In this issue:

Understanding Alzheimer's

Alzheimer's disease is caused by chemical changes in the brain that kill brain cells. As the brain cells die, a person slowly loses the ability to think and care for him- or herself. This is why Alzheimer's is referred to as a "progressive" disease.

Researchers are learning more by studying brain chemistry, and medicines that can help some symptoms of Alzheimer's have been developed. These medicines can improve a person's ability to function and enhance quality of life as well. However, there is no cure for this disease.

Alzheimer's disease usually occurs in people over age 65. The risk of getting it increases with age.

In general, people with Alzheimer's:

Forget recent events
Have problems starting and completing tasks
Have problems learning new information
Have problems doing usual tasks correctly as the disease progresses
Have problems using words correctly
Get mixed up about time and place
Make poor decisions
Lose things
Have changes in mood, such as depression or anxiety
Have changes in behavior

People with Alzheimer's also often have behavior problems. It is important to have these problems treated since they can make caring for your loved one more difficult.

Behavior problems may include:

Not sleeping at night
Becoming angry easily
Seeing things that are not there (hallucinations)
Having false ideas about what is going on (delusions)

The rate at which Alzheimer's progresses differs from person to person. At first, there is a decline in memory and thinking skills. Later, other abilities are affected. Eventually, the person suffering from this disease will need full-time care.

To diagnose Alzheimer's, the doctor will take a medical history and order blood, urine, and other tests. A brain scan may show whether other types of brain changes are causing the symptoms. The tests will help rule out other causes, which could include a thyroid condition, heart disease, a stroke, or a brain tumor. The sooner a diagnosis is made, the sooner treatment can start.

A person with Alzheimer's disease should continue to see his or her doctor for regular checkups. This will ensure that other medical conditions do not cause more problems. Family members caring for a loved one should come to each doctor appointment.

That way, they will hear the doctor's instructions and can ask questions. It is not safe to count on the person with Alzheimer's to understand and remember instructions.

Family members are usually the main caregivers for people with Alzheimer's. This can be very stressful. Families should stay in contact with the loved one's doctors and other providers. As the disease progresses, these providers can offer information about helpful resources and guide caregivers on how to manage care and plan for the future.

UPMC has one of the best centers in the United States for research and treatment of Alzheimer's disease. For more information on this topic, visit the websites of the Alzheimer Disease Research Center or the Institute on Aging, both part of the University of Pittsburgh.

Source: UPMC

Self-care for those who care for others

Caring for a loved one? You need care too. The Powerful Tools for Caregivers program can help.

Caring for a loved one who needs help can be challenging. In partnership with the University of Pittsburgh Institute on Aging, UPMC for Life offers the Powerful Tools for Caregivers program. This program, designed specifically to help family caregivers, will teach you how to take care of yourself while you care for a spouse, relative, or friend who lives at home or in a nursing home.

Classes consist of six weekly sessions.
Two specially trained and experienced class leaders conduct the classes.
Interactive lessons, discussions, and brainstorming will help you take the "tools" you choose and put them into action in your life.
You will receive a book, The Caregiver Helpbook, which contains important information on many aspects of caring for a loved one, including:

Hiring in-home help
Making legal and financial decisions
Deciding whether someone should continue to drive

You will learn to use tools that can help you:

Reduce your stress.
Communicate effectively with others (family members, your doctor, and other caregivers).
Take care of yourself.
Reduce guilt, anger, and depression.
Relax your mind and body.
Make tough decisions.
Set goals and solve problems.
Get rid of negative self-talk.

Learn more by downloading the Powerful Tools for Caregivers brochure. To have a printed copy mailed to you, call our UPMC for Life Health Care Concierge team at 1-877-539-3080 Monday through Friday from 8 a.m. to 8 p.m. and Saturday from 8 a.m. to 3 p.m. TTY/TDD users should call 1-800-361-2629.

Have you moved or changed your phone number?

If you have recently moved or are planning to move, or have changed your phone number, please let UPMC for Life know! Call our Health Care Concierge team with your new address and phone number. We are available at 1-877-539-3080 Monday through Friday from 8 a.m. to 8 p.m. and Saturday from 8 a.m. to 3 p.m. TTY/TDD users should call 1-800-361-2629.

