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HEALTHY-FOOD NATURAL-BEAUTY YOGA

Adult female acne: Why it happens and the emotional toll

close-up photo of a woman's face showing a serious acne breakout around her eye and down the right side of her face

Acne can be frustrating, especially when it does not go away after your teenage years. Believe it or not, acne can continue to affect adults beyond adolescence, or develop for the very first time in adulthood. This may be particularly distressing for adult women, who are more likely to get acne after the age of 20 compared to men.

What is adult female acne?

Adult female acne can look very similar to teenage acne. While adult acne is commonly thought to affect the jawline and chin, it can appear on any part of the face or trunk. Adult women can have clogged pores, inflamed pus-filled bumps, or deep-seated cysts. Unfortunately, treatment options that worked well in the teenage years may not work as well in adult females with acne, due to triggering factors such as hormonal imbalance, stress, and diet.

There are many reasons adult females can get acne. Hormonal disturbances caused by pregnancy, menstrual cycle, menopause, and oral contraceptives can contribute to acne by modifying the production of certain hormones. These hormones stimulate oil production within the skin, promoting the growth of acne-causing bacteria. Stress can increase the production of substances that activate oil glands within the skin of acne patients. Consumption of dairy and high-glycemic foods is also linked to acne. Certain hair or skin products can clog pores and cause comedonal acne (blackheads and whiteheads). A board-certified dermatologist can help determine the appropriate treatment for the type of acne you have.

Consequences of adult acne and scarring

The extent to which acne causes emotional distress varies, and is not related to the severity of the acne or acne scars. Some women with acne may experience disruption in their personal and professional lives as they fear stigmatization in relationships and employment. Adult females may also be more likely to seek treatment for active acne when acne bumps and scarring persist.

Acne scarring can be disfiguring. Permanent changes in skin texture in the form of pits or raised scars may not be easily concealed with makeup. Raised scars may also lead to skin picking and worsening skin texture and pigment.

Acne can also heal with red or dark spots that may not resolve for weeks to months. The dark spots may persist even longer without proper sun protection, especially on darker skin. Having both acne and dark spots may negatively impact one’s quality of life and self-perception.

The emotional toll associated with acne may include an elevated risk of developing depression compared to patients who do not have acne. Clinical studies show that having severe acne can negatively affect quality of life on par with long-term diseases such as arthritis, diabetes, back pain, and asthma. If you have acne, extensive scarring, or dark spots of any severity that are affecting your mental health, you may benefit from earlier intervention with oral medications.

What are options for treatment and support?

Acne is a medical condition, but it only needs to be treated if the acne or marks left behind from it are bothersome to you. Please see a board-certified dermatologist (in person or virtually) for the best available options if you wish to seek treatment.

Your dermatologist may prescribe a combination of topical (skin) and oral treatments. Some of these medications may not be appropriate if you are pregnant or breastfeeding, or carry risks. Ask your dermatologist about hair and skin products that may be irritating, clogging pores, or promoting oil production in the skin, making your acne worse. Also, avoid skin picking to prevent scarring, and try to minimize emotional and physical stressors.

For individuals with dark spots or scarring, consult a board-certified dermatologist to get a personalized treatment geared to your skin concerns. Use a broad-spectrum, tinted sunscreen daily and reapply it every two hours to help prevent acne marks from worsening. If your acne is causing you significant mental distress, ask your doctor about mental health resources. Additionally, seeking treatment for your acne may help you feel better. Consider joining online or in-person support groups in your area.

For more information, visit the American Academy of Dermatology Acne Resource Center.

Follow Dr. Nathan on Twitter @NeeraNathanMD
Follow Dr. Patel on Twitter @PayalPatelMD

About the Authors

photo of Neera Nathan, MD, MSHS

Neera Nathan, MD, MSHS, Contributor

Dr. Neera Nathan is a dermatologist and researcher at Massachusetts General Hospital and Lahey Hospital and Medical Center. Her clinical and research interests include dermatologic surgery, cosmetic dermatology, and laser medicine. She is part of the … See Full Bio View all posts by Neera Nathan, MD, MSHS photo of Payal Patel, MD

Payal Patel, MD, Contributor

Dr. Payal Patel is a dermatology research fellow at Massachusetts General Hospital. Her clinical and research interests include autoimmune disease and procedural dermatology. She is part of the Cutaneous Biology Research Center, where she investigates medical … See Full Bio View all posts by Payal Patel, MD

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HEALTHY-FOOD NATURAL-BEAUTY YOGA

Numb from the news? Understanding why and what to do may help

image of an error screen used in television transmission, showing vertical bars in various colors with the words please stand by superimposed with white letters in a black box

In the spring of 2020, the pandemic catapulted many of us into shock and fear — our lives upended, our routines unmoored. Great uncertainty at the onset evolved into hope that, a year later, a semblance of normalcy might return. Yet not only do people continue to face uncertainty, but many of us have also reached a plateau of fatigue, resignation, and grief.

We are living through a time of widespread illness, social and political unrest, economic fractures, and broken safety nets. Whether each of us experiences the ravages of this time close to home or as part of a larger circle, the symptoms of collective trauma are widespread. Many of these symptoms — feeling overwhelmed, anxious, fatigued — may be familiar. One deserves special mention: numbness. As a psychiatrist who has considerable experience treating refugees suffering from trauma, and an author and teacher who works with collective trauma, we have learned a great deal about how numbness affects us all.

Newsfeeds: Friend or foe?

Compounding our challenges are our news viewing habits. During times of uncertainty, we are each, in our own way, experiencing vulnerability. Fears that had lain dormant for years may be activated, causing low-grade stress or full-blown anxiety. These fears are exacerbated by what might be called the “toxic trauma story” churned out by mainstream news channels.

