In the Spotlight

By Debra Jaliman, MD

Debra Jaliman, MD, is a world-renowned dermatologist with a private practice on Fifth Avenue in Manhattan and the author of Skin Rules: Trade Secrets from a Top New York Dermatologist. Internationally recognized for her research and work in clinical and cosmetic dermatology, Jaliman is at the forefront of the latest skin care news, clinical updates, emerging trends, and more.

“Out, damned spot” is a familiar line to many as it’s one said by Lady Macbeth. I don’t think she was referring to skin cancer when she said that line. And to think that a spot could kill us at any time. Malignant melanoma is just such a spot. Every hour in the United States someone dies from a malignant melanoma and it’s on the increase. From 1970 to 2009 the incidence of melanoma increased by 800 percent among young women and 400 percent among young men. Although melanoma is rare in children, there are still 300 to 400 new cases diagnosed every year and the number is increasing every year.

In my practice alone we find a few every week. The troubling part is that they are becoming more and more difficult to spot as they are starting to look like abnormal moles or, as I say, a wolf in sheep’s clothing. I have found light brown spots with a pinpoint dark spot inside or a light brown spot with a  slightly irregular edge that ended up being melanoma. Melanoma can be found anywhere but are more common on the legs of women and the backs of men. We have to be even more vigilant.

So what can you do? Wear a broad- spectrum SPF 30 sunscreen every day, even when it’s cloudy. Make certain to apply enough and re-apply after sweating or swimming. Consider wearing sun protective clothing at the beach and UV 400 sunglasses. Avoid the midday sun from 10 am to 4pm. Never use sun lamps or tanning beds. Become familiar with your moles. Do a self-exam at least twice a year.

If a mole changes in size, shape, itches or bleeds have it checked immediately.  A trained dermatologist can look at your skin with magnifiers or can use a specialized camera (MelaFind)  This Monday is May 6 which is Melanoma Monday where there will be skin cancer screenings across the country by board certified dermatologists. This is a free service provided by the American Academy of Dermatology to spread awareness about ways to prevent melanoma and other skin cancers.  If you haven’t already been to the dermatologist this would be a good time to get your yearly skin checkup. It just may just save your life.

By Andrea Boidman

Andrea Boidman is the Executive Director of Hearing Health Foundation (HHF), the leading national non-profit funder of hearing research. Andrea has written articles for publication on the importance of hearing research and prevention of hearing loss. She has also appeared on television and radio advocating for healthy hearing and HHF’s work on a regenerative cure for hearing loss.

As the Executive Director of Hearing Health Foundation, every day I speak with people who are living with a hearing loss. It may surprise you that, on average, people wait seven to 10 years from the time that they notice a hearing problem before they get their hearing tested! This May, Hearing Health Foundation is launching a campaign to encourage people to get their hearing tested—because for people like Rich, treating the hearing loss can help keep you connected to your friends and family.

Rich is a 62-year-old professor who started noticing that he couldn’t understand his wife when she spoke to him from a different room. It became harder to hear his students sitting in the back of a classroom, and he noticed he was missing important parts of phone conversations. “I realized I was relying on context clues to get me through phone calls,” Rich says. He decided to do something about his hearing loss—he wanted to be able to communicate better, but he also wanted to prevent his hearing from worsening.

There are over 50 million Americans with a hearing loss—but most people don’t do anything about their hearing loss. Depression and isolation are common side effects; it becomes easier to stay home than go out, and so people with an untreated hearing loss tend to disengage from their friends and family. Even more shockingly, people with a mild untreated hearing loss are twice as likely to develop dementia—and this risk only goes up with the severity of hearing loss!

How do you know it’s time to get your hearing checked?

