Category: Health

Sept. 20, 2022 – Patients who navigate what can feel like an endless series of checkups and lab tests to confirm a long COVID diagnosis face an even harder path ahead: Figuring out where to go for care.

Treatment options are as complex and varied as the symptoms that come with this condition, experts say. And there aren’t yet clear evidence-based clinical guidelines or best practices to point patients – or their doctors – in the right direction.

The first stop should ideally be the person who knows patients best – their primary care provider, says Tochi Iroku-Malize, MD, founding chair and professor of family medicine for the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell in Hempstead, NY.

But because of the long list of symptoms that can be caused by long COVID, from exhaustion and “brain fog” to chest pain, fever, and rash, a center that brings together specialists may be the best choice for patients who can get to one.

“This is a new field, and different providers have different levels of comfort and experience managing these symptoms,” says Aaron Friedberg, MD, clinical co-lead of the Post-COVID Recovery Program at the Ohio State University Wexner Medical Center.

Sometimes, symptoms may only affect one or two very specific parts of the body, and in that case, patients may get all the care they need by having their primary care doctor refer them to a specialist – like an ear, nose, and throat doctor for lost taste and smell, or a physiatrist for muscle fatigue, he says.

“However, if a primary care provider is not as comfortable managing this condition, or if there are multiple areas of the body being affected, seeing a post-COVID specialist may be helpful,” Friedberg says.
Patients should also consider treatment at a specialized long COVID clinic if their primary care provider refers them to people who simply aren’t able to help, says Kristin Englund, MD, director of the reCOVer Clinic at Cleveland Clinic, which treats long COVID patients.

“Specialty physicians often have their own diseases that they treat best,” she says. “Some cardiologists are experts in coronary artery disease but may not have expertise in the complications of long COVID, and the same goes for pulmonologists who may be experts in asthma, but again, not long COVID.”

But access can be a big problem for patients. Specialty clinics dedicated to long COVID care tend to be concentrated at academic medical centers in major cities and may have long waits for new patients. People living in rural areas, people with disabilities, and ethnic minorities may all be less able to find specialized care. The U.S. federal government’s Administration for Community Living has a guide that notes that finding care can be complicated.

“Finding the resources and supports you need can be overwhelming,” it says.

But if patients can get to one, a long COVID center can help when symptoms are severe or make patients less able to keep up with their typical daily routines, says Benjamin Abramoff, MD, who leads the American Academy of Physical Medicine and Rehabilitation’s multidisciplinary long COVID collaborative.

This is also a good way to go if patients don’t see enough improvement and want a second opinion, says Abramoff, who is also director of the Penn Medicine Post-COVID Assessment and Recovery Clinic.

Today, there’s at least one long COVID center in almost every state – 48 out of 50, according to the patient advocacy group Survivor Corps. Most are in major cities and run by hospital or health care systems that work with academic medical centers. Most of these centers see people who have had symptoms for at least 3 months, and many have months-long waiting lists for new patients.

Given the lack of guidelines or long-term data on how well many long COVID treatments work, vetting these specialized centers is tricky, experts say.

“The biggest challenge right now is that because this is such a new field, there is not a formal standard of care for this condition, and there is no formal accrediting body for post-COVID treatment centers,” Friedberg says.

But there are still some things that can point to a better – or worse – choice.

“The current best standard is to have a multidisciplinary clinic with providers familiar with the available medical evidence and close connections between multiple specialties, including rehabilitation, cardiology, pulmonology, psychiatry, neurology, and other specialties working together,” Friedberg says. “I would recommend looking for these types of clinics as a first choice.”

When possible, patients should seek out a long COVID clinic at an academic medical center or hospital with a good track record for quality care, experts say. Even though there aren’t yet quality ratings specific to long COVID, patients can see how hospitals rate in other key areas, like preventing infections and surgical complications, using free tools like Medicare’s Hospital Compare website.

If clinics promise outcomes that sound too good to be true, patients should steer clear, says Alba Miranda Azola, MD, an assistant professor in physical medicine and rehabilitation and co-director of the Post-Acute COVID-19 Team at Johns Hopkins University School of Medicine.

“As more clinics crop up, some bad actors are preying on patients with promises like miracle cures that they can’t possibly deliver,” she warns. “There is very limited knowledge on the efficacy of certain interventions that are being advertised, and it pains me to see some patients being taken advantage of, paying hundreds or thousands of dollars for ‘miracle’ cures or ‘miracle’ diagnostic tests that truly have no strong scientific evidence to support or justify their use.”

A good clinic should also coordinate care with a patient’s primary care provider, says Kathleen Bell, MD, a neuro-rehabilitation specialist at the University of Texas Southwestern O’Donnell Brain Institute who helped establish their COVID Recover program. While sharing medical records, treatment plans, and clinical notes is common, not every place does this well – and poor coordination can be a red flag that a clinic isn’t a great option, given how complex long COVID care can be.

“This is pretty much standard procedure,” Bell says. “But because this is so new and probably overwhelming to some PCPs [primary care providers] because of the numbers and lack of clear guidelines, strengthening that communication is indicated.”

Nonetheless, a primary care doctor should be included, at least at first.

“Your primary care provider knows your medical history and is well-equipped to treat long COVID within the context of your whole health,” says Iroku-Malize, who’s also president-elect of the American Academy of Family Physicians.

