Tag: Medicine

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Corticosteroid exposure associated with hospitalization for severe pain event among patients with sickle cell disease

Corticosteroid exposure associated with hospitalization for severe pain event among patients with sickle cell disease

People with sickle cell disease (SCD) who were recently prescribed a corticosteroid – a medicine frequently used to treat asthma or inflammation – were found to be significantly more likely to be hospitalized for a severe pain event, according to a paper published today in the journal Blood. The research also found that older adults, women, and people who were not taking the drug hydroxyurea to manage their underlying SCD symptoms were the most likely to be hospitalized.

SCD is the most common inherited red blood cell disorder in the United States, affecting an estimated 100,000 people. According to the Centers for Disease Control and Prevention (CDC), SCD affects one out of every 365 Black or African American births and one out of every 16,300 Hispanic American births. Pain events, also known as vaso-occlusive episodes (VOE), are the most common complications of SCD and can result in intense pain and potentially irreversible organ damage.

Apart from case reports, researchers say this is the first study to systematically evaluate the association between corticosteroid exposure and hospitalization for VOE.

Individuals living with SCD often suffer crippling episodes of pain, which can greatly impair their quality of life. Based on our data, corticosteroids are commonly prescribed for conditions unrelated to their underlying SCD. Vaso-occlusive events and related hospitalization appear to follow corticosteroid prescription fairly quickly. This evidence suggests corticosteroids may be contributing to the events and should be avoided as much as possible in these patients.”


Ondine Walter, MD, Study Author, Toulouse University Hospital in France

Notably, the median time between filling a prescription for a corticosteroid and hospitalization was just five days. Also striking was the fact that nearly half (46%) of patients with SCD had been prescribed at least one systemic corticosteroid during the study period. Dr. Walter said the results underscore the need for widespread education of clinicians and patients alike about the potential risks of using corticosteroids, especially when there isn’t a clear indication to use them.

“Corticosteroids are mostly easy to avoid, and in circumstances when they are necessary, it’s important to start them in collaboration with an SCD expert and to take all appropriate precautionary measures to administer them safely,” said Dr. Walter.

The study used data from a total of 5,151 patients with SCD drawn from the French National Health Insurance Database between 2010 and 2018. Patients had to have at least one hospitalization for VOE to be included, and corticosteroid exposure was identified using outpatient prescribing records.

The study found that those who had exposure to a corticosteroid – defined in the month leading up to the event – were significantly more likely to be hospitalized for VOE. People who were also taking hydroxyurea seem to have less risk of hospitalization compared with those not taking the drug, which may signal a potential protective effect of hydroxyurea on the occurrence of VOE, Dr. Walter explained. Hydroxyurea is often prescribed to reduce the number of pain events caused by SCD as well as the need for blood transfusions. The risk of admission was also lower in men compared to women and in children compared to adults.

“Some factors such as hydroxyurea use, male gender, and younger age were associated with a lower risk of hospitalization for VOE after corticosteroid exposure in our study. Still, based on these results, we still need to think twice about using corticosteroids when treating patients with SCD,” said Dr. Walter.

This study is limited in that it can only show an association between corticosteroids and VOE-related hospitalizations and not prove causation. Because corticosteroid exposure was based on dispensing data, it is also not possible to confirm that patients took the medicine, only that the prescription was filled.

With future research, investigators aim to understand how corticosteroids may prompt VOE. Studies have shown that the cessation of corticosteroids, in particular, has been associated with rebound pain. ASH’s Clinical Practice Guidelines on SCD recommend against using corticosteroids for acute pain management in patients with SCD. This study adds important data about the association of corticosteroid use with subsequent VOE to a growing body of evidence that suggests corticosteroids should be used only when needed, and under the guidance of an SCD expert.

Source:

American Society of Hematology

Journal reference:

Walter, O., et al. (2022) Risk of vaso-occlusive episode after exposure to corticosteroids in patients with sickle cell disease. Blood. doi.org/10.1182/blood.2021014473.