• You find yourself asking “what?” more often than you used to, and realize that you are missing parts of conversations or that you respond inappropriately.
• Smiling and nodding becomes your go-to response during a conversation.
• You feel nobody speaks clearly anymore—everyone, it seems, is mumbling!
• Friends and family tell you that your television or radio is too loud.
• When you are in a restaurant or a crowded place, you can’t hear or understand the person across from you because there is too much background noise.
• You are less inclined to go out in public and find yourself turning down invitations to parties and dinners.
• It’s harder to understand women and children.
• It becomes difficult to understand somebody over the telephone.
• You have a persistent ringing or buzzing in your ear.

If you suspect a hearing problem, see a hearing healthcare professional as soon as possible. The sooner your hearing loss is treated, the better chances of preserving the hearing you have. Hearing Health Foundation has resources to find a local professional.

A hearing test will generally take less than an hour. Many people will see an audiologist first, although you may be referred to an ear, nose, and throat specialist to rule out any diseases or disorders of the ear.

At the exam, the first step is a thorough case history, which helps the hearing professional with any insight into the causes of the hearing loss. Next, the provider will look into your ears with a special light called an otoscope. Tests to measure your hearing range may include:

• Pure-tone testing – you may use earphones, and will be asked to indicate (often by raising your hand) in which ear you hear a sound. The results are recorded in an audiogram.
• Speech testing – you will be asked to identify different words, and you will need to certain repeat words
• Tests of the middle ear
• Auditory Brainstem Response (ABR) – electrodes record brain wave activity in response to sound
• Otoacoustic emissions (OAEs) – sound vibrations from the inner ear measured with a small probe inserted into the ear canal.

Results are usually available the same day, so you can discuss with your hearing care provider your type of hearing loss and the recommended treatment.

For some, assisted listening devices are the answer. These include amplified telephones and FM systems that provide a sound feed from a microphone the speaker wears into a receiver that you wear around your neck. For others, hearing aids will make a world of difference, and there is a wealth of options to choose from, from miniature models that sit deep in the ear canal to others that are ideal for active lifestyles, even swimming.

Rich received his hearing aids in February, and has already noticed a great improvement, especially when talking on the telephone. “I was impressed with how discreet some of the models of hearing aids are today. My friends and family ask me all the time if I’m wearing my hearing aids, since they are almost invisible!”

Take Hearing Health Foundation’s Pledge for Hearing Health today, and we’ll help you prepare you for your first visit and find a hearing care professional in your area.

Hearing Health Foundation is the largest private funder of hearing research, with a mission to prevent and cure hearing loss through groundbreaking research. Since 1958 Hearing Health Foundation has given away millions of dollars to hearing and balance research, including work that led to cochlear implant technology. In 2011 Hearing Health Foundation launched the Hearing Restoration Project (HRP), a consortium of scientists working on cell regeneration in the ear. The goal of the Hearing Restoration Project is to find a biologic cure for hearing loss within the next ten years through innovative research surrounding inner ear hair cell regeneration. Visit hhf.org to learn more.

By Margaret I. Cuomo, MD

Did you know that when you wash your face, shampoo your hair, or brush your teeth, you may be  increasing your cancer risk?  It may be the case because personal care products often contain cancer-causing chemicals.

The International Agency for Research on Cancer (IARC) classifies more than 400 chemicals as carcinogens or probable or possible carcinogens. Some of these chemicals are found in food, and many are present in health and beauty products.

Personal care products are divided into “cosmetics,” and “drugs” by federal law. Cosmetics include skin moisturizers, shampoo, hair color, toothpaste, deodorant, makeup, perfumes, lipsticks, and nail polish. The Food and Drug Administration (FDA) regulates drugs, but cosmetics are not subject to FDA approval before reaching the market.

However, personal care products that treat or prevent disease or affect the body’s function are classified as “drugs,” and require FDA approval. These products include acne or dandruff treatments, sunscreen products, antiperspirants, and diaper rash ointments.  Some products, such as antiperspirants or anti-dandruff shampoos are classified as both cosmetics and drugs, and must meet the requirements of both categories.

For too many years, consumers have been exposed to many harmful chemicals in products sold in the United States. For example, formaldehyde, found in hair straighteners, is a known carcinogen according to the International Agency on Research on Cancer (IARC). It is estimated that approximately one-fifth of all cosmetics and personal care products in the United States contain chemicals that decompose and release formaldehyde.