Some patients may be able to get all the treatment they need close to home, with their primary care provider coordinating any needed referrals to specialists and doing regular checkups to monitor recovery, experts say. This can make care more accessible and affordable for patients, who don’t need to travel long distances or see faraway specialists who don’t take their insurance.
Because long COVID is so new, and so many interventions for the condition are still unproven, clear conversations between doctors and patients about the possible risks and benefits of proposed treatment plans are also crucial, says Abramoff.

And regardless of whether patients ultimately stick with a primary care provider or transition to a long COVID center for care, they should reevaluate their options if recovery stalls.

“One indication of good care is that the person you’re seeing is willing to continue to work with you and has next steps in the treatment plan if their initial treatment is ineffective,” Abramoff says.

Find more long COVID resources here.

By Steven Reinberg
HealthDay Reporter

TUESDAY, Sept. 20, 2022 (HealthDay News) — They look so cute, grazing quietly in your backyard. But the overpopulation of white-tailed deer across the Northeastern United States could help spread Lyme disease and another tick-borne illness, anaplasmosis, especially in suburban areas, a new study suggests.

The research points out that these deer, which carry ticks that transmit the two diseases, are no longer confined to wooded areas, but often live within yards of suburban homes, increasing the risk of transmission.

“Your yard is their home, and if you’re concerned about ticks or tick management, or potentially damage done, then you need to recognize that this is where they actually choose to live and either work with them or manage against them,” said lead researcher Jennifer Mullinax. She’s an assistant professor of wildlife ecology and management at the University of Maryland.

The deer themselves are not a threat to health. But the black-legged (deer ticks) and lone star ticks they carry spread Lyme and other diseases, Mullinax explained.

Lyme disease is a bacterial infection caused by the bite of an infected tick. It causes symptoms such as a rash, fever, headache and fatigue. If left untreated it can spread to the heart, joints and nervous system. Anaplasmosis causes similar symptoms and can lead to hemorrhages and kidney failure.

The ticks that cause these illnesses lodge and breed on your lawn.

As development encroaches on their habitats, deer are living closer to humans, and landscapes offer easy grazing on grasses, shrubs and flowers, Mullinax said. Your lawn is “warm, it’s safe, there’s fewer predators, and it’s just convenient,” she said.

This five-year study found that suburban deer often spend the night within 55 yards of human homes.

For the study, Mullinax’s team tracked 51 deer that were outfitted with GPS tracking devices.

The trackers revealed that deer avoided residential areas during the day, but gravitated to them at night, especially during winter. The animals often slept near the edges of lawns and within yards of houses and apartment buildings.

So many deer in residential areas increase the risk of human exposure to tick-borne illnesses, Mullinax said. Reducing tick populations by removing deer or treating areas where deer bed down can help limit the spread of disease, she said.

Managed deer hunting can help keep the tick population in check, but culling the herd can be hard to accomplish, the study pointed out. People don’t want hunters in suburban areas, and chemically reducing the fertility of deer hasn’t worked, it added.

Mullinax said it’s possible to limit access to your yard by installing deer fencing or mulch barriers, but a better way to prevent disease may be to control the tick population.

“Most people get Lyme disease from the ticks in their yard. There are a lot of different methods to control ticks,” she said. “For the county agencies and state agencies, it’s really pointing them to make some adjustments in managing the deer population.”

Dr. Marc Siegel is a clinical professor of medicine at NYU Langone Medical Center in New York City who reviewed the findings.

He offered several strategies to reduce the tick population in your yard: Cut your grass short. Have your yard sprayed for ticks. Use tick repellent. And check your body and clothing for ticks after you’ve spent time outdoors.

“I tell them to look for bumps on their scalp and in their pubic area,” Siegel said. “I tell them that if you feel fatigued, it may not be COVID — it may be Lyme.”

Because Lyme disease can be hard to diagnose, Siegel said he’s not afraid to prescribe antibiotics if he suspects Lyme disease by symptoms alone.

“I’m in the category of over-treaters,” he said. “But this study makes me not look bad, because it’s basically saying these things are going out of control. We expect to see a lot more disease.”

The research was published online Sept. 17 in the journal Urban Ecosystems.

More information

There’s more about Lyme disease at the U.S. Centers for Disease Control and Prevention.

SOURCES: Jennifer Mullinax, PhD, assistant professor, wildlife ecology and management, University of Maryland, College Park; Marc Siegel, MD, clinical professor, medicine, NYU Langone Medical Center, New York City; Urban Ecosystems, online, Sept. 17, 2022

Sept. 20, 2022 – The immune system is among the most complex and mysterious in the human body, and it is more versatile than previously understood, report researchers in the emerging field of mechanoimmunology, tracking how our bodies fight illness and how to successfully intervene.

Unlike other systems that rely on organs to operate, the immune system uses millions of different specialized cells to patrol every corner of the body for invaders and dispatch them as needed. It also relies heavily on the microbiome, the bustling communities of bacteria that carry out many of our essential functions even though they aren’t actually our own body cells.

Scientists are learning more and more every day about how the immune system works, and now, researchers at the Buck Institute for Research on Aging in Novato, CA, have begun discovering how physical – rather than just chemical – forces in the cellular environment also play a vital role in immune functions.

Mechanical activity has already been seen as playing a role in other body systems, particularly the cardiovascular and skeletal systems. Buildup in arteries of the heart can lessen blood flow, too much pressure on bone can prompt stress fractures, and pressure on tissue can cause scarring.

The idea that physical properties, rather than just chemical reactions, have a significant impact on immune function is a new idea that’s only just beginning to get attention. Dan Winer, MD, an associate professor at the Buck Institute, discovered in his study of obesity that increases in fat tissue activate fibrosis – thickened scar tissue – which then triggers surrounding cells to go on alert for potential threats to the body and respond to chronic disease.