Resources for Life and the five wishes tool

We plan for many things each day. But one thing we often do not plan for is how we want to be treated and whom we want to make decisions for us if we become unable to make decisions for ourselves.

Knowing the answers to these questions before you need them is called advance care planning. Although it can be hard to talk about your wishes before a crisis or serious illness happens, doing so ensures that you will be treated the way you want to be treated. Advance care planning focuses on your quality of life up to and including the end of life.

Resources for Life is pleased to offer you the Five Wishes tool at no charge. Five Wishes is an easy-to-use advance care tool that helps you think not only about your medical wishes, but also your personal wishes.

In addition, Resources for Life can help you with your advance care planning. For example:

Counselors can help you prepare to talk with your loved ones about your choices.
Resources for Life services provide 30 minutes of free legal consultation to help you discuss advance care planning.

Call your UPMC for Life Health Care Concierge and ask to talk to a Resources for Life representative. We can send you the Five Wishes tool, schedule a telephone counseling appointment, or refer you for legal consultation. Call our UPMC for Life Health Care Concierge team at 1-877-539-3080 Monday through Friday from 8 a.m. to 8 p.m. and Saturday from 8 a.m. to 3 p.m. TTY/TDD users should call 1-800-361-2629.

Generic drugs make cents!

Generic alternatives often cost much less than brand-name medications. Generic drugs are safe, effective, and broadly prescribed by many doctors.

There are many generic medications available in the same classes as brand-name drugs. There are generic drugs available to treat high blood pressure, high cholesterol, depression, osteoporosis, and many other conditions. Also, it is expected that even more brand-name medications will become available as generics in 2012.

Unfortunately, only 1 in 4 Medicare members have talked with their doctor about less expensive generic alternatives that may provide the same medical results. Talk with your doctor to find out if a generic alternative is right for you. Not only will a generic drug lower your copayments and out-of-pocket costs, it may help you avoid falling into the prescription drug coverage gap.

Talk to your doctor at your next appointment about making the switch to generics.

Have you received your flu shot? There's still time!

Unpredictable. That's the best way to describe flu season, which officially began in late October. It's impossible to know what the 2011-12 flu season has in store for us. What we do know is that the flu is a highly contagious respiratory illness that can cause mild to severe illness and can even be fatal. Every year, more than 200,000 people are hospitalized with the flu. The best way to protect yourself and your family is to get vaccinated every year.

Even healthy children and adults can become very sick from the flu and spread it to family and friends. You can pass on the flu before you even know you are sick!

The Centers for Disease Control and Prevention (CDC) recommends that everyone over the age of 6 months get vaccinated. Those at higher risk for serious complications include:

People age 65 and older
Children younger than 5, but especially children younger than 2
People with health conditions such as asthma, chronic lung disease, cardiovascular disease, and diabetes, as well as kidney, liver, and neurological disorders
Pregnant women

Others who should get a flu shot:

Health care workers
Residents of nursing homes or other long-term care facilities, as well as family and friends who have contact with a resident
Caregivers of young children, especially children under 6 months, who are at the highest risk of flu-related complications

The sooner you get a flu shot, the sooner you'll be protected. However, experts agree, it's never too late to get a flu shot.

If you have questions about getting a flu shot, be sure to talk to your doctor. To locate a physician in your area, visit www.upmchealthplan.com and click on Find a Doctor. You also may call our UPMC for Life Health Care Concierge team at 1-877-539-3080 Monday through Friday from 8 a.m. to 8 p.m. and Saturday from 8 a.m. to 3 p.m. TTY/TDD users should call 1-800-361-2629.

Note: Not all people should receive the flu vaccine. Talk to your doctor to find out if this vaccine is right for you.

Healthy comfort food

As the dark days and cold winter weather arrive, they can bring the "blahs" to the happiest of spirits. All too often people turn to food during these icy western Pennsylvania winters to cheer themselves up.

Instead of reaching for high-fat, high-sodium, and high-calorie convenience foods for you and your family, try your hand in the kitchen with any of these healthy, homemade recipes. Spend a day cooking, and then portion and freeze the recipes so you have healthy and delicious options to choose from any day of the week. Plus, your house will smell delicious.

