Hardening Of The Categories: Why We Have A Shortage Of Physicians To Treat COVID-19 Patients

Because science is advancing our understanding of medicine at an exponential rate, physicians and surgeons have been turning to subspecialization as a means to narrow their required domains of expertise.  “Carving out a niche” makes sense in a profession where new research is being published at a rate of two million articles per year. Just filtering the signal from the noise can be a full time job.

However, the consequences of narrowing one’s expertise is that you lose flexibility. For example, an orthopedist who has subspecialized in the surgical management of the shoulder joint doesn’t keep her skills sharp in knee replacement surgery or other general surgical procedures that she once performed. Neurologists who focus on movement disorders become comfortable with a small subset of diseases such as Parkinson’s, but then close their doors to patients with migraines or strokes.

The continued march towards ultra-subspecialization has been a boon in urban and academic centers, but has left spotty expertise in surrounding areas and small towns. And now, the COVID-19 pandemic has unmasked the biggest downside of niche medicine: a hardening of the categories that prevents many physicians from being able to help in times of crisis. Retina specialists, plastic surgeons, rheumatologists, and radiation oncologists (to name just a few) may want to help emergency medicine physicians (EM), internists (IM), and intensivists (CCM) expand their reach as COVID cases surge and hospitals become overwhelmed. But what are they to do? They are not trained to manage airways, place central lines, or monitor renal function, and legitimately fear legal repercussions should they attempt to do so.

Medicine is fundamentally based upon apprentice-style learning – this is why we undergo years of residency training – to stand shoulder-to-shoulder with more senior experts and learn their craft under close supervision. Upon graduation from medical school, physicians are deemed ineligible to treat patients until they have practical experience under their belts. The old adage: “see one, do one, teach one” is the bedrock of how we train. So now, there needs to be a pathway available for those who have completed residency to re-train to meet the demands of this crisis and others.

Perhaps it’s a radical idea to consider pairing subspecialist physicians with current frontline COVID-19 doctors – but turfing patients to “non physician practitioners” or NPPs when access is limited to an emergency medicine specialist,  internist, or intensivist, seems to be the current plan. I believe that medical school and internship are a solid foundation for COVID management (common to all physicians), and that given a designated EM, IM, or CCM mentor, the willing subspecialists will be able to follow protocols and take on new challenges rapidly and with excellence. I hope that the government will issue more detailed “good Samaritan” type laws to protect mentors and their subspecialty partners from frivolous law suits in times of COVID (those in place are for volunteer positions only), and that the house of medicine, led by the AMA and other sub-specialty organizations, will pave the way for rapid cross-disciplinary instruction and certification.

Going forward, there should be opportunities for post-residency, mid-career physicians to complete fellowship programs outside of their sub-specialty’s usual offerings. An ophthalmologist should have the ability to spend a year studying pulmonary medicine, for example, if they want to moonlight with an ICU physician in the future. In our current system, it is very difficult to obtain a fellowship after significant time has elapsed since one’s residency training. While there are a few “re-entry programs” for physicians who haven’t practiced clinical medicine for years, there is no path established for those who simply wish to switch specialties or assist outside of their specialty in a time of crisis.

I am not arguing that a fellowship should be considered equivalent to a residency program. We may need to create a new type of physician certification that allows fellowship-trained physicians from unrelated residency programs to operate under the license of an agreeable mentor/sponsor already established in the field by virtue of medical school and residency training. This would open up employment opportunities for over-specialized physicians, while not threatening those who are residency-trained in the field. In essence, this would allow physicians to operate in the way that NPPs have been for decades, and get subspecialty physicians off the bench and into the fight against COVID and perhaps into underserved areas more effectively as well.

For those subspecialists who have become disillusioned with their field, but still enjoy medicine or surgery – their talent could be retained if there were a path to re-training. An estimated 20% of physicians would change their specialty if they could. Currently, physicians have few clinical options if they no longer wish to practice in the field in which they completed a residency. I suspect that sweeping physician burnout rates (highest among mid-career physicians) could be improved by providing opportunities for “reimagining” themselves – and course-correcting to rekindle the scientific and clinical passion that led them to apply to medical school in the first place.

This would require some mental and regulatory flexibility – which could be a good side effect of the otherwise dreadful COVID pandemic.

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The Paradoxical Under-employment of Rehab Physicians During the COVID-19 Pandemic

I used to joke that for all the hardships of being a physician, at least we had job security. Little did I know that a viral illness would put some physicians “on the bread line.”

The COVID-19 pandemic has negatively impacted the physician workforce in both anticipated and unanticpated ways. While stay-at-home orders decrease temporary demand for cosmetic and elective surgical procedures by dermatologists and orthopedic surgeons, inpatient rehabilitation facilities are also feeling the squeeze, though the number of patients who need their services are growing exponentially (due to post-COVID syndromes).

