MyLittleBird Well-Being series responds to reader questions:
Q: I’ve had two eye doctors tell me never to use eye drops for redness (just get more sleep!). Any information on why that is or why it’s actually safe?
A: “It’s fine to treat minor irritation, exhaustion and occasional redness with eye drops,” according to Medicalnewstoday. But eye drops that work as vasoconstrictors, like Visine, can cause redness rebound if used too many days in a row. The alternative, lubricating drops, known as artificial tears, can be more helpful—though the most effective ones require a prescription.
The “just get more sleep” part of the advice, meanwhile, is increasingly a focus of research on how to accomplish that, as well as on how interference with sleep affects whole-body health. “Being exposed to light when your body ought to be resting…can have a significant negative impact,” reported Northwestern neurologist Phyllis Zee and colleagues. In their study, “just one night of moderate light exposure during sleep [like that coming from streetlights outside an unshaded window] impaired glucose and cardiovascular regulation in otherwise healthy young study participants.”
For red eyes—also pink, yellow or orange—the best treatment is usually time. And even when appearing completely bloodshot, they are usually nothing to worry about. In the case of discoloration—the result of tiny blood vessels swelling, leaking or bursting —eyes can take as long as three weeks to absorb the blood and slowly turn white again. When linked to irritation caused by an object like an eyelash, redness should disappear within several hours, although longer-lasting discoloration due to an injury, such as a scratch, can lead to infection and require antibiotic treatment to avoid lasting damage.
Highly contagious conjunctivitis—also called pinkeye and characterized by extreme itchiness—requires antibiotics, too, as well as frequent hand-washing to prevent spreading. A rare cause of redness, uveitis—inflammation of the eye that can come on suddenly, often accompanied by pain and blurred vision—is a reason to seek immediate medical care. And regular ophthalmological visits can watch out for swelling linked to glaucoma.
Dry eyes alone can be a reason for seeking medical treatment. Dry Eye Syndrome (DES) has been publicized in recent years by Jennifer Anniston talking about her affliction on TV. Also called keratoconjunctivitis, DES includes decreased tear secretion, production of poor-quality tears and/or accelerated evaporation of tears, associated with swelling around and on the surface of the eyes.
Common causes of excessive dryness include hormonal changes during menopause, air pollution, winter weather and seasonal allergies. Allergy treatments like antihistamines and decongestants can make dry eyes worse, but teasing out the cause can be difficult. As a result, some allergy sufferers rely on Alaway antihistamine eyedrops in the morning; and Systane Ultra lubricating drops for symptoms of DES at other times of day.
Dry eyes can, alternatively, be a symptom of the immune disorder called Sjogren’s syndrome, which affects moisture-producing glands throughout the body and occurs most often in women over 40. They may also be a symptom of other immune-related conditions like rheumatoid arthritis. Deficiencies in vitamin A and thyroid hormone can be other reasons for eye dryness.
Finally, overuse of so-called “redness relief” eyedrops, which prolongs or even increases redness, can be another reason for seeking medical intervention. Writes New Jersey ophthalmologist Sydney Tyson, “Over time [redness relief drops] really prevent your eyes from naturally recovering.”
Redness-relief drops work by constricting superficial blood vessels on the eye surface that may have dilated to help the eyes respond to irritation. When the drops’ effects wear off, vessels can dilate to an even larger degree, which increases redness and is why experts advise using these drops “one to two days maximum.”
Lubricating drops, on the other hand, increase blood flow to the surface of the eyes and “will actually help repair the damage done by exposure to adverse conditions,” says Tyson. (Concern about preservatives in lubricating drops have led many to choose preservative-free “PF” versions of popular brands, such as Refresh.) Tyson includes redness-relief drops in the category of adverse conditions.
For sufferers of eye problems who have a hard time getting enough sleep, the Northwestern team advises against eating at night, as well as eliminating light as much as possible. Chronobiotic drugs like melatonin can also help “open the doors of sleep by inhibiting the propensity to wakefulness” in the brain, which can occur in late evening, according to researchers in China and Texas. In addition, melatonin works as “the chemical code of darkness [providing] information crucial to the neuroendocrine system.”
I haven’t used redness-relief drops since a bad experience with Visine years ago but was unfamiliar with the alternative lubricating potions. Now I will see if they soothe sore eyes due to seasonal allergies, as well as to insufficient sleep. But hearing the advice to “just get more sleep” makes me bristle: even with the help of nightly melatonin, my best efforts sometimes fail. There are, however, remaining steps I could take, such as skipping coffee ice cream for dessert, putting away the mystery page-turner and quitting Words with Friends. And I should probably readjust those cumbersome blinds.
—Mary Carpenter regularly reports on need-to-know topics in health and medicine.
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“I FOUND my voice” is how Virginia finance manager A.M. described her experiences—as we all saw happen—in a recent DC therapy group. Her first move was not merely speaking up when she felt shy or taking a controversial position, but exploding suddenly to take on a group member who’d made hurtful comments to others without anyone ever confronting her. That day, A.M.’s voice broke in, angry and pointed but also thoughtful and articulate, after years of her near-silence. In the weeks to come, A.M. would come out with amusing comments and begin tackling issues that had plagued her for as long as we knew.
With anxiety and depression on the rise since the beginning of the pandemic—reported by more than four of every 10 adults, about 43%, according to a recent census—and mental health professionals in short supply for individual therapy, more people are joining therapist-led groups. (Other kinds of groups include those led by peers.) What group therapy can offer, Nicole Cammack, psychologist and advisor for the mental health platform Sesh, told the Washington Post, is “broader perspective [for] solving life’s troubles.”
“Social anxiety, anger from others and fear of humiliation” are reasons people are reluctant to join therapy groups, writes Harvard psychiatrist Joseph Shay in his research paper titled “Terrified of Group Therapy.” But Shay concludes, “the research literature has established the definitive benefits of group therapy [such as] having opportunities to observe and change relationship patterns.”
“Psychologists say, in fact, that group members are almost always surprised by how rewarding the group experience can be,” posts psychotherapist Ben Johnson on the American Psychological Association website. Johnson points out that group therapy gives members the chance to receive feedback from many individuals and to address relationship concerns, such as asking for help and dealing with conflict.
And group therapy can be more effective than individual for mood disorders, such as depression and bipolar disorder, according to a recent meta-analysis by psychologists at Penn State and Brigham Young University. Contemporary therapies, such as C.B.T. (cognitive behavior therapy) and D.B.T. (dialectical behavior therapy), often incorporate therapy groups as do treatment programs for eating disorders and substance use.
Group therapy has been around since the early 20th century but burst onto the scene with the early 1960s “human potential movement” in the form of encounter groups —which “encourage strong emotional expression; the participants are not labeled patients; the experience is not labeled ‘therapy,’ but nonetheless the groups strive to increase inner awareness and to change behavior,” according to the report from a 1970 task force of the American Psychiatric Association.
“The number of encounter groups has proliferated to such a degree . . . the intensive group experience movement [is] one of the most rapidly growing social phenomena in the United States,” wrote the task force, chaired by Stanford University psychiatrist Irvin Yalom, considered by many the “father” of group therapy. Among 200 or so encounter groups in the Palo Alto, California, vicinity at the time, intensive “marathon” psychodrama groups met in concentrated stretches—such as up to 36 hours over weekends.
At Stanford summer school in 1969, I had friends who participated in these groups, which sounded terrifying when one described the dramatic emotional encounters designed to break people down, with the goal of making them more receptive to change. A few years later, though, a college course called “Encounter Groups” began with one that met every day for two weeks—which seemed safer, maybe because we were in college together. Nonetheless, some people got very angry, others cried, and I discovered a few things about myself.
But not nearly as much as during my five years in the DC group that included financier A.M. Most “therapy” groups are either “open” with new members joining at any time; or “closed” with everyone beginning at the same time and a specific meeting length, such as 12 weeks. Mine, on the other hand, varied in size from five to seven members with each of us starting at a different time when a slot opened up—after meeting several times beforehand with the psychologist group leader.
I joined after my life took several major turns and, after years of various one-on-one therapies, I thought a different format might help me navigate the future. Believing everyone else knew each other very well, I was on edge in the early meeting but hesitant to pose personal questions because these had enraged my mother. I never asked how long each had been a member. Slowly I experimented with querying the others, and then talking about my own family background, my work and my sons more honestly than I was used to. Slowly I felt a new acceptance among people I hadn’t known at all, which surprised me.
What also surprised me was afterwards when a work colleague I’d always thought had her life very together emailed that she had “LOVED group therapy.” Later she wrote: “(after avoiding even the idea of it) . . . it was such a non-threatening way to learn about myself without being defensive—I learned a lot through the back-and-forth among the other members of the group; it felt safe . . . I learned that people can disagree, even fight, and nobody dies!”
These were my thoughts exactly— also that A.M.’s explosion improved my group, and we all learned a lot. Although some of us had grumbled about the upsetting member, very circumspectly and briefly, no one had spoken up before. When A.M. started off, I felt a tension that was familiar in the presence of conflict. But then I began to appreciate her outburst and finally exuberant, as if the air were clearing, and we began to explore issues we’d all been having. And no one died.
—Mary Carpenter regularly reports on need-to-know topics in health and medicine.
Q: I have long wanted a green burial, preferably in a burlap bag in a forest in an unmarked grave, but I fear that may be difficult to achieve. I now love the idea of body composting. I wonder if such a service will come to the East Coast before my demise.
MyLittleBird: In the four years since MyLittleBird’s “Alternatives to Burial and Cremation,” organizations focusing on green burials have expanded their listings and evaluations—notably the Green Burial Council, with its mission to “prevent meaningless greenwashing in the green burial world.” And new sites like Cake offer guidance through the morass of burial choices and responsibilities.
