake schedule problems such as those due to jet lag
  • side effects

Chronic insomnia is more complex and often results from a combination of factors, including underlying physical or mental disorders. One of the most common causes of chronic insomnia is depression. Other underlying causes include arthritis, kidney disease, heart failure, asthma, sleep apnea, narcolepsy, restless legs syndrome, Parkinson's disease, and hyperthyroidism. However, chronic insomnia may also be due to behavioral factors, including the misuse of caffeine, alcohol, or other substances; disrupted sleep/wake cycles as may occur with shift work or other nighttime activity schedules; and chronic stress.

In addition, the following behaviors have been shown to perpetuate insomnia in some people:

  • expecting to have difficulty sleeping and worrying about it
  • ingesting excessive amounts of caffeine
  • drinking alcohol before bedtime
  • smoking cigarettes before bedtime
  • napping in the afternoon or evening
  • or continually disrupted sleep/wake schedules

These behaviors may prolong existing insomnia, and they can also be responsible for causing the sleeping problem in the first place. Stopping these behaviors may eliminate the insomnia altogether.

Insomnia is found in males and females of all age groups, although it seems to be more common in females (especially after menopause) and in the elderly. The ability to sleep, rather than the need for sleep, appears to decrease with advancing age.

Patients with insomnia are evaluated with the help of a medical history and a sleep history. The sleep history may be obtained from a sleep diary filled out by the patient or by an interview with the patient's bed partner concerning the quantity and quality of the patient's sleep. Specialized sleep studies may be recommended, but only if there is suspicion that the patient may have a primary sleep disorder such as sleep apnea or narcolepsy.

Transient and intermittent insomnia may not require treatment since episodes last only a few days at a time. For example, if insomnia is due to a temporary change in the sleep/wake schedule, as with jet lag, the person's biological clock will often get back to normal on its own. However, for some people who experience daytime sleepiness and impaired performance as a result of transient insomnia, the use of short-acting sleeping pills may improve sleep and next-day alertness. As with all drugs, there are potential side effects. The use of over-the-counter sleep medicines is not usually recommended for the treatment of insomnia.

Treatment for chronic insomnia consists of:

  • First, diagnosing and treating underlying medical or psychological problems.
  • Identifying behaviors that may worsen insomnia and stopping (or reducing) them.
  • Possibly using sleeping pills, although the long-term use of sleeping pills for chronic insomnia is controversial. A patient taking any sleeping pill should be under the supervision of a physician to closely evaluate effectiveness and minimize side effects. In general, these drugs are prescribed at the lowest dose and for the shortest duration needed to relieve the sleep-related symptoms. For some of these medicines, the dose must be gradually lowered as the medicine is discontinued because, if stopped abruptly, it can cause insomnia to occur again for a night or two.
  • Trying behavioral techniques to improve sleep, such as relaxation therapy, sleep restriction therapy, and reconditioning.

Relaxation Therapy.
There are specific and effective techniques that can reduce or eliminate anxiety and body tension. As a result, the person's mind is able to stop "racing," the muscles can relax, and restful sleep can occur. It usually takes much practice to learn these techniques and to achieve effective relaxation.

Sleep Restriction.
Some people suffering from insomnia spend too much time in bed unsuccessfully trying to sleep. They may benefit from a sleep restriction program that at first allows only a few hours of sleep during the night. Gradually the time is increased until a more normal night's sleep is achieved.

Another treatment that may help some people with insomnia is to recondition them to associate the bed and bedtime with sleep. For most people, this means not using their beds for any activities other than sleep and sex. As part of the reconditioning process, the person is usually advised to go to bed only when sleepy. If unable to fall asleep, the person is told to get up, stay up until sleepy, and then return to bed. Throughout this process, the person should avoid naps and wake up and go to bed at the same time each day. Eventually the person's body will be conditioned to associate the bed and bedtime with sleep.

The Right Regiment for You

The Right Regiment for You

You've discussed your symptoms and risk factors with your doctor, you've done some research, and you've decided to take hormone therapy (HT)1. Before you take any pills, apply patches, or rub in creams, you need the answers to some questions: What should you take, how much should you take, and when should you take it?

What to Take

While there is no set combination or dosage of hormones that works for every woman, a hormone therapy regimen may commonly include a combination of:

* a form of estrogen
* a form of progesterone
* and, if needed, an androgen such as testosterone

The Estrogens: Not All Alike

While we tend to think of estrogen's relationship to our reproductive function first, this hormone actually nourishes and protects our bodies in hundreds of ways, from our hearts, to our bones, to our skin and hair. In the uterus, estrogen causes the lining (endometrium) to thicken and build up each month until it is sloughed as a menstrual period.

''Estrogen'' is often used as a general term, but it is actually a category of hormones. Of the many types of estrogen our bodies make, these are the three produced in major amounts:
  • Estradiol
is the most potent form of estrogen, and the one produced in the largest amounts by a woman's ovaries before menopause. Estradiol levels fall after menopause. The brand names Estrace®, Estraderm®, Vivelle®, Alora®, FemPatch™, Estring®, and Climara® contain estradiol.
  • Estrone
is the predominant estrogen in a woman's body after menopause. When ovarian function declines, the fat cells in a woman's body take over the role of synthesizing estrone. Premarin® and Ogen® contain estrone (Premarin also contains other estrogens derived from the urine of pregnant horses).
  • Estriol
is known as the ''weak'' or ''forgotten'' estrogen. Produced in large amounts by the placenta during pregnancy, estriol is also converted in small amounts by the liver. Estriol is not commercially available in the U.S.

You have a variety of estrogen preparations to choose from.

Commonly prescibed estrogens include:

* Estraderm® (transdermal skin patch)
* Estring® (vaginal ring)
* Climara® (transdermal skin patch)
* Vivelle® (transdermal skin patch)
* FemPatch™ (transdermal skin patch)
* Estrace® (oral tablet, vaginal cream)
* Ogen® (oral tablet, vaginal cream)
* Premarin® (oral tablet)

When taken alone as a medication, estrogen can cause the cells in the uterine lining to become crowded or malformed. Progesterone, on the other hand, controls that effect, protecting you from endometrial abnormalities. You can choose between synthetic forms of progesterone, called progestins, and natural progesterone (progesterone USP), which must be compounded by a pharmacist2.

