Harvard Health Blog

Harvard Health Blog http://www.health.harvard.edu/blog Harvard Health Blog: You’ll find posts from Harvard Medical School physicians and our editors on a variety of health news and issues. Tue, 18 Jul 2017 16:05:00 +0000 en-US hourly 1 http://www.health.harvard.edu/images/misc/logo-HHP_shield.png Harvard Health Blog http://www.health.harvard.edu/blog 102 120 Harvard Health Blog: You’ll find posts from Harvard Medical School physicians and our editors on a variety of health news and issues. 6 ways to keep your child safe this summer http://www.health.harvard.edu/blog/6-ways-keep-child-safe-summer-2017071812077 http://www.health.harvard.edu/blog/6-ways-keep-child-safe-summer-2017071812077#comments Tue, 18 Jul 2017 14:30:59 +0000 http://www.health.harvard.edu/blog/?p=12077 With all the outdoor activities available to kids during the summer, it’s a good idea to take a moment to consider these tips to make sure everyone plays and stays safe.The post 6 ways to keep your child safe this summer appeared first on Harvard Health Blog.]]> Follow me on Twitter @drClaireIt’s summer — time for vacations, summer camp, outdoor activities, and all sorts of other fun. Some of those fun summer activities, though, can have health and safety risks.Here are six things you can do to help be sure that everyone’s summer memories are good ones:Use sunscreen. This sounds obvious, but often we still forget to use it. We remember when we go to the beach or pool, but we don’t always think of it when we go sightseeing, do gardening, go to an outdoor event, or just play outside. If your child is going to be out in the sun, use sunscreen. Use a sunscreen that is water resistant, at least SPF 30, and blocks both UVA and UVB rays. Cover all exposed skin, and remember to reapply every couple of hours, sooner if your child has been in the water. Not only does this protect your child from the discomfort of sunburn, it may prevent future skin cancer.Make sure your child is always supervised around water. Never rely on flotation or safety devices such as lifejackets; while they can be helpful and should be used whenever recommended (like when kayaking or on other boats), there is simply nothing that takes the place of constant supervision. Drowning can be very quiet; if you wait to hear your child yell for help, you will miss it. Summer can be a good time to improve your child’s swimming skills. While even good swimmers can drown, all children should learn to swim; check out swimming lessons in your area. And remember, if you have a pool, it should be fenced on all sides, separated from the house, and have a self-latching or self-locking gate.Use insect repellent. Experts are saying that this year could be a bad one for ticks especially, and while most of the time mosquito bites just lead to itching, they can lead to illnesses like West Nile or Zika. So along with getting into a sunscreen habit, get into the habit of using insect repellent when your child goes outside. The chemical that gives the best protection against both mosquitoes and ticks is DEET (N, N-diethyl-meta-toluamide). The higher the percentage of DEET, the longer it protects; don’t use higher than 30% on children, and don’t reapply. While the most common side effect of DEET is skin irritation, there is a very small risk of brain effects such as seizures. Oil of lemon eucalyptus can be effective as well and has fewer side effects, so it can be a good choice if the risk of bites is a bit lower. The Environmental Protection Agency has a great tool that can help you choose insect repellents based on what you are trying to protect against and for how long.Make sure your child wears a helmet when recommended. Whether it’s biking, riding a scooter, or playing sports such as baseball or football, helmets can keep your child’s head — and brain — safe. The Consumer Product Safety Commission has some really useful information for choosing the right and best helmet for different activities.Use your lawn mower safely. Every year, thousands of children are hurt due to lawn mowers, and some of those injuries can be serious. Remember that a child should be at least 12 years old before using a push mower and at least 16 before a riding one, and that sturdy shoes and eye protection are crucial for whoever uses the mower. Always check the lawn before mowing to look for anything that might become a projectile, and when purchasing a push mower, look for one that stops moving forward when the handle is released. If you have young children, it’s best to have them play inside when you mow. The American Academy of Pediatrics has a video that reviews lawn mower safety tips.Review what to do if your child gets lost or separated from you. When you are outside, especially in the woods or in crowded public places, it’s easy to get separated. While cell phones are helpful, not all children have them, you can’t count on reception, and the battery doesn’t last forever. Whenever you go somewhere, talk about what to do if you get separated. Have a meeting place, identify the “helping people” such as staff or policemen that are safe to go to, and otherwise talk through possible scenarios. It only takes a minute to do and can make all the difference.The post 6 ways to keep your child safe this summer appeared first on Harvard Health Blog.]]> http://www.health.harvard.edu/blog/6-ways-keep-child-safe-summer-2017071812077/feed 1 12077 https://www.facebook.com/sharer/sharer.php?u=http%3A%2F%2Fwww.health.harvard.edu%2Fblog%2F6-ways-keep-child-safe-summer-2017071812077 ]]> Safe summer grilling tips http://www.health.harvard.edu/blog/safe-summer-grilling-tips-2017052611805 //hhpblog.s3.amazonaws.com/blog/wordpress/wp-content/uploads/2017/07/iStock-481761080-Copy.jpg 2017-07-18 10:30:59 2017-07-18 14:30:59 6 ways to help keep your baby at a healthy weight http://www.health.harvard.edu/blog/6-ways-to-help-keep-your-baby-at-a-healthy-weight-2017041111575 //hhpblog.s3.amazonaws.com/blog/wordpress/wp-content/uploads/2017/07/iStock-481761080-Copy.jpg 2017-07-18 10:30:59 2017-07-18 14:30:59 Summer is the perfect time to fine tune your diet http://www.health.harvard.edu/blog/summer-perfect-time-fine-tune-diet-201607149967 //hhpblog.s3.amazonaws.com/blog/wordpress/wp-content/uploads/2017/07/iStock-481761080-Copy.jpg 2017-07-18 10:30:59 2017-07-18 14:30:59 Asking saves lives: A simple question can keep children safe from gun injury http://www.health.harvard.edu/blog/asking-saves-lives-a-simple-question-can-keep-children-safe-from-gun-injury-2017062011913 //hhpblog.s3.amazonaws.com/blog/wordpress/wp-content/uploads/2017/07/iStock-481761080-Copy.jpg 2017-07-18 10:30:59 2017-07-18 14:30:59 An easy way to eat healthier this summer: Find a farmers’ market http://www.health.harvard.edu/blog/easy-way-eat-healthier-summer-find-farmers-market-201606239872 //hhpblog.s3.amazonaws.com/blog/wordpress/wp-content/uploads/2017/07/iStock-481761080-Copy.jpg 2017-07-18 10:30:59 2017-07-18 14:30:59 //hhpblog.s3.amazonaws.com/blog/wordpress/wp-content/uploads/2017/07/iStock-481761080-Copy.jpg Most cases of pink eye (conjunctivitis) don’t require antibiotics http://www.health.harvard.edu/blog/cases-pink-eye-conjunctivitis-dont-require-antibiotics-2017071712032 http://www.health.harvard.edu/blog/cases-pink-eye-conjunctivitis-dont-require-antibiotics-2017071712032#respond Mon, 17 Jul 2017 14:30:54 +0000 http://www.health.harvard.edu/blog/?p=12032 While bacterial conjunctivitis responds to antibiotic treatment, many people with the more common viral type are prescribed antibiotics unnecessarily, which contributes to increased resistance to these medications.The post Most cases of pink eye (conjunctivitis) don’t require antibiotics appeared first on Harvard Health Blog.]]> If you or your child has ever had acute conjunctivitis or “pink eye,” you know how nasty it can be.  “Crusty,” “goopy,” “bloodshot,” “itchy,” and “gritty” are all common words used to describe the eye condition that affects some six million people in the US every year.What is conjunctivitis exactly?Conjunctivitis is inflammation of the conjunctiva, which is the thin membrane that covers the whites of the eyes. There are three main types of conjunctivitis: allergic, viral, and bacterial.Allergic conjunctivitis often accompanies other allergy symptoms like itchy, runny nose or sneezing.Viral conjunctivitis is the most common and is triggered by the same viruses that cause the common cold. Therefore, it is usually accompanied by cold symptoms like runny nose and cough.Bacterial conjunctivitis causes a thick discharge and responds to antibiotic eye drops or ointment.Treating conjunctivitisIt can be hard to distinguish between viral and bacterial conjunctivitis simply by looking at it, so many doctors treat with a topical antibiotic “just in case” it is bacterial. However, according to ophthalmologists bacterial conjunctivitis often goes away on its own, and the practice of treating everyone “just in case” is irresponsible. A new study by the American Academy of Ophthalmology in the journal Ophthalmology shows just how big a problem the overuse of antibiotics for conjunctivitis has become.Researchers looked at more than 340,000 enrollees in a large US managed care network with newly diagnosed acute conjunctivitis from 2001 through 2014. They found that almost 60% of the patients filled at least one prescription for a topical antibiotic.White, more educated, and more affluent patients were more likely to fill antibiotic prescriptions, and the type of doctor making the diagnosis made a difference. Emergency room doctors, urgent care physicians, internists, and pediatricians were more likely to prescribe antibiotics than ophthalmologists.Why routine antibiotics for conjunctivitis isn’t such a great ideaOverprescribing antibiotics, even topical ones like drops and ointments, can do more harm than good. Patients may suffer from side effects and allergic reactions to the medication. Parents are asked to administer unnecessary eye medication to an infant or child, which, believe me, can be incredibly challenging. And the inappropriate use of antibiotics continues to fuel resistance, making antibiotics less and less effective when we really need them.As an urgent care physician, I know how hard it is to tell a patient or a parent that they have to wait for something to run its course. They want a quick fix and I want to provide it. And some schools won’t let a child with conjunctivitis return to class without proof they have been on an antibiotic for 24 hours. However, we have to educate schools and the public at large that most conjunctivitis is harmless and will go away on its own, and that most cases of conjunctivitis should not be treated with an antibiotic.Here’s what you can doThere are some simple things you can do at home to ease your symptoms. Warm compresses can help loosen eyelid crusting. Cool compresses and artificial tears can soothe irritated eyes. Over-the-counter eye drops and antihistamines can help ease the itching and tearing associated with allergic conjunctivitis.Bottom line: if you think you or your child has conjunctivitis, call your doctor’s office. They can often make recommendations over the phone, but don’t be surprised or upset if they say you don’t need a prescription. They are doing you and the public at large a favor.The post Most cases of pink eye (conjunctivitis) don’t require antibiotics appeared first on Harvard Health Blog.]]> http://www.health.harvard.edu/blog/cases-pink-eye-conjunctivitis-dont-require-antibiotics-2017071712032/feed 0 12032 https://www.facebook.com/sharer/sharer.php?u=http%3A%2F%2Fwww.health.harvard.edu%2Fblog%2Fcases-pink-eye-conjunctivitis-dont-require-antibiotics-2017071712032 ]]> Why Public Schools Should Require the HPV Vaccine http://www.health.harvard.edu/blog/why-public-schools-should-require-the-hpv-vaccine-201509148268 //hhpblog.s3.amazonaws.com/blog/wordpress/wp-content/uploads/2017/07/iStock-507756448.jpg 2017-07-17 10:30:54 2017-07-17 14:30:54 It’s NOT a “pink Viagra” http://www.health.harvard.edu/blog/its-not-a-pink-viagra-201508218198 //hhpblog.s3.amazonaws.com/blog/wordpress/wp-content/uploads/2017/07/iStock-507756448.jpg 2017-07-17 10:30:54 2017-07-17 14:30:54 Antibiotics don’t speed recovery from asthma attacks http://www.health.harvard.edu/blog/antibiotics-dont-speed-recovery-asthma-attacks-2017010410941 //hhpblog.s3.amazonaws.com/blog/wordpress/wp-content/uploads/2017/07/iStock-507756448.jpg 2017-07-17 10:30:54 2017-07-17 14:30:54 Vitamin D testing not recommended for most people http://www.health.harvard.edu/blog/vitamin-d-testing-recommended-people-201411267547 //hhpblog.s3.amazonaws.com/blog/wordpress/wp-content/uploads/2017/07/iStock-507756448.jpg 2017-07-17 10:30:54 2017-07-17 14:30:54 Which kids are most likely to have prolonged concussion symptoms? http://www.health.harvard.edu/blog/which-kids-are-most-likely-to-have-prolonged-concussion-symptoms-201604149437 //hhpblog.s3.amazonaws.com/blog/wordpress/wp-content/uploads/2017/07/iStock-507756448.jpg 2017-07-17 10:30:54 2017-07-17 14:30:54 //hhpblog.s3.amazonaws.com/blog/wordpress/wp-content/uploads/2017/07/iStock-507756448.jpg This is your brain on alcohol http://www.health.harvard.edu/blog/this-is-your-brain-on-alcohol-2017071412000 http://www.health.harvard.edu/blog/this-is-your-brain-on-alcohol-2017071412000#comments Fri, 14 Jul 2017 10:00:49 +0000 http://www.health.harvard.edu/blog/?p=12000 Moderate drinking may have negative long-term effects on the brain’s health, but as yet the research is inconclusive, and must be weighed alongside the evidence that moderate alcohol consumption benefits the heart. If you’re a moderate or light drinker trying to decide whether to cut back for health reasons, you probably want to consider a variety of factors.The post This is your brain on alcohol appeared first on Harvard Health Blog.]]> It’s no secret that alcohol affects our brains, and most moderate drinkers like the way it makes them feel — happier, less stressed, more sociable. Science has verified alcohol’s feel-good effect; PET scans have shown that alcohol releases endorphins (the “pleasure hormones”) which bind to opiate receptors in the brain. Although excessive drinking is linked to an increased risk of dementia, decades of observational studies have indicated that moderate drinking — defined as no more than one drink a day for women and two for men — has few ill effects. (A drink equals 1.5 ounces of 80-proof spirits, 5 ounces of wine, or 12 ounces of beer.) However, a recent British study seems to have bad news for moderate drinkers, indicating that even moderate drinking is associated with shrinkage in areas of the brain involved in cognition and learning.What the study saidA team of researchers from University of Oxford looked at data from 424 men and 103 women who are participating in the 10,000-person Whitehall Study, an ongoing investigation of the relationship of lifestyle and health among British civil servants. At the beginning of the study in 1985, all of the participants were healthy and none were dependent on alcohol. Over the next 30 years, the participants answered detailed questions about their alcohol intake and took tests to measure memory, reasoning, and verbal skills. They underwent brain imaging with MRI at the end of the study.When the team analyzed the questionnaires, the cognitive test scores, and the MRI scans, they found that the amount of shrinkage in the hippocampus — the brain area associated with memory and reasoning — was related to the amount people drank. Those who had the equivalent of four or more drinks a day had almost six times the risk of hippocampal shrinkage as did nondrinkers, while moderate drinkers had three times the risk. However, the only link between drinking and cognitive performance was that heavy drinkers had a more rapid decline in the ability to name as many words beginning with a specific letter as possible within a minute.What does this mean?The study results don’t come as news to Dr. Kenneth J. Mukamal, associate professor of medicine at Harvard Medical School. Dr. Mukamal and his colleagues reported similar findings in 2001. His team studied 3,376 men and women who were enrolled in the Cardiovascular Heart Study and who had also undergone MRI scans and had reported their alcohol consumption. The Harvard researchers also found that brain volume shrank in proportion to alcohol consumed, and that atrophy (shrinkage) was greater even in light and moderate drinkers than in teetotalers.Yet the meaning of the MRI scans is still far from clear, Dr. Mukamal says. “There’s