Nearly 54% of Americans are now considering a green burial, and 72% of cemeteries are reporting an increased demand, according to a recent National Funeral Directors Association survey. Requirements for green burials, such as the condition of the body and use of a casket, vary by state and by cemetery.
Green burials involve no embalming—or only organic embalming—and usually no vault or grave liner. While some cemeteries require grave liners to keep the surrounding earth from caving in (because that makes grass mowing difficult), the Green Burial Council recommends no grass cutting or chemicals to control weeds, as well as graves dug and filled using only hand tools.
While green burials can obviate costly caskets, green options, such as “shroud burial,” may use a casket to ease the transport and lowering of the body. Green caskets employ biodegradable materials such as bamboo, paper, cardboard, wool, banana leaf and cedar. But green burials can also be costly, depending on location—mostly due to the varying prices of burial plots, with urban areas the most expensive: Plots in New York City go as high as $25,000.
Answering oft-posed questions, the Green Burial Council site reassures that unembalmed bodies do not pollute the ground with toxic chemicals, because “soil is the best natural filter there is.” Wild animals will not dig up corpses: “Burials occur at 3.5 feet under the ground with, at minimum, an 18-inch smell barrier. Animals are much more interested in living prey…we’re just not that delicious.” Similarly, humans are unable to smell buried bodies, which take up to two years for complete decomposition.”
Body composting, on the other hand, involves placing the body in a container with organic materials, such as wood chips; exposing the container to oxygen and heat; and rotating it like a typical composter to speed the body’s decomposition. According to US Funerals Online, the resulting “soil” —which can be returned to the family or donated to a conservation entity—“will be very nutrient-rich and make excellent fertilizer.”
Not yet available in the District, what’s also called “natural organic reduction” (NOR) is increasingly popular, especially among “city dwellers who don’t have access to large expanses of land to take advantage of a greener burial,” according to Spectrum News. In Colorado, Oregon, Vermont and Washington, where it is currently legal—with legislation introduced in California, Illinois, Massachusetts and New York—companies offering NOR charge around $5,000 to $7,000.
The mushroom burial suit, another green option, is a full body suit made using mushrooms to speed decomposition, which “is accepted at most green burial cemeteries,” according to Cake. From its inventor and manufacturer, Coeio, the suit costs about $1,500, with smaller pouches for pets at about $200. The mushroom burial suit can fit inside a casket if desired, and burial must be at least four feet deep to ensure proper germination of the mushrooms.
For green burials, including plot plus interment, public cemeteries charge anywhere from $900 to $4,000; and private cemeteries, anywhere from $2,500 to $8,000 and higher in some urban areas. Another option is home burial, with restrictions varying by state. DC one of the few that does not allow it under any conditions.
But money is not the main issue for people committed to lowering the environmental costs of their deaths. “Supporting the operation of a natural burial ground through the purchase of a cemetery plot can help to fund permanent protection of important natural areas,” according to Cake.
Traditional burial, on the other hand, involves “a few gallons of toxic embalming fluid, which will soon leach out of your body and then out of your casket, which will most likely be stored for posterity in a cemetery that uses tons of pesticides and astronomical amounts of water to keep it looking nice,” according to howstuffworks.
“Flame cremation,” currently the most popular option in the U.S., releases the CO2 equivalent to burning about 800,000 barrels of oil – as well as soot and mercury from dental fillings–into the atmosphere. Newer, electric cremation uses less fuel and can be powered by renewable energy. The cheapest “direct cremation” — just the body with no service, performed within 24 hours of death— costs as low as $495; adding a cremation service brings it closer to $3,000.
The greenest options of all —tree burial (leaving the body high in a tree or entombed in the trunk) and sky burial (also known as “exposure,” relying on vultures to take care of the remains) —require no container or plot at all. But green burials can be carbon neutral —with human composting using about one-eighth the energy as cremation—and appears to be expanding across the country.
“Improved logistics and availability of natural burial grounds” are helping to expand eco-burial options, writes US Funerals Online editor Sara Marsden-Ille. With more green cemeteries emerging across the U.S., and even traditional cemeteries adding a designated green section to cater to this demand… I think I would opt for my remains to naturally decompose in a conservation area and return to the earth in eternity…rather than a quick reduction in a steel vat to produce a bucket of soil.”
Cremation with ashes scattered in the ocean always seemed like the best choice for me— until I learned about the environmental costs of cremation. And while I hesitate to pay big bucks to end up as that bucket of compost, the soil is scatterable and thus also an appealing way to give back to the land. I am reconsidering.
—Mary Carpenter regularly reports on need-to-know topics in health and medicine.
AS THE U.S. appears to be heading into what some call its third pandemic winter, many unknowns remain. Most questions concern how much one can or should do— isolation, masking, testing—to remain safe and healthy.
Vulnerable individuals, including those age 65 and older, worry about spending time in public places and especially about eating out. And people who receive a positive Covid test result and are eligible for Paxlovid worry about whether or not to take the drug—which lowers risk of severe disease but can cause rebound Covid symptoms. Another question concerns Evusheld, a practically unknown medication that boosts antibodies in people whose levels are low.
But last week brought the answer to what had been the most pressing conundrum: whether to get an additional Covid booster ASAP or wait for new vaccines that target omicron subvariants BA.4 and BA.5—which together now account for most Covid cases in the U.S. On Wednesday, the FDA issued emergency use authorization for the new bivalent booster—one half is the original shot; and the other, a reformulation against BA.4 and BA.5. On Friday, the CDC added its support.
The new boosters should be in pharmacies now—available to anyone over 18 who has completed the initial vaccination doses, whether or not they have received boosters, as long as their last shot was at least two months ago. White House coordinator Ashish Jha told the New York Times, “If you’ve not gotten a vaccine shot this year, go get one now. It could save your life.”
Not everyone is excited about the new vaccine. Some point out that there has not been enough time to do human studies on increased efficacy compared to the original vaccine. Based on a primate study, cellular immunology specialist at the National Institute of Allergy and Infectious Diseases Robert Seder told the Washington Post that an omicron booster did no better than an additional shot of the original vaccine. Instead, Seder is working on a nasal vaccine that could help block infections.
And while “vaccines are super important… they can’t do this job alone,” Katherine Wu, a reporter for The Atlantic with a degree in microbiology, told The Atlantic newsletter. Wu calls current public messaging “baffling” — first that “things are so much safer now…leaving people to wonder why they need a booster at all;” and that other “pandemic protections are unnecessary now that the updated booster is here…we know that vaccines, as good as they are, can’t prevent all infections. They can’t totally prevent long COVID.”
The U.S. continues to average about 90,000 infections and 475 deaths every day —with high numbers for the most part among the under- and unvaccinated. Fifteen million seniors have not received their first booster, according to Bipartisan Policy Center medical advisor Anand Parekh. “The CDC estimates that among those 50 and older, the unvaccinated had a 29-fold increased risk of dying from Covid-19, and vaccinated people with only one booster had a 4-fold increased risk, compared to those with two or more booster doses.”
Good Covid news in recent months has, however, led to a “receding level of anxiety among the very liberal, including many younger adults,” according to the New York Times’s latest Covid poll, reported in its Morning Newsletter. “The share of the very liberal who say the virus presents a great risk to their own personal health has fallen to 34 percent,” a 13-point drop since March. What is different, according to “The Morning,” is that the antiviral drug Paxlovid —as well as the immunity-booster Evusheld—are now “widely available, reducing the risks for vulnerable people.”
While Paxlovid has proved most effective in reducing hospitalization and deaths from the Omicron variant in those 65 and older, new Israeli research suggests that it has “little effect” in younger patients.
But many people are wary of Paxlovid’s risk of rebound—Covid symptoms that recur within days after the five-day course of the drug—that could be affecting anywhere from 2% to 6%, or a much higher percentage, of patients. Dr. David Ho, professor of medicine and at Columbia University, believes there is some evidence that a longer course of the drug would do a better job of clearing the virus and preventing rebound.
“I think people should consider the possibility of Paxlovid rebound like a known side effect of the medication,” George Washington University health policy expert Leana Wen told CNN. “However, the possibility of this side effect is not a reason to avoid a medication that is highly effective at reducing severe illness.. that can reduce the likelihood of being hospitalized or dying by nearly 90%.”
Early evidence also suggests that Paxlovid could improve clearance of the virus from the body to help stave off long Covid. According to a recent NIH study based on autopsies of 44 people who died from Covid or were infected when they died, “the virus can last in widespread parts of the body—including the brain—for seven months after infection.”
“Some long Covid sufferers are in their third year with the condition,” writes New York Times columnist Zeynep Tufekci. The most reliable statistics on long Covid, according to Tufekci, come from an ongoing British national survey that has found 2.8 percent of people in Britain reported “ongoing symptoms that they attributed to having had Covid”—with .6% saying daily activities had been “limited a lot.” In the U.S., he wrote, “.6% would mean about “two million people potentially facing a debilitating condition.”
About Evusheld, STATnews headlines in July called it “a crucial drug to protect the most vulnerable [which] goes vastly underused.” Available since December 2021, Evusheld injections contain two antibodies that stay in the blood for about six months, “smothering the virus in the event of exposure or infection.”
Evusheld was “supposed to offer salvation, a way of protecting immunocompromised people who couldn’t respond to vaccines” because of having cancer or a genetic condition, according to STAT. But “only a tiny fraction of the roughly 7 million patients who might be eligible have received it. Hundreds of thousands of doses sit on shelves in hospitals and infusion centers across the country.”
I have not yet had Covid and remain concerned about catching it, mostly because of the risk of long Covid. I will get the new vaccine as soon as possible. And if, as scheduled, I need to do maskless in-person presentations this fall, I will ask my doctor about Evusheld. Otherwise, I will wear a mask and try to avoid spending time, especially eating, indoors in public places—and to smile through whatever ribbing I get about my behavior from other people.
