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Which would you be? By the wonderful Grace Farris.
P.S. The funniest Halloween costume, and four fall traditions.… Read more
The post Last Minute Halloween Costumes appeared first on Cup of Jo.
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Oct. 27, 2022 – The pandemic changed a lot. The way we work, educate our kids, and visit the doctor. The job market, the housing market, and entire industries. Our average life expectancy fell by nearly 3 years.
But the pandemic has also changed something else: You.
That’s not just a guess. Scientists have been putting out papers documenting the many ways you – and all of us – have changed, from habits to health. The latest such study suggests that our very personalities have changed.
Researchers from Florida State University and other institutions compared data pre-pandemic versus later and found declines in four traits: extroversion, openness, agreeableness, and conscientiousness. The changes were about “one-tenth of a standard deviation,” roughly the level of personality change you’d expect to see over a decade – not 2 years. A fifth trait, neuroticism, also increased in young adults.
In some ways, that’s the opposite of what should happen as we grow and mature, explains study author Angelina Sutin, PhD, a professor of behavioral sciences and social medicine at Florida State University College of Medicine. The paper calls it “disrupted maturity.” Normally, neuroticism goes down, and agreeableness and conscientiousness go up.
“In young adults, we found the exact opposite pattern,” Sutin says. Middle-aged adults also saw a decline in agreeableness and conscientiousness, though the oldest adults saw no significant changes.
“Having a worldwide pandemic was a stressor that affected everyone in some way,” Sutin says. “There has not been an event like that in modern time, in modern psychology, that we could look at that disrupted all of society.”
Natural disasters are disruptive and stressful but tend not to affect the entire population. They also don’t last as long.
“The pandemic has been this ongoing threat,” Sutin says. “It’s hard to have gone through this experience and not been changed in some way.”
Scientists have seized the opportunity to study all kinds of things: the pandemic’s impact on our blood pressure, our microbiomes, our eyesight, our mental health. Many more long-term changes may be revealed with time.
Are they permanent? Perhaps – but perhaps not. We are not without agency; if you’re feeling more anxious and stressed (signs of neuroticism), you can seek help and learn ways to manage that. If you’re concerned about conscientiousness, practice those skills: Stick to a schedule, follow through on commitments.
“All those things that make conscientious people conscientious,” Sutin says.
On the other hand, some changes – like washing your hands more and reevaluating what matters – may be positive. And those you can choose to keep.
It starts with taking a moment to reflect and recognize what changes are helpful or harmful, which you’d like to carry forward, and which you’ll leave behind.
So, how have we changed since the pandemic? Have a look.
Our Blood Pressure Went Up
A study of half a million U.S. adults found systolic blood pressure (the top number in your blood pressure measurement) jumped by about 2 millimeters of mercury from April 2020 to December 2020, while diastolic pressure (the bottom number) went up, too. (This after holding steady in 2019 and the first 3 months of 2020.)
Stress activates the sympathetic nervous system, raising blood pressure, says study author Luke Laffin, MD, of the Cleveland Clinic’s Center for Blood Pressure Disorders. It also inspires unhealthy behaviors, like scarfing down junk food, drinking alcohol, and sleeping less.
Even a small rise in blood pressure can increase heart attack and stroke risk. But you can help reverse the damage by exercising, cutting back on salt and saturated fat, making sleep a priority, and taking blood pressure medications as prescribed. Another useful exercise: Take a long look at how you react to stress triggers, no matter if they come from family, TV, or social media. Tracking your blood pressure at home can help too, Laffin says. Find validated monitors at ValidateBP.org.
We Need More Space
Remember Seinfeld’s “close talker” (Judge Reinhold) who gets uncomfortably I-can-feel-your-breath close? We all know that visceral urge to step back, and now we may be stepping back even farther.
Taking advantage of a pre-pandemic study on personal space, researchers at Massachusetts General Hospital recruited the same people for a new study after the pandemic began. They found that space needs increased by 45%, from 2 to 3 feet to 3 to 4 feet, on average.
The clever part of this study is that they used both real people and avatars to test the results.
“Even though avatars are not real, we do not want an avatar in our personal space,” says study author Daphne Holt, MD, a psychiatrist at Massachusetts General Hospital. You can’t catch COVID from an avatar. Yet people still needed more space in a virtual setting, suggesting the brain systems regulating personal space may have been altered.
No need to force this one. You’ll readjust at your own pace, Holt says.
“These behaviors are fairly automatic and sensitive to change, and thus should quickly adapt again to the new normal.”
We’ve Become Germ-Fighting Ninjas – and That May Be Bad for Our Health
For many of us, the pandemic was a crash course on virology and immunology. We now know what a spike protein is, the difference between an N95 and a regular-old face mask, the virtues of alcohol-based hand sanitizer, and how far and fast virus-carrying droplets can travel.
But we may have fended off good germs too, meaning your microbiome may have taken a hit.
“We have a tension in our society between hygiene and healthy [microbe] exposure,” says Brett Finlay, PhD, a professor of microbiology and immunology at the University of British Columbia and author of Let Them Eat Dirt.
That goes back well before the pandemic, to when scientists discovered about a century ago that germs cause infection. That’s when we broke out the disinfectant, sterilizing our world and killing healthy microbes in the process.
“When we realized this and how important the microbiome is to our health, we started pushing back,” says Finlay. “Then COVID came along, and we went back to being hyper hygienic, which will set us back considerably.”
Healthy microbes help protect against disease. And a BMJ study even found that the gut microbiome may influence COVID severity.
Strike a balance, Finlay recommends. Keep handwashing, but eat more fiber, fermented foods, and probiotics, and cut back on sugar, flour, and red meat. Also exercise, manage stress, and get outside. Microbes in the environment can be ingested and become part of your gut community, where they can help fuel healthy gut cells, he says. A pet is another good way to expose yourself to different microbes.
Our Vision Got Blurrier
The pandemic, by virtue of trapping us indoors and keeping us close to screens, may have sped up a rise in nearsightedness, or myopia, especially among young children. That’s when you can see things up close but struggle to view objects far away. The fix is simple: glasses. But if myopia worsens too quickly, it can increase the risk of retinal detachment and glaucoma, conditions that in turn can lead to permanent blindness.
