My Health - Newer drugs are improving survival for men with metastatic prostate cancer

Treatments for advanced prostate cancer that’s metastasizing, or spreading in the body, are getting better, and men with the disease are living longer because of them, new research has found.

For years, the only available treatments for these aggressive tumors were androgen-deprivation therapies (ADT) that block testosterone, the male sex hormone that makes prostate cancer cells grow faster. Giving ADT slows cancer progression, but tumors typically develop resistance against it within three years and start growing again.

But then newer treatments for metastatic prostate cancer started showing up. A drug called docetaxel was approved by the FDA in 2004, followed by cabazitaxel in 2010, sipuleucel-T in 2011, abiraterone in 2011, and enzalutamide in 2012. Each of these drugs targets metastatic prostate cancer in different ways, and men who took any one of them in clinical trials lived longer than men who took ADT by itself.

For the current study, researchers set out to answer a unique question. They wanted to know if the combined market availability of these drugs was making a survival difference for men being treated for metastatic prostate cancer in the general population.

To find out, they divided men tracked by a national cancer registry into two groups. One group of 4,298 men had been diagnosed with metastatic prostate cancer between 2004 and 2008, and another equally sized group was diagnosed with the disease between 2009 and 2014. All the men in both groups were matched in terms of age, race, cancer stage at diagnosis, treatment, and other factors.

Results showed that the duration of survival before men died specifically from prostate cancer lasted approximately 32 months among those diagnosed during the earlier time frame, and 36 months among those diagnosed during the later one. Similarly, the duration of survival before men died from any cause after a metastatic prostate cancer diagnosis was 26 months between 2004 and 2008, and 29 months during the 2009–2014 time frame.

The authors acknowledge that the survival improvements are modest, but add they may not fully account for longer survival improvements from abiraterone and enzalutamide, which only came into widespread use at the end of the study period. Furthermore, men who respond extraordinarily well to the new treatments may live far longer than those who don’t. In general, the evidence provides “valid evidence in support of [newer] novel treatments,” the authors wrote.

Dr. Mark Garnick, the Gorman Brothers Professor of Medicine at Harvard Medical School and Beth Israel Deaconess Medical Center, and editor in chief of HarvardProstateKnowledge.org, says, “This study provides important information that men with advanced forms of prostate cancer are now living longer than they once did, sometimes years longer. Those of us who have been treating prostate cancer for decades appreciate this study’s fundamental finding that the improved longevity from newer cancer drugs is considerable.”

The post Newer drugs are improving survival for men with metastatic prostate cancer appeared first on Harvard Health Blog.

from Harvard Health Blog http://ift.tt/2E4xAkC
Original Content By : http://ift.tt/1UayBFY

My Health - Why teenagers eat Tide pods

Follow me on Twitter @drClaire

It’s been on the news recently: teens are eating Tide detergent pods — despite the fact that eating them can be lethal. They film themselves doing it; it’s the “Tide Pod Challenge.”

It’s not like they don’t know it can be dangerous. Besides the fact that it’s common knowledge that detergent isn’t food, there has been a lot of media coverage about the dangers of toddlers getting into them, about how Tide pods are not just poisonous but possibly lethal.

The media coverage, actually, is part of the problem. But the real problem is the adolescent brain.

Adolescence is a crucial moment in life, the transition between childhood and adulthood. The brains of adolescents reflect that transition. They have the ability to take in a lot of information, to learn quickly, that children have — and their brains are beginning to build the connections that adults have, the connections that make different parts of the brain work together more quickly and effectively. The last part of the brain to build those connections is the frontal lobe. This is important, because the frontal lobe is the part of the brain that controls insight and judgment, the part that controls risk-taking behaviors.

Basically, teens are quick learners without a whole lot of insight or judgment, and risk-takers. As frustrating as this may be for parents, teachers, and others who have to deal with teens on a daily basis, it makes evolutionary sense.

Teens have to learn so much as they get ready to become adults. They have to learn not only academic subjects, but how to navigate life: how to hold down a job, drive, pay bills, and everything else an adult needs to do to survive. It’s a staggering amount of information, really.

They also have to take risks. Just think about it: leaving home, getting a job, falling in love… it’s a lot of scary firsts. Those risks are hard to take when you fully understand how things can go wrong, and how we are all flawed and mortal. They are much easier to take when you think you are invincible.

Unfortunately, teens don’t limit their risk-taking to leaving home or falling in love. They take dumb risks, the same kind we took as teenagers. We took them because we thought we were invincible, and because our friends were watching and egging us on. That’s another part of teen reality: what their peers think matters a lot.

That’s where the media coverage comes in — more specifically, social media. Back when I was a teen, the group of friends watching and egging me on was relatively small, and most of them were people I’d chosen to be friends with, at least some of whom had some interest in my well-being. They were also there in person, and we could talk about risks before taking them.

With social media, today’s teens have potentially millions of people watching and egging them on, mostly people they didn’t choose, who are not there in person — and who have zero interest in their well-being. It’s “I dare you” in proportions we can’t measure or imagine, played out in the latest “challenge” (there have been plenty of them) and broadcast via their ever-present phones.

That’s why the American Association of Poison Control Centers reported 86 intentional exposures to laundry detergent packets in the first three weeks of 2018. And those are just the ones that got reported.

YouTube has said they will take down any reported videos, which is good, but there will undoubtedly be another challenge. We can’t make social media go away, any more than we can change the adolescent brain.

We must realize that social media has changed the world adolescents are growing up in; while it has upsides like connectedness, it also can put them at risk. We need to find ways to use the power of social media for good, like the video the New England Patriots’ Rob Gronkowski has made telling teens not to eat Tide pods. We also need to spend more time with teens, both talking and listening. We need to help them navigate this new socially connected world; we need to help them understand where and how to draw the line, so that they stay safe.

The post Why teenagers eat Tide pods appeared first on Harvard Health Blog.

from Harvard Health Blog http://ift.tt/2DMPHIh
Original Content By : http://ift.tt/1UayBFY

My Health - A neurologist talks about kids and headaches

It’s not uncommon for a child to complain of a headache. But what should a parent do? When should you worry? What are features that are cause for concern and should prompt a call to the pediatrician, or even a trip to the emergency room? For kids with headaches, do they necessarily need to take medication, or are there other nondrug treatments that may be just as effective?

When to call your pediatrician

The cardinal rule for thinking about headaches is “first or worst.” In practical terms, if your child has never had a headache before, you need to evaluate carefully.

• Did he have any recent head trauma, such as a fall or a sports injury?
• Was she sick with a bad virus?
• Is he vomiting or or have a fever?
• Is she unable to walk, talk, and eat normally?

If the answer to any of these questions is “yes,” it’s time to call the pediatrician. A concussion, a severe infection, or even a rare but more ominous cause for a headache could be the trigger. Many people worry about a brain tumor, but this is very unlikely. You should never be alone with worry about your child’s headache, and your pediatrician can help to steer you toward the best treatment.

Kids can experience migraine headaches

Children can and do get migraine headaches. The rate is estimated at 5.5%, but underdiagnosis may falsely lower the number. Think about migraine in particular if a parent has migraines, as there is a strong genetic link. Kids’ migraines are different than adults’: the pain can be on both sides of the head and not last as long. But just like in grownups, kids can be totally incapacitated with a migraine, needing to lie in a dark room with profuse nausea and vomiting. It’s not possible to make a diagnosis after just one headache, though. Kids need to have at least two episodes to be diagnosed with migraine. Ibuprofen can be a very effective treatment once a headache hits, but don’t forget about ice, which can also relieve pain and decrease inflammation. A bag of frozen peas is lightweight, and the child can position it comfortably over his or her head.

There is a migraine-specific class of drugs called triptans that is used to stop migraines when they start. One formulation called zolmitriptan is approved for use in children. It comes in a nasal spray so it can be used for kids who can’t swallow pills. For children with frequent migraines, it may be necessary to try to prevent them. Certain medications are used for both children and adults, such as amitriptyline and topiramate. A recent study found that combining amitriptyline with a form of cognitive behavioral therapy (a type of mind-body work that helps to change a person’s response to pain and anxiety) can be more effective than the drug alone. And some children will respond to cognitive behavioral therapies alone as preventives. Health insurance often covers these treatments, so be sure to ask about options.

The more typical kid headache

Tension-type headaches are more common. The old name for these was “hat band headache” and that’s often what the pain is like. Kids describe pressure around their forehead or entire head, not the throbbing of a migraine. Often they can function, eat, go to school, and even play sports although they don’t feel well. Ibuprofen may help, and relaxation and fluids may be adequate to treat a tension-type headache.

Lots of parents are concerned about screen time triggering headache, and it’s a valid concern. Bright lights and screens definitely can trigger migraines in susceptible children and adults, but staring at a computer, phone, or iPad can trigger a headache for anyone if used for too long. Encourage limits on screen time, taking breaks, and getting up to stretch when working or playing games.