a great deal of doubt about whether the atrophy seen on MRI is due to loss of brain cells or to fluid shifts within the brain.” He explains that this type of atrophy shows major improvements within weeks when alcoholics stop drinking, which wouldn’t be the case if it were caused by brain cell death. “The study offers little indication of whether moderate drinking is truly good, bad, or indifferent for long-term brain health,” he says.What should you do?If you’re a moderate or light drinker trying to decide whether to cut back for health reasons, you probably want to consider a variety of factors:Moderate drinking still seems to be good for your heart. More than 100 observational studies have linked moderate drinking to a reduced risk of heart attack, ischemic (clot-caused) stroke, peripheral vascular disease, sudden cardiac death, and death from all cardiovascular causes.Moderate drinking has also been associated with a lower risk of gallstones and diabetes.For women, even moderate drinking can increase the risk of breast cancer. If you’re a woman at average risk, a drink per day can increase your lifetime risk of breast cancer from 8.25% to 8.8%The social and psychological benefits of moderate alcohol consumption. One thing health statistics haven’t measured is the enjoyment of moderate drinking. It is fine to enjoy a glass of wine as the perfect accompaniment to a good dinner, or celebrate a happy occasion with a cocktail with friends.The post This is your brain on alcohol appeared first on Harvard Health Blog.]]> http://www.health.harvard.edu/blog/this-is-your-brain-on-alcohol-2017071412000/feed 4 12000 https://www.facebook.com/sharer/sharer.php?u=http%3A%2F%2Fwww.health.harvard.edu%2Fblog%2Fthis-is-your-brain-on-alcohol-2017071412000 ]]> Experts say no amount of alcohol is safe during pregnancy http://www.health.harvard.edu/blog/experts-say-no-amount-of-alcohol-is-safe-during-pregnancy-201510198453 //hhpblog.s3.amazonaws.com/blog/wordpress/wp-content/uploads/2017/07/iStock-514457134-1-Copy.jpg 2017-07-14 06:00:49 2017-07-14 10:00:49 People who exercise more also tend to drink more (alcohol) http://www.health.harvard.edu/blog/people-who-exercise-more-also-tend-to-drink-more-alcohol-201603189265 //hhpblog.s3.amazonaws.com/blog/wordpress/wp-content/uploads/2017/07/iStock-514457134-1-Copy.jpg 2017-07-14 06:00:49 2017-07-14 10:00:49 Perspective on alcohol use and cancer risk http://www.health.harvard.edu/blog/perspective-alcohol-use-cancer-risk-2016081210089 //hhpblog.s3.amazonaws.com/blog/wordpress/wp-content/uploads/2017/07/iStock-514457134-1-Copy.jpg 2017-07-14 06:00:49 2017-07-14 10:00:49 Nutritional psychiatry: Your brain on food http://www.health.harvard.edu/blog/nutritional-psychiatry-your-brain-on-food-201511168626 //hhpblog.s3.amazonaws.com/blog/wordpress/wp-content/uploads/2017/07/iStock-514457134-1-Copy.jpg 2017-07-14 06:00:49 2017-07-14 10:00:49 A stronger heart may keep your brain young http://www.health.harvard.edu/blog/a-stronger-heart-may-keep-your-brain-young-201602249182 //hhpblog.s3.amazonaws.com/blog/wordpress/wp-content/uploads/2017/07/iStock-514457134-1-Copy.jpg 2017-07-14 06:00:49 2017-07-14 10:00:49 //hhpblog.s3.amazonaws.com/blog/wordpress/wp-content/uploads/2017/07/iStock-514457134-1-Copy.jpg How to get people to eat more vegetables: Change how you describe them http://www.health.harvard.edu/blog/get-people-eat-vegetables-change-describe-2017071311985 http://www.health.harvard.edu/blog/get-people-eat-vegetables-change-describe-2017071311985#respond Thu, 13 Jul 2017 13:30:19 +0000 http://www.health.harvard.edu/blog/?p=11985 Researchers tested the appeal of vegetables by using different types of labels to describe them in a college cafeteria setting. They found that more evocative and colorful descriptions encouraged greater consumption than ones that highlighted the nutritional aspects.The post How to get people to eat more vegetables: Change how you describe them appeared first on Harvard Health Blog.]]> Follow me on Twitter @RobShmerlingWe all know the drill by now: the healthiest diets are those with a good balance of protein, carbohydrates, and healthy fats with an emphasis on high fiber, whole grains, and modest portion sizes. Vegetables play a featured role in most healthy diets.For example, the Harvard School of Public Health’s “Healthy Eating Plate” says that with few exceptions, the more vegetables we eat, the better. (The big exception? Potatoes! They have high carbohydrate content and affect blood sugar in a similar way as sweets, so moderation is recommended.)And yet for many, vegetables remain low on the dietary priority list. Sure, some people just don’t like them. Perhaps they remember the bland, squishy, unappealing green beans of their elementary school cafeteria. Maybe it’s simply a bias against foods considered healthy. And of course, for many it’s hard to compete with high-calorie, deep-fried, and sweetened options.Researchers have discovered the answer: Better marketing!Well, maybe. The study was simple. A large university cafeteria served its usual vegetables (and other foods) in their usual way and researchers tallied how many people chose each vegetable. However, the sign in front of a chosen vegetable was randomly changed in one of four ways:“Basic”: The label simply stated the name of the vegetable (e.g., “corn”).“Healthy restrictive”: The sign included the name of the vegetable plus something missing that might make it healthier (e.g., “reduced-sodium corn”).“Healthy positive”: the vegetable was described as having something extra that might make it healthier (e.g., “vitamin-rich corn”).“Indulgent”: the label described the vegetable in a novel or exciting, or, one might argue, “over the top” way (e.g., “rich, buttery roasted sweet corn” or “dynamite chili and tangy lime-seasoned beets”).Here’s what they found:Nearly 28,000 diners, about 30% of the total, chose the selected vegetable.Labeling mattered — 25% more people chose the featured vegetable when it had the indulgent labeling than when it had the basic labeling. In addition, the amount of the featured vegetable chosen was greater when the more elaborate description was provided.Labels touting the healthier aspects of the vegetable (such as vitamin-enriched or sodium-restricted) seemed to have the opposite effect — fewer diners chose these vegetables than when only the name of the vegetable was used.Surely there’s more to itIt seems a bit simplistic to think that just calling a food something snazzy can make people eat more of it. But marketing experts have been doing this for years, influencing consumer choices by coming up with just the right description, phrase, or jingle. Of course, I’ve never seen ad campaigns promoting “twisted citrus-glazed carrots” or “tangy ginger bok choy and banzai shiitake mushrooms.” Maybe vegetables just need better public relations consultants.Now what?There are some uncertainties in this research. For example, we don’t know from this study whether the effect of labeling vegetables would be long-lasting. It might work for a while and then wear off as diners realize that despite the fancy description, it’s still the same old corn. And people eating at a big university cafeteria might be different from those choosing to eat at a fancy restaurant, a fast food dive, or eating at home. And we don’t know how good these vegetable dishes really were or how accurate the “indulgent” labeling was. So, as usual, we’ll need more research to address these questions.Still, the findings are promising and suggest that, at least for adults, emphasizing how healthy vegetables are may not be nearly as effective as emphasizing how good they taste. It’s possible that such approaches could reverse the assumption that healthy foods don’t taste good. And more adults eating vegetables could lead to something even more remarkable: kids could start eating their vegetables as well.The post How to get people to eat more vegetables: Change how you describe them appeared first on Harvard Health Blog.]]