Category: Health

Oct. 18, 2022 – On a warm summer day in June, Amy Nadel sat in a waiting room at Johns Hopkins as one of her children was coming out of the operating room and another was preparing go in. And in a similar room in another part of the hospital, another family was sitting through the same thing. They were linked not by coincidence, but by one life-saving thing they were about to trade: kidneys.

Nadel’s son Jonah Berke had just had one of his kidneys removed, where it was rushed across the hospital in a sterile cooler to be transplanted into an anonymous recipient. At the same time, her daughter Rachael Moskowitz was ready to receive a kidney that had just come from an anonymous donor somewhere else in the hospital. You’d be forgiven for thinking this sort of thing only happens in a Grey’s Anatomy episode. But this dramatic process, called kidney paired donation (KPD), is one of the ways people may receive kidney transplants.

Nadel’s kids were one pair in this sort of donation. Jonah had decided to donate to benefit his sister Rachael, after she had gone through years of complicated health battles. After untold doctors’ appointments, numerous surgeries, and countless hours worrying for Rachael’s well-being, the whole family arrived at Hopkins with hope and a fully loaded Netflix queue, ready for a new chance at life. 

Nadel looks back on that tense day with pride. She says everyone thinks their kids are special, but she can’t help but think, “My kids started from below zero, and look where they are.”

As odd as it may sound, their family was lucky – Rachael got her kidney and someone else did too. But kidney paired donations are far from the norm. Most people in kidney failure wait an average of 4 years before they get the call that a donor organ is available. Nearly 5,000 people die each year waiting on that list. But if more people were willing to sign up for KPD, that waiting time may shrink, says David Klassen, MD, the chief medical officer at the United Network for Organ Sharing.

The first successful kidney transplant took place in 1954, using a live donor’s twin brother. For a while, that was the standard route for donating the organ, as society felt squeamish about using organs from deceased donors. Eventually, around the mid-1960s, new guidelines about brain death from Harvard Medical school allowed donations from the deceased to become commonplace.

Living donation is also an option, whereby one person donates one of their healthy kidneys (as it’s possible to live a healthy life with just one functioning kidney) to another person. A recently removed kidney can last for an estimated 36 hours outside of the body, if stored and transported correctly, which has allowed for some living kidney donations to happen across state lines.

After the transplant, the person who received the kidney must be on a type of medication that stops their immune system from attacking the new organ. This is called immunosuppression, and most immunosuppressant drugs come with unpleasant side effects. People who get transplants are particularly susceptible to infections and cancer, among other diseases, since their immune system can’t fight at the level it normally would. But if the drugs work properly and the organ does not get rejected by the body, a donated kidney will usually last about 15 to 20 years.

For decades, direct living and deceased donation were the only options for people seeking a kidney transplant. But in 1991, doctors in South Korea performed the first known kidney paired donation. They were ahead of the curve, establishing a government-run KPD program within the decade. The United States caught up in 2000, completing the country’s first KPD at Rhode Island Hospital. But the use of this new protocol was neither universal nor speedy. By 2005, there were only 26 KPDs per year in the U.S., according to data from the Organ Procurement and Transplantation Network. 

The slow uptake was owing to a few issues. First, not many people knew about the option, says Susan Rees, a registered nurse and the chief operating officer for the Alliance for Paired Kidney Donation. So, when someone found out they weren’t a match for the person they intended to be a live donor for, the story ended there. Second, it took a while to standardize the data set. Rees calls KPDs a “team sport,” with the need to establish a matching database, and the requirement for multiple entities across different cities and states to work together to compile and compare their data. The alliance was one of the first nonprofits to compile this data, beginning in their home state of Ohio.

The third reason the uptake of KPD was slow was legal concerns about the process, says Klassen. Transporting organs across state lines for purposes other than direct donation wasn’t protected by the law at first. This was thought to deter organ traffickers. But in 2007, Congress passed the Charlie Norwood Act, which assured the legality of paired donation in specific medical circumstances.

So today, KPDs have increased, but they’re still not common. Since 1998, there have been slightly over 10,000 kidney paired donations in the U.S., which is a little over 5% of the total 173,000 living donations. The other 95% of living donors were direct match donations. These are the typical donations you hear about, between siblings, friends, or parents and children.

Rachael is by no means the typical person you’d expect to need a kidney transplant. At 36 years old, she’s a young mom and a full-time first-grade teacher. But she has a complicated medical history, including a glycogen storage disorder, a history of blood transfusions, a former liver transplant, a premature pregnancy, and long-term use of immunosuppressants. Each of those may have scarred her kidneys over time, leading to renal failure, Rachael was told by her nephrologist.

That failure meant Rachael had to begin dialysis in April of 2020. Not only had the world shut down due to the pandemic, meaning Rachael had to adapt to online teaching, but she was also caring for her 1-year-old daughter. Even with the support of her husband and family, it was exhausting balancing multiple long dialysis appointments each week with normal life. She quickly opted to switch to peritoneal dialysis, which allowed her to get the procedure at home each night instead.

Though this was an improvement, she says it wasn’t much of a way to live. The logistics were difficult, she had very low energy, and it was getting in the way of her spending valuable time with her daughter. So, though she’s grateful for the machine that kept her alive, “it was like I missed out on life for 2 years,” she says of that time.

This is consistent with what providers see too. Dialysis is a treatment, but it’s not a replacement for a functioning kidney, Rees says. Even after the procedure, there’s only a brief window of relief. Rees says that the next day, the patients are exhausted. And because of the logistical difficulties and fatigue, she’s even seen people lose their jobs and go through financial crises. 

While she was going through dialysis, and on a waiting list for a kidney, many people in Rachael’s life signed up to see if they were a match. One by one, they discovered no one was. There are many reasons someone may not be a match for organ donations. But there are a few things that make a person develop more pan reactive antibodies, which make it harder to match them. These include prior blood transfusions, pregnancy, and previous transplant. Rachael had had all three, making her what Rees calls a highly sensitized patient.

