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Whether you’re seeing a new blockbuster at the movie theater, enjoying a first date at a restaurant or giving a presentation at work, the last thing you need is a nosebleed. Nosebleeds – also called epistaxis – are common and, thankfully, severe ones are rare. However, their normalcy doesn’t stop them from interrupting your daily life.

Read on to learn what causes nosebleeds, how you can stop them and steps you can take to prevent them from happening.

Why do we get nosebleeds?

First, let’s talk about the anatomy of our noses and why nosebleeds happen. The nose does more than just smell. It acts like a filter, removing toxins and bacteria from the air we breathe to keep us from getting sick, while also warming and humidifying the air to prevent lung irritation.

In order to condition the air, our nasal passages are lined with blood vessels. These delicate blood vessels lie close to the surface of the nasal passage and transfer heat from our blood to the air as we inhale.

Blood vessels in the nose typically break when they are disturbed in some way – either by environmental conditions or by something solid inserted into your nose – resulting in a nosebleed.

Nosebleed causes

The two most common culprits of nosebleeds are dry air and nose picking. Dry air causes the normally moist membranes in our nasal passages to dry out. When these membranes crack and crust over, they expose and break the blood vessels underneath. The reason nosebleeds happen so often in the winter is because heated indoor air has almost no moisture.

Nose picking causes trauma to the delicate membranes inside your nose, especially if your or your child’s fingernails are long – this is why nosebleeds are so common among children between 2-10 years old. The force of an inserted finger is enough to damage the blood vessels.

Nosebleeds can also be caused by:

• Sinusitis
• The common cold
• Allergies
• A deviated septum
• Blood thinners
• Blood clotting disorders
• Impact to your nose
• Insertion of a foreign body into your nose
• Inhaling irritants

How to stop a nosebleed

A nosebleed can be a startling event, but it’s important to stay calm because stress can make the bleeding worse. Take the following steps to stop nosebleeds fast:

Lean forward, not back

Sit upright and lean your body forward, making sure your head stays above your heart. While it used to be common practice to tilt the head up and back to treat a nosebleed, this is no longer recommended as it can cause blood to flow into the throat and stomach, putting you at risk of choking or vomiting. With your head positioned forward and slightly down, blood can drain out of your nose.

Pinch your nostrils shut

Find the spot on your nose where the bony ridge – the bridge – tapers down to soft cartilage. Place your thumb and forefinger on either side of this area, just above your nostrils, and pinch with firm pressure. However, you should still be able to scrunch your nose underneath your fingers. With your nostrils shut, breathe through your mouth while squeezing.

Apply consistent pressure

Pinch your nose for at least 10 minutes before checking to see if your nosebleed has stopped. If you release the pressure from your nose before the burst blood vessel has been able to form a clot, you risk restarting the bleeding. After 10 minutes, check the flow. If you’re still bleeding, resume pinching and maintain pressure for another five minutes.

Apply ice

If your nose is still bleeding after 15 minutes, apply an ice pack to the bridge. This will help constrict the blood vessels and stop the bleeding. Make sure to continue pinching your nose with your fingers while using the ice pack.

Types of nosebleeds

There are two different types of nosebleeds, based on the location of the broken blood vessel inside your nasal passages.

Anterior nosebleed

Anterior nosebleeds occur at the front of the nose, where the blood vessels are relatively small. Blood will flow out of one or both nostrils. Anterior nosebleeds are more common and less serious than the posterior type. They can almost always be resolved at home.

Posterior nosebleed

Posterior nosebleeds occur at the back of the nose, where the blood vessels are larger. The blood flow is heavier, and you may feel blood dripping down the back of your throat in addition to coming out of your nose. A posterior nosebleed may indicate a larger health issue and usually requires medical treatment.

How to prevent nosebleeds

Nosebleeds happen. In fact, about 60% of people will experience at least one nosebleed during their lifetime. However, that doesn’t mean you have to suffer through them. There are several things you can do to prevent nosebleeds:

• Use a humidifier in the winter, or year-round if you live in a dry climate
• Don’t smoke, as cigarette smoke can irritate your nose and sinuses
• Don’t put anything solid up your nose, including your finger
• Use saline nasal sprays or nose drops to keep your nasal passages moist
• Apply moisturizing gels or ointments, like petroleum jelly, to dry nasal passages
• Avoid aspirin and ibuprofen, both of which act similarly to blood thinners. If pain relief is needed in the days following a nosebleed, use acetaminophen (Tylenol) instead

When to worry about a nosebleed

Most nosebleeds are not serious and will usually resolve on their own. However, if you or your child’s nosebleeds are frequent – they occur more than once a week for several weeks – you should talk to your primary care doctor or your child’s pediatrician. Other factors that may warrant a conversation with your doctor about your nosebleeds include:

• You’re currently taking blood thinners (anticoagulants)
• You’re showing signs of anemia, such as weakness, pale skin and tremors
• You have a blood clotting disorder
• You take medication through your nose

When to seek emergency care

A nosebleed is rarely a medical emergency, but you should be aware of several symptoms that make it into something more serious. Go to urgent care or the emergency room if you experience any of the following with your nosebleed:

• You can’t get the bleeding to stop even after 20 minutes of applied pressure
• You’re bleeding so heavily that it’s hard to breathe
• The amount of blood is a cup or more
• You feel dizzy and weak

Treatment for chronic nosebleeds

Your primary care doctor may refer you to an ear, nose and throat (ENT) specialist if your nosebleeds are frequent enough to interrupt your daily life. The ENT doctor will ask questions about the frequency and duration of your nosebleeds, as well as your medical history and current medications.
They may perform a nasal endoscopy, a procedure in which a thin wire with a camera and light on the end is inserted into your nose. This allows the ENT doctor to view the inside of your nasal passages and sinuses.

Based on their findings, they may recommend the following treatments:

• Nose cauterization: During this procedure, your doctor will use a chemical or electrical device to cauterize, or seal, any abnormal blood vessels inside your nose.
• Nasal packing: Your doctor will insert gauze coated with an antibiotic ointment into one or both of your nasal passages to put direct pressure on the blood vessels. The depth to which it’s inserted depends on whether you’re having anterior or posterior nosebleeds. The gauze will remain in your nose for a few days. Depending on the type of packing, your clinician will have you return for the removal, or the gauze will dissolve on its own.
• Surgery: If a deviated septum is the cause of your nosebleeds, your doctor may suggest a procedure called a septoplasty. A septoplasty straightens your septum, allowing for better airflow in your nose.

If nosebleeds have become a regular and disruptive part of your life or the life of your child, our ENT specialists are here to help.

As menopause approaches, you’re experiencing a lot of changes. Your periods are becoming more irregular. You might be noticing some more moodiness or sleep issues. And if you’re like many women, you might also be noticing an increase in your weight – even if you haven’t changed your diet or lifestyle habits.

So, why is this happening? Read on to learn why people tend to gain weight during menopause, and what you can do about it.

Why does menopause cause weight gain?

Though more research is needed, menopause generally isn’t considered the main reason for weight gain between ages 45 and 55. However, the decrease in estrogen levels that comes with menopause can contribute in a couple ways.

First, estrogen promotes muscle mass, and muscle mass affects metabolism – which is how your body uses energy. Less estrogen means less muscle mass, so you’re more likely to develop a slower metabolism during perimenopause and after you reach menopause. With a slower metabolism, you don’t need as many calories to maintain the same weight.

Decreased estrogen can also cause your body to start storing more fat in your abdomen compared to other areas of your body – some people refer to this as the “menopause belly.” Together with decreasing muscle mass, this can lead to higher levels of body fat and a heavier appearance, even without a change in weight.

Other factors that contribute to menopausal weight gain

Aging and lifestyle factors are more commonly associated with perimenopause weight gain and post-menopause weight gain. Like changes in hormones, aging also brings natural decreases in muscle mass and metabolism. So it becomes especially easy to take in more calories than your body needs, and store that extra energy as fat. But lifestyle factors like what you eat, how much you eat and how much physical activity you get can affect your weight the most.

Getting enough physical activity is something that’s often neglected. In fact, as of 2018, one study showed that only 23% of adults in the United States were getting as much physical activity as the Centers for Disease Control and Prevention (CDC) recommended. We also tend to become less active as we age, whether it’s because of increased responsibilities, common aches and pains, injuries or just falling out of the habit of exercising.