> http://www.health.harvard.edu/blog/get-people-eat-vegetables-change-describe-2017071311985/feed 0 11985 https://www.facebook.com/sharer/sharer.php?u=http%3A%2F%2Fwww.health.harvard.edu%2Fblog%2Fget-people-eat-vegetables-change-describe-2017071311985 ]]> People who exercise more also tend to drink more (alcohol) http://www.health.harvard.edu/blog/people-who-exercise-more-also-tend-to-drink-more-alcohol-201603189265 //hhpblog.s3.amazonaws.com/blog/wordpress/wp-content/uploads/2017/07/iStock-506824326.jpg 2017-07-13 09:30:19 2017-07-13 13:30:19 Flu news: Now most people with egg allergies can get a flu shot http://www.health.harvard.edu/blog/flu-news-now-most-people-with-egg-allergies-can-get-a-flu-shot-2016100610411 //hhpblog.s3.amazonaws.com/blog/wordpress/wp-content/uploads/2017/07/iStock-506824326.jpg 2017-07-13 09:30:19 2017-07-13 13:30:19 Making one change — getting more fiber — can help with weight loss http://www.health.harvard.edu/blog/making-one-change-getting-fiber-can-help-weight-loss-201502177721 //hhpblog.s3.amazonaws.com/blog/wordpress/wp-content/uploads/2017/07/iStock-506824326.jpg 2017-07-13 09:30:19 2017-07-13 13:30:19 Taming the pain of sciatica: For most people, time heals and less is more http://www.health.harvard.edu/blog/taming-pain-sciatica-people-time-heals-less-2017071212048 //hhpblog.s3.amazonaws.com/blog/wordpress/wp-content/uploads/2017/07/iStock-506824326.jpg 2017-07-13 09:30:19 2017-07-13 13:30:19 The type of fat you eat matters! http://www.health.harvard.edu/blog/the-type-of-fat-you-eat-matters-201509228333 //hhpblog.s3.amazonaws.com/blog/wordpress/wp-content/uploads/2017/07/iStock-506824326.jpg 2017-07-13 09:30:19 2017-07-13 13:30:19 //hhpblog.s3.amazonaws.com/blog/wordpress/wp-content/uploads/2017/07/iStock-506824326.jpg Taming the pain of sciatica: For most people, time heals and less is more http://www.health.harvard.edu/blog/taming-pain-sciatica-people-time-heals-less-2017071212048 http://www.health.harvard.edu/blog/taming-pain-sciatica-people-time-heals-less-2017071212048#respond Wed, 12 Jul 2017 14:30:48 +0000 http://www.health.harvard.edu/blog/?p=12048 While not as common as other types of back pain, sciatica can cause intense discomfort, but often the best course of treatment involves controlling the pain and keeping active while the condition subsides.The post Taming the pain of sciatica: For most people, time heals and less is more appeared first on Harvard Health Blog.]]> Despite being a less common cause of low back pain, sciatica is still something I regularly see as a general internist. Primary care doctors can and should manage sciatica, because for most individuals the body can fix the problem. My job is to help manage the pain while the body does its job. When a person’s symptoms don’t improve, I discuss the role of surgery or an injection to speed things up.What is sciatica?Sciatica refers to pain caused by the sciatic nerve that carries messages from the brain down the spinal cord to the legs. The pain of sciatica typically radiates down one side from the lower back into the leg, often below the knee. The most common cause is a bulging (“herniated”) disc in the lower back. Discs are tire-like structures that sit between the bones of the spine. If the outer rim of the disc tears, usually due to routine pressure on the lower back, the jelly-like inner material can come out and pinch or inflame the nearby nerve. Sciatica is most common in people 30 to 50.How do you know if it is sciatica?The key to diagnosing sciatica is a thorough history and a focused exam. Unfortunately, many patients expect an x-ray or MRI, and doctors, often facing time constraints, order one even though we know imaging tests don’t really help us treat early sciatica any better. The symptoms of sciatica are often worse with sitting or coughing, and may be accompanied by numbness or tingling in the leg. A physical exam can confirm that the sciatic nerve is involved, and I look for weakness or diminished reflexes in the legs that suggest that someone needs early referral to a specialist. (This doesn’t happen often.) With this information, I can make an initial diagnosis and start treatment.Treating pain… and managing expectationsMany people think (understandably) that the worse the pain, the more likely something bad is going on. However, this isn’t true for sciatica. The body can reabsorb the disc material that is causing symptoms, even for those with severe pain. So, treatment focuses on controlling pain and keeping people as active as possible. If the pain is excruciating, lying down for short periods can help, but prolonged bed rest does not. So once the pain diminishes, I tell patients to get up and start walking short distances. Since sitting increases pressure on the discs in the lower back, I recommend avoiding prolonged sitting or driving. Many people try treatments like physical therapy, massage, acupuncture, and chiropractic manipulation, but evidence suggests that while these approaches may help typical low back pain, they are less helpful for sciatica. Over-the-counter pain medicines like ibuprofen and naproxen can help. When they don’t I may recommend short-term use of stronger, prescription pain medicines.The good news is that for most (roughly three out of four) people, symptoms improve over a few weeks. Rarely, I’ll find weakness on exam, such as a foot drop, and refer for immediate surgical evaluation. For those not improving after six weeks, surgery is an option. We know surgery can speed up recovery, but by six to 12 months people who have surgery are usually doing about as well as those who decide to just give the body more time to heal on its own. Surgery involves removing the disc material that is affecting the nerve. It is generally a very safe procedure, and while complications are rare, they can happen. What’s more, 5% to 10% of people who have surgery will not be helped by it, or may have worse pain afterwards.Patients often ask about spinal injections — where steroid medicine is injected into the affected area. It is worth considering for those with uncontrolled pain or for those with persistent, bothersome symptoms who want to avoid surgery. Injections can provide short-term relief. Like any procedure, it has uncommon risks including more pain, and it doesn’t seem to decrease the need for future surgery.Staying patient-focused… and “hurt” doesn’t always mean “harm”For most patients with sciatica, it’s worth seeing your primary care doctor. Patients who come in are often scared. Typically, it is pain the likes of which they may have never had. They want relief and, rightly, they want it now. That is the appeal of surgery and injections, but I also know that most will get better with time and can avoid even the uncommon risks of these procedures. When I see a patient in my office I can assess and identify the few who need immediate referral to a specialist. But for most, I try to reassure that hurt doesn’t mean harm, and that my treatments are geared to managing pain and keeping them active while the body fixes itself. For those not improving, I will get an MRI prior to referring for surgery or an injection, if the patient decides that speeding up recovery is right for them. For those who feel that they can manage the pain, I can reassure them that they can delay surgery for up to six months without risking long-term problems down the road.SourcesHerniated lumbar intervertebral disk. New England Journal of Medicine, May 2016.Evaluating and managing acute low back pain in the primary care setting. Journal of General Internal Medicine, February 2001.Epidural corticosteroid injections for radulopathy and spinal stenosis. Annals of Internal Medicine, September 2015.The post Taming the pain of sciatica: For most people, time heals and less is more appeared first on Harvard Health Blog.]]