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The physical effects of overactive bladder are obvious. But the emotional impact isn’t talked about as much. You might avoid going on road trips with friends, playing sports, or visiting your grandchildren because you’re self-conscious about leaking or having to stop a lot to use the restroom. 

“People start to live their lives around management of their bladder,” says Aqsa Khan, MD, a urologist at the Mayo Clinic in Phoenix, AZ.

Social Challenges

Even at home, OAB can make the simplest social interactions stressful. Khan says one of her patients, a 50-year-old woman, described having a nice chat with her neighbor in the yard when she suddenly started to pee in the middle of her conversation. To cover it up, she turned the garden hose onto herself.

The loss of control, Khan says, can be devastating. “It’s losing something that really defines you as a social being,” she says. “It makes you feel infantilized, in a way. It takes you back to wearing diapers.”

Intimacy

OAB can also impact intimacy. You might avoid sexual activity because you’re worried about leaking. This can lead to bigger relationship issues. If your partner doesn’t know what’s wrong, they may think it has something to do with them. Try your best to open up and trust your partner to be supportive.

Intimacy challenges are tough enough for couples who have been together for decades. They can be even more overwhelming when you’re in the dating game. “[OAB] can be a huge elephant in the room when starting up those more intimate relationships,” says A. Lenore Ackerman, MD, PhD. She’s the research director for UCLA Health’s Division of Female Pelvic Medicine and Reconstructive Surgery.

Sleep Trouble and Depression

You might wake up four times a night but go right back to sleep each time. Others may only get up twice a night. But they have so much trouble getting back to sleep each time that it has a huge effect on their quality of life. “It’s torture,” Khan says.

That’s because when you don’t get enough rest, your body doesn’t get the chance to recuperate. This could lead to other issues, including problems with brain function. There is a strong link between OAB and depression, Ackerman says, and poor sleep is a key factor. “Sleep is really centrally important to all of it,” she says.

Stress and Tension

The anxiety surrounding OAB can also make your physical symptoms worse. Just as you might clench your jaw without realizing it, people with OAB often clench their pelvic floor muscles, says Veronica Asence, DPT. She’s a physical therapist at Lahey Hospital & Medical Center in Burlington, MA, who specializes in pelvic health.

“Your pelvic floor is always active: supporting your pelvis, holding up your organs,” she says. “If we’re clenching our pelvic floor muscles in relation to the urge [to pee] and the anxiety surrounding that urge, it’s like we’re constantly tucking our tail.”

This nonstop squeezing can wear them out. So much so they lose control when you need them the most. You could see a big change in your symptoms just by working on ways to ease your anxiety and the pelvic floor tension that comes with it.

Fighting the Stigma

If you’re older, you might think urinary issues are a normal part of aging. (They’re not.) But if you’re young, OAB can carry an additional level of shame and self-blame. You might wonder how this could be happening or what’s “wrong” with you.

Shame can be a major block in asking for help, but OAB is more common than you think. “Talk to your friends,” Ackerman says. “Odds are some of them have it, too.” In fact, Ackerman says the first thing she does when meeting a new patient is tell them about her own urinary problems.

By talking about it more, others with OAB will likely feel more comfortable looking for long-term treatments instead of just managing symptoms with pads, backup underwear, catheters, and other items. They can be a great way to take back control. For instance, new products are often designed with light, flattering fabrics that secretly hold lots of fluids. But they sometimes stop people from getting professional help, Ackerman says.

“You don’t have to deal with this alone,” Ackerman says. “This happens to a lot of us, and there’s treatment, and we want to get you treatment.”

Talk to Your Doctor

“Physicians get into this line of work because they want to help patients,” says Sevann Helo, MD, a Mayo Clinic urologist in Rochester, MN. “We can’t improve something we don’t know is a problem.”

If your doctor doesn’t know how to treat OAB, they should refer you to someone who can. With help, you can take control. “It doesn’t matter if you’re 28 years old or 88 years old,” Asence says. “Your bladder can be retrained at any point in your lifetime.” The key, she adds, is to be persistent and take care of your whole self. “The bladder’s personality is a lot like a toddler: it does best with structure, discipline, and a healthy environment.”