Even with all those compounding issues, what would’ve taken Rachael untold years was solved in mere months, when Jonah volunteered to enter the KPD donor pool. Here’s how that pool works.

Think of those memory matching games you used to play as a kid. The database serves as the memory storage, the proxy for you. All the cards start flipped over, with unknown donor profiles.

You start with one card, person 1 (in this case, Rachael) who needs a kidney. Person 1 is a pink circle. You then flip over a second card, person 2 (in this case, Jonah) who is willing to donate a kidney. But person 2 is a purple triangle.

No match. So, we pull another card. Person 3 turns out to be another person who needs a kidney. They’re a purple triangle, a match for Jonah. And when we flip the accompanying card, we find person 4, a pink circle, a willing donor matched to Rachael. Hurray, matching pairs!

Because of the database, person 1 can get a kidney from person 4 and person 3 can get a kidney from person 2. This chain can continue on and on, depending on how many people match. There have been chains up to 10 pairs long. 

This may sound like a big logistical nightmare. You may be thinking, what about organ donation from deceased people? And of course, registering to be an organ donor is an important piece of this puzzle. 

Both Klassen and Rees and the Berke/Nadel family urge people to sign up to be an organ donor. But only about 2% of people who are registered donors will end up being able to donate their organs, Klassen says. To be a valid option, someone must die while on life support in the hospital. Otherwise, they are pretty much only able to donate tissue. That leaves us at the starting point set out earlier. A person in kidney failure has an average of 4  years waiting time, and each year, that person has a 15%-20% chance of dying while waiting, Rees explains.

But adding in KPD makes the situation less dire. That is, if there is the database to support it and enough people are willing to sign up. At this point, there are separate databases for people to take part in KPD across the country and the world. The United Network for Organ Sharing and the Alliance for Paired Kidney Donation have some of the bigger aggregates, but they are far from having all the data. Rees says standardization would help.

The more people in the database, the more possibilities there are for people to match. Though some people may be uncomfortable not directly donating to the person they intended to, Rees says the people she’s observed feel pleased anyway.

In Jonah’s case of wanting to donate to his sister, this served as only a minor bump in the road. 

“Well really, it’s like saving two lives with your kidney, not just one,” he says.

For Rachael, everything has changed since the donation; even her skin tone, requiring her to  buy a new color of foundation. She realizes now how bad she felt each day while on dialysis. But above all, she’s grateful for the sacrifices Jonah and the anonymous donor made, and she’s grateful to be able to rejoin the living world.

And as for Jonah, life has returned to normal. His recovery was speedy, and he’s back doing the job he loves with his typical cheerful attitude. He’s doing so well, in fact, that if he could go under the knife again, he said he would. He would do anything for his sister. “If I could donate my other kidney, I would do it. I wouldn’t even think about it. You know, if I could donate my heart, I would give my heart up.”

Oct. 18, 2022 – Move over, BA.5. There are some new kids in town and no one is sure yet if we should be worried.

But there is concern that COVID-19 virus subvariants BQ.1 and BQ1.1 will become a major threat in the U.S. and that XBB could alter the COVID picture globally. 

At this point, infectious disease experts have only predictions. 

A worst-case scenario would be a surge of one or more strains that evade our immune protections just as a predicted fall and winter surge hits the United States.

At the same time, we know a lot more about SARS-CoV-2 than we did when COVID first became a household name. And despite some widespread pandemic fatigue, people know the basics of protection at this point should it be necessary – gulp — to go back to masking, obsessive handwashing, and keeping a safe distance from our neighbors. 

The most recent CDC data shows BQ.1 and BQ.1.1 subvariants have grown to about 12% of circulating virus strains in the U.S., doubling in the past week, compared to only 1% a month ago. 

“I don’t think we should panic, but I am little concerned,” says Hannah Newman, MPH. “I would not be surprised to see a surge of infections as we enter respiratory season and in light of the emergence of new subvariants.”

“We are already seeing COVID on the rise in some European countries, in part due to these circulating subvariants,” adds Newman, director of infection prevention at Lenox Hill Hospital in New York City.

The emergence of BQ.1 and BQ1.1 in the U.S. and XBB globally is not completely unexpected, says Amesh Adalja, MD. “This is a virus that’s going to continue to evolve to become more able to infect us, and so these variants should not be surprising.”

Better Protection From Bivalent Boosters?

One unanswered question is how well the new bivalent mRNA vaccine boosters could work against these specific subvariants.

“The new booster is a better match to what is circulating than the old booster, but we don’t know what that means in real life,” says Adalja, senior scholar at the Johns Hopkins Center for Health Security in Baltimore. It’s difficult to answer that question because no one is planning to compare the two booster types in a clinical trial. 

Newman is more optimistic. “A bit of good news is that the bivalent COVID booster will provide some protection against these strains, and we really just need people to roll up their sleeves and receive it,” she says.

The XBB subvariant, currently surging in Singapore, could be a cautionary tale for the U.S., says Eric Topol, MD, founder and director of the Scripps Research Translational Institute in La Jolla, CA, and executive editor of Medscape, WebMD’s sister site for medical professionals.

For example, prior to XBB emerging, the COVID reinfection rate in Singapore was 5%. Now it is 17%. “So that means a lot of people who had an infection are going to get hit again,” Topol says. Furthermore, Singapore reports 92% of their population is vaccinated and their uptake of boosters is twice the U.S. rate. 

“And despite that, they have a very significant wave, which is going to be bigger than anything except the original Omicron,” he says. 

Fewer Treatment Options

The drug Paxlovid will continue to play an important role in preventing more severe COVID outcomes, Adalja says. This is because “Paxlovid works on a whole different area of the virus, different from these mutations that get around immunity.”

In contrast, evidence so far suggests that monoclonal antibody therapies will not be effective against these new subvariants. “The ability to evade monoclonal antibody treatments is a concern for me, because it could leave our most vulnerable open to more severe outcomes,” Newman says. 

