Category: Health

By Jackie McDonald, as told to Hallie Levine

About 25 years ago, I was at the beach with my two young children. It was just another lovely day together playing in the water and sand. We walked over to the concession stand to grab lunch. I noticed a man staring at me. At first, I thought nothing of it — I was used to guys and their admiring glances. But this time, I realized he wasn’t gazing at me with appreciation, but with horror. I grabbed my kids and got into my car. When I looked at myself in the side view mirror, I was in total shock. Who was this woman with patches of white circling her mouth, lips, and eyes?

It was my first real moment grappling with living with vitiligo. All of a sudden, I’d gone from being a lovely young woman to someone I didn’t recognize. Thankfully, today I accept and embrace my vitiligo, but it was a long, hard road getting there.

Grappling With the Diagnosis

I learned I had vitiligo when I was 31, right after the birth of my second child. I had already been diagnosed with Hashimoto’s disease, which is an autoimmune thyroid disease. (The two conditions sometimes occur together.) I had gone to see my dermatologist after I noticed a white, nickel-sized spot on the inside of my wrist. I’d spent the summer at the beach and was very tan. In contrast, the spot showed up as a glowing white orb. It unnerved me.

The dermatologist was very brusque: he spent 2 minutes explaining that I had vitiligo and the spots would most likely spread to other parts of my body. I was confused and kept asking questions, but he brushed me off. It was clear that he thought he couldn’t “fix” me and wanted to move on to his next patient. He wrote me a prescription for steroid cream and walked out.

At first, the vitiligo seemed manageable. I dressed strategically, in long sleeves and pants. Then it spread to cover more than a quarter of my skin — my hands, elbows, legs, and back. But it didn’t really start to bother me until the vitiligo appeared on my face and makeup wouldn’t cover it. At first, I tried eyebrow pencils and powders, but I gave up when they didn’t do anything. Self-tanners were also too messy and difficult to apply to only my spots.

My vitiligo didn’t seem to faze my husband or kids, but it upset me. I wanted to keep it private. I wanted to present myself to the world as the person I was before the spots — that’s who I felt I was. I hated the fact that almost every time that I went to the store, I’d pull out my wallet and the checker would automatically stare at their hands. Even though they never said anything, I could tell that they wondered what was going on. I hated being that woman with vitiligo.

How I Moved Forward

One day, I accidentally spilled furniture stain on my arm. I was amazed to see that the color matched my skin and hid a white vitiligo patch. I decided then and there to create a nontoxic stain for skin to camouflage vitiligo. Over the next few years, I tried everything from hair dyes and henna products to food coloring and eyebrow pigments. Nothing worked, but I didn’t give up. In my research, I’d read comments on YouTube videos from these young girls who were devastated by this condition. To see them write that they didn’t want to leave the house, and worry that they’d never get a boyfriend, broke my heart. I did youth ministry, and I knew how easily teens and young adults could spiral into crisis. I wanted to help them.

Then I noticed an advertisement for Fake Bake’s self-tanner. I reached out to the company with a pitch for a product designed specifically for those with vitiligo. They got back to me that same day. A year later, Vitiligo Vanquish by Fake Bake was on the market. It’s been a life changer for me: I apply it twice a week on my spots with more frequent touch ups on my hands.

For me, finding a way to cover my spots has given me the confidence to do things like go into stores or shake hands without worrying about awkward stares or conversations. But I also recognize that some people don’t want to cover their vitiligo, and that’s absolutely fine, too. I’m not ashamed of my spots.  I just enjoy going out into the world as one color.

What I Want Other People With Vitiligo to Know

I’ve spoken to so many young girls who worry that they’ll never go on a date because they have vitiligo. I make sure I take the time to explain to them that if a guy rejects you because of some spots, you don’t want anything to do with him anyway. I’m single now, and while I don’t bring up my vitiligo on my first date, I make sure that a man knows before we get too serious. If my vitiligo scares him off, that’s his problem. I want to be able to swim in the ocean or go a couple days without my Vitiligo Vanquish without worrying about what some guy thinks.

But there’s also nothing wrong with covering up your spots if you want to. I get notes from people with vitiligo every day who are embarrassed that they want to “hide” their vitiligo. But sometimes, you don’t want to keep having to discuss your condition at work or want people to get to know you without focusing on your spots. Every person with vitiligo needs to make their own choice.

Regardless, I encourage anyone with vitiligo to embrace their skin. Vitiligo is beautiful. Let’s celebrate it, whether you choose to occasionally camouflage your spots or proudly display them openly.

By Erika Page, as told to Hallie Levine

I’ve been living with vitiligo since I was 7 years old. It started as small spots on the back of my spine but quickly spread, first to my knees and elbows, then all over my body. By the time I reached my early 20s, I’d lost all of my skin pigment. I put on a brave face because I didn’t want anyone to know how much I was hurting, but I had moments where I’d lie in a crumpled heap, crying on the floor. The worst part was the feeling of lack of control.

When you have vitiligo, it’s easy to feel like you’re the only person in the world living with the disease. But you’re not. There’s a whole village of us out there. Thanks to the internet, there are a number of ways to find your vitiligo tribe, too. Whether it’s through social media platforms like Facebook or Instagram, personal blogs, or even through my own website, Living Dappled, there are ways to connect with others and feel less alone.

The Power of Connection

I’ll never forget the first time I connected with another person with vitiligo. I was 26. Up until then it had never occurred to me to try to speak to someone with my condition — it seemed so personal and it wasn’t something that I wanted to share. Then one day, I stumbled upon a vitiligo blog that really resonated with me. The woman was about my age and lived in New York City. I messaged her on LinkedIn, and we ended up talking on the phone for more than an hour. 