In states of emergency, hospitals at (or over) capacity have the right to commandeer beds from other units within their system. So for example, if there is a unit devoted to the rehabilitation of stroke or car accident victims, the hospital might re-allocate those beds to COVID-19 patients. There is also financial incentive to do so because Medicare pays 20% higher rates to hospitals for each COVID patient that requires admission.

So what happens when the rehab unit turns into a COVID unit? A few things. First, the patients who need inpatient rehabilitation with close physician monitoring are turfed to nursing homes. Fragile stroke patients, those with high risk for neurological or cardiac decompensation, and inpatients with complex medical problems (such as internal bleeding, kidney failure, or infectious diseases) are sent to a lower level of care without suficient oversight by physicians. These patients often crash, get readmitted to the hospital, or in the worst case, decline too quickly to be saved.

Second, the physicians who take care of rehab patients (rehabilitation physicians, also known as physiatrists) hand over care of the COVID patients (in the former rehab unit) to hospitalists, reducing their own workloads substantially while the hospitalists are overwhelmed and at risk for burn out.

Third, hospitals are struggling to cut costs due to the suspension of their lucrative elective surgical pipelines during COVID surges – and put a moratorium on hiring additional physicians who would normally be assisting with growth and expansion efforts in neuromuscular, brain and spinal cord injury rehabilitation.

Finally, in some cases rehab units are experiencing low censuses not because their beds were commandeered for COVID patients, but because elective surgeries have diminished and patients are afraid of coming to the hospital. Many of those with symptoms of heart attacks, strokes, brain injuries, etc. are staying home and “gutting it out” while reversible or treatable injuries and disabilities become permanent. The devastating toll will be difficult to quantify until normal medical surveillance and care resumes.

Meanwhile, physiatrists with outpatient practices and pain management clinics are experiencing a dramatic drop in patient throughput, with telemedicine visits largely inaccessible to the poor and disabled populations they serve. Those outpatient physicians seek to augment their income with part-time inpatient work, and unprecidented numbers are seeking employment through locum tenens agencies. Unfortunately, agencies have scant inpatient jobs to offer for the reasons I discussed above, and competition is fierce among agencies and physicians alike. It’s often the case that 7 or more agencies will contact a physician within hours of a new job posting, and that job will be filled before the physician can respond – and at an hourly rate 20-30% lower than pre-COVID days (based on my personal experience).

These are some of the unexpected underemployment consequences of the COVID pandemic for one sub-specialty group: physiatry. I imagine the forces at play may be similar for my peers in oncology, neurology, or preventive medicine, for example.

One thing is for sure: emergency medicine physicians, internists, and critical care specialists are facing a tsunami of patients while others of us are sitting on the bench, wanting to help but not trained to do so, “sheltering in place” as the non-COVID march of disease and disability continues apace.

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Homeopathic treatments for anxiety: What to know

Homeopathy for anxiety uses mixtures of herbal, mineral, and other natural products to relieve anxiety symptoms. These very dilute homeopathic concoctions would sometimes be toxic in high doses.

The Anxiety and Depression Association of America report that anxiety is the most prevalent mental health condition in the United States, affecting 18.1% of the adult population each year.

While many people experience relief from therapy, others find that therapy alone is not enough. Anti-anxiety medications may work for some people but can also trigger unpleasant side effects. While there is little scientific evidence to support it, some people find homeopathy helpful.

The Food and Drug Administration (FDA) do not regulate homeopathic treatments, so the ingredients in these treatments may be less consistent and, in some cases, dangerous. It is essential to speak to a doctor before trying homeopathic approaches.

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A person should speak to their doctor before trying any homeopathy product.

The theory behind homeopathy is that “like cures like,” and the lower the dosage, the more effective a treatment can be.

If a person has an illness, a practitioner may recommend that they take very low doses of a substance that would cause the same symptoms as their illness in high doses.

Homeopaths believe that lower doses of the same ingredient might reverse symptoms. There is no conclusive scientific evidence to suggest that these homeopathic remedies work.

The British Homeopathic Association, which uses this approach, highlights the following remedies for anxiety:

  • Arsenicum album: This herbal remedy may help with chronic anxiety, depression, and gastrointestinal symptoms.
  • Ignatia: This may help depression or anxiety following a sudden trauma or shock.
  • Natrum muriaticum: This may help chronic stress and mild depression.
  • Sepia: Sepia may help people who feel drained and unloved, and it may be particularly useful with postpartum mental health issues.

The National Center for Homeopathy also recommend these additional treatments for anxiety:

  • Aconite: Some people believe this can help treat acute anxiety attacks.
  • Argentum nitricum: Practitioners may suggest this for individuals who have anxiety about small spaces, heights, bridges, and personal health.
  • Lycopodium: This may help those who have anxiety due to responsibilities, which may become a fear of failure.
  • Silica: Some people think silica can help those who have a lack of self-confidence and fear of public speaking.
  • Stramonium: Advocates believe this may help people whose anxiety is causing night terrors.