Cran Apple Crisp

Ingredients:
4 apples, cored and thinly sliced
1 16-ounce can whole cranberry sauce
2 teaspoons soft margarine, melted
1 cup uncooked oatmeal
⅓ cup brown sugar
1 teaspoon cinnamon

Preparation:

Preheat oven to 400°F.
Wash apples and remove cores. With peel on, slice thinly.
In a bowl, combine the cranberry sauce and apples. Pour into an 8x8-inch pan.
Combine melted margarine with oatmeal, brown sugar, and cinnamon until well blended. Sprinkle over apple-cranberry mixture.
Cover and bake for 15 minutes.
Uncover and bake 10 more minutes, until the topping is crisp and brown.
Serve warm or cold.

Yield: 8 (¾ cup) servings

Nutritional Information Per Serving: 220 calories, 2 g protein, 52 g carbohydrate, 2 g fat, 0 mg cholesterol, 4 g fiber, 25 mg sodium

Mushroom Barley Soup

Ingredients:
1 tablespoon oil
1 onion, chopped
2 celery stalks, sliced thin
2 carrots, peeled and sliced thin
2 cups sliced mushrooms
½ cup quick cooking barley
1 teaspoon garlic powder
½ teaspoon ground thyme
3 cups chicken broth
2 cups water
1 tablespoon chopped fresh parsley

Preparation:

Heat oil in large soup pot over high heat. Saute onion, celery, carrots, and mushrooms until golden (about 4 minutes).
Add the rest of the ingredients, except for the parsley, and bring it to a boil.
Lower heat to a simmer and cook until the barley is tender (about 20 minutes).
Sprinkle parsley on top of soup and serve hot.

Yield: 4 (1 ½ cup) servings

Nutritional Information Per Serving: 170 calories, 8 g protein, 26 g carbohydrate, 5 g fat, 0 mg cholesterol, 6 g fiber, 100 mg sodium

Turkey Patties

Ingredients:
1 ¼ pound ground turkey
1 cup bread crumbs
1 egg
¼ cup chopped green onions
1 tablespoon prepared mustard
½ cup chicken broth
Nonstick cooking spray

Preparation:

Mix ground turkey, bread crumbs, egg, onions, and mustard in a large bowl. Shape into 4 patties, about 1/2-inch thick.
Spray a large skillet with cooking spray. Add patties and cook, turning once to brown other side. Cook until golden brown outside and white inside, about 10 minutes. Remove.
Add chicken broth to skillet and boil over high heat until slightly thickened, about 1 to 2 minutes. Pour sauce over patties.
Serve on buns.

Yield: 4 (1 patty) servings

Nutritional Information Per Serving: 340 calories, 30 g protein, 20 g carbohydrate, 15 g fat, 165 mg cholesterol, 2 g fiber, 440 mg sodium

All recipes were provided by the U.S. Department of Agriculture.

Important pharmacy changes

UPMC for Life is very proud of its large pharmacy network, which includes more than 30,000 pharmacies. It includes local pharmacies and national chains such as CVS/pharmacy, Giant Eagle, Kmart, Rite Aid, Sam's Club, Target, Walmart, and Wegmans.

Beginning in January 2012, Walgreens will no longer be part of the UPMC for Life pharmacy network. If you currently have your prescriptions filled at Walgreens, you will need to go to a new pharmacy as of January 2, 2012.

If you need help finding a new pharmacy, call our UPMC for Life Health Care Concierge team at 1-877-539-3080 Monday through Friday from 8 a.m. to 8 p.m. and Saturday from 8 a.m. to 3 p.m. TTY/TDD users should call 1-800-361-2629.

For your eyes only

Despite being the second-leading cause of blindness in this country (macular degeneration is first), and despite afflicting one of every 10 Americans over age 70, glaucoma doesn't get the

publicity it should. So, in honor of January being Glaucoma Awareness Month, it's time to revisit this vitally important topic. Your eyes will thank you for it.

What is glaucoma?
Glaucoma is a condition that normally develops when too much fluid pressure builds up inside the eye (though glaucoma can occur when fluid pressure is normal). Over time, the increased pressure can damage the optic nerve at the back of the eye, which can lead first to a loss of peripheral (side) vision, then to blindness. "The majority of glaucoma cases involve what is called primary open-angle glaucoma," says Joel S. Schuman, MD, director of the UPMC Eye Center and a leading expert on the disease. "The scary thing about this form of glaucoma is there are no obvious symptoms until you have lost a good deal of your sight, and at that point the damage is irreversible." There are other less common forms of the disease, including angle-closure glaucoma and normal pressure glaucoma.