In addition to aging and lifestyle factors, other possible causes of menopausal weight gain may include:

• Genetics
• Health conditions such as depression, diabetes and hypertension
• Medications like antidepressants, antipsychotics and steroids

How to lose weight during menopause

While it’s important to get regular physical activity and maintain a healthy diet throughout your life, a slowing metabolism during menopause – and as you age – makes healthy lifestyle choices even more important.

Making healthy choices can help prevent excessive weight gain that could lead to other health conditions as you get older, such as breathing problems, heart disease, type 2 diabetes and more. Here are a few tips for staying healthy during menopause:

Get consistent, varied exercise

Different forms of exercise offer different benefits. But regular exercise of any kind has been shown to help with everything from sleep to digestion, as well as symptoms of depression and anxiety. So, taking steps to stay active

• Strength training engages your muscles to push, pull or support weight. It builds muscle mass, which helps offset the loss of metabolism caused by aging and decreased estrogen. Strength training also slows age-related bone loss and can be a big part of preventing postmenopausal osteoporosis. It’s recommended that adults do strength training activities at least twice a week.
• Low-impact aerobics are activities that make your heart beat faster without putting a lot of pressure on your joints. Examples include brisk walking, cycling and swimming. Regular aerobic activity reduces your risk of heart conditions, type 2 diabetes, high blood pressure and more. It’s recommended that adults get at least 75 minutes of vigorous aerobic activity or 150 minutes of moderate aerobic activity per week.

Build a structured diet based around whole foods

Now that you need fewer calories overall, it’s important to focus on getting them from whole-food sources like fruit, vegetables, legumes, nuts and lean meats. They tend to be less caloric than processed foods, and their nutrient density can help maintain your energy levels if you need to cut down on calories to reach your goals.

In addition, you may find that it’s helpful to focus on the structure of your diet – such as eating meals at consistent times and preparing healthy snacks ahead of time. Keeping a journal to track your eating and drinking habits can also help identify opportunities for healthy changes.

Get enough sleep

If you plan to start a new exercise regimen based on the advice above, quality sleep is going to be a big part of helping your body recover between workouts. But studies also suggest that how much sleep you get can affect your metabolism. Specifically, sleep deprivation has been linked to increases in your body’s level of ghrelin, a hormone that increases appetite; and decreases in leptin, a hormone that suppresses appetite.

So if you’re sleeping less due to disturbances from menopause symptoms, it may help to see if you can improve your sleep hygiene, such as by practicing a relaxation technique like meditation before bed and avoiding liquids for a few hours beforehand.

Talk to your doctor about hormone therapy

Hormone therapy (HT) helps relieve menopause symptoms and prevent certain conditions like osteoporosis through the use of estrogen supplements, progestin supplements or both. Taking an estrogen supplement during menopause may make it easier to lose weight or gain muscle mass, depending on your diet and activity level, but it isn’t considered a long-term solution for weight management. Talk to your care provider about whether hormone therapy may be right for you.

Get the support you need before and after menopause

Experiencing unexpected weight gain and other menopause symptoms can impact your physical and mental health. So if menopause is making you uncomfortable, talk to an expert. Your primary care doctor or a women’s health specialist like an OB-GYN can help you get relief with a personalized care plan.

At HealthPartners, some of our OB-GYN care providers are even certified by the North American Menopause Society to help people manage their menopause symptoms.

Though they keep us upright and allow us to move through our daily lives, we don’t often think about our bones until we break one. However, awareness of our bone health only becomes more important as we get older.

In the U.S., an estimated 10.2 million men and women currently suffer from osteoporosis, a condition that causes bones to become weak, brittle and easily breakable. Another 44 million people have low bone density that puts them at risk.

Below, we’ll discuss osteoporosis symptoms, screenings and prevention tips to help you stay on top of your bone health.

What is osteoporosis?

Bones are living tissue that our bodies are constantly breaking down and rebuilding. The rate of this process fluctuates as we age, but renewal starts to slow after age 50. Some loss of bone mass is a natural part of the aging process – in other words, our bones decrease in density and strength as we get older.

But when our bones begin to lose more mass (and at a faster pace) than our bodies can keep up with, they become brittle and weak, breaking easily. This is osteoporosis, which is defined as “porous bone.”

Osteoporosis causes around two million fractures each year, and for most people, a fracture is the first indication that they might have the condition. This is why osteoporosis is sometimes called a “silent disease.” A bone that breaks too easily is often the first symptom that people experience.

Osteoporosis symptoms and what to look for

As mentioned, most people never experience any early symptoms of osteoporosis. The first sign is often a broken bone from something that wouldn’t ordinarily have caused one, like a minor fall from standing height, a jolt against a hard surface or even just a sneeze or cough. Osteoporosis fractures are most common in the wrists, hips and vertebrae.

Other symptoms of osteoporosis include:

• Back pain
• Changes in the way you walk
• Changes to your posture, like a stooped or hunched spine
• Gradual loss of height of 1.5 inches or more

Osteoporosis can cause pain in your bones that is typically more severe than the normal aches of getting older. Pain linked to osteoporosis is most common in the neck and back, the result of spinal compression fractures. This pain is worse while walking and standing but can ease slightly when lying down.

What causes osteoporosis?

Our bones are a repository, or holding space, for vitamins and minerals that the body can draw upon when needed.

Osteoporosis happens when the body takes vitamins and minerals – mainly calcium – from our bones faster than they can be replenished. Healthy bone is already porous, or full of tiny holes, but osteoporosis makes the holes bigger, causing the inner structure to weaken and become more prone to fracture.

Osteoporosis is a common condition among post-menopausal women because the hormone estrogen regulates the process of bone renewal. When women experience a sharp drop in estrogen levels during and after menopause, this process is disrupted. Men are also affected by osteoporosis, but in fewer numbers than women.

Who is most at risk for osteoporosis?

There are several risk factors that can make you more likely to develop osteoporosis.

Gender

Both men and women can be affected by osteoporosis, but women are more likely to develop it due to the decline in estrogen levels during and after menopause. Women also tend to have smaller bones with a lower bone mass compared to men, making them more vulnerable.

Genetics

You are more likely to develop osteoporosis if someone in your immediate family also has the condition, especially if they have suffered a hip fracture because of it.

Race

People of Caucasian and Asian descent have a higher chance of developing osteoporosis than those of other races.

Endocrine diseases

Conditions like diabetes, hyperthyroidism and hyperparathyroidism interfere with the levels of hormones in your body, specifically the hormones that regulate the minerals calcium and phosphorus, which affect the normal process of breaking down and rebuilding bones.

Sex hormone disorders

Estrogen and testosterone both play an important role in maintaining bone health. While estrogen is involved in bone density maintenance and renewal, testosterone contributes to muscle growth, which then encourages bone growth. Chronically low levels of estrogen and testosterone can cause rapid bone degeneration.

Additional medical conditions

Some diseases can increase your risk of osteoporosis, like COPD, HIV/AIDS, rheumatoid arthritis, inflammatory bowel disease (IBD), chronic kidney disease, and prostate and breast cancer.

Other risk factors include:

• Chronic calcium and vitamin D deficiency
• Being underweight with a BMI of 19 and below
• A sedentary lifestyle
• Heavy alcohol consumption and tobacco use
• Long-term use of certain medication types, like steroids and anticonvulsants

How is osteoporosis diagnosed?

If one or more of the risk factors discussed above applies to you, your primary care clinician can start screening you for osteoporosis at age 50. If you have recently broken a bone and are older than 50, your doctor may also recommend an osteoporosis screening. Otherwise, regular osteoporosis screenings start at age 65 for women and age 70 for men.

Even if you’ve never had a fracture, it’s a good idea to understand the current health of your bones. Ask your primary care doctor if an osteoporosis screening is right for you. They may recommend a bone densitometry screening, which is the diagnostic tool for osteoporosis.

Bone densitometry screening (DXA scan)

A bone densitometry screening, also called a DXA scan or bone mineral density test, is a type of X-ray that measures the density of your bones. Using two X-ray beams of different strength, the DXA machine will measure how much of each beam is able to pass through your bones. This gives your doctor an idea of how thick your bones currently are.

The results of your bone density scan are then compared to those of healthy young adults (25-30 years old) and calculated into a T-score. Your doctor will use the T-score to assess your risk of fracture and diagnose you with osteoporosis or osteopenia.

