The development of atherosclerosis, or hardening of the arteries, is a process that begins early in life and can culminate decades later in clinical events such as heart attack, coronary artery revascularization (stents and bypass surgery) and stroke. Much basic science and clinical work has been done to understand this process in an effort to identify clinical interventions that can prevent or slow this systemic process.

More than a century ago, early investigators identified both inflammatory cells (part of the immune system) and fatty cholesterol deposits in the inner lining of arteries with established atherosclerotic disease. In terms of these two pathological pathways, our early efforts in atherosclerotic cardiovascular disease prevention focused primarily on reducing the accumulation of lipids in the arterial wall through interventions that lower LDL (bad) cholesterol (dietary change or medication use). 

Since those initial observations, numerous scientific studies led to the notion that atherosclerosis develops following an injury to or dysfunction of the lining of the arterial wall (called the endothelium) that stimulates the immune system causing an inflammatory response to promote repair of the injured artery wall lining. In 1999, a pathologist named Russell Ross published a landmark paper that formally characterized atherosclerosis as an inflammatory disease which starts with endothelial dysfunction that then leads to various degrees of inflammatory response (N Engl J Med. 1999; 340:115–126). Causes of endothelial dysfunction include high levels of LDL cholesterol, cigarette smoking, hypertension and diabetes which later also became clinical targets for primary and secondary prevention of atherosclerotic cardiovascular disease.

In 2002, experts in the field of atherosclerosis convened to discuss markers of inflammation that could be measured during a routine clinical examination to identify individuals at high risk for developing heart disease or stroke (Circulation. 2003;107:499-511.). These blood test markers included high-sensitivity C-reactive protein (hs-CRP), white blood cell (CBC) count and fibrinogen (a precursor to fibrin, the main structural protein of blood clots, that also is an acute phase reactant that can increase dramatically during bouts of inflammation or infection).

Ultimately, hsCRP was identified as a risk marker that could be routinely measured in the blood and was independently associated with the development of cardiovascular events, joining the list of cardiovascular disease risk factors such as cholesterol, smoking, body mass index, diabetes, hypertension, exercise level and family history of premature heart disease. Kenneth H. Cooper, MD, MPH, Founder and Chairman of Cooper Aerobics shares “more than 20 years ago, measuring hsCRP became part of the annual examination at Cooper Clinic in 2004.”

With the use of the hsCRP blood test, researchers were able to quantitatively identify the relationship between inflammation and the risk of experiencing a cardiovascular disease event. In general, levels of hsCRP <1, 1 to 3, and >3 mg/L connote lower, moderate and higher relative cardiovascular risk, respectively, when interpreted in the context of other traditional cardiovascular risk factors. Importantly, hsCRP levels ≥ 2.0 mg/dL (associated with moderate cardiovascular risk) may be present in as any many of 50% of U.S. adults (Journal of the American College of Cardiology Volume 54, Issue 25,  2009, Pages 2388-2395).

Based on this wealth of clinical data, the role of chronic inflammation has now taken center stage in the settings of both primary and secondary prevention of atherosclerotic cardiovascular disease. In 2025, the American College of Cardiology released a scientific statement summarizing these clinical advances and provided a table of consensus recommendations. For individuals without a history of cardiovascular disease (primary prevention group), these experts recommend at least one measurement of hsCRP to assess cardiovascular risk. If it is high, the importance of a healthy diet, regular exercise, cigarette cessation and obtaining/maintaining a healthy weight (all of which have been shown to reduce hsCRP) cannot be over-emphasized. Anti-inflammatory dietary patterns include the Mediterranean diet and the DASH diet. Recommendations for regular physical activity are at least 150 minutes per week of moderate intensity exercise or 75 minutes per week of high intensity exercise. Consideration also ought to be given to treating high LDL cholesterol with statin medication in the setting of a high hsCRP.

For individuals who have already been diagnosed with cardiovascular disease, the presence of an elevated hsCRP may impact treatment recommendations regarding LDL treatment targets (lower in the setting of inflammation). Some clinical trial data suggest the use of other therapies (such as low dose colchicine) specifically focused on reducing inflammation may also be associated with risk reduction in patients with established heart disease.  

The scientific story regarding the link between inflammation and atherosclerotic cardiovascular disease is far from complete. Many evidence gaps remain. Many questions remain to be answered through scientific research including interactions among inflammation, genetics and environmental factors as well as improved health habits and drug prescriptions for cardiovascular disease prevention.

Cooper Clinic’s annual preventive exam includes hsCRP testing as part of the standard blood work. To learn more about Cooper Clinic preventive exams and how an annual exam can help you manage and improve your health, visit cooper-clinic.com or call 866.906.2667.

Article provided by Kenneth H. Cooper, MD, MPH, Founder and Chairman of Cooper Aerobics, and Nina B. Radford, MD, FACC, Cardiologist at Cooper Clinic.

Drumroll please…In 2025, the publication of an updated Hypertension guideline was eagerly welcomed by health care providers across a wide range of medical specialties. This long-awaited collaboration of more than a dozen clinical organizations replaces the 2017 guidelines and addresses Prevention, Detection, Evaluation and Management of High Blood Pressure in Adults. The document reminds us about fundamental risks associated with hypertension, provides clarity about hypertension treatment goals and introduces a few new concepts.

First and foremost, hypertension affects heart and brain health. It is the most prevalent and modifiable risk factor for the development of cardiovascular disease. This umbrella term includes:

• Coronary heart disease: heart attacks, stents and bypass
• Heart failure
• Atrial fibrillation
• Stroke
• Dementia
• Chronic kidney disease
• All-cause mortality

Blood Pressure Basics

Blood pressure readings have two values. The top number is the systolic blood pressure (SBP) and the bottom number is the diastolic blood pressure (DBP).

