November Featured Story – 25 Signs and Symptoms of Alzheimer’s Disease

ow can you tell if someone has Alzheimer’s disease? Here are symptoms of the memory-robbing disorder.

Kristin Koch | October 13, 2015 | For Health.com

Is it Alzheimer’s?

Everyone struggles to come up with a name once in a while. But how can you tell if it’s more serious?

“One symptom alone does not necessarily indicate that a person has Alzheimer’s or dementia,” says Raj C. Shah, MD, of the Rush Memory Clinic at Rush University Medical Center, in Chicago. (Dementia is chronic loss of cognition, usually affecting memory, and Alzheimer’s causes 50% to 80% of dementia cases.)

There are many other causes of memory loss, including vitamin B12 deficiency, and brain, thyroid, kidney, or liver disorders. However, having several other symptoms could be a sign of Alzheimer’s disease (AD). Recognizing the signs of dementia can help lead to a quicker diagnosis.

Memory loss

Serious memory loss and confusion are not a normal part of aging. But forgetfulness caused by stress, anxiety, or depression can be mistaken for dementia, especially in someone who is older.

“We all forget the exact details of a conversation or what someone told us to do, but a person with AD will forget what just happened, what someone just said, or what he or she just said and therefore repeat things over and over again,” says Lisa P. Gwyther, co-author of The Alzheimer’s Action Plan: A Family Guide ($9-20; amazon.com).

Memory loss isn’t consistent, and people with AD may forget the dog’s name one day and remember it the next. “Nothing is certain or predictable with most dementias except they do progress,” says Gwyther.

Agitation and mood swings

It’s common for someone suffering from AD to seem anxious or agitated.

They may constantly move around and pace, get upset in certain places, or become fixated on specific details. Agitation usually results from fear, confusion, fatigue, and feeling overwhelmed from trying to make sense of a world that no longer makes sense, explains Gwyther.

Certain circumstances can also make the individual more anxious, such as relocating to a nursing home. In addition to agitation, rapid and seemingly unprovoked mood swings are another sign of dementia—going from calm to tearful to angry for no apparent reason.

Impaired judgment

A person with AD will begin to make decisions that seem silly, irresponsible, or even inappropriate and are a marked departure from past behavior, such as dressing improperly for the weather or no longer being able to assess for themselves what is safe.

“The earliest changes in judgment usually involve money. So people who were normally very cautious with their finances will start spending in unusual ways, like giving money to unworthy strangers like telemarketers, or withholding money they should pay, because they incorrectly believe their utility company is suddenly untrustworthy,” says Gwyther.

Money trouble

AD sufferers have difficulty with abstract thinking as the disease progresses, making numbers and money particularly troublesome.

While missing an occasional monthly payment isn’t something to worry about (at least in terms of the brain’s health), if your loved one suddenly has difficulty handling money, paying bills, managing a budget, or even understanding what numbers represent, it could be a sign of dementia.

Difficulty with familiar tasks

A person suffering from dementia often takes longer to complete, and may have trouble finishing, everyday tasks that he or she has done hundreds of times before.

For instance, a former whiz in the kitchen may have a problem making his or her signature dish or even remembering how to boil water.

Common activities like remembering how to get to a familiar location, play a favorite game, or manage a budget may also prove difficult.

Trouble planning or problem-solving

As dementia progresses, your loved ones may have trouble concentrating and find that fairly basic activities take them longer to do than before.

In particular, they may struggle to develop and follow a plan, like creating and using a grocery list, following a recipe, or keeping track of monthly bills.

This difficultly is far more pronounced than making the occasional error when balancing a checkbook or forgetting an item on your grocery list.

Misplacing things

Finding car keys in the freezer, the remote in a sock drawer, or routinely discovering other “missing” items in strange spots is usually a strong indicator that your family member may be suffering from dementia.

Although we tend to associate forgetfulness with the natural aging process, people with AD don’t just occasionally forget where they left their car keys or reading glasses; they leave them in unusual places and are later unable to retrace their steps to find them.

Often they’ll also become suspicious and accuse someone else of hiding or stealing their belongings.

Confusion with time or place

Disorientation as to time and place, such as forgetting where you live, getting easily lost, and losing track of dates, seasons, and the passage of time is a common experience for individuals with AD.

“The real issue with AD is perception of time,” explains Gwyther. “Five minutes can seem like five hours for someone with AD, so a husband may think his wife has been gone for hours or even weeks, even if it’s just been a few minutes, or he might tell his grandchild that he hasn’t seen him in five years, even though he just saw them yesterday.”

Difficulty communicating

As dementia progresses, a person’s language and communication skills diminish. He or she may stop mid-conversation and not know how to continue.

Vocabulary can be especially troublesome. A person may struggle to find the right word; call things by the wrong names (e.g., a car a TV); substitute unusual or incorrect words for familiar words and names (e.g., calling one’s husband “him” or “that guy”); invent new words; or use familiar words over and over again.

With time, people may rely on gestures instead of speaking, revert back to speaking in a native language, or just speak less in general.

Wandering

Unfortunately, about 60% of people with dementia have a tendency to walk off, wander aimlessly, and become lost, often repeatedly.

Restlessness, fear, confusion related to time, the inability to recognize familiar people, places, and objects, as well as stress can all cause wandering.

In some cases, the person might leave the house in the middle of the night to fulfill a physical need, such as finding a toilet or food, or he may be attempting to “go home” because he doesn’t realize he is home or he believes it’s 20 years earlier and he needs to go to a former job.

Repetitive speech or actions

The frequent repetition of words, statements, questions, or activities is a hallmark of dementia and AD.

Sometimes this repetitive behavior is triggered by anxiety, boredom, or fear of the environment or to achieve comfort, security, or familiarity.

Trouble with visual or spatial relationships

One symptom of dementia is vision problems that are different from typical age-related problems such as cataracts.

People with AD tend to have difficulty reading, judging distances, and determining color or contrast as time goes on.

In terms of perception, they may look in a mirror and think someone else is in the room instead of realizing they are looking at a reflection.

Dementia can also cause changes in visual and spatial abilities. They can find it tough to distinguish food from the plate it’s on, for instance.

Seemingly purposeless activity

If your relative begins to routinely engage in seemingly pointless endeavors, like opening and closing a drawer, packing and unpacking clothing, pacing, or repeating demands or questions, it may be a sign of AD.