What causes glaucoma?
Experts aren't sure about this. One popular theory is that the eye's natural fluid-drainage system becomes inefficient as you age, which causes the fluid buildup and increased pressure. However, glaucoma can occur in people with normal eye fluid pressure. Another theory is that glaucoma occurs because of inadequate blood flow to the optic nerve, which causes damage over time, and subsequent loss of sight. Still another theory finds that toxins in the body damage the optic nerve. Any or all of these mechanisms can play a role in nerve damage in glaucoma.

What are the symptoms?
With open-angle glaucoma, there is a gradual loss of peripheral vision, often in both eyes. In its advanced stages, people often get tunnel vision. The second-most common form of the disease, angle-closure glaucoma, sometimes results in sight impairment within a day. Symptoms of this form of glaucoma are far less subtle than with open-angle glaucoma, and may include severe eye pain, nausea and vomiting, blurred vision, halos around lights, and reddening of the eye.

How is glaucoma diagnosed?
Typically by way of tonometry, a quick and painless way of measuring the fluid pressure inside your eye, otherwise known as intraocular pressure. An eye doctor may also use instruments that can look through the pupil to the optical nerve, in order to check for damage. The doctor may also do a visual field test to measure your peripheral vision.

Am I at risk for glaucoma?
Risk increases when you reach age 40. For African-Americans, who tend to have a higher incidence of the disease, risk goes up earlier. A family history of glaucoma is also a strong risk factor. Other risk factors include poor vision, diabetes and certain other medical conditions, and frequent use of steroid medications such as prednisone. "All of these factors are individually important, but when you have several together, it's even more critical to have your eyes checked frequently," says Dr. Schuman. "For instance, if you're older, African-American, and have a family history of glaucoma, it's important to get tested once a year. Your doctor may recommend testing even more frequently than that." People under 60 with no risk factors are fine getting tested every three to five years, according to the American Academy of Ophthalmology.

Can I go to the optometrist to get checked, or should I see an ophthalmologist?
"Optometrists are very good at providing routine, everyday care of your eyes," says Dr. Schuman. "But if you're looking for a complete medical eye evaluation, or suspect there may be problems, or have a strong family history of glaucoma, an ophthalmologist would be a good way to go. Ophthalmologists are MDs, are trained in medical and surgical care, and can better evaluate you in the larger context of your entire body, not just your eyes."

How is the disease treated?
Though you can't prevent or cure glaucoma, the great news is that it is very treatable if caught early. The first thing your doctor will normally try is medicated eye drops to decrease eye fluid pressure. If these don't bring down the pressure, there is also oral medication that can be effective. Researchers are also developing certain new drugs that protect the optic nerve from glaucoma-related damage. If medications don't work, your doctor may recommend either laser surgery or actual surgery to improve fluid drainage inside the eye.

Any final recommendations?
"Most important, get regular eye exams, especially if you have risk factors for glaucoma," advises Dr. Schuman. "This is so critical because there are no symptoms until the damage is done, and at that point you can't reverse it. But you can keep this from happening if you catch the disease early and treat it. Treatment can be very effective as long as you're consistent with your medication, doctor visits, and remain in the care of an eye doctor."

UPMC's Diagnostic Gold Standard
To confirm a diagnosis of glaucoma or other eye disease, Dr. Schuman helped to develop what is known as optical coherence tomography (OCT), which is the most powerful tool now available for early detection of glaucoma. It quickly, painlessly, and non-invasively produces a 3-D image of the eye, which then can be compared to what healthy eye tissue looks like. "Also known as spectral OCT, this test has become the standard of care globally," says Dr. Schuman. "It also allows us to track changes in eye health over time." Yes, but does insurance cover it? "If your doctor believes there is something happening in the eye that looks problematic, he or she can order the OCT test and it will normally be covered," he says.

It's time to schedule your annual visit!

The beginning of a new year is a great time to resolve to make things in your life better. Why not use the start of each new year as your reminder to schedule an annual visit with your primary care physician or nurse practitioner?

