Sick child this school year? Planning for the inevitable during a pandemic

Children get sick; it’s part of life. They catch colds, they get fevers, they throw up and get diarrhea. Most of the time, it’s nothing at all. But this year, as we struggle through the COVID-19 pandemic, every sniffle will be complicated.

The problem is, the symptoms of COVID-19 can be not just mild, but similar to the symptoms of all the common illnesses kids get all the time. Symptoms can include

• fever, even a mild one
• cough (that you don’t have another clear reason for)
• breathing difficulty
• sore throat or runny nose (that you don’t have another clear reason for)
• loss of taste or smell
• headache (if with other symptoms)
• muscle or body aches
• nausea, vomiting, or diarrhea.

And even if there is another explanation for that sore throat or cough, it doesn’t mean that your child couldn’t also have COVID-19. People can get two germs at once.

Set the bar low for keeping sick children home

This is not a year when you can send your child to school or daycare with that cough, or that one vomit, or that low-grade temp, and hope for the best. This is a year when we need to do our best to keep every sick person home, whether they have COVID-19 or something else. This is also not a year to skip the flu shot. We need there to be as little influenza as possible this year for everyone’s safety and well-being.

Here’s what you should do if your child gets any of the symptoms above:

• Keep them home from school or daycare. I understand that this may mean missing work, but there is simply no choice.
• To the extent that it is possible, keep them away from other family members.
• Call your doctor. If they have any trouble breathing, a high fever, severe pain or irritability, or unusual sleepiness, you should go to an emergency room. Otherwise, your doctor will advise you about next steps, including testing for COVID-19.

Theoretically, everybody with any of the above symptoms should be tested. But that may not be possible. And for some children — those with mild symptoms who aren’t in daycare or school, whose parents are working remotely and who don’t have contact with high-risk individuals — a test may not be crucial as long as everyone can stay home. Make sure you talk with your doctor and understand exactly what you and other family members need to do if your child is not tested.

The difference between quarantine and isolation

Quarantine and isolation are two terms that are used a lot these days, and while they are often used interchangeably, they aren’t the same thing.

• Quarantine means staying home: no trips to stores, or anywhere outside of the house or yard.
• Isolating means staying away from other people in the home — in a separate room, preferably with a separate bathroom (or wiping down in between), wearing a mask when they must leave their room, and not sharing utensils, towels, or anything else with anyone.

What to do if a test for COVID-19 is positive or you cannot get a test

The American Academy of Pediatrics and the Centers for Disease Control and Prevention (CDC) recommend these steps:

If your child tests positive for COVID-19:

• Make sure you are in touch with your doctor, follow all recommendations, and call for help if you have any concerns about how your child is acting or feeling.
• Isolate your child at home, to the extent that this is possible.
• Don’t send them back to school or daycare until at least 10 days from the start of their symptoms (longer if they are still sick), and until they have not had a fever for at least 24 hours without any fever-reducing medications.

Children who test positive are considered infectious until that 10 day/no fever point. So family members living with the child need to quarantine until 14 days after the 10-day point (if anybody gets sick, call your doctor). They also should wear masks and do their best to isolate from others at home, as you never know which person might get sick.

Getting family members tested doesn’t change the quarantine requirement — because the incubation period can be as long as 14 days. Theoretically you could be infected at day nine of your child’s infection — and not show symptoms for 14 days after that. It’s best to wait four to five days after the 10-day day point to be sure the test will be accurate (although any family member with symptoms should schedule a test right away). Testing family members can pick up asymptomatic cases — and may reset the quarantine clock for everyone else. Your doctor can guide you through.

This is going to be hard, and very disruptive, but it’s the only way to contain the virus.

If you can’t or don’t test your child, all the same instructions apply — because you don’t know if they have COVID-19. So you need to act as if they do, to be safe.

What to do if a test for COVID-19 is negative

If your child tests negative for COVID-19, talk to your doctor about what to do and when your child can return to school or daycare. It will depend on your child’s symptoms and whether another diagnosis was made.

What to do if your child is exposed to COVID-19 away from home

If your child is exposed to someone with COVID-19 outside of the home (being within six feet of them for 10 to 15 minutes), call your doctor for advice. Most likely, you will be told that your child needs to quarantine for 14 days after their last exposure to that person. As above, if you decide to test you should wait a few days — unless your child develops symptoms, in which case testing right away is a good idea. A negative test won’t get your child out of quarantine, but if they test positive then you will know to start isolating them — and start the clock for everyone else’s quarantine.

This is complicated, I know. Call your doctor’s office if you have questions — and check out the website of the American Academy of Pediatrics.

The post Sick child this school year? Planning for the inevitable during a pandemic appeared first on Harvard Health Blog.

from Harvard Health Blog https://ift.tt/3n3PJTi

Read More

Treating mild hypothyroidism: Benefits still uncertain

Your thyroid, a tiny, butterfly-shaped gland located in front of your windpipe (trachea) and below your voice box (larynx) can have a profound impact on your health and well-being. Throughout life, your thyroid is constantly producing hormones that influence your metabolism. These hormones affect your mood, energy, body temperature, weight, heart, and more.

A brief overview of hypothyroidism

Your thyroid produces two kinds of thyroid hormones: T4, or thyroxine, and T3, or triiodothyronine. These hormones influence every cell, tissue, and organ in your body, from your muscles, bones, and skin to your digestive tract, brain, and heart, by controlling how fast and efficiently cells convert nutrients into energy — a chemical activity known as metabolism.

The thyroid gland is under the influence of the pituitary gland. No larger than a pea and located at the base of the brain, the pituitary gland controls your thyroid’s production of thyroid hormone by releasing thyroid stimulating hormone (TSH).

TSH levels in your bloodstream rise or fall depending on whether there is enough thyroid hormone made to meet your body’s needs. Higher levels of TSH prompt the thyroid to produce more thyroid hormone, while lower levels signal the thyroid to produce less.

Hypothyroidism occurs when the thyroid fails to produce enough thyroid hormone to meet the body’s needs, thereby slowing metabolism. In someone with overt hypothyroidism, thyroid hormone levels are below normal and TSH levels are well above the normal range.

What is mild hypothyroidism?

Subclinical, or mild, hypothyroidism doesn’t meet the standard definition of hypothyroidism. In mild hypothyroidism, you may or may not have symptoms and your levels of T4 and T3 are normal, but your TSH levels are slightly elevated. Mild hypothyroidism is diagnosed by a blood test.

More than 10 million adults in the US have hypothyroidism, the vast majority of which is subclinical.

What are the risks of leaving mild hypothyroidism untreated?

Whether or not to treat mild hypothyroidism is a subject that has been studied and debated for years. What worries doctors most about mild hypothyroidism is the potential link between untreated mild hypothyroidism and coronary artery disease. Results of research on whether subclinical thyroid disease causes heart problems have been conflicting. The condition has been associated with heart and blood vessel abnormalities, and studies indicate that treating mild hypothyroidism can improve various markers of heart structure and function.

However, a recent study published in the Journal of the American Medical Association may give doctors pause. The researchers studied people with mild hypothyroidism who had also had a heart attack. They treated one group of these patients for their mild hypothyroidism, and left the condition untreated in the other group. The study showed that those treated for mild hypothyroidism did not have better heart function than those who were not treated.

What are the downsides of treating mild hypothyroidism?

When mild hypothyroidism is treated, levothyroxine (T4) is the treatment of choice.

A 2017 trial published in The New England Journal of Medicine found that treating people ages 65 and older for mild hypothyroidism doesn’t have much of a benefit. The authors found no real differences in symptoms between participants who received levothyroxine and those who got a placebo. The authors say many older adults revert to normal thyroid function on their own, without treatment. A follow-up study recently published in the Annals of Internal Medicine analyzed data from patients enrolled in the 2017 NEJM study, and determined that even those with the greatest number of symptoms did not benefit.

In addition to the possibility that the treatment may not offer any benefit, there are other reasons for caution. Overtreatment — prescribing thyroid medication to someone with subclinical disease who may not need treatment, or giving excessive thyroid medication — comes with serious risks, particularly thyrotoxicosis, the presence of too much thyroid hormone in the body. This happens frequently; estimates suggest 20% or more of those treated with thyroid hormone experience thyrotoxicosis. Long-term complications of even mild thyrotoxicosis can include heart problems and bone loss.

Considering the risks and benefits of treatment

If you are weighing the pros and cons of treatment for hypothyroidism, discuss the following questions with your doctor:

• How might I benefit from treatment? Could it treat my symptoms? Prevent heart disease? Help me conceive?
• What are the risks of treatment?
• How will we know if treatment is working, and how long will it take to determine this?
• For how long will I need to continue treatment?