By Cara Murez HealthDay Reporter

HealthDay Reporter

WEDNESDAY, Oct. 12, 2022 (HealthDay News) — Celebrity Khloe Kardashian announced Tuesday that she had survived a second bout of skin cancer, this time on her face.

Kardashian said her “incredibly rare” tumor was removed by Beverly Hills surgeon Dr. Garth Fisher after the reality TV star noticed a bump that wouldn’t go away.

“I decided to get it biopsied 7 months after realizing it was not budging,” Kardashian, 38, wrote in an Instagram post.

Kardashian had initially thought the bump was a pimple, but later was seen by multiple doctors who told her the tumor was “incredibly rare for someone [her] age.”

She was told to have surgery immediately after the biopsy results were returned.

“All my margins appear clear and now we are onto the healing process,” Kardashian wrote over a picture of her face with a bandage. “You’ll continue to see my bandages and when I’m allowed, you’ll probably see a scar (and an indentation in my cheek from the tumor being removed).”

Kardashian had been wearing a bandage on her face for a few weeks.

In her post she also revealed that this was the second time she had skin cancer.

“At 19-years-old, I had melanoma on my back, and I had a surgery to remove that as well,” Kardashian said. “I am someone who wears sunscreen every single day, religiously so no one is exempt from these things. Please take this seriously and do regular self-exams as well as your annual checkups.”

Kardashian also shared recent videos and photos of her wearing the bandage in public, thanking her dermatologists, surgeon and also her makeup artist for “dealing with” the face bandages.

Kardashian said that she was “lucky and all I have is a scar to tell a story with. I hope you enjoy how fabulous I’m making these face bandages look.”

More information

The U.S. Centers for Disease Control and Prevention has more on skin cancer.

SOURCE: Instagram

Oct. 12, 2022 — When 16-year-old Jake Gallagher died of a heart attack while playing video games, the U.K. teen’s death made international headlines. Many reports called the 2013 case a rare isolated incident, noting the teen had an underlying heart condition that put him at risk.

But new research suggests such cases are more common than you might think. 

Australian scientists who reviewed nearly 70 studies and reports on cardiovascular risks from electronic gaming identified 22 children and teens who lost consciousness while playing video games and experienced heart rhythm problems and other cardiac complications.

Nineteen of the mostly male gamers, aged 7 to 16, experienced serious irregular heartbeats known as ventricular arrhythmia. Six had heart attacks, and four died suddenly. The researchers also found only 7 of the 22 had received a prior diagnosis of arrhythmia or other heart problems.

“Video games may represent a serious risk to some children with arrhythmic conditions; they might be lethal in patients with predisposing, but often previously unrecognized arrhythmic conditions,” notes lead investigator Claire M. Lawley, MBBS, PhD, with The Heart Centre for Children in Sydney, Australia, in a statement. “Children who suddenly lose consciousness while electronic gaming should be assessed by a heart specialist as this could be the first sign of a serious heart problem.”

Such cases are rare, says Christian Turner, MBBS, a co-author of the report, published in the journal Heart Rhythm. Even so, the findings suggest parents monitor their children for signs of stress while gaming — such as sudden fainting or blacking out during periods of high excitement — that might signal an underlying heart condition that could put their lives in danger.

“The population at risk is exceptionally small,” he says. “Children playing games electronically would be at no greater risk than playing school sports or being physically active. For a parent, if their child has a new blackout, faint, collapse or seizure, they should be checked out by their local or family doctor. The family’s doctor will then determine if further tests are necessary.”

In an editorial accompanying the new report, Daniel Sohinki, MD, with the Department of Cardiology at Augusta University in Georgia, argues that the study’s findings suggest screening programs — similar to what’s recommended for collegiate sports — aimed at identifying underlying cardiac issues “should encompass athletes being considered for participation in eSports.”