Osteopenia is a precursor to osteoporosis. With osteopenia, your bone density is low, but not yet low enough to be considered osteoporosis.

After your bone densitometry screening, your doctor can use your T-score to complete a fracture risk assessment (FRAX). This is a tool that calculates your risk of an osteoporosis-related fracture over the next 10 years. It involves questions about your lifestyle, your family medical history and your other medical conditions.

Osteoporosis treatment

If you’ve been diagnosed with osteoporosis, there’s no need to panic. It’s possible to slow the loss of bone mass and maintain healthy function through treatment, which may include:

Medication

There are several medicines your doctor may prescribe to slow bone degeneration or increase the rate of bone renewal. They come in multiple forms, most commonly an oral pill or injection. The frequency with which these medicines are taken varies. Some must be taken every day while others are weekly or just once a year. Your doctor can determine which type is right for you and your lifestyle.

Exercise and physical therapy

Physical therapy meant to slow the progression of osteoporosis will focus on weight training, posture correction and balance improvement. Weight-bearing exercises, such as walking, jogging and dancing, can also improve and maintain bone health.

Dietary changes

With osteoporosis, you’ll want to include plenty of healthy sources of calcium and vitamin D in your diet. Milk, yogurt, almonds, oranges, kale and spinach are chock-full of calcium, and you can find large amounts of vitamin D in fatty fish like salmon and sardines. It’s recommended that you increase your levels of calcium through diet rather than supplements, because our bodies absorb calcium from food better than calcium from supplements.

Vitamin D supplements

Our bodies absorb calcium through the intestines, and vitamin D helps the intestines be more receptive to calcium. To increase the calcium in your diet, you can take vitamin D supplements. Regular exposure to sunlight is another way to elevate your vitamin D levels.

Hormone therapy

Your doctor may prescribe medications that help increase the levels of estrogen in your body. However, these can have adverse side effects like an increased risk of breast cancer.

Osteoporosis prevention

There are steps you can take to maintain healthy bones as you age and reduce your risk of osteoporosis.

Diet and sunlight

Most people who live in northern latitudes don’t get enough vitamin D from the sun, especially those with darker skin. Include plenty of calcium and vitamin D in your diet, and make sure you are getting enough sunlight, usually 10-30 minutes of midday exposure. Contrary to popular belief, wearing sunscreen won’t inhibit your body’s production of vitamin D from the sun. Many people who live in northern latitudes, like the Upper Midwest, should take vitamin D supplements year-round.

Exercise

Exercise, especially weight-bearing exercise, can be highly beneficial for strengthening and stabilizing your muscles and bones. Weight-bearing exercises involve putting your bones and muscles under minor stress in the act of fighting gravity. This activates the cells in your bones that are responsible for creating new tissue. Find weight-bearing activities you enjoy, like hiking, running, strength training and dancing. And it doesn’t have to be complicated – walking just one mile a day can help maintain bone density.

Lifestyle

Because alcohol and tobacco affect the overall health of your body, they impact your bone health as well. Smoking and heavy alcohol consumption can cause poor circulation, hormonal imbalances, and calcium and vitamin D deficiencies. There’s no safe amount of tobacco use, but it’s safe to drink alcohol in moderation, about 1-2 drinks per day.

Fall prevention

You can prevent falls at home by making sure carpets and rugs are firmly fixed to the floor without any sections that stick out or that may slide underneath you. You can also install grab bars in your bathroom, position electrical cords away from where you walk and keep objects like books, papers and clothes off the floor. When you’re out and about, wear nonslip footwear, hold onto handrails where available and use a cane or walker if necessary.

When to see a doctor about osteoporosis

When you maintain healthy bones, you can maintain mobility and independence as you age – things that help make your golden years truly golden. If you suspect you may have low bone density, it’s a good idea to make an appointment with your primary care doctor. They can help coordinate a bone density screening for you and determine the right treatments for your needs.

Pot. Hemp. Weed. Grass. Marijuana. Cannabis goes by many names. Should we also be calling it medicine?

Research shows that approximately 25% of people with a cancer diagnosis use medical cannabis to manage cancer-related symptoms. And many more may wonder if medical cannabis could be a good addition to their cancer treatment plan. But people have questions about cannabis safety, effectiveness, how to access it and more – and they aren’t sure where to find answers.

“Up to this point, the use of cannabis in cancer care has been patient trial and error,” said Dr. Dylan Zylla, medical director of the HealthPartners Institute Cancer Research Center. “They’re also getting information from the internet, friends and family. This all puts a lot of responsibility on the patient when they don’t have a medical background, or experience in pharmacology and dosing. This is not the way it should be – and it’s certainly not how we practice the rest of medicine.”

This is where Dr. Zylla – who’s an oncologist – along with clinicians and researchers aim to make a difference.

With his help, we answer some of the most common questions about what medical cannabis is, what we know about its potential benefits for cancer patients and more. Plus, we’ll show you how Dr. Zylla and his team are working to further research, while also providing interested patients with medical guidance to use cannabis safely and effectively as part of their cancer treatment plan.

First things first, what is medical cannabis?

Simply put, medical cannabis can be the whole plant or certain parts extracted from Cannabis sativa (the same plant commonly known as marijuana, weed or pot). These products are used to treat specific medical conditions. Depending on where you live, medical cannabis may or may not be legal, or your options may be limited.

What are the types of medical cannabis products?

When you think of cannabis, you probably think of the dried flower that can be smoked or inhaled through a vaporizer. But that’s not the type of medical cannabis that’s usually used to help manage cancer-related symptoms. Instead, most people use products such as pills, oils and topical creams made with cannabinoid extracts.

What are cannabinoids?

Cannabinoids are chemicals that naturally occur in cannabis. There are two main cannabinoids that give cannabis its therapeutic effect.

• Tetrahydrocannabinol (THC) – This is the psychoactive ingredient in cannabis that makes someone feel high. But it can help improve nausea, pain, appetite loss and insomnia.
• Cannabidiol (CBD) – This chemical doesn’t give you a high and it’s not addictive or intoxicating. But it can make you feel more comfortable and lessen your pain.

Manufactured cannabis products can have one or both chemicals – whole flower always contains both.

Is there a difference between medical cannabis and recreational cannabis?

If you use recreational cannabis to treat your cancer, does it automatically become medical cannabis? From a medical and legal perspective, there are some key differences between recreational and medical marijuana.

Legal status

The legality of cannabis, THC and CBD is complex and depends on what, where and why cannabis is being used. Here are the influencing factors:

• Federal and state laws – U.S. federal law prohibits the use of marijuana. But many states have made medical cannabis legal, and some have also legalized recreational marijuana. Federal drug law exists separately from state law.
• Available products – Even if medical cannabis is legal in a state, the choice of medical cannabis products can vary widely. For example, in Minnesota, both extraction products and whole flower are available for certified patients. In Wisconsin and Iowa, only CBD oil is allowed as medical cannabis.
• Drug approval status – The U.S. Food and Drug Administration (FDA) has not approved cannabis or naturally derived cannabinoids for cancer care. The FDA has approved a synthetic THC medication that can be used even when medical cannabis is not allowed under state law. However, these medications are not well tolerated by most people and can cause severe side effects in some people. So, they’re rarely prescribed.
• Retail CBD and THC products – To make things even more confusing, CBD products have been sold online and at retail stores nationwide as supplements – as long as they have less than 0.3% THC. But that’s changing in some places. For example, in July 2022 Minnesota passed a new law allowing edible products containing up to 5mg of THC per serving, as long as the products were originally derived from hemp plants.

Where you buy it

Every state oversees medical cannabis a little differently. But in Minnesota, for example, medical cannabis is only available at dispensaries regulated by the Minnesota Department of Health. Over-the-counter CBD and THC products are available in retail storefronts or office buildings.

Product quality

In many states, medical cannabis dispensaries are required, by law, to have an independent, third-party lab test their products to prove that they are free from impurities such as mold, heavy metals and residual solvents. These labs also verify that the reported percentages of THC and CBD are accurate.

Who can purchase it

Every state has different requirements for purchasing medical cannabis. For example, in Minnesota patients need to be certified by a clinician who is managing their medical condition or symptoms. This clinician is usually someone from oncology, primary care or palliative care. Patients also need to register with their state’s cannabis program. The annual fee for registering can be up to $250 or more, depending on your state.

Why is medical cannabis becoming more accepted as part of a treatment plan for cancer and other conditions? Research.