The post Treating mild hypothyroidism: Benefits still uncertain appeared first on Harvard Health Blog.

from Harvard Health Blog https://ift.tt/36h7NDw

Read More

Managing the new normal: Actively help your family weather the pandemic

When the pandemic first began earlier this year, it seemed like if we could just hunker down until perhaps summer, things would get better and we’d be able to get back to life as usual (or at least something similar to life as usual). We were in survival mode: we cut corners and made do, broke some parenting rules, and otherwise made choices we would never usually make. Because that’s what you do when you are in survival mode.

It’s now very clear that the pandemic is here for at least this school year, and survival mode is taking on a whole new meaning. It’s time to make new habits and routines specifically for the pandemic. It’s time to make better and more durable choices that can help keep us healthier — and happier.

Some things obviously aren’t about choices. If you have lost loved ones, are struggling financially, are living in a dangerous situation, or if you or anyone in your family is having thoughts of self-harm, please reach out for help. Your doctor may be able to direct you to resources in your community.

What I am talking about is practical, daily life choices that we can make in a different way that may help us feel and live better. Be proactive — and do it as a group activity with your partner and family, so that everyone feels heard and invested.

Identify the pain points and tackle those first

Think about the past few months, and literally make a list of everything that was particularly hard. Lack of structure? Too much screen time for everyone? Problems getting kids to do their remote work? Problems getting your own remote work done? Feeling isolated from friends and family?

Work together to come up with ideas to tackle these pain points. They might include:

• Clear daily routines (use something like a white board so that all are on the same page). Along with those routines, have rules about screen time limits.
• For those doing remote work or remote school, create spaces they can use that approximate school or work spaces (no school from bed, for example).
• Come up with some non-screen activities for all of you. Books with pages, for example. Blocks for kids, arts and crafts, dollhouses, and other things that spur imagination.
• Set up regular remote contact with friends and family that you haven’t seen. Consider widening your “bubble” to include some select friends and family that you trust to be safe and take precautions.
• If you have a partner, work out the division of labor in a way that feels fair to both of you.

Identify activities that make you happy, and build them in too

We really need this now; it is crucial, not optional. We need to be deliberate in this. Identify both things that people can do alone, and things that you can do together, and make them part of your routines. Maybe it’s some alone time for each of the adults, a date night (light some candles at a table after the kids go to sleep and put your phones aside), a family game night, some daily silliness… whatever makes you smile, build it in.

Identify ways to become healthier, both physically and mentally

This too is crucial; it’s not something we can put aside anymore. For example:

• Be sure everyone is getting enough sleep (at night, not during the day, unless someone works a night shift).
• Eat healthy foods. I know, pandemics seem to justify comfort food. But too much cookies, ice cream, and chips catch up with you eventually, and start to make you feel bad instead of good.
• Get exercise. Every day is best, but do it at least five times a week — and make sure everyone in the family does it. It could literally be dancing in the kitchen, or a YouTube exercise video. If you can get outside, even for a short walk, all the better — we need to be places that don’t have ceilings sometimes.
• Be mindful of your alcohol and other substance use. That little bit to “take the edge off” can be a slippery slope.
• Build in time for communication with each other. It could be as simple as device-free family dinner and at least one device-free check-in with your partner.
• Reach out to your doctor if you or anyone in your family is feeling particularly sad or anxious. There are many resources available. Lots of counselors offer virtual sessions. Don’t wait, hoping things will get better. They may only get worse, and at the very least will get better with help.

We will make it through this. The choices we make today will make all the difference in who and how we are when we emerge — so let’s make them proactively, wisely, and with kindness.

Follow me on Twitter @drClaire

The post Managing the new normal: Actively help your family weather the pandemic appeared first on Harvard Health Blog.

from Harvard Health Blog https://ift.tt/2S0K9CR

Read More

Lifestyle medicine for all: Healthy food comes first

“Lifestyle medicine is only for rich people, right?” a colleague asked me several years ago, questioning my involvement in this relatively new field of medicine that guides people toward healthy habits. This has been a common misperception, for sure.

But across the US, a revitalized brand of health activism is intent on bringing lifestyle medicine to a broader range of people. This is backed by a new effort from the American College of Lifestyle Medicine to engage communities most affected by chronic disease.

The first pillar of healthy lifestyle: Food is medicine

Lifestyle medicine is an evidence-based practice of helping people adopt and sustain healthy behaviors like improving diet, increasing activity, managing stress, sleeping well, moderating alcohol consumption, and quitting tobacco. Large studies show such habits can extend our lives by well over a decade. What’s more, these habits can even keep these extra years free of diseases like diabetes, heart disease, strokes, and cancer.

Eating a plant-based diet — meaning a diet rich in vegetables, fruits, beans and legumes, nuts and seeds, and whole grains — can lower inflammation, as well as the risk of many chronic diseases such as diabetes, heart disease, strokes, and cancer. Simply put, food is medicine. Some doctors are providing this information to patients as part of their regular medical care.

But many people do not have easy access to healthy plant foods. Especially now, they may be suffering from significant financial limitations, unemployment, and unstable housing. Or they may live in a “food desert,” where grocery options are severely limited, or worse, a “food swamp,” an area where fast food and junk food are more available than anything else. Living in a food swamp puts people at a higher risk of becoming overweight or obese.

Ways to help change the equation

Helping patients access healthy plant foods is critically important. And some doctors and academic medical centers are taking action to bring healthy foods to underserved communities.

Food pantries. Dr. Jacob Mirsky is a physician at Massachusetts General Hospital and co-director of the department of medicine’s Healthy Lifestyle Program. He works in an underserved community north of Boston, where he directs his clinic’s new plant-based food pantry. When he prescribes a plant-predominant diet to his patients, he also is able to provide the plants. He views this work as activism and a potent way to address inequalities while also taking care of his patients.

Plant-based food pantries and food prescription programs have been positively received by communities. One such program in a rural, low-income area of Texas provided 30 pounds of fresh produce to households identified as food-insecure — meaning they did not have enough food to eat — every two weeks for six months. Participants described the program as critical for helping them feed their families, and 99% reported that they consumed all or almost all of the food they received.

Education and support. Dr. Michelle McMacken is an assistant professor of medicine at New York University’s Grossman School of Medicine, and director of the Plant-Based Lifestyle Medicine Program at NYC Health and Bellevue Hospital. She is working to make lifestyle medicine services available to as many patients as possible, regardless of socioeconomic status.

“I believe everyone deserves access to lifestyle medicine, especially the highest-risk, most vulnerable patients who potentially stand to benefit the most,” she says. “The majority of my patients — including those facing significant socioeconomic challenges — want to learn what they can do to become healthier. We collaborate to figure out how they can leverage lifestyle medicine within their own situation.”

Despite challenging circumstances, she has seen patients achieve health transformations, including weight loss and improved cholesterol and blood sugar levels.

Programs that educate people about the power of plant foods can have a big impact. A study of 32 Latinx people with type 2 diabetes living in a medically underserved area of California offered a five-week program introducing participants to the power of plant foods. Declines in blood sugar continued even six months after that program had ended.

Connecting people and food. The Family Van is a longtime mobile health program supported by Harvard Medical School that provides free education, resources, and some clinical services to anyone, regardless of insured status. A large part of what they do is help people access nutritional support through SNAP (Supplemental Nutrition Assistance Program) and locate low-cost produce sources like The Fresh Truck and The Daily Table. They also will provide grocery gift cards along with their healthy diet counseling. The Family Van has been collecting data such as body mass index, blood pressure, blood sugars, and ore for over a decade, and has published several papers showing that such interventions work.

Programs like these are essential and wonderful, but there is a lot more work to be done. In our Healthy Lifestyle Program at Massachusetts General Hospital, we hope to establish the practice of healthy lifestyle as the standard of care for preventing and treating chronic disease for all of our patients. To do this, we are developing practical, accurate methods to assess clinically important diet and lifestyle factors at every patient’s physical exam. At the same time, we’re studying evidence-based approaches to help people eat and live healthier, including our plant-based food pantry, health coaching, and web-based group education classes. We hope that in the future, every one of our patients will have access to the quality information, resources, and support that they need to live their healthiest life.

The post Lifestyle medicine for all: Healthy food comes first appeared first on Harvard Health Blog.

from Harvard Health Blog https://ift.tt/33ZOICQ

Read More

CBD for chronic pain: The science doesn’t match the marketing

If you ask health care providers about the most challenging condition to treat, chronic pain is mentioned frequently. By its nature, chronic pain is a complex and multidimensional experience. Pain perception is affected by our unique biology, our mood, our social environment, and past experiences. If you or a loved one is suffering from chronic pain, you already know the heavy burden.