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Leakage after left atrial appendage occlusion associated with higher risk of adverse events

Leakage after left atrial appendage occlusion associated with higher risk of adverse events

Patients who had leakage to the left atrial appendage due to incomplete device sealing after left atrial appendage occlusion (LAAO) experienced more clotting and bleeding events within a year following their procedure compared with patients who had no leaking, according to a study presented at the American College of Cardiology’s 71st Annual Scientific Session.

The study, which included data from more than 50,000 patients, is by far the largest to date to assess how leaking after LAAO affects the likelihood of adverse health outcomes. The results suggest that even small leaks are associated with a 10%-15% higher risk of adverse events.

Our study shows that any leak matters, and we should find ways to optimize the procedure to minimize the proportion of patients who end up with leaks. Because this is a preventative procedure, it is important to find ways to master this and prevent leaks from happening. Fortunately, there are indications that leaking might be less common with newer devices and improved techniques.”


Mohamad Alkhouli, MD, professor of medicine at Mayo Clinic and study’s lead author

Stroke is a major concern in patients with atrial fibrillation (AFib), the most common heart rhythm disorder. Blood thinners are the primary medical option for reducing the risk of strokes, which are caused when a blood clot blocks an artery in the brain; however, blood thinners are not suitable for many patients due to drug interactions, bleeding complications, cost, frequent blood checks with warfarin or other reasons. The WATCHMAN device, approved by the U.S. Food and Drug Administration in 2015, is designed to help prevent strokes by sealing off the heart’s left atrial appendage where blood can pool and clot. It is now widely used to reduce the risk of stroke in patients with AFib who cannot tolerate long-term use of blood thinners.

For the study, researchers analyzed data from 51,333 patients who underwent LAAO procedures with the WATCHMAN device between 2016-2019 as recorded in the ACC’s LAAO Registry, a database that includes nearly all LAAO procedures conducted in the U.S. and is part of the College’s NCDR registries. Echocardiograms were used to classify the size of any leaks around the device an average of 45 days after a LAAO procedure, a standard part of the clinical follow-up for this procedure. Registry data also included information about subsequent adverse health events occurring in the years after the procedure.

Overall, researchers found that 73.4% of patients had no leaks, 25.8% had small leaks (greater than zero but less than 5 millimeters across) and 0.7% had large leaks (greater than 5 millimeters)—proportions similar to those reported in previous registry studies and clinical trials.

While relatively few patients—roughly 2%-3%—experienced adverse events in the year following their LAAO procedure, the researchers found that the relative risk of these events varied significantly between patients with and without leaks. Compared to patients who had no leaking, those with small leaks had a 10% higher relative risk of suffering any major adverse events, an 11% higher relative risk of major bleeding complications, and a 15% higher relative risk of clotting-related events, including stroke, systemic embolization and transient ischemic attacks.

The study revealed no significant differences in the rate of adverse events between patients with large leaks and those with small or no leaks, which Alkhouli said is likely due to the use of anticoagulants in these patients. Instructions for the WATCHMAN device indicate that patients who have residual leaks greater than 5 millimeters across should be considered to have a failed procedure, and they are generally treated with anticoagulants.

Alkhouli said leaking is relatively common with LAAO procedures because the size and shape of the left atrial appendage varies widely from person to person, which can make it difficult for operators to position the device in a way that completely seals off the appendage. He noted that the shape of the appendage portion where the leaked blood flows into could affect the associated risks. More recent technologies, such as the use of CT scans to image the appendage and software that allows users to practice the procedure virtually before operating on a patient, could help operators place the WATCHMAN device in a more optimal position. Alkhouli said newer generation WATCHMAN device designs, which were introduced in 2021, could also help to reduce the risk in some patients.

The study was based on registry data reflecting real-world practices, meaning variations in the measurement of leaks could exist and may impact the results of the study, Alkhouli said. He added that future studies could help clarify whether using blood thinners in some patients with leaks smaller than 5 millimeters would be helpful in reducing stroke risk.

This study was simultaneously published online in the JACC: Clinical Electrophysiology at the time of presentation. The study was funded by Boston Scientific, maker of the WATCHMAN device.

Alkhouli will present the study, “Residual Leaks Post Left Atrial Appendage Occlusion,” on Sunday, April 3, at 12:15 p.m. ET / 16:15 UTC in the Main Tent, Hall D.