Now, his lab is expanding its focus on mechanoimmunology to discover how physical forces impact autoimmunity, the increase or decrease of inflammation and healing forces after tissue injury.

Expanding scientists’ understanding of those forces will open the door to new therapies for treating disease – approaches that rely on changing the physical microenvironment of tissue rather than delivering drugs to induce chemical reactions. For example, cirrhosis, a scarring of the liver, involves tissue far stiffer than surrounding healthy liver tissue. If researchers can develop a treatment that reduces that stiffness, nearby immune cells may crank down their inflammatory response in the liver, which could have a positive impact on fatty liver disease. Other applications of this concept might address how therapeutics respond to infections or help speed up healing

By Amy Norton        
       HealthDay Reporter

TUESDAY, Sept. 20, 2022 (HealthDay News) — As opioid overdose deaths continue to soar, a Canadian program points to one way to save lives: providing “safer” opioids to people at high risk of overdose.

That’s the conclusion of a study evaluating Canada’s first formal “safer opioid supply,” or SOS, program. Such programs aim to prevent overdoses by giving vulnerable people an alternative to the increasingly dangerous street supply of opioids.

In this case, the London, Ontario-based program provided clients with a daily dose of prescription opioid tablets, as well as basic health care, counseling and social services.

The result was a rapid drop in emergency department trips and hospitalizations among the 82 clients studied, the researchers found. And over six years, there was not a single overdose death.

“I think this is a landmark study,” said Thomas Kerr, director of research at the British Columbia Centre on Substance Use, in Vancouver, Canada.

Kerr, who was not involved in the study, acknowledged that SOS programs are controversial and have their critics. Concerns have included the possibility of opioid pills being sold, or people crushing the tablets and injecting them, which carries the risk of overdose or infection.

But criticisms of safer supply have been made in the absence of data, Kerr said.

“The whole conversation has been clouded by misinformation,” he said. “When we’re talking about matters of life and death, we can’t rely on people’s opinions.”

Kerr said he hoped the new findings “will mute some of the misinformation.”

The study was published Sept. 19 in the CMAJ (Canadian Medical Association Journal). Itcomes amid an ever-worsening opioid epidemic.

In the United States, opioid overdose deaths have been on the rise for years, and the situation worsened after the pandemic hit. In 2020, nearly 92,000 Americans died of a drug overdose — largely involving opioids, according to the U.S. Centers for Disease Control and Prevention.

The crisis has mainly been driven by illegally made versions of the painkiller fentanyl, a synthetic opioid that is 50 times more potent than heroin, health officials say. Illicit fentanyl is sold in various forms, including pills made to look like other prescription opioids. It’s also commonly mixed into other illegal drugs, like cocaine and heroin, to boost their potency. The result is that users are often unaware they’re taking fentanyl.

Safer supply programs are based on the principle of harm reduction — that overdoses, infections and other consequences of opioid addiction can be prevented, without requiring people who misuse drugs to be completely abstinent.

The new findings come from a program begun in 2016 at London InterCommunity Health Centre. It provides clients with hydromorphone (Dilaudid) tablets, dispensed daily, as well as many other services — including primary health care, treatment for infections like HIV and hepatitis C, counseling, and help with housing and other social services.

The researchers, led by Tara Gomes, of Unity Health Toronto, looked at data on all 94 clients who entered the program between 2016 and March 2019. They compared 82 of those people against 303 individuals diagnosed with opioid addiction who did not take part in the program.

Over one year, the study found, emergency department visits and hospitalizations fell among program clients, while remaining unchanged in the comparison group. And while clients had medication costs — covered by Ontario’s prescription drug plan — their yearly health care costs outside of primary care plunged: from about $15,600, on average, to $7,300.

Again, there was no substantial change in the comparison group.

Dr. Sandra Springer is an associate professor at Yale School of Medicine, in New Haven, Conn., who has helped craft practice guidelines for the American Society of Addiction Medicine.

“This study is further evidence that programs that meet patients where they are and provide easy access to clinical care for treatment of opioid use disorder can save more lives and reduce health care costs,” said Springer, who was not involved in the research.

Opioid dependency itself can be treated with medication-assisted therapy, which involves counseling and medications like buprenorphine, methadone and naltrexone.

“While this SOS program did not provide traditional medications for the treatment of opioid use disorder to all participants, those medications were available to patients through the program,” Springer noted.

And, she said, other research has shown that when people who use drugs are offered “compassionate care,” they are more likely to accept “evidence-based treatment.”

The extent to which SOS programs will spread remains to be seen. In 2020, Health Canada announced funding for several additional pilot programs. And last year, New York City opened two overdose prevention sites — where people with opioid addiction can use the drugs in a clean, supervised setting, and be connected with health care and social services.

The sites are the first publicly recognized overdose prevention centers in the United States.

Kerr said that in the face of an opioid crisis that is only worsening, “the status quo response is not sufficient.”

“We have to try new approaches,” he said, “and scientifically evaluate them.”

         
         More information        

The U.S. National Institute on Drug Abuse has more on opioid use disorder.

         

SOURCES: Thomas Kerr, PhD, director, research, British Columbia Centre on Substance Use, professor, social medicine, University of British Columbia, Vancouver, Canada; Sandra Springer, MD, associate professor, medicine, Yale School of Medicine, New Haven, Conn.; CMAJ, Sept. 19, 2022, online

                 

The average person spends thousands of dollars a year on skincare products—lotions, creams, serums, tonics, and ointments designed to moisturize, heal, and fend off the outward signs of aging. For most people, the foremost consideration when choosing skincare products is, “Does it work?” However, the growing popularity of so-called clean beauty products indicates that more people are also caring about the quality of the ingredients they slather so liberally over their faces and bodies.