Although from the outside it might seem like these behaviors are futile or even crazy, experts say they usually fulfill a need for the person, such as the need to feel productive or busy.

Withdrawal

AD can be a lonely and isolating disease that can result in a general lack of interest in surrounding activities or withdrawal from family and friends. People with AD may start to remove themselves from hobbies, social activities, work projects, or sports they previously loved, perhaps because they forget how to perform their favorite pastime, like knitting or playing the piano.

It’s also likely that because of all the changes they have experienced, they may feel embarrassed or ashamed and therefore avoid social situations and friends entirely.

Loss of initiative and motivation

If apathy, loss of interest in social activities and hobbies, and social withdrawal occur in the early or mid-stage of AD, they may be due to depression.

About 40% of people with AD also have depression. Unfortunately, identifying depression can be difficult, and the cognitive impairment makes it difficult for the person to articulate his or her feelings.

If a family member sleeps all the time or watches TV all day and refuses to do any other activities, she may have depression as well, and you should talk to her doctor.

Don’t recognize family and friends

As AD progresses, your loved one may not always recognize you or other family members and friends, which can be heart-breaking.

“Recognition does come and go for a while,” says Gwyther. “In general, people forget what they just learned or whom they just met, then friends, and family last. But sometimes it’s hard to explain why someone remembers one child’s name and not another. Well-practiced memories and stories last longer than newer ones, but in the very late stages, people may only remember their parents.”

Loss of motor skills and sense of touch

Dementia affects fine motor skills, interfering with one’s ability to button or unbutton clothes or use utensils, like forks and knives.

But motor problems, like weakness or trembling hands, or sensory symptoms, like numbness or loss of sensation, may also be a sign of a different type of disease such as Parkinson’s, so it’s important to discuss your parent’s or relative’s specific symptoms with a doctor.

Difficulty dressing

Dressing is difficult for dementia patients, who sometimes feel overwhelmed by the choices or may not remember even how to dress, tie a shoe lace, or buckle a belt.

They may wear the same thing over and over again, forgetting that they wore the same outfit the day before. And as previously mentioned, buttoning and unbuttoning clothes can become more difficult in the mid-to-late stages of AD due to a decline in motor skills.

Disregard for grooming and hygiene

As the illness progresses, individuals with AD often forget to brush their teeth, bathe regularly, change their clothes, and even use the toilet.

They may not remember why they even need to bathe or brush their teeth.

Likewise, they may forget how to comb their hair, clip their fingernails, shave, or use a toothbrush or comb.

Forgetting meals

People with dementia can literally forget to eat and drink, especially because many AD patients experience decreased appetite and interest in food.

On the other hand, others forget that they’ve already eaten and, as a result, eat lunch or dinner multiple times a day. Oddly enough, it’s not unusual for a person with AD to develop new favorite foods and suddenly dislike foods he or she previously loved.

Additionally, the person may lose the ability to tell if a food or beverage is too hot to eat or drink, forget to chew slowly and swallow, or not remember how to use eating utensils and revert to eating with their fingers.

Inappropriate behavior

In the mid and especially late stages of Alzheimer’s, a person may begin to lose control of his or her impulses and act out in inappropriate or uncharacteristic ways.

“They may say tactless things, like ‘Gosh, you got fat,’ that they would have never said before,” says Gwyther.

Additionally, people with AD may forget that they are married and begin to flirt and make inappropriate sexual advances, or they might start taking their clothes off at inappropriate times or in unusual settings.

Shoplifting is not uncommon among adults with AD, who don’t understand or remember that they must pay for items in stores.

Delusions and paranoia

Some people may go from seemingly irrational suspicions (say that someone else stole their glasses) to firmly held false beliefs or delusions (say that someone is trying to hurt or kill them).

Additionally, they may begin experiencing hallucinations or seeing, hearing, smelling, or tasting things that aren’t there.

A person may see the face of a former friend in a door or hear voices, for instance. According to experts, memory loss and the ensuing confusion associated with AD may cause the person to perceive things in new, unusual ways or become suspicious or misinterpret what he or she actually sees and hears.

Verbal and physical aggression

As the dementia worsens over time, it is not unusual for someone to become physically or verbally aggressive.

Verbal outbursts, including cursing, arguing, name calling, shouting, and threatening, are common, and some patients will even get physical, hitting and pushing caregivers, for example.

These aggressive acts often seem to come out of nowhere, but there’s usually a reason behind the behavior that may not be readily apparent to family members or caregivers, such as physical discomfort, inability to communicate properly, or frustration at a situation.

Trouble sleeping

Certain symptoms, like restlessness, anxiety, agitation, disorientation, and confusion, tend to get worse as the day goes on and even continue through the night, often resulting in difficulty sleeping and wandering.

Experts call this phenomenon “sundowning,” and it can be due to exhaustion, changes in the person’s biological clock, the inability to separate dreams from reality, and a decreased need for sleep that can occur with age.

As much as 20% of Alzheimer’s patients experience sundowning at some point, and it’s a common reason that family members decide to put their loved one in a nursing home.

Clingy or childlike behavior

Experts refer to the tendency for AD sufferers to become completely dependent on a certain individual and constantly follow them around as “shadowing.”

Shadowing tends to occur at the end of the day or in the evening when the person may begin to feel particularly worn down, confused, and fearful.

“It’s often a result of getting scared in a world that is confusing to them, so the patient constantly needs the person they most trust in view,” explains Gwyther. “If that person is out of sight, they may not know how long they’ve been gone or where to find them, so they will follow them around the house and even into the bathroom.”

Getting diagnosed

Even if someone has Alzheimer’s, it doesn’t mean his or her life is over; a person with AD can live a meaningful and productive life for many years, but it’s important to get a proper diagnosis.

People often wait too long to seek help, says Dr. Shah.

“Most diagnoses are still made in the moderate stage, after most individuals have been experiencing symptoms for years already,” says Dr. Shah. “It doesn’t help the person or family to wait until symptoms become so obvious that the diagnosis can be easily made. It is better to seek an evaluation earlier to help maintain quality of life and to prevent social or medical crises due to memory loss.”

This story was written by Kristin Koch for Health.com. To see the original story, click here.

November Featured Story – Type 2 Diabetes

What is type 2 diabetes

Type 2 diabetes is a chronic condition that affects your body’s use of glucose (a type of sugar you make from the carbohydrates you eat). Glucose is the fuel your cells need to do their work. You need glucose for energy. You also need insulin, a hormone produced by the pancreas that helps glucose enter your cells so that it can be converted to energy.