The limited available recent research on these remedies has mostly been in animal studies. For example, one 2012 study found that ignatia might relieve anxiety in mice. The mice who received this remedy displayed reduced physical signs of anxiety.

However, the authors of a 2017 systematic review and meta-analysis looked at 75 trials of homeopathic remedies. They found that “reliable evidence is lacking” and that the quality of the existing evidence was low.

Some other natural treatments with more robust research supporting their use include:

Lavender

Lavender is a popular ingredient in many natural products because of its pleasant aroma.

Some research suggests that lavender aromatherapy may improve a wide range of anxiety symptoms, including symptoms of generalized anxiety and phobias.

A 2010 study compared people with dental anxiety using lavender aromatherapy to those who received no treatment. Only the lavender group reported that their level of anxiety had decreased.

Another 2010 study compared people with generalized anxiety who used a lavender essential oil preparation called silexan to those who took the anti-anxiety drug lorazepam.

Both groups had similar improvements in sleep and anxiety. However, the lavender oil group was less likely to experience grogginess.

Valerian root

Valerian root, which is available in capsule form, may help relieve anxiety in some people. It is a popular home remedy for insomnia.

Some research in animal models, including a 2010 study, suggests that Valerian may help relieve anxiety symptoms. In the study, rats that received valerian displayed a reduction in anxious behaviors.

Learn more about taking valerian for anxiety and insomnia in this article.

Magnesium

According to a 2012 study, magnesium deficiency may cause anxiety. This suggests that magnesium supplementation may reverse anxiety in people who do not get enough of this vital nutrient.

A 2017 systematic review assessed the effects of magnesium supplementation on feelings of stress and anxiety. Researchers found that magnesium did improve symptoms of anxiety. However, the quality of the evidence was low, pointing to the need for more data.

Learn more about the symptoms of a magnesium deficiency in this article.

Passionflower

Passionflower has a long history of use as a sedative and may help relieve anxiety. The authors of a 2017 review found good evidence for its effectiveness in helping treat anxiety and nervousness.

Learn more about the benefits of passionflower for anxiety and insomnia in this article.

The fact that a remedy is “natural” does not mean that it is safe. The risks of using homeopathic treatments include:

  • interactions with other drugs
  • ingredients that the label does not list
  • contamination of ingredients
  • formulations that vary from bottle to bottle
  • safety issues that researchers have not studied or documented

The Food and Drug Administration (FDA) do not evaluate the claims that homeopathic supplement manufacturers make. This means there is no certainty that the products work even when the manufacturers claim they do.

A person using homeopathic treatment for anxiety may also be at risk of allergic reactions or negative side effects.

Having anxiety does not necessarily mean a person needs to take medication. In fact, therapy, meditation, diet changes, exercise, and other lifestyle changes can be highly effective.

People can speak to a doctor or specialist, such as a therapist or psychiatrist, for help choosing the right treatment.

Anxiety is highly treatable with the right combination of therapy, lifestyle changes, and, in some cases, medication.

While some natural remedies can make good complementary treatments for people with anxiety, there is little scientific evidence that homeopathy is safe or effective.

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6 evidence based ways to calm down

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Top 10 evidence based supplements for anxiety

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Health24.com | How masturbating, breathing and 23 other simple habits can make you the healthiest you’ve ever been

You know the basics of what you need to do to help your health: Eat right, get moving and stop smoking.

Those are the majors, but as any guy who lifts to build muscle knows, the accessory work is pretty damn important, too.

Just like how you need to give your smaller muscles some love if you want to build a truly impressive physique, you have to pay attention to the little stuff if you want to become the healthiest man you can be.

The good news is, tons of these health accessory work is super easy to implement. The harder part? It can be difficult to know what you really need to focus on.

So we’ve taken the guesswork out of it for you. We picked the brains of 25 of the top doctors, nutritionists, sex therapists and other wellness experts out there to determine the single best thing you can do to help your health.

We’re not talking large, overarching life changes – these are the simple, small things you can get started on right now.

Take a read through the list and pick out the ones you want to try. Your body and mind will thank you.

1. Make time for masturbation

Take your health into your own hands. When your stress levels peak, masturbation can help you unwind, says relationship therapist Paul Hokemeyer, PhD. That’s because reaching orgasm will release a whole slew of feel-good hormones, like oxytocin and prolactin, which leave you with that calm, sleepy feeling you typically experience after climax.

“Too often we forget that our bodies are incredible machines that can provide us with all sorts of wonderful coping and performance mechanisms,” says Hokemeyer.

And while it works wonders for your mood, masturbating can also help prevent prostate cancer, the third leading cause of cancer death in men.

In fact, men between the ages of 20 to 29 who ejaculated 21 times or more each month are 19% less likely to be diagnosed with prostate cancer than those who ejaculated less often, according to research from Boston University.

Read more: 11 shocking facts you never knew about masturbation

2. Spot the ugly ducking on your skin

Melanoma isn’t the most common kind of skin cancer, but it’s responsible for the greatest number of deaths. You can increase your chances of beating the cancer by catching it early.