Why does it matter? Skin is the largest organ of the human body. It is also permeable. Anything we put on our skin makes its way inside, so we certainly don’t want to be applying harmful substances to our skin. We also rely on our skin to provide a barrier with the outside world, keeping harmful organisms where they belong. When it’s healthy, skin plays an important role in the immune system. In part, it does this by housing its own microbiome. The skin microbiome is distinct from the one you might be more familiar with in the gut, but just like the gut, the skin microbiome can be disrupted. When that happens, a host of health issues can follow Thus, we want to protect the skin microbiome, and one way we do that is by not applying harsh, even toxic, substances.

And of course, we want our skin to feel good. Dry, itchy, painful skin will make a person miserable. Even when it doesn’t cause physical discomfort, skin conditions can cause embarrassment. After all, it’s the outer shell that we present to people. Granted, other people don’t judge us as much as we think they do (they’re too busy worrying about how other people are judging them), but it’s natural to want to put your best foot—or best face—forward.

All this is to say, we want safe, effective, and affordable ways to care for our skin. Here’s where I’d start.

Choosing the Best Skincare Products

If you walk into your local drugstore and pick up any skincare product or cosmetic off the shelf, you’ll see a mile-long list of unpronounceable ingredients. Unpronounceable doesn’t automatically mean bad or harmful, but it can be hard to distinguish between ones you feel good about putting on your body and those you’d be better off avoiding.

More and more companies are making an effort to produce safer skincare products to meet consumers’ increasing demands. Labels proudly display buzzwords like natural, green, clean, non-toxic, and earth-friendly. The problem is, none of these terms are regulated by the FDA, so ultimately, they could mean anything… or nothing. The FDA does have a short list of banned or regulated ingredients, and “it’s against the law to use any ingredient that makes a cosmetic harmful when used as intended.” Beyond that, each manufacturer or retailer gets to decide for themselves what constitutes “clean” skincare.

Therefore, it’s up to the consumer to find trustworthy brands and to scope out the ingredients in the products they buy. You can really go down a rabbit hole here; some skincare companies list literally thousands of suspect ingredients they’ve banned. If that’s too overwhelming—and I wouldn’t blame you if it is—here are the top four I’d recommend avoiding.

Common skincare ingredients to avoid:

1. Parabens

Parabens are ubiquitous in personal care products including shampoos, conditioners, makeup, toothpaste, lubricant, shaving gel, moisturizers, and sunscreens. They are controversial due to their potential estrogenic effects and the possibility that they could be linked to various health problems. Although the evidence for their harm is inconclusive, public anti-paraben sentiment is strong enough that many companies have removed parabens from their products.

What to look for: Any word with “paraben” as the suffix in the ingredient list. Look for “paraben-free” on labels.

2. Phthalates

Being plasticizers, phthalates are abundant in plastics, but they also show up in most cosmetics, especially nail polish (to keep the polish from becoming brittle on the nail) and synthetic fragrance (as a preservative). Like most other plastic compounds, phthalates are endocrine disruptors. In humans, epidemiological studies have linked phthalate exposure to an alarming array of issues including insulin resistance and diabetes, obesity, allergies, asthma, and poor sperm function. Kids and adults are both at risk.

Now, correlation does not necessarily imply causation, but the observational studies coupled with potential physiological mechanisms (endocrine disruption) make me pretty suspicious of phthalates. Of course, much of our exposure comes from plastics and the ambient environment, but that doesn’t mean we shouldn’t limit exposure through cosmetics, too.

What to look for: Fragrance almost always contains phthalates. Sometimes, ingredient names will have the suffix “phthalate,” but you can’t always rely on that. You know what? Just be wary of that “phth” (how the heck do you even pronounce that?) because it shows up in the middle of words, too. As with parabens, many manufacturers are now letting you know when phthalates are absent in their products.

3. Fragrances

Fragrances are exactly what they sound like: synthetic compounds added to products to make them “smell good” (subjectively—I often despise them). And they’re everywhere.

The real problem with fragrance is that fragrance recipes are considered trade secrets. Companies don’t have to disclose the chemicals contained in a particular fragrance. Unfortunately, most synthetic fragrances contain phthalates, which I’ve already covered, and synthetic musks, which have been shown to impair endogenous cellular defense mechanisms. Basically, synthetic musks may hamper our cells’ ability to detoxify. Many fragrance ingredients are also allergens.

What to look for: Fragrance, parfum, aroma.

4. UV-filtering chemicals

Many sunscreens use UV filters like benzophenone and oxybenzone for their UV-blocking properties, but they also come with a cost: endocrine disruption. Certain forms of benzophenone, for example, inhibit the action of thyroid peroxidase, an enzyme necessary for the production of thyroid hormone. Chemical sunscreens frequently contain parabens and other problematic ingredients, as well.

If you’re looking for safer sun protection, opt for a hat and a lightweight cover-up, or go for a mineral sunscreen instead.

What to look for: Benzophenone, oxybenzone (benzophenone-3), octyl-methoxycinnamate, para-aminobenzoic acid (PABA), 3-benzylidene camphor (3-BC), 3-(4-methyl-benzylidene) camphor (4-MBC), 2-ethylhexyl 4-methoxycinnamate (OMC), homosalate (HMS), 2-ethylhexyl 4-dimethylaminobenzoate (OD-PABA). These are different chemicals with similar effects.