People are looking for novel, nonaddictive ways to treat pain

Given the ongoing challenges of chronic pain management coupled with the consequences of the opioid epidemic, pain management practitioners and their patients are searching for effective and safer alternatives to opioids to alleviate pain. With the legalization of marijuana in many states and resulting cultural acceptance of this drug for recreational and medical use, there has been an increased interest in using cannabis for a myriad of medical problems, including pain.

Cannabis (most commonly obtained from the Cannabis indica and Cannabis sativa plants) has three major components: cannabinoids, terpenoids, and flavonoids. While there are over a hundred different cannabinoids, the two major components are tetrahydrocannabional (THC) and cannabidiol (CBD). Historically more attention has been paid to the psychoactive (euphoric “getting high”) component of the cannabis plant, THC; there have been fewer scientific studies on the medical use of CBD, a non-psychoactive component of the plant.

What’s the thinking behind using cannabis for chronic pain?

CBD is emerging as a promising pharmaceutical agent to treat pain, inflammation, seizures, and anxiety without the psychoactive effects of THC. Our understanding of the role of CBD in pain management continues to evolve, and evidence from animal studies has shown that CBD exerts its pain-relieving effects through its various interactions and modulation of the endocannabinoid, inflammatory, and nociceptive (pain sensing) systems. The endocannabinoid system consists of cannabinoid receptors that interact with our own naturally occurring cannabinoids. This system is involved in regulating many functions in the body, including metabolism and appetite, mood and anxiety, and pain perception.

What’s the research that CBD works in humans?

Given its promising results in animal models, along with its relative safety, non-psychoactive properties, and low potential for abuse, CBD is an attractive candidate to relieve pain. Unfortunately, there is a lack of human studies about the effectiveness of CBD. However, there is an abundance of commercial advertisements about the magical effects of CBD, and it is frequently presented as a cure-it-all potion that will treat everything including diabetes, depression, cancer, chronic pain, and even your dog’s anxiety!

So far, pharmaceutical CBD is only approved by the FDA as adjunct therapy for the treatment of a special and rare form of epilepsy. Currently, CBD alone is not approved for treatment of pain in the United States. But a combination medication (that contains both THC and CBD in a 1:1 ratio) was approved by Health Canada for prescription for certain types of pain, specifically central neuropathic pain in multiple sclerosis, and the treatment of cancer pain unresponsive to optimized opioid therapy. There is currently no high-quality research study that supports the use of CBD alone for the treatment of pain.

Why is CBD presented to the public this way, when it is not without risks?

Given the rapid change in the legality of cannabis coupled with the increased appetite for something new, and driven by unprecedented profit margins, the advertising for cannabinoids in general and CBD in particular has gone wild. The FDA is very clear that it is illegal to market CBD by adding it to a food or labeling it as a dietary supplement. And it warns the public about its potential side effects, as it’s often advertised in a way that may lead people to mistakenly believe using CBD “can’t hurt.” CBD can cause liver injury, and can affect the male reproductive system (as demonstrated in laboratory animal studies).

Most importantly, CBD can interact with other important medications like blood thinners, heart medications, and immunosuppressants (medications given after organ transplantation), potentially changing the levels of these important medications in the blood and leading to catastrophic results, including death. Also, more information needs to be gathered about its safety in special populations such as the elderly, children, those who are immunocompromised, and pregnant and breastfeeding women.

Many of the CBD products on the market are unregulated

In fact, the FDA has issued several warning letters to companies and individuals that market unapproved new drugs that allegedly contain CBD. The FDA has tested the chemical content of cannabinoid compounds in some of the products, and many were found to not contain the levels of CBD the manufacturers had claimed they contain.

Beware of powerful testimonials

Finally, there is anecdotal wisdom, when experiences by patients and health professionals have positive results. While the experience or medication could be beneficial, that doesn’t mean it is going to work for everyone. That’s because each and every person is unique, and what works perfectly for one patient could have no effect on another patient. This is especially true for pain, where many other factors (our mood and stress level, our environment and other medical conditions, and our previous experiences) can affect the perception of pain. Please be careful, and keep in mind that some of these incredible-sounding testimonials are merely marketing materials meant to lure consumers to buy more products, as the CBD market is expected to hit $20 billion by 2024.

The bottom line: Don’t make CBD your first or only choice for pain relief

If you or someone close to you is considering trying CBD, I would recommend Dr. Robert Shmerling’s advice about the dos and don’ts in choosing an appropriate product. Until there is high-quality scientific evidence in humans, it is difficult to make a recommendation for the regular use of CBD in chronic pain management.

The post CBD for chronic pain: The science doesn’t match the marketing appeared first on Harvard Health Blog.

from Harvard Health Blog https://ift.tt/3cB1jR7

Read More

Cough and cold season is arriving: Choose medicines safely

With the summer winding down and fall moving in, colder weather will arrive soon — along with cold and flu season. Millions of Americans get the common cold each year, often more than once. To counter coughs and runny noses, many will turn to over-the-counter (OTC) medications available for relief without a prescription.

Heading to the pharmacy for some relief? Read this first

While OTC medicines do not cure or shorten the common cold or flu, they can ease some symptoms. Finding a product that fits your needs, however, may not be so straightforward. A recent study evaluated brand-name OTC medications marketed as cold, allergy, sinus, and nasal remedies. It found that 14 common brand names, such as Mucinex, Tylenol, Robitussin, Benadryl, and Theraflu, accounted for 211 unique products, yet all of these products contained only eight active ingredients, alone or in combination.

Half of those ingredients turned up in more than 100 different products, very often combined with up to three other active ingredients. In total, 688 combination products were found. Many appear under the same brand name, and all aim to remedy colds, allergies, or sinus and nasal ailments. No wonder a trip to a pharmacy aisle can be confusing (and the study did not even include store-branded and generic products).

How to safely choose cough and cold medicines

So, how to choose from a myriad of similar products? First, understand that many products contain more active ingredients than you need. And yes, those extra active ingredients have side effects and may interact with other medicines you take. The simplest advice is to check the list of active ingredients on the package, and pick a product that targets your particular symptoms.

• For sore throats, headaches, and muscle aches a pain reliever such as acetaminophen or a nonsteroidal anti-inflammatory drug such as ibuprofen will do the trick. These will also break a fever.
• Runny nose, watery eyes, and sneezing may be relieved by an antihistamine, such as chlorpheniramine. Antihistamines can cause drowsiness, so caution is advised when taking an antihistamine during the day.
• Nasal congestion responds temporarily to decongestants, such as phenylephrine and pseudoephedrine. However, decongestants can cause insomnia and agitation. These medications can also increase blood pressure and heart rate, so check with your doctor or a pharmacist if you have diabetes, glaucoma, heart disease, high blood pressure, prostate problems, or thyroid problems. Some decongestants are available as a nasal spray. These should not be used for more than three days, as longer use can lead to rebound congestion.
• Common cough medicine ingredients are guaifenesin, which can help clear mucus, and dextromethorphan, a cough suppressant. The relief they provide is minor, if any. Guaifenesin is relatively safe; on the other hand, excessive use of dextromethorphan may increase blood pressure, cause irregular heartbeat, and make you feel dizzy.

What to be careful about

Despite glamourous claims and an ever-growing arsenal of products, over-the-counter cough, cold, and flu medications provide only minor relief for some symptoms, which will go away on their own without any treatment.

• Be aware that the American Academy of Pediatrics does not recommend any over-the-counter cough and cold preparations for children under the age of 6.
• If you’re taking more than one product, make sure you don’t double up on ingredients. Acetaminophen, in particular, is present in many cough and cold medications, as well as in some prescription pain medications. While safe in low doses, it can be toxic to the liver in high doses (above 4 grams daily), so check the labels.
• Most of these products contain multiple ingredients, many of which have potentially serious side effects. Do not assume they are safe for you, and do read labels carefully. Talk to a pharmacist or your doctor when in doubt.
• Always let your doctor know about all the medicines and supplements you’re taking. A brand name may not offer enough information, so bring products or packages to your visit.

These precautions are especially important if you have underlying medical conditions, such as high blood pressure or heart problems.

The best treatment for common colds is plenty of rest and liquids. Prevention is better still. So wash your hands and stay away from sick people, if possible. And get a flu shot — it won’t prevent a cold, but it’s the best way to prevent flu, and you don’t want to be worrying about flu this year.