“If strains are able to escape antibody immunity and monoclonal antibodies aren’t effective, we can expect to see more severe symptoms in high-risk individuals who would otherwise benefit from these treatments,” she says. 

In particular, the monoclonal antibody bebtelovimab and the monoclonal combination Evusheld may be less effective against the new subvariants, Adalja says. 

Does Recently Infected Mean Protected?

Most people who had COVID-19 within the past 3 to 6 months will likely have antibody levels to protect them, at least against severe disease, Adalja says. That’s one reason U.S. officials suggest people wait 3 months to get a booster after infection and Canadian officials recommend 6 months. 

“You’re certainly going to be protected against severe disease,” Adalja adds. “How long you’re going to be protected, how immune-evasive these variants are, and the degree to which their immune-evasiveness reaches, that’s going to determine if you’re susceptible to infection.”

After natural immunity wanes, these immune-evasive variants could infect someone again, but they are more likely to experience a mild case, Adalja says. 

Newman agrees. “There is a level of natural immunity that is gained with recent infection. However, it wanes over time. Staying up to date with vaccinations and boosters is the most proven and effective way to achieve uniform protection.”

What is known is that COVID is likely to be with us for a while, Adalja says. “I was someone who was very forthright about this, that this was never going away. I wasn’t thinking this is like a hurricane that is going to leave one day. I thought this is a new normal,” he says.

He adds we’re making progress on COVID being managed as an outpatient illness.

The Future Is Uncertain

It’s difficult to predict exactly what will happen this fall and winter based on current evidence, says Gregory Poland, MD, an internal medicine doctor at Mayo Clinic in Rochester, MN. 

Throughout the pandemic, however, what happens in the U.K. and India has consistently signaled what happens in the U.S. And these other countries are experiencing “significant upticks in the subvariants,” he says. 

“Unfortunately, there is no crystal ball that will predict for sure what a future wave might look like at this moment,” Newman says. “It will really depend on whether a variant will outcompete other strains and the prevention measures taken.” 

She is also concerned about a convergence of COVID and flu over the winter.

“Prevention fatigue paired with upcoming holiday gatherings could be a potential for more superspreading events,” Newman says.

One concern is the relatively low uptake of the bivalent boosters among Americans, Topol says. “This is going to be really bad because a few weeks from now, we will face a very significant wave.” 

The relaxation of pandemic protection measures and the waning of immunity as more and more Americans go more than 6 months from their last immunization also are concerning, Topol says. “Our immunity wall is just developing more and more holes in it.”

“We’ll see a wave even before the BQ1.1 really takes effect,” Topol predicts. “And then the two together could make for a very bad December or January.”

Colorado-based remote patient monitoring company BioIntelliSense on Tuesday announced the acquisition of AlertWatch, a patient monitoring platform.

AlertWatch aggregates data and provides clinicians with a composite view of patient vital sign trends.

The company received four FDA 510(k) clearances for its product offerings for the operating room, labor and delivery unit, and intensive care unit. AlertWatch is also used in general care wards and with at-home care. 

BioIntelliSense will add AlertWatch to its HealthCast portfolio and integrate the platform with its BioButton wearable, a product used for continuous vital sign monitoring for 60 days that captures temperature, respiratory rate and heart rate at rest.

“The addition of AlertWatch offers healthcare providers comprehensive continuous monitoring solutions, and an accelerated path from adoption to full scale utilization. The patented AlertWatch multi-parameter interface displays and analyzes data from inpatient vitals, the electronic medical record (EMR), laboratory systems and BioIntelliSense medical-grade wearables, to provide clinical intelligence across care settings and acuity levels,” Dr. James Mault, founder and CEO of BioIntelliSense, said in an email. 

THE LARGER TREND

AlertWatch is a new addition to BioIntelliSense’s patient monitoring portfolio, which includes wearable products that allow clinicians to collect patient data outside the hospital. 

BioIntelliSense’s tools include BioSticker, a body sticker that captures medical data and analytics with early detection capabilities, and BioButton, a product used for continuous vital sign monitoring. The company announced a $45 million Series B raise last year. 

In August, it announced a strategic partnership with Medtronic for the U.S. hospital and 30-day post-acute home distribution rights for BioButton. AlertWatch will now be integrated with the BioButton wearable, and be available through Medtronic as well.

Oct. 18, 2022 – This just in: College students drink, use drugs, and break the law. 

OK, so that’s not exactly news. But this is: A “fear of missing out” – playfully termed FOMO in the social media era – can predict these bad behaviors with surprising accuracy. That’s what researchers from Southern Connecticut State University found in a new study published in PLOS One. 

After surveying 472 undergrads (ages 18 to 24), researchers found that students with higher levels of FOMO were more likely to engage in academic misconduct, drug and alcohol use, and breaking the law. 

FOMO is the “chronic apprehension that one is missing rewarding/fun experiences peers are experiencing,” the paper says. It’s most common between ages 18 and 34, but anyone can feel it – and most people (nearly 90%) have. 

“Almost all of us experience FOMO with most hopefully not engaging in any serious maladaptive, dangerous, or illegal behavior,” says Paul McKee, a PhD student in the Cognitive Neuroscience Admitting Program at Duke University and the study’s lead author. “That being said, there is evidence, in this study and others, that those with higher levels of FOMO may be more likely to experience negative mental health consequences like increased anxiety or depression, or engage in less-than-desired behaviors.” 

Students in the study completed a 10-question quiz designed to assess FOMO levels. They were asked to rate on a 1-to-5 scale how true each of the following statements were: 

1. I fear others have more rewarding experiences than me.

2. I fear my friends have more rewarding experiences than me.

3. I get worried when I find out my friends are having fun without me.

4. I get anxious when I don’t know what my friends are up to.

5. It is important that I understand my friends’ “in jokes.”

6. Sometimes, I wonder if I spend too much time keeping up with what is going on.

7. It bothers me when I miss an opportunity to meet up with friends.

8. When I have a good time, it is important for me to share the details online (e.g. updating status).

9. When I miss out on a planned get-together, it bothers me.

10. When I go on vacation, I continue to keep tabs on what my friends are doing.

The higher a student’s average FOMO score, the more likely they were to have engaged in bad behaviors. 