Source:

American College of Cardiology

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Reduced kidney function caused by antithrombotic therapy can influence bleeding events

Reduced kidney function caused by antithrombotic therapy can influence bleeding events

Antithrombotic therapy is prescribed to prevent thrombotic (blood clotting inside a blood vessel) events but the treatment also increases the likelihood of experiencing a bleeding event, which can be extremely serious if it occurs in a vital organ. Aging societies tend to have an increased number of patients undergoing antithrombotic therapy, and the drugs used in this treatment can affect kidney function. In particular, reduced kidney function caused by antithrombotic medications can significantly influence bleeding events. It is highly recommended that patients, especially those with decreased kidney function, have a detailed discussion with their doctor about the possible risks and benefits of proceeding with antithrombotic therapy.

Patients with heart arrythmia (atrial fibrillation) have a high risk for thrombotic events in blood vessels that could lead to permanent organ damage-;such as cerebral infarction-;and are prescribed antithrombotic therapy to lower their risk of developing blood clots. However, the risk of bleeding events simultaneously increases due to the nature of these medications. The severity of these bleeding events is highly variable, ranging from epistaxis (nosebleeds) to fatal brain hemorrhage.

While kidney function is known to be related to bleeding event risk, researchers at Kumamoto, Miyazaki, and Tohoku Universities in Japan conducted a post-hoc subgroup analysis of the Atrial Fibrillation and Ischemic Events with Rivaroxaban in Patients with Stable Coronary Artery Disease (AFIRE) trial to determine the impact of kidney function on the risk of recurrent bleeding events during antithrombotic therapy. Their analysis revealed that the effect of kidney function on recurrent bleeding risk events was quite large for patients undergoing this treatment. They also found that the bleeding risk decreased with time for patients with healthy kidney function but remained high for patients with decreased kidney function. Clearly, the decision to use such a therapy should be balanced between the expected antithrombotic effects and bleeding risks.

In most cases, it is considered better to continue antithrombotic therapies even after bleeding events as long as the event was not severe. However, it is not surprising that both patients and physicians hesitate to continue the therapy after any bleeding event. To assess for drug safety and efficacy, these drugs are usually measured by the numbers of bleeding and thrombotic events. Unfortunately, in the assessment of antithrombotic therapy, most studies only consider the first event in their analyses even though patients could experience multiple events throughout their lifetime. This study revealed that the impact of kidney function on bleeding risk during antithrombotic therapy is larger than estimated in previous studies. Furthermore, patients with healthy kidney function appear to have a decreased risk of experiencing a bleeding event over time, but the risk for patients with reduced kidney function remains high as time continues.

A detailed discussion between patients and physicians based on all current scientific evidence about the risks and benefits of antithrombotic therapy is highly recommended. Our analysis should be quite useful in facilitating this type of discussion.”


Dr. Kunihiko Matsui, Study Leader, Kumamoto University Hospital’s Department of General Medicine and Primary Care

Source:

Journal reference:

Matsui, K., et al. (2022) The impact of kidney function in patients on antithrombotic therapy: a post hoc subgroup analysis focusing on recurrent bleeding events from the AFIRE trial. BMC Medicine. doi.org/10.1186/s12916-022-02268-6.

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World events, time change and anger piling on pandemic pressures

World events, time change and anger piling on pandemic pressures






Chuck Norris

Chuck Norris


Don’t care much for the constant mid-March ritual of moving our clocks ahead one hour? According to Beth Ann Malow, a professor of neurology and pediatrics at Vanderbilt University, 63% of Americans would like to see it eliminated.

The thing is, daylight saving time represents much more than a disruption to daily routines. Given the stresses heaped upon us in our world of uncertainties, it could be the proverbial straw that broke the camel’s back.

“Beyond simple inconvenience,” writes Malow on TheConversation.com, “Researchers are discovering that ‘springing ahead’ each March is connected with serious negative health effects.”

“In a 2020 commentary for the journal JAMA Neurology, my co-authors and I reviewed the evidence linking the annual transition to daylight saving time to increased strokes, heart attacks and teen sleep deprivation,” she says.