The endocrine-disrupting chemicals (EDC’s), including BPA and parabens, affect our hormones and endocrine systems, and can be passed from mom to baby during pregnancy. These chemicals are ubiquitous, and are found in many personal care products, cosmetics, electronics, and pesticides. BPA is frequently found in plastic bottles containing water and other beverages, the lining of cans containing food, and even cashier receipts. Parabens are EDC’S  that mimic estrogens, and are used in cosmetics, moisturizers, hair care and shaving products.

In February, 2013, the United Nations issued the most comprehensive report on EDC’s to date, highlighting the link between EDC’s and cancers of the breast, prostate and thyroid, non-descended testes in young males, and attention deficit in children.

These chemicals enter our environment through industrial wastes and agricultural run-off, are ingested in food and water, inhaled as gases and particles in the air, and absorbed by skin contact.

The UN report emphasized that known EDC’s are only the “tip of the iceberg.” It noted that more testing is needed to identify other possible endocrine disruptors and their effects on humans.

Should the FDA regulate harmful chemicals? In 2012, the FDA prohibited the use of BPA in baby bottles and children’s drinking cups. If there is enough of a concern to ban of BPA in products used by infants, why not eliminate it in those products used by older children, and adults?

As the stewards of our public health, the FDA and other federal entities should call for the research to determine the safety of these chemicals. The burden of proof should lie with the manufacturers to demonstrate the safety of these chemicals in consumer products.

There are some indications that industry will step forward to protect consumers.

Last August, Johnson & Johnson became the first major consumer products company in the U.S. to commit to removing a variety of harmful chemicals, including formaldehyde, parabens and BPA, from its consumer products by the end of 2015.  Aveeno, Clean and Clear and Neutrogena are all Johnson & Johnson brands that will be included in this bold initiative.

Let’s hope other major companies will follow the good example of Johnson & Johnson.

Congress also has an opportunity to protect consumers from carcinogens. The Safe Chemicals Act would phase out chemicals linked to cancer and reproductive abnormalities and would require new chemicals to be screened before going on the marketplace. It would also require manufacturers to fully disclose ingredients and give FDA the authority to recall dangerous products. Another act to be considered, the Carcinogen-Free Label Act, would allow companies to voluntarily display the “Carcinogen-Free” label on personal care products. As consumers, we should all contact our congressional representatives to demand that this legislation is passed, and we should lobby the companies selling personal care products to take action now.

Being clean and well-groomed should not oblige us to increase our cancer risk.

Margaret I. Cuomo, MD, is the author of A World Without Cancer and a board certified radiologist who served as an attending physician in diagnostic radiology at North Shore University Hospital in Manhasset, New York, for many years. Specializing in body imaging, involving CT, ultrasound, MRI, and interventional procedures, much of her practice was dedicated to the diagnosis of cancer and AIDS. She is the daughter of former New York Governor Mario Cuomo and Mrs. Matilda Cuomo, and sister to Governor Andrew Cuomo and CNN’s Chris Cuomo, and wife of Howard S. Maier. She resides in New York.

By Amy Nadel

Amy Nadel is the executive director of partnerships at Medscape. She is also the proud mother of two “zebra” young adults. Her 26-year-old daughter has glycogen storage disease type 1A (Von Gierke disease) and ankylosing spondylitis (a type of spinal arthritis) and other issues related to those diseases. Her 21-year-old son is a special-needs young adult.

Both children are living their lives to the fullest, more independently than was ever thought possible. She is so proud of them that she is almost without words.

If you’ve watched Grey’s Anatomy, Private Practice, House, Chicago Hope, ER or even St. Elsewhere, you have probably heard the phrase drilled into the heads of medical students that “when you hear hoofbeats, think HORSE, not zebra.” To a doctor, this means look for the obvious diagnosis, not the rare one. But sometimes it IS a zebra, not a horse. My daughter is a zebra, several times over, and that makes me a “zebra mom.”