Here’s the problem: People with type 2 diabetes (also known as diabetes mellitus) can’t properly use or store glucose, either because their cells resist it or, in some cases, they don’t make enough. Over time, glucose builds up in the bloodstream, which can lead to serious health complications unless people take steps to manage their blood sugar.

Type 2 diabetes affects more than 29 million Americans, including nearly eight million who don’t even know they have it. You may be at greater risk of developing type 2 diabetes if it runs in your family, if you are of a certain age or ethnicity, or if you are inactive or overweight.

Type 2 diabetes vs. type 1 diabetes

What’s the difference between type 1 and type 2 diabetes?

Type 1 diabetes is an autoimmune disease in which the body does not produce insulin. The immune system destroys insulin-producing cells in the pancreas. Type 1 diabetes is usually diagnosed in children, teens, and young adults. People with type 1 diabetes need life-long insulin therapy.

Type 2 diabetes is much more common. In type 2 diabetes, the body doesn’t use insulin properly or, in some cases, doesn’t make enough. It’s usually diagnosed in middle-aged or older adults, but anyone can develop type 2 diabetes. It can be managed through diet, exercise, and medication.

What causes type 2 diabetes?

Type 2 diabetes occurs when the body doesn’t use insulin as it should or when the pancreas doesn’t make enough insulin to ferry glucose out of the bloodstream and into the cells. Instead, the glucose builds up in the blood, resulting in high blood sugar.

When your body can’t use insulin properly, it’s called insulin resistance. Insulin resistance is responsible for most cases of type 2 diabetes. Scientists don’t know why cells in the body become resistant to insulin, but it’s clear that certain genetic and lifestyle factors play a role. Here are the most common:

  • Your genes. Type 2 diabetes tends to run in families. Scientists haven’t pinpointed the gene or genes responsible for insulin resistance. But even if you inherit certain genes that amp up your risk, it doesn’t mean you will go on to develop type 2 diabetes. How you live your life also affects your risk.
  • Your race. Certain racial groups, especially African Americans, Latinos, Native Americans, and Asian Americans/Pacific Islanders have a higher risk of developing type 2 diabetes than white people.
  • Your lifestyle. There’s nothing you can do about the genes you inherit. But you can control how you live. Being overweight is the main risk factor for developing insulin resistance, especially if you carry that extra weight around your waist. Being sedentary, smoking, drinking too much alcohol, and consuming a high-fat, low-fiber, sugar-laden diet can all increase your type 2 diabetes risk. You can reduce your risk by adopting healthier habits.
  • Your existing health concerns. Other medical issues that can increase your risk of developing type 2 diabetes include:
    • Having prediabetes. Prediabetes means having higher-than-normal blood glucose levels but not high enough to be diagnosed with type 2 diabetes. People with prediabetes who don’t control their blood sugar can go on to develop type 2 diabetes.
    • Having gestational diabetes. Women who have gestational diabetes have elevated blood sugar levels during pregnancyand are at higher risk of developing type 2 diabetes later on. Moms should be tested six to 12 weeks after giving birth to screen for the condition.
    • Having another condition linked to type 2 diabetes. Polycystic ovary syndrome, for example, affects women’s sex hormones and is associated with an elevated diabetes risk, as is a history of heart disease or stroke.

Type 2 diabetes symptoms

Type 2 diabetes can sneak up on you. Many people don’t know they have it because symptoms usually develop slowly over time. But there are several signs of type 2 diabetes to watch for. Early indicators include increased urination, thirst, and hunger. Over time, excess sugar in the bloodstream can lead to other symptoms, including slow-to-heal wounds and frequent infections. If you develop any of these symptoms of type 2 diabetes, talk to your doctor.

  • Excessive urination. Running to the bathroom more often than usual or producing more urine than normal (including at night) can be one of the first signs of type 2 diabetes. Excessive urination, also called polyuria, occurs when blood sugar levels are too high. The kidneys have to work overtime to filter the excess sugar out of your blood, and some of it gets flushed out of the body in your urine.
  • Increased thirst. Excessive thirst, also called polydipsia, is another classic sign of type 2 diabetes. When your blood glucose is higher than normal, excess sugar spills into your urine, pulling water with it, and you have to urinate more frequently. You can become dehydrated from all that extra urination, so you then become thirsty, leading you to drink even more–and urinate more.
  • Increased hunger. When you are insulin resistant or don’t make enough insulin, glucose can’t enter your cells. Starved for energy, you get hungrier than usual. Excessive hunger or increased appetite is also known as polyphagia.
  • Blurred vision. High blood sugar can cause the lens of the eye to swell, causing blurry vision. If your blood sugar levels fluctuate, you may notice at least a temporary improvement when sugar levels are closer to normal.
  • Unexplained weight loss. Sudden or unplanned weight loss can be a sign that your cells aren’t getting glucose for energy. Without that sugar for fuel, your body begins burning fat and muscle instead, leading to weight loss.
  • Fatigue. When blood sugar is elevated, that fuel can’t get to its destination. As a result, your energy lags, and you feel depleted. You may not be sleeping well, either, if you make frequent nighttime trips to the bathroom to empty your bladder.
  • Frequent infections. Yeast and bacteria thrive on sugar, so when blood glucose levels are abnormally high, there’s a greater risk for frequent or more severe yeast or urinary tract infections.
  • Slow-healing wounds. People with type 2 diabetes may find that it takes a long time for skin injuries to heal. That’s because sugary blood is thicker and moves more slowly, especially through narrow blood vessels, meaning healing blood and oxygen takes longer to reach damaged tissue. Having open sores and wounds also boosts the risk for infections.
  • Dry, itchy skin. Everyone gets dry skin, but itchy feet, ankles, or legs could be signs of type 2 diabetes if you have other symptoms too. Fluid loss due to frequent urination plus poor circulation and nerve damage due to thick, sugary blood can dry out your skin, especially on your lower extremities.

How is diabetes diagnosed?

Several tests may be used for diagnosing diabetes. A simple blood test known as a hemoglobin A1C (or glycated hemoglobin test) measures average blood glucose levels over the past three months. (Why three months? Because glucose attaches to a protein called hemoglobin in red blood cells, and those cells get recycled and replenished about every three months.)