A separate post on TheConversation.com co-authored by Deepa Burman, co-director of the Pediatric Sleep Evaluation Center at UPMC Children’s Hospital of Pittsburgh, and Hiren Muzumdar, director of the Pediatric Sleep Evaluation Center, notes that sleep deprivation can result in increases of workplace injuries and automobile accidents. One individual’s sleep deprivation can affect an entire family.

People are also reading…

“You may notice more frequent meltdowns, irritability and loss of attention and focus,” they say.

I wonder, could uncontrolled anger be far behind?

Now, watching a devastating war unfold on social media is also hammering away at our collective mental health. We’re all being heightened by graphic and disturbing images that fill our feeds, writes Time magazine reporter Jamie Ducharme.

“Tracking up-to-the-minute developments can come at a cost. … Footage and photos from Ukraine flooding social media and misinformation spreading rampantly (has) implications for public health,” she reports.

It has long been the responsibility of traditional media outlets for editors to decide which content is too graphic to show, or to label disturbing images with warnings. As pointed out by Roxane Cohen Silver, a professor of psychological science at the University of California, Irvine, today anyone “can take pictures and videos and immediately distribute that (on social media) without warning, potentially without thinking about it.”

Jason Steinhauer, founder of the History Communication Institute, says, “Russia has been waging a social media and misinformation war for the past 10 to 12 years.” This has only gotten worse since its invasion of Ukraine.

We should not be surprised at all that studies now suggest that news coverage of the pandemic has contributed to our mental distress. “Adding yet another difficult topic to the mix can worsen those feelings,” Cohen Silver says.

Yet the war is hardly the only attack on our senses. At a time when we are most vulnerable, the Federal Trade Commission reports that predatory fraudsters bilked consumers of an estimated $5.8 billion last year. According to the agency, it represents a 70% increase over 2020. “Almost 2.8 million people filed a fraud complaint, an annual record” and “the highest number on record dating back to 2001,” reports the FTC. “Imposter scams were most prevalent, but investment scams cost the typical victim the most money.”

“Those figures also don’t include reports of identity theft and other categories,” the report points out. “More than 1.4 million Americans also reported being a victim of identity theft in 2021; another 1.5 million filed complaints related to ‘other’ categories (including credit reporting companies failing to investigate disputed information, or debt collectors falsely representing the amount or status of debt).”

The mounting stresses placed upon us are now posing a threat to not just our mental and financial health but our physical well-being.

According to a working paper from researchers at the Naval Postgraduate School and the University of Pennsylvania, “In 2020, the risk of outdoor street crimes initially rose by more than 40% and was consistently between 10-15% higher than it had been in 2019 through the remainder of the year.” Researchers also believe that the finding “points to the potential for other crimes to surge the way homicides have as cities reopen and people return to the streets,” says the report.

Adds Megan McArdle commenting on the report in an op-ed for the Washington Post, “community trust in the police might have plummeted, possibly making people more likely to settle scores on their own. Or police might have reacted to public anger by pulling back from active policing, creating more opportunities for crime.”

Hans Steiner is a professor emeritus of Stanford’s Department of Psychiatry and Behavioral Sciences who has logged decades of work studying anger and aggression. In an interview posted on the Stanford University website, he says he believes that “the coronavirus pandemic, with its extreme disruption of normal daily life and uncertainty for the future, compounded by several other crises (economic distress, racial tension, social inequities, political and ideological conflicts) puts us all to the test: we find ourselves immersed in a pool of negative emotions: fear, sadness, contempt, and yes, anger. What do we do with this forceful emotion?”

“Anger signals that we are being threatened, injured, deprived, robbed of rewards and expectancies,” Steiner says. It should be “one of our adaptive tools to deal with the most difficult circumstances. Sometimes it becomes an obstacle to our struggles, especially when it derails into aggression and even violence.”

Anger problems are now spilling over into record accounts of hate crimes. It seems that today’s circumstances, with anger management and rule of law seemingly at an all-time low, have caused many individuals to become ticking time bombs. Reports CBS News, “the total number of hate crimes nationwide has increased every year but one since 2014, according to FBI data, which includes statistics through 2020.”