Arriving at the right HT formulation for you can take some time and adjustment. For many women, 0.625 mg Premarin® or 1 mg Estrace® are good starting dosages of estrogen. Dosages of progesterone will vary depending on the type of progesterone you are taking, and whether you are on a continuous or cyclical regimen.

If the intitial HT dose gives you uncomfortable side effects or doesn't alleviate your symptoms, your doctor can adjust the dose, try a different form of estrogen, or low-dose natural progesterone instead of synthetic progestin, depending on your individual situation.

Patch, Pill, or Cream?

In choosing the form of hormone therapy that is best for you, there are several factors you and your healthcare provider will want to consider, including which symptoms are most important for you to manage.

Because the level of heart and bone protection differs with various forms of HT, your individual profile and family history of these conditions may come into play. Some women value convenience very highly, and choose a form of HT that is easiest for them to remember how and when to take. Finally, some women weigh the costs of various forms, and factor that into their decision.

Points you may want to keep in mind in deciding between oral (taken by mouth), transdermal (skin) patch, transdermal (skin) cream, or vaginal cream estrogen:

* The estrogen skin patch is typically more expensive than oral estrogen, and the adhesive sometimes causes skin irritation.
* The skin patch may be a good choice for you if your triglyeride levels are abnormally high. Transdermal estrogen enters the body through the skin and does not raise triglyceride levels. Oral estrogen appears to increase triglyceride levels somewhat because it passes through the liver.
* Estrogen in cream form can be very effective in treating urinary and vaginal problems. (Premarin®, Estrace®, and Ogen® are commercially available as vaginal creams; natural low-dose estrogen therapy can be compounded as a cream or suppository by a pharmacist per your healthcare provider's direction).
* Vaginal estrogen creams may not have protective benefits in regard to heart or bone health.

Natural Hormone Options

Used in connection with hormones, the term ''natural'' can be confusing. When we say ''natural'' we mean molecularly identical to the hormones produced in your body. That's the key difference between the synthetic progestins and natural progesterone, for example.

The synthetic progestins (Provera® is a commonly-prescribed progestin) are similar to the progesterone your body produces, but the subtle chemical differences can significantly influence the hormone's action and side-effects in the body. Synthetic progestins can cause side-effects of irritability, nausea, depression, and water retention in some women. Natural progesterone is molecularly identical to the hormone made in the body, and many women find it easier to tolerate.

Many women call Women's Health America and the consulting pharmacists at Madison Pharmacy Associates to ask if there is a ''natural estrogen'' they can take with their natural progesterone. They are often surprised to learn that commerically manufactured and frequently-prescribed forms of estrogen (Estrace® and Estraderm® for example) are ''natural'' estrogens. Choosing among the various low-dose estrogens is a decision best made by you and your healthcare provicer based on the specific symptoms that need to be managed.

Women who are taking the hormone testosterone to alleviate lack of sex drive also have the option of taking the natural form of this hormone. Natural testosterone is not commercially available and must be compounded by a pharmacist. The section on ''Checking Testosterone After Hot Flashes'' tells more about how to decide if testosterone may be helpful for you.

When to Take It

If you're taking hormone therapy, you can choose between two types of regimens: cyclical and continuous combined. Taking HT cyclically, the most frequently prescribed regimen, mimics a menstrual pattern: you take estrogen every day and progesterone for 12-14 days of the month.

When you finish taking progesterone each month, you experience bleeding as your body ''withdraws'' from the hormone progesterone, and the endometrial lining sloughs away. Continuous combined therapy, in which women take estrogen and progesterone every day, typically eliminates the breakthrough bleeding after some initial spotting in the first one to three months. Most women report fewer side-effects with this regimen.

Evaluating Your Choices

Whatever hormone therapy regimen you choose, be aware of two very important points, says Dr. Wulf H. Utian:

1) The therapy must be evaluated at least annually by both you and your doctor, sooner if you experience side effects or problems. No hormone therapy should ever be considered permanent, although you may be taking the hormones indefinitely.

2) No single hormone ''recipe'' exists that will fit every woman. The first regimen you try may not work for you, but don't give up. Your doctor should fine-tune your hormone regimen to your individual needs -- your risk factors, your symptoms before and during therapy, and your lifestyle.

The consulting pharmacists at Madison Pharmacy Associates routinely work with women and their healthcare providers to individualize low-dose natural hormone therapy regimens, and are available to advise you. You can have your healthcare provider call 1-800-558-7046 for a comprehensive consultation with a pharmacist.

1 Some women should not take estrogen: women who have had breast or uterine cancer; women with chronic blood-clotting problems, unexplained vaginal bleeding, or serious gall bladder or liver disease; or women who are or might be pregnant.

2 Madison Pharmacy Associates P O Box 259690, Madison, WI 53717-9690, 1-800-558-7046 specializes in compounding natural hormones.

3 More reasons than ever for HT,'' T.L. Bush, R.D Gambrell, Jr., and V. Miller, Patient Care, Nov. 15, 1993, pp. 103-132.

Estrogen for Younger Looking Skin

Estrogen for Younger Looking Skin

Estrogen and Skin-Aging

Well-known for its influence on osteoporosis and mood, estrogen also appears to exert strong influence on aging of the skin. Estrogen receptors are located in the skin, and studies show that estrogen increases the activity of skin fibroblasts, cells that produce collagen. Collagen is the connective tissue that adds ''plumpness'' to skin, giving it structure, tone, and thickness. It helps keep moisture in the skin by insuring the production of hyaluronic acid and acid mucopolysaccharides.

Declining Hormone Levels Correlate With Declining Skin Integrity

During menopause, when the production of hormones in the ovaries diminishes significantly and eventually stops altogether, it is not surprising that most women notice changes in their skin, most noticeably dryness and wrinkling. Studies show declining levels of estrogen associated with menopause are linked to a decline in skin integrity and function. The skin thins out and loses its elasticity causing wrinkles to deepen, and the process of cell renewal slows down, resulting in less radiance and a duller complexion. Some estimates show that skin loses up to 30% of its collagen in the first five years after menopause, and without intervention, post-menopausal skin will continue to degenerate.

Estrogen Replacement Improves Skin

Maintaining optimal levels of estrogen, however, appears to safeguard against many of these effects. Women who use estrogen therapy after menopause have been shown to have thicker, healthier skin. A study in the British Medical Journal found that the collagen content of skin in postmenopausal women who underwent estrogen replacement therapy was 48% greater than in those who did not - suggesting that, in aging women, estrogen protects skin similar to the way it protects bones. Skin wrinkling may also diminish as a result of the effects of the hormone on the elastic fibers and collagen. The same study also showed women who take both estrogen and testosterone have skin that is 48 percent thicker (and healthier) than women who don't take either hormone.