The formula is simple: brutal facts associated with high emotion attract viewers. As the old adage says, “If it bleeds, it leads.” Negative news around vaccine reactions or political unrest provides the ultimate sensational content for viewers. But for most Americans, this daily onslaught of negativity exerts a toll on mind, body, and emotions.

Numbness is one possible response to trauma

When a situation is overwhelming, your body protects itself by entering a “fight, flight, or freeze” mode. Our responses to the pandemic and continuous uncertainty, fueled by doomscrolling and newsfeeds, range from hyperactivation (fight or flight) to numbness (freeze). While the three Fs refer to the body’s stress response in the moment, these reactions can continue long after exposure to trauma.

In medical terms, numbness occurs when nerves are damaged, leading to partial or total loss of sensation in the body. We can also describe numbness related to our psychological well-being: a lack of enthusiasm and interest in life, a sense of apathy and indifference. The spectrum ranges from mild apathy to disassociation to a heavy, weighty lethargy, which is often a symptom of severe depression. “Freeze” refers to a paralyzed or frozen state associated with post-traumatic stress disorder (PTSD) and major depression. We have each worked with thousands of people — some refugees, some not — who have experienced this level of trauma.

The numbness many people are experiencing and describing these days didn’t necessarily begin with the pandemic, nor is a toxic stream of trauma stories the only source feeding it. It may have been there for many years, only to be triggered by recent personal and societal challenges.

This numbness is not just a lack of feeling; its symptoms vary. You might feel a low level of anxiety operating in the background, much like an operating system running our computers silently. You may feel no emotion or a sense of frozenness during the day, followed at night by insomnia or nightmares. Some people who are refugees cannot watch the daily news, since it is a terrifying trigger that floods them with memories of their past traumas.

How does numbness affect us collectively?

Millions of people turn to their phones and devices for daily notifications of traumatic news. These instantaneous alerts offer little space for digestion and reflection. That harmful combination of speed and trauma can strike at our nervous systems, overwhelming us until we are too numb to comprehend the complex range of experiences flooding in over the last days, weeks, and years. What happens to us as a culture, grappling with this cumulative phenomenon?

Where collective trauma now exists, we need to seek ways to facilitate dialogue and restoration. The numbness following traumatization reduces our capacity to witness suffering. We lose our reflective capacity to be self-aware, which reduces empathy and compassion. Indifference and disconnection can contribute to further atrocities, fueling a feedback loop that makes new traumas more likely to occur.

Collective numbness can surface as epidemic substance misuse; food, sex, or entertainment addiction; media overuse; or in other ways. It reveals itself as a collective shutting-down to crisis, which can derail healing.

How can you counter numbness and feeling overwhelmed?

As individuals, we can spend more time practicing self-care, as outlined in the Harvard Program in Refugee Trauma toolkit. For example, take time to reflect on the resources and sources of support you have in your life. Spend quality time with family, and if possible, in nature. Set boundaries on news devices to give your nervous system a chance to relax. Turn off your notifications, leave your phone far from your bedroom at night, and consider periodic news fasts to give your system a full recharge.

Developing a mindfulness practice can help reduce stress, allowing people to digest and integrate hidden emotions or experiences buried under numbness. One option is a practice called 3-sync: imagine a journey of witnessing yourself, moving deliberately as you notice the state of your body first, then your mind, and finally, your emotions. Following this during meditation can help you become aware of imbalances within yourself, as well as areas of strength and vitality. Another practice, global social witnessing, is a conscious process of witnessing the news, and digesting it with our minds, bodies, and emotions fully present.

By working together to be with whatever is present, acknowledging and feeling our discomfort, resistance, and pain, we may move closer to integration and a sense of healing during this time of upheaval.

About the Authors

photo of Richard F. Mollica, MD

Richard F. Mollica, MD, Contributor

Dr. Richard F. Mollica is a professor of psychiatry at Harvard Medical School, and director of the Harvard Program in Refugee Trauma (HPRT) at Massachusetts General Hospital. A pioneer in international research on refugee trauma, he … See Full Bio View all posts by Richard F. Mollica, MD photo of Thomas Hübl

Thomas Hübl, Guest Contributor

Thomas Hübl is a renowned teacher, and author of Healing Collective Trauma: A Process for Integrating Our Intergenerational and Cultural Wounds. Since 2002, he has led dialogue and restoration processes around collective trauma with more than … See Full Bio View all posts by Thomas Hübl

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HEALTHY-FOOD NATURAL-BEAUTY YOGA

If climate change keeps you up at night, here’s how to cope

photo of a newspaper article warning of worsening climate change as the planet warms, shown outside against a blue sky and sun

A forest fire in northern California and a mile-long glacier breaking apart appear in your news feed. The stark reminders of climate change are constant, and may cause additional stress to your daily tasks. For example, in surveying your shopping cart filled with wipes, sandwich bags, and packets of baby food, you may question your choices, knowing that the plastic in those items will never break down completely. You may feel guilty about driving the short distance to the store, or you may struggle to stop worrying about how your actions will affect future generations.

What is climate anxiety?

Climate anxiety, or eco-anxiety, is distress related to worries about the effects of climate change. It is not a mental illness. Rather, it is anxiety rooted in uncertainty about the future and alerting us to the dangers of a changing climate. Climate change is a real threat, and therefore it's normal to experience worry and fear about the consequences. Anxiety about the climate is often accompanied by feelings of grief, anger, guilt, and shame, which in turn can affect mood, behavior, and thinking.