It’s important to ask about stress and anxiety when evaluating your child’s headache. School-avoidance headaches can be tough to diagnose. Careful questions and discussion with teachers and guidance counselors may help a parent figure out if a headache is actually a way for a child to avoid bullying or a difficult situation at school. This hopefully leads to intervention and resolution of the triggers.

The bottom line

If your child tells you she has a headache, take her seriously. Ask questions about type of pain, other symptoms, and recent events. Enlist your pediatrician to help make the right diagnosis. It may be useful to see a pediatric neurologist. And if the child has a fever, can’t stop vomiting, or tells you he has double vision or trouble moving his arms or legs, go directly to the emergency room. Chances of this are very rare. Most headaches are very treatable.

References

Pediatric migraine. Medscape Neurology Clinics, 2009.

Trajectory of Improvement in Children and Adolescents With Chronic Migraine: Results From the Cognitive-Behavioral Therapy and Amitriptyline Trial. Journal of Pain, June 2017.

The post A neurologist talks about kids and headaches appeared first on Harvard Health Blog.

from Harvard Health Blog http://ift.tt/2rOAGUX
Original Content By : http://ift.tt/1UayBFY

My Health - 10 things you can do for your pet when it’s cold outside

Follow me on Twitter @RobShmerling

Venturing out in frigid conditions with our golden retriever, I was wishing I had worn another layer or two. And that got me thinking. Sparky’s got a thick coat of fur, but is that enough? Is there more I should be doing for him during cold snaps? On our last walk, I’m pretty sure he would have said yes.

In fact, there are a number of things we can do to make sure our pets are safe during the worst of winter. Here are 10 things experts recommend:

1.  When returning from a walk, clean off your pet’s paws and check them for redness or cracks.

2.  Apply petroleum jelly (or other paw protection product) to your dog’s paw pads. Or, have your pet wear booties.

3.  Use only pet-friendly ice melt.

4.  Get a coat or sweater for your short-haired dog.

5.  If your pet usually sleeps on the floor or near a window or door, get them a pet bed and move it away from the coldest parts of the house.

6.  Don’t leave your pet in a car. Although we hear often about the risks of pets overheating in cars in the warmer weather, cars cool down quickly in winter and pose a risk for pets left inside.

7.  Don’t leave your pet outside. Even for dogs or cats that spend most of their time outdoors, bring them inside during cold weather.

8.  Trim their nails. Long nails can’t grip the ice, which makes walking more slippery.

9.  Look out for cats near your car. They may take refuge in the garage or huddled next to a warm car and get injured when the car moves.

10.  Recognize signs of hypothermia (including confusion, slowed movement, anxiousness) or frostbite (such as blisters or discoloration of the skin). If you suspect either, bring your pet inside right away and contact your veterinarian.

But wait, there’s more

Some other recommendations are probably self-evident but worth emphasizing. Take shorter walks to avoid cold exposure. Avoid partially frozen rivers, lakes, or ponds that might not support the weight of your pet. And winter is no time for the short haircut or close-cropped look — save that for warmer weather.

Pets may burn more calories maintaining their body temperature when it’s cold, so some experts recommend that for active pets that spend time outdoors in cold weather, food portions should be a bit larger than usual.

This, too, shall pass

Eventually the harsh winter weather will turn warmer. Until it does, keep in mind that your pet may not like the cold any more than you do. Fortunately, there’s a lot you can do to make it easier on him or her.

Talk to your veterinarian about any specific health concerns you have about your pet. And, for more information, check out these tips from the American Society for the Prevention of Cruelty to Animals (ASPCA).

The post 10 things you can do for your pet when it’s cold outside appeared first on Harvard Health Blog.

from Harvard Health Blog http://ift.tt/2DOqpNa
Original Content By : http://ift.tt/1UayBFY

My Health - Acupuncture for headache

It is easy to ridicule a 2000-year-old treatment that can seem closer to magic than to science. Indeed, from the 1970s to around 2005, the skeptic’s point of view was understandable, because the scientific evidence to show that acupuncture worked, and why, was weak, and clinical trials were small and of poor quality.

But things have changed since then. A lot.

Thanks to the development of valid placebo controls (for example, a retractable “sham” device that looks like an acupuncture needle but does not penetrate the skin), and the publication of several large and well-designed clinical trials in the last decade, we have the start of a solid foundation for truly understanding the effectiveness of acupuncture.

How do we know if acupuncture really works for pain?

Individual large-scale clinical studies have consistently demonstrated that acupuncture provided better pain relief compared with usual care. However, most studies also showed little difference between real and sham (fake) acupuncture. In order to address this concern, a 2012 meta-analysis combined data from roughly 18,000 individual patients in 23 high-quality randomized controlled trials of acupuncture for common pain conditions. This analysis conclusively demonstrated that acupuncture is superior to sham for low back pain, headache, and osteoarthritis, and improvements seen were similar to that of other widely used non-opiate pain relievers.

And the safety profile of acupuncture is excellent, with very few adverse events when performed by a trained practitioner. Meanwhile, basic science studies of acupuncture involving animals and humans have shown other potential benefits, from lowering blood pressure to long-lasting improvements in brain function. More broadly, acupuncture research has resulted in a number of insights and advances in biomedicine, with applications beyond the field of acupuncture itself.

Is acupuncture really that good?

We understand why there may be continued skepticism about acupuncture. There has been ambiguity in the language acupuncture researchers employ to describe acupuncture treatments, and confusion surrounding the ancient concept of acupuncture points and meridians, which is central to the practice of acupuncture. Indeed, the question of whether acupuncture points actually “exist” has been largely avoided by the acupuncture research community, even though acupuncture point terminology continues to be used in research studies. So, it is fair to say that acupuncture researchers have contributed to doubts about acupuncture, and a concerted effort is needed to resolve this issue. Nevertheless, the practice of acupuncture has emerged as an important nondrug option that can help chronic pain patients avoid the use of potentially harmful medications, especially opiates with their serious risk of substance use disorder.

Finding a balanced view

A post on acupuncture last year dismissed acupuncture as a costly, ineffective, and dangerous treatment for headache. This prompted us to point out the need for a measured and balanced view of the existing evidence, particularly in comparison to other treatments. Although the responses that followed the article overwhelmingly supported acupuncture, it nevertheless remains a concern that this practice attracts this kind of attack. Acupuncture practitioners and researchers must take responsibility for addressing deficiencies in acupuncture’s knowledge base and clarifying its terminology.

That said, we need to recognize that acupuncture can be part of the solution to the immense problem of chronic pain and opiate addiction that is gripping our society. That this solution comes from an ancient practice with a theoretical foundation incompletely understood by modern science should make it even more interesting and worthy of our attention. Clinicians owe it to their patients to learn about alternative, nondrug treatments and to answer patients’ questions and concerns knowledgeably and respectfully.

Sources

Acupuncture in patients with osteoarthritis of the knee: a randomised trial. Lancet, July 2005.

Acupuncture in Patients With Chronic Low Back Pain: A Randomized Controlled Trial. JAMA Internal Medicine, February 2006.

Acupuncture in patients with tension-type headache: randomised controlled trial. BMJ, August 2005.

Acupuncture for Patients With Migraine: A Randomized Controlled Trial. JAMA, May 2005.

Acupuncture for Chronic Pain: Individual Patient Data Meta-analysis. JAMA Internal Medicine, October 2012.

Survey of Adverse Events Following Acupuncture (SAFA): a prospective study of 32,000 consultations. Acupuncture in Medicine, December 2001.

Safety of Acupuncture: Results of a Prospective Observational Study with 229,230 Patients and Introduction of a Medical Information and Consent Form. Complementary Medicine Research, April 2009.

The safety of acupuncture during pregnancy: a systematic review. Acupuncture in Medicine, June 2014.

Cost-effectiveness of adjunct non-pharmacological interventions for osteoarthritis of the knee. PLOS One, March 2017.

Paradoxes in Acupuncture Research: Strategies for Moving Forward. Evidence-Based Complementary and Alternative Medcine, 2011.

The Long-term Effect of Acupuncture for Migraine Prophylaxis: A Randomized Clinical Trial. JAMA Internal Medicine, April 2017.

The post Acupuncture for headache appeared first on Harvard Health Blog.

from Harvard Health Blog http://ift.tt/2DDSUxS
Original Content By : http://ift.tt/1UayBFY

My Health - Involuntary treatment for substance use disorder: A misguided response to the opioid crisis

Recently, Massachusetts Governor Charlie Baker introduced “An Act Relative to Combatting Addiction, Accessing Treatment, Reducing Prescriptions, and Enhancing Prevention” (CARE Act) as part of a larger legislative package to tackle the state’s opioid crisis. The proposal would expand on the state’s existing involuntary commitment law, building on an already deeply-troubled system. Baker’s proposal is part of a misguided national trend to use involuntary commitment or other coercive treatment mechanisms to address the country’s opioid crisis.