Talking to someone else with vitiligo made me feel normal. She knew my story before I even had a chance to tell her. She understood my pain and what I was going through. We talked about how it feels like no one gets it. Sure, a family member or friend might comfort you while you’re upset, but they can’t understand the ultimate reality of living with spots every day. When I hung up the phone, I cried, but I also felt a sense of peace: I had realized how much power there was in not feeling alone.

I decided then and there to launch a website. I’d been surprised at the lack of resources for people living with vitiligo. I also had loved to write since childhood. Why not combine my two passions to create a positive, uplifting platform? I wanted to capture the little moments of living with vitiligo: what’s it like to be stared at in the grocery store or to shake hands with someone when you first walk into a meeting. More importantly, I wanted to create a space where people could talk about how to live with vitiligo — especially in a positive, inspiring way.

Gaining Strength Through Social Media

When I was first diagnosed, there were no Instagram accounts I could turn to for inspiration or advice. Today, however, anyone who’s newly diagnosed can easily get

onto social media and follow other people who look just like them. That’s a beautiful gift. It’s very empowering to not only have your Instagram feed filled with these folks, but to realize that the condition doesn’t take over their entire lives. You learn that while you’re a person who has vitiligo, it doesn’t define who you are. It’s a small but fundamental shift when it comes to learning how to live with vitiligo.

It also inspires in other ways, too. A few years ago, another woman with vitiligo on Instagram dared me to take off my tanner, which I had been wearing head to toe for a few years to cover my vitiligo. The idea made me sick to my stomach at first. But the idea had been planted. A year later, I had the courage to dart into the grocery store without tanner for 5 minutes.  At first, I felt exposed, but once I got back into the car, I felt calm and confident. I had been seen by people without tanner and makeup — quite literally my worst fear — and nothing had happened.

How to Find Your Tribe

There are so many ways to reach out and get a virtual or in-person connection. The first are social media networks, such as a Facebook group or an Instagram account. These are safe spaces where you can get ideas, share thoughts, and get social support. (You can find a list of Instagram accounts to follow here.) There are also membership networks like the Dappled Darlings Community, which provides members with a private Facebook group, monthly virtual discussions, live community interviews and curated vitiligo news.

In-person support can also be important. Groups like the Global Vitiligo Foundation can point you to local events near you. There’s also the annual World Vitiligo Day conference, with allows you to connect with both medical experts and other patients.

One way I’ve personally connected with other women with vitiligo is through Living Dappled’s photo shoots. It’s been amazing to watch people’s confidence grow throughout the day as we photograph them. I remember once as we sat down for lunch, one of the women confided that she’d never worn a dress that showed off her legs before. She’d felt empowered to that day, as part of a larger community.

That’s the thing about vitiligo: you can see someone else with it and form a strong connection without even knowing each other’s name. We get each other the way partners, or parents, or children can’t. Just the act of opening up and talking about your skin helps you grow. The more you talk about it and own it, the more confident you become in who you are.

Jennifer Schmid had just learned she had pancreatic cancer and that she would need surgery to remove part of her pancreas, stomach, and intestines. Schmid’s oncologist recommended she have a CT scan to check for cancer anywhere else in her body.

That’s how doctors found the spot on her lung.

To 61-year-old Schmid, of Newhall, CA, this news sounded about as bad as it could get. The pancreas cancer must have been so advanced that it had already spread to her lungs, she thought. But that wasn’t the case.  

Schmid’s oncologist ordered genetic sequencing of both the lung tumor and the pancreas tumor. That’s a test to read the unique DNA of each tumor. It revealed that the two tumors were completely different from each other. Schmid didn’t have a single advanced cancer that had spread from her pancreas to her lungs. She had two separate early-stage cancers: lung cancer and pancreatic cancer. This made all the difference in Schmid’s treatment and long-term prognosis.

“It was a stroke of luck that they found that spot on my lung and that they figured out it was not a metastasis,” Schmid says.

Two separate primary cancers, as opposed to one that has spread to multiple parts of the body, require different treatment and, in many cases, can come with a far better outlook than a single metastatic cancer. And it happens more often than people might think. 

How Common Is It? 

While it may seem like a rare case of lightning striking twice, it’s not terribly uncommon for a person to get two primary cancers – even at the same time. 

Researchers estimate that about 1 in 20 people with cancer have another separate cancer at the same time. They define “at the same time” as two tumors occurring within less than 6 months of each other. It’s even more common to have two different cancers at separate times – that is, a second cancer more than 6 months after the first. This happens in up to 1 in 5 people who have had cancer. 

Lauren Stevens of Louisville, OH, was one of those 1 in 5. She had lived with a brain tumor from 2004 to 2019. Her doctor monitored it with routine scans and as long as it didn’t grow, they chose not to operate. A scan in 2019, however, showed that it had started to grow – and fast. 

Stevens, now 50, had surgery to remove most of the tumor followed by radiation and chemotherapy. Then she resumed routine scans to monitor the remaining tumor that the surgeon wasn’t able to remove. 

Continuing to live with an inoperable brain tumor, Stevens started seeing blood in her stool. A colonoscopy and biopsy revealed that she had colon cancer. Soon, Stevens was back in chemotherapy and radiation followed by surgery to treat this second cancer while still living with the first. 

Understandably, living with cancer since she was 32 years old has been daunting for Stevens. There were times when she wanted to give up and no longer pursue the recommended care. But 7 years ago, she got a new reason to live.

“I have a grandson now,” she says. “He just turned 7. I didn’t know my grandparents growing up. I want my grandson to remember me. We’re very close. I think the sun just rises and sets on him.”

Who Gets Cancer Twice?