How common is climate anxiety?

According to a survey by the American Psychological Association, more than two-thirds of Americans experience some climate anxiety. A study published by The Lancet found that 84% of children and young adults ages 16 to 25 are at least moderately worried about climate change, and 59% are very or extremely worried. This makes sense, as children and young adults will disproportionately suffer the consequences of environmental changes. A 2021 UNICEF report estimates that one billion children will be at "extremely high risk" as a result of climate change. Children and young adults are also particularly vulnerable to the effects of chronic stress, and climate anxiety may affect their risk of developing depression, anxiety, and substance use disorders.

How does climate change affect mental health?

In addition to existential worries and fears about the future, climate change can affect mental health directly (such as through natural disasters or heat) and indirectly (through displacement, migration, and food insecurity). Rising temperatures have been associated with increases in emergency department visits for psychiatric reasons, and may impair cognitive development in children and adolescents. Furthermore, food insecurity is associated with depression, anxiety, and behavioral problems.

How can you manage climate anxiety?

As uncertainty and a loss of control characterize climate anxiety, the best treatment is to take action. On an individual level, it’s therapeutic to share your worries and fears with trusted friends, a therapist, or by joining a support group. You can also make changes to your lifestyle consistent with your values. This may include deciding to take fewer flights, joining a protest, or increasing public awareness about climate change through advocacy. Joining an organization like The Good Grief Network can help you process feelings related to climate anxiety and connect with others to take meaningful action.

How can you help a younger person?

Climate anxiety disproportionately affects children and youth. To be an ally for a child, adolescent, or younger adult with climate anxiety, you can consider showing your support in the following ways:

  • Validate their concerns. “I hear you, and it makes sense that you are worried (or angry) about this issue.”
  • Help direct their efforts to advocacy groups. Spend time together researching organizations that they can get involved with.
  • Educate yourselves on steps you both can take to minimize your impact on the environment.
  • Support your loved one’s decisions to make changes to their lifestyle, especially changes they can witness at home.
  • Spend time in nature with your family, or consider planting flowers or trees.

The bottom line

Climate anxiety is rife with uncertainty, but taking action may help you feel in control. Talk with others, join forces, and make lifestyle changes based on your values.

About the Author

photo of Stephanie Collier, MD, MPH

Stephanie Collier, MD, MPH, Contributor

Dr. Stephanie Collier is the director of education in the division of geriatric psychiatry at McLean Hospital; consulting psychiatrist for the population health management team at Newton-Wellesley Hospital; and instructor in psychiatry at Harvard Medical School. … See Full Bio View all posts by Stephanie Collier, MD, MPH

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HEALTHY-FOOD NATURAL-BEAUTY YOGA

Younger adults with kidney disease struggle with health disparities

A partial view of a person having dialysis that shows twisting intravenous tubes going into one forearm arm; his other hand is on top of a plaid blanket

Chronic kidney disease (CKD) affects an estimated 37 million people in the United States. Often, it begins and progresses silently, causing no obvious symptoms until kidney function is severely impaired. During early stages, up to nine in 10 people aren’t aware that they have it.

If kidney disease is caught early and treated properly, serious problems may be avoided. Once kidneys fail, ongoing dialysis or kidney transplant is necessary. But barriers to care are highest for Black and Hispanic people with advanced kidney disease, and also for younger adults ages 22 to 44, according to a recent study.

How does kidney disease affect the body?

As a doctor who focuses on patients with kidney disease, I’ve found that it helps to explain a few basics. Our kidneys have several jobs. Their most important task is to regularly remove toxins from the bloodstream and excess water from the body by making urine.

If you have CKD, your kidneys are not removing toxins from your blood as well as they should. At its most severe, this can progress to end-stage kidney disease (ESKD), which is when the filtering capacity of your kidneys is reduced enough to make you feel ill.

If this occurs, two main forms of treatment can replace your kidney function: dialysis or a kidney transplant. Dialysis can be performed at a treatment center, or at home after appropriate training. Transplant surgery and post-surgical care occur at specialized centers.

What causes kidney disease?

High blood pressure, diabetes, and high cholesterol are three common risk factors for developing chronic kidney disease. Smoking, obesity, and frequent use of over-the-counter anti-inflammatory medicines, such as ibuprofen or naproxen, worsen kidney function over time.

Severe cases of COVID-19 requiring hospitalization have emerged as a separate risk factor for CKD. And genetic factors may predispose a person to kidney disease as well.

Gaps in kidney care are contributing to health disparities

Statistics show that people who are non-Hispanic Black, Hispanic, and Native American bear a disproportionate burden of kidney disease. For example:

  • For every white person who develops ESKD, three Black people develop it.
  • While non-Hispanic Black patients make up only 13% of the US population, they represent 35% of people currently on dialysis.
  • Among patients initially on a wait list for a kidney transplant in 2014, median wait times were approximately 64 months for Black patients, 57 months for Hispanic patients, and 37 months for white patients.

Most likely, disparities in CKD reflect a combination of the social determinants of health, genetics, and a higher burden of other diseases that contribute to kidney disease, such as high blood pressure and diabetes. Barriers to getting proper treatment — particularly early treatment — play a role, too.

A recent retrospective study in the American Journal of Kidney Medicine suggests age is also a factor. The researchers reviewed data from more than 800,000 patients who received dialysis at home, dialysis at a treatment center, or a kidney transplant between 2011 and 2018. They found

  • white people in the study were more likely than people of color to use at-home dialysis or receive a kidney transplant within 90 days.
  • the care gap was greatest among adults ages 22 to 44. Black patients in this age group were 79% less likely, and Hispanic patients were 53% less likely, than white patients to receive a kidney transplant within 90 days.