How to Promote Healthy Skin

Healthy skin is more than what you rub on it. Your lifestyle is reflected in your healthy glow—or lack thereof.

Sleep

When you don’t sleep enough, your skin suffers. Insufficient sleep leads to impaired skin barrier function and accelerated skin aging. Sleep deprivation has a direct impact on the integrity of the skin, including the production of collagen. The result is saggier, more wrinkle-prone skin, a sallow complex, and under-eye circles to boot.

Want healthy, good-looking skin? Get plenty of high-quality sleep.

Hydrate

If you’re dehydrated, so is your skin. To maintain skin elasticity, make sure you’re drinking enough water.

And avoid drinking too much alcohol. Alcohol abuse has long been associated with various conditions of the skin, including jaundice, hyperpigmentation, flushing, and psoriasis. While I doubt most readers take their alcohol consumption to abusive proportions, these extreme cases indicate that alcohol isn’t particularly skin-enhancing.

Build a Healthy Gut

The state of your gut biome is central to basically every aspect of your health, so why not your skin? Scientists acknowledge that the state of your gut affects you skin via the “gut-skin axis.” Rosacea, for example, can be a sign of underlying H. pylori infection. Gut dysbiosis—too many undesirable microbes and/or too few of the good guys—leads to leaky gut and systemic inflammation that in turn contributes to skin afflictions like atopic dermatitis, psoriasis, hidradenitis suppurativa, and alopecia. Folks with these skin conditions also tend to have higher rates of ulcerative colitis, Crohn’s disease, and irritable bowel disease. It’s all connected.

Therefore, it behooves all of us to take steps to shore up gut health:

DIY Primal-friendly Skincare

If the idea of researching and choosing safe skincare products has your head spinning, here are some ways you can use simple items you probably already have in your home to nourish your epidermis.

Scrub with sugar or sea salt: Finally, a good use for sugar. Be careful using abrasives on the face, but these are great for the neck down.

Moisturize with avocado oil: Avocado oil is packed with good-for-your-skin nutrients, like carotenoids, healthy fat, and vitamins A, D and E. Together, they can boost collagen production, fade age spots, calm inflammation, and treat sunburns. Pour a few drops in your hand and work it into clean, damp or dry skin.

Remove makeup with jojoba oil: Try the oil cleansing method if you haven’t yet.

Dab on apple cider vinegar: The acidity of apple cider vinegar can potentially help with acne, atopic dermatitis, and psoriasis. Just make sure you dilute it first.

Moisturize with shea butter: Shea butter—packed with stearic, palmitic, linoleic, and oleic acids, as well as vitamins E and A—smooths dry skin like no other. It’s best when used in its purest, rawest form, so seek out unrefined shea butter.

Make your own deodorant spray: I’ve had many readers tell me they no longer need deodorant after going Primal, but if you want something for your pits, mix equal parts vodka and distilled water in a small spray bottle. Add a few drops of your favorite essential oil (lavender and tea tree are nice), and voila.

To Shower or Not to Shower?

Water, the most basic element of hygiene. How could we possibly go wrong there? Grok, for his part, had access to mineral-rich, relatively pristine lakes, rivers, and springs. To really emulate Grok, we’d have to wash ourselves with pure, unchlorinated water (sorry to all those readers who have city water) and abandon all soaps, shampoos, toners, cleansers, and lotions.

Now I know some hardcore individuals who have given up showering and all personal care products. I’m not saying you have to, I’m saying it’s possible. But I also don’t blame you if that’s a bridge too far. That said, if your water is chlorinated to the point where you can smell it, or if you have chronic skin conditions of any kind, consider fitting a water filter to your shower head. And ease up on the soap lathering. Your skin was designed to produce its own oils to provide natural protection against the elements, and a good lather is going to reverse all that hard work. Wash off the dirt, sure. Subject your skin microbiome to an aggressive sand-blasting, no.

Thanks for stopping by, folks. What changes have you seen to your skin since going Primal? What kinds of practices and products do you use for good skin health? Also, what have you stopped doing or buying that made a positive difference?

If you’d like to add an avatar to all of your comments click here!

This post is authored by guest contributor Professor Vishaal Kishore, the Executive Chair of the Cisco-RMIT Health Transformation Lab

The recent report of the Australian Royal Commission into Aged Care Quality and Safety tells us two critical things. First – something systemic is going on in aged care: the elements of the system are not working together to produce optimal outcomes. Second – the issue is one of respect: our system is not treating individuals the way that they ought to be treated.

Our challenge is to find a way to make the Australian aged care system simultaneously more connected, and more compassionate. And this is where technology has a crucial role to play – but the role is a complex one. Done right, technology can be core to making our system more respectful. Done poorly, technology can merely contribute to making a disrespectful system more efficient at being disrespectful.

At the Health Transformation Lab, we – along with Cisco – set out to explore the profound role that technology can play in reorienting our aged care systems around connection and respect. But those of us who work in innovation in the care economy know that words are not enough – so we set out not just to write about why technology can transform aged care, but also to demonstrate how. The end result is something of which we all are deeply proud – in a few short months RMIT and Cisco had been able to demonstrate how technology could be used to improve the experience of people in aged care and also free up much needed time for staff to focus on their core role: delivering care.

Perhaps most excitingly, these technologies all exist right now – our task is just to arrange them and deploy them in new and exciting ways.