Children are especially at risk.
“The younger the person, the more influence near activity has on progression of myopia,” says Howard Krauss, MD, a neuro-ophthalmologist at Providence Saint John’s Health Center in Santa Monica, CA. “But even the young adult may induce myopia with prolonged near work,” as may be the case among law students and medical students.
You can help protect yourself (or your child) against myopia progression by getting outside, Krauss says. Exposure to bright light triggers the release of dopamine, which may prevent the eye from elongating (the basis of myopia). Maximize your outdoor time as you can, aiming for at least 2 hours a day.
Our Teeth Hurt
Some 70% of dentists saw more teeth grinding, or bruxism, among patients. Dr. Google noticed too: Searches for “bruxism,” “teeth grinding,” and “teeth clenching” spiked between May and October 2020.
Grinding is linked to stress, and some research suggests the tensing-and-relaxing motion (like chewing gum) may be a subconscious stress reducer.
If it gets bad enough, grinding can cause tooth fractures or loss of teeth, says Robert DiPilla, DDS. If you’re concerned, see your dentist. A fitted mouth guard may solve the problem.
We’re More Anxious (and More Aware of That, Too)
Rates of depression and anxiety soared during the pandemic. The reason? Take your pick: unprecedented stress, frustration, isolation, uncertainty, grief over losing loved ones. Some research points to “emotional contagion.” That’s when you see other anxious people, so you start to feel anxious too, an effect that can run rampant on social media.
But guess what? We’ve noticed. A recent survey from CNN and the Kaiser Family Foundation found that 9 out of 10 adults believe there’s a mental health crisis in the U.S. today. We’re talking more about mental health now, says Ariana Mufson, a social worker in Newton Centre, MA, and we may be more aware of it than ever, as evidenced by the rise in demand for mental health services.
“People I hadn’t seen in years came back to my practice,” says Mufson, “and I received daily referrals to the point where I had to keep a long waitlist.”
Paying more attention to your mental health is a positive change. So put down the phone and keep up the self-care. Our mental health needs “exercise” just as our bodies do, Mufson says.
We Stopped Catching Colds
It’s not true that getting infections boosts general immunity. In fact, infection can cause inflammation and may trigger autoimmune disease. One study found that prior infection with a common cold coronavirus may have increased the risk of severe illness from COVID.
“One of the things we learned from the pandemic was how effective masking is at preventing all sorts of illnesses,” says Meghan May, PhD, a professor of microbiology and infectious disease at the University of New England College of Medicine. Take the unusually low 2020-2021 flu season, she says.
“We can apply that knowledge forward to help curtail diseases other than COVID.”
Keep washing your hands, using sanitizer, and minding your personal space, May recommends. And continue to eat outside at restaurants if you can, even during the chilly months of cold and flu season. Heat lamps, fire pits, and portable stoves have become common at many places, she notes.
We Reevaluated What Matters
Amid the disruption and isolation, the pandemic may have helped us focus on what’s most important. Engagements, career shifts, and moves all spiked. Job loss and furloughs encouraged many to reconsider their careers, prompting an unprecedented high in U.S. resignations. Inflation forced some to rethink their spending – a Capital One survey found 58% of those surveyed have completely changed how they think about money due to the pandemic.
This is one change you want to make permanent, so keep fostering that compassionate and curious inner voice, says Mufson.
“Ask yourself, ‘Is this job making me happy? Is it giving me the work-life balance I want? Do I have enough free time to see family and friends?’” If not, figure out the steps needed to get where you want to be.
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Before she began competition in the 2022 Rogue Invitational, which will run in Austin, TX, from Oct. 27-30, 2022, Polish CrossFitter Gabriela Migała went to a unique place to refine and polish up her strength and conditioning. It might not have been that outside of the box for an athlete seeking every edge.
On Oct. 27, 2022, Migała posted a video to her YouTube channel that features her traveling to Hafthor Björnsson’s commercial gym, Thor’s Power Gym, in Kópavogur, Iceland. Her primary mission was to work on her deadlift and sandbag proficiency while being coached by two-time World’s Strongest Man (WSM) finalist Stefán Sölvi Pétursson.
[Related: How to Do the Weighted Pull-Up — Benefits, Variations, and More]
From the moment she stepped out of her car — beaming while speculating if Björnsson is actually as big as his reputation says he is — Migała seemed eager to continue implementing some strongwoman-level training into her general routine. (Note: Björnsson was not in attendance.)
“I’m really happy to learn some new stuff from the best people,” Migała explains to the camera. “So it’s gonna be fun. It’s gonna be really helpful.”
Veering away from her usual CrossFit-centric routine apparently wasn’t easy for Migała. She describes herself as a person who appreciates consistency in her daily planning, making the initial slight transition a little challenging.
“Before I came to Iceland, that was one of my concerns,” Migała said of her reservations about trying a different training style. “I’m the type of person who likes to have everything scheduled. I like my routine. I don’t really like too many changes. Leaving my gym, and my equipment, and my everything was quite stressful. I wasn’t sure about this, especially so close to a competition [the 2022 Rogue Invitational].”
Ultimately, Migała appeared to be won over by the temporary variation after some time. She seemed to believe she acclimated well and that this sort of focus helped her become more versatile.
“It actually turned out to be a really good decision,” Migała says. “It’s really good training because I think, as an athlete, you should be able to adapt to everything and not really be used to doing the same stuff in the same safe space.”
[Related: How to Do the Hip Thrust — Variations, Benefits, and Common Mistakes]
As for her workout, Migała kept it quick, efficient, and effective when it came to the deadlift. That’s because her workout was not centered around pulling heavy weight. Pétursson had Migała refocus and rework her deadlift technique in a healthy manner for improved strength in the long run, and she seemed to appreciate the coaching.
“It’s so different; I think it’d be so much easier if you could start from zero rather than forgetting your old technique after doing it for so many years,” Migała said. “… But, yeah, practice makes perfect.”
Migała would follow the initial deadlift coaching by cruising through a field portion length of the gym while lifting and re-lifting an 80-kilogram (176.3-pound) sandbag. By the end of the workout, Migała shined with excitement about what she was able to accomplish.