A normal A1C is below 5.7%. A higher percentage reflects higher blood glucose levels. Prediabetes is defined as a reading of 5.7 to 6.4, while diabetes is diagnosed when glucose levels reach 6.5% or higher.

A fasting plasma glucose test measures blood glucose at a single point in time. Generally, this test is performed first thing in the morning before breakfast, after at least eight hours of fasting. A normal reading is less than 100 milligrams per deciliter (mg/dl). A reading of 100 to 125 mg/dl signals prediabetes, and a reading of 126 mg/dl or higher indicates diabetes.

An oral glucose tolerance test measures your body’s ability to handle glucose. It is mostly used to diagnose gestational diabetes. First, blood is drawn after an overnight fast. Then you drink a special glucose solution, and your blood is drawn again two hours later. A normal reading at that time is 139 mg/dl or below. A reading of 140 to 199 mg/dl indicates prediabetes, while diabetes is diagnosed at 200 mg/dl or above.

A random or casual plasma glucose test may be performed any time you have diabetes symptoms. It doesn’t require fasting. A reading of 200 mg/dl or above suggests diabetes.

These tests cannot distinguish between type 1 and type 2 diabetes. Generally, people with type 1 diabetes are diagnosed as children, teens, or young adults, while type 2 diabetes usually occurs in adults 45 and older. Type 1 diabetes is an autoimmune disease, so an autoantibody test may be done to help a doctor determine if you have type 1 or type 2 diabetes.

Type 2 diabetes treatment

Type 2 diabetes is treated through diet, exercise, and medication. The goal of treatment is to keep blood sugar under control and stave off diabetes complications.

Some people manage through diet and exercise alone. Others need oral medicines, insulin, other injectable medications, or some combination of type 2 diabetes med–along with healthy food and fitness–to keep blood sugar in check.

There are lots of treatment options. What your doctor prescribes may depend on what other health conditions you have and how well certain medications work for you.

Diabetes treatment includes:

  • Metformin. This oral medication comes as a pill or liquid. It’s often the first medicine that people with type 2 diabetes take. Metformin improves your body’s use of insulin and reduces the amount of glucose your liver makes.
  • Sulfonylureas. These pills stimulate the release of insulin by the pancreas and help the body use insulin better. Popular sulfonylureas include glimepiride (Amaryl), glipizide (Glucotrol), and glyburide (DiaBeta, Micronase, and Glynase).
  • Meglitinides. Much like sulfonylureas, this class of medicines boosts insulin production in the body. These oral meds, including repaglinide (Prandin) and nateglinide (Starlix), are fast acting and don’t stay in the body for long, so they must be taken just before meals.
  • Thiazolidinediones. Also known as TZDs or glitazones, these oral medications work by lowering insulin resistance. This class includes pioglitazone (Actos) and rosiglitazone (Avandia).
  • Gliptins or DPP-4 inhibitors. This class of drugs improves the release of insulin in the body. One example is sitagliptin (Januvia).
  • SGLT2 inhibitors. These oral medicines help your kidneys remove sugar from the body through urine. The class includes canagliflozin (Invokana), dapagliflozin (Farxiga), and empagliflozin (Jardiance).
  • GLP-1 receptor agonists. Injectable drugs like exenatide (Byetta), liraglutide (Victoza), and dulaglutide (Trulicity) control blood sugar by slowing digestion, improving how insulin works in the body, and preventing the liver from releasing too much sugar into the bloodstream.
  • Insulin therapy. There are many different types of insulin. They vary by how soon they start to work, when they peak, and how long they last. Insulin comes in different strengths and has multiple delivery methods–needle, pen, pump, port, jet injector, and inhaler.
  • Bariatric surgery. Research suggests that weight-loss surgery can improve blood sugar control in some obese people with type 2 diabetes. Some people may no longer need diabetes medication after bariatric surgery, but these results tend to vary patient to patient.

Can type 2 diabetes be cured or reversed?

No treatments can cure diabetes. But this chronic condition can be controlled, and sometimes symptoms even disappear for periods of time.

Remember, type 2 diabetes develops gradually as the cells in the body resist insulin or the pancreas fails to make enough of it. For a while, there’s enough insulin to get by. But, in time, the body can no longer convert glucose into energy, causing blood sugar levels to spike.

Type 2 diabetes treatments don’t fix this problem. There’s no type 2 diabetes cure. But medications can help people normalize their blood sugar, and gaining control over your blood sugar is crucial for preventing or reducing complications.

Left untreated, type 2 diabetes can wreak havoc, damaging the heart, blood vessels, nerves, kidneys, brain, eyes, feet, and skin. It increases the risk for heart attack and stroke. It can lead to kidney failure. People with type 2 diabetes can lose their vision. In some severe cases, people with type 2 diabetes need a foot or a leg amputated. The risk of these and other complications is why it is so important to keep your blood sugar under control.

Type 2 diabetes diet

A healthy diet can help people with type 2 diabetes shed excess weight and manage blood sugar. While there’s no one-size-fits-all meal plan for controlling type 2 diabetes, watching what and how much you eat can go a long way.

One option for your type 2 diabetes diet is to adopt a plant-based Mediterranean-style of eating, incorporating healthy oils, fish, fruits, vegetables, nuts, and beans.

Or “Create Your Plate” with the help of an online tool by the American Diabetes Association. Fill half of your plate with non-starchy vegetables, one quarter with protein and one quarter with grains or other starchy foods. Add a serving of fruit, dairy, or both, and use healthy fats in small amounts. Round out your meal with water or a low-calorie drink like unsweetened coffee or tea.

Some people learn to count carbohydrates, since carbs affect blood sugar more than protein and fat. Keeping track of daily carb consumption can help keep blood sugar levels within a normal range. A dietitian or diabetes counselor can help you learn to track grams of carbohydrate in the foods you eat.

Type 2 diabetes prevention

To prevent type 2 diabetes, take a close look at your health habits. There’s a lot you can do to lower your risk, and even modest changes can help.

  • Eat healthy. To prevent weight gain–a major risk factor for type 2 diabetes–eat more fruits and vegetables, cut back on sugary drinks and desserts, and watch your portion sizes.
  • Lose weight. If you’re overweight, dropping just 5% to 7% of your weight (that’s 10 to 14 pounds for a 200-pound person), and keeping that weight off, can prevent or delay type 2 diabetes.
  • Get physical. The American Diabetes Association recommends a combination of aerobic exercise and strength training. Aim for 30 minutes of moderate to vigorous exercise, like brisk walking, swimming, cycling, or tennis, at least five days a week. Strength-training exercises build muscle mass, which helps you burn more calories, even when you’re at rest, so you can keep those pounds off.