Your annual visit is the perfect time to get a status check on your current health, find out what you're doing well, and learn to take better care of yourself.

An important part of your annual visit is finding out which health screenings are right for you. A health screening is an exam to identify or rule out a health condition. Regular screenings can catch health problems in the early stages, when they are easier to treat. Some people are at higher risk of developing health problems than others.

Your Health Care Concierge can help you find a doctor, schedule an appointment, and tell you about guidelines for preventive care. Call our UPMC for Life Health Care Concierge team at 1-877-539-3080 Monday through Friday from 8 a.m. to 8 p.m. and Saturday from 8 a.m. to 3 p.m. TTY/TDD users should call 1-800-361-2629.

The U.S. Preventive Services Task Force (USPSTF) recommends that people age 50 or older receive the following screenings and vaccines (the list does not include all the tests that are recommended).

Screenings and Vaccines	Who?	When?
Physical exam (annual wellness exam)	Men and women	Every year
Blood pressure screening	Men and women	Every year
Blood tests and urinalysis: Screen for various illnesses and diseases (high cholesterol, diabetes, and kidney or thyroid dysfunction) before symptoms occur	Men and women	Every year
Cholesterol test	Men and women	Every year
Flu vaccine	Men and women	Every year
Eye exam with screening for glaucoma	Men and women	Every year
Mammogram	Women	Every 1-2 years
Bone density test for osteoporosis	Women	Discuss with your doctor
Body mass index screening for obesity	Men and women	Discuss with your doctor
Pneumonia vaccine	Men and women	Discuss with your doctor
Screen for colon cancer	Men and women	Discuss with your doctor
Diabetes Tests
HbA1C blood test	Men and women	Every year
Microalbumin (urine)	Men and women	Every year
Eye exam for diabetic retinal disease	Men and women	Every year

Why are these health screenings important?

Continue reading for more information about important preventive screenings.

Blood pressure screening
High blood pressure usually has no warning signs or symptoms. People can think they have perfectly normal blood pressure until suddenly they have a heart problem or a stroke. High blood pressure may have silently damaged their heart and blood vessels over a long time. The only way to know if your blood pressure is normal is to have regular blood pressure tests. High blood pressure is the No. 1 cause of stroke.

Cholesterol test
High cholesterol is a major risk factor for heart disease, heart attack, and stroke. A cholesterol screening can predict your risk for developing heart disease. Early detection of high cholesterol will allow your doctor to determine the best treatment to help you live an active and healthy life. There are two types of cholesterol: "good" and "bad." Optimally, your good cholesterol (HDL) should be higher than 50 and your bad cholesterol (LDL) should be less than 100. Total cholesterol should not exceed 200. Annual cholesterol screenings will help you become familiar with your cholesterol levels. Your doctor will recommend the appropriate treatment plan based on your test results. This may include healthy lifestyle changes and medication.

Flu vaccine
The influenza virus, or flu, contributes to many unplanned hospitalizations every year. In the worst cases, the flu can be life threatening. Flu shots prevent flu and ease symptoms if you get the flu. Visit your primary care doctor to get your free flu shot. Or get your flu shot at a designated location in your community.

Glaucoma screening
Glaucoma can rob you of your sight without warning or symptoms. More than 3 million Americans have glaucoma, and about half of them don't know it. Everyone is at risk for glaucoma, but people age 60 and older are at higher risk. There is no cure for glaucoma. However, medication or surgery can slow or prevent further vision loss. The appropriate treatment depends upon the type of glaucoma. It may include medication (usually prescription eye drops) or surgery.

Mammogram
According to the American Cancer Society (ACS), an estimated 192,370 new cases of invasive breast cancer were diagnosed in 2009 among women in the United States. The ACS also reports that an estimated 40,610 breast cancer deaths were reported. A mammogram remains the best available method to detect breast cancer early. However, no medical test is always 100 percent accurate, and mammography is no exception. Research is under way to improve the technology to lead to better accuracy and to create new technologies. Medicare covers a mammogram every year for women age 40 and older who are Medicare recipients.