Cannabis has been used in alternative medicine for centuries, but it has only recently entered the modern health care world.

“I’d say that it’s really only within the last 20 years that researchers have been looking at medical cannabis for improving symptoms such as nausea, loss of appetite and pain,” said Dr. Zylla. “There’s significant data showing the impact cannabis can have on quality of life in patients with cancer.”

While more studies are needed on the benefits of medical marijuana, particularly its specific benefits as a cancer treatment, there’s a growing amount of data supporting its medicinal properties. Right now, research supporting the medical use of cannabinoids includes over 20 completed clinical trials with more on the way.

While that may not seem like a lot, 10 of these studies are randomized controlled trials – the type of studies considered to be the gold standard in clinical research.

In these studies, one group receives the treatment (the treatment group) while another group does not (the control group) – and patients don’t know which they’re in. This approach helps to prove if the benefits of a specific treatment are both meaningful and real.

What is the big benefit of using medical cannabis for cancer? Symptom management.

Research shows that incorporating medical cannabis into a treatment plan can help improve a patient’s symptoms, making coping with cancer treatment easier.

Dr. Zylla has led groundbreaking studies, along with researchers from HealthPartners Institute, University of Minnesota and Minnesota Department of Health. One study followed patients with stage IV cancer using cannabis over a four-month period, and found that cannabis use resulted in significant improvement in:

• Chemotherapy-induced nausea and vomiting
• Depression
• Disturbed sleep
• Fatigue
• Lack of appetite
• Pain

Can cannabis reduce the need for opioids for pain management? It’s possible.

As we learn more about the dangers of opioids and opioid addiction, there’s an interest in safer alternatives. And it appears that cannabis is an option to reduce the negative side effects of opioids while keeping pain under control.

Large studies show 36% of people with cancer no longer use opioids while on medical cannabis, and another 10% can reduce the amount they use. Similarly, in the Cannabis in Cancer (CanCan) trial conducted at HealthPartners, patients using cannabis appeared to require less opioids.

Medical cannabis in practice: Ensuring patient benefit and safety

While cannabis may be effective, the other part of the equation is safety. Are there risks in using medical cannabis as part of your cancer treatment plan?

The truth is that cannabis isn’t for everyone. As with any treatment, there are guidelines in place to ensure that it’s used appropriately and safely.

State rules for medical cannabis

To use medical cannabis, patients need to qualify based on state laws. In Minnesota, people over the age of 18 who are experiencing symptoms related to their cancer or cancer treatment, can qualify for medical cannabis if they have one or more of the following:

• Severe or chronic pain
• Nausea and severe vomiting
• Severe muscle or weight loss

Medical cannabis can be used for any type of cancer, but primarily cancer that’s more advanced. Other qualifying conditions for medical cannabis in Minnesota include chronic pain, post-traumatic stress disorder, epilepsy, severe or persistent muscle spasms, and sleep apnea.

“In Minnesota, about 75% of people who use medical cannabis for their cancer are over 50 years old,” Dr. Zylla said. “At HealthPartners specifically, patients who use cannabis often have stage IV cancer of the breast, lung, colon or pancreas.”

Cannabis and other cancer treatments

Research is ongoing to understand how cannabis interacts with other cancer treatments. But here’s what we already know:

• Chemotherapy– Cannabis is generally viewed as a safe addition to the types of chemotherapy delivered through a vein in your arm, and is shown to reduce the nausea and appetite loss that often comes with this type of therapy.
• Targeted therapies– If a patient is on a targeted medication, clinicians need to check for potential drug interactions with cannabis. Targeted medications are typically processed through the liver and researchers are still learning how cannabis affects liver function.
• Immunotherapy– Immunotherapy is one of the most promising areas being researched in cancer clinical trials. But cannabis can impact your immune system and has anti-inflammatory effects, both of which can make immunotherapy less effective. So if you’re on an immunotherapy, it may not be a good idea to use cannabis.

Patient health factors

Before considering medical cannabis as part of a patient’s treatment plan, doctors evaluate other health factors as well. Medical cannabis may not be a good choice for people who have:

• Problems related to their heart, lungs, liver or kidneys
• A history of substance abuse or psychiatric disorder
• A family history of schizophrenia
• Hypersensitivity to cannabinoids

Dosing

People usually think the benefits of cannabis outweigh any negatives, but some people experience nausea related to the smell, as well as headaches, anxiety and difficulty sleeping. Proper dosing can help minimize the downsides of medical cannabis while allowing people to get the most benefit.

“We use a ‘start low and slow’ approach,” said Dr. Zylla. “The dosing is very different for everybody, so we take time to get it right.”

Part of the process is choosing the right combination of products to best manage a patient’s unique symptoms.

“We often use a balanced product – such as a product with a one-to-one ratio of THC and CBD – but it depends on a patient’s symptoms,” said Dr. Zylla. “CBD balances some of the ‘high’ feeling and some of the negative side effects, but higher THC is helpful for pain, nausea and sleep.”

What is the cost of prescription cannabis?

The only type of “cannabis” that insurance companies can cover is synthetic THC medications approved by the FDA. This limit is because cannabis is still illegal at the federal level – even though some states have made it legal.

As an out-of-pocket cost, medical cannabis can put a significant dent in a wallet – on average, a patient spends about $3,000 on cannabis per year when managing chronic noncancer pain. For example, a report on medical cannabis pricing in Minnesota found the average monthly spend on cannabis by patients with cancer was $236. And for many people, this price is too high.

“Of the patients who completed the CanCan clinical trial, 44% planned on purchasing cannabis through the state program,” Dr. Zylla said. “For people who didn’t plan to continue using cannabis, cost was the biggest barrier to ongoing use.”

At HealthPartners, we’re serious about making health care more affordable and we believe there are things we can do to balance cost with effectiveness –including the choice of medication and how much is used. This mindset applies to cannabis, too.

“Most people can tolerate higher doses of cannabis to better manage their symptoms,” said Dr. Zylla. “But there’s the cost issue. Our goal is to create cannabis treatment plans that use products at the lowest dose possible to help minimize both cost and potential side effects.”

Minnesota’s CanCARE clinic: Helping patients understand medical cannabis options

At HealthPartners, we want to provide the best possible care and access to the latest treatment options. These are core to our purpose as an organization, as we strive to be a partner for good℠ to our patients and the communities we serve.

With that in mind, Dr. Zylla led the development of the HealthPartners’ Cannabis in Cancer Research and Education (CanCARE) clinic in Minnesota. The clinic is both for patients considering using medical cannabis and current users who would like guidance in managing their cancer symptoms.

“We offer education on how to safely use cannabis and provide dosing guidance to do it successfully – and ideally, cost-effectively,” said. Dr. Zylla. “We help ensure they’re not using products that aren’t going to make any difference or using too much.”

The CanCARE clinic is seeing great results, with a high patient satisfaction rate – 96% of patients said they would recommend the clinic and 95% said they learned more about cancer and cannabis during their visit.

The reason for these great results?

“I think it just comes down to them feeling more educated and more confident in what they’re going to get out of cannabis,” said. Dr. Zylla.

 

Have you noticed your jaw making a popping or clicking sound? Does it hurt to open your mouth widely at the dentist? Or maybe it’s sore when taking a large bite of something. If so, chances are good that you could be experiencing a TMJ disorder.

Temporomandibular disorders (TMD, often called TMJ) are very common, affecting an estimated 10 million Americans. Learn more about this uncomfortable jaw condition and the many ways it can be treated.

What is the temporomandibular joint (TMJ)?

TMJ stands for temporomandibular joint. You have two, one on each side of your face, just in front of your ears. These joints serve as the connection between your jaw and your skull, as well as the muscles in your face, enabling you to do everyday things like talk and chew.

What is TMD?

TMD (temporomandibular disorder) is a medical term used to include a wide range of conditions characterized by pain and/or dysfunction of the temporomandibular joints and associated structures (such as the chewing muscles, tendons and ligaments). But often the term “TMJ” is used to describe any problem with that particular joint.

TMJ can be painful for some people, while for others the bigger problem is loss of jaw functionality. In some cases TMJ doesn’t require any treatment interventions, but the condition can still be bothersome – interfering with everyday activities like talking, eating or even sleeping.