The CARE Act and involuntary hold

Right now, Section 35 of Massachusetts General Law chapter 123 authorizes the state to involuntarily commit someone with an alcohol or substance use disorder for up to 90 days. The legal standards and procedures for commitment are broad; a police officer, physician, or family member of an individual whose substance use presents the “likelihood of serious harm” can petition the court.

Upon reviewing a petition, the court can issue a warrant for the arrest of the person with substance use disorder. The individual — who is not charged with a crime — is held pending an examination by a court-appointed clinician. The statute mandates that the determination proceed at a rapid pace, making it difficult to mount a meaningful defense.

The CARE Act proposes to further accelerate this process. The proposal would allow clinical professionals — including physicians, psychiatric nurses, psychologists, and social workers (or police officers when clinicians are not available) — to transport a person to a substance use treatment facility when the patient presents a likelihood of serious harm due to addiction and the patient will not agree to “voluntary treatment.” Upon determination by a physician that the failure to treat the person would create “a likelihood of serious harm,” the treatment facility has 72 hours to get the person to agree to voluntary treatment. If the person refuses, but the facility superintendent determines that discontinuing treatment would again cause “a likelihood of serious harm,” the facility must petition the court for involuntary treatment under the process outlined in Section 35.

The expanded use of these laws

Laws that allow the state to commit people for substance use disorder are not new. The number of states with such laws went from 18 in 1991 to 38 jurisdictions, and counting. Existing laws vary significantly in the specific criteria for commitment, length, and type of treatment, if any is provided. The use of this mechanism has rapidly expanded as the opioid crisis has worsened; Massachusetts, with a population of under 7 million, committed a shockingly high number — more than 6,500 individuals — in 2016. Ironically, this expansion has occurred in conjunction with calls to move away from a criminal justice and toward a public health approach to the crisis, including a more concerted emphasis on treatment for people with addiction. But this well-intentioned shift carries little meaning when coercion and institutionalization are involved. In fact, 70% of the beds for men in Massachusetts are at a prison facility, where patients wear prison uniforms and answer to correctional officers. In recent months, these facilities have been rocked by a series of high-profile scandals, including escapes, suicides, and alleged sexual assault.

Do these laws help or hurt?

Existing data on both the short- and long-term outcomes following involuntary commitment for substance use is “surprisingly limited, outdated, and conflicting.” Recent research suggests that coerced and involuntary treatment is actually less effective in terms of long-term substance use outcomes, and more dangerous in terms of overdose risk. The prospects for positive outcomes from the CARE Act are especially bleak, given the standard of care currently available to Massachusetts residents committed under Section 35. The facilities housing Section 35 patients commonly offer counseling sessions and classes to “learn more about addiction;” shockingly few offer appropriate medication. In fact, the treatment provided is often not rooted in science at all. The state’s own mandated evaluation of overdose data has found that people who were involuntarily committed were more than twice as likely to experience a fatal overdose as those who completed voluntary treatment.

Though further research is needed to confirm these findings, there are several possible reasons for this. One is that recovery is much more likely when it is driven by internal motivation, not by coercion or force (i.e., the person must “want to change”). Second, the state may actually route individuals to less evidence-driven programs on average (e.g., “detox”) than the kind of treatment accessed voluntarily (i.e., outpatient methadone or buprenorphine treatment). Finally, those receiving care in outpatient settings may be more likely to receive services that help address underlying physical or mental health needs, which are often at the root of problematic substance use.

Involuntary commitment for people with substance use disorder deprives them of liberty, fails to offer evidence-based treatment, and may leave patients worse off by making them vulnerable to overdose risk. But for the families or medical providers of individuals with substance use disorder, court-ordered involuntary commitment for their loved ones or patients may seem like an attractive option, or indeed the only viable one, to get them into treatment. Understanding the procedures, ramifications, and consequences of involuntary commitment is vital before initiating a process that deprives a person of liberty just as much as prison would.

What is the alternative?

There is far too little on offer in Massachusetts — or elsewhere — that would trigger the timely assistance and intensive case management necessary to support people in crisis. In the absence of such supports, involuntary commitment promises to help families that are desperate to find treatment for their loved ones. Unfortunately, the promise offered by involuntary treatment is a false one. Instead, we need to develop new approaches to support families and patients in non-coercive, evidence-driven ways.

The post Involuntary treatment for substance use disorder: A misguided response to the opioid crisis appeared first on Harvard Health Blog.

from Harvard Health Blog http://ift.tt/2E7n35u
Original Content By : http://ift.tt/1UayBFY

My Health - Top 10 Health Benefits Of Cycling Everyday

Top 10 Health Benefits Of Cycling Everyday

Health and Fitness Tips
Health is the level of functional and metabolic efficiency of a living organism. In humans it is the ability of individuals or communities to adapt and self-manage when facing physical, mental, psychological and social changes with environment.

My Health - The crucial brain foods all children need

Follow me on Twitter @drClaire

The first 1,000 days of life are crucial for brain development — and food plays an important role.

The ways that the brain develops during pregnancy and during the first two years of life are like scaffolding: they literally define how the brain will work for the rest of a person’s life. Nerves grow and connect and get covered with myelin, creating the systems that decide how a child — and the adult she becomes — thinks and feels. Those connections and changes affect sensory systems, learning, memory, attention, processing speed, the ability to control impulses and mood, and even the ability to multitask or plan.

Those connections and changes cannot be undone, either. How the brain begins is how it stays.

The environment a child lives in, and how they are loved and nurtured, is crucial for these connections and changes. Breastfeeding can also make a big difference, not just because breast milk is the perfect first food but also because of the close contact with the mother that is part of breastfeeding.

There are also certain nutrients that are necessary for healthy brain development. These nutrients include:

• Protein. Protein can be found in meat, poultry, seafood, beans and peas, eggs, soy products, nuts and seeds, as well as dairy.
• Zinc. The food that has the most zinc, interestingly, is oysters — but it’s also found in many meats, fish, dairy products, and nuts.
• Iron. Meats, beans and lentils, fortified cereals and breads, dark leafy vegetables, and baked potatoes are among the best sources of iron.
• Choline. Meat, dairy, and eggs have lots of choline, but so do many vegetables and other foods.
• Folate. This nutrient, which is especially important for pregnant mothers, can be found in liver, spinach, fortified cereals and breads, as well as other foods.
• Iodine. Seaweed is a great source of iodine, but we also get it from iodized salt, seafood, dairy products, and enriched grains.
• Vitamin A. Along with liver, carrots, sweet potato, and spinach are good sources of this vitamin.
• Vitamin D. This is the “sunshine vitamin,” and the best way to get it is to get outside. The flesh of fatty fishes such as salmon have it, as does fish liver oil, and products fortified with it, such as fortified milk.
• Vitamin B₆. The best sources of Vitamin B₆ are liver and other organ meats, fish, potatoes and other starchy vegetables, and fruit (not citrus).
• Vitamin B₁₂. Vitamin B₁₂ is naturally found in animal products, such as meat, fish, eggs, and dairy.
• Long-chain polyunsaturated fatty acids. An example is omega-3 fatty acids. These are most easily found in fatty fish and fish oils, but can be found in some other oils, and many foods are also fortified with them.

For some pregnant women and children, getting all of these nutrients can be a challenge. Families who are vegetarian, especially those who are vegan, may find it particularly challenging. Meeting with a nutritionist may be helpful. Many families have limited, starch-heavy diets without much in the way of vegetables or fish. Pregnant women and small children in those families may also have trouble getting all the brain nutrients they need.

For many families, it’s not that they choose not to eat these foods — it’s that they can’t afford them. Meats, fish, and fresh vegetables can be expensive. That’s why the American Academy of Pediatrics released a policy statement entitled “Advocacy for Improving Nutrition in the First 1,000 Days to Support Childhood Development and Adult Health.”

There are many government-funded programs, such as the Special Supplemental Nutrition Program for Women, Infants, and Children (also known as WIC), the Supplemental Nutrition Assistance Program (or SNAP, formerly “food stamps”), or the Child and Adult Care Food Program, that help low-income families get the food they need to be healthy, and support breastfeeding. It’s important that these programs continue and be funded to meet the need. While community-based food pantries and soup kitchens are important, they can’t always provide all the nutritious food pregnant women and children need, let alone provide as much or as often as it is needed.

As a country and as a world, we need to work together to be sure that every child gets the best start possible.

The post The crucial brain foods all children need appeared first on Harvard Health Blog.

from Harvard Health Blog http://ift.tt/2E2RSs2
Original Content By : http://ift.tt/1UayBFY

My Health - Top 10 Health Benefits Of Swimming That You May Not Know

Top 10 Health Benefits Of Swimming That You May Not Know

Health and Fitness Tips
Health is the level of functional and metabolic efficiency of a living organism. In humans it is the ability of individuals or communities to adapt and self-manage when facing physical, mental, psychological and social changes with environment.