These disparities may be driven partly by the fact that Black and Hispanic patients are less likely to receive appropriate early-stage kidney care, and by differences in insurance. They may also be less likely to have access to a living kidney donor. An important limitation of this study is that these findings cannot be applied to other minority groups.

The bottom line

The good news is that most people can prevent kidney disease by following healthy lifestyle habits, such as eating a low sodium diet, getting moderate exercise, not smoking, and minimizing alcohol intake. If you have high blood pressure, diabetes, high cholesterol, or heart disease, you should be tested for kidney disease once a year. High blood pressure and diabetes — which occur more often among Black Americans and people of color in the US than among white Americans — harm kidneys. Studies such as the one described above increase our understanding of health disparities in kidney disease, with the hope of one day coming up with an equitable solution for everyone, no matter their background or age.

About the Author

photo of Christopher Estiverne, MD

Christopher Estiverne, MD, Contributor

Originally from New Jersey, Dr. Christopher Estiverne is currently a staff nephrologist at Brigham and Women’s Hospital in Boston, where he specializes in care of patients with chronic kidney disease. He completed his medical degree and … See Full Bio View all posts by Christopher Estiverne, MD

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HEALTHY-FOOD NATURAL-BEAUTY YOGA

Poliovirus in wastewater: Should we be concerned?

The tip of a pink highlighter pen running over the word "Polio;" a few words from a definition of the illness are also shown

Polio is a potentially life-threatening or disabling illness that spreads from person to person. Thanks to vaccination, the United States has been polio-free since 1979, and the spread of this highly contagious disease has been interrupted in most countries. Yet on June 22, the United Kingdom Health Security Agency announced that it had detected poliovirus in a most unexpected place: the sewers of London.

Over the past several months, scientists at the agency repeatedly found poliovirus in London sewer water. The viruses were genetically similar, suggesting that they were the result of limited spread within a family or close-knit community. Just how concerned should all of us be about this news?

Health clues found in wastewater

Sampling of wastewater for genetic material from viruses is a powerful tool used by epidemiologists to track outbreaks of polio and other diseases. Surges in the amount of SARS-CoV-2 RNA in Boston wastewater have been highly predictive of COVID outbreaks. Wastewater may also help to detect the spread of influenza and antibiotic-resistant bacteria.

Poliovirus infection was once a common and dreaded disease. Most people with poliovirus either had no symptoms or mild gastroenteritis (stomach flu). But one in 100 people developed paralysis, or poliomyelitis. In half of the affected patients, this paralysis was permanent.

In the UK, wild poliovirus has been eliminated since 1984. Although great progress has been made in many parts of the world, complete eradication of polio has been elusive. Pakistan and Afghanistan have never been free from wild-type polio, and outbreaks have recently taken place in Malawi and Mozambique, countries which had previously eliminated polio.

The reasons for this backsliding are complex. Some contributing factors are diversion of scarce resources toward the COVID-19 pandemic, backlogs in vaccine manufacturing, anti-vaccine agitation, and violence directed at vaccine workers.

Another problem is vaccine-derived poliovirus. In the United States and most other countries, injections containing killed viruses are used. While these vaccines are safe, they are less effective than oral vaccines at breaking the chain of polio transmission. Oral vaccines stimulate long-lived immune responses in the lining of the intestines, where polioviruses replicate. Unfortunately, oral vaccines contain weakened but live viruses, which occasionally revert to a more dangerous form. In fact, the poliovirus found in London was a vaccine-derived strain that the infected individual had likely acquired from travel abroad.

Who is at risk for poliovirus stemming from this source?

Vaccine-derived viruses pose little risk to highly vaccinated populations, but they are able to spread in communities with low polio vaccination rates. In some cases, this can even cause paralytic disease. Because of these risks, steps are being taken to gradually phase out the use of oral polio vaccines.

If you’re concerned about polio, the best protection against this disease is vaccination. Children should receive a full series of four shots of inactivated polio vaccine, given at specific intervals, that helps with developing immunity.

Nationwide, rates of childhood polio vaccination in the United States are still high (nearly 93%). However, some infectious disease experts worry that the weakening of vaccine mandates in some areas has created islands of vulnerability in this sea of immunity. Communities in the US with low childhood vaccination rates have been vulnerable to large measles outbreaks in recent years, and might also be vulnerable to polio outbreaks.

With few exceptions, adults who were fully vaccinated as kids do not need booster shots. These exceptions include travel to a country with active polio transmission, laboratory work with poliovirus, or providing health care to polio patients and their close contacts. A single lifetime booster dose of inactivated polio vaccine is adequate for these high-risk scenarios.

About the Author

photo of John Ross, MD, FIDSA

John Ross, MD, FIDSA, Contributor

Dr. John Ross is an assistant professor of medicine at Harvard Medical School. He is board certified in internal medicine and infectious diseases, and practices hospital medicine at Brigham and Women’s Hospital. He is the author … See Full Bio View all posts by John Ross, MD, FIDSA

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HEALTHY-FOOD NATURAL-BEAUTY YOGA

Year three of the pandemic is underway: Now what?

A pattern of smaller and larger coronovirus cells in light red against an orangey-pink background

Let’s not kid ourselves: the pandemic is still with us, despite how it may sometimes seem.

Increasingly, people are going back to work in person. Schools reopened this spring. And mask mandates are history in most parts of the US. In many places, case rates are falling and deaths due to COVID-19 have become uncommon. For many, life now closely resembles pre-pandemic normalcy. So, what do you need to know about where we are now?