Bone density test
Many women start to worry about osteoporosis only after they reach menopause. But for some women this might be too late. Osteoporosis weakens bones and makes them more prone to breaking. Because this condition has no symptoms, you may not know you are at risk until you actually break a bone. A bone mineral density (BMD) test can detect osteoporosis before a bone breaks. The test takes a picture of your bones and measures bone density at various sites on your body. UPMC for Life covers BMD tests at no cost to you, but you must have a prescription from your doctor. If you have been diagnosed with osteoporosis, talk to your doctor about treatment. There are a number of FDA-approved generic medications for the treatment or prevention of osteoporosis.

Body mass index
(Body Mass Index) BMI is used as a screening tool to identify possible weight problems for adults. Calculating BMI is one of the best methods for helping to assess whether a person is overweight or obese. The use of BMI allows people to compare their own weight status to that of the general population. In addition to not feeling great, being overweight or obese can lead to a host of health conditions, including coronary artery disease, type 2 diabetes, high blood pressure, high cholesterol, liver disease, and osteoarthritis, among others.

Pneumonia vaccine
Pneumococcal disease kills more people in the United States each year than all other vaccine-preventable diseases combined. The Centers for Disease Control and Prevention (CDC) recommends all adults age 65 and older be vaccinated. The vaccine is very safe. About half of the individuals who get the vaccine have very mild side effects, such as redness or pain where the shot is given. Getting the disease is much more likely to cause serious problems than getting the vaccine.

Colon cancer screening
If you knew you could reduce your risk of dying from cancer of the colon or rectum (colorectal cancer) by 60 percent, would you do it? Most people would probably answer, "Yes, of course." However, while colorectal screening has been shown to be effective in reducing the risk of death, many people remain hesitant to have these tests. But if you are over age 50, you should be screened for colorectal cancer. In fact, it may save your life. As a UPMC for Life member, you are covered for colorectal cancer screening.* Talk to your doctor about which screening method is right for you.

If you have diabetes:

Blood pressure check
High blood pressure is an important risk factor for the development and worsening of many complications of diabetes, including diabetic eye disease and kidney disease. It affects up to 60 percent of people with diabetes.

Hemoglobin A1c (HbA1c)
Tracks your blood glucose level over the last three months. The HbA1c goal for most people is below 7. High blood glucose levels can harm your heart, blood vessels, kidneys, feet, and eyes.

LDL screening
Your LDL is the level of "bad" cholesterol in your blood. Having an LDL level of more than 100 can cause a buildup in your arteries that clogs your blood vessels. This can lead to heart problems.

Dilated eye exam
Diabetes is the leading cause of new cases of blindness among adults ages 20 to 74. Diabetic retinopathy causes 12,000 to 24,000 new cases of blindness each year. If you have diabetes, it's very important to have a yearly comprehensive vision examination, including a dilated eye examination.

Urine microalbumin
This test checks for protein (albumin) in the urine. When the kidneys are working properly, albumin is not present in the urine. When the kidneys are damaged, small amounts of protein can be found in the urine. Early detection of protein in the urine can help preserve kidney function. Your doctor may also order lab tests for your blood urea nitrogen (BUN) and creatinine levels.

Source: U.S. Department of Agriculture

Do you know where your thyroid is?

January is Thyroid Awareness Month, and if ever a medical condition could benefit from increased awareness, this would be it.

An estimated 59 million Americans have thyroid problems, but the majority do not know it. Most Americans have never had a thorough thyroid checkup. In fact, most Americans do not even know where their thyroid is located.

The thyroid gland is located on the front part of the neck, below the Adam's apple. This gland produces thyroid hormones, which regulate body metabolism and are important in controlling the delivery of oxygen and energy to every cell in your body.

If your thyroid is not functioning properly, it can affect every aspect of your health, especially weight, energy level, and tendency toward depression.

The most common form of thyroid disease is too little thyroid hormone, which is known as hypothyroidism. People with low thyroid hormone levels can gain weight, lose energy, become depressed and exhausted, lose their hair and their sex drive, find it hard to remember things, and find it hard to concentrate.

Other thyroid diseases include overactive thyroid (hyperthyroidism), which is caused by too much thyroid hormone. This can result in anxiety, insomnia, rapid weight loss, diarrhea, high heart rate, high blood pressure, and other concerns. Another disease is goiter, an enlargement of the thyroid, which can create breathing and swallowing problems as well as be physically unattractive.