The Benefits of Topical Estrogen Creams

For women who cannot tolerate or are not interested in estrogen replacemen, topical forms of specialized estrogen creams, using the estrogen, estriol, can produce similar beneficial effects on facial skin without raising the level of estrogen in the body.

Considered the ''weakest'' of the estrogens, research shows estriol may turn out to be the estrogen that is a good alternative for a wide array of anti-aging and hormone replacement applications, including hot flashes, insomnia, vaginal atrophy, and facial wrinkles.

In a study published in the International Journal of Dermatology, topical estrogen appeared to increase the amount of collagen in skin with marked improvement in skin elasticity and firmness after six months of treatment.

The study showed topical estrogen cream:

* Decreased wrinkle depth and pore size by 61% to 100%
* Increased skin thickness by 7% to 15%
* Increased skin lipid sebum production by 35%
* Markedly improved skin hydration

Other Benefits

In addition to its influence on skin aging, it has been suggested that estrogen also increases cutaneous wound healing by regulatind the levels of a cytokine. In fact, topical estrogen has been found to accelerate and improve wound healing in elderly men and women. The role of estrogen in scarring is unclear, but recent studies indicate that the lack of estrogen or the addition of tamoxifen may improve the quality of scarring.
Hormone Testing

As always, hormone level testing can help take the guesswork out of hormone therapy and determine a program that is just right for you.

Hormones and Aging

Hormones and Aging

Hormones are powerful chemical messengers produced by your body that tell your cells what to do, and regulate every organ and major body system. Hormones affect everything from your ability to fall asleep, to your mood, thinking ability, cholesterol level, response to stress, and the speed at which you age.

As we age, hormone levels decline, creating a severe hormone imbalance that may contribute to many of the diseases associated with aging including depression, osteoporosis, coronary artery disease, and loss of libido.


By the time a woman enters menopause, she may already have experienced two decades of hormonal imbalance. After menopause, when all her hormone levels decrease significantly, risk of major diseases increases. These include:

Heart disease - Rates of heart disease in postmenopausal women gradually climb until they equal the rates typically seen among men. According to the American Heart Association, heart disease is the leading killer of American women (American Heart Association 2004).

Osteoporosis - Hormone deficiencies are clearly associated with bone loss and osteoporosis, beginning even in the third decade of life. By the time a woman reaches 50, her risk of an osteoporotic bone fracture is significantly increased.

Alzheimer's and dementia - Loss of hormones is associated with neurodegeneration and increased risk of dementia, such as Alzheimer's disease and Parkinson's disease.


Many physicians accept diminished hormone levels as an inevitable consequence of aging and dismiss the anti-aging benefits of restoring youthful hormone levels. However, research indicates that, in addition to relieving menopausal symptoms, optimizing hormone levels can benefit conditions such as osteoporosis, depression, fatigue, and excess weight. Among the most important hormones for women to monitor and balance are free estrogen, testosterone, and DHEA.

Estrogen Is Important for Osteoporosis Prevention

Strong, healthy bone is continually maintained through a process of bone resorption (removal of old bone) and bone formation (deposition of new bone). During this process, estrogen plays an important role in protecting against bone loss. Sufficient levels of progesterone and testosterone are also important. A woman's risk of bone loss and osteoporosis increases dramatically after menopause when estrogen and other hormone levels decline. The primary preventative treatment modality in the U.S. for postmenopausal osteoporosis is hormone therapy. Studies show that hormone therapy could potentially prevent 80% of vertebral fractures and reduce hip fractures by about 50%.

Testosterone Linked to Libido and Well-being

Although women produce only small quantities of testosterone, this important hormone helps women maintain muscle strength, bone mass, and sexual function. A woman's testosterone level decreases throughout her adult life, and, by menopause, is about 50% of what it was at 20.

In one study published in the New England Journal of Medicine in September 2000, testosterone patches were tested on 75 surgically menopausal women whose declining testosterone levels had resulted in a loss of libido. Study participants using testosterone patches were two to three times more likely to have an increase in sexual activity and improved overall well being than those not using patches.

Studies Suggest Hormones Affect Skin Integrity and Elasticity

During menopause, when the production of hormones in the ovaries diminishes significantly and eventually stops altogether, it is not surprising that most women notice changes in their skin, most noticeably dryness and wrinkling. Studies show the skin thins out and loses its elasticity causing wrinkles to deepen, and the process of cell renewal slows down, resulting in less radiance and a duller complexion. Some estimates show that skin loses up to 30% of its collagen in the first five years after menopause, and without intervention, post-menopausal skin may continue to degenerate.

Maintaining optimal levels of estrogen appears to exert strong influence on aging of the skin. A study in the British Medical Journal found that the collagen content of skin in postmenopausal women who underwent estrogen therapy was 48% greater than in those who did not -- suggesting that, in aging women, estrogen protects skin similar to the way it protects bones. Another study suggested that skin wrinkling may also diminish as a result of the effects of the hormone on the elastic fibers and collagen. The same study also showed women who take both estrogen and testosterone have skin that is 48 percent thicker (and healthier) than women who don't take either hormone.

Estrogen Helps Maintain Healthy Vaginal Tissue and Prevent Urinary Incontinence

Vaginal dryness and atrophy, urinary frequency, urinary incontinence, and repeat urinary tract infections are problems that many women experience during and after menopause. These symptoms occur because falling estrogen levels can lead to thinning of the vaginal and urethral tissue and weakening of the muscles around the bladder.

Supplemental low-dose estrogen has a very robust local effect on the many estrogen receptors in these tissues and can be useful in reducing vaginal dryness and thickening skin and mucosa. Studies show low-dose estrogen can also lower vaginal pH, promoting a healthy environment for the growth of protective flora, which may then help prevent urinary tract infections.

DHEA - The Fountain of Youth Hormone

DHEA, a hormone produced by the adrenal glands, has been called the ''fountain of youth'' hormone because of its widespread positive role in maintaining youthful function as we age. Levels of DHEA peak in our twenties then begin a dramatic decline, which is associated with diminishing immunity, memory, libido and energy, and lowered resistance to age-related diseases. DHEA also plays an important role in how we handle stress and in bone mineral density.