Sohinki says what’s needed is a better understanding of how stress — mental or physical — stimulates the cardiovascular system in ways that can be dangerous to gamers and traditional sports athletes alike. The same might also be said of other highly stressful activities, such as watching horror films or exciting competitive sporting events that get your heart beating faster.

“What it comes down to is what kind of stress stimulates the cardiovascular system,” he says. “Whether that’s mental excitement or physical exertion, it’s something that increases your heart rate and increases the stimulated input to the cardiovascular system … that’s the common underlying theme between aerobic exercise and competitive video games.”

He notes that new findings should prompt a rethinking of conventional belief that video games are safer for kids with underlying heart problems than traditional sports, such as basketball, soccer, and hockey, that can put young athletes at risk for sudden cardiac death.

“I think in the past, there’s been a thought that if there’s a child who we believe is at risk for arrhythmia or some sort of cardiovascular complication from aerobic exercise, then maybe some sort of sedentary activity, like playing a video game, would be safer for them,” he says. “But what this paper argues is that if you have a child whom you believe to be at risk for a cardiac event for whatever reason, you can’t necessarily be assured that a competitive video game is going to be a safer activity for them.”

The Australian investigators who conducted the new review based their conclusions on dozens of studies and reports on children who experienced sudden loss of consciousness while playing video games and were determined to have underlying heart conditions. 

Among the researchers’ findings:

• Of the 22 cases identified, multiplayer war gaming was the most frequent trigger. 
• 19 males (86%) were identified as having experienced suspected or proven ventricular arrhythmia during electronic gaming.
• Six (27%) experienced cardiac arrest and four (18%) died suddenly.
• Underlying heart conditions were known in just seven (31%) patients beforehand, but confirmed in 12 (54%) afterward.
• The most common underlying conditions were heart rhythm disorders known as CPVD (catecholaminergic polymorphic ventricular tachycardia) and LQTS (congenital long QT syndrome).

The research team also found a high incidence of genetic variants (63%) among the gamers, which has significant implications for their families. In some cases, the investigation of a child who lost consciousness during video gaming led to other family members being diagnosed with an important familial heart rhythm problem.

Turner says he believes the researchers’ findings, while troubling, shouldn’t lead to calls for widespread screening of all children — with echocardiograms, stress tests, or other procedures — before clearing them to play video games.

“We, in Sydney, Australia, feel the potential harms of screening all children for such a rare condition outweigh the potential benefits,” he says. “Screening would entail performing an exercise stress test on every child in the community and is certainly not practical in the real world. The medical community is already well aware that syncope [loss of consciousness] during sport should be investigated. Our findings in this report suggest that syncope during electronic gaming should be similarly investigated.”

But Sohinki argues that any child who has had symptoms of a potential heart condition should at least get a standard physical exam and be evaluated for any symptoms that might suggest video gaming could pose a potential risk. These recommendations are in line with guidelines of the National College Athletic Association (NCAA) for sports athletes, which estimates sudden cardiac death strikes between 1 in 40,000 and 1 in 80,000 players each year.

“For the NCAA, the minimum is a comprehensive medical history and physical examination that’s aimed at identifying either cardiac symptoms or a personal or family history of cardiovascular disease,” he notes. “That’s recommended for all NCAA athletes. So I think there’s a strong argument to be made that … that should be extended to any person who is going to participate competitively in a video game. I think you could justify a history and physical examination as being is a cost-effective intervention. I would support that.”

For Sohinki, who has a young son and is a gamer himself, the issue is both a personal and professional concern. He practices what he preaches.

“I have a 3-year-old and he’s watched me play video games and asked to play games as well,” he says. “I also have a [heart] valve condition that is heritable, so he’s already had an echocardiogram screening. But if he didn’t have any symptoms or a known history of cardiovascular disease, I’m not sure I would have anything more than a medical history and physical screening before letting him play video games.”

Oct. 12, 2022 – Ever since his mid-30s, Greg lived in a nursing home. An assault 6 years earlier left him barely conscious, unable to talk or eat. Two years of rehab did little to help him. Most people in Greg’s condition would have remained nonverbal and separated from the world for the rest of their lives. But at age 38, Greg received a brain implant through a clinical trial. 