Data from a large survey of U.S. adults administered between 2017 to 2020 showed that overall, almost 50% of adults had blood pressure > 130/80 mmHg or were taking medications to treat high blood pressure. Although the diagnosis of hypertension is often associated with older age, it is common in younger age groups as well. I was surprised to read that in the 18-29 age group, 20% of men and 9% of women had hypertension.

Diagnosing Hypertension

Making the diagnosis of hypertension is not as easy as you may think. Multiple measurements of blood pressure are often required in the clinical office setting and at home. Furthermore, many factors impact accurate measurement of blood pressure including: 

• Use of appropriate equipment: appropriately sized arm cuff
• Patient characteristics: no caffeine, exercise and smoking for 30 minutes before the measurement; no talking to office staff or scrolling on the phone
• Patient positioning: sitting, feet on the floor, back supported, arm supported at the level of the heart
• Measurement protocol: at least two measurements taken one minute a part on the same arm

Also, because a person’s blood pressure can vary, an office blood pressure measurement is ideally taken twice on two separate occasions during a clinic visit.

If a diagnosis of hypertension is suspected or treatment of hypertension is initiated, home monitoring of blood pressure is a valuable tool for your health care provider. When choosing a home blood pressure monitor, it is important that the device has been validated for accuracy (validatebp.org) and that the cuff size is appropriate for the size of the arm. Measuring your blood pressure with a cuff that is too small for your arm will often result in over-estimation of blood pressure and may lead to a false diagnosis of hypertension.

The American Heart Association website has excellent resources about home blood pressure monitoring including helpful video tutorials. Visit the Home Blood Pressure Monitoring web page.

Watch Cooper Clinic Exercise Physiologists Cristen Dicken and Ashton Gray share how to properly take an at-home blood pressure test.

Modifiable Risk Factors

Hypertension results from multiple factors including:

• Individual clinical risk factors such as overweight, obesity and obstructive sleep apnea
• Frequent use of medications such as decongestants or NSAIDs (nonsteroidal anti-inflammatory drugs)
• Genetic predisposition
• Health habits such as sedentary lifestyle or poor diet and chronic stress

Thus, a cornerstone of hypertension management is improvement in any modifiable risk factors for hypertension:

• Maintaining or achieving a healthy weight
• Following a heart healthy eating pattern by reducing sodium intake and increasing dietary potassium intake
• Adopting a moderate physical activity program
• Reducing or eliminating alcohol intake
• Managing stress

These updated guidelines add important information about the impact of stress on prevention and management of hypertension. Stress reduction through meditation, breathing control techniques or yoga may be reasonable to prevent or treat elevated blood pressure and hypertension, as an adjunct to changes in other health habits or medication treatment.

Medical Treatment of Hypertension

For all individuals with an average blood pressure ≥ 140/90 mmHg, in addition to making any necessary modifications detailed above, treatment with hypertension medication is recommended.

For high-risk individuals with a personal history of clinical cardiovascular disease, previous stroke, diabetes or chronic kidney disease, and an average blood pressure ≥ 130/80 mmHg, in addition to making any necessary modifications detailed above, treatment with hypertension medication is recommended.

For low-risk individuals (without a personal history of the high-risk conditions listed above) and an average blood pressure ≥ 130/80 mmHg, it is reasonable to focus on modifiable risk factors for hypertension for 3-6 months prior to initiating hypertension medication. The impact of changes in weight, diet and physical activity can add up and may eliminate the need for hypertension medication altogether:

• Consume a diet rich in fruits, vegetables, whole grains and low-fat dairy products
• Reduce content of saturated and total fat
• Reduce body weight by ≥ 5%
• Limit sodium intake to < 2,300 mg/day
• Engage in aerobic exercise for 90-150 minutes per week
• Engage in meditation or device guided breathing control to slow respiration

What many patients may not know is individuals who are diagnosed with hypertension and well treated on medication with average blood pressure levels <120/80 mmHg still have twice the risk for developing cardiovascular disease compared to individuals without hypertension who have average blood pressure levels <120/80 mmHg naturally. Thus, prevention of hypertension is critical!

To schedule a comprehensive preventive exam at Cooper Clinic, visit cooper-clinic.com or call 866.906.2667.

Article provided by Nina B. Radford, MD, FACC, Cardiologist at Cooper Clinic.

There are a number of reasons to see a dermatologist at Cooper Clinic. You may have specific reasons such as acne, acne scarring, melasma, eczema or skin cancer. You may have concerns about a suspicious mole or growth. You may want to reduce signs of wrinkles and age spots. Or you may want to schedule an appointment to get a skin cancer exam. A visual, whole-body examination should be performed once a year. “Visiting the dermatologist for the first time can feel a bit daunting, especially if you’re not sure what to expect. Helen Kaporis, DO, FAAD, Preventive and Cosmetic Dermatologist at Cooper Clinic, shares tips on what to expect.

“The skin is the largest organ in your body,” says Dr. Kaporis. “It is constantly changing, so getting a baseline check is important.”

Prepare for Your Visit

“You can make the most of your dermatologist appointment by being prepared,” said Dr. Kaporis.

Here are some important steps:

• Dress for the Appointment
  Wear comfortable clothing that is easy to remove. Dermatologists often require a full-body skin examination, which means you will need to change into a gown. Loose-fitting clothes can make this process smoother and more comfortable.

• Make a List of Medications
  Compile a comprehensive list of the medications you are currently taking, including prescription drugs, over-the-counter medications, supplements and vitamins. Some medications can affect your skin and it’s important for your dermatologist to have this information to avoid any potential interactions or side effects.
  
  “Be sure to bring a list of all medications and supplements you are taking,” says Dr. Kaporis, “and show up free of jewelry, hair bands, hair clips and nail polish and remove any makeup so your dermatologist can have an unobstructed view of your skin.