Signs of TMJ disorders

While each person is different, there are some telltale symptoms of TMJ disorders to look out for, including:

• Jaw pain or facial soreness
• Headaches
• Difficulty opening mouth widely
• Pain when chewing
• Clicking or popping sounds
• Jaw locking open or closed
• Jaw misalignment (feeling of jaw coming unhinged)
• Bite feeling off or misaligned
• Tinnitus (ringing in the ears)
• Tooth pain
• Earaches
• Swelling along sides of face
• Neck or shoulder pain

What causes TMJ disorders?

TMJ disorders can happen for a variety of reasons. Sometimes it runs in the family, while other times it’s related to your environment and the habits you have. For example, if you chew gum after every meal or clench your jaw when you’re anxious.

Here are some of the most common causes for TMJ:

• Genetics
• Grinding or clenching your teeth
• Stress and anxiety causing clenching or muscle tension
• Sports injuries leading to jaw misalignment
• Anatomical irregularities of the jaw

How is TMJ diagnosed?

Dentists or primary care doctors typically diagnose TMJ disorders by listening to your symptoms and doing a physical examination. Frequently dentists discover and diagnose TMJ dysfunction during a regular dental checkup.

During the physical exam, the clinician will watch you opening and closing your mouth. This helps them observe your jaw’s range of motion and look for any misalignment. They will also press their fingers to your face looking for any tender areas. And, of course, your dentist will take a look inside your mouth. If you’re someone who clenches or grinds your teeth, there can be signs of wear or damage on your teeth consistent with the habit.

Additionally, dentists may order an X-ray to look more closely at the structure of your bones and temporomandibular joints, or an MRI to examine the soft tissues around the joints and any areas of swelling.

After diagnosis, your dentist will recommend the best treatment options for you. They may refer you to other specialists if they think it’s needed, including an oral maxillofacial surgeon, in rare cases.

How can TMJ disorders be treated?

Depending on the severity of your symptoms, your doctor or dentist may recommend a variety of treatment options.

Lifestyle changes and home remedies for TMD

For nearly everyone with TMD, it’s important to make adjustments to your everyday life to lessen the strain on your jaw joints and allow them to heal and align properly. Here are some home remedies that doctors and dentists often recommend before, or in addition to, other treatment methods to help improve symptoms.

• Eat softer foods
• Avoid chewing gum
• Avoid certain jaw movements (like wide yawns or resting your chin on your hand for long periods)
• Learn relaxation or facial stretching techniques (your doctor or dentist can show you relaxation techniques and stretches)
• Apply heat/cold to sore or swollen areas (Tip: Apply an ice pack to the area for 10 minutes to treat pain or swelling. Afterward, do some facial stretches, then apply a warm compress to the area to relax the muscles. Do this as often as needed.)
• Focus on not clenching or grinding your teeth (Tip: To improve the tendency, make an “N” sound. This puts the tip of your tongue on the roof of your mouth, behind your front teeth, making it difficult to grind or clench. Practicing this can form a positive habit that counteracts the urge to clench.)

Wearing a splint or nightguard

For people who clench or grind their teeth during their sleep, wearing a splint can be a game changer. These plastic mouthpieces can be custom made or bought as a standard size. They fit over your teeth and provide a stable surface for your upper and lower teeth to close on to improve alignment, reduce pressure and prevent tooth damage. Your clinician can help you figure out what will work best for you.

Wearing a mouthguard while playing sports

Dentists – and sports trainers and coaches – often recommend that athletes wear a mouthguard to protect their teeth and jaw from sports injuries. An impact to the face can jostle your jaw and joints, leading to misalignment or more severe injury.

Medication

Doctors and dentists may recommend taking OTC medicines like ibuprofen (Advil or Motrin) or acetaminophen (Tylenol) for occasional relief from pain and swelling. They may also prescribe anti-inflammatories, low doses of antidepressants or muscle relaxers to help ease the muscle tension in your jaw, temple, neck and shoulders. It’s important to follow all use recommendations for medications.

Physical Therapy

When people have a more severe case, or if they don’t see improvement with initial treatment methods, they may be referred to a physical therapist. Physical therapists focus on evaluating the overall head and neck musculoskeletal system and providing treatment recommendations tailored to each individual patient.

Things that can make TMJ worse

Some things we do can make TMJ worse. To prevent worsening symptoms, or avoid developing TMJ in the first place, try to avoid:

• Grinding or clenching your teeth
• Chewing gum (or no more than 15 minutes per day)
• Opening your mouth widely (such as yawning widely or biting into things like apples or tall sandwiches)

When to see a doctor or dentist about TMJ

Experiencing a twinge of jaw pain every now and then is a normal part of life. Like when you take a bigger bite than you had planned. But if you’re noticing persistent symptoms of pain, difficulty opening or closing your mouth, or difficulty while talking or eating, it’s time to bring it up to your doctor or dentist.

Your primary care doctor or your general dentist is a great person to ask as a first step. You probably see them at least once per year, and they can help you understand what you’re experiencing. They may recommend remedies to improve your symptoms, or they may refer you to an orofacial pain specialist for more specialized TMD treatment.

To make a dentist appointment, find a dentist or choose a location and then call to schedule.

You want the best health, so it makes sense that you want the best health care team, too. At HealthPartners, we have hundreds of incredible care providers, giving you many choices when looking for a doctor who fits your needs and care preferences.

Our doctors are often recognized for providing the highest level of care. In fact, more than 120 of our doctors were recently named to Minnesota Monthly’s 2022 Top Doctors list. For some, this is a repeat honor, having made the list of Minnesota Monthly Top Doctors in 2021 or previous years. Some are also among those named 2022 Rising Stars and Top Doctors by Mpls.St.Paul Magazine.

To create their yearly Top Doctors list, Minnesota Monthly contacts thousands of doctors in the Twin Cities metro area and Olmsted County. Each doctor is asked to share three doctors within each specialty area that they’d recommend to others. The Top Doctors for the year are those with the most votes.

If you’re looking for your own “top doctor” to be part of your care team, you want someone you’re comfortable with and trust to help you reach your health goals. Below, you’ll be able to meet this year’s Top Doctors and explore doctors across a variety of specialties.

Our 2022 Minnesota Monthly Top Doctor honorees

Select a specialty to learn more about top doctors and find your own top doctor.

Allergy and immunology

Depend on our top-rated allergists to help you get relief from seasonal, skin and food allergies.

Cardiology and cardiac surgery

Our board-certified cardiologists and cardiac surgeons provide complete heart health, including preventive care, managing chronic conditions and recovery support.

Colon and rectal surgery

Our award-winning colon and rectal surgeons provide expert care for colon cancer, rectal cancer, inflammatory bowel disease, hemorrhoids, fissures, fistulas and more.

Cosmetic surgery

If you’d like to enhance your appearance, our award-winning cosmetic surgeons can help.

• Jason L. Buseman, MD | Park Nicollet Plastic Surgery, Saint Louis Park
• Anthony J. DeAngelis, MD | Park Nicollet Plastic Surgery, Saint Louis Park
• Harley S. Dresner, MD | HealthPartners Specialty Center, Saint Paul
• James H. Kong, MD | Park Nicollet Plastic Surgery, Saint Louis Park
• Mark E. Lovaas, MD | Park Nicollet Plastic Surgery, Saint Louis Park

Critical care medicine

Our award-winning critical care doctors provide compassionate care for life-threatening injuries and illnesses.

Dermatology

Depend on top-rated dermatologists to provide expert care for your skin, hair and nails, helping to manage conditions like acne and hair loss, and monitoring your skin for signs of cancer.

Endocrinology and metabolism

Our award-winning doctors care for a range of endocrine conditions, including diabetes, thyroid disease, bone and calcium disorders, adrenal disease and hypogonadism in both children and adults.

• Amy B. Criego, MD | Park Nicollet Specialty Center, Saint Louis Park
• Jacklyn M. Ellickson, MD | HealthPartners Specialty Center, Saint Paul
• Laura M. Gandrud Pickett, MD | Park Nicollet Specialty Center, Saint Louis Park
• Nicole S. Nader, MD | Park Nicollet Specialty Center, Saint Louis Park
• Betsy L. Schwartz, MD | Park Nicollet Specialty Center, Saint Louis Park

Family medicine

Find top-rated family medicine doctors to provide a range of care to people of all ages – everything from treating minor injuries to managing conditions like high blood pressure, diabetes and more.

Gastroenterology

Find award-winning digestive health care for celiac disease, gastric reflux, liver and pancreatic disorders, gastrointestinal cancers, irritable bowel syndrome and more.