“Maladaptive behaviors were more likely for someone with a 3 than a 2, but even more so likely for a 4 compared to the 3,” says McKee. 

Those behaviors included classroom incivility (like using your cellphone during class), plagiarism, alcohol and drug use, stealing, and giving out illegal and prescription drugs. And the associations remained even after controlling for gender, living situation, and social and economic status. 

In the end, the researchers were able to use FOMO to predict whether a student would engage in academic misconduct with up to 87% accuracy, drug use with up to 78% accuracy, illegal behavior with up to 75% accuracy, and alcohol use with up to 73% accuracy. 

That’s impressive, especially when you consider that a short, simple screening – including the 10 questions above — could be all it takes to predict these behaviors, McKee notes. 

The new study fits with previous research that has linked FOMO with negative outcomes like anxiety disorders, sleep problems, and higher alcohol use. 

Research also links FOMO with social media use. 

“There is enough literature out there today that shows strong evidence of a bi-directional relationship between FOMO and social media use,” McKee says. In other words, “FOMO may lead to more social media use, but more social media use may also lead to FOMO.”

More research is needed to better understand the link between FOMO and behavior, the researchers say. That could help us reduce its potential harms. 

Oct. 18, 2022 — Women who use chemical hair straightening products may be at an increased risk for uterine cancer, according to new research from the National Institutes of Health.  

Women who use straightening products more than four times per year have the highest risk for developing uterine cancer, according to the study. More specifically, the researchers found that women who used straightening or relaxing products more than four times per year were more than twice as likely to develop uterine cancer compared to those who don’t use these products. 

Lead study author Alexandra White, PhD, said that about 1.64% of women who don’t use chemical hair straightening products develop uterine cancer by age 70. But for frequent users of these products, that risk goes up to 4.05%. 

“This double rate is concerning,” she said. But “it’s important to put this information into context,” she noted, as “uterine cancer is a relatively rare type of cancer.” 

Previous research has linked hair product use, such as hair dye, to increased risks of other hormone-sensitive cancers such as breast cancer. But researchers believe this is the first analysis that examined the use of hair straighteners in relation to uterine cancer.

The study examined hair product usage and uterine cancer incidence during an 11-year period among 33 ,947 women whose ages ranged from 35 to 70. The analysis controlled for variables such as age, race, and risk factors. 

Uterine cancer is the ninth most common type of cancer in the United States, according to the National Cancer Institute, with more than 65,000 new cases diagnosed annually. More than 12,000 deaths are caused by uterine cancer each year.

Hair straightening product usage was more common among women with low physical activity and among African American women, the study found. 

“Because Black women use hair straightening or relaxer products more frequently and tend to initiate use at earlier ages than other races and ethnicities, these findings may be even more relevant for them,” said Che-Jung Chang, PhD, one of the study authors,  in a statement. 

The study was funded by the Intramural Research Program of the National Institute of Health and the National Institute of Environmental Health Sciences and was published in the Journal of the National Cancer Institute on Monday. 

I don’t consider myself a biohacker, but I do intentionally engage in practices that I believe will extend my healthspan and lifespan. Cold plunges are one of them. Cold exposure goes into the bucket along with things like resistance training, intermittent fasting, sun on your skin, and sauna—all stimuli that stress the body and prompt it to become stronger and more resistant to chronic and acute health issues. 

I’m tempted to say that cold plunges are an easy way to challenge your system, but if you’ve ever stepped up to the edge of an icy stream or cold pool, you know there’s nothing easy about forcing yourself to get in, sink down to your neck, and make the intentional choice to stay there. Veteran cold plungers and winter swimmers will tell you that over time your body acclimates so it becomes easier to tolerate the cold. You’ll even come to eagerly anticipate your next plunge. That’s all true. But there will always be a part of your brain that tells you, “You don’t have to do this. C’mon, stay warm and dry.”

Each plunge requires you to overcome that little voice. It’s not easy, but it’s simple in the sense that just about everyone can find a way to harness the power of cold. And everyone should because the benefits of cold exposure are pretty impressive: 

• Reduces inflammation by lowering pro-inflammatory cytokines and increasing anti-inflammatory cytokines
• Triggers the release of immune cells that can ward off illness 
• Converts white fat into more metabolically active brown or beige fat
• Ramps up metabolic rate and boosts weight loss
• Promotes mitochondrial biogenesis
• Improves insulin sensitivity

More than these physical benefits, the fact that it’s not easy is arguably the biggest upside of all. The mental fortitude you build when you intentionally and repeatedly put yourself in uncomfortable situations is undeniable. One of the most profound disconnects between our modern world and the one our ancestors inhabited is just how comfortable we are most of the time. We now have to go out of our way to simulate the physical and mental challenges that for most of history were just a part of everyday life. 

I’ve been regularly immersing myself in cold water for years now, and I’m convinced that that’s one of the reasons why I still feel as good as ever mentally and physically. Here’s how to get started.

How I Cold Plunge

Early in the day, I like colder temperature for shorter duration. Generally that means water in the mid to low 40s for a minute or two. (That’s Fahrenheit; 4 to 7 degrees Celsius.) Get out, lightly towel off, dress. Don’t do anything special to warm up. Go about your day energized and refreshed.

Later in the day, I like a little less cold (48 to 51 degrees F, 8 to 10 degrees C) but for a longer duration, anywhere from 3 to 5 minutes. If it’s after 6 p.m. and my intention is to prepare myself for a better night’s sleep, I want to be a little chilly (shiver slightly) after I get out, but only for 20 or 30 minutes. If you overdo it, shivering into the night can be a bit uncomfortable (and I have done that). So if I feel I’ve gone too long, I might take a warm shower to bring my body temperature up a bit. Sometimes I hit the sauna for 12 minutes before I plunge. That can buy me a few more minutes in the cold.