Anyone who has had any type of cancer could get a second cancer of any type. But research shows that those who’ve had bladder cancer or non-Hodgkin’s lymphoma are at greatest risk for second cancers. Lung cancer appears to be the most common second primary cancer. 

There are a number of reasons why a person might develop two separate primary cancers in their lifetime. 

Chance. Anyone is at risk of developing cancer at any given time. You have a lifetime risk, for example, for lung cancer and a separate risk for, say, colorectal cancer. So while it’s less common than having just one of those cancers, it is possible that you could get both. 

Genetics. You can inherit genes from your parents that raise your risk for specific cancers. Mutations in the BRCA1 and BRCA2 genes, for example, that you inherit from a parent raise your risk for breast cancer (as well as ovarian and pancreatic cancers). You can also inherit a gene that raises your risk for colorectal cancer. This genetic predisposition is called Lynch syndrome. 

“This is why it’s important to have genetic testing to look for one of these syndromes if you have two primary cancers,” says Joleen Hubbard, MD, an oncologist at Mayo Clinic. “There are many that we can test for, but there are also probably many cancer syndromes that we aren’t aware of yet.” 

Common risk factors. Many factors that raise your risk for one cancer raise your risk for others as well. Smoking and tobacco use, for example, cause at least 14 different types of cancer. Obesity, alcohol use, and an unhealthy diet are other risk factors for several different kinds of cancer. Exposure to harmful substances in the environment can raise risk for more than one type of cancer, too. 

Previous cancer treatment. Radiation and chemotherapy for one cancer can raise the risk for another cancer down the line. But doctors don’t typically call these cancers second primary cancers. They are radiation-induced or chemotherapy-induced secondary cancers. 

How Do Doctors Diagnose Two Separate Cancers?

With many cancers, when you get a diagnosis, the doctor will order imaging of your chest, abdomen, and pelvis to see if the cancer has spread beyond where it started. For cancers that commonly spread to the brain, such as lung cancer, testing might include brain imaging, too. 

If additional tumors show up in these images, they might contain clues as to whether they arose from the same cancer or a different one. 

“If you have a patient that has two separate masses and they look different on a PET scan – one lights up more than the other – that raises our suspicion that they might not be the same malignancy, which would require us to sample both areas,” says Arsen Osipov, MD, the oncologist who managed Schmid’s care at Cedars-Sinai Cancer in Los Angeles. He runs the Pancreatic Cancer Multidisciplinary Clinic.

A biopsy and genetic sequencing of both tumors, like Schmid had, can tell doctors definitively whether they are looking at one cancer or two. 

“Finding out whether a person has two primary cancers versus a single cancer that has metastasized is critically important,” Osipov says. “It could have been assumed that she had metastatic pancreatic cancer, but actually she had two separate cancers that could each be treated definitively with the intention to cure. You take care of one, then the other, and those cancers are not as advanced as a single cancer with metastasis would have been.”

What’s the Treatment for Two Separate Cancers?

When two different cancers arise at the same time, doctors have to make a judgment call: Which cancer should they treat first? 

In unusual cases, the two cancers may share characteristics that would make them respond to the same targeted drug or chemotherapy regimen. 

“This would be an ideal scenario, but it’s very rare,” Osipov says. 

When two simultaneous primary cancers require two different treatments, Hubbard says, “You’ll either treat the most life-threatening cancer first or sometimes it may be best to treat the one that’s easiest to treat first.” 

Schmid had abdominal surgery first for the pancreatic cancer and then radiation and chemotherapy for her lung cancer. The chemotherapy is still in progress. 

What If It Happens to You?

If you get a diagnosis of metastatic cancer, make sure you get a biopsy of the metastases to make sure you don’t have two separate cancers.

“Most centers are already doing this,” Hubbard says, “and this is why your doctor needs to biopsy a metastatic site.”

Osipov recommends that people with two simultaneous primary cancers get care at a cancer center where they can work with a multidisciplinary team that includes oncologists, surgeons, radiologists, and pathologists who can all work together on your case. Keep in mind that oncologists tend to specialize in particular types of cancer, so if you have more than one type of cancer, you’d want a team of oncologists at a cancer center to determine which cancer to treat first.

At the least, Hubbard adds, patients with two cancers should get a second opinion on their diagnosis and care.

“This helps not only the patient but the primary treating oncologist have a better idea of what tumors they are dealing with, what treatment options are available, and the best order in which to treat the cancers.”

No matter what your scale says, being comfortable in your own skin is up to you. It can be tough, in a society that prizes unrealistic images. But it’s possible, and it starts with what you say when you look in the mirror.

One of the first rules of achieving a healthy and happy body image is to stop allowing “put-downs” in front of the mirror, says Lori Osachy, body image expert and lead therapist at The Body Image Counseling Center in Jacksonville, Fla.

“Even if in the beginning that means you have to jump in front of the mirror and shout, ‘You’re awesome,’ and then immediately jump back out, that’s OK,” she says. “The goal is to retrain your brain how to think positively about your reflection and your body.”

Over time, telling yourself that you’re beautiful, even if you don’t believe it at first, will improve your confidence, she says. The psychology behind this technique is called “cognitive behavioral therapy,” a method that psychologists and therapists use to stop negative thoughts and replace them with positive ones instead.

Robyn Silverman, PhD, body image expert and author, agrees that “faking” confidence will eventually turn bad body thoughts into good ones, though it takes time.

To speed up the process, Silverman suggests posting notes with positive messages on your mirror to remind yourself of your good qualities. Those notes don’t always have to be about your looks. Jotting down things about your character will help you develop a more positive attitude toward your reflection.

Be Your Own Body Image Advocate

You would never tell your friend she looks fat in a bathing suit, or tell your coworker his arms are scrawny, so why would you tell yourself that?