Celebrities with type 2 diabetes

Actors, athletes, and musicians aren’t immune to type 2 diabetes. While some famous folks with diabetes say the diagnosis came as a surprise, others were aware of risk factors they faced, like a family history of the disease. After making healthy changes, many chose to speak out about the dangers of type 2.

Actor Tom Hanks announced his type 2 diabetes diagnosis in 2013, revealing that his blood sugar levels had been high for years before he was diagnosed. It’s possible that his yo-yo dieting for roles–he gained 30 pounds to play Jimmy Dugan in A League of Their Own and later shed 50 to play Chuck Noland in Cast Away–could have increased his risk of blood sugar problems.

Celebrity chef Paula Deen, famous for dishes loaded with fat and calories, confirmed she had type 2 diabetes in 2012. A buttery diet alone will not necessarily cause diabetes, however; Deen spoke out about other risk factors that can play a role in the disease, like age, genes, and stress.

Tennis legend Billie Jean King was diagnosed with type 2 diabetes in 2007. After years of battling with her weight, she used the diagnosis as motivation to lose 35 pounds. Music producer Randy Jackson also lost weight after a type 2 diabetes diagnosis. With gastric bypass surgery, he shed almost 100 pounds and got his blood sugar under control.

Other notable stars with type 2 diabetes include self-proclaimed “divabetic” Patti Labelle, who was diagnosed after passing out on stage in 1994; actor Paul Sorvino, who experienced fatigue and increased thirst for months before he was diagnosed; and Dick Clark, who became a spokesperson for the American Association of Diabetes Educators 10 years after he himself was diagnosed.

This story was written for Health.com. To access the original story, click here.

October Featured Story – National Breast Cancer Awareness Month!

3 Breast Cancer Survivors: Stories on Faith, Hope and Purpose

by Vanessa Cunningham for HuffingtonPost.com

 

In life you may come across a strong, bold, beautiful and courageous woman. One who inspires, motivates and has a zeal for life. These three extraordinary women are inspiring to me, women in general and to breast cancer patients/survivors. In the midst of their darkest hours, these women decided to opt for a fighter mentality instead of a defeated one. To them, life was worth fighting for, as it’s a precious gift from God. Each survivor will share their story, key survival mechanisms, what they are up to in the world today, and will end with some words of encouragement. Meet Bershan Shaw, Robin Devonish Scott and Taneeka Brown.

Bershan Shaw

Her Story:

In 2007 at just 33 years old, Bershan’s dreams were abruptly eclipsed by the cold, hard reality of 1.2 cm tumors, endless visits to oncologists and having to face her own mortality at a young age. Bershan decided to face her illness head on, with a positive spirit, and with support from her family and her husband. To protect herself from infertility, she opted for radiation treatment instead of chemotherapy. All was well for a short while, but two years the cancer returned. Two weeks before her wedding, her doctors gave the bleak diagnosis: stage four breast cancer with six to nine months left to live. It appeared her fight was over.

The warrior in Bershan had been tested many times in her 33 years. But when she was told her cancer was unbeatable, and it was time to set her affairs in order, the warrior inside her rose up to meet the impossible with a spirit of hopeful defiance. Bershan leveled a steady gaze at her team of grieving oncologists and replied, “This is not my life. I will not die, because I was meant for more.” True to her word, Bershan has done much more. Rather than living in the shadow of a stage four cancer diagnoses, Bershan chose to work tirelessly on her mental, physical and spiritual health. Seven years later, she is cancer-free (no evidence of disease).

3 Survival Mechanisms:

Prayer. “God is my all in all. I got on my knees and prayed if God keeps me alive then he could use me as a vessel to help millions.”

Positive affirmations. “I say positive affirmations everyday nine times a day because it sticks in your head. Endless good comes to me in endless ways.”

Eating healthy and exercising. “You have to eat healthy and take control of your mind and body. I changed my thoughts and attitude, which changed my life. Change your diet and make changes for the better because your body is your temple.”

Her life today:

Bershan is a life coach, author and motivational speaker. Determined to be a blessing to others, she started a unique social network support site, URAWarrior.com. The site offers those struggling with life altering issues a safe, supportive place where they can find connection, comfort, inspiration, and above all, hope for a brighter tomorrow.Bershan is also the author of URAWARRIOR 365 Ways to Challenge You to a Better Life.

Words of encouragement:

Embrace your warrior spirit and “step into your greatness” and turn your pain into your purpose. Live life with no regrets because when you’re done, you’re done.

Robin Devonish Scott

Her Story:

One day Robin felt a lump in her breast and arm pit, but she just associated with her menstrual cycle. After a series of examinations, Robin was diagnosed with stage IIB cancer in 2009. After hearing these three words from her doctor “you have cancer,” Robin immediately started to cry uncontrollably as her husband Rory comforted her. Robin went through chemotherapy for six months, and radiation for seven weeks. During the times she experienced physical weakness, and the loss of her hair, she realized her circumstance changed her views and thoughts on life (for the better of course). She began to experience life through a different lens, becoming more empathetic and more spiritually in tune. The support of her friends, husband and church family kept her going during this difficult time.

Most importantly, she learned the importance of being humble. She stated, “Cancer has a funny way of stripping and humbling you in ways not otherwise imagined.” She has been breast cancer free since her initial diagnosis in 2009.

3 Survival Mechanisms:

Focus on what’s important. A lot of what we think and do is really not as important as living a life of purpose that is designed by God.

Learn to let things and people go. Learn to release the hurt and the people that have hurt you. Most people don’t know they have hurt you so just let go, heal from it and move on.

Prayer. Prayer is talking; prayer is purging; prayer is cleansing; prayer allows you to forgive; prayer allows you to obtain mercy; prayer is surrender; prayer is rejoicing; prayer is crying; but most of all, prayer is so necessary.

Her life today:

Robin is a coach and the Self Publishing Maven who helps her clients share and publish their stories. She also has a book “The Gift of Cancer“ scheduled to be released on December 8, 2004. She hopes to leave a legacy of books and information for people to glean from, for decades to come.

Words of encouragement:

There is nothing like the possibility of death to make you know what you want to do in life. Don’t wait until death is knocking to choose life. Choose it now and make the decision to live, in passion, on purpose and with a sense of urgency.