PROMISES offered by mind-changing drugs—from relief of depression, anxiety and symptoms of OCD and PTSD, to a vastly improved sense of the self and the universe—have been burgeoning since the early 2000s. At that point, reputable scientists and research institutions restarted research on these drugs that had been on hold since the 1970s. This summer, the Netflix series How to Change Your Mind, based on Michael Pollan’s 2018 hugely bestselling book of the same name, highlighted the drugs’ immense potential.
In psychedelic therapy, psilocybin (known as magic mushrooms) and ketamine are “leading the way,” according to Field Trip Health, which runs ketamine-assisted therapy clinics. While the two compounds overlap in their effects and fall under the umbrella term psychedelics, psilocybin belongs in the category of hallucinogens while ketamine originated as a dissociative anesthesia drug.
The most recent Forbes weekly Innovation Rx email featured news items on both. First, to “advance its ketamine-based treatment for depression,” the biotech startup Freedom Biosciences received $10.5 million; and next, psilocybin combined with psychotherapy, “helps drastically curb alcohol addiction,” according to research at NYU. In the NYU trial that involved 93 participants who struggled with excessive drinking, by the end of eight months, half of those who received psilocybin had stopped drinking compared with about one-fourth of those who received a placebo.
“This is a watershed moment… a time for a lot of hope,” said Rachel Yehuda, mental health director at the Bronx Veterans Affairs Medical Center. Several trials of psychedelic substances now underway from the Department of Veterans Affairs became possible after the FDA’s recent designation of psilocybin and MDMA (Ecstasy) as “breakthrough therapies” for the treatment of PTSD and depression.
What convinced long-time psychedelics researcher Roland Griffiths, now at Johns Hopkins, was the data. In the Netflix series, Griffiths refers to the Mystical Experience Questionnaire —repeatedly validated by research—that assesses individual psychedelic experiences based on 30 questions addressing positive mood, sacredness and “experience of unity with ultimate reality.”
Johns Hopkins researchers have recently documented brain changes by comparing MRI scans from individuals after they had taken psilocybin to those after taking a placebo. With psilocybin, the scans showed decreased activity in the brain region called the claustrum, believed by some to be the “seat of consciousness.” According to the researchers, turning down activity in the claustrum “ties in with what people report…feelings of being connected to everything and reduced senses of self or ego.”
Despite increasing research showing the mental health benefits of psychedelic drugs, obstacles—both financial and legal — continue to impede their use. In addition, long-term therapy with ketamine can cause tolerance and urinary tract infections; and psilocybin “trip” experiences can be unpleasant.
Psilocybin is an illegal Schedule 1 drug, defined as having a high risk of abuse and no “currently accepted medical use.” As a result, taking psilocybin requires either locating and then qualifying for one of the rare research studies —or buying the drug illegally and, for some, seeking out sometimes-costly therapeutic trip support.
Although Oregon has legalized psilocybin and a few cities like Denver have reduced the legal consequences of possessing the drug, prospects for national legalization are dim: Drug companies have little motivation to support a chemical that can be found naturally in the wild and can require as little as one dose for successful treatment.
Ketamine, the only legally available psychedelic, has been in use since the 1960s for surgical anesthesia and has provided dramatic relief from both depression and anxiety in a matter of days—compared to weeks for traditional medications. “The most important breakthrough in antidepressant treatment in decades” is how Thomas Insel, past director of the National Institute of Mental Health, referred to ketamine.
But ketamine can be costly—with clinics around the country offering infusion sessions lasting about three hours for between $350 to $1,000 each, and most people return for additional doses several weeks or months apart. In addition, a STAT news investigation into hundreds of ketamine clinics found wide-ranging inconsistencies, with some having no mental-health professionals to check patients at each infusion.
Nasal spray delivery of the related esketamine, approved in 2019 by the FDA, makes the drug more accessible for some patients—although guidelines require use “under the supervision of a health care provider in a certified doctor’s office or clinic.” Despite some complaints about getting the dosage right, the spray can help prolong the period between infusions and offers the possibility of microdosing several times a day as needed.
The two drugs, psilocybin and ketamine, operate on different receptors in the brain— but both appear to enhance the ability of neurons to interact with each other by releasing neurotransmitters, while mood disorders can impair this ability. Psilocybin affects serotonin receptors, which alter mood and happiness; ketamine works on different brain receptors important for learning and memory. But both kinds of receptors are located in the brain’s prefrontal cortex which, UCDavis chemistry professor David Olson told the New York Times, “talks to a whole bunch of brain regions that regulate things like mood, emotion, fear, reward.”
Great variation exists in different people’s responses to both of these compounds— not unlike the way symptoms of mental health conditions may present differently, as well as the way individuals respond differently to drugs that treat anxiety and depression. In one study, psilocybin was similarly effective for treating depression as the antidepressant Lexapro—but some people didn’t respond to either drug. Of the estimated one-third of people with a mental health condition like depression who do not respond to psychedelic treatment, differences may be due to genetic variations in the serotonin receptors.
Responding in part to questions raised by the Netflix series, Michael Pollan and others at the Berkeley Center for the Science of Psychedelics have collected resources on a new website, which covers topics such as psychedelics and spirituality, risk and microdosing. The site also proposes questions, for example, how to choose a psychedelic therapist?
I am curious about these drugs—especially psilocybin, mostly because I have no disabling mental health problem that could justify paying for regular ketamine infusions. I have found organizations around the U.S. that offer “guided psychedelic trips”— Psychedelic Passage, for example, provides “trip sitters” for up to six individuals at a time. But I can’t imagine trusting an unfamiliar guide other than in a research institution study. For now, my curiosity is on hold although I anticipate changes in the world of psychedelics—possibly in the near future.
—Mary Carpenter regularly reports on need-to-know topics in health and medicine.
In this entry to MyLittleBird’s Summer Update Series, Mary addresses tick-borne illnesses, notably the most common—Lyme disease. Others also on the rise in the U.S., as the tick vectors move northward with climate change, include Rocky Mountain spotted fever, which causes a rash and if untreated can lead to death; and Alpha gal syndrome, spread by the Lone Star tick and causing a potentially deadly allergic reaction to meat.
LYME DISEASE, according to a 2022 meta-study, has afflicted more than 14% of the world’s population—more than 9% of U.S. residents, with the highest rates in Central Europe—reported by NBC news in June. The study assessed the seroprevalence, levels of antibodies in the blood, of the disease in more than 158,000 people around the world.
Lyme disease, though, has benefited from the Covid pandemic with better attention and new research on long-lasting symptoms common to both diseases: disabling fatigue, cognitive problems that include difficulty focusing and pain. Posted last May on the Johns Hopkins Lyme Disease Research Center site: “We are hopeful that the tremendous resources for long-haul Covid research could help accelerate Lyme disease knowledge and treatments as well.”
Long-lasting Lyme symptoms may be more likely when treatment is delayed, according to a Johns Hopkins study —important information for anyone who thinks they might have been bitten by a tick, have a rash that could be the result of a tick bite or have flu-like symptoms including painful muscle aches. They should insist their doctor prescribe at least three weeks of doxycycline —or otherwise find a more Lyme-savvy doctor who will.
From Mary’s earlier post on Lyme disease:
As of July, 2019, Lyme disease had moved into all 50 states, with a 20% rise in incidence compared with 2016. Data from New Jersey-based Quest Dynamics show “positive results for Lyme are both increasing in number and occurring in geographic areas not historically associated with the disease,” according to CBS news.
To reiterate our advice, it’s time to ratchet up anti-tick measures. Wear light-colored clothing to make ticks easier to spot—and long pants tucked into socks. Spray the insecticide (as opposed to insect repellent) permethrin heavily on clothing and repeat after every one or two washes. What might be easier over time is purchasing pants pre-treated with permethrin, on which effects last through dozens of washings.
In addition, apply insect repellents containing DEET, picaridin and lemon eucalyptus oil directly on the body. Within two hours of walking in grass or any vegetation not closely trimmed, take a hot shower and check your clothes and body. Ticks love warm, moist areas like armpits, hair and especially groin areas—although the nymph or juvenile tick that most often transmits Lyme disease can be hard to spot, “with bodies as small as a freckle or the tip of a pencil.” Wash clothes in hot water; and before or instead of washing, dry for 10 minutes at a high temp in a dryer.
In addition, protect predators of the white-footed mice, because mice are crucial to the larval stage of the life cycle of Lyme-carrying ticks and considered primary vectors of Lyme disease. An individual mouse can carry up to 100 ticks at a time. At the next stages, nymphs are most dangerous to humans, and adult ticks live and mate on deer—responsible for spreading the larvae. Be especially kind to neighborhood foxes, which can intimidate prey animals like mice to hide and become less likely to end up as tick food, according to Arlington Patch.
If you find a tick attached to your skin, remove it as soon as possible—within 24 to 36 hours, before the tick has the time to inject the Lyme bacteria—and save the tick. Even without the characteristic bull’s-eye shaped rash—which occurs in only around half of Lyme cases—showing the tick to medical professionals can help persuade them to begin antibiotic treatment. Blood tests that confirm Lyme disease rely on the development of a measurable immune response, sometimes requiring weeks to show a clear result.
Because some doctors underestimate Lyme risks and dismiss reports of symptoms, a physician familiar with tick-borne diseases may provide the best treatment, advises Kris Newby, producer of the Lyme disease documentary Under Our Skin. “Don’t waste valuable treatment time trying to convince an inexperienced physician that you’re really sick.”
Lyme-savvy doctors are also more likely to be aware of updated treatment protocols, notably prescribing doxycycline for three or four weeks rather than the two weeks initially deemed sufficient. Newby advises contacting the International Lyme and Associated Diseases Society for a list of local practitioners. Locally, the Johns Hopkins Lyme Disease Research Center is a resource for treatment of Lyme, in particular “Post Treatment Lyme Disease Syndrome.”