• Note Any Blemishes or Concerns
  Before your appointment, take the time to examine your skin and make note of any spots, moles, rashes or other blemishes that concern you. This will ensure you don’t forget to mention anything during your consultation. It can be helpful to write them down, take photos on your phone or circle them on your body to show your dermatologist.

Past Medical History

Your medical history, including that of your blood relatives, is crucial information for your dermatologist. Many skin conditions have genetic components, so knowing your family’s medical history can provide valuable insights.

• Personal Medical History
  Be prepared to discuss your own medical history in detail. This includes any past skin conditions or treatments, allergic reactions, surgeries and general health issues. Conditions such as diabetes or autoimmune diseases can influence skin health.

• Family Medical History
  Your dermatologist will also want to know about your family’s medical history, particularly any history of skin cancer or other skin conditions. This information can help in assessing your risk factors and tailoring your treatment plan.

Full-body Exam

A full-body skin examination is a thorough check of your skin from head to toe. This examination is essential for detecting skin conditions at an early stage. In particular, the exam is an important part of skin cancer screening.

• Importance of the Exam
  Early detection of skin cancer significantly increases the chances of successful treatment. Regular full-body exams can identify issues before they become serious. Even if you feel healthy, these exams are crucial as some skin cancers can develop without noticeable symptoms.

• What to Expect
  During a full-body exam, you will change into a gown and the dermatologist will systematically examine your skin. They will look for any unusual moles, spots or lesions. If they find anything suspicious, they may take a closer look using a special magnifying tool called a dermatoscope.
  
  “Expect to dress down to your underwear and put on a gown so your dermatologist can check you from head to toe,” Dr. Kaporis says. “Some dermatologists are faster and some are slower with their skin checks, but what is important is thoroughness. They may use a dermatoscope to better observe certain lesions. Remember, your dermatologist is there to help you with all your skin concerns, even ones you don’t know about yet.”

Discuss Your Concerns and Treatment Options

Open communication with your dermatologist is vital. Don’t hesitate to bring up any skin issues that concern you, no matter how minor they may seem.

• Common Concerns
  Some common concerns people discuss with their dermatologist include acne, eczema and signs of aging. Each condition has various treatment options, from topical creams to advanced therapies. Your concerns can be either health-related or specific to cosmetic treatments.

• Treatment Options
  Depending on your condition, your dermatologist may suggest treatments such as prescription medications, lifestyle changes or procedures such as cryotherapy or laser treatments. Ask about the pros and cons of each treatment option to make an informed decision.

Skin Care Consultation

One of the key benefits of visiting a dermatologist is receiving professional advice on how to take better care of your skin.

• Personalized Skin Care Routine
  Your dermatologist can help you develop a personalized skin care routine, tailored to your skin type and any specific conditions you have. This might include recommendations for cleansers, moisturizers, sunscreens and other skin care products.

• Tips for Healthy Skin
  In addition to product recommendations, your dermatologist can offer tips on lifestyle changes that promote healthy skin, such as staying hydrated, eating a balanced diet and protecting your skin from the sun. Your dermatologist may also recommend specific skin care products to improve your skin’s health.

Benefits of Visiting the Dermatologist

Regular visits to the dermatologist offer numerous benefits, from early detection of skin issues to personalized skin care advice.

• Peace of Mind
  Knowing a board-certified dermatologist has thoroughly examined your skin and that any concerns are addressed can provide significant peace of mind. This is especially true for individuals with a family history of skin cancer or other serious skin conditions.

• Early Detection and Treatment
  Dermatologists are trained to spot signs of skin cancer and other conditions early, which is critical for effective treatment. Early intervention can prevent minor issues from becoming serious health problems.

• Expert Advice
  Dermatologists can provide expert advice on a wide range of skin issues, from managing chronic conditions such as acne and psoriasis to improving the overall health and appearance of your skin.

See Our Dermatologists

Regular check-ups can lead to early detection of potential issues, personalized treatment plans and valuable skin care advice, contributing to your overall well-being and peace of mind.

Did you know the Cooper Clinic dermatology team sees patients both through direct appointments and as part of our comprehensive physical exams?

Cooper Clinic Dermatology— cooperclinicdermatology.com | 972.367.6000

Cooper Clinic Preventive Exam— cooper-clinic.com | 972.560.2667

One in eight women will be diagnosed with breast cancer at some point in their lives. Hearing the words, “you have cancer,” can be shocking, frightening and emotional. Just ask Cooper Clinic radiologist and breast imaging subspecialist R. Vance Dell, MD, MBA, MHCM, FACR, whose wife was diagnosed with breast cancer more than two decades ago.

“Her doctor called me in and said, ‘Vance, I’ve never seen a faster growing cancer,’” says Dell. “I was scared to death.” 

It was that diagnosis that led Dell to specialize in breast cancer mammography, a career he’s poured his heart into ever since. Here, he discusses when women should begin undergoing annual mammograms and how 3D mammography can help with early detection and diagnosis.

When to Get Screened 

When should women start having annual mammograms? 

“The rule Cooper Clinic recommends and follows is to get a mammogram at the age of 40 and continue every year,” says Dell. 

If breast cancer runs in your family, Dell says the rules change a bit. Then, he recommends starting annual mammograms 10 years earlier than the first degree relative was diagnosed. 

“For example, if a woman was diagnosed at the age of 45 and she has daughters, then they should start receiving annual mammograms at age 35,” explains Dell.

The Power of 3D Mammography

The best way to detect breast cancer early on is with 3D mammography. 

“It’s been proven to find cancer smaller and on average, 15 months earlier than with normal mammography,” explains Dell. 

How does it work? Genius™ 3D Mammography takes a series of detailed images of the breast. This allows breast tissue to be evaluated layer by layer in more detail, helping to screen for cancer as small as the size of a tic-tac. 

“A tic-tac is exactly 10 millimeters from one end to the other,” explains Dell. “When we catch breast cancer in women that size or smaller, 99% are alive five years later and more than 96% are alive 20 years later.”