Normal moles can grow and change, but they usually do so symmetrically and very slowly over the course of years, says Dr Saira J George, an assistant professor of dermatology at the University of Texas MD Anderson Cancer Centre.

Any mole that is changing in size, shape or colour within weeks or months warrants special attention. But pay extra special attention if the mole in question is an “ugly duckling” that looks different from the rest of your other moles.

Doctor checking a man's mole.

Read more: 5 cancers that kill men – and how to spot them before it’s too late

3. Mind your breath

“For the first 10 minutes of your next workout, commit to breathing solely through your nose,” suggests Nathan Helming, head coach and co-founder of The Run Experience.

“The reduced airway passage will force you to breathe more deeply to fully engage your diaphragm for more powerful and relaxed belly breathing. It works if you’re going on a run, taking a spin or even lifting weights on your own.”

After you practice this for the first time, you’ll quickly realise how often you tense up and hold your breath in your chest, neck and shoulders. This type of tension can actually lead to greater stress levels, poorer performance, and even side-stitches and cramps, explains Helming.

4. Perform a daily tick check

Do a tick check daily, paying extra close attention to anything below the belt that’s about the size and colour of a poppy seed, says Dr Thomas Mather, director of the TickEncounter Resource Centre at the University of Rhode Island.

That can be a nymph-stage tick, which can be loaded with disease-causing germs, like the bacteria that causes Tick Bike Fever. These ticks typically latch on at shoe level and crawl up, until they get “stuck” where underwear or skin folds restrict their further ascent.

So when you’re sitting on the throne each day, check your scrotum and penis for any spots that fit the bill. And if you do see one, remove it with a tweezers.

Despite what you may have heard about a lit match getting rid of the buggers, it’s never a good idea to touch a hot object to a tiny tick attached to your scrotum.

5. Check out your chest

Men can also get breast cancer – about 2 500 cases are diagnosed in the US this year alone, says Dr Sharon Giordano, chair of the department of health services research at the University of Texas MD Anderson Cancer Centre.

If you develop any symptoms like a lump under your nipple or bleeding from your nipple, head to your doctor for further evaluation, as these can be signs of breast cancer in guys.

Your doctor may order a mammogram, ultrasound or biopsy to check for cancer.

6. Have ‘The Talk’ 

Four out of every five men don’t talk to others about their sexual health – or any health issue, for that matter, a survey from Orlando Health found. That’s a problem, since knowing where you stand health-wise can help ensure your equipment works years down the line, says Dr Jamin Brahmbhatt, a urologist at Orlando Health.

So talk with your partner about STI history, and your family about any health risks that may affect you, like high blood pressure, obesity or diabetes. All those conditions can lead to problems with erections down the road, so if you know you’re at genetic risk of them now, you can be on the lookout for signs and symptoms that might be signalling them.

That means you may be able to start medical treatment – and lifestyle changes – as soon as possible. And that can help prevent problems with your penis before they start.

7. Calm your mind

Stress is a culprit behind six of today’s leading causes of death, says Dr Marlynn Wei, a New York City psychiatrist and author of The Harvard Medical School Guide to Yoga.

 But as little as five minutes of mindfulness a day can tamp down stress and improve your health.

“Pick a regular time that works best for you – in the morning or before bed – and make your practice part of your normal routine,” she says.

Try evenly paced yoga breathing, guided audio meditation or a few yoga poses. Or just take a few minutes every morning to set an intention for the day.

“Regular, consistent practice is key – and it will become easier over time,” she says.

Man relaxing on the grass

8. Get your heart pumping 

“Exercise at least 30 to 40 minutes a day most days of the week,” says Dr Prediman K Shah, director of the Oppenheimer Atherosclerosis Research Centre and Atherosclerosis Prevention and Treatment Centre at the Cedars Sinai Heart Institute.

He recommends cardio most days a week and weights twice a week.

Read more: Most effective fat burning workout

9. Protect your pearly whites

The number one thing you can do for your teeth is obvious: Brush twice a day for two minutes with fluoride toothpaste, every dentist ever is obligated to tell you.

But this year, you should also be wary of a common tooth saboteur: sports drinks. They stain teeth and erode enamel, studies show.

If you use them, “drink the clear sports drinks,” says Dr Mark S Wolff, chair of the department of cardiology and comprehensive care at the New York University College of Dentistry. That can help alleviate stain risk.

10. Fill up on fibre

The average guy consumes less than half the recommended 30 to 38g of fibre per day, and that’s a problem.

“One of the most unsung heroes of a healthy diet is dietary fibre,” says Dr Akash Goel, a gastroenterologist at New York Presbyterian Hospital.

Fibre helps you keep your cholesterol and blood sugar levels under control and protects you from heart disease, diabetes and obesity.

Dr Goel recommends adding more greens, beans and seeds your diet. His favourites are mustard and collard greens, split peas and lentils, and chia or flax seeds.