While over-the-counter DHEA supplements are widely available and may be valuable in the quest for healthy aging, too much DHEA can ''cascade'' or turn into other hormones, creating further hormone imbalance. On the other hand, DHEA levels typically increase on their own when other hormones are brought back into balance. As with all hormones, measuring your hormone levels before supplementation is critical.



This online resource guide provides information about cataracts. It answers questions about causes and symptoms, and discusses diagnosis and types of treatment

Glaucoma Defined

What is glaucoma?

Glaucoma is a group of diseases that can damage the eye's optic nerve and result in vision loss and blindness. Glaucoma occurs when the normal fluid pressure inside the eyes slowly rises. However, with early treatment, you can often protect your eyes against serious vision loss.

What is the optic nerve?

The optic nerve is a bundle of more than 1 million nerve fibers. It connects the retina to the brain. (See diagram below.) The retina is the light-sensitive tissue at the back of the eye. A healthy optic nerve is necessary for good vision.

What are some other forms of glaucoma?

Glaucoma section

Open-angle glaucoma is the most common form. Some people have other types of the disease.

  1. Low-tension or normal-tension glaucoma. Optic nerve damage and narrowed side vision occur in people with normal eye pressure. Lowering eye pressure at least 30 percent through medicines slows the disease in some people. Glaucoma may worsen in others despite low pressures.

    A comprehensive medical history is important in identifying other potential risk factors, such as low blood pressure, that contribute to low-tension glaucoma. If no risk factors are identified, the treatment options for low-tension glaucoma are the same as for open-angle glaucoma.

  2. Angle-closure glaucoma.
    The fluid at the front of the eye cannot reach the angle and leave the eye. The angle gets blocked by part of the iris. People with this type of glaucoma have a sudden increase in eye pressure. Symptoms include severe pain and nausea, as well as redness of the eye and blurred vision. If you have these symptoms, you need to seek treatment immediately.

  3. This is a medical emergency.
    If your doctor is unavailable, go to the nearest hospital or clinic. Without treatment to improve the flow of fluid, the eye can become blind in as few as one or two days. Usually, prompt laser surgery and medicines can clear the blockage and protect sight.

  4. Secondary glaucomas.
    These can develop as complications of other medical conditions. These types of glaucomas are sometimes associated with eye surgery or advanced cataracts, eye injuries, certain eye tumors, or uveitis (eye inflammation). Pigmentary glaucoma occurs when pigment from the iris flakes off and blocks the meshwork, slowing fluid drainage. A severe form, called neovascular glaucoma, is linked to diabetes. Corticosteroid drugs used to treat eye inflammations and other diseases can trigger glaucoma in some people. Treatment includes medicines, laser surgery, or conventional surgery.
  5. Congenital glaucoma.
    Children are born with a defect in the angle of the eye that slows the normal drainage of fluid. These children usually have obvious symptoms, such as cloudy eyes, sensitivity to light, and excessive tearing. Conventional surgery typically is the suggested treatment, because medicines may have unknown effects in infants and be difficult to administer. Surgery is safe and effective. If surgery is done promptly, these children usually have an excellent chance of having good vision.

  6. Secondary glaucomas.
    These can develop as complications of other medical conditions. These types of glaucomas are sometimes associated with eye surgery or advanced cataracts, eye injuries, certain eye tumors, or uveitis (eye inflammation). Pigmentary glaucoma occurs when pigment from the iris flakes off and blocks the meshwork, slowing fluid drainage. A severe form, called neovascular glaucoma, is linked to diabetes. Corticosteroid drugs used to treat eye inflammations and other diseases can trigger glaucoma in some people. Treatment includes medicines, laser surgery, or conventional surgery.

Causes and Risk Factors

How does open-angle glaucoma damage the optic nerve?

In the front of the eye is a space called the anterior chamber. A clear fluid flows continuously in and out of the chamber and nourishes nearby tissues. The fluid leaves the chamber at the open angle where the cornea and iris meet. (See diagram below.) When the fluid reaches the angle, it flows through a spongy meshwork, like a drain, and leaves the eye.

Sometimes, when the fluid reaches the angle, it passes too slowly through the meshwork drain. As the fluid builds up, the pressure inside the eye rises to a level that may damage the optic nerve. When the optic nerve is damaged from increased pressure, open-angle glaucoma--and vision loss--may result. That's why controlling pressure inside the eye is important.

Glaucoma before surgery.

Does increased eye pressure mean that I have glaucoma?

Not necessarily. Increased eye pressure means you are at risk for glaucoma, but does not mean you have the disease. A person has glaucoma only if the optic nerve is damaged. If you have increased eye pressure but no damage to the optic nerve, you do not have glaucoma. However, you are at risk. Follow the advice of your eye care professional.

Can I develop glaucoma if I have increased eye pressure?

Not necessarily. Not every person with increased eye pressure will develop glaucoma. Some people can tolerate higher eye pressure better than others. Also, a certain level of eye pressure may be high for one person but normal for another.

Whether you develop glaucoma depends on the level of pressure your optic nerve can tolerate without being damaged. This level is different for each person. That's why a comprehensive dilated eye exam is very important. It can help your eye care professional determine what level of eye pressure is normal for you.

Can I develop glaucoma without an increase in my eye pressure?

Yes. Glaucoma can develop without increased eye pressure. This form of glaucoma is called low-tension or normal-tension glaucoma. It is not as common as open-angle glaucoma.

Who is at risk for glaucoma?

Anyone can develop glaucoma. Some people are at higher risk than others. They include:

  • African Americans over age 40.
  • Everyone over age 60, especially Mexican Americans.
  • People with a family history of glaucoma.

Among African Americans, studies show that glaucoma is:

  • Five times more likely to occur in African Americans than in Caucasians.
  • About four times more likely to cause blindness in African Americans than in Caucasians.
  • Fifteen times more likely to cause blindness in African Americans between the ages of 45-64 than in Caucasians of the same age group.

A comprehensive dilated eye exam can reveal more risk factors, such as high eye pressure, thinness of the cornea, and abnormal optic nerve anatomy. In some people with certain combinations of these high-risk factors, medicines in the form of eyedrops reduce the risk of developing glaucoma by about half.

Medicare covers an annual comprehensive dilated eye exam for some people at high risk for glaucoma.

What can I do to protect my vision?