Unfortunately, Dell says cancer is usually double that size, about 20 mm in length, before it can be felt by a woman or her physician. 

“By this size, 20 to 60% of the cancers have already spread to the lymph nodes,” says Dell.

 Only about one third of facilities in the country have 3D equipment, including Cooper Clinic. That’s something Dell’s patients are willing to travel for.

“I’ve had several patients who live in another state and have felt a lump in their breast, called me and chose to fly back to Cooper to see me because we have such advanced technology,” says Dell. He says in one of those cases, the patient’s mammogram depicted cancer.

Preparing for a Mammography

There are a few things Dr. Dell says women should know when preparing for a mammogram. First, the procedure can be uncomfortable, but this is only because of the need to get a clear picture of the breast. The clearer the picture, the better opportunity to identify any potential problems.

Secondly, women should not be afraid to ask questions of the radiologist or technologist performing the exam. Being comfortable with their expertise and trusting their knowledge can help make the procedure a bit more relaxing.

Since mammogram screening quality was mandated by law in 1992, breast cancers have been found much earlier and mortality has dropped by 35%. Dr. Dell explains, “for every 1,000 women screened, we can expect to find three to six cancers.”

Who’s at Risk?

While having a family history of breast cancer can increase your risk, no family history does not necessarily decreases your risk of breast cancer. “Actually, three out of four new cancers found are in women with no family history of breast cancer,” says Dr. Dell. No matter the risk, an annual mammogram reduces the chance of dying from the disease.

A factor that women should be aware of when it comes to their own breast health is breast density. About 50% of women above the age of 40 have dense breasts, which means their ratio of fibroglandular tissue (which includes milk ducts) to breast fat is increased. Because 97 percent of breast cancer originates in the milk ducts, women with more fibroglandular tissue (denser breasts) have a slightly increased chance of developing breast cancer. Though cancers can be harder to find in dense breasts, Dr. Dell notes that ultrasound technology can be used in addition to mammography to provide the most thorough screening possible. The increased use of ultrasound in breast screening is now a national trend.

Breast cancer also affects men—about 1,800 men die of breast cancer each year. The disease can be much more lethal in men. Due to smaller breast size, the cancer can spread more rapidly from the breast to other parts of the body.

Why You Should Never Skip

Women in their 40s have a lot on their plate and while some items can be put on the back burner, Dell says mammograms shouldn’t be one of them.

“Many women might think it’s just skipping a mammogram,” says Dell. “But really, they’re just giving possible undetected cancers time to grow.”

Dell says many women are also fearful of mammograms due to radiation. While radiation in high doses can cause cancer, Dell says a woman can have a mammogram every year from the age of 40 until she’s 100 with no impact to her health. “That amount of radiation she would receive is less than if she would have lived in Denver, Colorado, for 60 years,” says Dell. 

Making sure women come in annually for their mammograms is personal to Dell. Why? It was just days before his wife’s first mammography, at the age of 40, she felt a lump in her breast. Because they caught the cancer early and acted quickly, she’s alive and thriving today. 

For more information about breast imaging and 3D mammography at Cooper Clinic, visit cooper-clinic.com or call 972.560.2651.

We encounter germs every day and our bodies build natural immunity to many, but vaccines can help reduce the risk posed by many germs and diseases.

Having immunizations and making sure they are up to date not only helps protect your health but helps protect your family and friends. “Getting an infection is sort of like a game of chance, and that game is extended to family and friends who are being exposed to these infections,” says Steven Lilly, MD, MBA, Cooper Clinic Platinum Physician. By having your immunizations up to date, you are reducing the spread of infection while in contact with others. Getting proper immunizations is essential to protecting your community, friends and family. Vaccinations can help the body fight infections such as:

• Flu
• COVID-19
• Tetanus
• Shingles
• Respiratory syncytial virus (RSV)

When traveling abroad, some countries recommend additional vaccines not regularly administered in the United States. “Other parts of the world still have diseases that are now rare or eliminated in the U.S., and getting vaccinated can help protect vulnerable populations when you return,” says Mita Patel, PA, Physician Assistant at Cooper Clinic.

Importance of Getting Vaccinated and How Vaccines Work

“Vaccines are meant to stimulate the immune system, which leads the body to be ready for the next time it comes across the infection,” explains Dr. Lilly. Some vaccines can be administered by mouth or nasal spray, but the majority are given by injection into a muscle.

Once administered, the vaccine causes immune cells in the body to produce antibodies. Dr. Lilly explains, “cells are then trained and ready to recognize infections if they come into contact.” Vaccines typically take several weeks to become totally effective, allowing immune cells to learn, respond and produce antibodies. “It is a gradual process. You still have partial immunity in the first few days after receiving an immunization,” says Dr. Lilly.

Staying Up To Date

It’s easy to lose track of the vaccines you have taken and when. Dr. Lilly recommends meeting with your primary care physician to learn if you are missing vaccines or if you need booster shots.

Booster Shots

After time, some vaccines can become ineffective and booster shots are made to help strengthen the effectiveness of the original vaccine. A booster shot is an additional dose of the vaccine, and it helps increase the immune system response. “Viruses or infections can change over time. The original vaccine you may have had might not cut it anymore. That’s where new booster shots come in and strengthen the immune system,” explains Dr. Lilly. An example of a vaccine that requires a booster shot is Tetanus, Diphtheria, Pertussis (Tdap), which is recommended every 10 years.

Flu Shots

Influenza (flu) viruses are constantly adapting, which means flu shots must change every year to target circulating viral strains. Flu shots are developed and offered annually. COVID-19 has been similar in this way.

Immunization for Travel

When you’re planning a trip abroad, people usually begin by booking their hotels and building their itinerary. One step often forgotten from the planning process is checking to see which vaccinations are recommended for a given destination such as sub-Saharan Africa, South America and Southeast Asia. These and other parts of the world may have diseases that are relatively rare in the U.S. If exposed to these diseases, they can cause severe complications and increase the spread to fellow travelers and your community.