Many symptoms can indicate a thyroid problem, including:

Fatigue. You can't get enough sleep and need daily naps to function.
Weight changes. Difficulty losing weight can be a sign of hypothyroidism.
Depression and anxiety. Hypothyroidism is most commonly associated with depression, and hyperhthyroidism with anxiety and panic attacks.
Cholesterol issues
Family history. A family history of thyroid problems puts you at a higher risk for those problems.
Bowel problems
Hair/skin changes. Hair loss is frequently associated with thyroid problems.
Neck discomfort/enlargement
Muscle and joint pains, carpal tunnel/tendonitis

Thyroid problems can affect both men and women, although women are at greater risk. And, while women age 50 and older are at greatest risk, thyroid disease can strike at any age.

You don't need to have all of these symptoms to have a thyroid problem, but having some of them could be a possible sign of the condition. Undiagnosed thyroid problems can dramatically increase your risk of obesity, heart disease, depression, anxiety, hair loss, sexual dysfunction, infertility, and other health problems.

If properly diagnosed, people with thyroid problems can be treated, feel better, and live well. Ask your doctor if a thyroid test is something you should consider. He or she will take a blood sample and test your thyroid hormone levels.

Home safety — inside and out

When it comes to home hazards that are winter-related, fires and carbon monoxide poisoning are two of the biggest concerns. Both are more prevalent when the weather gets cold. But some simple precautions can prevent them from happening to you.

Reduce the risk of a home fire
A working smoke alarm can dramatically increase the odds of surviving a fire. Install smoke alarms on every floor of your house, including the basement, and in or near every bedroom and sleeping area. Change the batteries at least once a year, and test your smoke alarm monthly.

Ideally though, you want to prevent the smoke alarm from going off in the first place. The use of fireplaces and space heaters is one of the reasons there are more fires in winter. Use these heat-generators with care.

Space heaters
A space heater can help you stay warm while keeping heating bills down, but older models can be hazardous. Use only heaters that have a UL safety rating, indicating that they've been tested to meet the latest safety standards. Make sure your model will switch off automatically if it tips over.

Other important safety measures:

Keep the heater at least three feet away from bedding, drapes, furniture, and other materials that burn easily.
Plug your heater directly into the wall outlet; never use an extension cord, as the amount of current it requires could melt the cord, which could start a fire.
Unplug the heater if you leave the area and when you go to sleep.

Fireplace safety
There's nothing that takes the chill out of a cold winter's night better than flames crackling in the fireplace. Take these steps before you curl up. Have the chimney inspected (this should be done annually) and, if necessary, cleaned, especially if it hasn't been used in a while.

Once you have the green light to build a fire, make sure you have a screen in front of your fireplace to prevent sparks from jumping out.
If you're using synthetic logs, never break one apart to quicken the fire, or use more than one log at a time.
It goes without saying that you need to make sure the fire is out before you go to bed.

Prevent carbon monoxide leaks

Dirty, inefficiently burning furnaces can burn carbon monoxide, an odorless, colorless gas. To keep your furnace performing at its peak, a qualified technician needs to clean and maintain it every year.
Other sources of carbon monoxide leaks include chimneys with cracks and gas appliances such as stoves or dryers. Make sure your chimney is in good repair; gas appliances should be vented outside. Never use kerosene space heaters indoors.
Since you can't see or smell carbon monoxide, a carbon monoxide detector is vital. There should be one on every floor where people sleep, plus another one near any gas-burning appliance such as a furnace or water heater.

Outside — safe shoveling
Just 15 minutes of shoveling snow counts as moderate aerobic activity, so it's important to warm up before heading outside. Your warm-up can consist of five or 10 minutes of walking in place, or jumping jacks, plus some gentle stretches.

If you have a history of heart attack, high cholesterol, high blood pressure, heart disease, have a history of back problems, or you're a smoker, you may want to let someone else take on this chore.

Use proper form. Keep your knees bent and lift from your legs, not your back. Avoid twisting sideways as you're unloading the snow from the shovel. You'll be less likely to injure your back. If possible, push the snow instead of lifting it.

Pace yourself. Take a break every 15 minutes to allow your body to rest.

Pick the right shovel. A smaller model allows for lighter loads, and less stress on your body.

If you experience chest pain, shortness of breath, nausea or dizziness, put down the shovel and go inside. If symptoms persist for more than five minutes, seek emergency help.