Taneeka Brown

Her Story:

In April 2007 she felt a lump in her right breast. At the time she was in between jobs, experienced an insurance lapse, and didn’t know when the next one would begin. This was a terrifying time for her. Soon after she landed a temp job, and within 3-4 weeks her employer offered her a permanent position with insurance. Although she was afraid to get a mammogram, she kept a positive mindset and went anyway. After her examination, her doctor told her that she had stage 2 breast cancer. All she could ask her doctor at that point was, “Am I going to live?” and “What do I tell my kids?” After her appointment she remembers driving to her kid’s school to pick them up and thinking she couldn’t look at them, because she knew what they were about to face.

Long story short, the cancer over seven years advanced to stage 4 and has metastasized to her brain, lungs, kidney, liver, back, neck, and chest wall. She’s had multiple surgeries bi-lateral mastectomy, 10-hour breast reconstruction, hysterectomy, and a brain tumor removal. She endured three bouts of radiation, one to the brain, breast, and chest wall. To her friends and family Taneeka is considered a true survivor, although her cancer isn’t completely gone. She has been an inspiration to many as she has fought tenaciously for her life. There were times when the results looked grimed, but she fought to stay alive to raise her three children. To this day, doctors are shocked she is still alive.

3 Survival Mechanisms:

Prayer. Taneeka attributes her presence on earth today by the doing of God. She prays, reads the bible and attends church.

Speaking. She speaks at various breast cancer events sharing her story and testimony with breast cancer patients, which is therapeutic for her.

Creative outlets. Taneeka has always been a creative. She decided to start her own jewelry and shoes line.

Her life today:

Taneeka, along with her son John Cunningham Jr., started a non-profit called All So Pink, where breast cancer patients can craft and sell their creations. She is also a great mom and role model to her three children. They live in Orlando, Florida.

Words of encouragement:

Put your faith in God! He made a miracle out of my circumstance and can do the same for you.

I was moved to showcase these women in hopes that women would draw strength, courage, and hope from these stories. And to keep in mind that when your circumstance looks grim, keep a positive mindset, embrace the love and support from friends and family, and allow your faith to carry you through.

Please show your love and support for these women by commenting below.

Vanessa Cunningham is a Huffington Post contributor, nutrition & wellness expert of Unhealthy No More, Inc., best selling author, writer and speaker. She helps busy professionals reduce stress, banish unhealthy cravings, lose weight and increase their energy levels. She has also been featured on CNN iReport, Black Enterprise, Essence, MommyNoire, Everything Girls Love and MindBodyGreen. Head on over to her website to get your FREE gift “10 Ways to Live a Happy and Healthy Life.”

October Featured Story – National Mental Illness Awareness Week!

What It’s Like to Have ‘High-Functioning’ Anxiety

By Sarah Schuster for TheMighty.com

High-functioning anxiety looks like…

Achievement. Busyness. Perfectionism.

When it sneaks out, it transforms into nervous habits. Nail biting. Foot tapping. Running my fingers through my hair.

If you look close enough, you can see it in unanswered text messages. Flakiness. Nervous laughter. The panic that flashes through my eyes when a plan changes. When anything changes.

High-functioning anxiety feels like…

A snake slithering up my back, clamping its jaws shut where my shoulders meet my neck. Punch-in-the-gut stomach aches, like my body is confusing answering an email with being attacked by a lion.

High-functioning anxiety sounds like…

You’re not good enough. You’re a bad friend. You’re not good at your job. You’re wasting time. You’re a waste of time. Your boyfriend doesn’t love you. You’re so needy. What are you doing with yourself? Why would you say that? What if they hate it? Why can’t you have your shit together? You’re going to get anxious and because you’re going to get anxious, you’re going to mess everything up. You’re a fraud. Just good at faking it. You’re letting everybody down. No one here likes you.

All the while, it appears perfectly calm.

It’s always looking for the next outlet, something to channel the never-ending energy. Writing. Running. List-making. Mindless tasks (whatever keeps you busy). Doing jumping jacks in the kitchen. Dancing in the living room, pretending it’s for fun, when really it’s a choreographed routine of desperation, trying to tire out the thoughts stuck in your head.

It’s silent anxiety attacks, hidden by smiles.

It’s always being busy but also always avoiding, so important things don’t get done. It’s letting things pile up rather than admitting you’re overwhelmed or in need of help.

It’s that sharp pang of saying the wrong thing, the one that starts the cycles of thoughts. Because you said too much, and nobody cares, and it makes you never want to speak up again.

It’s going back and forth between everyone else has it together but you, and so many people have it tougher than you.

Get your act together.

Suck it up.

You’re not OK, you’re messing everything up.

You’re totally OK, stop being such a baby.

It’s waking up in the middle of the night sobbing because the worst-case-scenario that just went through your head at high speed seems so real, so vivid, that even when it’s proven to be untrue, it takes hours for your heart to slow down, to feel calm again.

Because how “OK” are you when a day without a plan is enough to make you crumble? When empty spaces make you spiral at the very anticipation of being alone with your thoughts? When you need to make a list to get through a Sunday: watch a show, clean your kitchen, exercise, answer five emails, read 10 pages, watch a show… ?

It’s feeling unqualified to write this piece because I’m getting by. It’s when you’re social enough to get invited to things, but so often find yourself standing in a room where it feels like no one knows you. It’s being good at conversation and bad at making close friends because you only show up when you feel “well” enough. Only text back when you feel ready. Because you’re afraid they’d hate you if they really knew you. That the energy would overwhelm them, and you’d lose them.

So you learn to rein it in. Channel it. Even though sometimes you do everything right (exercise, sleep, one TV show, five emails, 10 pages…) and you’re still left with racing thoughts, the panic. The not good enoughs.

When will it be enough?

Having anxiety means constantly managing motion that can be productive or self-destructive, depending on how much sleep you got. Depending on the day. Depending on the Earth’s alignment with Mars. Depending on…

It’s when “living with it” means learning how to sit with it. Practicing staying in bed a little longer. Challenging the mean, unrelenting voices that say you’re only worth what you produced that day.

It means learning how to say, “I need help.” Trying to take care of yourself without the guilt. It means every once in a while, confiding in a friend. It means sometimes showing up even when you’re scared.

It’s when answering a text impulsively and thoughtlessly is an act of bravery.

It’s fighting against your own need to constantly prove your right to exist in this world.