Not so fast: COVID remains a big problem

The virus is still very much with us, not behind us. According to the CDC, in the US there are nearly 100,000 new cases (likely an underestimate) and around 300 deaths each day due to COVID as of this writing. Despite this, more and more people are paying less and less attention.

That could be a big mistake. With summer travel season here and some dire warnings about fall and winter, it’s worth stepping back, taking a deep breath, and reassessing the situation.

Here are responses to five questions I’ve been hearing lately.

1. I haven’t gotten COVID by now. So, do I still need a vaccine?

Yes, indeed! Vaccination and boosters are the best way to avoid a severe case of COVID-19 infection.

Maybe you’ve been spared infection so far because you’ve been vigilant about physical distancing, masking, and other preventive measures. Or perhaps you’ve inherited genes that make your immune system particularly good at evading the COVID-19 virus. Or maybe you’ve just been lucky.

Regardless of the reason, it’s best not to let your guard down. The SARS-CoV-2 virus that causes COVID is highly contagious, especially the most recent variants. And while some people are at higher risk than others, anyone can be infected and anyone can become seriously ill from this virus. Even if you get a mild or moderate case of COVID-19, remember that some people experience symptoms of long COVID, such as fatigue and brain fog.

2. More and more vaccinated people are getting sick with COVID. And I’ve heard that more COVID-related deaths have occurred since vaccines rolled out than before they were available. So, how much of a difference do vaccines and booster shots really make?

They make a huge difference.

It’s estimated that COVID-19 vaccinations have saved more than two million lives in the US. If vaccination rates had been higher, estimates suggest more than 300,000 additional lives could have been saved.

We know that rates of infection, hospital admission, and death dropped dramatically among vaccinated people soon after vaccines became available. We also know that most severe cases of COVID-19 among the vaccinated occur among people who haven’t had a booster shot. Overall, severe cases and deaths remain much lower among people who are vaccinated and boosted than among people who are not vaccinated.

Is it true that the share of severe COVID cases and deaths occurring among the vaccinated has risen? Yes, but possible explanations for this trend actually show that vaccines continue to protect people from serious illness:

  • When rates of infection fall, overall rates of hospital admission and death fall for everyone, vaccinated or not. So, the gap between rates of infection and death between vaccinated and unvaccinated people gets smaller.
  • Available vaccines aren’t as effective against new variants of the virus. True, but these vaccines still effectively reduce the risk of severe disease.
  • Immunity wanes over time. That’s true for even the best vaccines, which is why boosters are needed. Yet only about a third of the US population has received a COVID booster. That makes it easier for the virus to continue to spread and mutate.
  • We’ve now logged more time with vaccines than without them since the pandemic began. Because no vaccine is 100% effective, the numbers of cases and deaths will continue adding up, eventually outnumbering pre-vaccine cases and deaths.

3. First, vaccines were going to solve this. Then we needed one booster shot. Now we need two. What’s happening, and why should I even consider this?

Good questions. The protection provided by most vaccines tends to wane over time. That’s why tetanus shots are recommended every 10 years. We’ve learned that protection against COVID-19 may wane a few months after the initial vaccine doses. A first booster is recommended for everyone who is vaccinated, five months after completing the two-dose Moderna or Pfizer vaccine series or four months after the single-dose J&J vaccine.

Because immunity from the first booster may wane sooner in older adults and people with certain health conditions, another Pfizer or Moderna vaccine dose is now available to those over age 50 and others at particularly high risk.

4. Now that mask mandates are in the rearview mirror and everyone is tired of COVID restrictions, what else helps?

It’s not yet clear that mask mandates should have been lifted as soon as they were, especially when rates of infection were starting to rise again. We’ll only know in retrospect if that was a good idea.

As for other measures, physical distancing, masking up, and other steps still make sense in certain situations. For example, if you’re using public transportation or traveling by air, a well-fitted mask can provide a measure of protection. If you’re regularly exposed to a lot of people and know you will soon be in close contact with someone who is at high risk, mask up and get tested in advance.

5. What’s the bottom line here?

Get vaccinated! If you’re eligible for a booster, get one. It makes no sense to get the initial vaccine and forego boosters. If you’re one of very few people who had a significant reaction to one type of vaccine, ask about getting a different type of vaccine as a booster.

When the pandemic began, few were expecting that more than two years later it would still be causing so much suffering and death. But we shouldn’t pretend it’s over; don’t throw out your masks just yet and do follow public health recommendations. If you’ve decided not to get vaccinated or boosted, think again (and again)!

Yes, we’ve all had it with the pandemic. But I think of it this way: when it looks like rain, throwing out your umbrella and pretending it’s sunny are decisions you’ll probably regret.

About the Author

photo of Robert H. Shmerling, MD

Robert H. Shmerling, MD, Senior Faculty Editor, Harvard Health Publishing

Dr. Robert H. Shmerling is the former clinical chief of the division of rheumatology at Beth Israel Deaconess Medical Center (BIDMC), and is a current member of the corresponding faculty in medicine at Harvard Medical School. … See Full Bio View all posts by Robert H. Shmerling, MD

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HEALTHY-FOOD NATURAL-BEAUTY YOGA

Can an implanted tongue-stimulating device curb your sleep apnea?

Man asleep in bed, snoring, on his side; woman awake and looking at him with one hand cupped over her ear to block noise

Loud snoring, grunts, and gasps can be a sign of obstructive sleep apnea, a serious disorder that causes repeated, brief pauses in breathing (apneas) throughout the night. It can leave people drowsy and depressed, and put them at risk for high blood pressure, heart disease, and other health problems.