My Health - Keeping carbon monoxide out of your home

Every year in the US, about 10,000 persons are treated for carbon monoxide poisoning, and roughly 400 die from unintentional exposure. This mostly occurs in our cold winter months, like now…

Why winter?

Carbon monoxide (CO) is an odorless, colorless, and tasteless gas normally found in the atmosphere at low levels. Many things contribute to the level of CO in the air, both outdoors (like pollution) and indoors (like tobacco smoke). High levels can also be produced from the burning of wood, gas, and other fuels. Poor heating systems or those with improper ventilation can lead to dangerous levels of CO in the air. This, coupled with energy-conserving “airtight” homes with insulation and sealed windows, can further trap CO inside. But unless you’re looking for it, you wouldn’t know you’re breathing in CO.

What happens with CO poisoning?

When CO is inhaled at high concentrations, it displaces the oxygen from the hemoglobin in red blood cells. That means the body doesn’t get the oxygen it needs. Symptoms of CO poisoning vary and may sound a lot like the flu — but there’s no fever. One clue may be a pattern of symptoms that occur in the same enclosed space, but that improve outside in fresh air. The most common complaint is headache. Other symptoms might be feeling tired, nauseated, dizzy, or short of breath. In more serious cases, this can progress to confusion, seizures, loss of consciousness, and death. The risks depend on your underlying health, the level of CO in the air (measured in parts per million, or ppm), and duration of exposure. Here are five important dos and don’ts to help protect you and your family.

1. Do get carbon monoxide detectors!

I cannot emphasize enough how important this is. My own personal story is that I believe this saved our infant son’s life, and ours, years ago. We were new to our condo, new to a fireplace, and very new to a baby. On one cold winter night, ignorant and oblivious, we made the mistake of closing the flue too early, missing the few slivers of embers hidden in the ashes. Fortunately, we had plugged an additional digital CO detector next to our son’s crib, which was behind a closed door and a floor above the fireplace. Then we made mistake number two, I am embarrassed to admit, by turning off the alarm, thinking the monitor had malfunctioned, and going back to bed when nothing seemed amiss. I am forever grateful that the alarm went off again, and this time we did not ignore it, realizing our mistake.

So make sure you have a battery-operated carbon monoxide detector (or one with battery backup) on every floor, in the hallway near bedrooms. States have different requirements regarding how CO detectors are placed in homes. Ideally, change batteries yearly and test monitors monthly. Some CO detectors also provide a digital reading of the level of CO ppm. If the alarm sounds, don’t ignore it (like we did). Move outside to fresh air and contact the fire department right away.

2. Do open the fireplace flue damper before lighting a fire, and leave it open until there are no embers and the ashes are cool. (See “Do” #1)

In addition, make sure the chimney and flue are clear before fireplace use.

3. Don’t leave the car running in the garage.

Though it’s tempting to warm up the car in the garage, don’t do it, as CO levels can rise quickly. And if you have an attached garage, don’t leave the engine running for very long even if the garage door is open, since CO can seep through wallboards into the house.

4. Do have your appliances and heating systems serviced as recommended.

Double check that your appliances and heating systems are working appropriately with proper ventilation. This includes making sure the vents are not blocked by snow and ice outside.

5. Don’t use generators indoors.

If you need to use a generator, make sure it is outside and at least 20 feet from windows and doors.

Hopefully, these basic tips will help make you more aware and prepared in your home. If you are looking for further information on CO safety issues, a good place to start is the US Environmental Protection Agency’s webpage Carbon Monoxide’s Impact on Indoor Air Quality.

The post Keeping carbon monoxide out of your home appeared first on Harvard Health Blog.

from Harvard Health Blog http://ift.tt/2Dv9CQ6
Original Content By : http://ift.tt/1UayBFY

My Health - Top 10 Natural Home Remedies For Heel Pain In Foot

Top 10 Natural Home Remedies For Heel Pain In Foot

Health and Fitness Tips
Health is the level of functional and metabolic efficiency of a living organism. In humans it is the ability of individuals or communities to adapt and self-manage when facing physical, mental, psychological and social changes with environment.

My Health - 10 Incredible Health Benefits Of Onions That Will Leave You Surprised

10 Incredible Health Benefits Of Onions That Will Leave You Surprised

Health and Fitness Tips
Health is the level of functional and metabolic efficiency of a living organism. In humans it is the ability of individuals or communities to adapt and self-manage when facing physical, mental, psychological and social changes with environment.

My Health - Revisiting options for improving results of breast reconstruction

There are a range of options for reconstruction following breast cancer surgery. When a mastectomy is performed, reconstruction can be achieved using various forms of implants, or with natural tissue taken from other parts of the body to reform the breast. Whether or not a woman chooses to pursue breast reconstruction is a very personal choice. Many women experience an excellent quality of life without reconstruction. However, for some women, undergoing reconstruction after a mastectomy can help improve certain aspects of self-image and well-being.

A new option when reconstruction results are disappointing

Unfortunately, despite advances in plastic and reconstructive surgery, the final cosmetic result of breast reconstruction can occasionally be less than satisfying. Women may have contour irregularities (e.g. indentations, bumps, or ripples), asymmetry, or defects in the reconstructed breast resulting in a disappointing cosmetic appearance. For these women, a new option is available to help correct the deformity. This procedure is fat grafting, also called autologous fat transfer or lipo-filling. It involves removing fat tissue from other parts of the body using liposuction techniques, processing the tissue into a liquid, and then injecting it into the site of the reconstruction to help improve contour and appearance. The tissue is usually taken from the thighs, belly, or buttocks.

Actually, fat grafting is not a new procedure. The process has been available for quite some time. However, it was not used often due to concerns about its safety. The good news is that a growing body of data suggests that the procedure is safer than originally thought, especially because of new and improved techniques that have reduced complication rates.

Recent data from the largest clinical trial investigating patient-reported outcomes following fat grafting showed that fat grafting may improve outcomes rated by patients undergoing breast reconstruction. The findings were reported last year in JAMA Surgery. The study was conducted between February 2012 and July 2016 at 11 sites associated with the Mastectomy Reconstruction Outcomes Consortium Study. Eligible patients included women over the age of 18 who had had breast reconstruction after mastectomy and were available to be followed in the study for at least two years. All types of breast reconstruction procedures (implant and natural tissue) were included in the study.

A total of 2,048 women were evaluated across centers in the United States and Canada. The average age of study participants was 49.4 years. The study found that women who required fat grafting to correct deficiencies in their breast reconstruction were able to achieve equal rates of breast satisfaction, psychosocial well-being, and sexual well-being, compared with women who did not require fat grafting, despite the fact that their initial ratings in these areas were lower prior to correcting the deformities.

An interesting question not explored in the study is whether we should use fat grafting to improve cosmetic results after breast conserving cancer surgery (i.e. lumpectomy). This is still an area of controversy due to concerns about fat cells stimulating potential residual cancer cells, and therefore increasing the risk of cancer recurrence. Although the data are not conclusive — and in fact, emerging studies suggest that fat grafting may not impact local recurrence — the potential risk still limits enthusiasm for fat grafting following breast conserving surgery.

What else is important about this study?

This study is the first of its kind to provide patient-reported outcomes about fat grafting, and reflects a growing trend of incorporating patient-reported outcomes into clinical trials. Gaining a better understanding of outcomes from the patients’ perspective helps researchers and clinicians to design and deliver care that truly meets the personal preferences and treatment priorities of women diagnosed with breast cancer.

I’d like to thank my colleague Dr. Dhruv Singhal, a plastic surgeon at Beth Israel Deaconess Medical Center, for his contributions to this post. 

The post Revisiting options for improving results of breast reconstruction appeared first on Harvard Health Blog.

from Harvard Health Blog http://ift.tt/2mSJyDp
Original Content By : http://ift.tt/1UayBFY

My Health - 20 Health Benefits Of Guava Leaves For Your Life

20 Health Benefits Of Guava Leaves For Your Life

Health and Fitness Tips
Health is the level of functional and metabolic efficiency of a living organism. In humans it is the ability of individuals or communities to adapt and self-manage when facing physical, mental, psychological and social changes with environment.

My Health - Access to safe, affordable birth control is a maternal health issue

I am a physician.

As a high-risk obstetrician (maternal-fetal medicine specialist) I pride myself on caring for women who are likely to become (or who are already) so ill that many others view caring for them as a burden. I help women achieve a safe pregnancy when colleagues have advised against pregnancy altogether. Whether it is the patient with such a complex surgical history that her cesarean delivery will include massive blood loss and a hysterectomy, or the patient with a history of liver transplant trying to carry a pregnancy for the fourth time (each unsuccessful as she struggles in and out of graft rejection), or perhaps the woman who spent weeks in the intensive care unit after each of her last two pregnancies because of complications from preeclampsia — these are the patients I care for.