When I had Lyme disease in 2008, it took almost two weeks to persuade my doctor to prescribe doxycycline, after which intense muscle aches and fatigue lasted for several months. Among symptoms that persist almost 15 years later, two have well-documented connections to Lyme disease: difficulty sleeping and peripheral neuropathy that causes numbness in the feet and legs resulting in difficulties with balance and walking. And a third, clearly linked to Lyme only recently: my cholesterol levels shot up 150 points during the acute stage and remain about 100 points higher today.
Which is why I tell anyone who thinks they might have been bitten by a tick, have a rash that could be caused by a tick or have flu-like symptoms, including muscle aches, to waste no time insisting their doctor prescribe doxycycline; otherwise look for one who will, as soon as possible.
—Mary Carpenter regularly reports on need-to-know topics in health and medicine.
In this entry to MyLittleBird’s 2022 Summer Update series, Mary updates her former post on dehydration— the topic of many reader queries—to caution readers of its ability to strike without warning; and to offer a quick test for dehydration, along with a solution that has helped her.
EARLY SIGNS of dehydration, called “heat illness,” can include water retention, cramping muscles and, in more serious cases, fainting, dizziness and vertigo. For anyone who has suffered a few bouts of unanticipated dehydration, skin tests are a quick way to check: Push one finger into skin on the arm or use two fingers to pull upward on the skin of the other hand—in both cases, the more slowly the skin resumes its normal appearance, the higher the risk of dehydration.
The danger of dehydration without warning can increase with age because of a diminishing ability to sense thirst. Also hard to detect, kidney function that declines with age can cause fluid imbalance in the body that increases risk. And the body becomes less able to retain water, allowing dehydration to occur more rapidly. Finally, sweat glands that help cool the body respond more slowly with age, allowing core temperatures to rise and increasing the time it takes to recover.
What can help during hot weather is salt pills or salty chews—taken either once a day or more often as well as with early signs of dehydration (although people with high blood pressure should be careful). “Saltstick Fastchews,” for example, which taste something like sweet tarts, include small amounts of four electrolytes and promise to “reduce heat stress and muscle cramping.”
HUMID DAYS of summer can be deceptive. You feel puffed up with fluids but your clothes are damp with sweat. Drinking more water, however, is not always the answer. Although the body usually can reabsorb fluid from the blood as needed, dehydration causes the blood to become more concentrated—leading to water retention in the kidneys as well as in tissues throughout the body.
Thicker blood makes the heart work harder to pump the blood, which can cause a rise in heart rate to maintain blood pressure. In addition, one of the body’s first cooling actions is increasing the heart rate to move blood and heat outward to the skin. An elevated heart rate can increase the risk of fainting, often accompanied by dizziness and nausea.
Other early signs of dehydration include dryer mouth and eyes, darker urine, and feeling more tired and irritable. Bad breath can be a clue because dehydration reduces saliva along with its bacteria-fighting abilities. Dehydration also interferes with the body’s ability to regulate temperature, causing body temperature to rise or sometimes, paradoxically, to fall—causing chills.
When severe dehydration reduces fluid in the blood to the point of impeding blood circulation to the organs, the most serious result is life-threatening shock—which requires medical attention. While shock usually occurs only in cases of severe diarrhea, extreme heat can increase the risk.
Sweat contains more sodium than other electrolytes. Both dehydration and drinking too much plain water when dehydrated can cause hyponatremia—insufficient salt in the blood—which can trigger muscle cramping. Cramping can also result when the muscles become overheated during exercise, as well as by overexertion of the calf muscles, insufficient warm-ups and magnesium and/or potassium deficiency.
In cases of severe dehydration risk, UNICEF and commercial rehydration packages include salt and carbohydrates—sometimes simply sugar—to mimic the normal composition of fluid in blood, which improves absorption.
To stave off dehydration ahead of time, alternatives include pre-cooling and heat acclimation. In a Scandinavian study of different cooling methods, 12 experienced male runners were tested on three separate occasions: first after drinking a room-temperature sweetened beverage, then after a sweetened “slushy” (icy) drink and finally after cooling their skin by draping cold towels around their necks, immersing their arms in cold water and wearing underwear filled with ice packs. The athletes performed better after both the slushy drinks and skin cooling than after a room-temperature drink—but the effects of core cooling from the slushy drink wore off faster than the effects of skin cooling.
A different study, at the Environmental Extremes Laboratory in Brighton, England, tested nine recreational runners doing a simulated 5K race four times at top speed in a 90-degree heated room: first with no preparation; then after pre-cooling with frozen underwear and a chilling arm plunge, plus a cooling vest; next, after formal acclimation—cycling for 90 minutes in 99-degree heat for five consecutive days; and finally, after both pre-cooling and acclimation. Acclimation made the biggest difference in subsequent running times; adding pre-cooling provided little additional gain.
Because overheating alters many bodily functions, including efficient production and use of energy, many athletes use cooling vests to reduce excess heat while exercising. In one study, however, core cooling did not increase any more for the group wearing a cooling vest than it did for those who simply sat in the shade ahead of time—the only difference for the former was cooler skin and a feeling of coolness. Also, cooling vests and underwear come with the risk that reducing perceptions of body heat can mask rising core temperatures—making heat-induced illness more likely.
When the forecast predicts hot weather, I begin many summer days with a salty Fastchew, and after outdoor exertion sometimes add one more. And if drinking plain water doesn’t seem to relieve my thirst, I mix in some lemonade —with a vague idea of using the UNICEF formula, or at least adding the sugar component.
—Mary Carpenter regularly reports on need-to-know topics in health and medicine.
In this entry to MyLittleBird’s 2022 Summer Update series, Mary discusses Skin Scourges of Summer, adding recent data about effects of climate change on the toxicodendrons—poison ivy, oak and sumac; along with better advice about how to respond in case of accidental contact.
FOR THE poison ivy plant in particular, higher levels of carbon dioxide in the air have spurred explosive growth, creating leaves so large the plant is barely recognizable—and leading to higher levels and greater potency of the urushiol oil that causes the allergic dermatitis rash.
Updated poison ivy warnings emphasize the tenacious endurance of urushiol oil on garden tools and everything else that comes into contact with the plant. Merely by cutting or pulling out the vine, urushiol can spread through the air onto the most carefully covered weeder. The best recourse after gardening is an immediate and thorough washing— not just everywhere on the body, but also the clippers, gloves, clothes and shoes.
Afflicted sufferers can find the rash unbearable— impeding daily activities and preventing sleep. A towel or other soft cloth soaked in cool or lukewarm, salty water can offer the quickest relief. But medicine-cabinet staples, including antihistamines like Benadryl, “do not help to relieve itching caused by poison ivy dermatitis,” according to Up to Date. Low-potency OTC steroid creams are also unhelpful, while antihistamine creams or lotions can make the rash worse.
Prescription-strength steroid creams can work better than OTC products for itching and redness, according to Drugs.com. But if the rash affects the face, hands or genitals, or covers more than 10% of the skin, most doctors prescribe corticosteroid pills that can “dramatically reduce symptoms.” Stopping any prescription steroid before the specified period can cause the rash to reappear.
More from Mary’s earlier post on Summer Skin Scourges:
Pool chlorine dries the skin but swimming anywhere else has risks. Swimmer’s itch —also called clam digger’s itch—comes from lakes, ponds and oceans where water parasites, often from bird droppings, can burrow into the skin to cause welts or blisters on areas that bathing suits don’t cover. A brisk towel rubdown can help remove critters when washing is unavailable.
Conversely, seabather’s eruption—or pica-pica—appears on areas of the body covered by bathing attire, including flippers and masks, when newly hatched jellyfish or sea anemones get trapped inside, most commonly in the waters off Florida and Long Island, NY.
Summer warmth can provoke prickly heat— miliaria or heat rash— when blocked sweat glands cause sweat to build up under the skin, producing itchy bumps. While sunburn appears uniformly red and only on exposed skin, heat rash occurs anywhere moisture can get trapped, particularly under the arms. Bursting bumps release sweat to create a prickly sensation. Common-sense advice suggests trying to avoid profuse sweating—for example, by reducing exertions during the hottest or most humid periods of the day.
Melasma, which looks more like sunburn, is a disorder that produces gradual pigmentation of the skin. Sunlight can provoke flares in summertime, while the condition can improve in the winter. Another ongoing skin condition that becomes worse in summertime is folliculitis—also known as “hot tub folliculitis” — that occurs when hair follicles become infected and often resembles pimples. The best recourse when possible is changing out of tight workout clothes or wearing looser-fitting options—and stay away from hot tubs, which can have irritating high chlorine and acid levels.
Small, scaly skin patches are most often actinic keratosis—also called solar keratosis— the most common early-warning sign of skin cancer. (Actinic refers to chemical changes produced by radiant energy—described as photochemical reactions, as in photography.) The two main non-melanoma or keratinocyte carcinomas are basal cell, occurring mostly on the face and neck, from which 80% of skin cancers develop; and squamous cell, found all over the body and accounting for 20% of skin cancers. The most dangerous skin cancer is melanoma, which can spread throughout the body.
Beachgoers incur additional risks in summertime. Pathogens that lurk in the sand include dermatophytes that can cause ringworm and athlete’s foot. In addition, hookworms and roundworms can enter the body through bare feet, or bare skin, but usually die after about six weeks.
The most familiar sand-borne bug, Staphylococcus aureus, or S. aureus, usually lives benignly on the skin but can penetrate through a cut or lesion. The most worrisome, antibiotic-resistant MRSA (multi-resistant staph aureus) has appeared in samples of sand and seawater from southern California beaches, although it’s unclear whether that bacteria has led to infections.