“Treat yourself as you would treat others, and you’ll find negative thoughts will lessen over time,” says Leslie Goldman, MPH, body image expert and author of Locker Room Diaries.

Ditch the things in your life that make you feel inferior, whether that is body-bashing friends, fashion magazines with supermodels, or TV shows that portray men and women in an unrealistic, sexist way, Silverman says. If a family member or roommate makes you feel bad about the way you look, talk to them directly and establish a “fat-talk-free policy,” she says.

If an advertisement or TV commercial makes you feel bad about yourself, examine it closer and look for the ways it’s trying to sell you something. “Remember, if we didn’t feel inferior to the models in the ads, we wouldn’t want to buy the product,” Silverman says.

Look Beyond the Scale

All too often, people get hung up on the number on the scale, rather than paying attention to how they feel, Silverman says. People of all sizes do that, and it doesn’t help.

Instead of focusing on one number — your weight — pay attention to how you feel when you wake up or after you hurry to catch the bus. Also check on all your other numbers, such as blood sugar, cholesterol, and blood pressure. Those may paint a better picture of your health than just your weight alone.

If you’re trying to lose weight, Silverman suggests swapping weight-loss oriented goals with fitness goals like keeping your cholesterol level down or training for your first 5K.

“Instead of running away from your old body on the treadmill or the StairMaster, work toward a goal that makes you feel accomplished,” she says.

Choose an exercise you love, and you’ll be more likely to stick with it, Osachy says. When you exercise for stress relief and fun, your weight and health may naturally start to fall into place, she says.

As an added bonus, doing something you love will make you see your body in a different light, Silverman says. For instance, instead of loathing your thighs, you’ll appreciate them because they enable you to do the things that you love, whether that is yoga or cycling.

Cut Yourself Some Slack

Forget perfection or rigid rules. It’s OK to splurge once in a while even if you’re trying to lose weight, Goldman says. Not letting yourself have a little cake at a party may make you more likely to overindulge later.

Focus on the bigger picture and praise yourself for the healthy choices you make, rather than the times you think you’ve “failed,” Silverman says.

Don’t label any food as “bad” or “good.” You’ll only feel worse about yourself and your body if you eat something that isn’t your definition of perfect, Goldman says.

Don’t Compare Yourself to Others

“Healthy comes in all shapes and sizes,” Goldman says.

Never resort to unhealthy measures, such as not eating or taking potentially dangerous supplements, to fit society’s idea of what looks healthy, Silverman says.

If you’re physically fit, and everything checks out with your doctor, you may want to redefine your weight-loss goals altogether. If negative thoughts about your body become overwhelming, or if you are finding it hard to give up perfectionistic habits about food, weight, or exercise, talk to your doctor or a counselor or therapist.

Oct. 4, 2022 — Paige E, a 76-year-old retired psychotherapist, had always enjoyed yoga, which she found relaxing, invigorating, and spiritually meaningful. As she grew older and faced increasing physical challenges, she began taking yoga classes for seniors.

When the COVID-19 lockdown began, Paige was concerned that she might need to give up yoga classes. She knew she could practice on her own but felt she needed the structure of a class and the support of an instructor. So she decided to take online classes with Howard Katz, a Teaneck, NJ-based yoga instructor, with whom she had taken in-person classes in the past.

At first, she was skeptical whether the online format would be useful. 

“I’m not very tech-savvy — in fact, I’m a tech dinosaur — and I worried that I wouldn’t be able to manage the technology or relate to a virtual format,” she says. 

She was also concerned because she has some brain challenges and wasn’t sure how they would impact her ability to participate in online learning.

“I don’t have classic dementia or Alzheimer’s, but I do have memory and organizational issues that are related to other health problems,” she says.

Fortunately, she was able to master the technology and benefit from the classes.

Feasible and Safe

 Online yoga became part of the “new normal” during the COVID-19 pandemic, and its use has remained since then. And although some people prefer in-person settings, many continue to prefer the convenience, affordability, and other benefits of online yoga. 

This is also true  for classes targeting seniors, including those with cognitive impairments. A recent study found that a remotely offered home-based chair yoga intervention was helpful for older adults with dementia. 

“The telehealth-based chair yoga intervention was found to be convenient to both participants and their caregivers in keeping them physically active, as it was easily accessible from home and did not require transportation or getting dressed, which reduced caregiver burden and stress,” says senior researcher JuYoung Park, PhD, a professor in the Phyllis and Harvey Sandler School of Social Work at Florida Atlantic University’s College of Social Work and Criminal Justice. 

Seniors with dementia “can focus on the chair yoga intervention more effectively in a comfortable home environment rather than in a community center, with its associated distractions,” she explains.

Notably, there were no injuries or other adverse events during the intervention, “indicating that online chair yoga with caregiver support is safe.”

Park stresses that some people might face technological challenges in accessing online sessions, so tech support should be provided if necessary. And “since the instructor cannot engage in direct action with the participant, it’s recommended that a caregiver attend sessions with the person with dementia, monitor the participant for safety, and assist in following the poses correctly.”

What Is Yoga for Seniors?

Katz teaches older adults in senior centers and also offers online and in-person group and private classes to seniors through his own yoga studio. 

“Senior yoga is regular yoga made accessible for older adults who might experience age-related physical challenges,” says Katz.

“With seniors, I usually start with gentle warm-ups, then guide them through basic standing forward bends, gentle back bends, and warrior poses,” says Katz.

Props such as blocks, straps, and chairs are offered, and postures are modified to accommodate the physical challenges of seniors. 