My favorite is in summer to plunge for a few minutes and then air dry in the warm sunshine. Depending on where I’m at in the world, I might do my plunges in an unheated swimming pool, lake, or ocean. More recently, I received a cold plunge tub (looks like a bathtub) for my home by Plunge, and I’ve been having fun playing around with the ability to manipulate the temperature. 

Now, this is just what I prefer. I crafted this protocol, if you can call it that, by looking at the research, talking to friends who are experts in performance and recovery, and mostly doing what feels good to me. I’m not overly concerned with getting it “right” every time. And I don’t really plunge for exercise recovery. I do it for the mental challenge and the great feeling after I get out. The “buzzy” feeling and energy I enjoy afterward tell me I’m accessing the benefits. 

Cold Plunge Best Practices

When I talk to people about cold exposure, first they tell me how much they hate the cold and could never do it. Then they all have the same questions: How cold does the water have to be? How long do I have to stay in? How often? Can I just take cold showers instead? 

First, the water should be cold enough to make you want to get out. That’s not specific, and that’s kind of the point. Hormetic stressors only work when they fall in that Cinderella zone between too much (so stressful that they do more harm than good) and not enough to force the body to adapt. Everyone’s “just right” place will depend on their personal cold tolerance, baseline health, and how many other stressors they’re juggling. 

Likewise, optimal time and frequency are also somewhat subjective. Generally, I like to stay in for a few minutes each time. More if the water is a bit warmer, less if it’s really frigid. Stanford neuroscientist and popular podcaster Andrew Huberman suggests that 11 minutes total per week, broken up into two to four sessions, might be best for boosting metabolism. Ten to fifteen minutes per week seems like a reasonable goal to me. 

Cold exposure—swimming in arctic waters, sitting in the snow wearing little to nothing for as long as possible—has become the extreme sport du jour. But that’s not what we’re talking about here. There is no medal for long-distance endurance in the cold plunge. Do what feels right. I have stayed in too long a few times (to set records for myself) and then regretted it because I overstressed my body. The idea is a brief hormetic stress and immune boost. Doing too much can have the opposite effect.

Cold plunges versus cold showers

Years ago, cold showers were all the rage. Now cold plunges rein supreme. Both have their merits, but I’m partial to plunges over showers. Fully immersing yourself in cold water is the most efficient way to stimulate the vasoconstriction and hormone release we want. In a cold shower, the water only hits some of your skin, so you don’t get as cold as fast. It’s too easy to “cheat” by keeping more of your body out of the water (even unintentionally). 

That said, cold showers are certainly better than nothing, and it doesn’t have to be either-or. You can do both. Studies have also found cranking your thermostat down to 62 degrees Fahrenheit (19 degrees Celsius) for a couple of hours a day stimulates brown fat. That’s not even that cold. You can also take advantage of nature’s thermostat and go outside in cold weather slightly, not dangerously, underdressed. 

Nothing entirely takes the place cold water immersion, though, especially when it comes to the mental benefits of doing hard things. Yes, you have to steel yourself to crank the faucet all the way to cold if you’re enjoying a nice warm shower. But it’s not the same as fully submerging yourself. 

Crafting Your Cold Plunge Routine

Here is how I would start incorporating cold plunges if I was a beginner:

1. Start slow. Gradually work your way up to colder and/or longer plunges (to a point—you can only go so cold and so long before it becomes dangerous).
2. Aim for 10 to 15 minutes per week as a baseline.
3. For the biggest benefits, submerge up to your neck and keep hands and feet under (or alternate dunking them in and out).
4. When you get out, dry off and allow your body to warm up naturally if possible. Dress in climate-appropriate clothing, but don’t blast the heater or start chugging tea unless you’re shivering uncontrollably. Some shivering is to be expected.
5. Supplement cold plunges with less intense cold exposure via turning down the thermostat, taking cooler showers, and going outside slightly underdressed. Be aware of your total stress load. Don’t overdo it.
6. Adjust your plunges based on your subjective experience each time. 

I’ll say it again: this is not a competition. What is tough for you might be easy for someone else, and vice versa. What’s tolerable for you today might feel almost unbearably difficult for you next week if other life stressors pile up. 

The goal with each plunge is to challenge yourself in a way that feels hard but adaptive. If you’ve ever purposefully put yourself in a hard situation—cold exposure, training for a marathon, climbing a mountain, or anything else where you butt up against your ability to endure—you’re familiar with wanting to quit and simultaneously wanting to continue because you feel yourself getting stronger in the moment. That’s the razor’s edge you’re aiming for. If it just plain hurts, cut the plunge short. Come back another day.

As you become more accustomed to cold plunging, experiment. Play around with water temperature, duration, and time of day. You might incorporate breathing exercises to bring a meditative aspect to your plunges (never practice controlled hyperventilation in water, though). Try getting in and out multiple times. Move your limbs around underwater. This disrupts the pocket of warm water that forms near your skin’s surface and makes the plunge feel colder. 

Be Safe

The beauty of cold exposure is that you can start mild and get more intense, monitoring how you feel along the way. Cold plunges of the type I’m talking about here are generally safe, but they are stressful. If you are concerned about your ability to handle the stress, listen to your gut or talk to your doctor. 

Plunging in very cold water elicits a cold shock response. This can be dangerous for people who have asthma or cardiovascular conditions. I’d caution even the most hale and hearty readers, if you decide to take this to extreme levels, take the time to acclimate to cold water and learn proper safety precautions. The Outdoor Swimming Society is a good place to start. 

All right, that’s what I do. I’m interested to hear what you’re up to. Who among you is already doing regular cold plunges? Who wants to start?

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After welcoming a new baby, the last thing that a parent wants to do is to leave the baby in the care of someone else. But that’s often the situation for parents and families of newborns in the Neonatal Intensive Care Unit (NICU).

Due to the nature of care and the NICU environment, parents and family members cannot always be with the baby 24/7. They may even miss critical milestones or updates if they need to step away from the NICU for work, to care for other children or even to get some much-needed rest.