General surgery

Our award-winning surgeons perform a range of surgeries. No matter what type of surgery you need, you’ll find compassionate expertise and a customized treatment plan.

• Amy C. Fox, MD | Regions Hospital – The Breast Health Center, Saint Paul
• Brian C. Grubbs, MD | Park Nicollet Specialty Center at Methodist Hospital, Saint Louis Park
• Emily S.T. Koeck, MD | Regions Hospital – The Burn Center, Saint Paul
• Christina T. M. Moses, MD | Hutchinson Health Clinic, Hutchinson
• Kevin J. Ose, MD | Park Nicollet Specialty Center at Methodist Hospital, Saint Louis Park
• Kristin N. Ritter, MD | Park Nicollet Jane Brattain Breast Center, Saint Louis Park

Geriatric medicine

Our top-rated geriatricians help elderly patients receive the best health care at home and in the clinic.

Gynecologic oncology

Depend on our award-winning experts for compassionate care and guidance for gynecologic cancers such as uterine cancer, endometrial cancer and cervical cancer.

Hand surgery

Our award-winning hand surgeons provide expert care for hand, arm and elbow injuries, strains, defects, arthritis and more.

• Deborah C. Bohn, MD | TRIA Orthopedic Center, Bloomington
• Erica J. Gauger, MD | TRIA Orthopedic Center, Woodbury
• Yvonne M. Grierson, MD | TRIA Orthopedic Center, Bloomington
• Jeffrey B. Husband, MD | TRIA Orthopedic Center, Bloomington
• Katharine S. A. Pico, MD | Regions Hospital – Orthopedic Surgery, Saint Paul
• Thomas F. Varecka, MD | TRIA Orthopedic Center, Bloomington
• Thomas M. Walsh, MD | TRIA Orthopedics, Saint Louis Park
• Christina M. Ward, MD | HealthPartners Specialty Center – Orthopedic and Sports Medicine, Saint Paul

Hospice and palliative medicine

Our award-winning hospice and palliative medicine specialists help patients find expert care and peace of mind during serious or terminal illness.

Hospital medicine

Whether you’re in the hospital for a scheduled surgery or for emergency care, you can expect to receive compassionate and expert support from our award-winning hospitalists.

• Natalia Dorf Biderman, MD | Park Nicollet Methodist Hospital, Saint Louis Park
• Alison A. Eckhoff, MD | Park Nicollet Methodist Hospital, Saint Louis Park
• Daniel J. Sullivan, MD | Park Nicollet Methodist Hospital, Saint Louis Park

Infectious disease

Our award-winning specialists help with rare or hard-to-treat infections, including HIV/AIDs and other bacterial, viral, fungal or parasitic infections.

Internal medicine

Our top-rated internal medicine doctors care for adults, providing preventive care, health screenings, condition management and treatment for illness and injury.

Maternal and fetal medicine

Our award-winning doctors provide expert care and support during complicated pregnancies, gestational diabetes, preeclampsia and birth defects.

Nephrology

Our top-rated nephrologists provide expert care for kidney disease, kidney failure, infections, cysts, dialysis and other kidney conditions.

Neurology

Our award-winning neurologists care for conditions such as stroke, dementia, epilepsy, Parkinson’s disease, multiple sclerosis, severe pain and more.

Neurosurgery

Depend on our top-rated neurosurgery specialists to provide expert guidance and treatment for back surgery, spine surgery and brain surgery.

Obstetrics and gynecology

Our award-winning OB-GYNs support women throughout their adult lives and provide guidance for pregnancy, birth control, periods and menopause.

Oncology and hematology

Depend on top-rated oncologists to provide award-winning cancer care that’s personalized to each patient, using the latest medical knowledge, advanced therapies and innovative treatments.

Ophthalmology

Find award-winning eye care, for everything from routine eye exams to treatments such as cataracts, macular degeneration, strabismus, amblyopia and chronic dry eyes.

Orthopedic surgery

Our orthopedic surgeons provide award-winning care for the entire musculoskeletal system – from head injuries to foot injuries and everything in between.

Otolaryngology

Our ear, nose and throat (ENT) doctors provide award-winning care for conditions such as chronic infections, tinnitus, vertigo, hearing loss, tonsillitis and sinusitis.

Pain medicine

If you have chronic pain, our award-winning pain specialists can work with you to develop a treatment plan that gets you back to enjoying life once again.

Pathology

Our award-winning pathologists use laboratory techniques to help find answers during the diagnosis or treatment of different diseases and medical conditions.

Pediatrics

Our pediatricians are known for providing award-winning care for children, including everything from routine checkups, illnesses and injuries to managing medical conditions.

Plastic surgery

Discover award-winning reconstructive surgery to help you achieve your goals.

• Ruth J. Barta, MD | HealthPartners Specialty Center – Plastic and Hand Surgery, Saint Paul
• Elaine J.C. Buckley, MB BCH | Regions Hospital – The Breast Health Center, Saint Paul
• Jason L. Buseman, MD | Park Nicollet Plastic Surgery, Saint Louis Park
• Harley S. Dresner, MD | HealthPartners Specialty Center – Otolaryngology, Saint Paul
• Christopher J. Hillard, MD | HealthPartners Specialty Center – Plastic and Hand Surgery, Saint Paul
• James H. Kong, MD | Park Nicollet Plastic Surgery, Saint Louis Park
• Ashish Y. Mahajan, MD | HealthPartners Specialty Center – Plastic and Hand Surgery, Saint Paul
• Jane A. Nemecek, MD | Park Nicollet Plastic Surgery, Saint Louis Park

Podiatry

Our top-rated podiatry specialists treat many different foot and ankle conditions, such as tendonitis, plantar fasciitis, heel pain, arch pain, bunions, ingrown toenails and more.

Psychiatry

Our award-winning psychiatrists provide compassionate mental health support for people of all ages.

• Christine R. Stanson, MD | Regions Hospital, Saint Paul
• In-Lin Tuan, MD | HealthPartners West Clinic, Saint Louis Park

Rehabilitation

Our award-winning rehabilitation specialists include speech therapists, physical therapists, occupational therapists and more.

Respiratory and pulmonary care

Our expert pulmonologists provide award-winning care for your lungs. We treat lung disease, pneumonia, infections, emphysema, asthma and other breathing problems.

Rheumatology

Our expert rheumatologists treat painful conditions that affect your joints, muscles and ligaments, including rheumatoid arthritis, lupus, gout, psoriatic arthritis, scleroderma and vasculitis.

• Joseph S. Bert, MD | HealthPartners Specialty Center – Rheumatology, Saint Paul
• Elie Gertner, MD | HealthPartners Specialty Center – Rheumatology, Saint Paul
• Elizabeth Z. Miller, DO | Park Nicollet Specialty Center, Saint Louis Park
• Rawad T. Nasr, MD | Park Nicollet Specialty Center, Saint Louis Park
• Linh Q. Ngo, DO | Park Nicollet Specialty Center, Saint Louis Park
• Tawatchai Paisansinsup, MD | Park Nicollet Specialty Center, Saint Louis Park
• Ellen R. Shammash, MD | HealthPartners Specialty Center – Rheumatology, Saint Paul
• Amanda L. Steele, DO | Park Nicollet Clinic and Specialty Center, Maple Grove
• Paul H. Sufka, MD | HealthPartners Specialty Center – Rheumatology, Saint Paul

Sleep medicine

Our award-winning sleep medicine experts treat sleep apnea, snoring, narcolepsy, shift work disorder, restless leg syndrome and other conditions.

Sports medicine

Get award-winning sports injury care, rehab, exercise training and nutrition advice from top-rated sports medicine specialists.

Thoracic surgery

Our top-rated thoracic surgeons provide chest surgery for heart disease, cancer and swallowing problems.

Urogynecology

Our award-winning urogynecologists provide expert care for female incontinence and pelvic floor concerns.

Urology

Our award-winning urologists are recognized for expert and compassionate treatment of bladder control problems, kidney stones, prostate cancer, erectile dysfunction and pelvic floor concerns.

Vascular surgery

Our top-rated vascular surgeons provide award-winning carotid artery surgery, varicose vein surgery, abdominal aortic aneurysm repair, dialysis access and more.

The best care for all your needs

These Top Doctors are just some of our expert primary care doctors and specialists across the Twin Cities and western Wisconsin. We have hundreds of doctors ready to provide personalized support for all your care needs.