When you shop for groceries, calculate the carb: fibre ratio, or the grams of carbs, dividing by the grams of fibre.

“Your benchmark number should be 10:1, which is the natural carb:fibre ratio in unprocessed wheat, a true whole grain,” he says. If the ratio is 5:1 or lower, even better.

“If you must eat bread, for example, go for one which has a carb:fibre ratio of 3.5:1,” he says.

11. Think like a dad

A paternal instinct could be good for you. “Run every decision about your own ‘health’ through this filter: will it help my kids have the best possible future?” says Dr David Katz, director of the Yale University Prevention Research Centre.

This strategy works because it covers everything.

“For our kids to thrive, we need to be kind. For them to care about nutrition, exercise, sleep, managing stress, avoiding toxins like tobacco – we need to show them we care. For them to have the planet they deserve – vital, vibrant, sustainable – we need to care about that now, and show it.”

All these things will benefit the next generation – and you.

A father and son playing outdoors

Read more: Rugby powerhouse Siya Kolisi on fatherhood

12. Take your holiday days

And don’t spend the whole time checking work email.

“Holidays improve sleep, boost creativity, reduce inflammation and stress, enhance immunity, and help you reconnect with your closest friends and family, which in turn creates a positive cascade,” says Dr Murali Doraiswamy, a professor of psychiatry and behavioural sciences at Duke University.

“There is no drug invented that can positively transform every tissue in your body as dramatically as a vacation can.”

Take a long vacation in the summer but sprinkle short ones throughout the year as well to sustain benefits.

13. Make minor goals to hit your major ones

Setting big, overarching fitness goals is great, but sometimes they can seem daunting. So here’s what to do, suggests trainer Tony Gentilcore, owner of CORE in Boston, US. Pick two or three “process goals” or small, more manageable goals that will help you work towards your main one.

For instance, say you want to squat twice your bodyweight. Instead of focusing solely on the sets, reps and load that will help you get there, make supplementary goals to work on it from another angle.

These could be ones like hitting the gym at least three times a week or setting aside seven to eight hours for quality sleep each night. Write your goals on a calendar and tack it up on the fridge, checking off each day you complete it. Shoot for 90% compliance by the end of the week.

Read more: Why all men should deep squat for 5 minutes a day

14. Prep your meals

A 2012 study published in the Journal of Personality and Social Psychology found that you spend up to four hours a day resisting temptations and desires. The number one desire is food, says nutritional advisor Dr Mike Roussell.

“I have noticed that clients get themselves into trouble with their diets when they wait until the last minute to decide what they are going to eat, as they succumb to whatever desire or urge they are having at the moment,” says Dr Roussell.

Planning when and what you are going to eat prevents you from succumbing to cravings, so prepare your meals ahead of time whenever possible, he suggests. When it isn’t possible, map out what you are going to eat and where, says Dr Roussell.

For example, if you’re going out to eat, take a look at the menu before you go, so you can take a glance at your options and commit to a healthier choice before you’re tempted by that fried chicken sandwich.

Meal prepping

15. Have lots of sex

Getting it on is good for you: A study published in the British Medical Journal found that men who had orgasms twice a week had half the risk of dying – even when the researchers took general health and fitness into account, says sex researcher Robin Milhausen, a professor of family relations and human sexuality at the Univeristy of Guelph in Canada.

In fact, having sex three or more times a week might cut your risk for heart attack and stroke by half, a follow-up study indicated.

But there are other benefits to having sex, she says, like improving your mental wellbeing and boosting intimacy between you and your partner.

Don’t assume you have to do it every night to notice the mental difference, either. Couples who do the deed more than once a week aren’t any happier that those who have weekly, suggests Canadian research.

Read more: Having sex once a week is the equivalent of a raise

16. Go back to the basics

“Each day, aim to eat about six to eight palm-sized portions of protein-rich food and six to eight fist-sized portions of vegetables. Protein and vegetables are the two most important food groups to help you reach your body composition and health goals,” says nutrition and exercise expert Brian St. Pierre, director of performance nutrition at Precision Nutrition.

Loading up on protein helps keep your hunger at bay, meaning you’ll feel fuller for longer. Plus, protein revs your metabolism and helps you build and preserve hard muscle.

As for vegetables? They’re nutrient powerhouses – loaded with filling fibre and water, vitamins, minerals and health-promoting phytonutrients, he says.

17. Make your car a sun shield

Install UVA/UVB clear coating on your car windows. It protects your eyes and skin from DNA damage that can lead to eye disease, skin cancer and premature ageing, says Dr Kimberly Cockerham, a surgeon in Plastics-Orbit-Neuro-Ophthalmology at Centre Valley Eye.

This doesn’t replace sunscreen, “but rather enhances its efficacy”, she says.

18. Walk your way to weight loss

If you’re looking to shed kilos, but have no idea how to start, try going for a 30 to 60 minute walk after one of your meals, suggests obesity specialist Dr Spencer Nadolsky.