If this sounds like you or a bed partner, a recent spate of advertisements for a mask-free treatment for the disorder may catch your attention. Known medically as a hypoglossal nerve stimulator, the pacemaker-like device moves the tongue forward during sleep. That helps reopen a collapsed airway — the root cause of obstructive sleep apnea. But how does it compare with other treatments, and who might be a good candidate?

A second-choice therapy for sleep apnea

Marketed under the name Inspire, the device was approved by the FDA in 2014. It’s a second-choice therapy intended only for people who can’t tolerate positive airway pressure (known as PAP or CPAP), according to Dr. Rohit Budhiraja, a pulmonary and sleep specialist at Harvard-affiliated Brigham and Women’s Hospital.

“Sleep apnea causes the muscles in the back of the throat to collapse, which leads to pauses in breathing that wake you up again and again,” he says. PAP, the gold standard therapy for sleep apnea, prevents airway collapse by using a small bedside machine attached to tubing that blows air through a face mask.

This can improve a measurement called the apnea-hypoxia index (AHI) by approximately 90%, lowering it below 5 in most people. The AHI is a score that gauges the severity of sleep apnea. An AHI between 5 and 14 is considered mild; between 15 and 29 is moderate; 30 and higher is severe.

Targeting tongue muscles is less effective

Inspire targets only the muscles of the tongue rather than the entire airway, so it isn’t as effective as PAP. In fact, the company’s stated treatment goal is to lower a person’s AHI by just 50% (or below 20), although some people may do better.

Because PAP is more effective, sleep specialists encourage people to stick with it by trying different strategies. But research suggests a quarter to a third of people have a hard time using PAP (see here and here). When that’s the case, Inspire may be an alternative, says Dr. Budhiraja.

Who might consider hypoglossal nerve stimulation?

In addition to trying PAP without success, you also must

  • have moderate to severe sleep apnea (an AHI score of 15 to 65)
  • have a body mass index (BMI) of 32 or lower (although some centers allow BMI values as high as 35), which means the device is not right for people in some weight ranges.

If you meet these criteria, you can ask your doctor for a referral to a sleep specialist or an ear, nose, and throat surgeon. The next step is sleep endoscopy. While you are sedated, a doctor passes a small tube with a light and a tiny video camera on one end through a nostril to examine your upper airway. Up to a quarter of people have an airway collapse pattern that can’t be remedied with Inspire, Dr. Budhiraja notes. And, as noted, others have too high an AHI score to try it.

A surgical procedure requiring general anesthesia

The device is implanted during a short, same-day procedure done under general anesthesia. A generator is placed just below the collarbone, a breathing sensor at the side of the chest by the ribs, and a stimulation electrode around the hypoglossal nerve under the tongue.

As with all surgery, possible risks include bleeding and infection. Some people experience tongue weakness, which can cause slightly slurred speech and minor swallowing problems. But this usually resolves within a few days, or for most people, within a few weeks.

The device must be activated a month after surgery at a sleep laboratory. The breathing sensor monitors your breathing and, when necessary, it tells the generator to send a small electrical pulse to the electrode to make the tongue muscles contract. The stimulation moves your tongue forward so you can breathe normally.

How does it feel?

“Some people describe a mild tingling sensation, but most say the feeling is hard to describe,” says Dr. Budhiraja.

At home, you use a small remote control to turn the device on at night and off in the morning. The remote is set to gradually increase the level of stimulation once or twice a week as tolerated until you reach the highest level. You then return to the sleep lab for a study to determine your optimal range. The remote is then programmed to that range.

Some people start noticing a difference in their sleep quality even at the lowest levels of stimulation. Yearly checks are recommended thereafter, and the replaceable battery lasts about 11 years. Medicare and most major insurance plans cover Inspire.

Once it’s working, hypoglossal nerve stimulation is definitely convenient: no maintenance, cleaning, or buying supplies as required with a PAP machine. “But because Inspire is less effective, it’s not considered a replacement for PAP,” says Dr. Budhiraja.

About the Author

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Julie Corliss, Executive Editor, Harvard Heart Letter

Julie Corliss is the executive editor of the Harvard Heart Letter. Before working at Harvard, she was a medical writer and editor at HealthNews, a consumer newsletter affiliated with The New England Journal of Medicine. She … See Full Bio View all posts by Julie Corliss

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HEALTHY-FOOD NATURAL-BEAUTY YOGA

Heart problems and the heat: What to know and do

A heat map of the world showing the hottest areas in red and orange; blue background

This spring, many parts of United States experienced historic heat waves. Now summer is officially underway, and experts are predicting hotter than normal temperatures across most of the country.

Extreme temperatures increase health risks for people with chronic conditions, including heart problems. If you do have a heart condition, here’s how to keep cool and protect yourself when temperatures rise.

How does hot weather affect the heart?

Not only does exposure to high heat increase the risk for heat exhaustion and heat stroke, but it can also place a particular burden on heart health. It stresses the cardiovascular system and makes the heart work harder. This can increase the chance of heart attacks, heart arrhythmias (irregular heartbeat), and heart failure.

According to the Environmental Protection Agency, the interaction of high heat and cardiovascular disease contributes to about a quarter of heat-related deaths.

And the higher the temperature, the greater the threat. A recent study in the journal Circulation looked at cardiovascular death rates over seven years in Kuwait, where daytime temperatures can reach triple digits in the hottest months. The researchers found a link between rising temperatures and the risk of cardiovascular deaths, with most occurring between temperatures of 95° F to 109° F.

“Climate change is giving us more, and unprecedented, heat that can be deadly, especially for people with heart disease,” says Dr. Aaron Bernstein, interim director of the Center for Climate, Health, and the Global Environment at Harvard T.H. Chan School of Public Health.