Surgeons installed an electrode on either side of his thalamus, the main relay station of the brain. 

“People who are in the minimally conscious state have intact brain circuitry, but those circuits are under-activated,” explains Joseph Fins, MD, chief of the Division of Medical Ethics at Weill Cornell Medicine in New York City. Delivering electrical impulses to affected regions can revive those circuits, restoring lost or weakened function. 

“These devices are like pacemakers for the brain,” says Fins, who co-authored a study in Nature about Greg’s surgery.

The researchers switched Greg’s device off and on every 30 days for 6 months, observing how the electrical stimulation (or lack thereof) altered his abilities. They saw remarkable things. 

“With the deep brain stimulator, he was able to say six- or-seven-word sentences, the first 16 words of the Pledge of Allegiance. Tell his mother he loved her. Go shopping at Old Navy and voice a preference for the kind of clothing his mother was buying,” recalls Fins, who shared Greg’s journey in his book, Rights Come to Mind: Brain Injury, Ethics and the Struggle for Consciousness.

After 6 years of silence, Greg regained his voice.

Yet success stories like his aren’t without controversy, as the technology has raised many ethical questions: Can a minimally conscious person consent to brain surgery?  What happens to the people being studied when clinical trials are over? How can people’s neural data be responsibly used – and protected? 

“I think that motto, ‘Move fast and break things,’ is a really bad approach,” says Veljko Dubljevic, PhD, an associate professor of science, technology, and society at North Carolina State University. He’s referring to the unofficial tagline of Silicon Valley, the headquarters for Elon Musk’s neurotechnology company, Neuralink. 

Neuralink was founded in 2016, nearly a decade after the study about Greg’s brain implant was published. Yet it has been Musk’s company that has most visibly thrust neurotechnology into public consciousness, owing somewhat to its founder’s often overstated promises. (In 2019, Musk claimed his brain-computer interface would be implanted in humans in 2020. He has since moved that target to 2022.) Musk has called his device “a Fitbit in your skull,” though it’s officially named the “Link.” 

Brain-computer interfaces, or BCIs, are already implanted in 36 people around the world, according to Blackrock, a leading maker of these devices. What makes Neuralink different is its ambitious goal to implant over 1,000 thinner-than-hair electrodes. If the Link works as intended – by monitoring a person’s brain activity and commanding a computer to do what they want – people with brain disorders, like quadriplegia, could regain a lot of independence. 

The History Behind Brain Implants

BCIs – brain implants that communicate with an external device, typically a computer – are often framed as a science-fiction dream that geniuses like Musk are making a reality. But they’re deeply indebted to a technology that’s been used for decades: deep brain stimulation (DBS). In 1948, a neurosurgeon at Columbia University implanted an electrode into the brain of a woman diagnosed with depression and anorexia. The patient improved – until the wire broke a few weeks later. Still, the stage was set for longer-term neuromodulation.

It would be movement disorders, not depression, that ultimately catapulted DBS into the medical mainstream. In the late 1980s, French researchers published a study suggesting the devices could improve essential tremor and the tremor associated with Parkinson’s. The FDA approved DBS for essential tremor in 1997; approval for Parkinson’s followed in 2002. DBS is now the most common surgical treatment for Parkinson’s disease.

Since then, deep brain stimulation has been used, often experimentally, to treat a variety of conditions, ranging from obsessive-compulsive disorder to Tourette’s to addiction. The advancements are staggering: Newer closed-loop devices can directly respond to the brain’s activity, detecting, for example, when a seizure in someone with epilepsy is about to happen, then sending an electrical impulse to stop it.

In clinical trials, BCIs have helped people with paralysis move prosthetic limbs. Implanted electrodes enabled a blind woman to decipher lines, shapes, and letters. In July, Synchron – widely considered Neuralink’s chief competitor – implanted its Stentrode device into its first human subject in the U.S. This launched an unprecedented FDA-approved trial and puts Synchron ahead of Neuralink (which is still in the animal-testing phase). Australian research has already shown that people with Lou Gehrig’s disease (also called amyotrophic lateral sclerosis, or ALS) can shop and bank online using the Stentrode.