Related posts

When I heard that my patient was back in the ICU, my heart sank. But I wasn’t surprised. Her paycheck usually runs short at the end of the month, so her insulin does too. As she stretches her supply, her blood sugar climbs. Soon the insatiable thirst and constant urination follow. And once her keto acids build up, her stomach pains and vomiting start. She always manages to make it to the hospital before the damage reaches her brain and heart. But we both worry that someday, she won’t.

The Inflation Reduction Act, passed last month, aims to help people like her by lowering the cost of insulin across America. Although efforts to expand protections to privately insured Americans were blocked in the Senate, Democrats succeeded in capping expenses for the drug among Americans on Medicare at $35 a month, offering meaningful savings for our seniors, some of whom will save hundreds of dollars a month thanks to the measure. In theory, the policy (and similar ones at the state level) will help the estimated 25 percent of Americans on insulin who have been forced to ration the drug because of cost, and will prevent some of the 600 annual American deaths from diabetic ketoacidosis, the fate from which I’m trying to save my patient.

Indeed, laws capping co-payments for insulin are welcome news both financially and medically to patients who depend on the drug for survival. However, in their current version, such laws might backfire, leading to even more diabetes-related deaths overall.

How could that be true? Thanks to the development of new drugs, insulin’s role in diabetes treatment has been declining over the past decade. It remains essential to the small percent of patients with type 1 diabetes, including my patient. But for the 90 percent of Americans with diabetes who have type 2, it should not routinely be the first-, second-, or even third-line treatment. The reasons for this are many: Of all diabetes medications, insulin carries the highest risk of causing dangerously low blood sugar. The medication most commonly comes in injectable form, so administering it usually means painful needle jabs. All of this effort is rewarded with (usually unwanted) weight gain. Foremost and finally, although insulin is excellent at tamping down high blood sugar—the hallmark of diabetes and the driver of some of its complications—it is not as impressive as other medications at mitigating the most deadly and debilitating consequences of the disease: heart attacks, kidney disease, and heart failure.

Read: People are clamoring to buy old insulin pumps

Large clinical trials have shown that two newer classes of diabetes medicines, SGLT2 inhibitors and GLP-1 receptor agonists, outperform alternatives (including insulin) in reducing the risk of these disabling or deadly outcomes. Giving patients these drugs instead of older options over a period of three years prevents, on average, one death for about every 100 treated. And SGLT2 inhibitors and GLP-1 receptor agonists pose less risk of causing dangerously low blood sugar, generally do not require frequent injections, and help patients lose weight. Based on these data, the American Diabetes Association now recommends SGLT2 inhibitors and GLP-1 receptor agonists be used before insulin for most patients with type 2 diabetes.

When a young person dies from diabetic ketoacidosis because they rationed insulin, the culprit is clear. But when a patient with diabetes dies of a heart attack, the absence of an SGLT2 inhibitor or GLP-1 receptor agonist doesn’t get blamed, because other explanations abound: their uncontrolled blood pressure, the cholesterol medication they didn’t take, the cigarettes they continued to smoke, bad genes, bad luck. But every year, more than 1,000 times more Americans die of heart disease than DKA, and of those 700,000 deaths, a good chunk are diabetes-related. (The exact number remains murky.) Diabetes is a major reason that more than half a million Americans depend on dialysis to manage their end-stage kidney disease, and that about 6 million live with congestive heart failure. The data are clear—SGLT2 inhibitors and GLP-1 receptor agonists could help reduce these numbers.

Still, uptake of these lifesaving drugs is sluggish. Only about one in 10 people with type 2 diabetes is taking them (fewer still among patients who are not wealthy or white). The main cause is simple and stupid: American laws prioritize profits and patents over patients. Because SGLT2 inhibitors and GLP-1 receptor agonists remain under patent protections, drug companies can charge exorbitant rates for them: hundreds if not thousands of dollars a month, sometimes even more than insulin. Doctors spend hours completing arduous paperwork in the hopes of persuading insurers to help our patients, but we’re frequently denied anyway. And even when we do succeed, many patients are left with painful co-payments and deductibles. The most maddening part is that despite their substantial up-front expense, these medications are quite cost-effective in the long run because they prevent pricey complications down the road.

Read: The risks of over-the-counter diabetes treatments

This is where addressing the cost of insulin—and only insulin—becomes problematic. Doctors are forced daily to decide between the best medication for our patients and the medication that our patients can afford. Katie Shaw, a primary-care physician with a bustling practice at Johns Hopkins, where I’m a senior resident, told me that plenty of her patients can’t afford SGLT2 inhibitors and GLP-1 receptor agonists. In such instances, Shaw is forced to use older oral alternatives and occasionally insulin. “They’re better than nothing at all,” she said.

If the cost of insulin is capped on its own, insulin will be more likely to jump in front of SGLT2 inhibitors and GLP-1 receptor agonists in treatment plans. That will mean more disease, more disability, and more death from diabetes.

Medicare patients might avoid some of these effects thanks to provisions in the IRA allowing Medicare to negotiate drug prices and capping out-of-pocket spending on prescriptions at $2,000 a year. The law also guarantees price negotiations for a handful of medications, but SGLT2 inhibitors and GLP-1 receptor agonists won’t necessarily be on the list. And most Americans are not on Medicare. Already, Shaw said, the patients in her practice who tend to be least able to afford SGLT2 inhibitors and GLP-1 receptor agonists are working-class people with private insurance. Some health centers, including the one Shaw and I work at, enjoy access to a federal drug-discount program that can make patent-protected medications, including SGLT2 inhibitors and GLP-1 receptor agonists, more affordable for the uninsured. But most Americans without insurance aren’t so lucky.

It would be cruel to choose between a world in which more people with type 2 diabetes are nudged toward a drug that won’t stave off the most dangerous complications, and one in which those with type 1 diabetes are priced out of life. In place of capping the out-of-pocket cost of just insulin, lawmakers should cap the out-of-pocket cost of all diabetes medications. This will both protect Americans dependent on insulin and smooth SGLT2 inhibitors’ and GLP-1 receptor agonists’ path to their revolutionary public-health potential.

Read: Big Pharma’s go-to defense of soaring drug prices doesn’t add up

The argument for lowering the cost of these drugs for patients is the same as the argument for insulin affordability: that it is both foolish and inhumane to make lifesaving diabetes medications unaffordable when their use prevents costly and deadly downstream complications.

Patients like mine need affordable access to insulin. But even more need access to SGLT2 inhibitors and GLP-1 receptor agonists. If the laws stop at insulin, many Americans could die unnecessarily—not from inadequate access to insulin, but from preferential access to it.

South Korean medtech company Puzzle AI is set to take on the medical AI voice technology assets of VUNO as part of a recently signed strategic agreement.

Established in 2018, Puzzle AI develops voice AI technology tools for the medical industry. Its portfolio of solutions includes VoiceEMR, which converts voice dictation into a medical record, and VoiceENR, a voice recognition tool for nurses.

WHAT IT’S ABOUT

The latest deal involves the transfer of VunoMed Deep ASR to Puzzle AI. The solution uses AI for automatic voice recognition and real-time and accurate documentation of dictated medical terms, even those that contain long and complex words or in mixed Korean and English languages. It has been adopted by over 20 major hospitals around South Korea since it was launched in 2019.

An internal performance test has found the solution to have over 98% speech recognition accuracy and conducts real-time medical documentation 1.5 times faster compared to conventional speed. 

According to a media release, VUNO will maintain the patent right for the technology, allowing it to receive license fees and sales commissions, while Puzzle AI will receive an exclusive license for the patent.

Following the transfer, Puzzle AI will handle the research and development of both companies’ medical AI solutions while VUNO will focus on sales and marketing.

WHY IT MATTERS

In a statement, VUNO said the turnover of its medical audio business to Puzzle AI will allow the company to focus on its medical imaging portfolio, which accounts for most shares of the company’s sales. It also plans to concentrate on research and development of health monitoring solutions, particularly its cardiac arrest prediction device, VunoMed DeepCARS.

MARKET SNAPSHOT

Last year, Nuance Communications, a US-based developer of conversational AI for healthcare, acquired Saykara, which specialises in mobile AI clinical documentation. Saykara’s flagship product called Kara is used for medical dictation and automatic clinical note creation during in-person or virtual visits. This mobile tool for iOS devices can be integrated with major EMR systems.