“It was the best session from all of the sessions since we came to Iceland,” Migała expressed. “It’s been so beneficial to be able to train with Stefan [Sölvi Pétursson]. He showed a few more cues for [lifting] sandbags … so it’s very good.”
[Related: How to Do the Weighted Pull-Up — Benefits, Variations, and More]
Migała is currently utilizing what she learned in training as a strongwoman at the 2022 Rogue Invitational. Chances are, it might help her round out an excellent performance in Austin.
Featured image: @gabimiga on Instagram
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By Chelcie Rice, as told to Hallie Levine
I learned I had diabetic retinopathy in 2004. Unfortunately, my diagnosis came a little too late, and I lost most of the vision in my right eye. Today, when I do advocacy work, I stress how important it is to stay up to date on your eye exams. It could save your sight, literally. Here’s what I want others with diabetic retinopathy to know.
When I was diagnosed, I had a lot of self-loathing. I’d noticed symptoms months earlier, when I bent over to pick something up and noticed black jellyfish-like streaks that drizzled down my left eye. I went to a local eyeglass shop for an eye exam from an optometrist, who told me I needed to see a retina specialist.
Unfortunately, I didn’t have health insurance at the time, so I put it off. Eventually, my symptoms got so bad that I had no choice. I needed a vitrectomy, which is a surgical procedure where the surgeon makes a tiny incision in your eye to drain blood from the middle of the eye and remove scar tissue that tugs on the retina. A year later, I had to have the same procedure done on my right eye, but it was too late. My retina completely detached, and I lost most of my vision.
I blamed myself, which seems ridiculous now. It wasn’t my fault that I couldn’t afford to pay for my medical care. But for those first few years after my eye surgeries, I lived in the fear of it happening again. If I lost the vision in my left eye, I’d be pretty much left blind. That stress is almost impossible to carry. You can’t live your life on pins and needles. I had to learn to push forward. One of the ways I did that was to begin taking my diabetes more seriously than I had in years past. I knew that if I got my blood sugars under better control, I would have less risk of other health complications, including loss of vision.
Thankfully, I can continue to do most day-to-day activities, with some modifications. While I can no longer read with my right eye, my vision is still good enough that I can drive and go to my day job at a credit union. My left eye is 20/20, but my right eye only has about 10% of its vision. That means when I look at something on my right, it’s very blurry, so much so that it’s like looking through a distorted mirror. There are also large patches of dark spots. I try not to put myself in positions where I have to drive at night, and when I do, I practice the route over and over during daylight hours so I know exactly where I’m going.
It took me a while to wrap my head around the fact that I have a disability and as such, am entitled to certain work-related accommodations through the Americans with Disabilities Act. I’ve been up-front with employers about my vision, and my current job has provided a great deal of modifications — for example, a large monitor for my computer so I can magnify my work.
A few months ago, I had a corneal erosion on my left eye. This is when the layer of cells on the surface of your cornea loosens. It’s very painful and can make your vision very blurry. My symptoms were always worse in the morning, so I couldn’t work for a few hours. But since it was related to my diabetes, I just filled out certain forms for my employer and it wasn’t counted against me. Don’t be afraid to ask for these accommodations. It’s your legal right to have them.
I’m a comedian, and for a long time I grappled with how much to tell my audience about both my diabetes and my diabetic retinopathy. But a few years ago, I watched another comedian who lives with cancer open up about his disease on stage. He told me later that it was my responsibility to talk about my diabetes and my vision because you never know whom you’ll reach. He’s right. After my shows, people will come up to me and tell me their personal stories as well.
It helps smooth over some awkward moments too. Like the time in the middle of my act I walked too close to the edge of the stage and almost fell off. It was only about an 8-inch drop, but when you’re almost blind in one eye, that’s really scary! I also always try to work some sort of diabetes joke into my act. I’ve even joked about my retina surgeries. It’s a way to educate people about diabetic retinopathy without them even realizing it.
When you have diabetes, you have got to stay on top of all your medical care. You see your endocrinologist every 3 months, your dentist at least twice a year, and foot and eye specialists at least once a year. Otherwise, little problems can become big ones, fast.
You also need to pay close attention to what’s going on with your eyes. People with diabetic retinopathy often see dark spots, or floaters, in their field of vision. I know all of my floaters well. But if I see something new, I pay close attention. If it doesn’t leave after a couple of days, I see my eye doctor. After two surgery scares, I’m not going to take any more chances.
And remember, if you ever feel the need to beat yourself up about your vision, remind yourself: you didn’t do this, diabetes did. Every morning, I wake up, get out of bed, give myself time for my vision to clear, and take on another day. That’s all we as people with diabetes can do. We need to meet all our challenges head-on and commit to staying heathy.
Stay aware of your body — including changes with your vision — and then go out and live your best life. I’m still tossing around the idea of riding a motorcycle, for example. I’ve seen people with eye patches ride them, so why not? I might not be able to ride across the country on a Harley, but I can at least take a spin around town. Anything’s possible. Don’t let your diabetic retinopathy hold you back.
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By Ashley Ann Lora, as told to Stephanie Watson
I was diagnosed with atopic dermatitis when I was 2 years old. I don’t remember much of it at that age, but my parents sure do. The redness and bumps on my face are obvious in almost every photo of me from back then. It’s very clear from those pictures just how much the condition truly affected me.
I remember sleeping with my parents to try to keep myself from scratching my skin all night. I missed a lot of days of school, especially when it got severe.
There were so many things I felt like I couldn’t do because of eczema. It stopped me from playing sports, hanging out with my friends, and doing what “normal” kids do. I shed a lot of tears during that time.
Finally, there was a moment when the eczema went dormant. It was the best 2 years of my life up to that point. For the first time, I was able to grow out my nails and wear short-sleeved shirts. I truly believed that my eczema was gone. But then, on a family trip to an amusement park, I got super sick and the eczema came back with a vengeance. My dream of being eczema-free was gone in a matter of hours.
Because eczema and allergies are closely related, I went through allergy testing. My doctor made all these little pricks on my back and applied different substances to see if I was allergic to them. There must have been 50 or 60 different marks on my back. I was allergic to almost every one of them, including trees, grass, and even certain types of rubber.