> http://www.health.harvard.edu/blog/taming-pain-sciatica-people-time-heals-less-2017071212048/feed 0 12048 https://www.facebook.com/sharer/sharer.php?u=http%3A%2F%2Fwww.health.harvard.edu%2Fblog%2Ftaming-pain-sciatica-people-time-heals-less-2017071212048 ]]> People who exercise more also tend to drink more (alcohol) http://www.health.harvard.edu/blog/people-who-exercise-more-also-tend-to-drink-more-alcohol-201603189265 //hhpblog.s3.amazonaws.com/blog/wordpress/wp-content/uploads/2017/07/iStock-486787220-1.jpg 2017-07-12 10:30:48 2017-07-12 14:30:48 Vitamin D testing not recommended for most people http://www.health.harvard.edu/blog/vitamin-d-testing-recommended-people-201411267547 //hhpblog.s3.amazonaws.com/blog/wordpress/wp-content/uploads/2017/07/iStock-486787220-1.jpg 2017-07-12 10:30:48 2017-07-12 14:30:48 Flu news: Now most people with egg allergies can get a flu shot http://www.health.harvard.edu/blog/flu-news-now-most-people-with-egg-allergies-can-get-a-flu-shot-2016100610411 //hhpblog.s3.amazonaws.com/blog/wordpress/wp-content/uploads/2017/07/iStock-486787220-1.jpg 2017-07-12 10:30:48 2017-07-12 14:30:48 Physical therapy as good as surgery and less risky for one type of lower back pain http://www.health.harvard.edu/blog/physical-therapy-as-good-as-surgery-and-less-risky-for-one-type-of-lower-back-pain-201504097863 //hhpblog.s3.amazonaws.com/blog/wordpress/wp-content/uploads/2017/07/iStock-486787220-1.jpg 2017-07-12 10:30:48 2017-07-12 14:30:48 For joggers, less may be more http://www.health.harvard.edu/blog/joggers-less-may-201502057687 //hhpblog.s3.amazonaws.com/blog/wordpress/wp-content/uploads/2017/07/iStock-486787220-1.jpg 2017-07-12 10:30:48 2017-07-12 14:30:48 //hhpblog.s3.amazonaws.com/blog/wordpress/wp-content/uploads/2017/07/iStock-486787220-1.jpg Think your child has a penicillin allergy? Maybe not. http://www.health.harvard.edu/blog/think-child-penicillin-allergy-maybe-not-2017071112054 http://www.health.harvard.edu/blog/think-child-penicillin-allergy-maybe-not-2017071112054#comments Tue, 11 Jul 2017 14:30:35 +0000 http://www.health.harvard.edu/blog/?p=12054 Because diagnosis of drug allergies is often done based on symptoms but without testing, many people who believe they are allergic to antibiotics such as penicillin do not in fact have the allergy.The post Think your child has a penicillin allergy? Maybe not. appeared first on Harvard Health Blog.]]> Follow me on Twitter @drClaireAllergies to penicillin are the most commonly reported medication allergy. This can be a real problem; if you are allergic to penicillin, it’s not just penicillin you can’t take. You can’t take amoxicillin and other antibiotics that are extremely similar, and it’s iffy whether or not you can take cephalosporins (such as cephalexin or cefdinir), a whole other really useful and commonly used class of antibiotics.See, that’s the thing: with most common infections such as ear infections, strep throat, or skin infections, if we can’t give you penicillin we end up with limited choices. Some of those choices don’t work as well — and some of them are stronger than we’d like, with more side effects.Now, this would be just an unavoidable reality of life for penicillin-allergic people, if it weren’t for the simple fact that a lot of them aren’t allergic to penicillin at all.How does this happen? Well, the diagnosis of drug allergy is generally what we call a “clinical diagnosis,” based on signs and symptoms rather than an actual test. Drug allergies can cause lots of different symptoms, such as rash, vomiting, and diarrhea. When a patient who is on a medication develops one of these symptoms, doctors very often end up diagnosing an allergy to be on the safe side. After all, drug allergies can be life-threatening, and reactions after the first one are often more serious.But there are pitfalls to this. First of all, sometimes doctors make the diagnosis based purely on patient or parent report, without seeing the rash or examining the patient. For example: a parent says the child had a rash, so the antibiotic is stopped and an allergy is diagnosed — but it turns out that the rash was just a diaper rash, not an actual allergy. A second, more common and more problematic pitfall is that, because the symptoms of a drug allergy can be easily confused with symptoms of a virus or other condition, often a drug allergy is diagnosed when the symptoms were caused by something else entirely. This can be especially true when a child takes amoxicillin for an ear infection, as ear infections commonly occur when a child has a cold caused by a virus — and those viruses can cause rashes and many other symptoms. Viruses commonly cause even hives, which we usually think of as being caused by an allergy.All of this means that there are lots of people out there who think they have an allergy who actually don’t.In a study recently published in the journal Pediatrics, researchers tested 100 children whose parents said they were allergic to penicillin based on what the researchers called “low-risk” symptoms. These low-risk symptoms included rash, itching, vomiting, diarrhea, runny nose, and cough. They also included children whose parents said they were allergic because of a family history of allergy. You know what they found when they did tests on the children? None of them actually had an allergy to penicillin.This doesn’t mean that anyone should start ignoring a diagnosed allergy to penicillin. It’s especially important not to ignore it if someone has what the researchers call “high-risk” symptoms, such as wheezing or any other kind of trouble breathing, swelling of the face or other parts of the body, fainting, a drop in blood pressure, or other symptoms of a serious allergic reaction.But it does mean that you should talk to your doctor if your child’s diagnosis of allergy was based on a low-risk symptom. It may be that doing further testing, or even trying a dose of penicillin under medical supervision, may make sense to be sure that the allergy, with all of its ramifications, really exists.The post Think your child has a penicillin allergy? Maybe not. appeared first on Harvard Health Blog.]]> http://www.health.harvard.edu/blog/think-child-penicillin-allergy-maybe-not-2017071112054/feed 1 12054 https://www.facebook.com/sharer/sharer.php?u=http%3A%2F%2Fwww.health.harvard.edu%2Fblog%2Fthink-child-penicillin-allergy-maybe-not-2017071112054 ]]> Diet not working? Maybe it’s not your type http://www.health.harvard.edu/blog/diet-not-working-maybe-its-not-your-type-2017051211678 //hhpblog.s3.amazonaws.com/blog/wordpress/wp-content/uploads/2017/07/iStock-514716570-1.jpg 2017-07-11 10:30:35 2017-07-11 14:30:35 8 things to watch for when your child has a headache http://www.health.harvard.edu/blog/8-things-to-watch-for-when-your-child-has-a-headache-2017051611761 //hhpblog.s3.amazonaws.com/blog/wordpress/wp-content/uploads/2017/07/iStock-514716570-1.jpg 2017-07-11 10:30:35 2017-07-11 14:30:35 More than sad: Depression affects your ability to think http://www.health.harvard.edu/blog/sad-depression-affects-ability-think-201605069551 //hhpblog.s3.amazonaws.com/blog/wordpress/wp-content/uploads/2017/07/iStock-514716570-1.jpg 2017-07-11 10:30:35 2017-07-11 14:30:35 If you think you’re depressed, don’t wait — find out http://www.health.harvard.edu/blog/if-you-think-youre-depressed-dont-wait-find-out-201510088401 //hhpblog.s3.amazonaws.com/blog/wordpress/wp-content/uploads/2017/07/iStock-514716570-1.jpg 2017-07-11 10:30:35 2017-07-11 14:30:35 Exercise: You may need less than you think http://www.health.harvard.edu/blog/how-much-exercise-do-you-really-need-less-than-you-think-201512088770 //hhpblog.s3.amazonaws.com/blog/wordpress/wp-content/uploads/2017/07/iStock-514716570-1.jpg 2017-07-11 10:30:35 2017-07-11 14:30:35 //hhpblog.s3.amazonaws.com/blog/wordpress/wp-content/uploads/2017/07/iStock-514716570-1.jpg More evidence that exercise helps keep your brain fit http://www.health.harvard.edu/blog/evidence-exercise-helps-keep-brain-fit-2017071011997 http://www.health.harvard.edu/blog/evidence-exercise-helps-keep-brain-fit-2017071011997#respond Mon, 10 Jul 2017 14:30:28 +0000 http://www.health.harvard.edu/blog/?p=11997 A review of dozens of studies on the benefits of exercise on cognitive health concluded that, for those over 50, just about any form of activity is beneficial if performed regularly.The post More evidence that exercise helps keep your brain fit appeared first on Harvard Health Blog.]]