When my daughter was diagnosed with a rare genetic condition, the prognosis was not good. I couldn’t believe what I was hearing: My baby had an incurable disease, and her life expectancy was only 5 to10 years. 

But here we are 26 years later. We have spent much time in the hospital over the years. We have learned to live with a zebra life, which in no way resembles the lives of families with “normal” children. Those of you who are in the zebra world know exactly what I mean: Nothing is what you would expect. Everything is a complication, a potential complication, or a crisis. The details differ from disease to disease, condition to condition, but one thing remains the same: There is no “normal” day for us. 

We are all working so hard to help our kids survive another day, week, month, year. Which means we have to find the best doctors, the best medical care, raise money for research, and try to network with the other parents who have kids with the same disease.

But then there is our real job: helping our children be “more than a disease” to themselves and to the outside world, and standing between the people who may say ignorant/cruel/uninformed things. (“Oh, really, she’s 8 years old? My 3-year-old looks older. Are you sure?”) Sometimes even a doctor at a hospital can forget there is a person attached to the disease. (“Hey, everyone come in and see this really BIG LIVER.”)

We have to try to shield them and, at the same time, empower them as much as we can to have as full a life experience as possible. This is where it gets REALLY weird for zebra parents.

We never thought we’d have to deal with our kids surviving long enough to grow up and take on the responsibilities of their complex conditions on their own.

Those of us who have loved ones with a rare disease feel we live in a very exciting time with new treatments, research, and novel approaches for genetic disorders. We see progress in rare diseases overall. But each disease has its own challenges and restrictions, so we are all very aware of the ticking clocks in our own lives.

Some of our children have survived well beyond the predicted “expiration date” we were given, which means that new health issues are likely to arise at any moment as our children get older. So this is the part where I talk about how lucky we are that they are living in this uncharted territory. But it is challenging for them and for us.

I’m now part of my child’s medical team by invitation only (her invitation). It is her time to take control and be the driver of her own care and treatment. Guess who’s having trouble with that? 

But no matter how upsetting and scary we find the never-ending onslaught of new medical problems that require yet another specialist/medication/procedure, the alternative is so much worse. We are so grateful to have her and watch her live her life as fully as possible, pulling that heavy wagon full of more and more rocks along with her. Frankly, that is “her normal.”

So here’s the reality: Rare-disease patients are not so rare anymore because people are living longer with their diseases.

Rare diseases touch all of our lives, and it is our collective responsibility to fight for more funding for research, to commit ourselves to patient registries, and above all, to encourage our children to live as normal lives as possible. That’s the job of the parent ultimately, and for parents like us it’s always a part of our lives because every day is a rare disease day.

More information:

The National Organization for Rare Disorders helps people with “orphan” diseases and assists the organizations that serve them. NORD is committed to the identification, treatment, and cure of rare disorders through programs of education, advocacy, research, and service.  This organization can help you get connected to the patient/parent organization for your disease.

Watch Priya Kishnani, MD, of Duke University Medical Center talk about children with rare diseases on Medscape.

By Margaret I. Cuomo, MD

February is Cancer Prevention Month, giving us a new opportunity to focus attention on the most effective way to reduce our cancer risk.

While we struggle as adults to avoid the cancer causing agents in our daily lives, America’s young people are particularly vulnerable.

Our children are our future, and we have a unique opportunity to positively impact our children’s lives during their development. In fact, children who have been taught that a healthy diet and regular exercise can decrease cancer risk can be the role models and teachers for their parents.

Obesity is an epidemic in the United States, involving 17% of young people ages 2-19 and more than 30% of adults. Obesity is a risk factor for cancer, as well as heart disease and diabetes. We should teach children to read labels and recognize that processed foods containing difficult-to-pronounce ingredients should probably be avoided. Likewise, children can learn to avoid harmful chemicals in personal care products such as shampoo, body wash, and toothpaste.