I went to a lot of doctor appointments from elementary school all the way up to high school. But from high school to college, I had given up on doctors because every visit was the same. I’d go into the exam room, the doctor would look at my skin, and within 5 minutes I’d walk out with a prescription for topical steroids.
The steroids would help temporarily, especially when my atopic dermatitis got really bad. But it felt like a Band-Aid, because eventually it would come back even worse. Then I’d have to go through the whole process again.
I had a love-hate relationship with mirrors growing up. I didn’t feel good about myself for a very long time. It was hard. Eczema affected me physically, socially, and psychologically. It felt very lonely because I thought I was the only one in the world living with this condition.
November 2014 was the beginning of my healing journey. I was in the middle of one of the worst flares of my adult life. I tried going through the same routine of using topical steroids, but this time it didn’t work.
I said, “enough is enough” and started doing my own research on eczema. I learned about topical steroid withdrawal and started to go through that process. It was rough. I had used steroids for more than 20 years. When I went off them, I had severe withdrawal symptoms that left me bedridden for almost a year and a half.
I lost half of my hair and part of my vision. My skin looked like a combination of snake and elephant skin. I shed so much that I constantly had to vacuum my bed and every corner of my house. It was like my body was going through a process of transforming itself.
In the middle of withdrawing from steroids, I got into a clinical trial of the biologic drug dupilumab (Dupixent). That was a game-changer. With that drug, I was finally able to start enjoying life. My skin was the clearest it had ever been. I felt normal!
In 2017, my skin was doing so well that I started to withdraw from dupilumab. I wanted to see how my skin would do without it. I wouldn’t recommend that approach for everybody, but I had confidence that my body could heal itself.
I’m currently not taking any medication. I’ve been focusing on more holistic practices like meditation, therapy, exercising, and eating foods that make me feel good. I’ve learned what works for me by seeing what has worked for other people.
The biggest lesson I’ve learned during my journey is that my eczema is correlated with my emotions. A lot of people say stress triggers their eczema. For me, anger, sadness, and depression trigger it, too. As I’ve become more aware of my emotions, I see how they affect me and I’ve learned to control them through meditation and breathing.
Years ago, I let eczema take over my life. I would get into an itching cycle and my whole world would crash down around me. I lost a lot of who I was because of it. I don’t remember much of my childhood because the eczema was so traumatic and it consumed so much of what was good about my life.
I’ve done a full 180 since then. When I began accepting my eczema and figuring out how I could work with it, I got my life back. There was even a point when I began referring to my eczema as “she.” She became my best friend. When she flared up, I would ask her how we could work together to heal. By personifying my eczema and relating to her instead of seeing her as my enemy, I started healing more quickly.
I still flare up, but atopic dermatitis no longer controls what I get to do on a particular day. My condition is no longer the deciding factor in what I wear, where I go, and who I hang out with.
In 2015, I started calling myself an eczema warrior. I am a warrior, in a sense, because I’ve courageously conquered my eczema (mentally more than physically) and continue to do so. I’ve come to terms with my eczema. I’m proud of her and I’m proud of how far we’ve come together.
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By Cassie Larkin, as told to Stephanie Watson
Treating our son, Kyan, for atopic dermatitis (eczema) has been a long haul. He was about 6 weeks old when we first noticed that he was breaking out in rashes. That was in May or June of 2013. We just figured he was sensitive to the heat.
Kyan was a pretty fussy baby. We tried switching him to different formulas, but his skin wasn’t getting any better. Between the fussiness and the rashes, we had him tested. That’s when he was diagnosed with eczema.
I had eczema as a baby, but I grew out of it pretty quickly. By age 2 or 3, my skin had cleared. That wasn’t the case for Kyan.
By age 2, his skin was just getting worse. The eczema was everywhere. We tried every cream, every lotion, every ointment. We put him in cotton pajamas and gloves. We rubbed oil onto his head to soothe his itchy scalp.
The pediatrician who was handling his care kept telling us, “This is normal. We have a lot of kids with eczema. Just try these lotions.” But the lotions weren’t touching the eczema and it wasn’t going away. It was constant.
As a parent, your job is to take care of your children and try to make them feel better when they’re sick. When you can’t make them feel better, it takes a little piece of you.
Watching Kyan suffer took a big piece of me. His skin was open and cracked. He had to be hospitalized for staph infections. We bathed him in diluted bleach, which burned his skin so much that he would scream and cry, but it was the only way to stop the infections.
Our daily eczema routine was 2½ hours long. At bedtime, we would bathe Kyan, then apply ointment all over his body to keep the inflammation down, and then put lotion on to seal in that moisture. Finally, we’d dress him in wet pajamas to soothe his skin enough so that he could sleep. Our morning routine was almost as long.
We tried a variety of medications, including the immune-suppressing drug methotrexate, which basically crashed Kyan’s damaged immune system to try to rebuild it. Every other week we had to get blood draws to see if the drug was damaging his kidneys and liver. We basically had to keep him in a bubble to prevent him from getting an infection.
Eczema was affecting every part of Kyan’s life. His hands were so inflamed and cracked that he couldn’t hold a pencil or bend his fingers to write in school. And he was so itchy and uncomfortable that he couldn’t pay attention in class. His teachers thought he might have autism or ADHD because he couldn’t focus, but he couldn’t focus because he was so uncomfortable.
Kyan suffered not only physically, but also emotionally. The kids teased him. They didn’t understand why he wore gloves to school. They didn’t get why his face was so blotchy. His teachers noticed the dead skin cells on his head and the way he’d scratch at his scalp and they kept flagging him for lice, which made the teasing even worse. Many times he would come home from school crying.
The eczema was relentless. It wasn’t stopping and it wasn’t getting better. I knew I had to be an advocate for my child. What we had tried so far wasn’t working.
We were referred to pediatric dermatologist Sheilagh Maguiness, MD, at M Health Fairview in Minneapolis. I just broke down in Dr. Maguiness’s office. I said, “I can’t do this anymore.”
When dupilumab (Dupixent) first came on the market, I remember Dr. Maguiness saying, “We need to get Kyan on this drug.”
The trouble is, dupilumab is expensive — about $3,000 an injection. We battled for 2 years with our insurance company, which wouldn’t cover the cost because the drug wasn’t approved yet for Kyan’s age group. Then in 2020, finally dupilumab was approved and we were able to get our insurance company to pay for it.