Today at IWK Health in Halifax, Canada, that’s not the case. IWK’s Chez NICU Home program provides families with online education, resources, and virtual connections to help them become more active participants in the care of their baby while in the NICU.

Chez NICU Home includes a web-delivered application created by the IWK that provides evidence-based education and resources for families with the ability to track their infant’s progress. From daily care activities, feeding and nursing, to the discharge process and understanding common NICU conditions, Chez NICU Home provides families with the information they need at anytime, anywhere. 97% of families that participated in the Chez NICU Home application agreed that the resources were extremely beneficial during an otherwise stressful time.

Each NICU room is also equipped with a high-quality Webex video device and collaboration technology that connects families to appointments with healthcare providers and local health professionals, or to family members who are unable to be there in person. For example, if spouses need to care for other children out of town, they can virtually participate in clinical rounds via Webex to get the latest update on the baby’s progress.

Leveraging Cisco technology to provide critical support and virtual connections has helped more than 450 families thrive during their stay in the NICU at IWK Health.

Chez NICU Home was a collaboration across IWK Health that included Innovation Services, a team of researchers, clinicians, and IT, in partnership with Cisco Canada and OnX. It was developed with support and financial contribution from the Government of Canada through the Atlantic Canada Opportunities Agency (ACOA) and the IWK Foundation.

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Almost all living creatures on Earth breathe in some way, even trees and plants. While breathing is something all people have in common, unfortunately we don’t all breathe clean air. Human activity and some natural forces allow toxic materials into our atmosphere, which is the layer of gases that surrounds our planet. This air pollution can threaten our health and quality of life.

The U.S. Environmental Protection Agency (EPA) created a tool called the Air Quality Index (AQI) to inform the public of the level of air pollution and the risks it can pose to our health. Air quality can change very quickly, and the AQI allows people to stay on top of current air conditions in their area, just like the weather forecast.

Below, we’ll discuss how to use the AQI to understand air quality in your community and what you can do to keep you and your loved ones safe when the air quality is poor.

What is air quality?

The average human takes about 22,000 breaths every day, supplying our body with the oxygen it needs to function. Clean, oxygen-rich air is essential for our health, but the air around us can also contain harmful substances, called pollutants. Air quality refers to the level of pollutants in the air.

Good air quality means the air is relatively clean and there are few or no pollutants present that day.

Bad (or poor) air quality means the air contains one or several pollutants in amounts that are hazardous to our lungs and overall health.

What causes bad air quality?

Poor air quality is polluted air, and there are many sources that contribute to air pollution:

• Human industry: Our cities, agricultural areas, power plants, factories and oil refineries pump pollutants into the air in the form of smoke, soot and smog.
• Transportation: Cars, buses, airplanes, trains and any machine with a combustion engine put pollution into the air through the exhaust they produce.
• Nature: The smoke and microscopic matter from forest fires, dust storms and volcanic activity can pollute our air, while wind and geographic features – like valleys – determine where many pollutants end up.

Air quality is more of a concern during the summer months, when the combination of pollutants in the air and heat creates dangerous conditions that can negatively affect everyone’s health.

Who is most at risk from poor air quality?

Air pollution isn’t good for anyone, but it’s especially bad for the very young and very old, people with certain health conditions, and people who spend a lot of time outside. Those most at risk of experiencing negative health effects in bad air quality are considered “sensitive groups.” This category includes:

• People who have cardiovascular or lung disease, including asthma, COPD and lung cancer
• Adults aged 65 and older
• Children and teenagers
• Pregnant women
• People who frequently exercise outside
• People living in poverty
• People who smoke tobacco or who live with someone that does
• People who live and work close to major roadways or industrial areas
• People who work outside

For some of these groups, it’s not a current health condition that makes them more sensitive to poor air quality, but other ongoing factors that increase their level of risk in air pollution, as well as their vulnerability if they were to develop an illness.

What is the air quality index (AQI)?

In 1970, the EPA established the Clean Air Act, a set of laws that restricts and regulates the amount of pollutants allowed in the air in the United States. The Air Quality Index (AQI) was created soon after. The AQI notifies the public of the air quality around where they live and work, and empowers them to make assessments of the individual health risks involved in venturing outside that day.

The AQI measures the following five pollutants:

• Airborne particles (solid matter)
• Ground level ozone
• Carbon monoxide
• Sulfur oxide
• Nitrogen dioxide

Most of these pollutants are invisible to the naked eye, colorless and odorless, and this makes air pollution hard to detect on our own. That’s why these substances are monitored by the EPA, which has determined a safe range for each. When any one of them surpasses their safe range, an air quality alert is triggered.

What is an air quality alert?

The AQI is divided into five categories, based on the level of pollutants in the air and the corresponding health risk they pose. As a measurement tool, the AQI spans from 0 to 500. An AQI of 50 and below means the air quality is good. The AQI increases with the amount of air pollution to reflect the rising health risk, first for select groups of people, and then for everyone.

An AQI of 200 and above means the amount of pollution in the air has reached dangerous levels for everyone, regardless of their current health or planned outdoor activities.

The Air Quality Index reads as follows:

0-50: Good (green) 
The air is clean and clear, and pollutants are mostly absent. It is safe for everyone to be outdoors.

51-100: Moderate (yellow) 
There are some pollutants in the air, but they are still within a safe range. However, people with certain health conditions that make them more sensitive to air quality should watch for symptoms.

101-150: Unhealthy for sensitive groups (orange) 
One or more pollutants in the air have surpassed their safe range. People in sensitive groups may want to limit outside exercise, while everyone else can continue outdoor activities with caution.

151-200: Unhealthy (red) 
People in sensitive groups should avoid extended or vigorous exercise in the outdoors. Everyone else should plan to shorten outdoor exercise or reschedule it for the morning when pollution can be lower.