How does the body shed heat?

Your body is designed to shed extra heat in two major ways, each of which may affect the heart:

Radiation. When the air around you is cooler than your body, you radiate extra heat into the air. This process requires rerouting blood flow so that more of it goes to the skin.

Evaporation. Evaporating sweat helps cool you down by pulling heat away from your skin. When the air is dry, this works well. But when it’s hot and humid, sweat just sits on the skin as your body temperature rises.

When air temperature approaches or exceeds body temperature, especially in high humidity, the heart has to beat faster and pump harder to help your body shed heat. On a hot and humid day, your heart may circulate two to four times as much blood each minute compared with a cool day.

Some medicines meant to help the heart can add to problems on hot days. For example, beta blockers slow the heartbeat and hinder the heart’s ability to circulate blood fast enough for effective heat exchange. Diuretics (water pills) increase urine output and raise the risk of dehydration.

How can you protect yourself and your heart when temperatures rise?

While exposure to high heat and heat waves affects everyone, having existing heart problems raises your risk for heat-related illness and hospitalization. So it’s especially important to try to follow basic strategies for staying cool, including these:

  • Monitor weather forecasts for heat advisories and stay inside on those days. If home is too hot, check with your town or city health department for cooling centers and other options to help you stay cool. If you venture outside, evening and early morning are often the coolest times. Rest in the shade whenever possible.
  • When outside, try to drink 8 ounces of water every 20 minutes. Set a timer to remind you. Never wait until you’re thirsty to drink,” says Dr. Bernstein. If you have heart failure, ask your doctor how much fluid you should drink daily, since fluids can build up and cause swelling. If you take diuretics, ask how much you should drink during hot weather.
  • Avoid soda or fruit juice and limit alcohol. Soda and fruit juice may slow the passage of water from the digestive system to the bloodstream. While research is limited, some studies have found that excessive alcohol intake may raise risk for heat stroke during scorching weather.
  • Protect your skin. Sunburn affects your body’s ability to cool down and increases dehydration. Wear a wide-brimmed hat, wraparound sunglasses, and lightweight, light-colored, loose-fitting clothing. Also, apply plenty of broad-spectrum or UVA/UVB protection sunscreen with SPF 30 or higher to all exposed skin 30 minutes before going out. Reapply every hour.

About the Author

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Matthew Solan, Executive Editor, Harvard Men's Health Watch

Matthew Solan is the executive editor of Harvard Men’s Health Watch. He previously served as executive editor for UCLA Health’s Healthy Years and as a contributor to Duke Medicine’s Health News and Weill Cornell Medical College’s … See Full Bio View all posts by Matthew Solan

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HEALTHY-FOOD NATURAL-BEAUTY YOGA

An emerging treatment option for men on active surveillance

tightly cropped photo of a sheet of paper showing prostate cancer test results with a blood sample tube, stethoscope, and a pen all resting on top of it

Active surveillance for prostate cancer has its tradeoffs. Available to men with low- and intermediate-risk prostate cancer, the process entails monitoring a man’s tumor with periodic biopsies and prostate-specific antigen (PSA) tests, and treating only when — or if — the disease shows signs of progression.

Active surveillance allows men to avoid (at least for a while) the side effects of invasive therapies such as surgery or radiation, but men often feel anxious wondering about the state of their cancer as they spend more time untreated. Is there a middle path between not treating the cancer at all and aggressive therapies that might have lasting side effects? Emerging evidence suggests the answer might be yes.

During a newly-published phase 2 clinical trial, researchers evaluated whether a drug called enzalutamide might delay cancer progression among men on active surveillance. Enzalutamide interferes with testosterone, a hormone that drives prostate tumors to grow and spread. Unlike other therapies that block synthesis of the hormone, enzalutamide prevents testosterone from interacting with its cellular receptor.

A total of 227 men were enrolled in the study. The investigators randomized half of them to a year of daily enzalutamide treatment plus active surveillance, and the other half to active surveillance only. After approximately two years of follow-up, the investigators compared findings from the two groups.

The results showed benefits from enzalutamide treatment. Specifically, tumor biopsies revealed evidence of cancer progression in 32 of the treated men, compared to 42 men who did not get the drug. The odds of finding no cancer in at least some biopsy samples were 3.5 times higher in the enzalutamide-treated men. And it took six months longer for PSA levels to rise (suggesting the cancer is growing) in the treated men, compared to men who stayed on active surveillance only.

Enzalutamide was generally well tolerated. The most common side effects were fatigue and breast enlargement, both of which are reversible when men go off treatment.

In an accompanying editorial, Susan Halabi, a statistician who specializes in prostate cancer at Duke University, described the data as encouraging. But Halabi also sounded a cautionary note. Importantly, differences between the two groups were evident only during the first year of follow-up. By the end of the second year, signs of progression in the treated and untreated groups “tended to be very similar,” she wrote, suggesting that enzalutamide is beneficial only for as long as men stay on the drug. Longer studies lasting a decade or more, Halabi added, may be necessary to determine if early enzalutamide therapy changes the course of the disease, such that the need for more invasive treatments among some men can be delayed or prevented.

Dr. Marc Garnick, the Gorman Brothers Professor of Medicine at Harvard Medical School and Beth Israel Deaconess Medical Center, editor of the Harvard Health Publishing Annual Report on Prostate Diseases, and editor in chief of HarvardProstateKnowledge.org, said the study points to a new way of approaching active surveillance, either with enzalutamide or perhaps other drugs. “An option that further decreases the likelihood that men on active surveillance will need radiation or surgery is important to consider,” he says. “This was a pilot study, and now we need longer-term research.”