“Some seniors can’t sit on the floor because they have difficulty getting up, so I modify the postures so that they can sit on a chair. Some have difficulty with balance, so they hold onto the chair or wall,” Katz notes. In fact, half the postures in his Yoga for Seniors classes are seated, while the other half are standing. 

Katz’s yoga classes emphasize breathing techniques. In particular, he likes to teach alternate nostril breathing (Nadi Shodhana), ocean-sounding breath (Ujjayi), and bee-breath (Brahmerie) which are calming for people with anxiety and stress and have other benefits as well — like lowering blood pressure, for example. 

All of Katz’s classes include meditation, which, he says, can bring calm, peace, and spiritual opening to people of all ages and has also been shown to be helpful in improving cognition and quality of life in seniors.

“I regard yoga postures and breathing as preparation for the most important component of yoga, which is meditation,” he explains.

Addressing the Special Needs of Seniors With Cognitive Challenges

Katz offers private in-person and online classes to people with cognitive impairments.   

“Classes are highly individualized, and all the components are modified, depending on the student’s cognitive level and needs,” he says. 

For example, he simplifies the breathing techniques or postures and explains everything more slowly, repeating instructions and explanations as often as necessary.

Some individuals with mild cognitive impairment can take classes alone. But those with more severe impairments or with dementia benefit from having a caregiver present for safety and to reinforce the yoga lesson, according to Katz. 

“It also creates a shared bond and activity for the caregiver and the student to do yoga together,” he says. 

Paige’s cognitive impairments are mild. She lives independently, does not require a caregiver, and successfully takes online classes with Katz, who “is patient and supportive when I don’t remember some things,” she says. “He explains things well, so I understand what each posture is designed to accomplish, and he creates a safe atmosphere, so I never feel rushed or judged.”

Paige feels that yoga has helped her physical health, cognition, and mood. 

“Yoga is a gift in my life, and I encourage other seniors to try it,” she says. 

Oct. 4, 2022 – Brent called his dad, Jeb Teichman, MD, in November 2019 saying he had felt sick for the past 3 days. The otherwise healthy 29-year-old had a cough, sore throat, and was running a fever.

“It was what the CDC would call classic influenza-like illness,” Jeb Teichman said. “It was too late to start antivirals, so I gave him advice on symptomatic treatment. We texted the next day, and I was glad to hear that his fever was trending down and that he was feeling a little bit better.”

Two days later, his son called again. 

“He said he was having trouble breathing, and over the phone I could hear him hyperventilating.” The retired pediatrician and health care executive told his son to seek medical care. 

“Then I got the call that no parent wants to get.” 

Brent’s cousin Jake called saying he couldn’t wake Brent up.

“I called Jake back a few minutes later and asked him to hold up the phone,” Teichman said. “I listened to EMS working on my son, calling for round after round of many medications. He was in arrest and they couldn’t revive him.”

“To this day when I close my eyes at night, I still hear the beeping of those monitors.”

Brent had no health conditions to put him at higher risk for complications of the flu. “Brent was a wonderful son, brother, uncle, and friend. He had a passion for everything he did, and that included his chosen calling of the culinary arts but also included University of Kentucky sports,” Teichman says.

Brent planned to get a flu vaccine but had not done it yet. “In his obituary, we requested that in lieu of flowers or donations, people go get their flu shot,” his father said.

“I’m here today to put a face on influenza,” Teichman said at a news briefing Tuesday on preventing the flu and pneumococcal disease, sponsored by the National Foundation for Infectious Diseases (NFID). 

New Survey Numbers ‘Alarming’

The NFID commissioned a nation survey of more than 1,000 U.S. adults to better understand their knowledge and attitudes about the flu, pneumococcal disease, vaccines, and the impact of COVID-19.

“We were alarmed to learn that only 49% of U.S. adults plan to get their flu vaccine this season,” said Patricia A. “Patsy” Stinchfield, a registered nurse, NFID president, and moderator of the news briefing. “That is not good enough.”

In addition, 22% of people at higher risk for flu-related complications do not plan to get vaccinated this season. “That’s a dangerous risk to take,” Stinchfield said. 

An encouraging finding, she said, is that 69% of adults surveyed recognize that an annual flu vaccination is the best way to prevent flu-related hospitalizations and death. 

“So, most people know what to do. We just need to do it,” she said.

The top reason for not getting a flu shot this year, mentioned by 41% of people surveyed, is they do not think vaccines work very well. Another 39% are concerned about vaccine side effects, and 28% skip the vaccine because they “never get the flu.” 

The experts on the panel emphasized the recommendation that all Americans 6 months or older get the flu vaccine, preferably by the end of October. Vaccination is especially important for those at higher risk of complications from the flu, including children under 5, pregnant women, people with one or more health conditions, the immunocompromised, and Americans 65 years and older. 

Stinchfield acknowledges that the effectiveness of the flu vaccine varies season to season, but even if the vaccine does not completely match the circulating viruses, it can help prevent serious outcomes like hospitalization and death. One of the serious potential complications is pneumonia or “pneumococcal disease.” 

“Our survey shows that only 29% of those at risk have been advised to receive a pneumococcal vaccine,” Stinchfield says.

“The good news is that among those who were advised to get the vaccine, 74% did receive their pneumococcal vaccine,” she said. “This underscores a key point to you, my fellow clinicians: As health professionals, our recommendations matter.”

Higher Doses for 65+ Americans

The CDC updated recommendations this flu season for adults 65 and older to receive one of three preferentially recommended flu vaccines, said CDC Director Rochelle Walensky, MD. The CDC is recommending higher-dose, stronger vaccines for older Americans “based on a review of the available studies, which suggested that in this age group, these vaccines are potentially more effective than standard-dose … vaccines.”