Steiner says that “maladaptive anger and aggression has the following characteristics: 1. It arises without any trigger, seemingly out of the blue; 2. it is disproportionate to its trigger in its frequency, intensity, duration and strength; 3. it does not subside after the offending person has apologized; 4. it occurs in a social context which does not sanction anger and aggression.”

Who among us has not seen or maybe even experienced some, maybe all, of these behavior characteristics?

“In such conflicts we need to remind ourselves that diatribes, lies and accusations will not move us forward; compassion, empathy and the reminder that we are all in this horrible situation together (needs to) inspire us,” Steiner advises.

Write to Chuck Norris at info@creators.com with questions about health and fitness.

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People with elevated blood pressure upon standing more likely to have risk for cardiovascular events

People with elevated blood pressure upon standing more likely to have risk for cardiovascular events

Among young and middle-aged adults with high blood pressure, a substantial rise in blood pressure upon standing may identify those with a higher risk of serious cardiovascular events, such as heart attack and stroke, according to new research published today in the American Heart Association’s peer-reviewed journal Hypertension.

This finding may warrant starting blood-pressure-lowering treatment including medicines earlier in patients with exaggerated blood pressure response to standing.”


Paolo Palatini, M.D., lead author of the study and professor of internal medicine at the University of Padova in Padova, Italy

Nearly half of Americans and about 40% of people worldwide have high blood pressure, considered to be the world’s leading preventable cause of death. According to the American Heart Association’s 2022 heart disease statistics, people with hypertension in mid-life are five times more likely to have impaired cognitive function and twice as likely to experience reduced executive function, dementia and Alzheimer’s disease.

Typically, systolic (top number) blood pressure falls slightly upon standing up. In this study, researchers assessed whether the opposite response – a significant rise in systolic blood pressure upon standing – is a risk factor for heart attack and other serious cardiovascular events.

The investigators evaluated 1,207 people who were part of the HARVEST study, a prospective study that began in Italy in 1990 and included adults ages 18-45 years old with untreated stage 1 hypertension. Stage 1 hypertension was defined as systolic blood pressure of 140-159 mm Hg and/or diastolic BP 90-100 mm Hg. None had taken blood pressure-lowering medication prior to the study, and all were initially estimated at low risk for major cardiovascular events based on their lifestyle and medical history (no diabetes, renal impairment or other cardiovascular diseases). At enrollment, participants were an average age of 33 years, 72% were men, and all were white.

At enrollment, six blood pressure measurements for each participant were taken in various physical positions, including when lying down and after standing up. The 120 participants with the highest rise (top 10%) in blood pressure upon standing averaged an 11.4 mm Hg increase; all increases in this group were greater than 6.5 mm Hg. The remaining participants averaged a 3.8 mm Hg fall in systolic blood pressure upon standing.

The researchers compared heart disease risk factors, laboratory measures and the occurrence of major cardiovascular events (heart attack, heart-related chest pain, stroke, aneurysm of the aortic artery, clogged peripheral arteries) and chronic kidney disease among participants in the two groups. In some analyses, the development of atrial fibrillation, an arrhythmia that is a major risk factor for stroke, was also noted. Results were adjusted for age, gender, parental history of heart disease, and several lifestyle factors and measurements taken during study enrollment.

During an average 17-year follow-up 105 major cardiovascular events occurred. The most common were heart attack, heart-related chest pain and stroke.

People in the group with top 10% rise in blood pressure:

  • were almost twice as likely as other participants to experience a major cardiovascular event;

  • did not generally have a higher risk profile for cardiovascular events during their initial evaluation (outside of the exaggerated blood pressure response to standing);

  • were more likely to be smokers (32.1% vs. 19.9% in the non-rising group), yet physical activity levels were comparable, and they were not more likely to be overweight or obese, and no more likely to have a family history of cardiovascular events;

  • had more favorable cholesterol levels (lower total cholesterol and higher high-density-lipoprotein cholesterol);

  • had lower systolic blood pressure when lying down than the other group (140.5 mm Hg vs. 146.0 mm Hg, respectively), yet blood pressure measures were higher when taken over 24 hours.