The medication has been huge for Kyan. We saw results within 3 weeks. There were no more open sores. We stopped needing to do the bleach baths and steroid creams. Within a few months, his skin was clear.
Today, we just give Kyan one shot every 2 weeks. And we apply lotion once a day, at night.
We hadn’t realized just how much atopic dermatitis had consumed our lives because it was our normal. Finding relief for Kyan has been huge. It’s been shocking how much freedom we have and how much better he feels.
Kyan has progressed so much, both emotionally and educationally, that it’s almost unreal. Now he’s in second grade. He’s excelling in school. He’s creating new friendships. He doesn’t have to wear gloves or avoid touching certain things. He’s like everybody else now. And he has a confidence he didn’t have before.
Seeing how much Kyan has blossomed and flourished as a student and as a person has been awe-inspiring. I was finally able to take the pain away. I was finally able to make him OK. That’s all you want for your child, to make them feel better.
Our hope is that Kyan will outgrow the allergies and atopic dermatitis at some point in his life. The chances of that aren’t the greatest, but we’re keeping our fingers crossed. For now, we just want to give other families some hope and help them see there is a light at the end of the tunnel and they aren’t alone in the journey to get there.
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By Karen Chen, as told to Stephanie Watson
I’ve had atopic dermatitis for as long as I can remember. When I was little, I remember getting a lot of rashes in the areas where my joints are — the insides of my elbows and knees. I was itchy all the time.
My pediatrician and the other doctors I visited at the time said it was normal for children to have eczema. They told me I’d eventually grow out of it.
I was so itchy that I had trouble falling asleep. I wore long-sleeved shirts to bed so that I wouldn’t scratch at my skin during the night.
My whole life revolved around catering to my eczema. I’d check the weather every day. If it was very dry or windy, I wouldn’t go outside. Just my hair hitting my face in the wind would irritate my skin.
I used to wear mainly dark clothes. My skin would bleed because I always had open wounds from scratching, and I was afraid of staining my white clothes.
I was so self-conscious that I went to great lengths to hide my skin. I wore long sleeves, even in the summer. Sometimes I wouldn’t leave my house when my eczema looked particularly bad.
I felt excluded from normal childhood activities. Many of them would exacerbate my skin. For example, I couldn’t swim because it would dry out my skin and make my eczema flare up. And if I got too sweaty while exercising, I would break out in itchy hives. When my friends wanted to go out for something to eat after school, I felt too terrible to join them.
I didn’t grow out of my eczema as my doctors had predicted. Instead, it started to get worse in high school. I was so itchy that I couldn’t focus in class and I couldn’t sleep at night. I started falling further and further behind. Because I didn’t want to tell my teachers that eczema was to blame, I came across as a student who didn’t try very hard.
I wish people understood how chronic illnesses affect people. Whenever I had to miss class in high school, I would tell my teachers and friends that I was out because I was sick. For most other people, being sick happens for a finite period of time — as long as it takes to get over a cold or other infection. There was an expectation that I would fully recover within a week and be back at school. But because my condition was/is chronic, whenever I would become “sick” with a bad flare-up, I’d remain bedridden without any timeline for recovery. It could be days, but more likely weeks and months, before I stopped flaring up and could go outside again. And when I did return, I felt only slightly less terrible and was still barely able to function.
Few people realize that eczema is a disability. Those around me were constantly minimizing my experience, and the effect the disease was having on my day-to-day life. If I hid my condition people didn’t take me seriously, and if I was honest about it, they didn’t want to be near me. It was a lose-lose situation.
Eczema affected me so much that it took me an extra year to graduate from high school. It felt like the world was moving on without me.
I have tried just about every medication, and a few alternative therapies, to manage my atopic dermatitis. I went to pediatricians, dermatologists, and allergists for advice. I rubbed on topical steroid creams of various potencies, and got steroid injections. I tried phototherapy, which is essentially a tanning booth that blasts UV rays at you. I used antihistamines and various lotions to try to tame the itch. Nothing helped.
I went on strong pills that suppressed my immune system. I remember the warnings on the bottles, which said these medicines were for people who had just gotten an organ transplant. That was pretty scary. I just wanted my skin to stop breaking out.
I also tried a lot of fad skin care trends over the years, like drinking 10 cups of water a day or rubbing coconut oil on my skin. None of them worked. Neither did the herbal remedies my family recommended.
My doctor tested me for allergies, pricking my skin to see if it broke out in hives. During one test, my doctor put patches of common allergens on my back. The tape irritated my skin so much that it itched for the entire 3 days that it took to do the test.
I took part in a clinical trial of a biologic drug used to treat psoriasis. I stayed in that study for a whole year, but the drug didn’t help me.
By the time I was 16, my doctors stopped telling me that my eczema would improve with age. At that point they realized it wasn’t going away.
I was always looking for new treatments. One day, I saw a story about dupilumab (Dupixent) in the news, and it looked very promising. I reached out to my doctor, Emma Guttman-Yassky, MD, at Mount Sinai in New York. I had moved to California by then, because I was hoping the warm climate might help clear my skin. I told Dr. Guttman-Yassky that I really wanted to get on this new drug, and she helped to expedite the process with my insurance company.
It’s a very expensive drug, so a lot of insurance companies want you to “prove” that you need it. They ask for an exhaustive list of everything you’ve tried, along with proof that nothing on the market has worked for you. I had to go through an extensive rejection and appeal process before I finally qualified for a patient assistance program.
Once I got on the medicine, it took a while for it to take effect. It was very gradual. But at some point, I realized that if I had a scab, it would go away in 3 months instead of the 3 or 4 years it used to take to clear up. And when I would apply steroid creams, for the first time they actually worked.
It took 6 months to a year for me to experience the full effects of the drug, but today I see a huge difference. When I was growing up, eczema was all over my body. Now I have only a few patches here and there. It’s very manageable. Most of the time I don’t even notice it’s there.
Unfortunately, there’s no cure for atopic dermatitis. I still get flare-ups, and I have to be careful about being outside for too long because the wind can dry out my skin. But compared to what I had before, it’s really manageable.