> I often prescribe exercise for my patients, sometimes more than once in the same visit — exercise for cardiovascular health, weight loss, stress management, lifting mood. Scientific evidence strongly supports the benefits of activity for all of these things. Plus, it’s free, and there are few side effects or medication interactions.So, is there an “exercise prescription” for boosting your brain?Mounting evidence also suggests that exercise can boost brain function and protect against dementia. This makes great physiologic sense: increased blood flow to the brain means more oxygen and nutrients in, and toxins out. But questions remain. Will exercise help older adults? What about those who already have some cognitive impairment, even early dementia? What type of exercise, how much, and for how long?A group of exercise physiologists in Australia scoured the research to try to answer those questions.They examined over 10,000 quality studies of exercise and brain function. By “quality” we mean randomized, controlled clinical trials (RCTs), which are experiments designed to test a specific hypothesis. The authors then limited their scope to published studies of people over 50 years old that tested at least four weeks of supervised exercise intervention, and included a validated measure of brain function at the beginning and end of each study. The research examined included healthy subjects or those with mild cognitive impairment, but excluded people with neurological or psychiatric diagnoses like strokes or depression. After all that, the list was whittled down to 39 studies.They then took the data from all those studies and applied complex statistical analyses to evaluate:the types of exercise (cardio, resistance training like weights, both, yoga, or tai chi)the exercise intensity (low, medium, high)the duration, in minutesfrequency (how often) and length (1 to 3 months, 3 to 6 months, or over 6 months)various brain functions (general cognition, attention, executive function, and memory).So, if you’re 50 or over, what workouts really help your brain?The gist of it is: any moderate cardio exercise performed regularly for at least 45 minutes, regardless of frequency or length, improved multiple cognitive functions, as did resistance training. Tai chi improved memory. These results were seen regardless of baseline cognition, meaning even people with early dementia saw benefits. Yoga did not have a statistically significant effect, but the authors point out that there were fewer articles testing tai chi and yoga interventions.So what does this mean? The authors expressed high confidence that many types of exercise can improve memory, and that we should focus on developing specific exercise prescriptions tailored to improving specific cognitive functions. In addition, more research is needed for activities well-suited for people with mobility issues (for example, yoga and tai chi).My opinion? This study provides further evidence supporting an active lifestyle generally, and an exercise plan specifically. Do you want to boost your brain function? You now know that you can walk briskly, jog, hike, cycle, do aerobics, or dance around for about 45 minutes to help keep your brain in shape. Or, take a Pilates class, lift some weights, perhaps even get some yard work or home improvements done, and see a benefit.Take-away: If you want to feel and function better, do something, just about anything, active.SourcesExercise interventions for cognitive function in adults older than 50: a systematic review with meta-analysis. British Journal of Sports Medicine, March 2017.University of Canberra. The Truth About: ExerciseThe post More evidence that exercise helps keep your brain fit appeared first on Harvard Health Blog.]]> http://www.health.harvard.edu/blog/evidence-exercise-helps-keep-brain-fit-2017071011997/feed 0 11997 https://www.facebook.com/sharer/sharer.php?u=http%3A%2F%2Fwww.health.harvard.edu%2Fblog%2Fevidence-exercise-helps-keep-brain-fit-2017071011997 ]]> What’s the evidence for evidence-based medicine? http://www.health.harvard.edu/blog/whats-evidence-evidence-based-medicine-2017031311194 //hhpblog.s3.amazonaws.com/blog/wordpress/wp-content/uploads/2016/02/Brain-health-and-exercise.jpg 2017-07-10 10:30:28 2017-07-10 14:30:28 People who exercise more also tend to drink more (alcohol) http://www.health.harvard.edu/blog/people-who-exercise-more-also-tend-to-drink-more-alcohol-201603189265 //hhpblog.s3.amazonaws.com/blog/wordpress/wp-content/uploads/2016/02/Brain-health-and-exercise.jpg 2017-07-10 10:30:28 2017-07-10 14:30:28 A stronger heart may keep your brain young http://www.health.harvard.edu/blog/a-stronger-heart-may-keep-your-brain-young-201602249182 //hhpblog.s3.amazonaws.com/blog/wordpress/wp-content/uploads/2016/02/Brain-health-and-exercise.jpg 2017-07-10 10:30:28 2017-07-10 14:30:28 Super-agers: This special group of older adults suggests you can keep your brain young and spry http://www.health.harvard.edu/blog/super-agers-this-special-group-of-older-adults-suggests-you-can-keep-your-brain-young-and-spry-2017070511957 //hhpblog.s3.amazonaws.com/blog/wordpress/wp-content/uploads/2016/02/Brain-health-and-exercise.jpg 2017-07-10 10:30:28 2017-07-10 14:30:28 Mindfulness meditation helps fight insomnia, improves sleep http://www.health.harvard.edu/blog/mindfulness-meditation-helps-fight-insomnia-improves-sleep-201502187726 //hhpblog.s3.amazonaws.com/blog/wordpress/wp-content/uploads/2016/02/Brain-health-and-exercise.jpg 2017-07-10 10:30:28 2017-07-10 14:30:28 //hhpblog.s3.amazonaws.com/blog/wordpress/wp-content/uploads/2016/02/Brain-health-and-exercise.jpg Stay safe in (and on) the water http://www.health.harvard.edu/blog/stay-safe-in-and-on-the-water-2017070712014 http://www.health.harvard.edu/blog/stay-safe-in-and-on-the-water-2017070712014#respond Fri, 07 Jul 2017 10:30:38 +0000 http://www.health.harvard.edu/blog/?p=12014 Pools, beaches, and boats are great ways to enjoy leisure time in the summer. Following some simple precautions will make your water activities safer for everyone.The post Stay safe in (and on) the water appeared first on Harvard Health Blog.]]> Headed to the beach or a day out on the lake? Most likely you’ll protect yourself from the sun with sunscreen, a hat, and sunglasses. Maybe you also take along insect repellent. But how good is your water safety knowledge? You can’t tuck it in a beach bag or backpack, but it’s essential to a good day on the water.According to the Centers for Disease Control and Prevention, between 2005 and 2014 nearly 10 people died each day from unintentional (non-boating related) drownings, and over 300 per year from boating related incidents. And water injuries can do great damage even when they are not fatal. Over half of drowning victims require hospital care beyond the emergency room, and some of them experience brain damage that requires long-term care.Enjoy the water safelyDrowning is the most common cause of unintentional death in children ages 1 to 4, and the second most common for ages 5 to 9, according to the CDC. But Dr. Josh Kosowsky, attending physician in emergency medicine at Brigham and Women’s Hospital, says these statistics can be avoided with proper supervision. He suggests taking your children to swim only at beaches or pools with lifeguards. Even adults should never swim alone. Think back to those times you had “buddy checks” at camp. “It may have seemed kind of hokey at the time,” he said. “But it works.”Would you recognize when a person is drowning? Maybe not. Most of us picture drowning as a loud activity with yelling and struggling from the victim, but in reality drowning is quiet, and goes easily unnoticed in a crowded lake or pool. Once someone starts taking on water, their voice box (larynx) begins to spasm, which is part of the reason there isn’t much screaming. The larynx closes to keep water from flowing into the airway, but it also means the lungs can’t take in air. When water does get into the smaller airways they tend to constrict, which is referred to as a bronchospasm. Survivors of a near drowning episode may develop wheezing as a result.Ideally, all backyard pools should have a secure fence. Storing pool toys away from the pool can deter children from being drawn to the water. And lastly, make sure your children are strong swimmers. Start them early with swim lessons to help them stay safe in the water.Water safety applies to adults too. Kosowsky points out that the danger isn’t just with operating the vehicle safely. Anyone on a boat who is “under the influence” is at risk for drowning. And of course, be sure there are plenty of life jackets around; federal law requires a life jacket for everyone on board.Head and neck injuries are always serious and can easily happen around the water. Make sure you only dive into an area where you know the depth. Dr. Kosowsky points out that body surfing in the ocean is an underrated risk because the waves can slam people head-first into the beach, causing serious neck and spinal injuries.Your water safety checklistIf being on or in the water is part of your summer plans, enjoy! But do include safety as part of your outing. Remember:✓ Supervise children in the water and avoid beaches, pools, and swimming holes that do not have lifeguards.