Meanwhile, Indian AI company Augnito launched last year its own AI-powered speech-to-text SaaS for producing clinical reports, such as radiology, histopathology and surgical notes. 

ON THE RECORD

“Through this deal, we have established a solid strategic partnership with Puzzle AI to continuously pursue profits related to medical voice business by enhancing business synergy effects, and at the same time, we have laid an important foundation for focusing our R&D capabilities on our main businesses, such as medical images and bio-signals,” said VUNO CEO Lee Ye-ha.

The Centers for Disease Control and Prevention is recommending updated COVID boosters, for people ages 12 and older.

These newly authorized shots are reformulated versions of the Moderna and Pfizer-BioNTech COVID-19 vaccines and they’re available at pharmacies, clinics and doctors’ offices around the country.

The boosters target both the original strain of the coronavirus and the two omicron subvariants which are causing most of the current infections. Vaccine makers have scrambled to rejigger the vaccines as they’ve become less effective against new variants.

“This virus has been mutating so quickly over the past two years,” says Judith Guzman-Cottrill, an infectious disease specialist at Oregon Health & Science University. “I feel like we’ve been playing catch up and finally we have caught up,” Guzman-Cottrill says.

Pfizer’s updated booster is available for anyone 12 and older. The Moderna booster is available for anyone 18 and older.

“If you are eligible, there is no bad time to get your COVID-19 booster,” CDC Director Rochelle Walensky told NPR. “I strongly encourage you to receive it,” she says.

But after talking to several infectious disease experts, we found there’s a whole range of opinions on who needs to boost and when. So, if you are navigating this decision, here are some things to consider:

Who needs a booster as soon as possible?

“I would recommend this booster shot for those who are immunocompromised or those who are 60 years [old] and above,” says Monica Gandhi, an infectious disease expert at the University of California, San Francisco. Gandhi says people in these groups are at highest risk.

According to CDC guidance, people are eligible if it’s been at least two months since they received their last COVID shot, either a booster or an initial vaccine, but some vaccine experts say it would be better to wait at least four months.

“I will get it,” says Physician Bob Wachter, who’s in his mid-60s and in good health. “I’m about eight months out from shot number four. And so my immunity has waned significantly,” Wachter says. He plans to get an updated booster as soon as it’s available as a hedge against serious infection, given COVID is still circulating widely with about 400 deaths per day.

“There’s no question that getting a booster increases the likelihood that you’ll have a benign case,” if you do get infected, he says.

Wachter also agrees with the CDC recommendation that younger adults get the booster. Boosting can protect against the risk of long COVID and helps protect the community at large by reducing transmission, if there’s another surge, he says.

“There are good reasons to get it, even for people that have a low chance of a super severe infection,” Wachter says.

When does it make sense to wait?

If you’ve had a recent COVID infection, it makes sense to wait.

Guzman-Cottrill and her children had mild infections in August, so she says she’ll wait until November to get boosted.

“Our natural antibody response will protect us against COVID for another few months. So I do think it makes sense to wait and get the updated booster about three months after our positive COVID test,” she says.

This is in line with the recommendation from CDC vaccine advisers — people who recently had COVID-19 may consider delaying a booster shot by three months. That’s what the country’s top infectious disease expert, Dr. Anthony Fauci says he plans to do. Fauci tested positive in mid-June and says he’ll wait three months before he gets his updated booster.

Guzman-Cottrill says both her teenagers will also get the new booster “to protect us from COVID this winter so we can avoid sick days from work and from school,” she says.

Can I time my shot for maximum protection at the holidays?

It won’t be a surprise if there’s another COVID surge this coming winter. Since the protection from boosters may only last several months, some people say they plan to wait to get the new booster in order to have maximum protection when the risk of infection is higher. “You can make a rational argument to wait until case rates are higher,” says Wachter.

If you’re trying to time it for the period of highest risk, he says, there are likely to be a ton more cases in December and January than there are in September and October.

However, Wachter says, this strategy is a bit like trying to time the stock market. It’s hard to predict exactly when the surge will happen, so there’s a risk in waiting.

“You are basically accepting a period of vulnerability that you don’t need to have,” he says. “And as I weigh all that, my thinking is I’d rather not do that.”

Another argument against waiting is that the protection from a booster shot is not instantaneous. “It does take a few weeks for our immune systems to be primed,” says Dr. Aniruddha Hazra, an infectious disease specialist at the University of Chicago. He says it could be risky to wait until a surge is already underway.

Hazra points out the vaccines can activate our immune systems in a few ways. Immune cells, known as B cells, help produce antibodies that fight off the virus in the short-term. Research shows COVID vaccines boost antibodies for several months, but then they begin to fade. After that, B cells and another type of immune cell, known as T cells, which can destroy infected cells, stick around to build a deeper immunity.

He says this deeper immunity was triggered and primed from the initial vaccines, so everyone who’s been vaccinated should have some protection against COVID But given the omicron subvariants circulating now are so different. “This [new] booster will definitely provide you with higher levels of antibodies, which are short term and short lived. It may also provide more deep-seated immunity,” he says.

Will the new booster shots prevent COVID infections completely?

No. There’s lots of enthusiasm for the updated boosters, but they are not a magic bullet

As SARS-CoV-2 has evolved, it’s become more transmissible, which is why delta and omicron led to such large surges, despite widespread vaccination in the U.S.

“The goal of this vaccine is to prevent severe illness,” says Paul Offit, director of the Vaccine Education Center at the Children’s Hospital of Philadelphia. He argues that many people who’ve already received three doses of vaccine remain well protected, so he doesn’t see a clear benefit to giving the new boosters to everyone 12 and up.

According to CDC data, people who have had one or two boosters have a 0.024% chance of being hospitalized with COVID-19. For people under 50, it’s even lower — 0.014%

Offit agrees that certain groups should receive the new booster including elderly adults, people who are immunocompromised and those with chronic conditions that put them at higher risk of serious illness. But he questions the value of another booster for healthy, younger people.

Offit says he had a mild infection in May that lasted a few days. He’s decided against getting the new booster. “I think I’m protected against serious disease.”

The new boosters offer a few months’ protection against infection, he says, but there’s no clear evidence of benefit beyond that.

NPR’s Rob Stein and Jane Greenhalgh contributed to this report.

Docquity, a Singapore-based online networking platform for healthcare professionals, has snapped up $44 million in a Series C funding round led by Japanese general trading firm Itochu Corporation. The round was also participated by other investors, including iGlobe Partners, Alkemi, Global Brain, KDV and Infocom.

This brings its total funds raised since its inception to $57.5 million.

WHAT IT DOES

With the aim of helping doctors be more informed and make better clinical decisions, Docquity provides a platform for more than 350,000 doctors to learn, connect, and collaborate through knowledge exchange and verified content across specialties.

It has partnered with over 250 medical associations across Southeast Asia to develop learning modules and deliver millions of continuing medical education (CME) credits to help doctors meet their compulsory CME requirements. It also ties up with pharmaceutical, consumer healthcare and medtech companies to reach and educate healthcare professionals.

The startup has set up offices in India, Indonesia, the Philippines, Malaysia, Singapore, Thailand, Vietnam and Taiwan.

WHAT IT’S FOR

According to a media release, Docquity will use its fresh funds to reinforce its presence in its existing markets and further scale its operations in new target markets in East Asia, including Japan and Taiwan. It also plans to enter the Middle Eastern markets, starting with the United Arab Emirates, Saudi Arabia, and Egypt.

Moreover, the new funds will also support the launch of Docquity’s newest initiatives: Docquity Academy, cohort-based learning for doctors in partnership with universities and senior medical practitioners; Docquity Clinic, a virtual clinic offering telehealth services; and Docquity Insights, which will harness data to provide insights into doctors’ needs. 

MARKET SNAPSHOT

Other similar networking platforms for healthcare professionals have raised investments in recent years. In October last year, Barcelona-based Top Doctors, which helps doctors promote their visibility and brand awareness, raised $13 million in Series B funding. In the same year in June, Doximity debuted on the New York Stock Exchange, collecting almost $600 million in proceeds from its initial public offering. 

Meanwhile, early this year in India, health tech startup MedPiper Technologies went live with its web-based networking platform for doctors called MConnekt. It followed the launch of the first online healthcare network in India, DocsCampus.com, which is run by healthcare solutions provider HealWell24.