If you have issues starting a workout routine, whether it’s physically out of reach or you haven’t found the motivation, walking won’t seem as daunting of a task.

“Going for a walk after a meal will not only help with your weight, but it will keep your blood sugars down, too. Plus, if you have a significant other it’s a great time to spend with them,” says Dr Nadolsky.

Not only that, but research suggests that walking can minimise your cravings, help you sleep better and even help you de-stress.

While it doesn’t seem like you’re working your body hard, you’ll burn more kilojoules walking than you would sitting on the coach, tempted by that post-dinner dessert. And who knows, maybe those walks will eventually turn into runs?

A couple walking their dog

19. Get vaccinated against cancer

Rates of cancers affecting the tonsils, base of the tongue and throat are rising – and the increase is due in large part to oral strains of human papilloma virus (HPV) that affect the mouth.

The good news is the HPV vaccine can help protect against these cancers if it’s given early enough, says Dr Eric Sturgis, a professor in the department of head and neck surgery at the University of Texas MD Anderson Cancer Center.

Kids should get a two-dose regimen of it before their 13th birthday, but if you missed out back then, you can reduce your risk of HPV-associated cancers through a three-dose catch-up series up until age 26.

20. Eat your greens

Aim to eat at least one serving of leafy greens, like kale and spinach, at every meal, says registered dietician Keri Glassman. Green vegetables offer a powerful dose of fibre, vitamins and minerals, including antioxidants and phytochemicals which have been shown to prevent heart disease and may help reduce the risk of cancer.

Experts believe that the carotenoids in leafy greens act as antioxidants, slowing the damage that free radicals cause our bodies, before they can do harm, says Glassman. Add variety to your diet or your go-to spinach salad by roasting hearty green veggies like broccoli rabe or blending beet greens into your smoothie.

21. Give yourself a break

If you want to take care of your mind, try being nicer to yourself.

“None of us are perfect, yet we often act as if we should be. We tend to give our friends a lot of leeway when they make mistakes, but we are often very harsh with ourselves,” says Dr Fred Rabinowitz, a professor of psychology at California’s University of Redlands.

“By beating yourself up, not only do you feel bad, but you also add extra pressure on yourself to not mess up, which interferes with performance.”

So, what’s a guy to do? Treat yourself like you would a friend, says Dr Rabinowitz. Give yourself a break so you have the energy to do better, rather than carry around the baggage of being angry with yourself.

The best way to do that is by being just as compassionate with yourself as you would be with your best buddy. Either out loud or mentally, give yourself a pep talk as if you were talking to him.

Try something like “You made a mistake, but you’re okay. You will fix it and move on.” Or, “Everyone makes mistakes. You didn’t intend to have it go this way. Learn from it and move on.”

22. Eat a handful of walnuts 

“Incorporating small snacks between meals will help increase your energy, keep your hunger at bay, and adds to your daily nutrient intake,” says certified exercise physiologist Jim White, owner of Jim White Fitness Studios.

Focus on 100 to 200 calories with a mix of protein, carbohydrates, and healthy fats at least two to three times per day, he says. Choose something like walnuts, which boast 4g of protein, 2g of fibre and the highest amount of plant-based omega-3 fatty acids over any other nut, in just one ounce.

“Pair them with non-fat Greek yogurt or eat all on their own, you’ll be getting a snack packed with optimal nutrients,” says White.

A handful of walknuts

23. Put a daily ‘check-in’ on your calendar

Talking to your partner can help ward off the stresses of everyday life, says sex researcher and relationship therapist Dr Sarah Hunter Murray.

“When our romantic relationship is running smoothly, it acts as a buffer that helps weather the storm of other stresses we might be facing in our lives. But if we’re feeling stressed in our relationship, it’s going to have the opposite effect,” she explains.

“To help keep stress low in your relationship, the best thing to do is talk often and openly.”

So make time every day to check in with your partner. While you don’t want to bring up every gripe and grievance you have with her, your feelings can crop up in less healthy ways if they aren’t properly addressed, so it’s important to share the harder things that are bothering you, too.

Feeling your partner “jokingly” put you down in front of your friends or seeing her put work ahead of spending time with you can manifest as bad eating habits, drinking or zoning out in front of the TV instead of going to the gym, says Dr Murray.

But when you address your issues head on, you’ll feel lighter – and that reduced stress helps in all areas of your wellbeing.

24. Roll up your sleeves

Even if you’re a healthy guy, there’s one shot you need to get each year: the flu vaccine, says board-certified infectious disease specialist Dr Brent W Laartz, author of How to Avoid Contagious Diseases.

Thousands of deaths could prevented each year if everyone got the shot, he says. (If you’re over 65, have a chronic illness, or smoke, you want to get the pneumonia vaccine, too.)