Milder staph infections can cause the skin sores of impetigo, which commonly afflict children and can run rampant on local beaches. For me, even after severe bouts of poison ivy, ringworm and dry skin, the worst summer skin experience involved being asked by a lifeguard to leave a private beach after someone reported seeing my bared waist covered with weeping impetiginous sores.
—Mary Carpenter regularly reports on need-to-know topics in health and medicine
THE LATEST self-tests that claim to detect “food intolerances”— to proteins, grains, fruits, vegetables, seafood, gluten, additives and preservatives—boast of relieving low-level chronic health complaints, such as digestive issues and fatigue. While most self-tests rely on blood and urine samples, “5Strands,” which costs as low as $50, offers “bioresonance” analysis of hair (five strands) to assess energy patterns and wavelengths for indications of reactions to about 600 food and beverage ingredients.
The accuracy and usefulness of self-tests, including those based on blood and urine samples, are in question, however, as is their vocabulary: “intolerances,” “sensitivities” and “allergies” to food. The only accepted diagnosis of digestive issues related to gluten is celiac disease—not an intolerance or sensitivity but an autoimmune disease —which requires a gut biopsy for the final determination.
As for 5Strands detecting energy patterns and wave lengths in a body’s response food, the American Academy of Allergy, Asthma, and Immunology told the “Today” show there is “no scientific evidence.” Also, biologic reactions to food ingredients depend on a host of factors and vary widely among individuals, making it difficult to establish the population-wide reference levels on which self-tests rely; and documenting any link of health improvements to the elimination of any specific food ingredients requires very large studies lasting over months or years.
Hair sample testing has, however, led to successful treatment of patients in alternative and functional medicine practices, for complaints of chronic, low-level health issues that have not been addressed or taken seriously by traditional health-care practitioners. By itself, however, close attention to an individual’s difficulties can lead to improved health, as can encouragement for anyone to pay greater attention to diet.
For DNAweekly reviewer Sara Turner, 5Strands testing detected a high intolerance to dairy products and beef, which she eliminated and afterwards “felt better”—leading to her enthusiasm for finding “a diet that lets me consume bacon, alcohol and noodles!” On the other hand, Turner pointed out that, despite personal experience with data analysis, it took more than five hours for her to make sense of the results —provided in long lists of obscure chemical ingredients.
Fatigue, aches and brain fog lifted “almost immediately,” Seattle hiking supply store owner Kristi Wood told the New York Times, based on InsideTracker blood testing that showed excessive levels of Vitamin D and led her to stop taking the supplements. And for ex-Army ranger Joseph Roberts, InsideTracker results prodded him to make changes, such as cutting back on the energy drinks responsible for his elevated vitamin B12 level—and he proclaimed the test “life-changing.”
An evaluation of 1,032 individuals using InsideTracker focused on vitamin D and LDL cholesterol—both having “important implications for a spectrum of health-related physiological processes,” according to Tufts University researchers. Vitamin D has correlated, for example, with nutrient intake and lipid metabolism; and LDL with iron storage and electrolyte status.
Interventions leading to healthier levels of both—and consequently to improvements in related biomarkers — included increasing vitamin D supplements; and, for LDL cholesterol, adding oats, green tea and dairy products to the diet. But researchers cautioned that improvements could result simply from information about “problematic biomarkers inspiring lifestyle changes independent of any recommendations received,” and that their analysis was observational and meant for “hypothesis generation only.”
For diet-related health problems, most self-test blood measurements assess levels of immunoglobulin G (IgG) antibodies —which are one element in a body’s immune reaction but are unreliable because they fluctuate daily depending on recent food consumption. More importantly, different, IgE, antibodies are the ones involved in true allergic reactions—and these vary so widely among individuals that it’s impossible to depend on single reference levels used in self-testing results.
But unreliable vocabulary may be indicative of the most undermining problems of self-testing—notably “food intolerance,” which most products use interchangeably with “food allergy” and “food sensitivity.” Unlike food allergies, which are related to the immune system, food intolerance arises from the lack of a specific enzyme required for digestion— as with lactose intolerance—which are not assessed by self-tests and are often accompanied by other factors that are difficult to test for.
As for “food sensitivities,” one review from a generally reliable site notes that these “are caused by an immune reaction driven by antibodies such as immunoglobulin G” and others, but never mentions the true food-related antibodies, IgE. Also the review includes such disclaimers as “some studies suggest that the presence of these antibodies may not be an accurate or reliable marker of a food sensitivity”; and “at-home food sensitivity tests are not recommended for diagnosing food sensitivities.”
And despite the review’s focus on food sensitivities, there is no mention of these for “Best at-home food intolerance test” (FoodMarble AIR) or “Best at-home food allergy test” (Labcorp food allergy test). Yet, included under a third category —Best if you already took a DNA test” (Vitagene), which “tests your DNA to see how your genetics influence your health” — is the disclaimer that “it is not possible to identify food sensitivities based on your genetics.”
“Omics” —global analysis techniques—might, on the other hand, in the future help create “precision nutrition,” based on an individual’s DNA along with such influences as environment, nutrition and lifestyle exposures. But, according to Spanish and Dutch researchers, “we are still far from being able to define and use” the iPop (integrated personal omic profile) as a preventive and diagnostic tool.
While self-testing is tempting as a way to inspire more careful attention to my diet, especially trial eliminations, such as dairy foods linked to inflammation and arthritis pain, which people constantly recommend I avoid. But because my salient food issues are not sensitivities but are instead related to the mechanics of digestion, I already avoid enough foods that are notoriously difficult to digest including beans, nuts and whole grains—even popcorn—and for now that’s the most attention I can devote to diet.
—Mary Carpenter regularly reports on need-to-know topics in health and medicine.
DCGRANT-WRITER CC had mostly ignored the flushed redness of her cheeks until her five-year-old granddaughter, sitting in her lap one day, asked “What are those red spots?” That comment sent CC to a dermatologist who diagnosed rosacea, a chronic inflammatory condition that progresses with sun exposure and age. Famous sufferers include Bill Clinton and W.C.Fields, but according to the Mayo clinic, rosacea is most “common in middle-aged women.”
After one or two bouts of rosacea—often in high-stress situations—some people never have another, but it can be important to keep track. Over time, redness and flushing “may cause small blood vessels in the face to enlarge permanently and become more visible through the skin..like tiny red lines (called telangiectasias),” writes Southern California dermatologist Gary Cole. Continued or repeated episodes of flushing may also promote inflammation, causing small bumps or leading to overgrowth of tissues that appear as a thickening and permanent swelling.
Rosacea usually occurs in flare-ups every few weeks or months, tending to get worse over time and set off by triggers—both environmental and lifestyle, but these can be complicated. Heat, for example, is a trigger, and while hot, sunny days can increase the risk of dehydration, that is not itself a trigger—but staying hydrated can help reduce symptoms.
People living in cities have more frequent flare-ups than those living in the countryside— considered both “environmental” and “lifestyle.” Spicy foods are common triggers as are specific ingredients like pepper and cinnamon. Many people cite alcohol as a trigger while others disagree, and many women report rosacea symptoms worsening with their hormonal cycle. But the most difficult-to-control trigger is stress.
While the cause of rosacea is unknown, it can run in families, commonly occurring in those with light skin of Northern European descent. Inflammation is part of the disease definition but may also play a role in its initial onset, due to an overactive immune system. And demodex mites — tiny parasites, which are very common in the skin of healthy individuals, but only in high numbers cause an array of symptoms requiring treatment — are often present in those with rosacea.
Of the four types of rosacea symptoms, the two that most often occur in combination are type 1 —red areas on the face, sometimes accompanied by small, visible blood vessels; and type 2— papules and pustules (bumps and puss-filled spots) that can look like pimples.
The inflamed eyes and eyelids that characterize a third rosacea type occur in up to 50% of sufferers. Eye symptoms range from the most common, mild dryness and irritation, to blurred vision, recurrent infections and the rarer sight-threatening keratitis, according to German dermatologist Carolyn Hilbring and colleagues. A fourth type of rosacea involves thickened skin on the nose that can make it look large, bumpy and bulbus, called rhinophyma.
Because the causes of rosacea are poorly understood and symptoms vary widely, the list of treatments include a wide range of anti-inflammatories and antibiotics in both topical and pill form. For some people with a high number of mites, for example, a topical cream like ivermectin helps fight the mites and can reduce inflammation, while others need oral antibiotics like doxycycline.
The antibiotic metronidazole, applied topically, is a first-line treatment that kills bacteria to reduce inflammation. Other topical drugs like brimonidine work by constricting blood vessels, which decreases blood flow to the face to reduce flushing; and beta blockers, commonly used to treat high blood pressure, have a similar effect. Oral contraception has helped those women whose rosacea worsens with their menstrual cycle.
CC’s dermatologist recommended treatments with the pulsed dye Vbeam laser, which uses yellow light to target blood vessels—heating them and causing them to collapse and be reabsorbed by the skin—without damaging surrounding tissue, explains Florida-based dermatologist Kerry Shaughnessy.
For CC, one treatment “certainly got rid of the red veins and reduced the red spots on my cheeks. It didn’t totally remove the rosy color, but I am sure that if I went in more regularly, it would be more effective.” The first round usually involves several treatments three to six weeks apart, and after that another every year or two. But cost is a major drawback to the laser option: It costs around $500 per session, which is rarely covered by insurance.
For local filmmaker KL, red, elevated bumps became more noticeable over the years, but laser treatment was financially out of reach. Her dermatologist started her off with topical metronidazole, along with a sodium sulfacetamide and sulfur cleaner — “all of which had no effect at all,” KL said.
The next doctor recommended the antihistamine Zyrtec, which could help with her seasonal allergies and hopefully treat her skin at the same time, along with Benadryl cream. These helped at first with the rosacea but not for long, and now she’s headed for a third opinion— a trial-and-error path, common among rosacea sufferers.