I feel better than I’ve felt in my entire life. The year before I started dupilumab, I was failing high school. Now I’m studying mechanical engineering at the University of California, Berkeley. It’s been night and day for me.
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Whether you call them boulder shoulders, capped delts, or the start of a classic v-taper, a set of muscular shoulders is one the most common aesthetic goals for many lifters.
That’s not to mention the overall performance boost you get from strengthening one of the most important joints in the upper body. Your shoulders are involved, to some degree, in almost all upper body movements. The versatile joint can perform a variety muscle actions in multiple directions.
To minimize your time and maximize your effort, your need to train the shoulders with a combination of exercises and motions. This means incorporating exercises designed for strength and power, high volume training, and isolation-focused work. Here is a rundown of the most effective exercises to attack your shoulders from all angles.
In order to maximize muscle recruitment, you need to produce high levels of force. Being in a more stable and supported position allows you to direct that force into the exercise you’re trying to perform. This is why well-designed exercise machines can be invaluable.
Imagine trying to fire a cannon out of a canoe — it’s unlikely you’re going to hit your target. The machine shoulder press creates the most amount of total-body stability so you can take the muscles through a full range of motion with more focus. You can also safely take those muscles closer to failure without worrying about controlling free weights.
Adjust the seat height so that the handles are slightly below shoulder-height. This is going to make sure there is constant tension in the muscle throughout the whole range of motion. Take an overhand (palms facing away) grip. If you have limited shoulder mobility, use a neutral grip (palms facing each other).
Raise your feet with a box, step, or foot pegs if the machine includes them. Lifting your feet will elevate the knees so that you can more successfully keep your low back in contact with the bench for added support. A secure footing also makes you less likely to slide forward in the seat when the set becomes challenging.
This is very similar to the machine shoulder press, but dumbbells allow you to take your shoulders through a longer range of motion. Your elbows can start the movement down by the sides of your body, move upward to the mid-point of the press, and moving together as your elbows lockout towards your body’s midline, stacking above your shoulders and underneath your wrists.
Dumbbells also offer the ability to rotate your hand position as you press, which can accommodate any wrist or elbow discomfort. This dumbbell press is an ideal alternative for lifters with joint problems.
Set an adjustable bench one notch below 90-degrees. This high angle allows the benefits of an overhead shoulder press while further reducing joint stress. The top part of the shoulder press is the joint’s most vulnerable position. By taking the bench down one notch from fully upright, you can still take the shoulders through a full range of movement but it’s safer because your upper back and shoulders have more room to move.
Begin with the dumbbells at shoulder-height, palms facing away from you. Press upward with control, bringing your thumbs toward each other as the weights pass above your head. Maintain control of the dumbbells and don’t allow them to bounce together at lockout. Pause briefly before returning to the starting position.
Success leaves clues and if this exercise was good enough for Arnold, then it’s good enough for you. This comprehensive movement incorporates full range of motion at the shoulders and elbows, plus coordinated movement at shoulder blades. This all combines to engage the serratus anterior, lateral and rear deltoids, trapezius, teres major and minor, plus some lats.
Sounds good to be able to hit all of those muscles in one go, right? Maybe. The problem is that you are spreading the effort, intensity, and force across so many muscles in varying amounts, so it might not be a top choice for building strength. But it’s a good pick when looking to accumulate more training volume to stimulate overall growth.
Set an adjustable bench at an extremely high angle, one notch below fully upright. Elevate your feet to really lock into the seat. Start with the two dumbbells at shoulder-height in front of the body with your palms facing towards you. Start to press them up. Once your hands reach eye-level, start to rotate your arms out to the side as you continue pressing. A common mistake with this exercise is rotating your hands to early, which just makes the exercise a basic seated shoulder press.
Rotate consistently as you press upward. At the top of the press, your hands should be facing forward. If you have limited shoulder mobility, they may end up neutral (facing each other). Reverse the entire motion on the way down back to the starting position.
Unilateral training can be very beneficial because we have something called the bilateral deficit, or BLD. While I do share the same initials, rest assured I did not come up with this concept. The bilateral deficit is essentially the body’s ability to more efficiently recruit individual limbs compared to working both limbs together.(2) For example, if you can shoulder press two 40-pound dumbbells simultaneously, you can likely press one 45 or 50-pound dumbbell for the same number of repetitions.
You can use the bilateral deficit to your advantage with the single-arm standing dumbbell press. This will not only allow you to use a relatively greater load, for increased strength and muscle gains, but the standing position can increase the range of motion and improve shoulder mobility.
Stand behind a vertical bench, holding a dumbbell at shoulder-level in one hand with your free hand on top of the bench for support. Push into the bench to create stability as you press the weight to lockout above your head. Lower the weight under control. Perform all reps with one arm before switching sides.
This exercise has become relatively popular over the last few years. In part, possibly because it’s named after one of the greatest strongmen of all-time, Žydrūnas Savickas, also known as “Big Z.” While the Z press is often performed with a barbell, using a pair of dumbbells can further increase the core stability challenge.
The Z press requires, and can improve, mobility in your thoracic spine (upper back) and it creates tremendous core engagement because your upper body is entirely unsupported. This means you probably won’t be moving very heavy weights, but the exercise can be great for accumulating plenty of muscle-building volume.
Sit on the ground with your legs extended straight. If you lack hip mobility or if it’s too uncomfortable, sit on a very low box or step. Make sure you keep your shoulders stacked over your hips and your spine straight.
Bring two dumbbells to shoulder-level with your palms facing forward. Press both weights overhead to lockout, being sure to keep your upper body vertical as you stabilize the weights. Pause very briefly at lockout and lower the dumbbells to your shoulders.
Legend has it that this exercise was initially used by the Cuban Olympic weightlifting team to strengthen their shoulders. It was also popularized by the legendary late strength coach Charles Poliquin. The Cuban press trains the smaller internal stabilizer muscles of the shoulder and upper back, as well as the aesthetic outer shoulder muscles.
It walks the fine line between being a “prehab” movement focused on preserving and building shoulder health and being a strict muscle-building movement with a long time under tension.
Stand with two light dumbbells at your sides with your palms facing behind you. Lift your elbows up and out to the side with your hands hanging straight down. Once your elbows are in line with your shoulders, rotate your arms to point your hands toward the ceiling, with the weights around eye-level. Keep a roughly 90-degree angle at your elbows.