When careful planning is critical for a safe pregnancy

In caring for these women, I see the highs and lows of life. I am still awed by the miracle of childbirth (it doesn’t matter how many times I witness birth, I still find it one of the most magical moments each and every time). However, I am also witness to the perils of pregnancy and childbirth. It happens more than you might think. Luckily, maternal deaths are rare, though complications that compromise a new mother’s health — hemorrhage, venous embolism, severe high blood pressure, organ failure, and intensive care admission — are on the rise. My patients, the very ill women whose health and lives may be at risk, and their families, need to determine if and when they are willing to accept the risks that come with pregnancy.

The current rhetoric of limiting access to affordable contraception will have the most dramatic effect on my patients. We are talking about preventing pregnancy to protect the mother, a concept that is too often left out of public and politically heated debates. For these women contraception is not simply a choice; it is a means of taking control of their health and future. I feel that we have a moral and ethical obligation to advocate for these patients. We need to fight and ensure that they decide if and when to attempt a pregnancy, a decision that may carry such substantial risk that it may never be a safe option.

A real life story

A colleague of mine cares for women very similar to those who come in and out of my office every day. She told me about a patient for whom complications of high blood pressure and diabetes resulted in the very premature birth of her baby. Both the mother and newborn spent time in their respective intensive care units. Both ultimately were sent home, the mother needing to start blood pressure medication and teetering on the edge of kidney failure. This new mom missed her postpartum contraception appointment. She reports she tried to get contraception shortly after that missed appointment, but after losing her job (and insurance) she was unable to afford contraception. Fast-forward six months; she is pregnant again — a pregnancy which risks this mom’s health and places an unexpected strain on her family, a pregnancy she had intended to delay.

It doesn’t have to be this way

There are many women for whom pregnancy is dangerous, and contraception is a lifeline for their long-term health. Too often there are significant barriers for women seeking affordable and effective birth control. When pre-existing conditions make pregnancy a potentially life-threatening event, limiting access to contraception is unacceptable. The medical community cannot allow this to happen. Maternal health is the keystone supporting the foundational well-being of families and children.

We need to pay attention, now

I fear the future. I fear that restrictions, roadblocks, and limited access will become the norm. What is missing in the coverage of this issue is the fact that the US has seen an unprecedented rise in maternal mortality. If government-endorsed limited access to contraception becomes reality, we have only seen the peak of the iceberg in our failure to protect maternal health.

I am a physician, an advocate, and a father. These are not separate roles, but rather so closely connected that my patients know my children’s names and my children know the events of my days. And for both, my patients and children, I am an advocate for access to safe health. I owe it to my patients to acknowledge and engage in dialogue protesting against this attack on women’s health. As a father I owe it to my children (specifically my daughter) to advocate against this emerging disparity in health care. If I sit back and do nothing, all the hours of play time I have missed, the birthday parties I was late for, and the holidays I have be on call for, mean nothing. Today’s political climate has inspired me to speak up.

The post Access to safe, affordable birth control is a maternal health issue appeared first on Harvard Health Blog.

from Harvard Health Blog http://ift.tt/2mMWOJt
Original Content By : http://ift.tt/1UayBFY

My Health - False alarm in Hawaii: Preparing for the unthinkable

Early last Saturday morning in Hawaii, cellphones flashed the following warning from the Hawaii Emergency Management Agency: “Ballistic missile threat inbound to Hawaii. Seek immediate shelter. This is not a drill.” Television and radio broadcast similar messages. For 38 minutes, until this warning was retracted, the residents of Hawaii and beyond were put into a state of utter panic and despair, concerned about a potential nuclear attack from North Korea.

These worries are not new

After the end of the Cold War, and after several decades of relative calm, the threat of nuclear war or of a rogue nuclear blast has recently come roaring back into the public’s consciousness. The CDC had originally scheduled a public briefing on how to prepare for a nuclear explosion for January 16th, but it has been postponed. The CDC still plans to address “planning and preparation” for a nuclear strike, and claimed that, “while a nuclear detonation is unlikely… planning and preparation can lessen deaths and illness.”

Here’s what you need to know

The CDC website ready.gov has excellent, downloadable, printable advice for both emergency kits and family plans. These precautions are important in general for a range of potential disasters from cyber warfare to extreme weather and climate instability. The CDC also suggests that you know ahead of time the location of the nearest fallout shelter, or nearby structures that would be suitable to shelter in place.

In the event of another warning, or an actual impending attack, the CDC recommends the following actions:

• Listen for official instructions and follow them carefully.
• Take cover as quickly as possible, underground if possible, and stay in place until instructed otherwise.

If there is an actual detonation, they recommend:

• Stay inside to avoid radioactive fallout and expect to stay inside for at least 24 hours.
• Evacuate if (and only if) you are instructed to do so.
• Do not look at the fireball or flash; this can blind you.
• If caught outside, take cover behind anything you can, and drop to the ground. Remain flat until the heat and shock waves have passed. Find something to cover your mouth and nose. Get inside and decontaminate as soon as possible, by removing clothing and washing up if possible.
• After the blast, stay away from damaged areas, damaged buildings, or areas that are determined to be heavily contaminated with radioactivity.
• Use only stored food and drinking water, as anything fresh may be contaminated.

It is important to note that nuclear weapons produce a large electromagnetic pulse that can fry electronics, so many devices such as televisions, computers, cars, and radios may not work after a nuclear blast. That makes keeping informed about official instructions and directives more difficult.

As a society we must strive to avoid the unthinkable

Ideally, our world wouldn’t still be facing the threat of annihilation 73 years after the incineration of Hiroshima by the nuclear device known as “Little Boy.” As a society, we must continue to strive to avoid the unthinkable. Nonetheless, if a nuclear blast does occur, many more of us may survive if we remain educated about how to react to this emergency, and if we remember to lend our neighbors a helping hand.

The post False alarm in Hawaii: Preparing for the unthinkable appeared first on Harvard Health Blog.

from Harvard Health Blog http://ift.tt/2DetJh6
Original Content By : http://ift.tt/1UayBFY

My Health - 20 Health Benefits Of Muskmelon That Will Amaze You!

20 Health Benefits Of Muskmelon That Will Amaze You!

Health and Fitness Tips
Health is the level of functional and metabolic efficiency of a living organism. In humans it is the ability of individuals or communities to adapt and self-manage when facing physical, mental, psychological and social changes with environment.

My Health - When to worry about your child’s sore throat

Follow me on Twitter @DrClaire

Sore throats happen all the time in childhood — and most of the time, it’s nothing to worry about. Most of the time, they are simply part of a common cold, don’t cause any problems, and get better without any treatment.

Sometimes, though, a sore throat can be a sign of a problem that might need medical treatment. Here are four examples:

Strep throat. This infection, caused by a particular kind of streptococcus bacteria, is quite common. Along with a sore throat, children may have a fever, headache, stomachache (sometimes with vomiting), and a fine, pink rash that almost looks like sandpaper. All of these symptoms can also be seen with a viral infection, so the only way to truly know if it’s strep throat is to swab for rapid testing and/or a culture. Strep throat actually can get better without antibiotics, but we give antibiotics to prevent complications, which, while rare, can include heart problems, kidney problems, and arthritis.

Peritonsillar or retropharyngeal abscess. This is a collection of pus either behind the tonsils (peritonsillar) or at the back of the throat (retropharyngeal) and can be dangerous. Redness and swelling on one side of the throat, or a bad sore throat with fever and neck stiffness, can be signs.

Stomatitis. This is caused by viruses, and leads to sores in the mouth and throat. It gets better by itself, but it can make eating and drinking very uncomfortable, which is why some children with stomatitis (especially very young children) end up with dehydration. There are medications that can help coat the sores and make drinking easier, to help prevent dehydration.

Ingestion. Little children are curious and don’t have the best self-preservation skills. If they drink something that is a strong acid or alkali, it can burn the mouth and throat as it goes down. Household products such as bleach, drain cleaners, toilet bowl cleaners, some detergents, and even some beauty products such as hair straighteners, can do terrible damage. If an adult didn’t witness the ingestion, all they might know is that the child is suddenly complaining of mouth and throat pain.

Here’s when you should call the doctor about your child’s sore throat

• if your child is having any trouble breathing, or if their breathing just seems different to you
• if your child is having trouble swallowing, especially if they are drooling
• if your child has a stiff neck
• if your child has a high fever (102° F or higher) that doesn’t go down with acetaminophen or ibuprofen, or keeps coming back after going down briefly
• if your child is refusing to drink or is drinking much less than normal
• if the pain is severe (any severe pain warrants a call to the doctor)
• if your child is so sleepy that they are hard to wake or keep awake
• if your child has a rash, headache, stomachache, or vomiting, to be checked for strep throat (or other infections). If your child has been around someone with strep, any sore throat warrants an appointment to get checked.

If none of those are happening, that’s good news — and chances are your child will be fine in a day or two.