In the coming months, the Health Transformation Lab is looking to work with industry partners, providers and others interested in doing something meaningful to improve the lives of people receiving aged care services in a multitude of settings. Based on our initial demonstrations I am confident that government and the sector broadly will start to understand that technology is not something to be balanced against ‘human-to-human’ care, but rather the very thing that enables it.

To learn more about how the collaboration with Cisco combines research and technology to address key recommendations, read our report on Transforming Aged Care.

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Sept. 19, 2022 — If you’re too stressed to sleep, taking time to practice a breathing regimen with ancient roots could help you find your way to slumberland.

The 4-7-8 breathing technique was popularized by Andrew Weil, MD, founder of the Andrew Weil center for Integrative Medicine at the University of Arizona, but it is based on pranayama, the yogic practice of breath regulation, CNN reported.

“What a lot of sleep difficulties are all about is people who struggle to fall asleep because their mind is buzzing,” Rebecca Robbins, a Harvard Medical School instructor and an associate scientist in the division of sleep and circadian disorders at Brigham and Women’s Hospital in Boston, told CNN. “But exercises like the 4-7-8 technique give you the opportunity to practice being at peace. And that’s exactly what we need to do before we go to bed.”

Weil’s website provides these instructions: Put the tip of your tongue behind your upper front teeth and keep it there during the whole exercise. That will make you exhale through your mouth around your tongue and inhale through your nose. Completely exhale with a whoosh sound, then inhale through your nose to a mental count of four. Hold your breath for a seven count. Exhale through your mouth with a whoosh sound for a count of eight.

Repeat this cycle three more times.

“If you have trouble holding your breath, speed the exercise up but keep to the ratio of 4:7:8 for the three phases,” Weil’s website says. “This breathing exercise is a natural tranquilizer for the nervous system.”

Raj Dasgupta, a clinical associate professor of medicine at the University of Southern California’s Keck School of Medicine, told CNN that the 4-7-8 technique appears to activate a person’s para sympathetic nervous system, which is responsible for resting and digesting. The technique reduces activity in the sympathetic nervous system, which is responsible for your fight-or-flight response.

While many people swear by the 4-7-8 technique, its effectiveness is not backed up by much scientific research.

Breathing exercises of all kinds help people relax and get to sleep, Kelly Waters, MD, a sleep medicine physician with Spectrum Health, told Prevention.

“The repetitive nature of breathing techniques is great for the last steps of settling,” she said. “The first stage of sleep is called the ‘hypnic’ stage, and these types of breathing techniques allow for a type of self-hypnosis.”

High blood pressure, heart disease, and diabetes are some of the most prevalent chronic conditions affecting many populations. This is largely so because age, family history, and gender make it nearly impossible for older persons to avoid becoming chronic disease statistics. However, an understanding of these illnesses and their connections can allow for better prevention and, better still, manage them adequately. 

What is High Blood Pressure? 

Blood pressure is the normal force that makes blood move in the circulatory system. Hence, it’s normal for everyone to have blood pressure, the rate at which blood flows in the body. During this flow, oxygen and other nutrients that nourish the organs and tissues in the body are pushed around. Therefore, it’s an essential part of the human body. Blood pressure also acts as an agent to deliver antibodies and white blood cells in the human body. 

However, human blood pressure can be dangerously low or high with every malfunction. High blood pressure will directly increase the risk of coronary heart disease and stroke. That is because when blood pressure is high, the arteries may be more resistant to blood flow, forcing the heart to work harder in pumping blood throughout the body.

What is Heart Disease?

Heart disease is any health condition that affects the cardiovascular system of the human body. Therefore, these heart conditions affect both the heart and the blood vessels. But it is also essential to note that there are different heart diseases. This is because these diseases also manifest and affect the body differently. 

For instance, coronary artery disease, the most common heart disease, affects the blood supply in the human body. This leads to the heart receiving less oxygen and nutrients than contained in normal blood pressure. Arrhythmia is another type of heart disease that occurs when the electrical impulses controlling the heartbeat become faulty. Hence, it causes the heart to beat too slowly, erratically, or quickly.

Diabetes

Diabetes is also a profound illness that affects humans. This disease occurs when the blood glucose or blood sugar is too high. This is so when the blood glucose, the main energy source, doesn’t get into the cells. Ideally, the blood glucose obtained from food should be helped by insulin, a hormone made by the pancreas to get to the cells for energy production. However, it may be a problem once the blood glucose stays in the blood and refuses to move to the cells. 

The connection between blood pressure, heart disease, and diabetes

One of the major connections that blood pressure, heart disease, and diabetes have is that they affect the blood vessels. Blood pressure, as the name implies, has to do with the flow of blood (mostly oxygen and nutrients) to the organs and tissues. Heart diseases and diabetes, on the other hand, also happen due to the malfunction of cells that have to do with the blood. Therefore, every human must pay attention to their heart health. 

Having a haven where you can safely talk about your health problems and how to prevent them is also essential. Ravkoo Health is one of the major healthcare marketplaces that can help you through this process. The reason is that online therapy and diabetes prevention services are available there. 

Another major link these three have is that most of the time, one occurrence often leads to the other. For instance, research shows that about two-thirds of adults with diabetes also use prescription medications to control their high blood pressure. That signifies a high chance of becoming hypertensive when an individual has diabetes. 

Also, there’s a high chance that someone with high blood pressure may eventually suffer from heart disease or stroke. Likewise, a person with diabetes and high blood pressure is more likely to develop heart disease or another condition. Hence, every human, especially adults, must go for regular health check-ups to know how to prevent and control any of these conditions. 