What about our nation’s college students? Franchises for popular fast food chains are abundant on college campuses, in addition to soda and processed snacks. The prevalence rate of obesity among college students has doubled over the past 15 years. Tobacco and alcohol are also widespread – both of which increase cancer risk.

We need a commitment on the part of our nation’s schools, from elementary school through college, to provide the education and resources our children need to lead healthier lives.

Let’s get serious about preventing cancer. Whether we are adults or children, members of the media or medical community, government, industry or cancer advocacy group, we can all contribute to a world without cancer.

Margaret I. Cuomo, MD, is the author of A World Without Cancer and a board certified radiologist who served as an attending physician in diagnostic radiology at North Shore University Hospital in Manhasset, New York, for many years. Specializing in body imaging, involving CT, ultrasound, MRI, and interventional procedures, much of her practice was dedicated to the diagnosis of cancer and AIDS. She is the daughter of former New York Governor Mario Cuomo and Mrs. Matilda Cuomo, and sister to Governor Andrew Cuomo and CNN’s Chris Cuomo, and wife of Howard S. Maier. She resides in New York.

By Margaret I. Cuomo, MD

What can we do to reduce our risk of getting cancer? WebMD asked Margaret I. Cuomo, MD, author of A World Without Cancer, to share some insights with us on this topic. Cuomo is a board certified radiologist who served as an attending physician in diagnostic radiology at North Shore University Hospital in Manhasset, New York, for many years. Specializing in body imaging, involving CT, ultrasound, MRI, and interventional procedures, much of her practice was dedicated to the diagnosis of cancer and AIDS. She is the daughter of former New York Governor Mario Cuomo and Mrs. Matilda Cuomo, and sister to Governor Andrew Cuomo and CNN’s Chris Cuomo, and wife of Howard S. Maier. She resides in New York.

What is the one most important step people can take to reduce cancer risk?

Maintain a healthy weight.

Obesity is a national epidemic, and is a risk factor for cancer, as well as heart disease and diabetes. A study published in the New England Journal of Medicine reported higher death rates from at least 14 different kinds of cancer among overweight populations, and noted that the heaviest people were 50 percent more likely to die from cancer than people of normal weight.

What are some of the most troublesome chemicals we are exposed to that may cause cancer?

At least 80,000 chemicals are manufactured in the United States, and we are exposed to many of them on a daily basis. We know with alarming certainty that some of them cause cancer. In fact, the International Agency for Research on Cancer states flatly that 100 agents in use today are “carcinogenic to humans,” and several hundred others are “probably” or “possibly” carcinogenic to humans. Yet, most of them remain unexamined and unregulated.

There are three chemicals in our daily lives that are of particular concern: Bisphenol A (BPA), perchloroethylene and parabens.

• BPA has been associated with breast and prostate cancer in mice, and an increased risk of miscarriage and polycystic ovary disease in humans. BPA is ubiquitous in consumer products, from plastic bottles containing water and other beverages, to canned food to cashier receipts. To reduce BPA exposure, avoid plastics with a 3 or 7 recycle code on the bottom, or look for products labeled “BPA-free”.. In 2012, the FDA banned BPA from baby bottles and children’s drinking cups.

• Perchloroethylene, or “perc,”, a chemical used in dry-cleaning, has been called a “likely human carcinogen” by the Environmental Protection Agency, or EPA. Workers in the dry cleaning industry have a higher incidence of several cancers, including non-Hodgkin lymphoma, multiple myeloma and bladder cancer. The Natural Resources Defense Council advises that consumers seek out alternate methods of dry-cleaning.

• Parabens are chemicals that mimic estrogens, and have been found within breast tumors. Parabens are found in moisturizers, hair care products, shaving products, processed meats, snacks, candy, and some liquid dietary supplements. The FDA has not banned parabens from consumer products, but says that it will consider new research as it becomes available. I recommend that you avoid ingredients with the word “paraben” in them, such as methylparaben.

Can vitamins and supplements help prevent cancer?