Here are some ways to make a child with a sore throat more comfortable

• Cold liquids, or cold foods like popsicles, ice cream, or refrigerated Jell-0. If they don’t want to eat, that’s fine, but they have to drink. Give sips of a little at a time if needed.
• Acetaminophen or ibuprofen. Check with your doctor for the right dose for your child’s age and weight.
• If your child has mouth sores, avoid foods that are salty, spicy, acidic (like orange juice), or sharp (like potato chips). Stick with bland and soft.
• Use a humidifier to help keep the throat moist.

As always: if you have any questions or concerns, call your doctor.

The post When to worry about your child’s sore throat appeared first on Harvard Health Blog.

from Harvard Health Blog http://ift.tt/2Dhogdk
Original Content By : http://ift.tt/1UayBFY

My Health - 10 Simple Home Remedies To Reduce Belly Fat In One Week!

10 Simple Home Remedies To Reduce Belly Fat In One Week!

Health and Fitness Tips
Health is the level of functional and metabolic efficiency of a living organism. In humans it is the ability of individuals or communities to adapt and self-manage when facing physical, mental, psychological and social changes with environment.

My Health - Medical marijuana

There are few subjects that can stir up stronger emotions among doctors, scientists, researchers, policy makers, and the public than medical marijuana. Is it safe? Should it be legal? Decriminalized? Has its effectiveness been proven? What conditions is it useful for? Is it addictive? How do we keep it out of the hands of teenagers? Is it really the “wonder drug” that people claim it is? Is medical marijuana just a ploy to legalize marijuana in general?

These are just a few of the excellent questions around this subject, questions that I am going to studiously avoid so we can focus on two specific areas: why do patients find it useful, and how can they discuss it with their doctor?

Marijuana is currently legal, on the state level, in 29 states, and in Washington, DC. It is still illegal from the federal government’s perspective. The Obama administration did not make prosecuting medical marijuana even a minor priority. President Donald Trump promised not to interfere with people who use medical marijuana, though his administration is currently threatening to reverse this policy. About 85% of Americans support legalizing medical marijuana, and it is estimated that at least several million Americans currently use it.

Marijuana without the high

Least controversial is the extract from the hemp plant known as CBD (which stands for cannabidiol) because this component of marijuana has little, if any, intoxicating properties. Marijuana itself has more than 100 active components. THC (which stands for tetrahydrocannabinol) is the chemical that causes the “high” that goes along with marijuana consumption. CBD-dominant strains have little or no THC, so patients report very little if any alteration in consciousness.

Patients do, however, report many benefits of CBD, from relieving insomnia, anxiety, spasticity, and pain to treating potentially life-threatening conditions such as epilepsy. One particular form of childhood epilepsy called Dravet syndrome is almost impossible to control, but responds dramatically to a CBD-dominant strain of marijuana called Charlotte’s Web. The videos of this are dramatic.

Uses of medical marijuana

The most common use for medical marijuana in the United States is for pain control. While marijuana isn’t strong enough for severe pain (for example, post-surgical pain or a broken bone), it is quite effective for the chronic pain that plagues millions of Americans, especially as they age. Part of its allure is that it is clearly safer than opiates (it is impossible to overdose on and far less addictive) and it can take the place of NSAIDs such as Advil or Aleve, if people can’t take them due to problems with their kidneys or ulcers or GERD.

In particular, marijuana appears to ease the pain of multiple sclerosis, and nerve pain in general. This is an area where few other options exist, and those that do, such as Neurontin, Lyrica, or opiates are highly sedating. Patients claim that marijuana allows them to resume their previous activities without feeling completely out of it and disengaged.

Along these lines, marijuana is said to be a fantastic muscle relaxant, and people swear by its ability to lessen tremors in Parkinson’s disease. I have also heard of its use quite successfully for fibromyalgia, endometriosis, interstitial cystitis, and most other conditions where the final common pathway is chronic pain.

Marijuana is also used to manage nausea and weight loss, and can be used to treat glaucoma. A highly promising area of research is its use for PTSD in veterans who are returning from combat zones. Many veterans and their therapists report drastic improvement and clamor for more studies, and for a loosening of governmental restrictions on its study. Medical marijuana is also reported to help patients suffering from pain and wasting syndrome associated with HIV, as well as irritable bowel syndrome and Crohn’s disease.

This is not intended to be an inclusive list, but rather to give a brief survey of the types of conditions for which medical marijuana can provide relief. As with all remedies, claims of effectiveness should be critically evaluated and treated with caution.

Talking with your doctor

Many patients find themselves in the situation of wanting to learn more about medical marijuana, but feel embarrassed to bring this up with their doctor. This is in part because the medical community has been, as a whole, overly dismissive of this issue. Doctors are now playing catch-up, and trying to keep ahead of their patients’ knowledge on this issue. Other patients are already using medical marijuana, but don’t know how to tell their doctors about this for fear of being chided or criticized.

My advice for patients is to be entirely open and honest with your physicians and to have high expectations of them. Tell them that you consider this to be part of your care and that you expect them to be educated about it, and to be able to at least point you in the direction of the information you need.

My advice for doctors is that whether you are pro, neutral, or against medical marijuana, patients are embracing it, and although we don’t have rigorous studies and “gold standard” proof of the benefits and risks of medical marijuana, we need to learn about it, be open-minded, and above all, be non-judgmental. Otherwise, our patients will seek out other, less reliable sources of information; they will continue to use it, they just won’t tell us, and there will be that much less trust and strength in our doctor-patient relationship. I often hear complaints from other doctors that there isn’t adequate evidence to recommend medical marijuana, but there is even less scientific evidence for sticking our heads in the sand.

The post Medical marijuana appeared first on Harvard Health Blog.

from Harvard Health Blog http://ift.tt/2Df1piE
Original Content By : http://ift.tt/1UayBFY

My Health - 9 Silent Signs Of Chronic Stress That You Must Never Ignore !

9 Silent Signs Of Chronic Stress That You Must Never Ignore !

Health and Fitness Tips
Health is the level of functional and metabolic efficiency of a living organism. In humans it is the ability of individuals or communities to adapt and self-manage when facing physical, mental, psychological and social changes with environment.

My Health - The ghost in the basement

Follow me on Twitter @BillEduTheater

We are fortunate to have a country home in the Catskills where we can escape city life. An eight-year-old neighbor often crosses our meadow or bikes over to stop by for a visit. While I’d like to think I’m the featured attraction, his visits are not just to see me; of much greater interest is our basement with its shelves of toys and games. Particularly appealing to this lad is the sports equipment: hockey sticks, goalie pads, a goal to shoot on, baseball mitts, a batting helmet, a catcher’s mask, soccer balls, and more. Name the sport and it is most likely we have equipment for it, even in different sizes.

I’ve given my young friend a few items: retaping a hockey stick that’s the right size for him, a pair of batting gloves, a cracked bat from a Bat Day at Yankee Stadium. He knows these were things that belonged to my son. Visits have been frequent, offering a chance to go to the basement so we could play some more floor hockey, or perhaps do a review of our inventory again, maybe hoping to catch me in a generous frame of mind. Downstairs amongst the gloves and balls and pads, waiting to be discovered, was The Question. “Where is your son, where is William?”

Knowing that sooner or later The Question that would come up, I had a conversation with his parents. Who explains William’s permanent absence to the young fellow? What is age-appropriate detail? Is there a better time for the discussion?

The Answer is, sadly, that William died from an accidental heroin overdose. At the time my wife and I became aware that William was using heroin, he was 22. He was already seeing a psychotherapist. Over the next two years we added an addiction psychiatrist, outpatient treatment, treatment with Suboxone, inpatient detox, inpatient treatment, outpatient treatment, outpatient detox, treatment with Vivitrol, more outpatient treatment, another inpatient treatment, more outpatient treatment, a revolving door of well over a dozen trips to and from the emergency rooms of at least four different hospitals, an attempt to work with another addiction psychiatrist, Alcoholics Anonymous, Narcotics Anonymous, and a home life fraught with tension, despair, sometimes hope during intermittent periods of sobriety, and always filled with the apprehension of misfortune.

That apprehension became fact when William accidentally overdosed shortly before his 24th birthday. Just four days prior he had gone to a hospital to ask to be admitted to inpatient detox. His insurance company denied the request as “not medically necessary.” Six weeks of comatose and/or heavily medicated hospitalization followed before the ultimate realization that William was consigned to a persistent vegetative state.

When we decided to permanently remove him from a respirator we attempted organ donation. Organ donation in William’s condition required an expedient demise within a tight one-hour time frame once removed from the respirator. William continued on and survived for another 21 hours before breathing his last in our arms. Ultimately, we made an anatomical donation of his body to Columbia University’s College of Physicians and Surgeons.

Once, William was young, curious, engaging, and adventuresome, much like our eight-year-old neighbor. I continue to question, puzzle, and agonize over the path that takes a boy from building with Legos, playing catch, bocce on our lawn, snow forts, an entertaining sense of humor, late night talks, fierce and courageous loyalty to friends, right-on-the-money analysis of people, situations, and numbers, a flash of the pads for a save, and the sweetness, strength, inspiration, and love that was William… to a death certificate that reads death due to “complications of acute heroin intoxication.”