Studies have shown that the early detection and treatment of glaucoma, before it causes major vision loss, is the best way to control the disease. So, if you fall into one of the high-risk groups for the disease, make sure to have your eyes examined through dilated pupils every two years by an eye care professional.

If you are being treated for glaucoma, be sure to take your glaucoma medicine every day. See your eye care professional regularly.

You also can help protect the vision of family members and friends who may be at high risk for glaucoma--African Americans over age 40; everyone over age 60, especially Mexican Americans; and people with a family history of the disease. Encourage them to have a comprehensive dilated eye exam at least once every two years. Remember: Lowering eye pressure in glaucoma's early stages slows progression of the disease and helps save vision.

Symptoms and Detection

What are the symptoms of glaucoma?

At first, there are no symptoms. Vision stays normal, and there is no pain.

However, as the disease progresses, a person with glaucoma may notice his or her side vision gradually failing. That is, objects in front may still be seen clearly, but objects to the side may be missed.

As glaucoma remains untreated, people may miss objects to the side and out of the corner of their eye. Without treatment, people with glaucoma will slowly lose their peripheral (side) vision. They seem to be looking through a tunnel. Over time, straight-ahead vision may decrease until no vision remains.

Glaucoma can develop in one or both eyes.

Normal vision
Normal vision
Scene viewed by a person with glaucoma
Same scene as viewed by a person with glaucoma

How is glaucoma detected?

Glaucoma is detected through a comprehensive eye exam that includes:
  1. Visual acuity test. This eye chart test measures how well you see at various distances. A tonometer measures pressure inside the eye to detect glaucoma.
  2. Visual field test. This test measures your side (peripheral) vision. It helps your eye care professional tell if you have lost side vision, a sign of glaucoma.
  3. Dilated eye exam. Drops are placed in your eyes to widen, or dilate, the pupils. Your eye care professional uses a special magnifying lens to examine your retina and optic nerve for signs of damage and other eye problems. After the exam, your close-up vision may remain blurred for several hours.
  4. Tonometry. An instrument (right) measures the pressure inside the eye. Numbing drops may be applied to your eye for this test.
  5. Pachymetry. A numbing drop is applied to your eye. Your eye care professional uses an ultrasonic wave instrument to measure the thickness of your cornea.


Can glaucoma be treated?

Yes. Immediate treatment for early stage, open-angle glaucoma can delay progression of the disease. That's why early diagnosis is very important.

Glaucoma treatments include medicines, laser trabeculoplasty, conventional surgery, or a combination of any of these. While these treatments may save remaining vision, they do not improve sight already lost from glaucoma.

  1. Medicines. Medicines, in the form of eyedrops or pills, are the most common early treatment for glaucoma. Some medicines cause the eye to make less fluid. Others lower pressure by helping fluid drain from the eye.

    Before you begin glaucoma treatment, tell your eye care professional about other medicines you may be taking. Sometimes the drops can interfere with the way other medicines work.

    Glaucoma medicines may be taken several times a day. Most people have no problems. However, some medicines can cause headaches or other side effects. For example, drops may cause stinging, burning, and redness in the eyes. Many drugs are available to treat glaucoma. If you have problems with one medicine, tell your eye care professional. Treatment with a different dose or a new drug may be possible.

    Because glaucoma often has no symptoms, people may be tempted to stop taking, or may forget to take, their medicine. You need to use the drops or pills as long as they help control your eye pressure. Regular use is very important. Make sure your eye care professional shows you how to put the drops into your eye. See tips (hyperlink to "How should I use my glaucoma eyedrops?") on using your glaucoma eyedrops.

  2. Laser trabeculoplasty. Laser trabeculoplasty helps fluid drain out of the eye. Your doctor may suggest this step at any time. In many cases, you need to keep taking glaucoma drugs after this procedure.

    Laser trabeculoplasty is performed in your doctor's office or eye clinic. Before the surgery, numbing drops will be applied to your eye. As you sit facing the laser machine, your doctor will hold a special lens to your eye. A high-intensity beam of light is aimed at the lens and reflected onto the meshwork inside your eye. You may see flashes of bright green or red light. The laser makes several evenly spaced burns that stretch the drainage holes in the meshwork. This allows the fluid to drain better.

    Like any surgery, laser surgery can cause side effects, such as inflammation. Your doctor may give you some drops to take home for any soreness or inflammation inside the eye. You need to make several follow-up visits to have your eye pressure monitored.

    If you have glaucoma in both eyes, only one eye will be treated at a time. Laser treatments for each eye will be scheduled several days to several weeks apart.

    Studies show that laser surgery is very good at reducing the pressure in some patients. However, its effects can wear off over time. Your doctor may suggest further treatment.

  3. Conventional surgery. Conventional surgery makes a new opening for the fluid to leave the eye. (See diagram.) Your doctor may suggest this treatment at any time. Conventional surgery often is done after medicines and laser surgery have failed to control pressure.

    Glaucoma after surgery.

    Conventional surgery is performed in an eye clinic or hospital. Before the surgery, you will be given medicine to help you relax. Your doctor will make small injections around the eye to numb it. A small piece of tissue is removed to create a new channel for the fluid to drain from the eye.

    For several weeks after the surgery, you must put drops in the eye to fight infection and inflammation. These drops will be different from those you may have been using before surgery.

    As with laser surgery, conventional surgery is performed on one eye at a time. Usually the operations are four to six weeks apart. Conventional surgery is about 60 to 80 percent effective at lowering eye pressure. If the new drainage opening narrows, a second operation may be needed. Conventional surgery works best if you have not had previous eye surgery, such as a cataract operation.

    In some instances, your vision may not be as good as it was before conventional surgery. Conventional surgery can cause side effects, including cataract, problems with the cornea, and inflammation or infection inside the eye. The buildup of fluid in the back of the eye may cause some patients to see shadows in their vision. If you have any of these problems, tell your doctor so a treatment plan can be developed.

Conventional surgery makes a new opening for the fluid to leave the eye.

How should I use my glaucoma eyedrops?