After adjusting for average blood pressure taken over 24 hours, an exaggerated blood pressure response to standing remained an independent predictor of adverse heart events or stroke.

“The results of the study confirmed our initial hypothesis – a pronounced increase in blood pressure from lying to standing could be prognostically important in young people with high blood pressure. We were rather surprised that even a relatively small increase in standing blood pressure (6-7 mm Hg) was predictive of major cardiac events in the long run,” said Palatini.

In a subset of 630 participants who had stress hormones measured from 24-hour urine samples, the epinephrine/creatinine ratio was higher in the people with a rise in standing blood pressure compared to those whose standing blood pressure did not rise (118.4 nmol/mol vs. 77.0 nmol/mol, respectively).

“Epinephrine levels are an estimate of the global effect of stressful stimuli over the 24 hours. This suggests that those with the highest blood pressure when standing may have an increased sympathetic response [the fight-or-flight response] to stressors,” said Palatini. “Overall, this causes an increase in average blood pressure.”

“The findings suggest that blood pressure upon standing should be measured in order to tailor treatment for patients with high blood pressure, and potentially, a more aggressive approach to lifestyle changes and blood-pressure-lowering therapy may be considered for people with an elevated [hyperreactor] blood pressure response to standing,” he said.

Results from this study may not be generalizable to people from other ethnic or racial groups since all study participants reported white race/ethnicity. In addition, there were not enough women in the sample to analyze whether the association between rising standing blood pressure and adverse heart events was different among men and women. Because of the relatively small number of major adverse cardiac events in this sample of young people, the results need to be confirmed in larger studies.

Source:

American Heart Association

Journal reference:

Palatini, P., et al. (2022) Blood Pressure Hyperreactivity to Standing: a Predictor of Adverse Outcome in Young Hypertensive Patients. Hypertension. doi.org/10.1161/HYPERTENSIONAHA121.18579.

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World Water Day events planned for Medicine Hat

World Water Day events planned for Medicine Hat

Photo 27537402 © Ken Backer | Dreamstime.com

By Chris Brown

This Saturday

Mar 16, 2022 | 9:46 AM

MEDICINE HAT, AB – A trio of events on Saturday at Connaught Pond will mark World Water Day in Medicine Hat.

To start the day, South East Alberta Watershed Alliance staff will demonstrate how to propagate plain cottonwood trees, followed by the Grasslands Naturalists showing how to identify native shrubs and trees.

The morning will end with participants picking up garbage from around the pond and at the trailhead of Marlborough Coulee.

The day will also serve as the launch of year two of the Adopt-A-Pond Initiative.

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Clinic marks Health Wagon’s return to larger public events

Clinic marks Health Wagon’s return to larger public events

WISE — Zion Family Ministries’ activity and kitchen spaces were busy on Wednesday as the Health Wagon got back to business with its annual late winter free clinics in Wise and Clintwood.

Health Wagon President and Executive Director Dr. Teresa Tyson said Wednesday’s event marks a pair of shifts for the more than four-decade-old organization that got its start as a small mobile exam van based in Dickenson County.

Wednesday’s clinic was the first of the late winter events since 2019, when COVID-19 forced Health Wagon staff to stop mass events for fear of the disease’s spread, Tyson said.

While the organization continued with smaller community visits and appointments at its Wise and new Clintwood main offices, she said the past two years have been a balance between public safety and continuing to serve a region facing a range of health care challenges.

Tyson said the clinic’s new name — Move Mountains Medical Mission — also marks a rebranding after two decades working with Tennessee-based Remote Area Medical on annual summer free clinics in Wise County. RAM officials in 2019 acknowledged that the Health Wagon had developed a range of partnerships and regional support allowing RAM to support other health care efforts across the U.S.

COVID-19 screening was the first step for patients at Zion Family Ministries on Wednesday, but Tyson said that was not the only stage for dealing with the disease.