While speaking in public, I have had facial redness intense enough to worry onlookers, along with more common symptoms like dry mouth and a rapid heartbeat. Beta blockers, recommended for anxious public speakers, seemed to help but made me sleepy. For my next event, I plan to try a cold-water face-dunk, known to set off the diving reflex, which can slow the breath and heart rate, quickly relieve stress and hopefully forestall future facial reactions.
—Mary Carpenter regularly reports on need-to-know topics in health and medicine.
RECENT COVID news suggests many reasons for hope —notably that each new Omicron variant seems to cause milder infection leading to fewer hospitalizations and deaths. But as of last week those numbers are rising, along with new evidence that each reinfection “appears to increase the chances that a person will face new and sometimes lasting health problems after their infection,” according to CNN.
Both greater contagiousness and higher numbers of reinfection have accompanied each new Omicron variant — with the latest variants infecting some people as soon as 20 days after their first infection. The currently dominant “BA.5 carries key mutations that help it escape antibodies generated by both vaccines and prior infection,” states the CNN report.
“The worst version of the virus we’ve seen” is how Scripps researcher Eric Topol describes the BA.5 variant that “quickly” became dominant in the U.S. While BA.5 officially causes about 100,000 new cases a day, that “wildly underestimates the true number,” Topol said, as many people do not report positive results from at-home antigen tests. In addition, antigen testing for the newer variants has resulted in more false negatives, sometimes with positive results only after greater delays or until full-blown symptoms develop.
“It feels as if everyone has given up,” Northwestern University epidemiologist Mercedes Carnethon told the Post. But Carnethon also said she is not as cautious as she used to be—because she doesn’t think a “zero covid” strategy is workable.
The “Swiss cheese model” of protection remains the best option: Take as many precautions as you can handle, which include vaccines and masks; testing after exposure and with symptoms; and avoiding large crowds in enclosed spaces. Whatever the limitations of each, layering them together like Swiss cheese should help cover the holes.
For masking alone, Japan has shown the greatest benefits—with the lowest death rate among the world’s wealthiest nations, and one-twelfth of that in the United States. Building on a tradition of social conformity, public pressure has increased mask-wearing there—with the buzzword “face pants,” indicating the similar embarrassment of lowering a mask to that of lowering one’s underwear in public.
In the U.S., Covid precaution guidelines are still evolving —as recorded in the Atlantic article “Five Covid Numbers that Don’t Make Sense Anymore.” Replacing an earlier formula for preventing infection—which was to avoid spending time with people for more than 15 minutes, at a distance of less than six feet, over a 24-hour period—is a newer reliance on a host of factors, such as the quality of ventilation and of the masks. For infected people, advice that they should isolate for 10 days, which then changed to five days, has given way to the use of negative testing to mark the end of contagiousness.
But in response to recent questions about the contagiousness of those clinically recovered people who continue to have positive test results, the CDC states there is “no evidence” that they have transmitted Covid to other people. Despite its equivocal conclusion that “most persons…are likely no longer infectious,” the CDC seems to be suggesting a return to the earlier 10-day guideline—for infected people to end isolation 10 days after symptoms began along with their improved symptoms and at least 24 hours without fever.
Greater risk of reinfection with the new variants could lead to more people with accumulated infections having a higher likelihood of severe symptoms—as well as of longer-term heart or lung problems, according to the new study of nearly 39,000 patients by St. Louis Veterans Affair Health Care System Chief Zivad Al-Aly. Acquiring a second infection, compared to the first one, was associated with twice the rate of people dying from any cause—whether or not people had been fully vaccinated.
Better protection against severe infection, on the other hand, has come with greater availability of the antiviral Paxlovid. Eligibility for the drug, to be taken within five days of receiving a positive Covid test, extends to anyone age 65 and over, as well as to others at high risk of severe symptoms. Although Paxlovid has caused rebound symptoms of Covid in 2 to 6% of cases, these usually resolve within a week—and taking the drug creates lower overall risk than not taking it.
With newer Omicron variants in the wings—such as BA2.75, first seen in India and now elsewhere, including the United States—and suggestions that the coronavirus might be evolving toward a new Greek letter altogether, people are wondering about their next vaccine or booster. The FDA has asked vaccine makers to investigate new formulas that target recent variants, which could be ready by late fall. The rapid evolution of the variants, on the other hand, makes it unclear whether vaccines developed now can combat a fall or winter surge.
Another unanswered question is about an upper limit on the total number of shots one person can receive. While experts say each shot provides immunity for anywhere between a few months to around six months, the current recommendation is to wait eight months before getting an additional booster. Meanwhile, no one seems to be mentioning a third booster —adding up to five shots altogether. Waiting eight months after my last booster in April might get me a better targeted vaccine, but will my protection last until then?
—Mary Carpenter keeps up to date on the seemingly endless Covid variants. Read more of her posts here.
Since Mary Carpenter wrote a MyLittleBird post about the medical benefits of water in 2014, not much has changed —but even non-swimmers are touting the benefits of what’s called the diving response or reflex.
PUBLIC speaking can be daunting—especially when it dries the mouth and blocks the breath. While most public speaking strategies emphasize preparation and more preparation, many rely on beta-blocker medications like propranolol, which relax the heart and blood vessels to lower blood pressure but often come with side effects like fatigue.
Dunking the face in icy water or simply covering it with a cold wet towel —especially on the forehead and the area around the nose—can activate the diving response or reflex (DR), which has many of the same benefits, minus the side effects of drugs. For the diving response, three independent reflexes combine to lower respiration, heart rate and arterial blood pressure.
“The dramatic bradycardia seen with underwater submersion…is mediated via the vagus nerve,” write Michael Panneton and Qi Gan at the St. Louis School of Medicine in Missouri. “The DR is thought to conserve vital oxygen stores and thus maintain life by directing perfusion to the two organs most essential for life—the heart and the brain.”
Stimulating the vagus nerve—which meanders down the body from the brainstem toward the chest and abdomen—engages the parasympathetic nervous system in charge of the body’s involuntary functions such as digestion. The vagus nerve can also direct the “relaxation response”—notably by way of different breathing techniques, including mindful breathing.
In the DR, vagal activation begins at the facial trigeminal nerve, located in the forehead and around the nose—which responds to splashes of cold water or to frozen vegetables and plastic bags of ice touching these areas. But the best method involves holding the breath, then plunging the face into icy water for 30 seconds, followed by taking a break and repeating the dunk.
The DR may be an evolutionary adaptation in the transition between fish and land-living animals, seen in fossil evidence from about 375 million years ago, writes Neil Shubin in Your Inner Fish. “What we saw gradually emerge from these rocks..was a beautiful intermediate…when we look inside the fin, we see bones that correspond to the upper arm, the forearm.. this is a fish with shoulder, elbow and wrist joints.”
For swimmers, very cold water—below 57 degrees—boosts metabolic rate and dopamine levels, along with reducing tension, fatigue and pain, according to Hirofumi Tanaka, director of the Cardiovascular Aging Research Lab at the University of Texas in Austin. Tanaka told Bonnie Tsui, author of Why We Swim, that swimming affects “two of the biggest hallmarks of aging: high blood pressure and arthritis.”
“We realized the effects of swimming actually surpassed the magnitude of the effects of walking or cycling,” Tanaka said. For arthritis patients, swimming in “cool” water at 80 degrees or lower “stimulated mobility—without pain—and circulation”; and lowered blood pressure more than land-based exercise training. For the coldest water swimming— advisable only for people who are healthy and do not have heart disease—more than 250 people have completed the “ice mile” in water temperatures 41 degrees or lower.
From Mary’s 2014 post on water:
Medical treatments involving water—hot water, steam, cold water, salt water and ice — are usually those people discover by experience but doctors rarely mention. For migraine headaches, while lifetime sufferers require serious medication, splashing icy cold water on the face can offer some relief— from a relaxation effect similar to that of the DR. Ice cubes alone or very cold water can slow or stop the onset of cold sores—if applied shortly after early warnings from a slight tickle or itch. Ice also helps treat oven burns, sunburns and other issues related to overheating; as well as swollen sprains and sore back muscles.
Salt water—in the ocean or with Epsom salts dissolved in a hot bath or foot tub —can heal cuts and scrapes, prevent or treat infection and soothe swelling and tired muscles. For swimmers, the ocean combines the balm of salt with the pain reduction that comes with weightlessness.
Finally, drinking water offers a long list of health benefits: aiding digestion; normalizing blood pressure; cushioning joints and protecting organs and tissues; regulating body temperature and maintaining a balance of electrolytes‰especially sodium. “Most people need about four to six cups of water each day,” according to Harvard Health —that can come from an array of sources, including water-rich foods, such as fruit and even caffeinated drinks. Signs of dehydration include weakness, dizziness, confusion and urine that is dark in color.
Swimming is my favorite exercise, but I avoid temperatures below about 70 degrees, fearful of freezing my toes off. A similar fear arises at the prospect of public speaking and its physical challenges of dry mouth and difficulty breathing. I plan to give the DR a try but am still trying to find a good way of drying off before speaking—especially for the latest presentations, involving close-ups that take place on Zoom.
—Mary Carpenter regularly reports on need-to-know topics in health and medicine.
Since Mary Carpenter’s last post on this topic in 2016, hearing aids have evolved —with new FDA regulations poised to create an explosion of online purchase possibilities as soon as this fall—and companies like Bose and Apple jumping in. Not until Mary’s recent participation in a University of Maryland hearing-aid study, however, did she get useful explanations about hearing aids, as well as surprising advice.