During most seasons, people 65 and older bear the greatest burden of severe flu disease, accounting for most flu-related hospitalizations and deaths. 

“They are the largest vulnerable segment of our society,” Walensky said. 

What Will This Flu Season Be Like?

Health officials in the flu vaccine business also tend to be in the flu season prediction business. That includes Walensky.

“While we will never exactly know what each flu season will hold, we do know that every year, the best way you can protect yourself and those around you is to get your annual flu vaccine,” she said while taking part remotely in the briefing. 

How severe will the flu season be this year? William Schaffner, MD, said he gets that question a lot. “Don’t think about that. Just focus on the fact that flu will be with us each year.”

“We were a little bit spoiled. We’ve had two mild influenza seasons,” said Schaffner, medical director of NFID and a professor of infectious diseases and preventive medicine at Vanderbilt University. “I think with all the interest in COVID, people have rather forgotten about influenza. I’ve had to remind them that this is yet another serious winter respiratory virus.” 

“As I like to say, flu is fickle. It’s difficult to predict how serious this next outbreak of influenza this season is going to be. We could look at what happened in the Southern Hemisphere,” he said. 

For example, Australia had the worst influenza season in the past 5 years, Schaffner said. “If you want a hint of what might happen here and you want yet another reason to be vaccinated, there it is.”

What we do know, Walensky said, is that the timing and severity of the past two flu seasons in the U.S. have been different than typical flu seasons. “And this is likely due to the COVID mitigation measures and other changes in circulating respiratory viruses.” Also, although last flu season was “relatively mild,” there was more flu activity than in the prior, 2020-21 season. 

Also, Walensky said, last season’s flu cases began to increase in November and remained elevated until mid-June, “making it the latest season on record.”

The official cause of Brent Teichman’s death was multilobar pneumonia, cause undetermined. “But after 30-plus years as a pediatrician … I know influenza when I see it,” his dad said.

“There’s a hole in our hearts that will never heal. Loss of a child is devastating,” he said. The flu “can take the life of a healthy young person, as it did to my son.”

“And for all those listening to my story who are vaccine hesitant, do it for those who love you. So that they won’t walk the path that we and many other families in this country have walked.”

To prove their point, Teichman and Stinchfield raised the sleeves Tuesday and received flu shots during the news briefing. 

“This one is for Brent,” Teichman said. 

Oct. 5, 2022 — What if a baby’s developing brain at the critical time just before birth and in the early days afterward establishes the lifetime risk for obesity?

Previous research has suggested that human genes associated with obesity determine whether a person will have a hard time maintaining a healthy weight later in life. For decades, researchers have looked for links between genetic variants and body mass index (BMI), explains Robert Waterland, PhD, professor of pediatrics-nutrition at Baylor College of Medicine in Houston, TX.  But the problem is the genetic ties found so far don’t explain weight gain and who is most at risk, he says. 

So could there be more behind rising obesity rates than genetics and lifestyle?

In their new study published in Science Advances, Waterland and his team looked at the possibility that environmental influences – such as poor nutrition and stress – during a critical window of brain development might influence obesity risk.

The research team led by Harry MacKay, PhD, a postdoctoral associate in pediatrics-nutrition at Baylor, focused on a tiny section of the brain called the arcuate nucleus of the hypothalamus, which regulates the body’s energy balance between food intake, physical activity, and metabolism.

They studied mice in the first few weeks of life and found that the arcuate nucleus undergoes extensive growth in a critical window of time when brains are particularly sensitive to programming, which will later determine how well the body senses whether it is hungry and when the body has enough food.

The scientists focused on epigenetics and worked to bookmark which genes would and would not be used in different cells. A big surprise in the research came when the investigators compared their epigenetic data in mice to human data and found that the regions targeted for epigenetic maturation in the mouse arcuate nucleus overlapped strongly with human genomic regions associated with BMI.

Waterland says that even though the work did not address when the epigenetic changes happen in humans, previous research has shown it happens earlier in humans than in mice. 

“My hunch is that the same epigenetic development that we have documented in the early postnatal mouse actually occurs during late fetal development in humans,” he says. 

If that is the case, “a big, big concern is the very high prevalence of maternal obesity in the U.S. and many developed countries in the world,” which may be affecting the health of new babies.

If future weight problems begin before birth or in those first weeks of life, some might feel doomed to a fate of obesity. But Waterland says the focus on genetics in earlier research wasn’t particularly encouraging either since it’s very difficult to change your genetics. 

“At least if we understand how environment affects development, then at least we can look for ways to improve this in the future,” he says. 

It’s too early to say whether obesity is actually a neurodevelopment disorder, Waterland explains, but if early research like this continues to build evidence, public health interventions to curb the worldwide obesity epidemic could focus more on prenatal and early life nutrition, healthy weight gain, and stress reduction.

Oct. 5, 2022 – Anthony Fauci, MD, the director of the National Institute of Allergy and Infectious Diseases and chief medical adviser to President Joe Biden, said this week that he isn’t ready to say that we are nearing the end of COVID-19. But as a country, we seem to be on the right track, Fauci said during a virtual conversation for the University of Southern California’s Annenberg’s Center for Health Journalism. 

This comes just 2 weeks after Biden said that “the pandemic is over” on CBS’s 60 Minutes. Last month, the World Health Organization also said the end of COVID is in sight. 

“It’s obvious that [the president’s statement] could be problematic because people would interpret it as ‘it’s completely over and we’re done for good,’ which is not the case, no doubt about that,” Fauci said. 

Instead, he interpreted the comment as a reference to the country’s improvement in case numbers and death rates over the last several months — that the worst is likely behind us. 

Fauci, who has been the subject of harsh criticism for his public messaging, chooses his words carefully, even with the promise of a brighter future ahead.