It’s learning how to validate your own feelings. That even though you don’t feel like you’re enough, and you’ll never be enough, it’s knowing you’re at least anxious enough to benefit from help. That admitting you need it doesn’t confirm voices’ lies. That taking a break doesn’t mean you’re a failure.

It’s finding your own humanity in the anxiety, in your weaknesses. It’s trying to let the energy inspire you, instead of bring you down. It’s forgiving yourself when it wins.

It’s a way to live, with this constant companion. Your bullying twin. Collapsible luggage you can bury away at a moment’s notice. Shove it under the bed. Pretend it’s not there until you can’t fit anymore. Until you can no longer ignore it. Until you have to face it.

A first good step is staring at it straight on and calling it by its name.

High anxiety can be a natural consequence of a busy lifestyle, but its existence is akin to the chicken and the egg. Which came first, the anxiety or the busyness? Am I always moving because I’m anxious or am I anxious because I’m always moving?

Either way, it’s not a noble way to suffer. It’s not a “better” way to be anxious. Just because you’re “functioning” doesn’t always mean you’re happy. And just because you’re functioning doesn’t mean you shouldn’t slow down, breathe and take one damn second to be happy the way things are.

In this very moment.

This quiet, short moment.

To remember the peace you found in that second of silence, until the electricity starts again, and you’re forced to move.

If you or anyone you know are experiencing symptoms of depression and need to talk to someone, please call the National Suicide Prevention Lifeline at 1-800-273-8255.

September Featured Story – National Prostate Cancer Awareness Month!

7 tips for a healthy prostate

Everything you need to know to stay ahead of the game.

by John Casey for MensFitness.com

More than 190,000 new cases of prostate cancer are diagnosed in the U.S. each year, according to the American Cancer Society. Fortunately, there is a lot you can do to keep your prostate healthy as you age—and stay ahead of the game. Here’s what Christopher Saigal, MD, an assistant professor of urology at UCLA’s Jonsson Cancer Center, says to do:

  1. Keep a healthy weight and exercise regularly.
  2. Eat more fruits and vegetables. Tomatoes, watermelons, pink grapefruits, guava and papaya contain lycopene, a powerful antioxidant. Cruciferous vegetables such as broccoli, cauliflower, cabbage, Brussels sprouts, bok choy and kale also are good choices.
  3. Let your doctor know if you have a family history of prostate cancer. Having a father or brother with prostate cancer more than doubles a man’s risk of developing this disease.
  4. Include more soy in your diet from sources such as tofu, soy nuts or soy flour or powders.
  5. Don’t smoke.
  6. Eat more selenium-rich foods such as wheat germ, tuna, herring and other seafood and shellfish, beef liver, kidney, eggs, sunflower and sesame seeds, cashews, mushrooms, garlic and onions. Selenium reduces risk of prostate cancer.
  7. Get a PSA blood test and digital rectal exam annually, beginning at age 50. Men at high risk, such as African American men or men with a strong family history of prostate cancer should begin testing at age 45.

September Featured Story – National Ovarian Cancer Awareness Month!

‘I Was 35 and Healthy—Until I Was Diagnosed with Ovarian Cancer’

What Sherry Pollex wants you to know about the disease that almost took her life.

BY CASSIE SHORTSLEEVE for Women’s Health Magazine September 22, 2016

Two years ago, Sherry Pollex was feeling off: She was super bloated (“I looked like I was three months pregnant,” she remembers) and had extreme abdominal pain.

“You know when something doesn’t feel right,” she says. “And I just knew something was really wrong.”

Like any health-conscious woman, she went to her primary care physician and was referred to an ob-gyn. The conclusion of an ultrasound: benign ovarian cysts. Nothing more.

Unfortunately, the doctors were wrong. Sherry’s pain worsened to debilitating pelvic woes. So just before jetting off on vacation, she called a family friend, a gastro-surgeon, and asked for a CT scan.

When the results came in, the doctor told Sherry to come in immediately—and to bring her family: The scan revealed tumors all over her pelvic area and abdomen.

Sherry was diagnosed with ovarian cancer—specifically stage III primary peritoneal carcinoma.

“When someone tells you something scary like that, that moment is forever ingrained in your head,” she says. “I was in shock. I was 35 and perfectly healthy with no family history of ovarian cancer.”

Sherry’s boyfriend, NASCAR driver Martin Truex Jr., and her mother broke down in tears. Her response? “I said to the doctor, ‘What do I need to do to beat this?’” she says. “In that moment, I was in survival mode.”

Sherry’s doctor urged her to get to a major medical center—fast. If she didn’t, she could be dead by Christmas. It was August 7.

A Road to Recovery

Five days post-diagnosis, Sherry underwent a grueling seven-hour debulking surgery, where a gynecologic oncology surgeon removes as much of the malignant tumors as possible, enhancing the effectiveness of chemotherapy—of which Sherry would need 17 months of.

Starting chemo a month after that kind of a procedure was tough, especially considering it was pumped through her belly.

“I felt like my body was just recovering from the surgery and then they wanted to hit me with eight hours of toxic chemicals once a week,” says Sherry. “I was emotionally and physically exhausted.” Sherry lost her tastebuds, her appetite, 27 pounds of healthy weight, her eyebrows, eyelashes, and hair.

But as she puts it: “You don’t get a reprieve when you’re fighting a deadly disease,” she says. “You just dig in and do it. You want to live so bad.”

A long-time advocate of pediatric cancer through the Martin Truex Jr. Foundation, she also felt the need to fight for the children. “What a hypocrite I would be if I had spent all these years teaching my cancer kids to fight and then didn’t try to beat it myself,” she says.

So she fought.

The Aftermath

After major surgery and almost a year-and-a-half of chemo, today—two years later—Sherry says she’s lucky: She’s cancer-free—for now. “I never take one day of being healthy for granted,” she says. “I know that any day, cancer can rear its ugly head again.”

She’s right: Statistics from Texas Oncology suggest the recurrence rate for advanced stage ovarian cancer is between 60 and 80 percent.

Though she suffers from fibrosis—when scar tissue builds up causing pain—Sherry’s doing relatively well. “I had to change some of the things I was doing physically,” she says. Because of the scar tissue, once normal runs are now too painful, so she’s taken up yoga and pilates and walks three miles a day. These are small changes in the scheme of things. “Altering your lifestyle isn’t a huge sacrifice when you’re just happy to be alive,” says Sherry.