The post Cough and cold season is arriving: Choose medicines safely appeared first on Harvard Health Blog.

from Harvard Health Blog https://ift.tt/2FUFaB0

Read More

Discrimination, high blood pressure, and health disparities in African Americans

Over the past few months, we have all seen the results of significant disruption to daily life due to the COVID-19 pandemic, high levels of unemployment, and civil unrest driven by chronic racial injustice. These overlapping waves of societal insult have begun to bring necessary attention to the importance of health care disparities in the United States.

Direct links between stress, discrimination, racial injustice, and health outcomes occurring over one’s lifespan have not been well studied. But a recently published article in the journal Hypertension has looked at the connection between discrimination and increased risk of hypertension (high blood pressure) in African Americans.

Study links discrimination and hypertension in African Americans

It has been well established that African Americans have a higher risk of hypertension compared with other racial or ethnic groups in the United States. The authors of the Hypertension study hypothesized that a possible explanation for this disparity is discrimination.

The researchers reviewed data on 1,845 African Americans, ages 21 to 85, enrolled in the Jackson Heart Study, an ongoing longitudinal study of cardiovascular disease risk factors among African Americans in Jackson, Mississippi. Participants in the Hypertension analysis did not have hypertension during their first study visits in 2000 through 2004. Their blood pressure was checked, and they were asked about blood pressure medications, during two follow-up study visits from 2005 to 2008 and from 2009 to 2013. They also self-reported their discrimination experiences through in-home interviews, questionnaires, and in-clinic examinations.

The study found that higher stress from lifetime discrimination was associated with higher risk of hypertension, but the association was weaker when hypertension risk factors such as body mass index, smoking, alcohol, diet, and physical activity were taken into consideration. The study authors concluded that lifetime discrimination may increase the risk of hypertension in African Americans.

Discrimination may impact hypertension directly and indirectly

Discrimination is a chronic stressor that has been proposed to contribute to adverse health outcomes, including hypertension. Discriminatory acts may directly impact hypertension via the stress pathway, triggering a rise in hormones that cause blood vessels to narrow, the heart to beat faster, and blood pressure to rise. Discrimination may also contribute to the development of hypertension through unhealthy behaviors, such as unhealthy eating or sedentary lifestyles. People may even avoid seeking medical care due to concern that they will experience discrimination in a medical setting.

Two other longitudinal studies (a type of study that follows participants over time) have examined discrimination and hypertension. A 2019 study published in Annals of Behavioral Medicine found that everyday discrimination may be associated with elevated hypertension risk among a sample of white, African American, Latino, and Asian middle-aged women. Another 2019 study in the International Journal of Environmental Research and Public Health found association between chronic discrimination and hypertension in a large sample of African American women.

Disparities are evident across health indicators

Racial and ethnic health disparities are reflected in a number of national health indicators. For example, in 2002, non-Hispanic Blacks trailed non-Hispanic whites in the following areas:

• people younger than 65 with health insurance (81% of non-Hispanic blacks versus 87% of non-Hispanic whites)
• adults 65 or older vaccinated against influenza (50% versus 69%) and pneumococcal disease (37% versus 60%)
• women receiving prenatal care in the first trimester of pregnancy (75% versus 89%)
• adults 18 and older who participated in regular moderate physical activity (25% versus 35%).

In addition, non-Hispanic Blacks had substantially higher proportions of deaths from homicide, and children and adults who were overweight or obese, compared to non-Hispanic whites.

Many factors contribute to health inequities

For African Americans in the United States, health disparities can mean earlier deaths related to development of chronic disease such as diabetes, hypertension, stroke, heart disease, decreased quality of life, loss of economic opportunities, and perceptions of injustice. In our society, these disparities translate into less than optimal productivity, higher health care costs, and social inequity.

It is clear that multiple factors contribute to racial and ethnic health disparities. These include socioeconomic factors such as education, employment, and income; lifestyle factors like physical activity and alcohol intake; social and environment factors, including educational and economic opportunities, racial/ethnic discrimination, and neighborhood and work conditions; and access to preventive health care services such as cancer screening and vaccination.

The solution to health disparities for African Americans is certainly within our societal grasp. It requires leadership at a state and national level, appropriate resource allocation, and larger and more focused clinical investigation.

The post Discrimination, high blood pressure, and health disparities in African Americans appeared first on Harvard Health Blog.

from Harvard Health Blog https://ift.tt/32QCXzf

Read More

Shorter dream-stage sleep may be related to earlier death

Time and time again, adequate sleep has been shown to be critical to daily functioning and long-term health. Sleep serves numerous roles: recovering energy for the brain, clearing waste products, and forming memories. Prior studies have clearly linked shortened sleep times to heart disease, obesity, reduced cognitive performance, worsened mood, and even a shorter life. There is now new research that suggests that lack of a certain type of sleep (the dream stage of sleep) may be related to an earlier death in middle-aged and older people.

What is REM sleep?

Normal sleep is broken down into two sleep types: rapid eye movement (REM) and non-rapid eye movement (NREM). NREM is further classified by depth of sleep; N1 and N2 are lighter sleep stages, and N3 is deep sleep, which is most restorative. (REM is the stage where vivid dreaming occurs.) Brainwave activity during this time appears similar to the brain’s activity while awake. REM periods generally occur every 90 minutes, and are longest during the second half of the night. REM sleep normally makes up 20% to 25% of sleep time.

How does sleep change with age?

Sleep time and sleep stages naturally change as we age. Total sleep time decreases by 10 minutes every decade until age 60, when it stops decreasing. Time in N3 sleep, the deepest sleep stage, also shortens with age; time in N1 and N2 tends to increase. As a result, people wake more easily from sleep as they age. The percentage of REM sleep also naturally decreases; thus, reduced time spent in REM may be a marker of aging.

The circadian rhythm is a 24-hour internal clock that governs numerous body functions including body temperature, release of hormones, and sleep time. The internal clock “advances” with age, so older adults tend to fall asleep earlier and wake earlier. Adapting to jet lag and shift work becomes more difficult. Daytime napping also increases as the strength of the circadian rhythm and the drive to sleep at night decrease.

Studies have also shown that older adults who are healthy may not perceive problems with sleep when it is actually impaired, or may assume that certain disruptions are part of aging when they have treatable conditions.

Why would less sleep increase my risk of death?

In the short term, sleep deprivation increases cortisol levels, causes increased blood pressure, decreases glucose tolerance, and increases the activity of the body’s fight-or-flight system, all of which are linked to increased risk of diabetes, heart attacks, and strokes. Daytime cognitive performance is also reduced, resulting in more accidents. Twenty-four hours of sustained wakefulness impairs driving ability to the same degree as a blood alcohol concentration of 0.10%, which is above the legal limit.

In the long term, both short and long sleep (less than five hours or more than nine hours) have been associated with earlier death. People who sleep less than four hours dramatically increase their risk of dying early, possibly through heart disease, diabetes, high blood pressure, chronic stress, lower immunity, and overall more rapid aging.

Less dream-stage sleep makes a difference

We know that short sleep is associated with increased mortality, but until now it has been unclear if shorter sleep in a particular sleep stage makes a difference in the health risks associated with sleep deprivation. A new study published in JAMA Neurology looked at the relationship between REM sleep and earlier death in two large study groups, one consisting of 2,675 older men and the other of 1,386 middle-aged men and women. They followed both groups over time and looked at the relationship between sleep stages and causes of death.

Both groups showed increased mortality rates related to a decrease in REM sleep, with a 13% higher mortality rate for every 5% reduction in REM sleep. REM sleep was the most important sleep stage for predicting survival.

Putting new research into context: What does this mean for me?

This study showed an association between reduced REM and increased mortality, but it did not demonstrate the cause of the association. REM deprivation could independently contribute to the development of numerous other diseases. The results apply more clearly to older adults, given that the age groups studied averaged in the 50s and 70s. Short REM may also be a marker of a sick or aging brain; less REM sleep has already been tied to a greater risk of dementia. Overall, ensuring adequate REM sleep is important to protecting your long-term health.

Getting better sleep in middle age and beyond

Maintaining good sleep should remain a priority throughout your life. Everyone can make healthy choices to maximize restorative sleep. Dr. Suzanne Bertisch has written previously about recommendations for improving sleep hygiene, and even more suggestions are available in the Harvard Health Publishing Special Health Report Improving Sleep: Getting a Good Night’s Rest.