In essence, diabetes is generally a risk factor for any cardiovascular disease. That is because diabetes can cause damage to the nerves and blood vessels around the heart, resulting in heart disease. Most of the time, hypertension and diabetes often coexist, thus leading to more damage than the occurrence of each alone. 

Dealing With These Conditions

The longer an individual has diabetes, the more they are prone to developing a heart condition. Diabetes and high blood pressure are extremely deadly and can greatly increase your heart attack or stroke risk. That’s the reason anyone with diabetes has to go through certain treatments to help them regulate or control their blood glucose. Since diabetes has no cure, proper management from Ravkoo Health is essential to avoid other diseases, especially health-related ones.

Numerous lifestyle modifications can reduce your blood pressure. Most of them are nutritional; however, regular exercise is also advised. For example, most medical professionals recommend brisk walking for 30 to 40 minutes each day, although aerobic exercise can improve your heart health.

Exercise not only lowers blood pressure but also strengthens the heart muscle. It might lessen vascular stiffness as well. Although it usually comes faster due to type 2 diabetes, this occurs as people age. You get to better regulate your blood sugar levels by exercising. You may create a customized workout program by working closely with your physician.

Conclusion

Leading and living a healthy lifestyle is essential to help regulate these conditions. For instance, you should try to eat and maintain a balanced diet. You should also quit smoking and avoid exposure to second-hand smoke. In addition, regular exercise, reducing alcohol intake, maintaining a healthy weight, and engaging in activities that help relieve anxiety and stress are some essential coping techniques.

While the tips are essential, they are not substantial, and you will need professional help. However, there are services at Ravkoo Health that can help if you or someone you love is having trouble managing any of these chronic diseases. Participants in these programs can learn the skills needed to manage chronic diseases’ effects on their lives.

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Gastric sleeve is a type of bariatric surgery for patients who are obese and their weight poses a significant risk to their health. It is also known as sleeve gastrectomy or vertical sleeve gastrectomy. This procedure reduces the amount of food a person can physically eat and fit inside their stomach. After the surgery, a person can expect to lose anywhere from fifty to ninety pounds in twelve months. 

Sleeve gastrectomy is performed using laparoscopy in which several small incisions on the stomach, the laparoscope, and other instruments required for the surgery are inserted. The surgery removed most of the stomach and reshaped the stomach into a narrow tube known as a sleeve. Unlike other bariatric operations, the small intestine is not operated upon. 

However, this surgery is only reserved for people for whom dietary changes and food regulations do not significantly affect their weight. Gastric sleeve surgery is performed in patients with class 2 diabetes with a body mass index of between 35 to 40. This surgery can also help in other accompanying ailments caused due to obesity, like sleep apnea, high blood pressure, cardiovascular diseases, or diabetes. 

A gastric sleeve is usually the last resort as it does carry some risks like any other surgery. Some common ones include bleeding, infection, blood clots, and breathing problems from general anesthesia. Moreover, after the surgery, the body loses its ability to absorb nutrients like calcium, vitamin B12, vitamin D, etc. Gastric problems, heartburn, excessive burping after gastric sleeve, and acid reflux are also common complications noticed with this procedure. 

A person needs to start preparing months before the actual surgery takes place. Bariatric surgeries are not recommended for people abusing drugs or alcohol as they might not be able to commit to permanent changes to their diets for the rest of their lives. Before the surgery, a patient enrolls in an education program to prepare for the surgery and for life after it.

Several physical tests need to take place before the surgery commences. The person might also be told to reduce weight before the surgery as this decreases the liver’s size, significantly reducing the risk. Patients who smoke must stop months before the surgery, and pain medications like ibuprofen, crocin, aspirin, or any blood thinning medications must be stopped. 

How Does The Surgery Take Place?

This surgery is performed under general anesthesia, which makes the person lose consciousness. Several small incisions are made on the stomach through which the laparoscopy is inserted through the upper abdomen. Other tools required for the surgery are also inserted through other incisions made on the abdomen. After this, a tube is inserted that is passed down to the stomach, and a laparoscopic stapler is used to resize and create the sleeve. The remaining portion of the stomach is pulled out through one of the earlier incisions. 

Due to the surgery’s laparoscopic nature, patients can usually leave the hospital during the day of the surgery itself. The recovery period after the surgery is quite long as a liquid diet needs to be maintained for the first couple of weeks and then switched to pureed and solid foods afterward. 

Eating regular solid food before letting the body get used to the new sleeve leads to vomiting, nausea, and stomach pain. It’s advised to chew the food properly before swallowing to ensure no large chunks are swallowed by mistake. After the surgery, regular blood tests are mandatory to ensure the patient has no deficiencies. 

Anastomotic Leaking

Anastomotic leaking happens when food and other digestive fluids leak into the abdominal cavity due to complications after the surgery. Around 1.5 to 6% of bariatric patients face anastomotic leaks, which can vary depending on the type of bariatric surgery performed. The symptoms of this leak begin to surface after only three days of the surgery. 

Some symptoms include increased heart rate, fever, abdominal or stomach pain, shoulder pain, decreased blood pressure, and reduced urine output. 

Anastomotic leaking is also more common in people who are obese, and the heavier a person is, the more at risk they are of developing the leak. 

A CT scan is used to diagnose an anastomotic leak and involves swallowing a dye to see if it is leaking into the abdominal cavity or not. Even if a leak is not detected, the doctor might still recommend an emergency operation just to be safe. If a leak is detected, antibiotics are given through an intravenous line, and the patient is operated upon to drain the fluid surrounding the abdominal cavity and repair the anastomosis. A tube might be inserted connecting directly to the small intestine to supply food until the leak heals properly. 