Of course, emotionally, it’s been hard. It “was tough to know that I couldn’t have kids,” she says. (Sherry’s surgery included a complete hysterectomy.)

But out of struggle comes a bright side. “You notice the sky is bluer and the grass is greener,” she says. “You wake up each day grateful to be there to make memories with family and friends. And you have a newfound purpose to educate other women about your experience so they don’t have to go through what you’ve been through.”

A New Mission

Since her diagnosis and treatment, Sherry started the site sherrystrong.org—a resource to empower women to know their bodies and recognize symptoms of ovarian cancer. “You have to be your own advocate for your health,” she says. “Had I not called our family friend and told him how much pain I was in that day, I wouldn’t be here today.” Only you know your body best. And sometimes you need to be the one to demand a test or ask questions.

Sherry is passionate about educating people on the options you have if, one day, you’re faced with a cancer scare. She’s a huge supporter of the Vermillion OVA1 blood test—the first FDA-approved blood test to evaluate cancer risk in a pelvic mass. “You can ask for it in the doctor’s office if you’re diagnosed with a pelvic mass,” says Sherry, noting she wishes she knew about it when she was told she had “benign” ovarian cysts.

OVA1 results help ID cancer risk and guide next steps—namely toward a gynecologic oncology surgeon if you’re at high risk for cancer. (If you have a pelvic mass, you can also take a quiz at knowpelvicmass.com to learn about your risk.)

Family history plays a huge role in knowing disease risk, too. While Sherry wasn’t “at risk” due to family history, if you are, testing for the BRCA1 or BRCA2 gene mutation can help you know where you stand.

“Knowledge is power,” says Sherry. “And we can’t change the survival statistics until we teach women what to look for and what to ask for.”

While ovarian cancer may be rare—the number is still significant. More than 22,000 women are diagnosed every year, and more than 14,000 women die from the disease, according to the American Cancer Society.

And as Sherry says, “What is the definition of ‘rare’ when it’s your sister, daughter, or mother?”

Featured Story – World AIDS Day!

On December 1, World AIDS Day, Focus On #MyRightToHealth
And some of the other biggest LGBTQ wellness stories of the week.

11/27/2017 10:50 am ET Updated Nov 27, 2017

Each week, LGBT HealthLink, a program of CenterLink, and researcher and blogger Corey Prachniak-Rincón bring you a round-up of some of the biggest LGBTQ wellness stories from the past seven days. For more LGBTQ Wellness, visit a page dedicated to the topic here.

 

Preparing for World AIDS Day

UNAIDS launched a new campaign on the human right to health ahead of World AIDS Day on December 1. The campaign focuses on connecting the right to “the highest attainable standard of physical and mental health,” which has been part of international law for 50 years, to the needs of people living with HIV today. The campaign includes action items for readers to get involved.

 

New Study Confirms Queer Smoking Disparity

A major study found that LGB adults smoked at a 38.8% higher rate than heterosexuals adults, with 27.8% – more than one in four – reporting that they are current smokers, compared to 20.1% of heterosexual adults. The authors believe that the stigma and discrimination faced by queer adults, plus intentional targeting by the tobacco industry, help explain these high rates.

 

Marking Transgender Awareness Month

Fenway Health marked Transgender Awareness Month with an infographic showcasing sobering facts about trans health. It notes that one in three transgender people have delayed needed care out of fear of mistreatment and that one in five transgender people has been outright denied care by a healthcare provider. The graphic also explores topics like economic disparities and violence.

 

Prostate Cancer and Gay Men

U.S. News published an article exploring how prostate cancer affects gay men, a disease that experts and patients say can present different challenges to queer people even though the diagnosis itself is the same. The article also notes that cancer surveys often omit asking sexual orientation and that there is a dearth of resources specifically for queer cancer survivors.

 

Links Between Financial Status and HIV Risk

A study examined the relationship between facing financial hardship and engaging in higher-risk sexual practices among queer men. It found that high levels of sexual hardship were associated with 1.28 times the risk of engaging in condomless intercourse and 2.36 times the risk of engaging in transactional sex, both of which are risk factors for contracting HIV.

 

Barriers to Gender-Affirming Care

Researchers surveyed 364 transgender adults in Massachusetts and found that 23.6% were unable to access gender-affirming care within the past year. Factors associated with having difficulty included having lower income and education levels, being younger, and having private insurance (suggesting state insurers like Medicaid were better than the private market).

Huge Cancer Disparity Linked to HIV

Researchers studied the cases of almost half a million people living with HIV in the U.S., and found that their anal cancer incidence rate was much higher than that of the general population. Queer men had even higher rates than others living with HIV, and those who had been diagnosed with AIDS rather than only HIV had a fourfold increase in anal cancer incidence.

 

Remembering Victims of Violence

NBC News reported on events happening around the world to commemorate Transgender Day of Remembrance on November 20. The founder of the occasion – which began after violence in Boston in 1999 – stressed the ongoing importance of naming violence against transgender people, which remains on the rise and disproportionately affects transgender women of color.

 

Journal Explores Queer Families

The Journal of Homosexuality published a special issue on LGBT families, noting in its introduction the need for “a useful framework” to explore topics like parenting and family units in the community. Articles include an examination of adult children of same-sex male parents, and a study on how microaggressions often question the validity of queer families.

 

Hep A Outbreak Grows in California

The Los Angeles Times reported on a disturbing outbreak of Hepatitis A than began in San Diego, mostly among that city’s homeless population, and has now spread to many queer men in Los Angeles. Queer men are generally at higher risk for Hepatitis A (and homelessness), and with 14 cases already reported outside of Southern California, the outbreak could yet spread.

 

Impact of Heterosexism on People of Color

A study examined the role of socioeconomic status in how heterosexism impacted queer people of color. Interestingly, the results suggested that those with higher socioeconomic statuses were more likely to have a negative mental health impact from heterosexism, suggesting they may need assistance in dealing with discrimination’s impact on their mental health.

 

The Smokeout Turns 40

The National Behavioral Health Network reported on the 40th anniversary of the Great American Smokeout, and highlighted the ways in which smoking disproportionately impacts people with mental illnesses and substance use issues – both of which disproportionately impact LGBT people. This may help to explain why LGBT folks smoke at about a 50% higher rate than others.

This story was written by Corey Prachniak-Rincón for Huffington Post. To view the original piece, click here.