Research on taking multivitamins for cancer prevention has shown some promise in recent studies, and taking a daily multivitamin makes good sense for both men and women.

In October, 2012, an article published in the Journal of the American Medical Association reported that daily use of a common multivitamin reduced the risk for cancer in a long-term study of about 15,000 male doctors. Those men taking the daily multivitamin had an 8% reduction in risk of developing cancer compared with those taking a placebo. The multivitamin use had no effect on the incidence of prostate cancer among the men studied, however. In addition, this study did not include men younger than 50 years old, nor women.

The vitamin with the best evidence for cancer prevention is vitamin D. Everyone, including children and adults, should have their vitamin D blood levels measured and then supplements should be discussed with their doctors. Many vitamin D experts internationally recommend a vitamin D blood level between 40 and 60 ng/ml, or 100 and 150 nmol/l, for cancer prevention. The daily dose of vitamin D supplementation will depend on each person’s blood level.

The most important way to get vitamins is through your diet. In A World Without Cancer, I explain that most experts recommend a plant-based diet, rich in vegetables, fruits, beans, and whole-grains as the best way to reduce cancer risk.

It’s also important to follow other cancer-preventing measures including exercising, ending smoking, limiting alcohol, and protecting our skin from the sun.

By Jamie Gentille

Jamie Gentille earned a BS in Biobehavioral Health from Penn State University, a Masters in Public Health from Walden University, and completed her child life internship at Children’s Hospital at Dartmouth. She lives in Northern Virginia with her husband of six years and works as Director of Child Life Services. Jamie has been living with HIV for 30 years and is an experienced public speaker on the topic. She is currently penning a memoir about her life as an HIV advocate and survivor.

Relationships aren’t easy. Anyone who has ever listened to a Taylor Swift song knows that. Even on the best of days, meeting new people is complicated. Throw a chronic disease into the mix, and it can be downright nerve-wracking. I spent much of my adolescence and young adulthood trying to figure out how to navigate the social scene, while secretly being HIV positive.

I was born with a serious cardiac defect called Tetrology of Fallot, and underwent open-heart surgery at age three to repair it. During this surgery, I received a blood transfusion that was unknowingly infected with HIV. We didn’t find out that I was infected until years later, when I was eight. At that time, it was a death sentence. Doctors gave me two years to live, and my family prepared for the worst. Thankfully, phase I drug protocols came to my rescue and I was able to begin an HIV medication regimen at age ten. These medications have kept me amazingly healthy and allowed me to grow into the thriving thirty-three year old that I am today.

When I was a kid, no one ever thought that I would live long enough to have to worry about dating, and what to tell people. But lo and behold, I was surviving, entering college, and facing the dating scene. Now what do I do?

While I had a million “what ifs” floating in my head, of one thing I was certain: I needed to be up front with people before it got too physical. I had to have “the talk” before I had “the sex.” I also knew that I had to tell prospective dating partners before we got too attached. Let’s face it — this kind of news could send someone running for the hills, and I didn’t want to be already in love with that guy who was running in the other direction.

One thing that I’ve learned is that there was never a perfect moment to tell someone that I was HIV positive. It’s not the kind of subject matter that I could slip in somewhere between political beliefs and favorite movies. So I just had to bite the bullet and put it out there. It was a leap I had to take early on, because it haunted me until I could get it out.

After the “there’s something I need to tell you” conversation, came the waiting game. For a brief moment, I was in charge – in charge of telling my story, answering questions, setting the facts straight. But when that was over, I had to let go, and let him react. This was where the paranoia set in. Is he going to freak out? Is he going to tell our friends? Is he going to shun me? Only time would tell, and this emotional purgatory was torture.

What I discovered was that most guys took it surprisingly well. After processing it, all but one guy decided that they could deal with it. It was heartbreaking to see this guy walk away after admitting that he couldn’t deal, but I didn’t hold it against him. I wasn’t in his shoes, and it would do no one any good to judge him for his decision.