EARLY HEARING loss can be imperceptible: unlike diminishing vision, which makes it difficult to read street signs, people are often unaware of sounds they cannot hear. But even mild hearing loss can create the feeling, as some describe it, of slowly becoming untethered from the world. The largest study to date on over 100,000 people over age 66 associated hearing loss with increased risk of depression, falls and dementia—but also showed that hearing aids lowered risks for all three. With FDA approval expected by fall of 2022, the new regulations would cut costs for acquiring hearing aids that today can be as high as $5,000 to as low as $500, including the required audiologist appointments involved in obtaining and adjusting them. In addition, the new regulations will make way for consumers to directly purchase newer hearing aids on which people can make their own adjustments.
Concerns remain, however, about the purchase of hearing aids without input from an audiologist—not only because adjustments can require fine tuning but also because an audiologist (usually in an ENT practice) can help detect causes of hearing loss, such as infection or wax build-up. Audiologists can also advise those whose hearing loss is too severe to be alleviated by external devices, for example, in some cases recommending a cochlear implant.
Current high costs involved in purchasing hearing aids, generally not covered by private insurance or Medicare, are an important reason for their adoption by fewer than 20% of the estimated 37 million Americans with hearing loss —which affects up to 50% of U.S. baby boomers. Meanwhile, many “hearing aids” currently being marketed online are unapproved and unregulated by the FDA, with potential risks from over-amplification that can damage existing hearing.
In a recent innovation, big box stores— notably Costco—offer testing, hearing devices and check-ups—from a trained technician rather than an audiologist—at about half the typical price tag, with high ratings from most users.
Alternatively, a different kind of hearing device simply amplifies environmental sound—not for those with hearing loss, but helpful to people who struggle to hear in certain situations. These PSAPs or PSADs (personal sound amplification products or devices) don’t require FDA approval and can be purchased online, but the new regulations will cover these and help insure their quality and safety. Drawbacks include slight risk of over-amplification that can damage existing hearing and difficulties if hearing loss deteriorates enough to require hearing aids—at which point the entire process must be restarted and new devices purchased.
Domination of the hearing-aid market by a handful of companies may be the main reason for high costs. But another factor is the high rate of return for hearing aids of between 10 and 20% in the U.S. Wearers complain that the devices do not help much in noisy environments, while those featuring an improved signal-to-noise ratio that reduces the volume of background noise (notably the Oticon More) do not rank high on the Forbes “Best of 2022” list.
And the newer digital hearing aids—which have advantages, such as smaller size and capabilities for finer tuning and better sound quality than older analog models—often create a several-second lag before digitized sound reaches the brain, during which time external noise seeps into the ear, creating a confusion of sounds.
Higher return rates also occur from people with milder loss, who might have trouble understanding why they need such a device. But, according to Michele Michaels, a hearing health care program manager at the Arizona Commission for the Deaf and the Hard of Hearing in Phoenix, alternative OTC amplification devices, such as PSAPs, can help them “accept that they might benefit from hearing aids.”
Common signs of early hearing loss include missing syllables and high-frequency consonants such as F, S and SH; and confusing similar words—making it hard to distinguish, for example, between fifteen and sixteen. Another is trouble understanding whispered words and voices coming from another room—causing complaints that others are mumbling or requests that they repeat what they’ve said. Because making sense of sound depends on redundancy to allow the brain to fill in gaps, missing too much can create insurmountable barriers to comprehension.
Hearing loss occurs over time when tiny hairs in the inner ear responsible for most hearing are destroyed. “Presbycusis” (presby is defined as old or aging) starts with diminished clarity —as the inability to hear soft, high-pitched sounds makes it harder to distinguish words. Another kind of damage, discovered only recently with improved imaging, can occur deeper in the auditory system– in the fragile brain cells that the tiny hairs communicate with, which visibly shrivel after exposure to very loud noises like a rock concert.
With this “hidden hearing loss”—or difficulty with “disintegrated sound” —people may do well on traditional audiograms in the silence of an audiology booth but struggle more than most to discern voices in noisy restaurants or to hear well in the theater when sitting far from the stage.
Increased risk of depression, dementia and falls that can accompany hearing loss may occur because damaged hearing forces the brain to “expend more effort to decode the sound signals it takes in, possibly at the expense of other brain functions,” according to Consumer Reports. “Another hypothesis is that hearing loss changes the physical structure of the brain in a way that could harm memory —and some evidence from brain imaging studies supports this theory.”
Because hearing aids do not help with hidden hearing loss, audiologists recommend strategies such as asking speakers to repeat themselves more slowly instead of more loudly. Also, some PSAPs include directional microphones and frequency modulators that work with headphones like air pods, which can improve sound quality.
After a years-ago diagnosis of hidden hearing loss, I received an audiogram during my recent volunteer participation in a University of Maryland study. Although the resulting graph showed mild loss that didn’t automatically qualify me for hearing aids, the researchers who generously talked with me afterwards noted the graph’s flat line dropping off dramatically in the high frequencies, which led one researcher to say: “If it was me, I would get them.” With high hopes that the new regulations will bring costs way down, I will continue pondering how to proceed.
—Mary Carpenter regularly reports on need-to-know topics in health and medicine.
DC-BASED FILMMAKER C.L. in the course of a few days lost two crowns—one on each side of her mouth. After two dentists on the West Coast recommended implants, at a total cost of about $10,000, a DC-area dentist proposed using 3D printing, a newer option for both crowns and implants—and recommended starting with the less expensive, less invasive crowns. Total cost: $2,000.
“The potential is, in fact, immense,” German researchers wrote in a recent research report on 3D printing in dentistry. In addition to significantly lower costs to patients of 3D models compared to traditional crowns and implants, 3D-printed items can be created, positioned and even re-tailored in one visit, and they “fit perfectly.” Gone is the need for two visits with an average 10-day wait in between for fabricating the replacement—while wearing temporary crowns that come off easily and can cause sensitivity.
Throughout medicine, the use of 3D printing has “exploded,” according to theconversation. Using plastics and resins similar to those used in dental replacements, “engineers and medical professionals now routinely 3D print prosthetic hands and surgical tools.”
Bioprinting (fabricating “three-dimensional structures of biological materials, from cells to biochemicals) [has as its] ultimate goal to replicate functioning tissue and material such as organs, which can then be transplanted into human beings,” theconversation notes. While connecting bioprinted structures to vascular systems that carry blood and lymph remains challenging, bioprinting has successfully created nonvascularized tissue like cartilage, as well as scaffolding that can support bone; and researchers have made but not yet transplanted human heart valves.
Creation of regulations to oversee the field of 3D printing for dentistry has lagged, however, and there is a lack of long-term research particularly on the safety of artificial resins and plastics. “There is only little data regarding the behavior of 3D printed devices or restaurations in the oral cavity,” according to the German researchers. “Data on plaque formation, elution (chemical extraction process) behavior, and general biocompatibility of 3D printed polymer materials are scarce…further data on specific materials are urgently required.” In addition, 3D printing has a slightly higher risk of infection for some individuals.
But compared to traditional dental replacements, 3D printed crowns and implants have greatly improved fit due to the “additive manufacturing” (AM) process of 3D printing. While the traditional process involves cutting away from a model made from a mold, AM allows practitioners to better tailor the item during the single visit by continuing to add layers of material.
First the dentist uses an intraoral scanning wand to make a 3D digital impression of the mouth and then operates the milling unit to produce the crown. Afterwards, the dentist paints and glazes each tooth to match the other teeth —in appearance, as well as the way it feels—and then bonds the crown into the mouth.
“Recent pricing guides have seen up to an 80% savings for patients in practices that use in-house dental 3D printing for their crowns and prosthetics,” according to 3dsourced, which deems crowns “perhaps the most versatile of dental procedures.” Crowns can strengthen a weak tooth, bridge and fill gaps and cracks, and act as replacements for broken or chipped teeth.
And single crowns are increasingly the best option for replacing a missing tooth—for the 120 million Americans who are “partially edentulous,” missing at least one tooth; in addition to more than 36 million who are completely edentulous,” according to Market-Reports. Producing crowns by 3D-printing makes them “far more reliable” than machined crowns, which can fall out because of subpar materials or improper fitting. Both traditional and 3D-printed crowns usually last 10 to 15 years.
Traditional crowns “have become outdated” since the development of the CEREC (Chairside Economical Restoration of Esthetic Ceramic), the “cool kid on Dentist Street,” according to New Jersey-based Stiles dental practitioners. Among drawbacks of traditional crowns are the materials, a combination of porcelain, gold, and/or silver fused to metal—because porcelain is prone to chipping and cracking, compared to ceramic and resin materials used in the CEREC crown.
“The pace of development in digital dental manufacturing has become impressive,” write the German researchers. Using the Gartner analysis “hype cycle,” 2014 predictions placed “full adoption” of 3d printing at 10 to 15 years.” Current obstacles include the dearth of training programs for AM and the costs of installing 3D printing facilities, as well as of the software and materials required. Dentists most likely to offer 3D printed-items are younger and working in group practices—which are on the rise. By 2017, only one in five dentists below 35 years of age in the U.S. worked in a solo practice.
For dentistry’s future, researchers are working on individual “biomimetic typodont” (artificial) teeth—grappling particularly with the challenges of recreating the mechanical functions of the human tooth, such as tactile feedback needed for accurate fitting and placement, according to British researchers. Using novel composites—for example, of glass and porcelain—typodont teeth have proved “mechanically comparable to extracted teeth.”
For bioprinting in medicine, the goal is transplantable organs—notably kidneys, desperately needed to cope with an extreme shortage of donated organs. And some have drawn parallels to cloning, predicting a future of “cloneprinting”—not just organs to help with the transplant shortage, but onto new possibilities for reviving extinct species.
Despite the lack of long-term research, advantages including the lower price, precision milling, and faster creation of 3D printed dental crowns and implants will, if the need arises, entice me away from my current dental-practice relationship of many years. At that point, I will need to look at updated reports and research on longer experiences with 3D printing, with particular focus on possible risks of the artificial materials involved.