If eyedrops have been prescribed for treating your glaucoma, you need to use them properly and as instructed by your eye care professional. Proper use of your glaucoma medication can improve the medicine's effectiveness and reduce your risk of side effects. To properly apply your eyedrops, follow these steps:

  • First, wash your hands.
  • Hold the bottle upside down.
  • Tilt your head back.
  • Hold the bottle in one hand and place it as close as possible to the eye.
  • With the other hand, pull down your lower eyelid. This forms a pocket.
  • Place the prescribed number of drops into the lower eyelid pocket. If you are using more than one eyedrop, be sure to wait at least five minutes before applying the second eyedrop.
  • Close your eye OR press the lower lid lightly with your finger for at least one minute. Either of these steps keeps the drops in the eye and helps prevent the drops from draining into the tear duct, which can increase your risk of side effects

What can I do if I already have lost some vision from glaucoma?

If you have lost some sight from glaucoma, ask your eye care professional about low vision services and devices that may help you make the most of your remaining vision. Ask for a referral to a specialist in low vision.

Many community organizations and agencies offer information about low vision counseling, training, and other special services for people with visual impairments. A nearby school of medicine or optometry may provide low vision services.

Current Research

What research is being done?

A large amount of research is being done in the U.S. to learn what causes glaucoma and to improve its diagnosis and treatment. For instance, the National Eye Institute (NEI) is funding a number of studies to find out what causes fluid pressure to increase in the eye. By learning more about this process, doctors may be able to find the exact cause of the disease and learn better how to prevent and treat it. The NEI also supports clinical trials of new drugs and surgical techniques that show promise against glaucoma.

Eye Health Organizations
Tips on Talking to Your Doctor
How to Find an Eye Care Professional
Order Glaucoma Publications from our online catalog

Content last reviewed April 2006

This online resource guide provides information about cataracts. It answers questions about causes and symptoms, and discusses diagnosis and types of treatment. It was adapted from Don't Lose Sight of Glaucoma (NIH Publication No. 96-3251) and Glaucoma: What You Should Know (NIH Publication No. 03-651).

The National Eye Institute (NEI) conducts and supports research that leads to sight-saving treatments and plays a key role in reducing visual impairment and blindness. The NEI is part of the National Institutes of Health (NIH), an agency of the U.S. Department of Health and Human Services.

This page was last modified in October 2007

Organ Transplants: What You Need to Know

Organ Transplants: What You Need to Know

Hearing from your doctor that you need a transplant is overwhelming and difficult news. Also overwhelming can be your sudden need for information on organ transplants. This article will get you started on what you need to know.

Organ transplantation -- the surgical removal of a healthy organ from one person and then putting it into another person whose organ has failed or was injured -- is often lifesaving and gives the recipient a wonderful new lease on life.

But organ transplants are also major surgery and carry potential risks and drawbacks, such as the chance of organ rejection. That's precisely why you and your loved ones need to gather as much information on organ transplants as possible, and as soon as possible.

Organ Transplants: An Information Overview

In the United States, six types of organ transplants are now performed, according to the United Network for Organ Sharing (UNOS), a nonprofit organization in Richmond Va., which administers the country's only Organ Procurement and Transplantation Network, which includes the organ transplant waiting list.

Organ transplants include kidney, pancreas, liver, heart, lung, and intestine; sometimes "double" transplants are done, such as kidney/pancreas or heart/lung.

In 2005, there were 27,527 transplants done in the U.S., according to UNOS, a slight increase over the total for 2004, when there was 26,541. To date, most donor organs have come from the deceased rather than living donors. In 2005, for instance, 20,635 donors were deceased, while 6,892 were living.

Most common, typically, are kidney transplants; least common single-organ transplants are the intestines.

Organs are matched using several characteristics, including blood type and size of the organ needed. Also taken into account is how long someone has been on the waiting list and the distance between the donor and the potential recipient.

You Need an Organ Transplant: What's Next?

Once your doctor gives you the news, he or she will typically refer you to a transplant center.

You aren't bound to go to the recommended center, says Gigi Spicer, RN, director of the kidney transplant service for Henrico Doctors' Hospital in Richmond, Va. This is the point at which you as a potential transplant recipient have to become very proactive, even if you're still reeling from the news.

It's a mistake to give up and let your health care team make all the decisions, Spicer says. There are some things you can't control, but a surprising amount you can.

Start by searching for transplant centers by organ type, by state or by region by going to the UNOS web page. Click on "Resources" and then "Member Directory."

You can get specific reports on centers nationwide by visiting the web page of the Scientific Registry of Transplant Recipients' U.S. Transplant web site, which is maintained by the University of Michigan's Ann Arbor Research Collaborative for Health. Included in the reports are waiting times, number of living vs. deceased donors, survival rates, and other facts.

The statistics can get complicated, so asking your own doctor or the facility to help you interpret is advised.

Another way to stay in the game, says Spicer, is to educate yourself about your disease as much as you can and gather as much information on organ transplants as possible.

Getting on the Organ Transplant Waiting List

Your natural first question is, how do I get on the transplant waiting list? To get on the national list, UNOS tells potential recipients to contact the transplant hospital you and your doctor have decided on and ask for an appointment. You will be evaluated by the transplant team, which will take into account your medical history, current health status, and other variables to see if you are indeed a good candidate for the transplant.

Every transplant hospital has its own criteria for evaluation. UNOS has also developed guidelines. If the team accepts you as a candidate, it will add you to the national waiting list maintained by UNOS.

To find out if you are on the list, check with your transplant hospital. Written notices about who is on the waiting list are not sent by UNOS. According to UNOS, you may ask to be listed at more than one hospital, but be aware that individual hospitals can have their rules about that; be sure to ask.

UNOS keeps a running total of the transplant waiting lists in the entire nation, organ by organ, on its web site and updates it regularly. In March 2007, for instance, 95,563 were on the waiting list nationwide for organs of all types.

Organ Transplant Waiting Times, Policies, Procedures

The average wait time varies by organ, age, blood type, and other factors. For instance, waiting times can reach five or six years for candidates waiting for deceased kidney organ donors.

UNOS has an online database known as UNET, which collects, stores, and analyzes data on the patient waiting list, organ matching, and the transplants. All U.S. organ transplant programs as well as organ procurement organizations and tissue typing labs work together to share the organs. The database allows the facilities to register patients, match donated organs to patients on the transplant waiting list, and manage the data of transplant patients before and after the surgery.

More than 200 transplant hospitals operate in the U.S.

Recently, new federal rules that tighten standards for the centers have been announced and take effect in June 2007. Among other requirements, the centers will be required to perform an average of 10 transplants a year, with some exceptions allowed, to keep federal funding.

UNOS distributes the organs first locally. But if no match is found, the organ is offered to a good match regionally and then nationally, if necessary.