While having a chronic condition like HIV presents many challenges, it also offers silver linings where you least expect them. These nerve-wracking conversations, for example, were fantastic litmus tests for a relationship. When I just knew that a guy would not be able to handle this kind of information and I was able to make a graceful “it’s not you, it’s me” kind of exit, without wasting too much of our time.  On the flip side, when a relationship did pass this test, it was that much stronger, and the feeling of relief is intoxicating.

When I told my now-husband, Paul, seven years ago that I was HIV positive, I knew he was a keeper and that I would never have to have this conversation again. He took it in stride and knew that it was something that we could deal with together. And we’ve been doing that ever since.

What got me through the tough stuff and to my happy ending was the support of my loving family and friends. It also required a very conscious effort to realize that I am not flawed or broken. There is nothing wrong with who I am. I am someone living with a chronic illness. Yes, my life is different, but different works

By: Michael W. Smith, MD

When I first read that question, I had to think about it a bit.

In a new survey, almost 70% of people around the world said they’d rather lose a limb or give up 10 years of their life rather than lose their eyesight. I think I agree. This question, among others, was asked to over 11,000 people across 11 countries in a survey performed by eye care company Bausch + Lomb.

Of course, the thought of losing a limb or eyesight is almost unbearable to those of us who don’t currently face those daily struggles. Having to choose sounds like the latest version of a Saw movie. But here’s how I decided.

If I lost a limb, there are medical treatments – prosthetics — that can help me become mobile again. I’d unlikely be able to move quite the same, but I could, at a minimum, get some function back. But there’s no prosthetic eye that gives you your vision back (unless you’re the Bionic Man, for those of us who can remember back that far). Maybe not a deep, thoughtful reason, but there you go.

So if our vision is so important to us, why do we ignore our eye health? In the survey only 21% had an eye exam in the last 5 years. I like to think many of us have become much more aware of our health in recent years, but that doesn’t seem to apply to our eyes. In the survey less than one third said they do what they should to preserve their eye sight. That includes getting regular eye exams, eating right to protect your vision, keeping a healthy weight, and wearing sunglasses to block damaging UV rays.

Here are two great reasons to get your eyes checked. First, your eye doctor can find vision problems early before they affect your vision and can often stop them in their tracks. In fact, most vision loss is preventable if found early.

Second, heard the saying that your eyes are the window to your soul? I’m not philosophically inclined enough to speak to that. But your eyes are definitely the window to your health – and not just your eye health. Your eye doctor can find certain conditions, such as diabetes, high cholesterol, and high blood pressure, years before you develop symptoms (actually, these conditions often don’t have any symptoms until a lot of damage is already done).

By keeping this in mind, hopefully none of us will ever have to face such a serious question about our eyesight.

On June 26, FRONTLINE (PBS) aired an investigation about the nation’s dental care system. WebMD readers were invited to view the show and join a chat with the reporters on the story the following day.  Below is a transcript of the Q&A.

Watch Dollars and Dentists on PBS. See more from FRONTLINE.

Dental care can be a matter of life and death. Yet millions of Americans can’t afford a visit to the dentist, resulting in preventable diseases, bankruptcy, and sometimes even death.

Why is dental care out of reach for so many?

In the new film “Dollars and Dentists,” FRONTLINE and the Center for Public Integrity reveal the shocking consequences of a ruptured dental care system, and explore some solutions to fix it.

Poor children are especially at risk — most dentists won’t see children on medicaid because there’s no profit margin. One in four children have untreated tooth decay, now the most common chronic illness among school-aged children.

Correspondent Miles O’Brien investigates how privately backed pediatric dental chains are popping up to treat these kids at Medicaid rates. But there’s suspicion some of these chains could be taking advantage of their young patients.

For adults with dental disease, the situation can be as dire — and bankrupting. While millions of Americans use emergency rooms for dental care, at a cost of more than half a billion dollars, corporate dental chains are filling the gaps in care, in some cases allegedly overcharging patients or loading them with high priced credit card debt.