And when you make your appointment for the flu shot, schedule it for the morning. Research from the University of Birmingham in the UK found that people had twice the number of flu antibodies – proteins that your body produces to fight off infection – after receiving the shot between 9am and 11am than those who got it between 3pm and 5pm did.

25. Stop pain fast

To protect against developing chronic pain, there are three things to keep in mind, says Dr Paul J Christo, an associate professor at Johns Hopkins Medicine and author of the upcoming book Aches and Gains: A Comprehensive Guide to Overcoming Your Pain.

First, don’t wait it out. If you’re in any kind of pain, see treatment fast. The more you wait, the more difficult it can be to treat. Secondly, reach out for help, whether it is a specialist or a support group. Finally, be open to traditional, integrative and innovative pain therapy options out there.

This article was originally featured on www.mh.co.za

Image credits: iStock

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Health24.com | ‘Chemotherapy is scary but I got through it’

“It was during breast cancer awareness month, October 2016, when I found a lump in my breast,” Simòne Schultz says.

“An advert on TV reminded me that I had not done a self-examination in a while, and the minute I put my hand down I felt a lump.”

Simòne was in her third trimester of pregnancy.

“I wasn’t too worried. My gynae felt the same when I called the next day to let him know. A few weeks later he did a fine needle biopsy and three days later I got the call. It wasn’t good news… They had to deliver my baby a few days earlier and do another biopsy. It was not a death sentence.”

Seven days later, Simòne’s daughter, Kylie, was born. “She was absolutely perfect.”

Her stay in the maternity ward was half for baby, half for scans and tests.

“I was officially diagnosed in my hospital bed in the maternity ward and started chemotherapy when my daughter was three weeks old. It meant many nights away from her, but I accepted that I could not be everything she needed me to be at that time, and that getting better was my main priority.”

Simone with her daughter Kylie during cancer treat

Simòne and her daughter Kylie during chemotherapy

Chemo is a scary word

“Chemotherapy is a very scary word but I got through it,” Simòne says. “The wonderful oncology nurses are angels and they guided me through my six months of treatment. I had a lumpectomy in June and have completed 33 radiation sessions. Yes, I get tired, I am tired!”

Cancer treatments combined with two children under the age of five is definitely not easy, she says, but somehow you find a way to make it work.

“My husband, family and friends have been absolutely amazing through this whole ordeal. People that I hardly knew were showing me their support, even strangers. I do allow myself to feel sad too – I cry, I get it all out and then I let it go.”

Simone Schultz with her kids on the last day of he

Simòne with her children, Kylie (who is turning one on 14 November 2017) and Cody (who turns five in February 2018). 

Being a survivor 

“I’m proud of myself for handling what I have gone through. I was the type of person that gets paranoid and thinks the worst of the slightest ache and pain. Now, dealing with cancer l realise I’m a lot stronger than I could ever have imagined. With God by my side, how could I not be?”

Simòne says she knows that she will always worry about things a little more now.

“I will have to have regular scans and check-ups; that’s all part of the parcel when going through cancer. But life is carrying on at the moment and I don’t think about cancer when I wake in the mornings. I am adjusting to my new life and embracing my new normal.”

Image credits: Supplied and Cotton & Rust

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Health24.com | How pregnancy can make you absent minded and forgetful

You’ve lost your keys again. And, for the third time this week you find your cellphone in the fridge. No, you’re not losing it. It’s just “pregnancy brain”.   

Pregnancy brain, also called momnesia or pregnesia, is the forgetfulness and brain fog many pregnant women experience. It’s a real and frustrating hallmark of pregnancy, affecting as many as 50 to 80% of expectant moms.  

If you suffer from pregnancy brain, you may forget why you walked into a room, where you put your purse, whether you switched off the washing machine, or leave objects in strange places.

A gush of hormones

Pregnancy unleashes a flood of hormones in your body. These hormones trigger major physiological changes, and interfere with your thinking and memory. On top of that, surging hormone levels can make you tired. Fatigue can shorten your attention span and slow your thought process.  

Not getting enough good quality sleep, which is a common struggle for many pregnant women, may also play a role. Sleep deprivation and disruption can affect how mentally sharp you feel, and lead to memory loss. It can make you more anxious and stressed, which can impact your ability to concentrate and remember things.

New priorities may also help explain why pregnancy has you feeling like a ditz. You may spend a lot of time thinking and worrying about your baby, and how motherhood will change your life. These thoughts can be overwhelming and distracting, and may leave you feeling forgetful and absentminded.

On the upside: some experts believe that memory change during pregnancy is evolutionary. It’s been suggested that pregnancy brain helps you forget other things and focus more on caring for your child. This may prepare you to become a better mother.

According to Dr Laura Glynn, a psychologist at Chapman University in California, even the slightest movement of the foetus in the womb can affect a woman’s brain and make her become more sensitive. This may help mothers become more attuned with their baby and prime them for caregiving.  

The good news is that pregnancy brain is temporary and doesn’t reshape or rewire your brain.