Finish by fully extending your arms and press to lockout. Reverse the process to lower the weights to the starting position. This exercise is a lot harder than it looks, so you won’t need much load or too many sets and reps. Starting with two sets of eight to 10 reps to learn the movement with very light weights.
This exercise is performed with a barbell and, as the name suggests, the bar travels behind the neck instead of in front. This bar path makes it easier to stay in a stronger, safer position with your upper body stacked and in alignment. However, it does require good upper back mobility and it makes the initial part of the press significantly more challenging for both your shoulders and your triceps.
The biggest complaint (or fear) some lifters have is that the behind-neck position requires a good amount of shoulder mobility in order to successfully go through the full range of motion. If you don’t have the mobility to perform the movement, don’t worry. There are many other exercises you can do, this is just not one of them. But the behind-the-neck press has been a staple for weightlifters and bodybuilders for decades, so it’s not an exercise to steer away from if you can handle it.
Set a barbell in a power rack at roughly shoulder-height. Grab the bar with your hands just outside shoulder-width and pull your elbows forward to sit directly below your wrists. Unrack the weight and take a small step backward. Brace your core, and keep your legs and torso stable as you press the weight up. Fully extend your arms at the top.
To lower the weight, focus on pulling your elbows towards the sides of your body to load the shoulders more than the triceps. Keep your elbows beneath your wrists throughout the exercise. Depending on your mobility, the bar might gently touch the base of your neck before you press back up again.
To many experienced lifters, this exercise is the end-all-be-all shoulder movement. The classic standing barbell press is a hallmark of old school weightlifting, classic bodybuilding, and all-around power and athleticism.
With this more common variation of the shoulder press, the barbell moves in front of the body. This creates two distinct challenges. First, core stability — You need to be more active in pulling your ribs down and tucking your hips under to stay stacked. Second, core control — You are unable to press straight up because the bar begins underneath your chin, so you have to move the barbell in an arching motion around your head while maintaining a strong center.
Set the barbell in a power rack at roughly shoulder-height. Grab the bar with your hands just outside shoulder-width. Take a small step back with the bar resting across the fronts of your shoulders. Brace your abs and press up, staying as close to your face as possible without hitting your chin, nose, or forehead (obviously).
As you reach the lockout, “punch” your head between your arms. Your biceps should end up in-line with your ears. Maintain control of the bar by attempting to pull the bar apart as you’re pressing the weight above your head. This one small change can make a big difference in how the movement feels on your muscles and joints.
The push press has been wide-spread with the rise in popularity of things like CrossFit and HIIT-style group fitness workouts. In the push press, you are focusing on dip and drive — using your legs and hips to get the weight above your head.
Using your legs allows you to move a load that you wouldn’t otherwise be able to press with strict form for as many reps. At the top of the rep, you can really overload your shoulders and triceps as they control the weight back down with a slow eccentric contraction.
Hold a barbell in front of your shoulders, with a shoulder-width grip and your hands facing away from your body. Bend your knees slightly and drop your hips as if you were about to initiate a front squat. Quickly and powerfully extend your legs and drive your hips forward to get the weights moving off your body.
When the barbell is in motion, use your arms to guide it above your head to lockout. Think “legs drive, arms guide.” Don’t squat too deep before rising. You’ll only make it harder to get the weights above your head quickly. For maximum power output, be sure to get the weights moving using leg drive, not shoulder pressing strength.
The machine lateral raise is a great exercise for isolating and emphasizing the lateral, or side, part of the shoulder muscle. The lateral head of the shoulder primarily responsible for abducting the arm, or raising it away from the midline of the body.
Many very successful bodybuilders will prioritize lateral raise variations like this to help create a classic v-taper upper body. The machine lateral raise offers constant resistance compared to a dumbbell, which offers varying levels of resistance due to the changing pull of gravity throughout the range of motion.
Sit in the machine with your chest supported on the pad, if available. With most machines, you’ll perform this exercise with your elbows bent at roughly 90-degrees and the pads sitting on the outside of your upper arms.
Lift both arms until they’re parallel with the floor. Your elbows and upper arms should be in-line with your shoulders. Lower the pads with control. The bent arm position helps to focus the work on the shoulders and reduces the temptation to use your traps and upper back muscles.
This version of the lateral raise is normally performed unilaterally (one arm at a time). The cable provides constant tension, so you are forced to work against the resistance throughout the whole range of motion.
The movement is also more strict because it is harder to use momentum to lift the weight due to the cable pulley. The cable setup also allows you to increase muscular stress in the lower portion of the repetition, compared to dumbbell lateral raises which have reduced resistance in the bottom of each rep.
Attach a single handle to a cable pulley set just below your knee. Stand sideways to the pulley with your non-working arm near the weight stack. Grab the handle with your palm facing the cable pulley. Begin with your arm slightly bent and your hand just below your belly button. Raise the handle sideways until your elbow is in line with your shoulder. Imagine reaching your hand out as far away from your body as you can. This should stop you from lifting your shoulders and engaging your traps.
Hold the top position for one second and initiate the eccentric portion as slowly. Pause briefly in the bottom position before starting the next rep to emphasize the stretched position.
This version of the classic dumbbell lateral raise puts you in a more supported position with a greater opportunity use strict form and avoid momentum. This shifts more stress onto the side head of the shoulders.
The chest-supported lateral raise is perfect for high volume with slow repetitions. The bench support reduces lower back strain by removing your ability to swing your torso when lifting the weights.
Set an adjustable bench slightly below vertical. Straddle the bench with your chest supported on the back pad. Bring your arms slightly in front of you, holding a dumbbell in each hand with your palms facing each other.
Raise your arms up and out to the sides. Focus on feeling tension in your shoulders and not your traps or back. Pause briefly when your hands reach shoulder-height. You can further reduce momentum and increase muscle tension by taking two seconds to raise the weights and two seconds to lower them.
The rear deltoid is the forgotten child of the shoulder family. It gets some secondary attention during many pulling movements like pull-ups, rows, and deadlifts, but this relatively small muscle head rarely gets the attention it deserves when it comes to direct shoulder training.