“I think it would be cavalier to all of the sudden say we’re through with [COVID],” he said. “Because remember, we were going in the right direction in the summer of 2021, and along came Delta. Then in the winter, along came Omicron. And since then, we’ve had sublineages of Omicron.” 

Especially as the winter months approach, Fauci said, precautions still need to be taken to reduce the chances of yet another spike. When asked about the precautions that he himself takes, Fauci explained that he still doesn’t go to indoor, sit-down dinners. He continues to attend receptions — noting that most of them are outdoors — without a mask on, but if he’s in an indoor setting “for a considerable period of time,” he keeps a mask on. 

A large portion of the conversation also reflected on the lessons that can be learned from mixed messages delivered by public health experts, including Fauci, during both the COVID pandemic and the more recent developments in monkeypox. 

“I have tried always to give the hard truth, but very often the hard truth is not heard under the circumstance under which it’s given,” Fauci said. He blames social media for the misrepresentation of public comments and the spread of misinformation for the overall lack of clarity that many have attributed to his and the CDC’s statements regarding COVID. 

Fauci said that if he could go back and do certain things differently, he would. If he had the choice, he would have tried to be much more careful during the early months of the pandemic in underlining the uncertainty of the situation we were going through. 

The major shortcoming the U.S. continues to face regarding the pandemic is the resistance to getting vaccinated and ultimately boosted for COVID, Fauci added. And when it comes to vaccines, he doesn’t see the message as polarizing. 

“People say [I’m a] polarizing figure,” Fauci said. “Well, when I say we should get vaccinated because it saves lives, and someone says no, am I the polarizing figure? Or is the person who is saying something that’s completely untrue creating the polarization?” 

Oct. 6, 2022 – Pamela Jock has always had regular periods, even as she rounded 50 and knew perimenopause was on the horizon. But shortly after receiving the second of a two-series COVID-19 vaccine in June 2020, her cycle began to change. At 52, it could indeed be perimenopause, but Jock had to wonder if the vaccine might have played a role. It turns out, the answer to her speculation is “maybe.” 

A new study, recently published in The BMJ,  did a deep dive into the possible link between the COVID vaccine and irregular periods. The investigation, led by Alison Edelman, MD, a professor of obstetrics and gynecology at Oregon Health & Science University, was prompted by more than 30,000 reports of cycle changes to the United Kingdom’s Medicines and Healthcare Products Regulatory Agency (MHRA). 

Using data from a period-tracking app called Natural Cycles, the study pulled in numbers from more than 20,000 women from around the world. The researchers considered the three menstrual cycles prior to vaccination, and at least one cycle after. They compared this to four menstrual cycles in a group that had not received the vaccine. 

The results revealed that on average, the vaccinated women got their periods 0.71 days late after the first shot. Those who received two vaccines within one cycle saw an increased cycle length of 4 days, on average. This tracks with Jock’s experience. “My cycle elongated to 30 days, versus my normal 26 days,” she says. “Then I had a gap between cycles of a few months.”

This is where the vaccine-cycle link gets murkier. Given Jock’s age, her big gap between cycles could very well be perimenopause, especially since the study only examined women between the ages of 18 and 45, who already had regular cycles. But Jock still wonders. “After I got my first booster in the fall of 2021, my periods flipped back to normal, showing up every 26 days,” she says. “But they were extremely heavy and I was tired and drained.” 

Follow-up bloodwork revealed anemia, potentially as a result. When she asked about a potential vaccine-irregular cycle link, says Jock, “The doctor didn’t think there was a connection, and that it was probably perimenopause.”

What’s Going On 

Whether in the age range of the people in the study or beyond, like Jock, the relationship between the COVID vaccine and menstrual cycle changes can stem from several things, says Esther Goldsmith, an exercise physiologist with bio-analytics company Orreco. 

“It may be influenced by when in your cycle you have your vaccination,” she says. “We know that changes in estrogen and progesterone in the menstrual cycle can affect the immune system and our immune responses. That’s why I think it’s really interesting that the study shows that those who had two doses in the same cycle were most affected.” 

Orreco’s data collection – which often focuses on female athletes – has shown the vaccine can have other impacts, as well, that may play a role. 

“We’ve also seen that the vaccine can affect oxidative stress and inflammation, things we measure through point-of-care blood analysis,” Goldsmith says. “Inflammation can influence symptoms, so using inference, the vaccine may also illicit a change in menstrual cycle symptoms.” 

Shaghayegh DeNoble, MD, with Advanced Gynecology and Laparoscopy of North Jersey, says she hears from many patients that their periods came later than expected, and/or that they were having heavier than normal periods after the vaccine – as well as after a COVID infection. 

“I remind them that many things can change our cycles, including travel, the change of seasons, and stress,” she says. “This happens all the time, and there are no long-term effects. I reassure them their cycles will return to normal.”

The research found that in most cases, normal occurred within one to two cycles after the vaccine, which aligns with what DeNoble’s patients reported, too. 

Putting Minds at Ease 

While the research may have established a probable connection between the vaccine and abnormal menstrual cycles, Goldsmith and DeNoble both emphasize the shots do not impact fertility. 

“I receive so many phone calls from women worrying that because their periods were off, their fertility may be at risk, too,” DeNoble says. “But fertility is not diminished due to the vaccine.” 

Jock says she is thankful fertility is not something that matters to her, anymore. “I would probably be worried if it were,” she admits. 

Goldsmith says such fears are unwarranted and wants women to put any alarm aside. “An abnormal period is a very natural response to something that is physiologically a big event for your body to deal with,” she says. “Menstrual cycles can be incredibly sensitive to change of all sorts, whether nutrition, lifestyle, stress, or the immune system. We shouldn’t be surprised, therefore, that it will respond to things like vaccines. This probably isn’t a new phenomenon, but it may not have been documented in the past.” 