Some fundamental steps to improve your sleep and health include:

• Get at least seven hours of sleep each night. If you still feel tired, sleep a little more; some people need eight or nine hours of sleep to feel rested.
• Keep a consistent bedtime and wake time. This will make falling asleep easier, and will keep your circadian rhythm aligned with your sleep and wake time.
• Try to sleep when your body naturally wants to fall asleep and wake up. This can differ from sleep and wake times required for work schedules, which also has negative consequences. A sleep doctor can help you realign your circadian clock with your schedule.
• Depression or other mood disorders can cause disrupted sleep. Talk to your doctor if you are feeling low, no longer enjoy your hobbies, or are struggling with anxiety or sadness.
• If you can’t fall asleep, stay asleep, or feel sleepy all the time, you may need evaluation from a doctor for a sleep disorder such as sleep apnea or insomnia. Treating these disorders can make a major difference in overall sleep quality and health.

The post Shorter dream-stage sleep may be related to earlier death appeared first on Harvard Health Blog.

from Harvard Health Blog https://ift.tt/3iDsgFM

Read More

Time for flu shots — getting one is more important than ever!

Wondering when to get your flu shot? The best time is before influenza (flu) starts circulating widely. For most people, September or October is ideal for protection through the whole flu season, as the immune response from the vaccine wanes over time. And while changes and restrictions due to COVID-19 may make getting a flu vaccine less convenient for some this year, the pandemic makes it more important than ever.

Why do I need to get a flu vaccine yearly?

Influenza A and Influenza B cause most cases of flu in humans. Both have many strains that constantly change, accumulating genetic mutations that disguise them from the immune system. Prior exposure to one strain of flu will not necessarily protect you from other strains. Your immune system might not even recognize the same strain if it has mutated enough.

The Centers for Disease Control and Prevention (CDC) constantly monitor changing strains of influenza around the world. They use this data to develop vaccines months before flu season starts to protect against the most likely strains to reach the US. This flu season, common strains are likely to include H1N1 and H3N2.

How effective is the flu vaccine?

Although the vaccine is not perfect, it is 40% to 60% effective in most years. And if you do get the flu it is likely to be milder, because vaccination reduces the risk of severe illness or death.

During the 2018–2019 flu season, 35.5 million Americans got sick with the flu, and 34,200 died from the flu. However, last year half of all Americans received the flu shot. The CDC estimates this prevented 4.4 million cases of flu, 58,000 hospitalizations, and 3,500 deaths. That’s equivalent to saving 10 lives per day during flu season. The flu vaccine has additional benefits for people with chronic medical conditions, like reducing the risk of heart attacks, strokes, or death among people with heart disease, and decreasing illness flares in people with chronic obstructive pulmonary disease (COPD).

Why is it especially important to get the flu vaccine this year?

Measures that help protect us against COVID-19 — such as distancing, wearing face coverings, and washing hands often — may also decrease the spread of flu. Yet it’s more important than ever to get vaccinated. The COVID-19 pandemic has caused shortages of hospital beds, ICU beds, and ventilators even outside of flu season. During flu season, when both the flu and COVID-19 will be circulating, hospitals may again face shortages, limiting their ability to care for people who are seriously ill with the flu, COVID-19, or both.

People can get COVID-19 and the flu at the same time. A recent study showed people who had COVID-19 and influenza B were sicker than those who had COVID-19 alone.

Also, COVID-19 and flu have similar symptoms like fever, chills, fatigue, body aches, and coughs. So people who get the flu may need to be tested for COVID-19, and then quarantine until they get the test result. This could mean more days out of work. It could also lead to testing shortages.

Which type of flu vaccine should I get?

The CDC recommends a vaccine for everyone 6 months or older, with very few exceptions. Which flu vaccine is right for you depends on factors like age, allergies, coexisting illnesses, and vaccine availability. For adults who have no allergies or chronic medical conditions, and who are not pregnant, the CDC does not recommend any one vaccine over another.

• Eleven flu vaccines are approved by the FDA for the 2020–2021 season. Most are available as shots, and contain either inactivated (killed) virus or recombinant virus (made using lab techniques). Vaccines can be made using egg-based or non-egg-based processes.
• A trivalent (three-part) flu vaccine contains two strains of influenza A (one H1N1 and one H3N2) and one of Influenza B.
• A quadrivalent (four-part) vaccine adds another Influenza B strain.
• A vaccine given as a nasal spray is quadrivalent, and contains live attenuated (weakened) virus. It’s approved for healthy, non-pregnant people ages 2 to 49.
• A high-dose flu vaccine and a flu vaccine with an adjuvant (an ingredient which boosts immune response) offer additional protection to people ages 65 and older. These are not approved for younger people.

Infants under 6 months are too young to be vaccinated, but if their mother received a flu vaccine while pregnant, babies have partial protection after birth. People who have had severe, life-threatening allergies to the influenza vaccine or any of its ingredients should not be vaccinated. However, most people with egg allergies can get the flu shot. Depending on their reaction to eggs, they can either get the same vaccines as someone without allergies or get an egg-free flu vaccine. If you have an egg allergy, any history of allergies to vaccines or components of the flu vaccine, or if you have had Guillain-Barré syndrome (a rare condition where the immune system attacks the nerves), talk to your doctor before getting vaccinated.

Where can I get a flu vaccine?

You can check with your doctor or health plan to find local flu vaccine clinics. Vaccines are also available at drug stores, supermarkets, and health clinics. Depending on insurance, the flu vaccine may be free.

You can also check with your local board of health for free vaccine sites. In many cities and states, you can call 211 for this information.

The CDC emphasizes how important it is for as many people as possible to get the flu vaccine this year, and issued guidelines for minimizing COVID-19 risks while doing so. Healthcare facilities are taking measures to reduce risk, such as symptom screening, spacing of appointments, and enforcing social distancing and mask-wearing. With appropriate precautions, COVID-19 exposure risk while getting your flu vaccine should be minimal, no greater than going to the store.

The post Time for flu shots — getting one is more important than ever! appeared first on Harvard Health Blog.

from Harvard Health Blog https://ift.tt/33BrQcN

Read More

Harvard Health Ad Watch: A feel-good message about a diabetes drug

This 60-second advertisement for Trulicity, a medication for diabetes, is one of the most feel-good medication commercials I’ve ever seen. The narrator never uses the scare tactic of so many other ads, listing the terrible things that could happen if you don’t take the treatment. Instead, from start to finish, music, images, and spoken words deliver empowering, encouraging messages focused on helping your body to do what it’s supposed to be doing despite having diabetes.

There’s a lot of good information here, but as in most direct-to-consumer health marketing there’s also some that’s missing. Let’s go through it, shall we?

Three actors, three positive messages

The ad opens with uplifting music and statements by three people with type 2 diabetes (though all are actors, as noted in text at the bottom of the screen). A woman faces the camera to declare

“My body is truly powerful.”

So far so good! Then a man wearing a hard hat and holding blueprints at a construction site states

“I have the power to lower my blood sugar and A1C.”

More good news! By the way, he’s referring to hemoglobin A1C (HbA1C), a molecule in the circulatory system that serves as a standard test of average blood sugar over the previous two to three months. A normal or nearly normal HbA1C suggests good diabetic control, while higher results indicate elevated blood sugar and poorer control of diabetes.

We then meet a third woman wearing scrubs, who works in the physical therapy department of a hospital. She says

“…because I can still make my own insulin and Trulicity activates my body to release it, like it’s supposed to.”

Well, that sounds good, too, right? Presented this way, Trulicity seems more natural, because it encourages the release of your body’s insulin rather than relying on injected insulin.

What is Trulicity anyway?

A voiceover tells us Trulicity is not insulin, it’s taken once weekly, and it starts acting from the first dose. Tiny print notes the generic name (dulaglutide) and the fact that it’s an injection “to improve blood sugar in adults with type 2 diabetes when used with diet and exercise.” Then we hear who should not take Trulicity, a list including children, people with Type 1 diabetes, and women who are pregnant. Possible side effects are described, such as nausea, low blood sugar, stomach problems, and allergic reactions (see full list here). The FDA requires this in all direct-to-consumer ads.

As the camera pans up to sun shining through leaves and a band plays in the background, we see the physical therapist again — having changed out of scrubs into regular clothes — at a picnic with her family. We hear a few more warnings about side effects and the risk of lowering blood sugar too much when taking Trulicity with other diabetes medications.

Standing in a beautiful park, the woman faces the camera and says

“I have it within me to lower my A1C.”

Finally, the voiceover makes the usual suggestion

“Ask your doctor about Trulicity.”

What this ad gets right

The description of dulaglutide as a non-insulin medication that stimulates the release of insulin is accurate. The text and spoken information about the medication, including who should and should not take it and the possible side effects, reflect the FDA-approved prescribing information. And the unspoken message — that people with diabetes can be active, working, social individuals — is also true (and, perhaps, underappreciated).