About the Author

photo of Charlie Schmidt

Charlie Schmidt, Editor, Harvard Medical School Annual Report on Prostate Diseases

Charlie Schmidt is an award-winning freelance science writer based in Portland, Maine. In addition to writing for Harvard Health Publishing, Charlie has written for Science magazine, the Journal of the National Cancer Institute, Environmental Health Perspectives, … See Full Bio View all posts by Charlie Schmidt

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HEALTHY-FOOD NATURAL-BEAUTY YOGA

Recognizing and preventing sun allergies

photo of a woman with a sunburned face standing in woods and looking skyward, sun is peeking through trees and she is holding her hands at the sides of her face

No one is truly allergic to the sun, but some people are quite sensitive to different types of sun rays and may develop mild to serious reactions after spending time in the sun.

There are several types of “sun allergies,” but polymorphous light eruption (PMLE), an autoimmune condition in the skin that occurs after sun exposure, is one of the most common. Other conditions considered as sun allergies are solar urticaria (hives and reddish patches that usually start 30 minutes to two hours after the sun exposure), actinic prurigo (papules and nodules that are intensely itchy on sun-exposed skin areas), and photoallergic reaction (when the UV rays from the sun modify the chemical structure of medications or products applied to the skin, and a person develops an allergy to the newly modified substance).

What causes PMLE?

People who have PMLE have immune cells that are triggered by sun rays, which attack their skin, and they develop a skin reaction to the sun’s the ultraviolet (UV) rays.

PMLE represents 70% of all sun-induced skin eruptions. It can affect both sexes and all skin types, and it usually starts when someone is a teen or young adult. PMLE may be an inherited condition. Being a female, having fair skin, and living in the north are other risk factors.

PMLE is more common in young women who live in temperate climates. People who live in temperate climates spend all winter out of the sun, so when it becomes warmer the sun exposure is intense. People who live in warmer climates are desensitized because they have a higher sun exposure all year.

What does PMLE look like?

PMLE can appear several hours or days after the first major sunlight exposure of the season, usually during spring or at the beginning of summer. The areas of the body generally affected the most are the ones that are covered during wintertime, but not in the summer: the neck, the chest, and the outer parts of the arms.

After exposure to the sun, people with PMLE usually notice reddish patches on their skin. These spots may itch, burn, or sting, but they typically don’t leave a scar. In more severe cases, the patches cover most of the body and may also be associated with headaches, fevers, tiredness, and low blood pressure. (If you experience these symptoms, see an urgent care provider for evaluation.) If you think you have PMLE or another sun allergy, a dermatologist is the best doctor to evaluate and treat your skin condition.

Does PMLE get better?

PMLE lesions often get better in approximately 10 days, and it’s important to avoid sun exposure until you are healed. People who develop PMLE can experience significant discomfort and have their life negatively impacted during the spring and summer months. However, repetitive sun exposure can make PMLE less likely to occur. The hardening effect, as it is called, means that the skin lesions that appear after the first episode are less severe, and they can be better tolerated during subsequent episodes.

What are current treatments for any sun allergy, including PMLE?

The best treatment is to prevent sun exposure. Avoid sunlight when it is most intense (from 10 a.m. to 4 p.m.), and use UV-protecting clothing or clothes made of darker and thicker fabrics, as they will prevent the UV rays coming from the sun from reaching your skin. Hats with a wide brim protect your scalp, face, and (partially) the neck.

Broad-spectrum sunscreens that protect your skin from both UVA and UVB rays should be used daily, even if it’s cloudy. Apply sunscreen on your face and any part of your skin that is not covered by a hat or clothing. Reapply sunscreen every two hours, and if you go swimming or get sweaty reapply more frequently (water-resistant sunscreen should also be reapplied).

If you develop PMLE, the areas of skin impacted can be treated with steroid creams. In severe cases, your doctor may recommend a short course of steroid pills. Medications that reduce the immune response, such as azathioprine, are options for treating PMLE, since it is an autoimmune condition (the body is attacking it is own healthy cells).

Antihistamines are medications typically used for allergies that may help shorten the duration of reddish patches that itch or burn, and they also reduce inflammation.

Hydroxychloroquine (a medication also used to treat malaria) can be used in case of flare-ups, or as a prevention method when people travel to sunny locations during winter vacations.

Oral Polypodium leucotomos extract, a natural substance derived from tropical fern leaves, may work as a potent antioxidant, and has anti-inflammatory properties that are beneficial in the prevention of PMLE. Other nutritional supplements containing lycopene and beta-carotene (vitamin A derivatives) have a similar effect. A dermatologist will guide you on the best way to use these medications.

The bottom line

Sun allergies are common in temperate climates, but with a dermatologist’s guidance, vigilant sun prevention, and medications they can be managed throughout the sunny months of the year.

About the Authors

photo of Neera Nathan, MD, MSHS

Neera Nathan, MD, MSHS, Contributor

Dr. Neera Nathan is a dermatologist and researcher at Massachusetts General Hospital and Lahey Hospital and Medical Center. Her clinical and research interests include dermatologic surgery, cosmetic dermatology, and laser medicine. She is part of the … See Full Bio View all posts by Neera Nathan, MD, MSHS photo of Lais Lopes Almeida Gomes

Lais Lopes Almeida Gomes, Contributor

Dr. Lais Lopes Almeida Gomes is a dermatology research fellow at Massachusetts General Hospital, and a pediatric dermatologist in Brazil. Her clinical and research interests include atopic dermatitis and global health. She is part of the … See Full Bio View all posts by Lais Lopes Almeida Gomes