Anastomotic leaks are not to be taken lightly and can be life-threatening due to the risk of infection and internal bleeding. Moreover, if undetected for a long time, they can also lead to ulcers, internal scarring, and a reduction in the anastomosis’s size, also known as a stricture. Some other risks include pneumonia and fistula, a drainage tract that develops between the gastric sleeve and stomach due to leaking. 

Conclusion

Anastomotic leaks are life-threatening complications that must be addressed as quickly as possible. Some common symptoms to look out for after the surgery are an increased heart rate of about 120 beats per minute or more, high fever, dizziness, and abdominal and shoulder pain. 

Other indicators of a leak might be revealed from blood work as an increased count of white blood cells, and C-reactive proteins are noticed in patients with anastomotic leaks. This is due to the fact that the body is actively trying to fight the infection. 

President Biden’s declaration that “the pandemic is over” could complicate the administration’s effort to battle COVID-19, public health experts say.

Biden made the remarks in a Sunday broadcast of 60 Minutes. “We still have a problem with COVID. We’re still doing a lot of work on it. But the pandemic is over,” he said. “If you notice, no one’s wearing masks. Everybody seems to be in pretty good shape. And so I think it’s changing.”

The president’s comments come as public health officials are trying to convince Americans to get a new booster shot, and as the White House has worked unsuccessfully for months to convince Congress to provide more than $22 billion in new funding for the COVID-19 response. Since Sunday night, Republicans have already used his words to question vaccine mandates that are still in place for the nation’s military and other federally funded programs.

At the same time, nearly 400 Americans are dying each day of COVID, according to the Centers for Disease Control and Prevention.

Multiple public health experts called Biden’s remarks “unfortunate.”

“When you have the president of the U.S. saying the pandemic is over, why would people line up for their boosters? Why would Congress allocate additional funding for these other strategies and tools?” said Dr. Celine Gounder, an epidemiologist and senior fellow with the Kaiser Family Foundation. “I am profoundly disappointed. I think this is a real lack of leadership.”

The remarks could cause political difficulties

The White House is currently fighting an uphill battle in Congress to secure $22.4 billion in emergency COVID-19 funding to support vaccinations, testing and further research. Some Republican support is needed in the Senate to secure the funding, which the administration has been seeking since the spring. It has been hard to come by as some GOP lawmakers argue that there is still unspent money from earlier COVID-19 funding measures that can be used.

In announcing the funding request earlier this month, an official told reporters on a briefing call that there is not currently “enough funding to get through a surge in the fall.” The administration has already stopped the program to send free test kits to Americans because of a lack of funds.

The president’s words could undercut the effort to get this money further.

Republicans are already using the statement to question the justification for ongoing pandemic measures, including the military’s vaccine requirement and mandates for vaccines and masks in federally funded Head Start education programs.

“Biden admitted last night that the COVID pandemic is over. In other words, there is no ‘ongoing emergency’ to justify his proposal for student loan handouts,” said Sen. Marsha Blackburn of Tennessee.

Some public health experts agreed with Biden’s characterization of a “change” in the pandemic. “It is a reasonable thing to do as we collectively move on from this emergency footing that we’ve been on for the last couple of years, and try to navigate a new normal,” said Dr. Bob Wachter, chair of UCSF’s Department of Medicine. “It’s an appropriate way of thinking about the threat as it stands today.”

Acknowledging the shift shouldn’t stand in the way of funds for COVID-related efforts, said Dr. Tom Frieden, who led the CDC during the Obama administration.

“We don’t have a pandemic of Alzheimer’s disease or influenza or heart disease. But Congress still needs to fund programs to address those problems,” he said.

The ongoing booster campaign could face challenges

The Biden administration’s public health leaders have sometimes struggled at times to present a clear, unified message about COVID-19. His administration has at times been criticized for a lack of communication or issuing guidance that seemingly conflicts with available data.

Now, the president’s remarks have thrown another wrench into the mix at a crucial moment.

The administration has just rolled out a new bivalent booster shot designed to target the omicron subvariants that have dominated caseloads in the country in recent months, and the agency is working to convince Americans to go out and get it. (Since the CDC recommended the shot earlier this month, hundreds of thousands of Americans have received it.)

But health officials have long struggled to convince Americans to get their shots. Only 68% of Americans completed their original vaccine course, and fewer than half of those have gotten any booster shot.

Most troubling are booster rates for people over 65, said Jennifer Nuzzo, the director of Brown University’s Pandemic Center. Data from the CDC show that while the vast majority of older Americans got the original vaccines, far fewer – only about a quarter – have also taken the two original boosters.

“If we do nothing else to reduce the number of deaths from COVID, we need to make sure that people who are at the greatest risk of severe illness and death – and that’s people over the age of 65 – that they get their booster,” Nuzzo said. “I don’t want to inadvertently send the signal that that’s not something they need to do anymore.”

She and other public health experts pointed to the winter, when a surge of new cases is likely as cold weather pushes socialization indoors, and holidays prompt people to travel to visit family and friends. A winter wave of cases will require tests, vaccines and other efforts to combat COVID, they said.

“I would say, let’s not declare the pandemic over,” said Dr. Carlos Del Rio, an infectious disease specialist at Emory University. “Let’s say that we’re in a very good place, and we need to continue working hard in order to stay in that good place.”

NPR’s Arnie Siepel contributed reporting.