What’s missing from this ad

Some important information provided only in text is easy to miss. It appears only for a few seconds, and some of the print is quite small — they don’t call it fine print for nothing! For example, you could easily miss the fact that Trulicity is available only by injection. Similarly, you could overlook the text explaining that Trulicity is not a first choice for the treatment of type 2 diabetes, and that diet and exercise are important in managing this condition.

Other missing information includes

• the meaning and relevance of HbA1C
• whether Trulicity reduces complications of diabetes, such as kidney disease, nerve damage, or visual problems, or improves quality of life or longevity; in fact, there is evidence it can reduce cardiovascular complications and death in high-risk individuals
• whether Trulicity is better than other treatments for diabetes, including other injectable treatments that work in a similar way, oral medications, or insulin
• the high cost of Trulicity: the “list price” is nearly $10,000/year, although health insurance or assistance programs may lower the out-of-pocket cost.

One other potentially misleading feature of the ad is the choice of actors. Excess weight is a major risk factor for type 2 diabetes. Yet, two of the three actors portraying patients, including the physical therapist who makes multiple appearances, appear close to normal weight. The third appears only modestly overweight.

The bottom line

Advertisements can provide a lot of useful information, but they can also be misleading. While there are regulations around what can and cannot be included in ads for prescription medications like Trulicity, these regulations do not require commercials to paint a full picture.

If you or a loved one has type 2 diabetes, there are better ways to learn about the options for treatment than a drug ad. Yes, talk to your doctor. But don’t limit your conversation to something you heard or read about in a feel-good drug ad.

The post Harvard Health Ad Watch: A feel-good message about a diabetes drug appeared first on Harvard Health Blog.

from Harvard Health Blog https://ift.tt/2ZGIrL0

Read More

6 all-natural sex tips for men

If you believe those upbeat, seductive advertisements, men only need to pop a pill to awaken their dormant sex life. Whether the problem is erectile dysfunction (ED) — the inability to maintain an erection for sex — or low libido, ED medications appear to be the quickest and easiest solution.

While these drugs work for most men, they are not right for everyone. ED drugs are relatively safe, but can cause possible side effects such as headaches, indigestion, and back pain. Plus, some men may not want their sex life dependent on regular medication, or simply can’t take them because of high or low blood pressure, or other health conditions.

Fortunately, there are some proven natural ways for men to manage their ED and increase vitality. Bonus: these strategies also can enhance your overall health and quality of life, both in and out of the bedroom.

Six ways to boost your sex life without medications

1. Get moving. Research has shown that regular exercise is one of the best medicines for ED. One study of almost 32,000 men ages 53 to 90 found that frequent vigorous exercise equal to running at least three hours per week or playing tennis five hours per week was associated with a 30% lower risk of ED compared with little or no exercise. It doesn’t really matter how you move — even walking is great — as long as you keep moving.
2. Eat right. Go bullish on fruit, vegetables, whole grains, and fish, while downplaying red and processed meat and refined grains. This type of diet lessened the likelihood of ED in the Massachusetts Male Aging Study. Another tip: chronic deficiencies in vitamin B₁₂ — found in clams, salmon, trout, beef, fortified cereals, and yogurt — may harm the spinal cord, potentially short-circuiting nerves responsible for sensation, as well as for relaying messages to arteries in the penis. Multivitamins and fortified foods are the best bets for those who absorb B₁₂ poorly, including many older adults and anyone with atrophic gastritis, a condition that may affect nearly one in three people ages 50 and older. Also, make sure you get enough vitamin D, which is found in fortified milk or yogurt, eggs, cheese, and canned tuna. A study in the journal Atherosclerosis found that men with vitamin D deficiency have a 30% greater risk for ED.
3. Check your vascular health. Signs that put you on the road to poor vascular health include soaring blood pressure, blood sugar, LDL (bad) cholesterol, triglycerides; low HDL (good) cholesterol; and a widening waist. Check with your doctor to determine whether your vascular system — and thus your heart, brain, and penis — is in good shape, or needs a tune-up through lifestyle changes and, if necessary, medications.
4. Measure up. A trim waistline is one good defense — a man with a 42-inch waist is 50% more likely to have ED than one with a 32-inch waist.
5. Slim down. Tip the scales at a healthy weight. Obesity raises risks for vascular disease and diabetes, two major causes of ED. And excess fat tinkers with several hormones that may feed into the problem, too. Need more reasons? Slimming down helps with tips 3 and 4.
6. See your dentist. A study in The Journal of Sexual Medicine found an association between gum disease and risk for ED. Gum disease causes chronic inflammation, which is believed to damage the endothelial cells that line blood vessels, including those in your penis.

The post 6 all-natural sex tips for men appeared first on Harvard Health Blog.

from Harvard Health Blog https://ift.tt/32yzSno

Read More

Learning to live well with a persistent illness

When we get an acute illness like the flu or a cold, we feel sick for a week or two and then get back to our usual lives. This is how illness is “supposed” to go. But what happens when illness doesn’t fit this bill? What do patients with chronic conditions like diabetes or multiple sclerosis, or with persistent symptoms of Lyme disease or long-haul COVID-19, do when they can’t go back to their normal lives? Having suffered from the latter two — tick-borne illnesses that have plagued me for two decades, and a case of COVID-19 that took four months to shake — I’ve learned a few lessons about living with persistent illness.

Reframe your mindset

The most important — and hardest — lesson I’ve learned is that with debilitating, persistent conditions, there is no going back. I got sick at age 25. I had been working full-time, living an incredibly active lifestyle, burning the candle at both ends. Suddenly, the candle was gone. Bedridden through years of intense treatment, all I could talk about was getting back on track. I even threw a big “back to life” party when I finally achieved remission. Then I went right back to the high-functioning lifestyle I’d always known.

Three months later, I relapsed completely. It took another couple of years of treatment to get well enough to attend graduate school, socialize, exercise, and work. The journey wasn’t linear. I had to pace myself to have more good days than bad. I realized I couldn’t just wipe my hands of my illnesses. These persistent infections were coming with me, and not only did I have to accept them, I had to learn to move forward with them in a way that honored my needs but didn’t let them run my life.

Recognize your needs

Our bodies are good at telling us what they need: food, sleep, down time. We’re not always good at listening to these messages, however, because we live busy lives and sometimes can’t or don’t want to make time to take care of ourselves. When you have a persistent illness, ignoring your body’s needs becomes harder, if not impossible, and the consequences are more severe.

I’ve learned that I have to pace myself physically and neurologically, stopping activity before I get tired so my symptoms don’t flare. I have to rest in the early afternoon. I must stick to a particular diet, stay on low-dose medications, and do regular adjunct therapies in order to maintain my health. Now, after recovering from COVID-19, I also need to be conscious of residual lung inflammation.

At first, I saw these needs as limitations. They take up time and energy and prevent me from living a normal life. But when I reframed my thinking, I realized that I’ve simply created a new normal that works in the context of my illnesses. Everyone, sick or healthy, has needs. Acknowledging and respecting them can be frustrating in the short term, but allows us to live better in the long term.

Think outside the box

Once you figure out how to best meet your needs, you can plan other parts of your life accordingly. Your health must come first, but it isn’t the only important aspect of your life, even when you have a persistent, debilitating illness.

I had to shift my thinking from feeling anxious and embarrassed by what I couldn’t do, to optimizing what I can. I can’t work a traditional 9-to-5 job anymore, but I can write and teach on a more flexible schedule. I can’t go for an all-day hike (and might not want to anyway, due to ticks!), but I can enjoy a morning of kayaking. What skills do you have to offer, and what innovative opportunities might put them to good use? What activities do you miss, and how can you do them in an adaptive way? If that’s not possible, what’s a new activity you could explore?

Hope for the future, but live in the present

Learning to live well with a persistent illness does not mean resigning yourself to it. I’m able to do more each year, even though I sometimes have short setbacks. I change medications. I try new therapies. I manage my illnesses as they are now, but I haven’t given up hope for a cure, and am always striving to find ways to make my life even better. I can’t control what my illnesses do, but I can control how I handle them. And that makes life a little brighter.

Follow me on Twitter @writerjcrystal.

The post Learning to live well with a persistent illness appeared first on Harvard Health Blog.

from Harvard Health Blog https://ift.tt/2RmJIlW

Read More

5 takeaways for returning to school

School districts in the United States are in a period of profound uncertainty, which will likely persist throughout the 2020–2021 school year. Many agree that remote teaching in spring 2020 was piecemeal and sub-optimal. Now, despite a stated universal commitment to full-time, in-person, high-caliber education, many states have rising rates of COVID-19, and teachers and parents share deep health concerns. Already we have witnessed a rapid and seismic transition from the beginning of this summer — in June, many schools planned to open full-time for in-person learning — to near-universal adoption of hybrid or remote teaching models. In fact, as of August 26th, 24 of the 25 largest school districts in the US will start their school year providing remote-only education.