Patel shares some common vaccinations travelers receive before traveling abroad:

• Hepatitis A and B
• Typhoid
• Yellow fever

“Ideally it is recommended to get these vaccinations four to six weeks, at least two weeks, prior to travel to allow the vaccine to be fully effective,” says Patel. In addition, Tetanus, Diphtheria, Pertussis (Tdap) and/or polio boosters may be recommended along with the flu vaccine.

For information about which vaccinations are recommended by different countries, visit the Centers for Diseases Control and Prevention (CDC) or World Health Organization websites.

Stigma on Avoiding Immunization

One of the most common reasons people avoid getting vaccinations are side effects. Dr. Lilly explains, “in most cases, vaccines cause mild symptoms such as soreness and redness on the arm or where the vaccine was administered. Less commonly, people may feel fatigued or have a mild fever for a day or two.” While severe side effects can rarely occur, these are typically far outweighed by the potential benefits of vaccines recommended by your medical provider.

Another misconception is that immunizations only need to be administered at an early age. While it is beneficial to get the needed vaccinations at an early age as your immune system is developing, staying up to date as an adult and getting needed booster shots can help strengthen the immune system to fight off or prevent illnesses.

Find out if you’re missing any vaccinations or need any booster shots by reviewing your medical records and discussing with your primary care team. 

For those who struggle with chronic pain, everyday activities such as taking care of family, going grocery shopping or even walking can be daunting. Pain can cause you to be uncomfortable, depressed and even hopeless.

Pain can form from multiple factors; some include:

1. Accident or injury
2. Inflammation in the immune system
3. Nerve damage from an illness
4. Medical issues or chronic pain

With debilitating pains, many have found prescription opioid medications to be a solution. “Opioids are fast-acting while treating pain. Once the medication gets into the vascular system, it starts providing relief to patients,” says Nichole Johnson, MD, FACP, CWS-P, Preventive Medicine Physician at Cooper Clinic. While these medications are effective at reducing pain, they are also addictive. In 2023, the Centers for Disease Control and Prevention reported 105,000 people died from a drug overdose and almost 80,000 involved opioids, a nationwide epidemic that is increasing as people continue to misuse opioids.

In addition to being addictive, opioid medications can cause uncomfortable side effects depending on the person’s sensitivity to the medication. Many experience the following symptoms immediately after starting the treatment:

• Slow breathing
• Constipation
• Nausea
• Loss of appetite
• Drowsiness

Finding the Best Treatment for You

In light of the opioid epidemic, the medical community is expanding its approach to pain management. To begin treatment, Dr. Johnson recommends speaking with your primary care physician and explaining the pain you are feeling. Your physician will help you determine what kind of pain management specialist to see. Here are common forms of pain:

• Neuropathy or Nerve Pain: When you damage your nervous system or it malfunctions, it can cause pain in your spine, brain, hands, feet and other areas of the body.

• Joint Pain from Arthritis: The immune system is attacking your joints which causes swelling and tenderness. Arthritis pain can worsen as you age.

• Myalgia or Muscular Pain: Muscle pain can be caused in numerous ways such as having bad reactions to medication, muscle stress from overuse or traumatic bodily injuries.

• Bone Pain: Bone pain is usually associated with bone fractures, trauma to the bone, injury after a physical accident and cancer related.

A misconception about pain management specialists is they only treat the pain. Dr. Johnson says, “pain management is typically meant to find the underlying cause of the pain, so opioids often act as a mere Band-Aid.” There are cases where opioids cannot be avoided, says Dr. Johnson. Finding the cause helps the physician determine which treatments are available for you and make some recommendations. Below are examples of pain management Dr. Johnson recommends based on the type of pain you may have.

• Oral and Topical Anti-inflammatory Medications: Anti-inflammatory creams help reduce swelling which then decreases pain from inflammatory conditions or injury.

• Anti-Seizure Medications: Those with neuropathic pain or nerve pain are often prescribed anti-seizure medication. The medication helps manage pain by targeting overactive pain signals sent from damaged nerves or overly sensitized nerves. Interfering with the abnormal electrical activity in the brain that causes pain, the medication scan block processes that result in electrical signals and alleviate pain.

• Massage Therapy: Massage is great for those with muscle pain caused by an injury and overuse of the body due to sports, physical activity or work. Massages can also help with inflammation and arthritis pain. Types of massage for pain relief include deep tissue massage, Swedish massage and hot stone massage. In addition, massage enhancements—such as magnesium oil, aromatherapy and percussion therapy—can help with the relaxation of the muscle and decrease pain.

• Anti-Depressants: If the pain is related to a person’s mental health, anti-depressants can help alleviate the pain. While it is not fully understood, anti-depressants are thought to help by acting on chemicals in the brain that assist with pain relief, such as serotonin.

• Exercise: Some autoimmune diseases involving joint pain improve with exercise and pain from fibromyalgia, rheumatoid arthritis and lupus responds well to exercise. Learn which types of exercise can ease pain and stiffness from arthritis.

While some of these treatments do not need prescriptions, speak with your pain management specialist or primary health physician to determine the treatments appropriate for your condition. For some, these treatments are not enough. For more extreme cases, some specialists can provide additional procedures to help alleviate pain, such as nerve blocking and steroid injections.

Finding the best pain management treatment is easier while working with a physician. If you are experiencing pain, please contact your primary care physician to determine your next steps in pain management. To learn more about pain management and improving your overall health, visit the U.S. Pain Foundation, where you can read treatment overviews, causes and more.

To schedule a comprehensive preventive health exam at Cooper Clinic, visit cooper-clinic.com or call 866.906.2667.