One thing I do know. When my young neighbor asks about William, I have to answer him openly and honestly. There’s more of William to share than some old hockey sticks and baseball bats. William’s story, like that of so many others, has to come out of the basement so that it can be the cautionary tale every growing boy should hear.

Bill Williams Blog

The post The ghost in the basement appeared first on Harvard Health Blog.

from Harvard Health Blog http://ift.tt/2EyoOrB
Original Content By : http://ift.tt/1UayBFY

My Health - Rhabdo: A rare but serious complication of… exercise

It’s a new year, the gyms are unusually busy, and many of us started a new physical activity. Several health clubs are offering fun, interactive, and dynamic exercises such as whole-body workouts, functional training, CrossFit, high-intensity interval training, spinning, etc.

Some of these classes are incorporating intense workouts, which was a hot topic in exercise physiology in 2017. There is significant enthusiasm around these programs among my friends, family, and patients. Some of these classes have loud music, lights, and trainers whose job is to push you to a new level. Increasing the intensity of a workout may bring significant health benefits for some; however, lately we are starting to see cases of a potentially life-threatening disease as a result of these activities. It’s called rhabdo.

The other day I saw someone wearing a shirt that said “Pushing until Rhabdo.” That made me cringe. And I realized that, although rare, some people do not understand how serious rhabdo can be.

What is rhabdo?

Rhabdo is short for rhabdomyolysis. This rare condition occurs when muscle cells burst and leak their contents into the bloodstream. This can cause an array of problems including weakness, muscle soreness, and dark or brown urine. The damage can be so severe that it may lead to kidney injury. Intense physical activity is just one of the causes. Others include medication side effects, alcohol use, drug overdose, infections, and trauma/crush injury. Fortunately, most people who have rhabdo do not get sick enough to require hospitalization. But if you develop any of these symptoms after a hard workout, it’s a good idea to set up an appointment with your doctor. A simple blood and urine test could help establish the diagnosis.

How to avoid rhabdo

I know you are probably excited about your new exercise program, and you want to excel. And that’s great. But take it easy, especially if this is a new exercise routine. You want to challenge your body, but avoid extremes. If you are working with a trainer, make sure you tell him/her where you stand in terms of fitness level and health concerns. In addition:

• Drink lots of water. That will help prevent problems and help flush your kidneys.
• Avoid using anti-inflammatory medications such as ibuprofen and naproxen. These drugs may worsen kidney function.
• Avoid drinking alcohol. Alcohol is a diuretic, which means it will make you more dehydrated. You need more fluids in your system, not the opposite.

If you experience intense pain and fatigue after your workout, you should call your doctor. Most cases of rhabdo are treated at home simply by increasing fluid intake. If muscle enzyme levels are high, or if there are signs of kidney problems, IV fluids may be needed. In some cases, we have to admit patients to the hospital and even to the ICU for close monitoring and further treatment.

Ramping up safely

Be smart and train your muscles to adapt to new activity. Exercise is better if it is enjoyable and entertaining, and I have to say that some of these classes are incredibly fun. But make sure that you listen to your body. Watch out for trainers who may push you too hard to the point of exhaustion. That should not be your goal when you are first starting a brand-new routine, especially if you haven’t been active for a while. A good trainer should get to know you and will tailor the exercise routine to your level of fitness. Adding a new workout to your day is probably one of the healthiest habits you can incorporate in 2018, but don’t “push until rhabdo.” Instead push slowly but consistently, challenging your body toward wellness and better function.

The post Rhabdo: A rare but serious complication of… exercise appeared first on Harvard Health Blog.

from Harvard Health Blog http://ift.tt/2D21yVL
Original Content By : http://ift.tt/1UayBFY

My Health - The flu is here — and so is a new advisory from the CDC

Follow me on Twitter @RobShmerling

It seems like we hear the same thing every flu season — it’s going to be bad this year. In fact, different years bring different strains of flu, and the numbers of cases, complications, hospitalizations, and deaths related to the flu vary from year to year.

So, what’s the deal this year?

The CDC has just issued an advisory. Here are the highlights:

Flu season is heating up. The number of cases is rising and the predominant strain — A(H3N2) — is one that in past years has caused more hospital admissions and deaths than other strains, especially among older adults and young children.

The flu vaccine may not be very effective. Estimates are that it’s about 32% effective, while last year it was 39% effective and most years it’s 40% to 60% effective. Still, vaccination is highly recommended. Some protection is better than none, and the flu may be less severe in people who have been vaccinated.

Antiviral medications can shorten the course of the flu and reduce its severity. These medications include:

• oral oseltamivir (generic or as Tamiflu)
• inhaled zanamivir (Relenza)
• intravenous peramivir (Rapivab).

The antiviral medications work best when started within two days of the onset of symptoms; even after two days, these medications can be beneficial.

When flu is strongly suspected, treatment with antiviral medications should not be delayed while waiting for the results of flu tests. This is especially true for those most likely to suffer complications of the flu such as the elderly, chronically ill, and young children.

Antiviral medications — like antibiotics but different

If you have never heard of antiviral drugs, you aren’t alone. Antivirals are treatments for viral infections just as antibiotics (such as penicillin or erythromycin) are for bacterial infections. You may not be familiar with them because there aren’t nearly as many antiviral drugs as antibiotics, and most viral infections go away on their own. But for certain serious viral infections — HIV and hepatitis C are good examples — highly effective antiviral drugs have revolutionized care, prevented suffering, and saved countless lives. For influenza infections, antiviral medications can be a big help as well.

What’s the plan?

When it comes to the flu, there’s a lot you can do to reduce your risk (and the risk to those around you). Here are some measures to take now:

• Get vaccinated. The list of reasons to avoid vaccination is short (such as having a severe reaction to the vaccine in the past); and no, the standard injected flu vaccine cannot cause you to get the flu.
• Let your doctor know right away if you have symptoms suggestive of the flu during flu season. The sooner you’re tested and treated, the better. The most common symptoms are:
  • fever and chills
  • sore throat
  • cough and runny nose or congestion
  • fatigue and achiness all over
  • headache
• Stay home. If you have flulike symptoms, avoid contact with others. If that means missing work, your boss should be grateful you aren’t exposing your coworkers.
• Wash your hands often and cover your mouth and nose when coughing or sneezing. If you are taking care of someone who has the flu, remind them to take these precautions.

In conclusion…

Maybe this year’s flu season will be milder than expected. But I wouldn’t count on it. I’ve had the flu and it’s not pleasant. Do what you can to lessen your risk. It’s worth the effort.

The post The flu is here — and so is a new advisory from the CDC appeared first on Harvard Health Blog.

from Harvard Health Blog http://ift.tt/2DfSJoY
Original Content By : http://ift.tt/1UayBFY

My Health - Never Do These Things After Running If You Don't want to be Healthy

Never Do These Things After Running If You Don't want to be Healthy

Health and Fitness Tips
Health is the level of functional and metabolic efficiency of a living organism. In humans it is the ability of individuals or communities to adapt and self-manage when facing physical, mental, psychological and social changes with environment.

My Health - 5 common problems that can mimic ADHD

Follow me on Twitter @drClaire

Attention deficit hyperactivity disorder, or ADHD, is very common — according to the most recent statistics, one in 10 children between the ages of 4 and 17 has been diagnosed with this problem. So it’s not surprising that when parents notice that their child has trouble concentrating, is more active or impulsive than other children, and is having trouble in school, they think that their child might have ADHD.

But ADHD isn’t the only problem that can cause a child to have trouble with concentration, behavior, or school performance. There are actually lots of problems that can cause symptoms that mimic ADHD, which is why it’s really important to do a careful evaluation before giving that diagnosis. Here are five common problems that parents and doctors should always think about:

1.  Hearing problems. If you can’t hear well, it’s hard to pay attention — and easy to get distracted. Now that more newborns are being screened for hearing problems before leaving the hospital, we are able to catch more cases early, but some slip through the cracks, and children can also develop hearing problems from getting lots of ear infections. Any child with behavioral or learning problems should have a hearing test to be sure their hearing is normal.

2.  Learning or cognitive disabilities. If children don’t understand what’s going on around them, it’s hard for them to focus and join in classwork. Children who have trouble understanding may also have difficulty with social interactions, which can be very quick, complex, and nuanced. Any child who is doing poorly in school should be evaluated and given the help they need. All public schools have a process for evaluating children and creating an Individualized Education Program, or IEP, for those who need help. Even if a child goes to an independent school, they can still get an evaluation through the public schools. Parents should talk to their child’s teacher and their pediatrician for guidance.