“One of the many things we’re doing is giving COVID shots and boosters and flu shots,” Tyson said. “The Coeburn Economic Development Authority gave us $500, and we’re using that to incentivize people to get vaccinated by putting their names in a drawing for cash prizes. That really helps because vaccinations are our best defense against the virus.”

Even though Tyson and her staff felt the pandemic situation had become safe enough to resume mass clinics like Wednesday’s event, the clinic and Thursday’s event in Clintwood were advertised as appointment-only by calls to the Health Wagon’s Wise and Clintwood offices. Tyson said the new system has helped spread out people onsite for health and safety.

While a pre-pandemic clinic would draw 150 to 200 people for services including physical exams, chest X-rays, pap smears, regular vaccinations, ultrasounds, prescription services, Medicare enrollment help and health education, Wednesday’s clinic still saw more than 100 patients.

Local attorney Brett Hall, working as a volunteer runner at Wednesday’s clinic, said he owed it to Move Mountains because Health Wagon medical staff probably saved his life when he contracted COVID-19 a second time despite being vaccinated.

“They were able to give me monoclonal antibodies when I showed symptoms and I was much better the next day,” Hall said.

Dr. Joe Frank Smiddy, who has operated the Health Wagon’s radiology van and provided chest X-ray services for its events, said COVID-19 has added an extra dimension to what had been a longtime focus on helping diagnose the region’s residents with COPD and black lung.

“Before COVID we were dealing with coal workers, COPD and asthma, people with lung fungus and smoking,” said Smiddy. “Immediately, when COVID hit, we knew that some of the COVID patients would have underlying lung disease and we started doing chest X-rays. If we could improve their lung health, they could deal with COVID better if they got it.”

Smiddy said “long COVID” — symptoms that infected patients face after recovering from the disease — pose another challenge for Health Wagon staff and other health care providers. While some long COVID symptoms can be neurological, Smiddy said some symptoms can be treated medically or by exercise and good health practices.

The Health Wagon’s X-ray and lung services can help patients determine if they can return to work or if they may be medically eligible for services such as Medicaid or Social Security disability, Smiddy added.Smiddy and Tyson said that Move Mountains Medical Mission’s partnership with the Virginia Dental Foundation’s Mission of Mercy dental care events in Southwest Virginia will continue. Tyson said the Health Wagon has applied to participate in a summer program where armed forces medical teams practice emergency deployments by offering human medical care and veterinary services for pets. She said the 2019 program was a success, with people coming to get pets treated and vaccinated leading to many getting needed medical care for themselves too.

“We’re excited about what we can do, we’re excited that it’s free health care, and we’re excited that it’s the Health Wagon,” said Smiddy.

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Ask SAM: Are there any shredding events coming up?

Ask SAM: Are there any shredding events coming up?

Mount Tabor United Methodist Church, 3543 Robinhood Road, Winston Salem, will have a shredding event from 9 a.m. to noon April 23. They will accept monetary donations to benefit food programs serving children in Forsyth County and other missions of the United Methodist Women. Make checks payable to Mt. Tabor UMC-Circle 5. For more information, call the church 336-765-5561 or go to www.mttaborumc.org.

New Philadelphia Moravian Church, 4440 Country Club Road, Winston-Salem, will have a document shred from 9 a.m. to noon April 23. The cost is $5 per box. Enter from Kilpatrick Street. They will unload. You do not have to get out of your vehicle. The shredding is sponsored by the Advent Class. Proceeds will benefit outreach ministries of the Moravian Church. For more information, call 336-972-0494 or visit www.newphilly.org.

Fries Memorial Moravian Church, 251 N. Hawthorne Road, Winston Salem, will have a community shred day from 9 a.m. to noon April 30. Shamrock Shredding will be shredding documents on-site in the church parking lot. Donations of $5 per file box or bag are requested. Paper only, no plastic or non-paper trash will be accepted. Proceeds will benefit local youth and family ministries.

Hopewell Moravian Church will have two shredding events at the Griffith Volunteer Fire Department, 5190 Peters Creek Parkway, Winston-Salem. The first will be 10 a.m. to 1 p.m. April 30. The second will be 10 a.m. to 1 p.m. June 25. A $5 per bag or box donation is suggested.