✓ Follow beach and pool safety rules, including types of flotation devices and toys allowed, and designated swimming areas.✓ Never swim alone.✓ Avoid alcohol anytime you’re around water, including while boating.✓ Pay attention to weather and water conditions, including threat of thunderstorms and rip currents.✓ Take appropriate health condition-related precautions (for example, for people with seizure disorders or heart or lung disease).The post Stay safe in (and on) the water appeared first on Harvard Health Blog.]]> http://www.health.harvard.edu/blog/stay-safe-in-and-on-the-water-2017070712014/feed 0 12014 https://www.facebook.com/sharer/sharer.php?u=http%3A%2F%2Fwww.health.harvard.edu%2Fblog%2Fstay-safe-in-and-on-the-water-2017070712014 ]]> Water, water everywhere http://www.health.harvard.edu/blog/water-water-everywhere-2016110310577 //hhpblog.s3.amazonaws.com/blog/wordpress/wp-content/uploads/2017/07/iStock-700268044-Copy.jpg 2017-07-07 06:30:38 2017-07-07 10:30:38 The 4 symptoms that mean your child must stay home from school or daycare http://www.health.harvard.edu/blog/the-4-symptoms-that-mean-your-child-must-stay-home-from-school-or-daycare-2017020711171 //hhpblog.s3.amazonaws.com/blog/wordpress/wp-content/uploads/2017/07/iStock-700268044-Copy.jpg 2017-07-07 06:30:38 2017-07-07 10:30:38 The big benefits of plain water http://www.health.harvard.edu/blog/big-benefits-plain-water-201605269675 //hhpblog.s3.amazonaws.com/blog/wordpress/wp-content/uploads/2017/07/iStock-700268044-Copy.jpg 2017-07-07 06:30:38 2017-07-07 10:30:38 Is treating “low T” really safe and effective? http://www.health.harvard.edu/blog/is-treating-low-t-really-safe-and-effective-201508208184 //hhpblog.s3.amazonaws.com/blog/wordpress/wp-content/uploads/2017/07/iStock-700268044-Copy.jpg 2017-07-07 06:30:38 2017-07-07 10:30:38 Holiday travels: Keeping kids safe and healthy http://www.health.harvard.edu/blog/holiday-travels-keeping-kids-safe-and-healthy-201512218881 //hhpblog.s3.amazonaws.com/blog/wordpress/wp-content/uploads/2017/07/iStock-700268044-Copy.jpg 2017-07-07 06:30:38 2017-07-07 10:30:38 //hhpblog.s3.amazonaws.com/blog/wordpress/wp-content/uploads/2017/07/iStock-700268044-Copy.jpg Here’s something completely different for low back pain http://www.health.harvard.edu/blog/heres-something-completely-different-for-low-back-pain-2017070611962 http://www.health.harvard.edu/blog/heres-something-completely-different-for-low-back-pain-2017070611962#comments Thu, 06 Jul 2017 14:00:24 +0000 http://www.health.harvard.edu/blog/?p=11962 With recently revised guidelines recommending that people with low back pain not take medication, it’s natural to wonder: what should I do, then? There are many options, among them heat, massage, yoga, and acupuncture.The post Here’s something completely different for low back pain appeared first on Harvard Health Blog.]]> Follow me on Twitter @RobShmerlingIt’s a question that has challenged generations of patients and their doctors. The answer has changed over the years. When I was in medical school in the early 1980s, bedrest for a week or more was often recommended for severe back pain. This sometimes included hospital admission. Then, research demonstrated that prolonged bedrest was actually a bad idea. It was no better (and often worse) than taking it easy for a day or two followed by slowly increasing activity, including stretching and strengthening the back.Medications, including pain relievers, non-steroidal anti-inflammatory drugs (NSAIDs), and muscle relaxants were a standard part of the initial treatment of back pain. But, recommendations released in February 2017 urge doctors to change their approach to back pain once again.Didn’t I just hear that NSAIDs don’t work well for back pain?You did. A recent study found that NSAIDs did not work well for back pain. But, new recommendations take that conclusion even further: it may be best to avoid medications altogether — at least at the start.The American College of Physicians has just come out with new guidelines for the treatment of low back pain based on a review of more than 150 studies. The big news? Medications tend to have only temporary and modest benefits, so it makes sense to try something other than a pill. The specifics depend on the type and duration of back pain.For new low back pain (lasting less than 12 weeks), try:heatmassageacupuncturespinal manipulation, as with chiropractic care.If these don’t work, NSAIDs or a muscle relaxant are reasonable options. But given their potential to cause side effects and their modest benefit, they aren’t the first choice.For chronic low back pain (lasting 12 weeks or more), try:exercise (including stretching, improving balance, and strengthening core muscles)physical therapyacupuncturemindfulness-based programs intended to cope with or reduce stress.Other approaches, such as tai chi, yoga, or progressive relaxation techniques may also be helpful.If these don’t work, treatment with NSAIDs, tramadol, or duloxetine is worth consideration. However, opioids should be considered only if other measures have failed and only after a thorough review of potential benefits and risks with your doctor.It’s important to emphasize these suggestions are for low back pain that might begin after an unusually strenuous workout or shoveling snow. It’s not for serious causes of back pain such as a major injury, cancer, infection, or fractures (see “red flag” symptoms below).What if the pain continues?If pain persists despite these non-medication and medication-based treatments, your doctor may want to consider additional tests (such as MRI) or treatments. Remember, each person’s situation is a little different, and even medications that don’t work well on average, may work well for you.You could see this coming?It’s been known for years that the vast majority of low back pain goes away on its own, regardless of treatment. So, the challenge has been to find something that safely eases symptoms while waiting for improvement.How do I know it’s nothing serious?You don’t. But, you should be reassured that the numbers are with you. Ninety-nine percent or more of people with low back pain do not have a serious cause. But to help make sure your back isn’t in that small sliver of dangerous causes, doctors use the “red flag” questions:Have you ever been diagnosed with cancer?Have you experienced unexplained or unintentional weight loss?Do you have an abnormal immune system (due to disease or medications)?Do you use intravenous drugs?Have you had a fever recently?Have you had significant injury to your back recently?Have you had bladder or bowel incontinence?These questions and a physical examination are intended to identify factors that would increase the chances that your back pain is due to infection, tumor, or other serious cause.So, what?These new guidelines endorse an approach to treating a common ailment that only a few years ago would have seemed outrageous. The remedies recommended are not brand new; but discouraging medication use as an initial step is a big departure from prior recommendations. An email alert I received just after these guidelines were published included the headline: “Take two yoga classes and call me next month?” It may not be such a bad idea!Medical practice rarely changes right away, and these guidelines may have relatively little impact in the short run. But I would not be surprised if non-pharmacological treatment of back pain becomes the norm over time. Many of my patients already seek out these treatments regardless of whether I recommend them. After all, the “usual” medications for low back pain are not all that effective and often cause trouble. It’s time we recognize that there are other, better ways to help.The post Here’s something completely different for low back pain appeared first on Harvard Health Blog.]]