If you’ve never experienced vision issues, it can be easy to take your eyesight for granted. But with dozens of eye conditions, millions of Americans struggle to see clearly. Cooper Clinic Optometrist Waziha Samin, OD, FAAO, shares the five most common eye disorders, how they can affect your vision and what signs to look for to help prevent or delay progression.

1. Refractive Errors

1. Refractive errors are the most common eye issue. The World Health Organization estimates more than 153 million people worldwide are visually impaired. Refractive errors occur when the eye cannot focus light clearly, resulting in blurry vision. Four common refractive errors include:

• Myopia (nearsightedness): Difficulty seeing long distances
• Hyperopia (farsightedness): Difficulty seeing objects up close
• Astigmatism: Distorted vision at all distances
• Presbyopia: Difficulty reading or seeing things at arm’s length

Those with refractive errors may need glasses or contacts to correct their vision. “Many patients first experience refractive error at night while driving,” says Dr. Samin. “They notice the streetlights are blurry or ‘streaky,’ which is not normal.” For small refractive errors, our eyes can often compensate in other ways to keep the image clear. However, this can lead to eye fatigue or blurry vision by the end of the day. At this point corrective lenses and contacts may be needed.

Data over the past few years shows an increasing number of children experiencing eye conditions. “One thing we are seeing with children is they are spending less time outside which has been linked to a higher risk of developing myopia,” says Dr. Samin. Natural light helps our eyes develop so it is important for children to spend time outside. It is also imperative to children’s correct vision issues, such as eye turns or refractive errors, as early as possible to prevent lazy eye in the future.

2. Dry Eye and Ocular Allergies

Dry eye occurs when the eye does not produce tears adequately to moisturize the ocular surface. Your glands could be under-producing or your tears could be drying up faster than they are being produced. Ocular allergies are similar but occur when your eyes become sensitive to allergens or other irritating substances.

Dry eye and ocular allergies can go hand-in-hand—many people have both but are often diagnosed with only one. Individuals with either of these conditions may experience grittiness, blurring of vision, foreign body sensation, redness, irritation and itchiness. Itchiness is typically worse for those with ocular allergies.

Anyone can develop either of these conditions at any age. It is important to find the root cause of ocular allergies so you know what to avoid and can treat your symptoms accordingly. Dry eye and ocular allergies are often treated with over-the-counter eye drops, allergy or prescription medications and lifestyle changes including avoiding smoke, limiting screen time and drinking plenty of water.

3. Cataracts

“Cataracts are the third most common eye issue because almost everyone develops them!” says Dr. Samin. Exposure to UV rays from the sun is the main cause of cataracts so protecting your eyes with sunglasses is helpful in preventing cataracts at a young age. The lens in your eye takes on the UV rays to protect your retina, but over time, your lens wears out and becomes cloudy resulting in cataracts. In your 40s, your lens stiffens and then in your 60s and 70s your vision may become cloudy. Those with cataracts typically experience glares when driving at night in addition to cloudy vision.

“No eye drops or over-the-counter medications are available for treating cataracts. However, cataract surgery is the number one performed surgery in the United States and is a very effective treatment.” During cataract surgery, the cataract (lens) is removed and replaced with an implant. Before surgery, your surgeon reviews implant options with you to determine which will work best for your situation. Typically, the surgery is performed on the “worse” eye first and, once it heals, the same surgery is performed on the other eye.

4. Age-related Macular Degeneration

Age-related macular degeneration (AMD) occurs when there is a large buildup of plaque in the macula—a part of the retina that controls central vision—due to oxidative stress. This progressive disease is largely genetic and many people who experience it often do not show symptoms until they are in the late stage.

• Dry AMD: The most common type, dry AMD occurs when the macula thins over time and accumulates plaque-like deposits. AMD progresses in severity and symptoms of early, intermediate and late AMD.

• Wet AMD: This less common type, wet AMD causes faster vision loss and is always considered the late stage. Wet AMD occurs when abnormal blood vessels grow in the back of the eye, damaging the macula.

“Early and intermediate AMD largely have no symptoms which is why it is important to have an annual comprehensive eye exam,” says Dr. Samin. In late AMD (wet or dry) symptoms may include wavy or crooked looking lines, blurry vision, blank spots and dimmer colors than normal. In addition, dry AMD can progress to wet AMD, and at that point the condition cannot be reversed—another reason early detection is crucial.

In addition to family history of AMD, a large risk factor is smoking—currently or in the past. Second-hand smoke also increases your risk of AMD. “I always ask my patients first if they smoke or have a history of smoking. If so, that is the number one risk factor we try to eliminate,” says Dr. Samin.

5. Glaucoma

Your optic nerve is connected to your brain and is comprised of millions of fibers that help you see. Glaucoma is a condition where the fibers of the optic nerve get sick and die off. This can be caused by a buildup of fluid pressure within the eye or lack of blood perfusion to the optic nerve. The main treatment for glaucoma involves lowering the pressure of the eye via prescription drops or surgery to stabilize the optic nerve.

In the beginning stages of glaucoma, there are no symptoms. But over time, you slowly lose vision starting with your peripheral (side) vision.

“You can have glaucoma and still live a great quality and quantity of life,” says Dr. Samin. “Since vision loss with open angle glaucoma is so gradual, many patients do not even know they have it. Having your eyes checked annually can help detect glaucoma early and start a treatment plan.” Those over the age of 60 and with a family history of glaucoma are especially at risk of developing the condition as well as those who smoke. Getting a regular eye exam, being aware of family history and wearing eye protection can all help prevent glaucoma.

Age-Related Eye Issues

Many eye issues are age-related such as some of the conditions mentioned above. As with any system in the body, your eyes begin to wear out with age and use. Although the five disorders mentioned above are the most common, this is not an extensive list of eye issues. Taking good care of your eyes starting at a young age is vital in ensuring you live a good quality and quantity of life. Your eyes can even act as a measure of your general health—showing signs of stroke, diabetes, cardiovascular disease, brain tumors and more. Keep an eye on your eye health with an annual comprehensive eye exam such as those offered at Cooper Clinic.