201-300: Very unhealthy (purple) 
Health alerts are triggered. People in sensitive groups should avoid any outdoor exertion. Everyone else should avoid extended or vigorous exercise, and plan to move all activities indoors.

301 and up: Hazardous (maroon) 
Everyone should avoid all outdoor activities.

Why air pollution is a health risk

If you spend time outside on a day when the AQI is high, the air pollution can make you feel unwell very quickly, but this is usually temporary. However, breathing polluted air for months or years can result in long-lasting or permanent health impacts. The length of your exposure determines the repercussions to your health.

Short-term exposure to air pollution can cause:

• Trouble breathing
• Headaches
• Dizziness
• Nausea
• Nose, throat, eye or skin irritation
• Recurring pneumonia and bronchitis

Long-term exposure to air pollution can cause:

• Damage to the cardiovascular system
• Diminished lung capacity and function, leading to chronic wheezing, coughing and shortness of breath
• New chronic lung conditions like asthma, emphysema and lung cancer
• The worsening of existing lung conditions like COPD and asthma, with more frequent asthma attacks
• A shortened lifespan

What to do when the air quality is bad

If you’re wondering about the air quality where you live or work, go to airnow.gov and enter your city or zip code. It will tell you the current AQI for the area, the forecasted AQI for the next three days and more.

Follow the tips below to stay safe on those days when the air quality is very unhealthy (purple) or hazardous (maroon):

• Avoid spending any time outdoors and keep children from playing outside
• Limit activities that cause you to breathe heavily
• Keep windows and doors closed to prevent outdoor air pollution from spreading through your home or workplace
• If it’s a hot day, turn on the air conditioner, but only if your AC model has a filter and doesn’t draw from outside air – if you don’t have air conditioning, try to go somewhere that does
• If you have to go outside, wear a N95, KN95 or P100 mask to protect yourself from inhaling pollutants

Indoor air quality

Good air quality in your home and workplace is just as important to your health and well-being as the air quality outside. In the U.S., we spend a lot of time indoors, so indoor air is the majority of what we breathe. And when the air quality outside is poor, you should be able to have an indoor space where you can safely stay until conditions improve.

Some common sources of indoor air pollution include:

• Household features and appliances that burn fuel like stovetops, furnaces and fireplaces
• Biological matter like mold, mildew and bacteria
• Household products that contain asbestos like insulation, ceiling and floor tiles, roofing shingles and vinyl materials
• Lead-based paint or pipes
• Secondhand tobacco smoke
• Wood furniture or flooring with stains or finishes containing formaldehyde
• Volatile organic compounds (VOCs) found in carpet, varnishes, glues and adhesives, upholstery, air fresheners and other products

Ways to improve indoor air quality

With so many potential sources, it’s easy to become overwhelmed at the thought of eliminating indoor air pollution. However, knowing there’s a problem is the first step to fixing it. And you can preserve your health and the health of your home by taking just a few steps to clear the air.

• Address air pollution directly by sealing, enclosing or removing any sources of pollution (including harsh cleaning solutions)
• Increase indoor ventilation by opening windows whenever possible and using ceiling fans
• Purchase an air filtering device that continuously pulls in dirty air and emits clean, filtered air
• Keep your home clean – dust, wipe down and vacuum surfaces often (in that order, to prevent the vacuum from kicking up too much debris) to get rid of dust and other irritants, and opt for cleaning products with natural ingredients, like vinegar.

Exercising during an air quality alert

Before going outside to exercise, it’s a good idea to check the current AQI, just like you would the weather. If the air quality is poor that day, consider:

• Your health history and current medical conditions
• The type, duration and intensity of the exercise you plan to do

Those in sensitive groups can exercise outside when the AQI is 150 or below, but should plan for a short, easy workout and watch out for symptoms. People who are not in a sensitive group can exercise outside when the AQI is below 200, but should also keep exertion mild and to a minimum.

Keep in mind that, no matter the AQI level, exercising near busy, congested roadways can expose you to high levels of vehicle emissions. Plan a different route for your run or bike ride that follows mostly residential streets, trails and parks.

Air quality in Minnesota and the Upper Midwest

The air quality across the state of Minnesota has been improving since 2003, and much of the Upper Midwest benefits from good air quality. However, as wildfires become larger and more frequent in western states and southern Canada, the Upper Midwest could experience increasing air pollution from smoke. Additionally, our increasingly warmer and drier summers allow for higher levels of harmful ozone pollution.

But not everyone in the Upper Midwest gets to enjoy good air quality. Low-income communities and communities of color in urban areas are disproportionately impacted by air pollution. This is typically the result of proximity to major highways and industrial areas. Air pollution will continue to be a problem until all of us can breathe clean air.

Care to help you breathe easier

It’s important to keep yourself and your loved ones safe during periods of poor air quality for long-term health and well-being. If you have concerns about air quality in your area, talk to your primary care doctor about what you can do to protect your lungs and your overall health.

For more information on air pollution and to get up-to-date air quality conditions in your area, visit airnow.gov.

I am still afraid of catching COVID. As a young, healthy, bivalently boosted physician, I no longer worry that I’ll end up strapped to a ventilator, but it does seem plausible that even a mild case of the disease could shorten my life, or leave me with chronic fatigue, breathing trouble, and brain fog. Roughly one in 10 Americans appears to share my concern, including plenty of doctors. “We know many devastating symptoms can persist for months,” the physician Ezekiel Emanuel wrote this past May in The Washington Post. “Like everyone, I want this pandemic nightmare to be over. But I also desperately fear living a debilitated life of mental muddle or torpor.”

Recently, I’ve begun to think that our worries might be better placed. As the pandemic drags on, data have emerged to clarify the dangers posed by COVID across the weeks, months, and years that follow an infection. Taken together, their implications are surprising. Some people’s lives are devastated by long COVID; they’re trapped with perplexing symptoms that seem to persist indefinitely. For the majority of vaccinated people, however, the worst complications will not surface in the early phase of disease, when you’re first feeling feverish and stuffy, nor can the gravest risks be said to be “long term.” Rather, they emerge during the middle phase of post-infection, a stretch that lasts for about 12 weeks after you get sick. This period of time is so menacing, in fact, that it really ought to have its own, familiar name: medium COVID.