> http://www.health.harvard.edu/blog/heres-something-completely-different-for-low-back-pain-2017070611962/feed 20 11962 https://www.facebook.com/sharer/sharer.php?u=http%3A%2F%2Fwww.health.harvard.edu%2Fblog%2Fheres-something-completely-different-for-low-back-pain-2017070611962 ]]> Here’s something unexpected: Sunbathers live longer http://www.health.harvard.edu/blog/heres-something-unexpected-sunbathers-live-longer-201606069738 //hhpblog.s3.amazonaws.com/blog/wordpress/wp-content/uploads/2016/06/Opiates-for-back-pain-blog.jpg 2017-07-06 10:00:24 2017-07-06 14:00:24 The psychology of low back pain http://www.health.harvard.edu/blog/psychology-low-back-pain-201604259537 //hhpblog.s3.amazonaws.com/blog/wordpress/wp-content/uploads/2016/06/Opiates-for-back-pain-blog.jpg 2017-07-06 10:00:24 2017-07-06 14:00:24 If you have low back pain try these steps first http://www.health.harvard.edu/blog/low-back-pain-try-steps-first-2017040311411 //hhpblog.s3.amazonaws.com/blog/wordpress/wp-content/uploads/2016/06/Opiates-for-back-pain-blog.jpg 2017-07-06 10:00:24 2017-07-06 14:00:24 Despite an Ebola death in the U.S., the likelihood of an epidemic here is low http://www.health.harvard.edu/blog/despite-ebola-death-u-s-likelihood-epidemic-low-201410097476 //hhpblog.s3.amazonaws.com/blog/wordpress/wp-content/uploads/2016/06/Opiates-for-back-pain-blog.jpg 2017-07-06 10:00:24 2017-07-06 14:00:24 Low fat? Low carb? Almost any healthy diet can work for losing weight http://www.health.harvard.edu/blog/low-fat-low-carb-almost-healthy-diet-can-work-losing-weight-201409037386 //hhpblog.s3.amazonaws.com/blog/wordpress/wp-content/uploads/2016/06/Opiates-for-back-pain-blog.jpg 2017-07-06 10:00:24 2017-07-06 14:00:24 //hhpblog.s3.amazonaws.com/blog/wordpress/wp-content/uploads/2016/06/Opiates-for-back-pain-blog.jpg Super-agers: This special group of older adults suggests you can keep your brain young and spry http://www.health.harvard.edu/blog/super-agers-this-special-group-of-older-adults-suggests-you-can-keep-your-brain-young-and-spry-2017070511957 http://www.health.harvard.edu/blog/super-agers-this-special-group-of-older-adults-suggests-you-can-keep-your-brain-young-and-spry-2017070511957#respond Wed, 05 Jul 2017 14:30:13 +0000 http://www.health.harvard.edu/blog/?p=11957 While some people seem genetically predisposed to retain mental sharpness in old age, there are things anyone can do that can help maintain cognitive ability, or perhaps improve it.The post Super-agers: This special group of older adults suggests you can keep your brain young and spry appeared first on Harvard Health Blog.]]> My Facebook page is a collection of links to stories about inspirational people. Almost all have a common theme — older people who do extraordinary things. Some of my favorite stories, though, involve those with acute mental prowess. This special group of adults ages 60 to 80, called “super-agers,” have a higher resistance to natural brain aging and thus can keep their gray cells young and vibrant.The science of super brainsWhat makes super-agers’ brains so super? A small study published in The Journal of Neuroscience looked at this question. Researchers enrolled 44 adults ages 60 to 80 and found that those who performed well on memory tests had brains with youthful characteristics. Specifically, the cortexes of their brains — the outermost layer of brain cells essential to many thinking abilities — were comparable in size to those of the younger adults in a control group. Scans found that the brain regions associated with the ability to learn and remember new information — which include the hippocampus and medial prefrontal cortex — were larger in super-agers than in normal older adults.Lead researcher Dr. Bradford Dickerson, associate professor of neurology at Harvard-affiliated Massachusetts General Hospital, said that one of the most surprising findings was that the size of the super-agers’ brains did not fall somewhere between the younger people and the other older adults. “Their brain size was close to equal to that of the younger subjects, which suggests that the brain size was preserved,” he says.Wouldn’t you like to be a super-ager too?Are super-agers born or made? Probably a little of both, says Dr. Dickerson. “There may be a genetic component that makes them more resilient to natural aging, but it also may be associated with lifestyle habits,” he says.So, can you become a super-ager? While you may not be able to transport your brain back to your 20s, it may be possible to maintain and even improve some cognitive function with a combined approach to treatment, says Dr. Dickerson. For example:Do regular aerobic exercise. Research has suggested that aerobic exercise can improve cognitive function, even if you begin later in life or have shown signs of mental decline. A study presented at the 2016 annual meeting of the Radiological Society of North America found that older adults (average age 67) with mild cognitive impairment who exercised four times a week over a six-month period (using either a treadmill, a stationary bike, or an elliptical trainer) experienced an increase in brain volume and better executive function.Get plenty of sleep. Using MRI scans, a study in NeuroImage looked at the brains of 41 healthy men who were deprived of sleep for one night. The researchers found that compared with those who’d had a regular night’s sleep, they showed a decline in memory and attention. Older adults often have trouble falling asleep or staying asleep, problems that may reflect drug side effects or health conditions. See your doctor if you have sleep issues.Lower anxiety with meditation. Chronic levels of anxiety may speed up the conversion to Alzheimer’s disease in people with mild cognitive impairment (MCI). In fact, a 2014 study in The American Journal of Geriatric Psychiatry found that in MCI patients with mild, moderate, or severe anxiety, Alzheimer’s risk increased by 33%, 78%, and 135%, respectively. Mindfulness meditation can help lower anxiety levels, according to findings published online earlier this year by Psychiatry Research. Meditation programs for beginners are offered at many yoga studios and senior centers. You can try a free online guided meditation exercise from Ronald Siegel, an assistant clinical professor of psychology at Harvard Medical School.The post Super-agers: This special group of older adults suggests you can keep your brain young and spry appeared first on Harvard Health Blog.]]> http://www.health.harvard.edu/blog/super-agers-this-special-group-of-older-adults-suggests-you-can-keep-your-brain-young-and-spry-2017070511957/feed 0 11957 https://www.facebook.com/sharer/sharer.php?u=http%3A%2F%2Fwww.health.harvard.edu%2Fblog%2Fsuper-agers-this-special-group-of-older-adults-suggests-you-can-keep-your-brain-young-and-spry-2017070511957 ]]> Brain science suggests “mind wandering” can help manage anxiety http://www.health.harvard.edu/blog/a-different-way-to-manage-anxiety-evidence-from-brain-science-2016111710659 //hhpblog.s3.amazonaws.com/blog/wordpress/wp-content/uploads/2017/07/iStock-609419576.jpg 2017-07-05 10:30:13 2017-07-05 14:30:13 Mild high blood pressure in young adults linked to heart problems later in life http://www.health.harvard.edu/blog/mild-high-blood-pressure-in-young-adults-linked-to-heart-problems-later-in-life-201506238100 //hhpblog.s3.amazonaws.com/blog/wordpress/wp-content/uploads/2017/07/iStock-609419576.jpg 2017-07-05 10:30:13 2017-07-05 14:30:13 A stronger heart may keep your brain young http://www.health.harvard.edu/blog/a-stronger-heart-may-keep-your-brain-young-201602249182 //hhpblog.s3.amazonaws.com/blog/wordpress/wp-content/uploads/2017/07/iStock-609419576.jpg 2017-07-05 10:30:13 2017-07-05 14:30:13 Can super-sizing start with baby bottles? http://www.health.harvard.edu/blog/can-super-sizing-start-baby-bottles-201606219919 //hhpblog.s3.amazonaws.com/blog/wordpress/wp-content/uploads/2017/07/iStock-609419576.jpg 2017-07-05 10:30:13 2017-07-05 14:30:13 Special MRI scan could identify stroke risk in people with atrial fibrillation http://www.health.harvard.edu/blog/special-mri-scan-could-identify-stroke-risk-in-people-with-atrial-fibrillation-201504287961 //hhpblog.s3.amazonaws.com/blog/wordpress/wp-content/uploads/2017/07/iStock-609419576.jpg 2017-07-05 10:30:13 2017-07-05 14:30:13 //hhpblog.s3.amazonaws.com/blog/wordpress/wp-content/uploads/2017/07/iStock-609419576.jpg