On June 27, reporters Miles O’Brien, David Heath, and Jill Rosenbaum took your questions about  “Dollars and Dentists” and American’s dental care crisis during a live chat.

You can read the chat transcript below.

Joseph Nowinski, PhD is the coauthor of Almost Alcoholic: Is My (or My Loved One’s) Drinking a Problem? (Hazelden, April 2012). Dr. Nowinski is a clinical psychologist who is currently Supervising Psychologist at the University of Connecticut Health Center, in addition to running his own private practice in Tolland, CT. He is internationally recognized for his work in substance abuse treatment. He has a private practice in Tolland, Connecticut. Learn more at http://www.thealmosteffect.com/.

Think about these scenarios:

• A father who falls asleep on the couch after having several drinks three or four days a week, thereby missing out on time with his kids and wife.
• A sales executive who likes to “sip” scotch on the rocks from the time he finishes his dinner to the time he goes to bed.
• A college student who repeatedly has trouble making it to class because he was drunk the night before.
• A mother who looks forward to her daily double glass of wine to help her get through the day.
• An assisted living resident who finds that two or three brandies every day helps to relieve her boredom.

What do all of the above people have in common? They are almost alcoholics. And there are many more almost alcoholics like them than there are true alcoholics in the world.

A New Look at an Old Problem

For many years health care professionals like myself have been accustomed to thinking about drinking in terms of just two diagnostic categories: alcohol abuse and alcohol dependence. In order to qualify for one of these diagnoses an individual has to suffer some fairly severe and obvious consequences directly related to drinking: a major health crisis, an arrest, loss of a job, etc. And to be diagnosed as alcohol dependent a person also has to experience physical symptoms of withdrawal if he or she stops drinking.

But what about all those men and women whose drinking does not qualify them for a diagnosis? Until now, because of this black-and-white way we’ve looked at drinking (either you’re an alcoholic, or you’re not), we’ve essentially considered all these people “normal.” But is that accurate? Might there be people who are suffering consequences because of their drinking, even though they are not alcoholics? The answer, in my opinion, is a resounding yes.

Could You (or a Loved One) be an Almost Alcoholic?

Rather than thinking in terms of just three categories (Normal, Alcohol Abuse, Alcoholism), it is probably more productive to look at drinking in terms of a spectrum like that depicted below:

I believe this illustration more accurately reflects the real “drinking world.” What it suggests is that an individual’s drinking can range anywhere from normal social drinking at one end of the spectrum, to almost alcoholic in the mid-range, to alcohol abuse or dependence. Moreover, these different areas are not separated by sharp lines; rather, they blend into one another. Of the three “problem” zones, the almost alcoholic zone is by far the largest.

Normal social drinking is the person who has a beer or two, or a glass of wine or two, not more than a few times a month, and almost always in a social context. This is the man or woman who meets friends for happy hour after work on Friday, who joins friends to watch a game on television, or who is invited to a party. Millions of people are normal social drinkers, and many of them never go on to be more than normal social drinkers.

As the illustration suggests, there is a large “gray area” that lies beyond normal social drinking but falls short of alcohol abuse and dependence. Many people slip into this gray zone. Some go only a short distance; others venture much deeper over time and may stay there, yet still are not alcoholics. Many men and women whose drinking patterns lie in the almost alcoholic zone are likely to be suffering, though, as are their loved ones. For example, they may be experiencing one or more of the following:

• Trouble sleeping soundly
• Mild depression
• Marital or family conflict
• Health problems that aren’t  recognized as related to drinking
• Declining performance at work

Connecting the Dots

One thing that has become very clear—and a major motivation for writing the book—is that most almost alcoholics (as well as health care professionals) often fail to see the link between drinking and any problems these people may complain of.  Being able to “connect the dots” and see the relationship between drinking and such problems allows the almost alcoholic to make a decision: to remain in the almost alcoholic zone (and risk venturing further toward alcoholism), or to choose to move back toward normal social drinking.