Cooper Clinic offers comprehensive eye care services—including an annual exam—as part of its preventive exam or a stand-alone service.

To learn more about Cooper Clinic preventive exams and how an annual exam can help you manage and improve your health, visit cooper-clinic.com or call 866.906.2667.

Faster, smarter and more personalized health care. Cooper Clinic Chief Medical Officer and Preventive Medicine Physician Michele Kettles, MD, MSPH, discusses health care technology.

Health care technology is constantly changing for the benefit of both doctors and patients. The rate of advancement in technology—from tracking health trends to making records more accessible with tools like electronic medical records (EMRs) and patient portals improves care for better outcomes.

Better Care with Digital Records

In the past, medical records were stored on paper and often kept only for seven years. Now, EMRs allow doctors to store unlimited data and easily spot patterns in a patient’s health—such as rising cholesterol levels—over time. This helps physicians personalize care more effectively.

Helping Patients Access Their Health Data

Modern health care tools such as patient portals provide patients 24/7 access to their own records online. However, many doctors and hospitals use different systems, making it difficult to see everything in one place. Ideally, each patient would have a single, secure portal—a “medical vault”—that stores all their health data, which doctors can also access when needed. Progress has been made in reducing the number of patient portals, but the dream of a sole source for all medical records for any individual patient hasn’t been realized yet.

Making Health Records Easier to Share

The 21st Century Cures Act, passed in 2016, made it mandatory for doctors to share full medical records with patients. This includes lab results, imaging and doctor notes. Before this law, doctors would share only what they thought patients needed. Now, patients have access to everything, which helps them better understand and manage their own health.

The law also addresses information blocking—when systems make it hard to share data. Some companies created closed software systems to keep competitors out, but this made it hard for doctors to get the information they need. The Cures Act is pushing software companies to allow patients to have better access to their health information.

Artificial Intelligence (AI) in Medicine

AI is one area of technology that has endless applications. To support doctors with diagnoses and treatment decisions, AI tools are now being used. One such tool is Open Evidence, a medical AI that helps physicians quickly find up-to-date, research-backed answers to complex medical questions. It uses vast amounts of clinical data and peer-reviewed studies to recommend treatment options, flag potential drug interactions and more. This helps doctors make better, faster decisions and ensures care is based on the latest scientific evidence.AI technology is also being used to help doctors better interpret diagnostic imaging. For example, at Cooper Clinic we have integrated a clinically-proven AI technology with our cardiac CT angiogram imaging to assist our physicians in more precisely identifying and measuring plaque buildup in the heart’s arteries.

A New Tool for Bone Health Assessment

Medical equipment is rapidly advancing as well. One such tool we use at Cooper Clinic is the Trabecular Bone Score (TBS). Unlike traditional bone density tests that only measure the quantity of bone, TBS analyzes the quality of the bone. This gives our doctors better insight into bone strength and fracture risk, especially in older patients with conditions such as rheumatoid arthritis. TBS can be performed using existing bone density scan images, making it a convenient and non-invasive way to improve diagnosis and treatment decisions for bone health.

What’s Next?

As health care technology evolves, the goal is simple: better care with less hassle. Whether it’s spotting health trends, avoiding duplicated tests or using AI such as Open Evidence to improve decisions, technology is making medicine faster, smarter and more personalized.

To learn more about Cooper Clinic preventive exams, visit the Cooper Clinic website or call 866.906.2667. 

Article provided by Michele A. Kettles, MD, MSPH, Chief Medical Officer and Preventive Medicine Physician at Cooper Clinic.

Spending time outdoors being active, enjoying nature and de-stressing is good for you. But more time in the sun means more exposure to its harmful rays, which can damage your skin. Even on overcast days, the sun’s rays can penetrate the clouds. Wearing sunscreen is one of the best ways to protect your skin and help prevent sunburn, skin cancer and premature aging.

Sunscreen is readily available, but in the last decade melanoma skin cancer cases in the U.S. have risen by 42%, according to the Skin Cancer Foundation, resulting in more than 8,000 deaths a year.

What Causes Skin Cancer?

The sun emits two types of ultraviolet rays:

• UVB rays: make up 5% of the sun’s radiation and cause burning
• UVA rays: are more harmful and penetrate deeper into your skin

Ultraviolet radiation is a “proven human carcinogen,” causing squamous cell carcinoma, basal cell carcinoma, which can develop into melanoma, according to the Skin Cancer Foundation.

Up to 95% of all ultraviolet radiation that reaches our skin is UVA rays. These rays, which can pass through glass, are equally intense throughout the year, while UVB rays become more powerful in the spring and summer, especially between the hours of 10 a.m. and 4 p.m.

UVA rays may not burn you, but they are the ones that primarily contribute to skin cancer, which is the most common type of cancer in the U.S. with more than 3.5 million people diagnosed each year. As little as 15 minutes in the sun could damage your skin, even on a cloudy day.

How Can You Protect Yourself?

Sunscreen is the tried-and-true method to protect yourself. But they’re not created equally. The Environmental Working Group (EWG) has investigated sunscreen products for 18 years and found only 25% of more than 1,700 products they’ve investigated offer broad-spectrum protection without troublesome chemical ingredients added to them.

In EWG’s 2024 Guide to Sunscreens report they found 229 products met safety and effectiveness standards. Fifty-one products met their standard for children.

To obtain the EWG’s passing grade, the product must:

• Be “green,” posing little hazard to health or the environment
• List every ingredient on the label, including nanoparticles and fragrances
• Have a sun protection factor (SPF) of 15 to 50
• Not contain ingredients restricted by the European Union and Canada as well as the U.S. Food and Drug Administration (FDA), U.S. Environmental Protection Agency, U.S. National Toxicology Program and California’s Proposition 65 list of known carcinogens and reproductive toxins

The FDA and EWG warn consumers that an SPF higher than 50 is not more effective. They also warn that people less frequently apply sunscreen with an SPF of 50+ because they think it applies more protection, when in fact it does not.