What Are Your Organ Donor Options?

You also may have a choice about whether the organ donor is deceased or living.

Living donors are arranged through the individual transplant centers, according to UNOS. Another option, if you need a kidney transplant, is to contact the National Kidney Foundation's National Donor Family Council.

Your living organ donor can be a spouse or other family member or an unrelated person such as a friend, Spicer says. The potential living donor's blood is tested to see if she is compatible with the recipient.

But even if the blood types are not compatible, you may be able to find a program that allows proxy donors. This is when someone who doesn't match the intended donor can still donate the organ for someone else's use, and the intended donor goes to the top of the transplant list. The concept is fairly new.

Those who need a transplant often ask if they can buy an organ. The answer is simple: No. In the United States, it is a felony to buy an organ.

Though other countries allow the sale of organs, a physician practicing in the U.S. would not place that organ, Spicer says.

Gathering Information on Organ Transplants

Depending on the organ being transplanted, you can get other help from a variety of organizations. UNOS has on its site an exhaustive list, from the American Heart Association, America Kidney Foundation and American Liver Foundation to state organizations such as the Georgia Transplant Foundation.

There's a wide array of information on organ transplants available to you. You can be an integral part of your care by tapping into these resources.

Cinnamon’s Secret Health Benefit?

Cinnamon’s Secret Health Benefit?

WebMD Feature from "EatingWell"

Rachael Moeller Gorman

The popular spice may help regulate blood-glucose levels.

With holiday favorites like pumpkin bread and spiced cider on the menu, recent research in the American Journal of Clinical Nutrition provides welcome news: cinnamon may help you better regulate your blood-glucose levels. In a study of 14 healthy people, scientists at Malmö University Hospital in Sweden gave half the subjects rice pudding mixed with about 3 teaspoons of cinnamon; the other half got an unspiced version of the dessert. Then, they switched: each group tried the opposite pudding. Both times, up to two hours after eating, the people who’d enjoyed the cinnamon-spiced pudding measured significantly lower blood-glucose levels than those who’d eaten the unspiced one—an indication that their blood sugar was moving more efficiently into cells, where it’s used.

Eating the spiced pudding also appeared to slow the movement of food from the stomach into the small intestine (a part of digestion called “gastric emptying”). Though researchers don’t know exactly how cinnamon slows digestion, the fact that it does may, in part, explain the lower blood sugar. “When food enters the intestine more slowly, carbohydrates are broken down slower, which leads to a lower [post-meal] blood-glucose concentration,” says the study’s investigator, Joanna Hlebowicz, M.D.

Other studies suggest that the spice also may improve blood-glucose levels by increasing a person’s insulin sensitivity, the ability of cells to respond to insulin’s signal to move glucose out of the blood. One 2003 trial of 60 people with type 2 diabetes reported that consuming as little as 1 gram (about 1⁄2 teaspoon) of cinnamon daily for six weeks reduced blood-glucose levels significantly. It also improved the subjects’ blood cholesterol and triglycerides—perhaps because insulin plays a key role in regulating fats in the body.

But other work disputes these findings. A 2006 study showed that insulin sensitivity in diabetic women taking cinnamon supplements did not improve. Why the discrepancy? It could be because the study examined only a specific population: postmenopausal women, many of whom were taking a variety of glucose-lowering medications (which wasn’t the case in the other studies), say the authors.

Bottom line: Sprinkling a 1⁄2 teaspoon of cinnamon on your oatmeal in the morning can’t hurt, it’s tasty and it just may, over time, help ward off diabetes. But don’t go overboard. Animal studies suggest that a compound in cinnamon called coumarin may be toxic in high doses (although humans may not be as susceptible). Cinnamon oils are particularly concentrated, so steer clear. And if you have diabetes, don’t try cinnamon supplements without talking with your doctor: combining them with a prescription medication may be dangerous.

Small Steps to Your Health

Small Steps to Your Health

Choose healthy foods, make healthy meals, be active 30 minutes a day ... these are just a few of the long list of actions you can do to get to, and stay at a healthy weight and prevent type 2 diabetes. It's not easy to do all of this every day living in today's fast-paced and fast-food world. It seems even harder if you have a lot of changes you need to make.

It's easier to make healthy lifestyle changes one step at a time -- over months and years. Think of each small step as one piece of your effort to change your habits for the better and for good. Making changes one step at time gives you your best shot at getting to and staying at a healthy weight and preventing type 2 diabetes.

The good news is that making just a few small changes to eat healthier and be more active can make a BIG impact on your weight and health। This tip sheet helps you learn how to make these changes step-by-step।

Is your health at risk?

People around you may tell you that you have a problem with your weight or health। But what do you think? If you don't believe you have a problem, you will not likely make the effort to make changes। You may even resent or be angry at the people pushing you to change. If you do believe you have a problem, you will likely succeed. Step number one: accept that you have habits you need to change.

Are you ready, willing, and able to change?

To succeed at making lifestyle changes you need to answer YES to the question: Are you ready, willing, and able to change? The experts say that for people to change, making the change must be important to them. In other words, you have good reasons to change. For example, you want to live long enough to see your grandchildren grow up. You must have more reasons to change than reasons not to change. The experts also say that you must be confident -- believe that you can change.

To succeed, take what you want to do and break it down into small steps। Then think about a few actions you are ready, willing, and able to change. Leave other habits that you don't feel ready, willing, and able to change for another time.

What are you ready, willing, and able to change?

To answer this next question, think about your current eating and activity habits. What foods do you buy? How active are you? Try to keep honest food records for a few days to get a true picture of what you eat. Based on your current habits, start with a few changes that are easy to tackle. Select changes for which you most want take action and will make the biggest impact. Perhaps choose one change that has to do with eating and another with activity. Remember; don't try to change everything at once.

For example, maybe you tend to eat a bowl of ice cream every night while you watch TV. Can you switch that ice cream to a healthier snack? Maybe fruit or a small bowl of cereal? Or just a smaller portion of ice cream. And can you take 15 minute break from the TV and go for a walk?

For each goal, think about four things:

  1. How long will you try this goal? Keep it short.
  2. Is it easy to do in your regular daily life? Keep it realistic.
  3. Is it limited in scope? Be specific.
  4. How often will you do this?