The rear deltoid is not only important for building a well-rounded, well-muscled shoulder. It also plays a key role in overall shoulder joint health. Strong posterior deltoids are associated with rotator cuff health and overall shoulder mobility.(3)
Adjust the seat height until the handles are in-line or slightly higher than your shoulders. If the handles are too low, you’ll get a lot of help from the muscles in the upper back and triceps which are both stronger than the rear deltoids.
Face into the seat, brace against the pad, and grab the handles with a thumbs-up grip. Keep your arms slightly bent as you pull back until your elbows are even with your shoulders. Focus on separating your hands as far away from your body as possible instead of pulling your shoulders together.
The cable rear delt flye allows you to take the muscle through a very long range of motion, across your entire body, with constant tension. The adjustable pulley makes it easier to set the height of the cable appropriately for your body compared to rear delt machines with fewer seat height options.
When performed correctly and with strict technique, this is an extremely effective high-tension, isolation exercise to zone in on the rear delt with minimal contribution from other body parts.
Set the cable pulley to just above shoulder-height. You can either hold the end of the cable without a handle attachment or, if it’s uncomfortable, grab a single rope handle. Set up perpendicular to the cable and grab the handle palm-down with your outside arm. Begin with your arm straight and your hand in line with your chin.
This is where the muscle will be at its most lengthened under load. Reach your arm away from your body, keeping your hand at chin-height to avoid recruiting muscles in the upper back. Don’t twist your upper body as your arm extends to the side. Pause briefly when your arm is extended directly to your side before returning to the starting position.
The full handstand push-up is a very advanced skill, but you can use a variation to successfully improve strength and shoulder mobility, with the latter being a major benefit.
By setting your feet on an elevated platform and “piking” your body into an L-shape, you build overhead pressing strength using only your bodyweight, while improving your leverage and reducing the overall load you need to press.
Place your hands on the floor and your knees on a 20 to 24-inch box or bench. Hinge at your hips to bring your upper body close to perpendicular to the ground. Bend your elbows to lower your head down toward the ground.
Keep your core engaged and maintain a stable position as you press up. Keep your hips stacked over your ribcage, and your shoulders over your hands. In the fully locked out position, drive your shoulders toward your ears to engage your serratus anterior (near your chest, ribs, and abs). This will open your upper back and shoulders for more range of motion.
Because your shoulder muscles are comprised of three separate heads, each emphasized by different movements and functions, a well-designed shoulder workout recognizes and addresses their differences. This is the most efficient way to build maximum size and strength.
The anterior deltoid, or front delt, is located in the front section of the shoulder muscle. It, appropriately, is involved in raising the arm from your side, in front of your body, to an overhead position.
Because this is an extremely common movement, the anterior deltoid is stimulated and recruited during many common exercises including many variations of the chest press, all varieties of overhead pressing, and even many biceps curls. Specific isolation exercises targeting the anterior deltoid are not often a focus of shoulder workouts, to avoid overtraining the frequently used muscle.
The lateral, or side, delt is the most aesthetically important section of the shoulders because it’s responsible for most of the visible width of the muscle. When looking to dramatically change your physique, emphasizing the side deltoid using lateral raise variations is the most efficient approach, but the side delts are also heavily recruited during any overhead press movement.
The posterior, or rear, deltoid head is sometimes considered part of the “upper back” musculature, but it resides specifically on the shoulder itself. This muscle head attaches along the shoulder blade and is involved in moving the shoulder blades toward and away from your spine. The rear delts also play a major role in pulling your upper arm backward from an extended position.
These two functions are similar to many back muscles, like the rhomboids, trapezius, and teres. While the rear delts contribute to many back exercises, they are often “overpowered” by relatively larger muscles, which is why rear delt flye variations are needed to prioritize the muscle.
Similar to other muscle groups, training a muscle more frequently seems to be better for strength, hypertrophy, and athletic performance.(4) Most people will do well training shoulders two times per week, as you’ll get a lot of extra work from many other upper body exercises like presses and rows.
If you were going to do a short-term specialization phase, you could train shoulders up to four or five times per week with a well-planned routine that manipulates volume and intensity to allow recovery and growth.
Categorize exercises into movements that focus on strength, volume, or isolation (single-joint). Pick one exercise for each of those categories. Strength exercises are programmed with relatively heavy weights and low reps. Volume movements are more efficiently trained with moderately challenging weights in the eight to 15 rep range. Isolation exercises include flye and raise variations which involve only the shoulder joint, not the elbow (which is involved in pressing exercises).
The most common mistake when it comes to shoulder training is doing too much isolation work — too many flyes and raises with less pressing. This could be a symptom of using a chest, shoulder, and triceps workout in your training split, or having an upper body workout which makes the shoulders a relatively lower priority compared to the back and chest.
However because your shoulders are involved in many movements indirectly, you can generally get away with relatively less direct volume as long as you achieve sufficient volume each week. Try to approach shoulder training with two main phases: Intensity and accumulation.
In an “intensity” phase, focus more on building strength and power. Pick either a strength movement, a volume movement, and an isolation movement or a strength and two isolation movements, and focus your shoulder training on this limited selection of movements.
In an “accumulation” phase, the focus is on performing more total volume so, appropriately, pick a volume exercise plus two isolation movements or three isolation exercises. Workouts will involve racking up the reps and piling on the muscle-building tension.
Alternating between those two phases, spending several weeks in each, can help you keep as much strength as possible during the accumulation phase while maintain work capacity and conditioning during the intensity phase, as muscle growth rolls in throughout both.
The design of the shoulder joint makes it versatile and crucial to a number of movements, but it can also be prone to injury if trained improperly. A simple and effective shoulder warm-up can mean the difference between results and nagging injuries, so take the time to get blood flowing before any session. Grab a resistance band and try this simple circuit.
“Shoulder press and lateral raise” is often the default shoulder workout for beginners. While those are two fundamental exercises, complete shoulder development requires a better thought-out approach to training. By choosing specific exercises to emphasize power, strength, or particular muscle heads, you can take your shoulder development and strength to the next-level. Rethink your approach to shoulder training, incorporate the right movements, and you’ll be on the way to a stronger, wider set of delts.
Featured Image: Halfpoint / Shutterstock
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