‘Mind your mind’

  • Work from a to-do list. Track your daily doings and mark them off once you’ve completed them. Stick Post-it notes around the house to help you remember simple things.
  • Set reminders on your cellphone, tablet or laptop.
  • Delegate as much as you can so you’ll have fewer things to remember or worry about.
  • Get a dose of choline. This mineral is the building block for the memory-forming brain chemical acetylcholine. Fill up with eggs, chicken, fish, spinach and peanuts.
  • Up your omega-3s. This nutrient is essential for brain health and may help boost memory. Find omega-3s in salmon, sardines, walnuts, flaxseeds and chia seeds. 
  • Avoid trying to do everything at once. Focus on one task at a time. You’ll feel more clearheaded and less forgetful.
  • Get plenty of sleep. Sleep is needed to learn and make memories, and stay mentally alert.
  • Don’t be too hard on yourself when you do forget things. Take a deep breath and try to keep calm. Stressing will only cloud your preggy brain even more. 
  • Laugh it off. Have a sense of humour about this airhead stage and get your partner to do the same.

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Health24.com | Postpartum depression likely in subsequent pregnancies

Between 10 and 30% of all mothers suffer from postpartum depression. It can happen any time after the baby is born, not only in the first few weeks after the birth. It can be mild or severe.

A new Danish study shows that women who have suffered from postpartum depression are more likely to go through it again after subsequent pregnancies.

Cushioning the blow

Postpartum depression occurs 27 to 46 times more frequently during subsequent pregnancies for mothers who experienced it after their first birth, researchers report.

These results show that women who have had postpartum depression in the past should prepare themselves if they get pregnant again, said lead researcher Marie-Louise Rasmussen, an epidemiologist with Statens Serum Institut in Copenhagen.

Antidepressants or psychotherapy could help cushion the blow or even head off postpartum depression, Rasmussen said.

“In theory, psychotherapy is preferred but not always sufficient and not always available. Often, the general practitioner has to add antidepressant medication,” Rasmussen said. “Social support from the spouse and surroundings is also very important.”

Resolved within a year

In most cases, women can expect to shake off their postpartum depression within a year, the researchers found.

“Based on this data, we would think for most women who receive treatment, their depression should be treated and resolved in six months or less,” said Dr James Murrough. He’s director of the mood and anxiety disorders program at the Icahn School of Medicine at Mount Sinai in New York City.

Postpartum depression generally takes hold of a new mother within days of delivery, although sometimes depression develops during pregnancy, according to the US National Institute of Mental Health.

Why does it occur?

Brain chemistry changes caused by post-delivery hormone fluctuations are a contributing cause of postpartum depression, along with the sleep deprivation experienced by most new parents, NIMH says.

Signs of postpartum depression can include feelings of sadness and hopelessness, frequent crying, anxiety or moodiness, changes in sleeping or eating patterns, difficulty with concentration, anger or rage, and loss of interest in activities that are usually enjoyable, according to the mental health institute.

A new mother with postpartum depression also might withdraw from friends or family and have difficulty forming an emotional attachment to her baby.

A bolt out of the blue

Rasmussen and her colleagues undertook this study to provide women facing pregnancy with better estimates of their overall risk of postpartum depression.

“Postpartum depression is a disease depriving families of a time period that should be filled with affinity, love and bonding,” Rasmussen said. “Especially for women with no prior experience with psychiatric disease, this must come as a bolt out of the blue.”

The researchers analysed data from Danish national registries on more than 457 000 women who delivered their first child between 1996 and 2013 and had no prior medical history of depression.

They reviewed medical records for signs of postpartum depression – specifically whether these women filled an antidepressant prescription or sought treatment for depression within six months after giving birth.

About 1 in every 200 women experienced postpartum depression, the researchers found.

But within a year of seeking care, only 28% of these women were still being treated for depression, the results showed. And four years later, that number was 5%. This new study was published in the journal PLOS Medicine.

Why treatment is important

The risk of postpartum depression in subsequent births was 15% for women who took antidepressants following their first birth and 21% for women who sought depression treatment at a hospital. That amounts to a 27 and 46 times higher risk than for women who didn’t experience depression during their first pregnancy, the researchers said.

“The episodes were characterised by a relatively short treatment duration, yet a notably higher rate of later depression and recurrent episodes of postpartum depression,” Rasmussen said.

The higher risk for women who’ve already experienced postpartum depression “suggests that there’s some underlying vulnerability to develop depression in these particular individuals,” Murrough said. “Basically, it’s not random. If you had it before, you could have it again.”

Murrough and Rasmussen urged pregnant women to discuss the risk of postpartum depression with their doctor, particularly if they suffered it before.

Tips on coping

The South African Depression and Anxiety Group (SADAG) gives the following tips on how to manage postpartum depression:

  • Don’t hesitate to ask for help.
  • Be realistic about your expectations for you and the baby.
  • Follow a healthy diet and get some exercise.
  • Make time for your partner and family members.

Image credit: iStock

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