With breakthroughs like these, it’s hard to envision any downsides to brain implants. But neuroethicists warn that if we don’t act proactively – if companies fail to build ethical concerns into the very fabric of neurotechnology – there could be serious downstream consequences. 

The Ethics of Safety and Durability 

It’s tempting to dismiss these concerns as premature. But neurotechnology has already gained a firm foothold, with deep brain stimulators implanted in 200,000 people worldwide. And it’s still not clear who is responsible for the care of those who received the devices from clinical trials. 

Even if recipients report benefits, that could change over time as the brain encapsulates the implant in glial tissue. This “scarification” interferes with the electrical signal, says Dubljevic, reducing the implant’s ability to communicate. But removing the device could pose a significant risk, such as bleeding in the brain. Although cutting-edge designs aim to resolve this – the Stentrode, for example, is inserted into a blood vessel, rather than through open brain surgery – many devices are still implanted, probe-like, deep into the brain. 

Although device removal is usually offered at the end of studies, the cost is often not covered as part of the trial. Researchers typically ask the individual’s insurance to pay for the procedure, according to a study in the journal Neuron. But insurers have no obligation to remove a brain implant without a medically necessary reason. A patient’s dislike for the device generally isn’t sufficient. 

Acceptance among recipients is hardly uniform. Patient interviews suggest these devices can alter identity, making people feel less like themselves, especially if they’re already prone to poor self-image. 

“Some feel like they’re controlled by the device,” says Dubljevic, obligated to obey the implant’s warnings; for example, if a seizure may be imminent, being forced not to take a walk or go about their day normally. 

“The more common thing is that they feel like they have more control and greater sense of self,” says Paul Ford, PhD, director of the NeuroEthics Program at the Cleveland Clinic. But even those who like and want to keep their devices may find a dearth of post-trial support – especially if the implant wasn’t statistically proven to be helpful. 

Eventually, when the device’s battery dies, the person will need a surgery to replace it. 

“Who’s gonna pay for that? It’s not part of the clinical trial,” Fins says. “This is kind of like giving people Teslas and not having charging stations where they’re going.” 

As neurotechnology advances, it’s critical that health care systems invest in the infrastructure to maintain brain implants – in much the same way that someone with a pacemaker can walk into any hospital and have a cardiologist adjust their device, Fins says.

“If we’re serious about developing this technology, we should be serious about our responsibilities longitudinally to these participants.”

The Ethics of Privacy

It’s not just the medical aspects of brain implants that raise concerns, but also the glut of personal data they record. Dubljevic compares neural data now to blood samples 50 years ago, before scientists could extract genetic information. Fast-forward to today, when those same vitals can easily be linked to individuals. 

“Technology may progress so that more personal information can be gleaned from recordings of brain data,” he says. “It’s currently not mind-reading in any way, shape, or form. But it may become mind-reading in something like 20 or 30 years.” 

That term – mind-reading – is thrown around a lot in this field. 

“It’s kind of the science-fiction version of where the technology is today,” says Fins. (Brain implants are not currently able to read minds.) 

But as device signals become clearer, data will become more precise. Eventually, says Dubljevic, scientists may be able to figure out attitudes or psychological states.

“Someone could be labeled as less attentive or less intelligent” based on neural patterns, he says. 

Brain data could also expose unknown medical conditions – for example, a history of stroke – that may be used to raise an individual’s insurance premiums or deny coverage altogether. Hackers could potentially seize control of brain implants, shutting them off or sending rogue signals to the user’s brain.

Some researchers, including Fins, say that storing brain data is no riskier than keeping medical records on your phone. 

“It’s about cybersecurity writ large,“ he says.  

But others see brain data as uniquely personal. 