Keep your goals realistic. Don't try to do too much too quickly. Let's look at three examples of realistic goals:

  • Eating: For the next month (how long), four days each week (how often) I will eat two pieces of fruit a day -- one at breakfast and one as an afternoon snack. (realistic and specific).
  • Eating: The next five times (how long) I go to a fast food restaurant (how often), I will order a small French fries and a single hamburger, rather than a large French fries and double hamburger (realistic and specific).
  • Physically active: For the next month (how long), four days each week (how often) I will take a 15 minutes walk after lunch three days a week (realistic and specific).
  • Notice that the eating goals are not "I will eat more fruit" or "I will eat healthier." The activity goal is not "I'll walk more." These goals aren't specific like the examples above.

For more realistic tips to change your eating habits, view Healthy Eating: Make It Happen, and to get more activity, view Be More Active, But How?

Set 1 to 3 goals at a time. Write them down. Put them in a place where you will see them often -- on the refrigerator, your bathroom or bedroom mirror, or in your purse or wallet.

Did you succeed?

The last step is to see how you did at making the change. Once the time you set is over, look at the goals you set. Ask yourself these questions: Did you succeed? Did you set your sights too high? Did something happen in your life to keep you from being successful? If you were successful, give yourself a BIG pat yourself on the back. (Or maybe a trip to the movies!)

Wait, you are not done! Making a change for two weeks or a month does not mean that it will stick for life। It's so easy to slip back to your old ways. Practice the new habits faithfully. It will take months before they become your way of life. If you weren't successful, try again. Revise your goals or choose easier ones. Make sure they contain the four parts of setting a goal that's within your reach. Make sure you want to make changes in this area and that you believe you can.

What is your next step?

Start the lifestyle change cycle again. Choose a couple of new goals to work on. Slowly, goal by goal, over time you'll be eating healthier and being more active ... and you'll be at a healthier weight. You'll also be on your road to preventing or delaying type 2 diabetes.

Healthy Weight Loss

Healthy Weight Loss

Does this sound familiar? You got tired of hearing your doctor and family bug you about losing weight to prevent or manage type 2 diabetes. So, you got a two-week diet plan from a friend. You started gung-ho. The first few days were great. Then you found there were nights you didn't have time to fix your food and the family dinner. By the weekend your family wanted to have pizza. And the diet went out the door when you left for your favorite pizza place.

Many people try to lose weight, but fewer people lose weight and keep it off. This happens for several reasons. Sometimes people try to lose too much weight too fast. Or they try to follow a food plan that isn't how they can eat long term. Reality is that losing weight in a healthy way and learning how to keep it off is not easy. It takes a new way of thinking. Are you ready?

  • Choose a time to start when you think life will be as calm and in control as possible.
  • Do a self-check on what and when you eat. Keep honest food records for about a week. Write down everything you eat or drink. Use these records to set a few food goals. These food goals should be small changes you can easily make to your existing food habits.
  • Don't look for a magic bullet diet. They don't exist. You'll do best if you base eating habits on what you found out in your self check food records. Do you snack a lot? Instead of chips or a candy bar, could you snack on a piece of fruit, pretzels, or some nuts? Are your portions too large? Do you eat too many sweets?
  • Be ready to change your food habits (and perhaps your family's food habits) for good. Say good bye to some of your unhealthy habits and food choices.

Do a physical activity self-check. How much exercise do you get? How can you work more of it into your day? The tip sheet – Be Active, But How can help.

Be Ready to Start

Here are some tips to help you prepare to start your healthy lifestyle changes.

  • Learn about how much you should eat to eat healthy.
  • Get hints for how to make healthy eating happen in your life.
  • Clear the refrigerator and pantry of those tempting items. Having them out of the house makes it easier to say no.
  • Stock the house with healthier foods. If you have plenty of fruits and vegetables, it will make it easier for you to eat them. Keep the fatty foods and sweets to a minimum.
  • Use soups, salads, raw vegetables, and fruit to fill up. Eating fewer calories doesn't mean facing an empty plate. You need to feel full to have long term success.
  • Think through how you will deal with common food problems. Don't put these on hold. Sometimes you'll have to grab a fast food meal. So, think about the healthiest and most satisfying options. You'll want to enjoy a restaurant meal now and then. Ask your dining partner if they are willing to share. Can you order a doggie bag and put half the food away before you eat? How can you deal with work parties and holiday meals? Having a plan will help you.

Benefits of Weight Loss

There are many benefits of weight loss. Here are just a few. Some improve your health and others help you feel better. As you get ready to lose weight, make a list of how losing a few pounds will benefit you. Put this list on your refrigerator or bathroom mirror.
  • Lower blood glucose if your blood glucose is higher than normal.
  • Lower blood pressure if your blood pressure is higher than normal.
  • Improve your blood fats if they are not in a healthy range.
  • Lighten the stress on your hips, knees, ankles, and feet.
  • Move around easier and breathe easier.
  • Have more energy.
  • Play more with your children or grandchildren.

Diabetes Prevention Program Shows Weight Loss Benefits

A large study, called the Diabetes Prevention Program, showed that if people at risk for type 2 diabetes lost a small amount of weight and became more active for three years they could prevent or delay type 2 diabetes. People also had other benefits of weight loss like lowered blood pressure.

If you already have diabetes, losing 10 to 15 pounds may help you lower your blood glucose, blood pressure, and improve your blood fats. Losing this weight may also help you cut down on some of the medicines you take. If you lose weight, talk to your doctor about whether you need to make changes in your medicines.
How Does Your Weight Stack Up?

Today, health care providers use a measure called BMI, short for Body Mass Index. This gives a good measure of your total body fat. BMI compares your height and weight. It shows if you are underweight, at a healthy weight, or overweight. Check out what your BMI is by using the BMI calculator.

- Below 18.5

- Between 18.5 - 24.9
Healthy Weight

- Between 25 - 29.9

- Over 30

Look at the BMI chart to find out how much weight you need to lose to move from obese to overweight or from overweight into a healthy range. Knowing this can help you set a good weight loss goal.
An Apple or a Pear?

Did you know that being an apple shape -- more fat around your middle, rather than a pear shape -- more fat around your hips; puts you at greater risk of type 2 diabetes and heart disease? Another measure you can take is of how far it is around your waist (your waist circumference).

Take a tape measure (a flexible one is best) and place it snugly (not tight) around your waist. Compare the length around your waist to the number below. If the length of your waist is to the same or bigger than the numbers below, you have too much weight around your waist.

Waist Circumference
Men: over 40 inches
Women: over 35 inches

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