Seeking perspective on a safe return to school

I began the summer thinking that I could contribute in some small way to fusing together basic public health and educational principles toward a safe return to school. I teach a course at the Harvard T.H. Chan School of Public Health on big public health campaigns. My daughter, an urban education scholar, lectures in my class on the value of parent-teacher collaboration. As a grandparent of three little boys ages 7, 4, and 3, and as a parent and father-in-law of two children and their spouses facing extraordinarily difficult decisions concerning school and day care, I am personally invested.

A colleague from a large social service agency shared a story of parents working in the hospitality industry. They face having to leave children, ages 6 and 8, home alone during the day trying to learn remotely. My own story — working years ago as a day care worker and unionized steelworker — affords me a sense of kinship with teachers. And during the past three months, while writing guidelines for school superintendents in Massachusetts and nationally, I’ve talked with parents of school-age children, school nurses, and superintendents navigating the raging debate over a safe return to school. The view differs depending on where you stand, but I have distilled some lessons.

Five takeaways: Steps and missteps in return to school

Sleepless nights, anxiety, and collaboration. In all of my conversations, whether it was with a school leader, a parent, a grandparent, or a school nurse, people shared the same stories of a succession of sleepless nights, coupled with the most difficult decision they have made in their personal and professional lives. Parents, in particular, speak of their anxiety, panic, exhaustion, powerlessness, and lack of support in trying to come up with a reasonable strategy for their children. At the same time, the potential for collaboration abounds. Parents and teachers are natural allies. They can jointly advocate for federal and state resources to ensure that our nation’s children can ultimately return to safe schools.

Lack of metrics. School superintendents, for whom I have come to have immense respect, have received little guidance on metrics to use as they decide to open schools now or close them later. They will need data on the number of cases in their community, trends over time, and the positive test rates for their areas and the areas closest to their districts. Parents are also looking for complete transparency as districts review community metrics to make closing or reopening decisions. There will be successful school openings and challenging ones. All interested parties need a forum to share their stories with one another.

Tutors, mentors, and collective space. Providing computers and hotspots is important to children and families who need them, although we also need to keep in mind that some families clearly have no internet access. Many families will need tutors, mentors, facilitators, and collective space to be skillfully educated in a remote setting. Low-income communities should be funded to promote and create community learning hubs that will be required for the millions of children who will not be educated in classrooms.

Masks and fabric face coverings. Mask wearing, dubbed the “interim vaccine,” must be the cornerstone of a national plan to reduce transmission in school settings and collective spaces. How can we reinforce mask wearing? For parents, teachers, and day care providers alike, the clock starts now as we vigilantly practice mask wearing before and after in-person schooling starts, then maintain this practice through the school year. School leaders, parents, and teachers can work together on crafting signage that reinforces the social norm of mask wearing in schools and on school buses, and incentivizing children for doing so.

Openness to evolving science and wisdom beyond our borders. Most importantly, we should all be humble about the limits of knowledge in the early stages of a pandemic, and expect changes as scientific understanding evolves. Initially, many experts believed that children did not get and did not transmit the virus. There was little basis to say this, as nearly every school in the US had shut down by no later than March 17th. We can look elsewhere for models, but schools in Europe started outdoors and never had more than 15 kids per class. If it were not for the surge that hit a large swath of the country in late June, we may have careened tragically toward full, in-person reopenings, with 25 children in a class and 66 children on a school bus. Recently, as schools opened in the US and abroad, we have been inundated with reports of cases diagnosed among students and teachers. However, basic public health principles of social distancing, mask wearing, and handwashing can prevail if consistently applied.

Schools cannot open safely if there are high rates of community transmission. School reopenings must take precedence over the opening of bars, indoor restaurants, and large indoor social gatherings. We all have a collective responsibility and social compact with one another to strive for a healthy and full return to school for our nation’s students and teachers.

For further discussion of return-to-school issues, listen to our “Living Better, Living Longer” podcast with Alan Geller, “Back to School: It’s Never Been More Complicated.”

The post 5 takeaways for returning to school appeared first on Harvard Health Blog.

from Harvard Health Blog https://ift.tt/3igjXQ5

Read More

Getting the best treatment for your fibromyalgia

Imagine being in pain and having your doctor tell you it’s all in your head. Unfortunately, this is not an uncommon experience for many of the six million Americans living with fibromyalgia, a chronic, painful condition.

People with fibromyalgia experience widespread pain, aches, and stiffness in muscles and joints throughout the body, as well as unusual tiredness. No one knows what causes this condition, and no apparent physical cause has been identified thus far. The most likely culprit is a brain malfunction that amplifies normal nerve responses, causing people with fibromyalgia to experience pain or other symptoms when nothing seemingly triggers them.

For those seeking relief, finding help can sometimes be a challenge. The best way to find a successful treatment strategy is to seek out a doctor who understands fibromyalgia, knows how to treat it, and can help you understand and cope with this condition. There are ways that you can improve your chances of finding the right match.

Understand your condition

The first step in this process is to arm yourself with the facts.

• Fibromyalgia is a real disorder. The American College of Rheumatology has created criteria that doctors can use to diagnose it (see this link for a patient-friendly version). It is recognized by national and international health agencies, including the World Health Organization.
• Fibromyalgia often coexists with mental health conditions such as anxiety and depression, but it is not caused by a mental illness.
• Fibromyalgia is not “in your head,” but it is related to brain activity. Differences in how the brain processes pain can be seen on functional MRI scans of people with fibromyalgia.
• The FDA has approved three drugs specifically for treating fibromyalgia: pregabalin (Lyrica), duloxetine (Cymbalta), and milnacipran (Savella). These drugs are effective against nerve pain, and are used for other conditions as well.

Seek referrals to providers who understand fibromyalgia

To find the right healthcare provider, it may help to go to those who already have experience in this area. Support groups provide a natural starting point. The National Fibromyalgia Association website lists support groups in each state that can help you find these initial connections. The organization can also provide a list of “fibro friendly” doctors in your state.

You can also look to your primary care doctor to help steer you in the right direction. Many doctors will be able to recommend a specialist who can help you manage your condition.

Once you settle on a prospective provider, make sure she or he is the right fit. Ask the office staff whether the doctor frequently sees patients with fibromyalgia and treats them on an ongoing basis. Also ask what treatments the doctor typically prescribes. Find out what type of services they provide; for example, do they offer telemedicine appointments? What services will they provide remotely, and which ones will require an office visit? If the answers aren’t what you’re looking for, or the office doesn’t seem receptive to your concerns, don’t be afraid to look elsewhere.

Connect your medical team

Once you do find the right provider, make certain that she or he is willing to communicate with your other providers. Many people with fibromyalgia need multiple doctors to manage their symptoms. Seeing multiple specialists can increase the risk of medication errors or harmful interactions of drugs prescribed by different doctors. In addition, your doctors may duplicate laboratory tests or other services. This can unnecessarily increase the cost of your care.

Finding the right doctor for your needs may not always be easy, but it’s worth the extra effort to increase your chances of successfully managing your condition.

The post Getting the best treatment for your fibromyalgia appeared first on Harvard Health Blog.

from Harvard Health Blog https://ift.tt/3k43xLa

Read More

Hormonal treatments for prostate cancer may prevent or limit COVID-19 symptoms

Men have roughly twice the risk of developing severe disease and dying from COVID-19 than women. Scientists say this is in part because women mount stronger immune reactions to the disease’s microbial cause: the infamous coronavirus called SARS-CoV-2.

Now research with prostate cancer patients points to another possible explanation, which is that the male sex hormone testosterone helps SARS-Cov-2 get into and infect human cells.

SARS-CoV-2 initiates infections by first latching onto its human cell receptor. But it can only pass into a cell with the aid of a second protein called TMPRSS2. Testosterone regulates TMPRSS2, such that levels of the hormone and the protein rise and fall together in tandem. If testosterone levels are depressed, scientists speculate, then TMPRSS2 levels might also be so low that the novel coronavirus is blocked at the gates.

At least five clinical trials are now investigating if drugs acting on testosterone and its own receptor “could either prevent or cure COVID-19 symptoms,” said Dr. Andrea Alimonti from the University of Lugano in Bellanzona, Switzerland.

Positive results from one study

During a recent study, Alimonti’s team reviewed data from 42,434 men who were being treated for prostate cancer in the Veneto region of Italy. Among them, 5,273 were getting androgen deprivation therapies (ADT) that suppress testosterone. (The hormone fuels prostate tumors, so ADT is for some men a mainstay of treatment.) According to that investigation, coronavirus infection rates in the ADT-treated men were four times lower than they were in men who were not getting ADT. The researchers acknowledged the need for more study, but proposed that ADT “could be used transiently in men affected by SARS-CoV-2.”