3.  Sleep problems. Children who don’t get enough sleep, or whose sleep is of poor quality, can have trouble with learning and behavior. Any child who snores regularly (not just with a bad cold) should be evaluated by their doctor, especially if there are any pauses in breathing or choking noises during sleep. Parents of teens should be sure that their children are getting at least eight hours of sleep and aren’t staying up doing homework or on their phones. In general, any time a diagnosis of ADHD is being considered, it’s important to take a close look at a child’s sleep and make sure there aren’t any problems.

4.  Depression or anxiety. It is hard to concentrate when you are sad or worried, and it’s not uncommon for a depressed or anxious child to act out and get in trouble. More than one in 10 adolescents has suffered from depression, and the numbers are higher for anxiety. Even more alarming, both depression and anxiety often go undiagnosed — and untreated — among children and adolescents. As part of any evaluation for ADHD, a child should also be evaluated for other mental health issues, not just because they can mimic ADHD, but because other mental health issues can occur with, or because of, ADHD.

5.  Substance abuse. This is something that should always be considered in an adolescent, especially if the ADHD symptoms weren’t present earlier in childhood (by definition, you have to have the symptoms before age 12 to get the diagnosis). Nobody wants to think that their child could be using drugs or alcohol, but by 12th grade about half of youth have tried an illicit drug at least once, and for some, it can turn into a habit — or worse.

Bottom line

Lots of problems can cause difficulties with attention and behavior. Any child who is showing those difficulties deserves a thoughtful, thorough evaluation to be sure that they get the right diagnosis, and the best treatment.

The post 5 common problems that can mimic ADHD appeared first on Harvard Health Blog.

from Harvard Health Blog http://ift.tt/2DdsNu2
Original Content By : http://ift.tt/1UayBFY

My Health - Another option for life-threatening allergic reactions

For some people, many foods, medicines, and bee stings mean life-threatening allergic reactions that require immediate treatment with injectable epinephrine. For many people, January means the start of a new drug deductible to be met. In June 2017 the FDA approved a new form of emergency epinephrine called Symjepi, which may be good news for people who must be prepared in the event of a life-threatening allergic reaction.

The seriousness of a severe allergic reaction

Severe allergic reactions affect anywhere from 5% to 70% of persons, depending on age and prior exposure. Anaphylactic or “type 1” (immediate hypersensitivity) reactions are the most severe forms of allergic reaction to a substance: insect venom, foods, or some drugs. People who have had prior exposure to an allergic substance are “sensitized” and when they are re-exposed, can have a reaction within seconds to minutes. Anaphylactic reactions are caused by the release of histamine and other chemicals throughout the body, resulting in leaky blood vessels that contribute to swelling of tissues in the mouth and airway and very low blood pressure. These symptoms can lead to difficulty swallowing and speaking, wheezing and severe shortness of breath, and death.

Treating severe allergic reactions

The treatment for severe allergic reactions is the administration of epinephrine (adrenaline) at the first sign of symptoms. Epinephrine is one of the chemicals in the body that raises blood pressure and heart rate. Epinephrine can be administered through an IV in the hospital, but since the 1980s, epinephrine has been available as a pre-filled syringe that can be obtained with a prescription and immediately injected into the thigh muscle when severe allergic symptoms are recognized.

The prevalence of severe allergies has been increasing since 2000. Anaphylaxis to some external chemical or allergen occurs in 2% of the population, and it is estimated that approximately 500 people die from anaphylactic reactions per year in the US. Because of this, more and more people need to have epinephrine available wherever they are (home, school, when traveling). So it is no surprise that the manufacture and marketing of pre-filled epinephrine syringes has been big news in the last two years.

Keeping epinephrine at the ready

Spring-loaded autoinjectors that contain epinephrine have been manufactured by several companies since 1987. In the last 30 years, changes in pharmaceutical companies and patent transfers resulted in a near-monopoly in the production of pre-filled epinephrine products. From 2009 to 2016, one company with a 90% market share dramatically increased the consumer cost for epinephrine injectors, resulting in an investigation and eventual settlement with the US Department of Justice.

Although not a spring-loaded autoinjector, Symjepi consists of two single-dose, pre-filled syringes of epinephrine, for the emergency treatment of anaphylactic and severe allergic reactions in adults. Each pre-filled syringe contains 0.3 mg epinephrine, the recommended initial dose for emergency treatment of anaphylaxis.

At an anticipated lower cost and small size, Symjepi could be an attractive addition to this slice of the pharmaceutical world. In November 2017, the company also submitted a second new drug application to the FDA for a junior version (0.15 mg dose for children between 33 and 65 pounds).

Given the growing prevalence of life-threatening allergies, a new, lower-cost alternative should place the availability of this potentially life-saving drug within greater reach.

The post Another option for life-threatening allergic reactions appeared first on Harvard Health Blog.

from Harvard Health Blog http://ift.tt/2mdNLlA
Original Content By : http://ift.tt/1UayBFY

My Health - 12 Banana Health Facts That You Probably Didn't Know

12 Banana Health Facts That You Probably Didn't Know

Health and Fitness Tips
Health is the level of functional and metabolic efficiency of a living organism. In humans it is the ability of individuals or communities to adapt and self-manage when facing physical, mental, psychological and social changes with environment.

My Health - 9 Quick Ways To Treat Chest Congestion At Home

9 Quick Ways To Treat Chest Congestion At Home

Health and Fitness Tips
Health is the level of functional and metabolic efficiency of a living organism. In humans it is the ability of individuals or communities to adapt and self-manage when facing physical, mental, psychological and social changes with environment.

My Health - Top 10 Tips To Help Treat Depression Naturally!

Top 10 Tips To Help Treat Depression Naturally!

Health and Fitness Tips
Health is the level of functional and metabolic efficiency of a living organism. In humans it is the ability of individuals or communities to adapt and self-manage when facing physical, mental, psychological and social changes with environment.

My Health - Working through workplace stigma: Coming back after an addiction

My first day returning to work after being treated for a severe opiate addiction was one of the most daunting moments of my life. Everyone in the office, from my manager to the administrative assistants, knew that forged prescriptions and criminal charges were the reason I had been let go from my previous job. My mind was spinning. What would my coworkers think of me? Who would want to work alongside an “addict”? Would they ever come to trust me? Did I even deserve to be here?

When my life was crashing and burning due to my addiction (detailed in my memoir Free Refills: A Doctor Confronts His Addiction), a return to work seemed like a distant prospect, barely visible on a horizon clouded by relapses, withdrawal, and blackouts. My finances, my professional reputation, and my family life were in terrible shape due to my drug-seeking behavior. Working was not a tenable option until I received treatment and established a solid track record of recovery, which a potential employer could rely on.

The fact that I was now in recovery was a great development, and it was further ratification of my progress that I had landed a job and was returning to work. So, why wasn’t I feeling overjoyed?

How stigma affects the return to work

As it turns out, the transition back to work after someone is treated for an addiction can be profoundly stressful. People recovering from addiction already tend to suffer disproportionately from guilt, shame, and embarrassment, and these feelings are often brought to the forefront during the unique challenges of returning to work.

Stigma is what differentiates addiction from other diseases, and is primarily what can make the return to work so difficult. If I had been out of work to receive chemotherapy or because of complications from diabetes, I certainly wouldn’t have felt self-conscious or self-doubting upon resuming my employment. With addiction, due to the prejudices that many people in our society hold, the return is psychologically complex and anxiety-producing. As I entered my new office, I was walking right into the fears, preconceptions, and potential disdain that my new officemates might share toward people suffering from a substance use disorder. For all I knew, I was the “dirty addict” that they now, against their wishes, had to work with.

“Bring your body and your mind will follow”

What I was taught in recovery, to deal with situations like this, is to “just keep your head up” and to “put one foot in front of the other.” Or, “bring your body, and your mind will follow.” When I first heard these phrases, I thought that they were mere platitudes, phrases without content, provided to motivate us through dark times. Now, I think they hold a great deal of wisdom.

As I walked through the door on my first day back, I did feel everyone’s eyes on me, and I did wonder if they were judging and criticizing me, but I made it to my desk without incident, and managed to power through my self-consciousness and get into the flow of my work. Every day, it became easier as I did a good job, deepened my connections with my colleagues, and accumulated good will, which would eventually replace any negative images that may have accompanied my arrival. Within weeks this was a non-issue, though at office get-togethers, my co-workers still somewhat awkwardly don’t know whether to put a wine glass at my place setting.

With all I had learned in recovery about communication, about humility, about connecting with others, I feel that I was in a better position to thrive in my workplace than I was before my addiction started in the first place. As more of my brothers and sisters in recovery return to employment, and as we succeed, the more difficult will it be for people to hold on to their negative attitudes and prejudices about substance use disorders. We can defeat the stigma by confronting it, putting one foot in front of the other, one step at a time.

 

The post Working through workplace stigma: Coming back after an addiction appeared first on Harvard Health Blog.

from Harvard Health Blog http://ift.tt/2Ctf1SR
Original Content By : http://ift.tt/1UayBFY