The American Academy of Dermatology recommends using water-resistant products with broad-spectrum protection and SPF of at least 30. Any sunscreen with an SPF less than 15 does not protect against skin cancer.

Ingredients to Avoid

According to a 2020 study by the FDA, oxybenzone is one of six sunscreen chemicals found in the bloodstream of volunteers at levels that exceed safety thresholds after only one day of use.

Oxybenzone was absorbed into the body at 50 to 100 times higher concentration than five other tested ingredients—avobenzone, octocrylene, homosalate, octisalate and octinoxate. Oxybenzone and another chemical, homosalate, then stayed in the bloodstream for seven to 21 days, the study found.

In May 2023, the FDA announced two ingredients—PABA and trolamine salicylate—would not be on the list of ingredients generally recognized as safe and effective.

How to Best Protect Yourself from Skin Cancer

Cooper Clinic Dermatology offers tips to keep you covered from head to toe year-round to help protect against skin cancer.

• Use a broad spectrum (UVA/UVB) sunscreen with an SPF of 30+ for best protection against the sun—be aware sunscreen products can no longer claim to be above SPF 50 because higher numbers are not proven to provide more protection.

• Apply sunscreen 365 days a year—rain or shine—because UVA/UVB rays still shine through on cloudy days.

• Use water-resistant sunscreen to help protect you when you are having fun in the pool or exercising outdoors—remember to reapply every two hours or immediately after swimming or excessive sweating.

• Sunscreen in bottles and lotions are best for our skin as opposed to sprays that may not rub in well—plus you have a better chance of using the recommended 1 oz. needed to cover your skin.

• Sunscreen that protects you from both UVA/UVB rays is best to help prevent burns and premature aging.

• Limit time in the sun, especially between the hours of 10 a.m. and 4 p.m., when the sun’s rays are most intense.

• Wear clothing to cover skin exposed to the sun, such as long-sleeved shirts, pants, sunglasses and broad-brimmed hats.

Prevention is key. Cooper Clinic recommends having a thorough, full-body skin cancer screening annually. It’s also important to do a self-check at home every month.

For more information about Cooper Clinic Dermatology’s skin cancer screening with a board-certified dermatologist or to book your screening, visit cooperclinicdermatology.com or call 972.367.6000.

When you think of bettering your health, the focus tends to be on exercising and eating nutritious food. “People forget that getting good quality sleep plays a vital role in your overall health,” says Sonya L. Merrill, MD, PhD, FACP, Sleep Medicine Physician at Cooper Clinic. “People don’t value or prioritize sleep—it’s seen as an afterthought. Sleep is the foundation on which good health is built. Diet and exercise cannot be as successful if you are exhausted.”

Having interrupted or poor-quality sleep can contribute to numerous medical conditions such as:

• High blood pressure
• Coronary artery disease
• Diabetes
• Obesity
• Impaired immune system
• Dementia

But what causes someone to have poor sleep? Dr. Merrill explains there are several reasons. “Pain can be a significant reason why someone isn’t able to sleep well, including back pain, joint pain and headaches. Urinary frequency also can wake you up multiple times throughout the night.” Environmental factors such as sleeping with the television on and sleeping with pets and children can disturb sleep. Substances such as caffeine, nicotine, alcohol and some medications are other factors.

Sleep Apnea

Undiagnosed sleep disorders such as sleep apnea can negatively impact sleep. Sleep apnea is a condition where an individual experiences repeated interruptions in air flow due to collapse of the upper airway. Symptoms include:

• Snoring
• Gasping
• Pauses in breathing or irregular breathing
• Night sweats
• Nocturia (urinary frequency at night)
• Daytime sleepiness
• Mood changes
• Forgetfulness
• Fatigue

Dr. Merrill shares, “Obstructive sleep apnea occurs because there is a decrease in muscle tone during sleep; the tongue and upper airway muscles relax, so the airway blocks partially or completely for 10 seconds or longer at a time.”  An individual’s anatomy contributes to the risk of obstructive sleep apnea. “Those who have small, crowded upper airways are more at risk, as well as people who are obese,” says Dr. Merrill.

Sleep Studies

If you struggle with symptoms of sleep apnea, the next step is to take a sleep test. At Cooper Clinic, we offer both at-home and in-lab studies.

• Home Sleep Apnea Test (HSAT): performed at home with a device that tracks your breathing while you sleep
• Polysomnography: an in-lab sleep study conducted by a sleep technologist to obtain comprehensive, accurate information about breathing as well as other aspects of sleep including sleep stages and limb movements

Dr. Merrill explains the differences and benefits of each test to help you determine the best option for you in our Considering a Sleep Study? Which One is Best for You? article.

Treating Sleep Apnea

The “gold standard” treatment for sleep apnea is continuous positive airway pressure (CPAP). A CPAP machine generates a continuous flow of pressurized air which keeps the airway from collapsing. CPAP typically reduces the number of apnea episodes by 90% or more.

Another treatment option is an oral appliance; this type of dental device moves the lower part of the jaw forward to stabilize and open the airway mechanically. A hypoglossal nerve stimulator implant may be an option for patients who are unable to tolerate CPAP. Finally, the FDA recently approved Zepbound (tirzepatide) to facilitate weight loss in obese patients with moderate to severe obstructive sleep apnea.

In addition to these treatments, Dr. Merrill also recommends 10 Tips for Better Sleep to help you establish a healthy sleep routine.

Bettering your sleep can do wonders for your health, both mentally and physically.

Cooper Clinic offers a comprehensive range of sleep medicine services—including lab-based studies and in-home testing. Visit the Cooper Clinic Sleep Medicine web page to learn more or call 866.906.2667.