Now armed with the research results, DeNoble says it will be easier to educate patients about what to expect with boosters. 

“It’s so important for us to be able to warn patients about potential side effects,” she says, “and it’s also important that we can put their minds at ease.” 

Goldsmith recommends that women track their cycles, documenting any changes – vaccine or not. 

“We should all pay attention to our cycles and make sure we’re looking after ourselves in these times in order to reduce the stress the body is under,” she says. 

While Jock will never know for certain if her irregular cycles were the result of the vaccine or perimenopause, she’s watching what happens when she soon receives the bivalent COVID vaccine. “I’m curious to see if this carries me along the same trajectory,” she says. 

Regardless of the inconvenience of an abnormal cycle, Jock has no regrets about getting the vaccine, she says: “I’d much rather stay healthy and avoid COVID.” 

Oct. 6, 2022 – Could taking vitamin C help reduce the chances of developing gout? A new study sheds light on this possibility. 

Gout is a form of inflammatory arthritis that has been on the rise in the U.S. in recent decades. Considered a lifestyle disease, some research has shown that instances of the condition have more than doubled in recent years as rates of obesity have skyrocketed. It’s caused by uric acid in the blood that builds up and crystalizes in the joints. Flare-ups are so intense that the joints can turn a cherry red and vibrate with intense – and sometimes seemingly intolerable – pain. 

While there are effective treatments, many people fail to take their medications when they’re not in pain, and if the condition goes unchecked, it can get much worse and cause permanent damage to the joints. 

“Gout can cause flare-ups that vary in frequency and severity; but sometimes when people aren’t experiencing them, they’re less likely to stay on top of their medications,” says Stephen Juraschek, MD, an assistant professor of medicine at Harvard Medical School. 

That’s why lifestyle interventions are seen as particularly relevant to a disease like gout. Vitamin C, for example, has few side effects, and for those with higher levels of uric acid in the blood, it could reduce the likelihood of getting the condition. A recent study published in The American Journal of Clinical Nutrition found that people who were given 500 milligrams of vitamin C versus a placebo had a 12% reduced risk of getting gout. The study of over 14,000 male doctors showed that men who weren’t overweight had the most significant reduction in the risk of getting the condition. (Excess weight has been shown to increase the risk of gout.)

As part of the study, participants responded to a questionnaire that asked whether they had ever been diagnosed with gout. Other studies have shown that vitamin C reduced the levels of urate in people without gout and broke down uric crystals in the blood, but this study took it a step further to show that the supplement actually reduced the risk of getting the condition.

“In addition to lowering levels of uric acid in the body, it’s thought that vitamin C may also minimize the inflammatory response to urate crystals,” says Juraschek. That’s because when flare-ups develop in joints throughout the body, much of the painful irritation is caused by the immune system’s response as it fights to break down the crystals. 

Juraschek says this likely wouldn’t change recommendations for patients with serious gout, but it could still have an impact. 

“For individuals who were told that they have gout but have had fewer flare-ups, they might be more open to taking vitamin C,” he says.

Will Settle, 42, of Hilton Head, SC, was not involved in the study, but he says he would be inclined to try most any safe preventive method. Gout runs in his family. His father and grandfather had it, and now, so does he. His flare-ups have slowed in recent years, which he says has a lot to do with his diet and lifestyle. He stopped eating seafood, started drinking more water, and stopped drinking as much alcohol – all of which he thinks has had a huge impact on the severity of his condition. (Both seafood and beer contain high levels of purines, which have been shown to increase the buildup of uric acid in the blood.) Settle says that other simple lifestyle changes like vitamin C would be an easy addition to his routine with few downsides. Plus, he hates having to take colchicine, a medication that’s meant to relieve pain but causes him intense diarrhea when he takes it. 

“Anything to reduce my flare-ups without having to take colchicine,” he says.

But the jury is still out as to whether vitamin C will have any real benefits. Study co-author Robert H. Shmerling, MD, is the former clinical chief of the Division of Rheumatology at Beth Israel Deaconess Medical Center in New York. He says the study shows that the effect of vitamin C in those undiagnosed with gout was rather modest. Also, vitamin C did not show a reduction in gout flare-ups in those who were already diagnosed with the condition. Not to mention that the study lacked diversity, as the people in it were all male and mostly white. Still, there’s little downside risk to taking vitamin C, and it might end up being worthwhile. 

“Maybe it will turn out to be an effective treatment in those who are at high risk, but we’re not there yet,” he says.

Robert Terkeltaub, MD, chief of rheumatology at the Veterans Administration Medical Center in San Diego and a professor of medicine at the University of California, San Diego, says there’s an unmet need when it comes to tools for gout prevention. 

“The disease impacts some 10 million Americans, and we need to better identify these individuals so we can intervene earlier,” he says. 

While vitamin C had a small but significant association with fewer new cases of gout, it did not lower it in those who already had the disease, says Terkeltaub. What’s more, researchers didn’t measure the levels of uric acid in the blood, which would have painted a more accurate picture of whether vitamin C actually reduced it in the body. 

“There remains no clarity on the potential role of vitamin C in either prevention or treatment of gout. That said, future research would be of interest,” he says. 

Still, gout patients like Settle aren’t ruling it out. Anything to avoid the pain that, at times, makes it difficult for him to get out of bed. He’s seen the benefit that simple lifestyle changes can make, and he’s willing to try just about anything to live a normal, arthritis-free life. 

“I’m always looking for simple ways to keep my flare-ups at bay,” he says.