“These are the only data that reveal a person’s mental processes,” argues a report from UNESCO’s International Bioethics Committee (IBC). “If the assumption is that ‘I am defined by my brain,’ then neural data may be considered as the origin of the self and require special definition and protection.” 

“The brain is such a key part of who we are – what makes us us,” says Laura Cabrera, PhD, the chair of neuroethics at Penn State University. “Who owns the data? Is it the medical system? Is it you, as a patient or user? I think that hasn’t really been resolved.” 

Many of the measures put in place to regulate what Google or Facebook gathers and shares could also be applied to brain data. Some insist that the industry default should be to keep neural data private, rather than requiring people to opt out of sharing. But Dubljevic, takes a more nuanced view, since the sharing of raw data among researchers is essential for technological advancement and accountability. 

What’s clear is that forestalling research isn’t the solution – transparency is. As part of the consent process, patients should be told where their data is being stored, for how long, and for what purpose, says Cabrera. In 2008, the U.S. passed a law prohibiting discrimination in health care coverage and employment based on genetic information. This could serve as a helpful precedent, she says. 

The Legal Question 

Around the globe, legislators are studying the question of neural data. A few years ago, a visit from a Columbia University neurobiologist sparked Chile’s Senate to draft a bill to regulate how neurotechnology could be used and how data would be safeguarded. 

“Scientific and technological development will be at the service of people,” the amendment promised, “and will be carried out with respect for life and physical and mental integrity.”

Chile’s new Constitution was voted down in September, effectively killing the neuro-rights bill. But other countries are considering similar legislation. In 2021, France amended its bioethics law to prohibit discrimination due to brain data, while also building in the right to ban devices that modify brain activity.

Fins isn’t convinced this type of legislation is wholly good. He points to people like Greg – the 38-year-old who regained his ability to communicate through a brain implant. If it’s illegal to alter or investigate the brain’s state, “then you couldn’t find out if there was covert consciousness”– mental awareness that isn’t outwardly apparent – “thereby destining people to profound isolation,” he says. 

Access to neurotechnology needs protecting too, especially for those who need it to communicate. 

“It’s one thing to do something over somebody’s objection. That’s a violation of consent – a violation of personhood,” says Fins. “It’s quite another thing to intervene to promote agency.”

In cases of minimal consciousness, a medical surrogate, such as a family member, can often be called upon to provide consent. Overly restrictive laws could prevent the implantation of neural devices in these people.

 “It’s a very complicated area,” says Fins. 

The Future of Brain Implants

Currently, brain implants are strictly therapeutic. But, in some corners, “enhancement is an aspiration,” says Dubljevic. Animal studies suggest the potential is there. In a 2013 study, researchers monitored the brains of rats as they navigated a maze; electrical stimulation then transferred that neural data to rats at another lab. This second group of rodents navigated the maze as if they’d seen it before, suggesting that the transfer of memories may eventually become a reality. Possibilities like this raise the specter of social inequity, since only the wealthiest may afford cognitive enhancement. 

They could also lead to ethically questionable military programs. 

“We have heard staff at DARPA and the U.S. Intelligence Advanced Research Projects Activity discuss plans to provide soldiers and analysts with enhanced mental abilities (‘super-intelligent agents’),” a group of researchers wrote in a 2017 paper in Nature. Brain implants could even become a requirement for soldiers, who may be obligated to take part in trials; some researchers advise stringent international regulations for military use of the technology, like the Geneva Protocol for chemical and biological weapons. 

The temptation to explore every application of neurotechnology will likely prove irresistible for entrepreneurs and scientists alike. That makes precautions essential. 

“While it’s not surprising to see many potential ethical issues and questions arising from use of a novel technology,” a team of researchers, including Dubljevic, wrote in a 2020 paper in Philosophies, “what is surprising is the lack of suggestions to resolve them.” 

It’s critical that the industry proceed with the right mindset, he says, emphasizing collaboration and making ethics a priority at every stage.

“How do we avoid problems that may arise and find solutions prior to those problems even arising?” Dubljevic asks. “Some proactive thinking goes a long way.”