And negative results from another

Other scientists are skeptical. Dr. Eric Klein, a urologist at the Cleveland Clinic Lerner College of Medicine, argues that testosterone may not regulate TMPRSS2 in the lungs as it does in the prostate. Suppressing the hormone, he says, might therefore have little consequence for preventing SARS-CoV-2 respiratory symptoms. In a recent study of 1,779 men with prostate cancer, Klein and his colleagues generated evidence showing that ADT did not protect from COVID-19. The paper is currently in press at the Journal of Urology and has not yet been published.

Still, Klein stopped short of dismissing the possibility that ADT could be therapeutically useful in treating COVID-19. “Definitive answers will only come from the results of ongoing clinical trials using various forms of ADT in COVID-19 patients,” he said.

Dr. Marc Garnick, the Gorman Brothers Professor of Medicine at Harvard Medical School and Beth Israel Deaconess Medical Center, and editor in chief of HarvardProstateKnowledge.org, agrees. “These studies — some positive and some negative — add to the complexities of fully understanding what affects coronavirus infectivity,” he says. “It is likely to be multi-factorial, and in some patients, testosterone levels may play a role. Pending results from large-scale clinical studies, however, no definitive recommendations about altering testosterone levels for COVID-19 treatment can be made.”

The post Hormonal treatments for prostate cancer may prevent or limit COVID-19 symptoms appeared first on Harvard Health Blog.

from Harvard Health Blog https://ift.tt/2FjKei2

Read More

Proposed guidelines likely to identify more early lung cancers

Lung cancer is the second most prevalent cancer in the US, and the deadliest cancer killer. In 2020, an estimated 135,720 people will die from the disease — more than breast, colon, and prostate cancers combined.

I’ll never forget meeting new, advanced-stage lung cancer patients who ask if their diagnosis could have somehow been made earlier, when treatment would have been more likely to succeed. In 2009, when I began practicing thoracic oncology, there were no approved screening tests for lung cancer.

A brief history of lung cancer screening

Hope for early detection and death prevention came in 2011 with the publication of the National Lung Screening Trial (NLST). This was the first randomized clinical trial to show a lung cancer mortality benefit for lung screening, using annual low-dose computed tomography (LDCT) scans for older patients with a significant smoking history. This led to the 2014 US Preventive Services Task Force (USPSTF) recommendation for lung cancer screening. The USPSTF recommended a yearly LDCT scan to screen people who met certain criteria: a 30-pack-year smoking history (smoking one pack of cigarettes per day for 30 years or the equivalent amount); being a current smoker or former smoker who quit within the past 15 years; and age from 55 to 80 years.

Since the NLST publication, an additional randomized clinical trial done in Europe (the NELSON trial, published in the New England Journal of Medicine in February 2020) also showed a reduction in lung cancer mortality associated with screening younger patients (ages 50 to 74) and with a lower pack-year smoking history. Based on this trial and other modeling information, the USPSTF issued a draft recommendation in July 2020 to change the current lung screening guidelines to include people ages 50 to 80, as well as current and former smokers with at least a 20-pack-year smoking history. For former smokers, the screening eligibility criterion remains a quit date within the past 15 years. The USPSTF estimates that following the proposed guideline could lead to a 13% greater reduction in lung cancer deaths compared to the current guideline.

Proposed guidelines could narrow racial disparities associated with screening eligibility

In addition to amplifying the benefits of screening by extending screening to younger patients with lighter smoking histories, the proposed changes may also help to eliminate racial disparities in screening eligibility. Blacks in the US have a higher risk of lung cancer compared to whites, and this risk difference occurs at lower levels of smoking. By extending the screening criteria, more people are eligible for screening, but the eligibility increases are enriched in non-Hispanic Blacks and women.

This is certainly a move in the right direction. But it’s worth noting that the rate of LDCT screening of eligible patients has been low (but is slowly increasing) since the initial lung screening guidelines were approved six years ago. My hope with the expanded eligibility criteria for lung screening is that we can renew the push to screen all eligible patients, and continue the necessary education of doctors and patients to incorporate lung screening into routine health care.

Weigh the risks and benefits of lung cancer screening

When I speak to colleagues and patients about lung cancer screening, one of the most frequent questions I receive is about the downsides of screening and how to evaluate the risks and benefits. My reply is to consider their willingness to undergo curative treatment like lung surgery or radiation treatment. Fortunately, there are now several treatment options available for most patients with lung cancer.

There are other risks to consider. For example, screening carries the possibility of false positive results that can lead to unnecessary scans, or even biopsies or surgery. A biopsy or surgery for what turns out to be noncancerous disease is a rare occurrence, but it can happen. Also, on occasion there can be a complication of a procedure. Knowing the risks before starting the screening process is important.

Progress in lung cancer screening has led to earlier diagnosis

I look forward to the day when we substantively decrease lung cancer deaths in the US and worldwide. Now, when I see patients with positive LDCT screens, I tell them how lucky we are to have found the cancer early, when we have a good chance of cure. Every time I deliver this news, I smile and think of the progress of the last 10 years, and I gear up to accelerate the momentum into the next decade and beyond.

The post Proposed guidelines likely to identify more early lung cancers appeared first on Harvard Health Blog.

from Harvard Health Blog https://ift.tt/32adwIK

Read More

Limiting COVID chaos during the school year

Child: “Will I go back to school this fall?
Parent: “I’m not sure yet.”
Child: “Do you know when we’ll find out?”
Parent: “I also don’t know that yet.”
Child: “Will school be the same for the whole year?”
Parent: “I don’t know that either.”

Sound familiar? If the only thing you do know is that plans are in flux, you’re not alone. School plans seem to be changing frequently — before the school year even has started in some places! With so much uncertainty, how can families limit the potential chaos that may unfold from last-minute decisions and changes? Below are four tips that may help.

Develop a plan for each school setup

Schools seem to be deciding among having all students return, all students attend school remotely, and a hybrid plan of the two. Although you can’t prepare for everything in the future, you can contain some of the mayhem by creating a plan for your family based on each of the three school scenarios. Because there is the possibility that schools may change their decisions throughout the school year, it may be helpful to develop all three now, in case any of them might be needed.

For example, when planning for a hybrid school year, have all caregivers in the house map out a schedule of child care coverage for the days when children would be home. For the remote learning days, creating a structured daily routine may help if the remote education doesn’t fill the whole school day.

It’s also important to talk to children about how school plans may change throughout the school year and what to expect from each plan. It can be helpful for children to understand why shifts in plans may happen, so explain that the goal of the changes would be to make sure schools can continue helping children learn while keeping them as healthy as possible.

No matter what school plan is in place on a given day, try to keep children’s schedules as consistent as possible. Keeping wake-up, meal, and bedtimes the same each day can help make children less vulnerable to the stress of other changes that may happen for them.

Plan for health and safety, too

If your children will have in-person classes, talk about healthy and safe hygiene practices while they’re in school: wearing masks, washing hands often, and paying attention to staying at a safe distance from others. Also share what you want your children to do when they return home. Where should they put their backpacks? When and where should they wash their hands when they get home? Decide how your children will get to and return home from school if you determine that needs to be different this year. For example, if your son used to carpool with other families or walk to school with other children, that plan may need to change to keep your son six feet apart from peers.

Check with your school for information about whether testing will be involved. If so, how and when would the school want a child to get tested? Also, ask about what steps the school will take if a teacher or student tests positive for COVID-19.

Make a family calendar

With so many plans in flux, a visual reminder of what the upcoming week will look like can help children keep track of the changes. Put a weekly family calendar in a shared space like the kitchen. Review the upcoming week when you’re together, such as Sunday around dinner time. You might find that it’s useful to review the next day’s schedule each night at dinner, too, to remind children what’s ahead for them. For younger children who are not of reading age, try using images, such as pictures of a school or a house, to illustrate where the child may be that day.

Create a space to share reactions

You might feel exasperated one day, sad the next, worried another, and hopeful the following day. Your children also may have a range of emotions as they navigate these trying and ever-evolving times with you. Talk to your children regularly about how they’re feeling about the plans, the changes, and more, to give them space to share their experiences and receive support. Perhaps the weekly calendar review time also could be when you check in and see how everyone is feeling about the school plans. None of you chose for this to happen, and you’re making the most of the situation by offering support and some predictability.

The post Limiting COVID chaos during the school year appeared first on Harvard Health Blog.

from Harvard Health Blog https://ift.tt/3he3Jpc

Read More