Just how much of a threat is medium COVID? The answer has been obscured, to some extent, by sloppy definitions. A lot of studies blend different, dire outcomes into a single giant bucket called “long COVID.” Illnesses arising in as few as four weeks, along with those that show up many months later, have been considered one and the same. The CDC, for instance, suggested in a study out last spring that one in five adults who gets the virus will go on to suffer any of 26 medical complications, starting at least one month after infection, and extending up to one year. All of these are called “post-COVID conditions, or long COVID.” A series of influential analyses looking at U.S. veterans described an onslaught of new heart, kidney, and brain diseases (even among the vaccinated) across a similarly broad time span. The studies’ authors refer to these, grouped together, as “long COVID and its myriad complications.”

But the risks described above might well be most significant in just the first few weeks post-infection, and fade away as time goes on. When scientists analyzed Sweden’s national health registry, for example, they found that the chance of developing pulmonary embolism—an often deadly clot in the lungs—was a startling 32 times higher in the first month after testing positive for the virus; after that, it quickly diminished. The clots were only two times more common at 60 days after infection, and the effect was indistinguishable from baseline after three to four months. A post-infection risk of heart attack and stroke was also evident, and declined just as expeditiously. In July, U.K. epidemiologists corroborated the Swedish findings, showing that a heightened rate of cardiovascular disease among COVID patients could be detected up to 12 weeks after they got sick. Then the hazard went away.

This is all to be expected, given that other respiratory infections are known to cause a temporary spike in patients’ risk of cardiovascular events. Post-viral blood clots, heart attacks, and strokes tend to blow through like a summer storm. A very recent paper in the journal Circulation, also based on U.K. data, did find that COVID’s effects are longer-lasting, with a heightened chance of such events that lasts for almost one full year. But even in that study, the authors see the risk fall off most dramatically across the first two weeks. I’ve now read dozens of similar analyses, using data from many countries, that agree on this basic point: The greatest dangers lie in the weeks, not months, after a COVID infection.

Read: Long COVID could be a ‘mass deterioration event’

Yet many have inferred that COVID’s dangers have no end. “What’s particularly alarming is that these are really life-long conditions,” Ziyad Al-Aly, the lead researcher on the veterans studies, told the Financial Times in August. A Cleveland Clinic cardiologist has suggested that catching SARS-CoV-2 might even become a greater contributor to cardiovascular disease than being a chronic smoker or having obesity. But if experts who hold this assumption are correct—and the mortal hazards of COVID really do persist for a lifetime (or even many months)—then it’s not yet visible at the health-system level. By the end of the Omicron surge last winter, one in four Americans—about 84 million people—had been newly infected with the coronavirus. This was on top of 103 million pre-Omicron infections. Yet six months after the surge ended, the number of adult emergency-room visits, outpatient appointments, and hospital admissions across the country were all slightly lower than they were at the same time in 2021, according to an industry report released last month. In fact, emergency-room visits and hospital admissions in 2021 and 2022 were lower than they’d been before the pandemic. In other words, a rising tide of long-COVID-related medical conditions, affecting nearly every organ system, is nowhere to be found.

If mild infections did routinely lead to fatal consequences at a delay of months or years, then we should see it in our death rates, too. The number of excess deaths in the U.S.—meaning those that have occurred beyond historic norms—should still be going up, long after case rates fall. Yet excess deaths in the U.S. dropped to zero this past April, about two months after the end of the winter surge, and they have stayed relatively low ever since. Here, as around the world, overall mortality rates follow acute-infection rates, but only for a little while. A second wave of deaths—a long-COVID wave—never seems to break.

Even the most familiar maladies of “long COVID”—severe fatigue, cognitive difficulties, and breathing trouble—tend to be at their worst during the medium post-infection phase. An early analysis of symptom-tracking data from the U.K., the U.S., and Sweden found that the proportion of those experiencing COVID’s aftereffects decreased by 83 percent four to 12 weeks after illness started. The U.K. government also reported much higher rates of medium COVID, relative to long COVID: In its survey, 11 percent of people who caught the virus experienced lingering issues such as weakness, muscle aches, and loss of smell, but that rate had dropped to 3 percent by 12 weeks post-infection. The U.K. saw a slight decline in the number of people reporting such issues throughout the spring and summer; and a recent U.S. government survey found that about half of Americans who had experienced any COVID symptoms for three months or longer had already recovered.

This slow, steady resolution of symptoms fits with what we know about other post-infection syndromes. A survey of adolescents recovering from mononucleosis, which is caused by Epstein-Barr virus, found that 13 percent of subjects met criteria for chronic fatigue syndrome at six months, but that rate was nearly halved at one year, and nearly halved again at two. An examination of chronic fatigue after three different infections—EBV, Q fever, and Ross River virus—identified a similar pattern: frequent post-infection symptoms, which gradually decreased over months.

Read: It’s not just long COVID

The pervasiveness of medium COVID does nothing to negate the reality of long COVID—a calamitous condition that can shatter people’s lives. Many long-haulers experience unremitting symptoms, and their cases can evolve into complex chronic syndromes like ME/CFS or dysautonomia. As a result, they may require specialized medical care, permanent work accommodations, and ongoing financial support. Recognizing the small chance of such tragic outcomes could well be enough to make some people try to avoid infection or reinfection with SARS-CoV-2 at all costs.

But if you’re like me, and trying to calibrate your behaviors to meet some personally acceptable level of COVID risk, then it helps to keep in mind the difference between the virus’s medium- and long-term complications. Medium COVID may be time-limited, but it is far from rare—and not always mild. It can mean a month or two of profound fatigue, crushing headaches, and vexing chest pain. It can lead to life-threatening medical complications. It needs recognition, research, and new treatments. For millions of people, medium COVID is as bad as it gets.