—Mary Carpenter regularly reports on need-to-know topics in health and medicine.
AFTER WRITING two previous posts (2014, 2019) on women who might be at risk for osteoporosis, Mary Carpenter’s new Georgetown University rheumatologist provided updated numbers on risks and needs for supplements and drug treatment, and a new focus on other issues. (Note: for all recommendations made below, readers should check with their personal physicians.)
At the time of the 2019 post, a U.S. government- appointed panel of physicians recommended “against daily supplementation” with vitamin D and calcium, while my internist advised stopping both, and my gynecologist recommended maximum doses.
Diminishing bone density occurs over time when bone resorption exceeds bone formation—which is controlled by hormones, such as estrogen and parathyroid hormone, as well as by specific proteins in the bone: osteoblast cells create new bone while osteoclasts break it down.
My new rheumatologist provided clarity and specificity, updated. Her recommended dose for calcium, advising not to take less or more, was 1,200 mg—ingested over the course of each day, in at least two separate doses to maximize use by the body. Determination of supplement amounts, however, required first measuring and subtracting dietary intake: for me, about 300mg from milk and cheese and maybe 200mg more from orange juice, a few vegetables and ice cream. For the 700mg still needed, calcium supplements should total 350mg twice a day.
For vitamin D, she advised 1,000 IU/day. By contrast, in 2019, research from the NHANES study involving more than 30,000 American adults linked vitamin D supplements of more than 400 IU/day a study with “an increased risk of death from cancer” and “increased cancer death and death from any cause,” according to the New York Times. In addition, studies showing benefits of calcium/vitamin D supplements at that time had not been controlled but observational, and they failed to assess diet, exercise and other important variables. Prescription drug treatment decisions began with my T-score, the measurement of bone mineral content by a DEXA or DXA scan —as an indication of bone density or strength. For women as a group, T-scores of -2.5 or below indicate a 33% chance of fracturing a hip compared with a 16% risk for those with a score of -1, the average for a 30-year-old woman. My -2.4 T-score is borderline, officially labeled osteopenia, which can signal problems ahead but is not itself cause for treatment. But adding my age, weight and race indicates higher risk, as does a broken kneecap from a fall several years ago. Among less clear risk factors, my mother’s health was generally too poor to say what caused what; and my lifestyle habits like eating and exercise are pretty good.
With all this information, my rheumatologist used a “10-Year Fracture Risk Calculator” that placed my “risk of any fracture” at 26%—in the red danger zone on the chart, compared to the average for my age of 15%. Her advice: start medication.
Osteoporosis drug treatment typically lasts two to five years—because longer regimens can increase the risk of side effects; and because improvements in bone strength by that time can prolong bone-protective effects after stopping the medication. For higher level drugs like Prolia, early research suggested that stopping the medication risked causing greater bone loss, but recently women with sufficiently improved T-scores have been able to go off medication entirely or move to less powerful drugs.
The first-choice drug treatment is usually bisphosphonates –which can slow bone breakdown by blocking the osteoclasts, in turn allowing osteoblasts to create more new bone. Of the various forms of bisphosphonates, including pills and injectable medication, my doctor recommended yearly infusions of zoledronic acid (Reclast), preferred for anyone who has had acid reflux, also known as heartburn, when stomach acid backs up into the esophagus and irritates the tissue.
GI issues can arise during the strict regimen involved in taking bisphosphonate pills such as Fosamax: once a week, first thing in the morning, on an empty stomach—followed by sitting or standing upright for at least 30 minutes before eating. Bisphosphonate drugs also have a small risk of side effects that include fractures of the femur and bone decay in the jaw.
The next level drug is generally Prolia, the monoclonal antibody denosumab, given by injection every six months —which slows bone loss by preventing the formation of the bone-dissolving osteoclasts. A different option is the selective estrogen receptor modulator (SERM) Evista, which produces estrogen-like effects in the body that include decreasing bone turnover. And synthetic parathyroid hormones such as Forteo increase bone density and strength.
On the other hand, high numbers of osteoporosis patients and their doctors “have turned their backs on bone-protecting medicine” — enough to cause a plateauing of hip fractures since 2012, following 10 years of declining rates. One study of 126,188 women with Medicare Part D drug coverage found fewer than one-third started drug therapy within a year of diagnosis.
The worst outcomes for osteoporosis sufferers come not from brittle bones themselves, but from the increased risk of falling—for which good balance is the best protection. “Yoga for osteoporosis”—with special series of poses and classes—focuses on balance, and not just in tree pose (standing on one leg). In her 2015 article,“12 Minutes of Yoga for Bone Health,” Jane Brody described research by Columbia University physiatrist Loren Fishman that found yoga increased bone density in the spine and femur.
“Yoga puts more pressure on bone than gravity,” Fishman told her. “By opposing one group of muscles against another, it stimulates osteocytes, the bone-making cells.”
Despite my years-long familiarity with osteoporosis, the new rheumatologist helped by homing in on two specific recommendations, in addition to the focus on balance: working on gait and weightlifting three times a week to build bone (she does not count swimming, although others disagree). While I appreciate this clarity and specificity, as well as the prescriptions and recommendations, it often takes me years to find out how well I can handle such a regimen, especially the weight-lifting. And I am just getting started.
—Mary Carpenter regularly reports on need-to-know topics in health and medicine.
MICRODOSING psychedelic drugs is “akin to walking outside and the sun is suddenly out,” Seattle bartender Erin Royal told the New York Times. Microdosing refers to taking anywhere from 5% to 30% of the full dose, most often of psilocybin or LSD, several times a week, with the most oft-cited goals of enhancing mindfulness and creativity—and often decreasing depression and anxiety. However, two recent, large, controlled studies trace enthusiastic users’ reports to a placebo effect.
Many aspects of the microdosing experience remain poorly understood, such as how the drugs work in the brain and why effects vary so widely among individuals. Also, there’s the question of what is the best dose and formulation for the desired effects —“sub-perceptual,” i.e., not altering perception of reality— for the two most popular microdosed drugs: psilocybin in about 80% of experiences and LSD in the rest.
Taking too little can feel like nothing but too much can make for a challenging or embarrassing day at the office—with no possibility of prediction without experimenting. In fact, only about one-third of microdosers carefully measure the amount; and “most users dose themselves aiming for a …subtle awareness that they’ve taken something” —which can mean closer to half a full dose, writes Dana Smith in the New York Times.
With “stacking,” microdosers combine psilocybin with substances, such as Lion’s Mane mushrooms, chocolate and the B vitamin niacin that helps the body turn food into energy. According to Nature, the goal is “to accentuate salutary effects” by way of either complementary cognitive-enhancing qualities or potential biochemical interactions.
(Another microdosed drug is Lithium, taken at full dose for schizophrenia but in OTC supplements at smaller amounts with the goal of neuroprotection —upping the cognitive vitality that decreases with aging.) Because the supplement formulations of lithium salts also occur in small amounts in drinking water and some foods, people believe these are safer and healthier than prescription medications.
Mental experience-altering chemicals fall into the larger category of biohackers— also called nootropics, racetams, eugeroics—prescription medications taken to boost cognitive function and productivity. The most popular of the “smart drugs” are amphetamines, such as Adderall and modafinil (Provigil), which is prescribed for sleep dysfunction to improve alertness. In a 2008 survey by the journal Nature, one in five readers had taken brain-boosting drugs, half of those using modafinil.
Smart drugs mainly work on the brain via dopamine, which acts as a “reward chemical” but also creates the potential for abuse. And because modafinil improves wakefulness, taking it over time can interfere with sleep—and has given some students the sensation of being neither awake or asleep but trapped in a twilight zone, which risks causing confusion and delirium.
Psychedelics, on the other hand, primarily work on the chemical messenger serotonin that affects mood as well as cognition and memory, Isabelle Grabski writes on a Harvard science blog. According to one hypothesis, psychedelics bind to serotonin receptors in the brain’s cortex responsible for sensory, motor and cognitive functions —leading to hallucinations and other effects.
But the two largest placebo-controlled trials of microdosing—from London and the Netherlands, both published last year—“suggest that the benefits people experience are from the placebo effect,” according to the New York Times. And a third placebo-controlled trial on microdosing LSD at the University of Chicago also found no difference between the LSD and placebo groups.
Study participants, self-selected respondents to a survey, were more likely to be older and live in an urban rather than a suburban area. Potential design flaws in these studies include self-selection as well as the self-sourcing of drugs by participants —making it harder to assess dosage; participants’ prior familiarity with microdosing, which would enable them to guess whether they were taking the drug or the placebo; and self-blinding.
Even when researchers didn’t tell subjects the purpose of the study or what they were taking, the Chicago study found no difference between the LSD and placebo group. And in the London study, 72% correctly guessed when they had taken the drug, leading the authors to conclude: “We could not confirm whether participants followed accurately the self-blinded procedure.”
Changes in brain activity and connectivity seen on scans after single small doses of LSD were similar to what is seen with larger amounts of the drug; and microdoses of psilocybin activated nearly half of the specific type of serotonin receptors acted on by heavier-dose psychedelics. Impact on the brain, however, does not equate with therapeutic value, according to David Erritzoe, clinical director of psychedelic research at Imperial College London. “If you can’t see in a proper trial that it works for…things that people can actually detect and feel and experience in their lives…it’s not that interesting.”
At full doses, psychedelics appear to increase neuroplasticity, which leads to the creation of more and different connections between neurons,” writes Grabski. She describes UC Davis research using the psychedelic DMT, in which microdosed rats continued swimming in a pool with no escape “after the untreated rats had already given up.”
Psilocybin has been as successful as SSRI drugs like Prozac in fighting depression as well as for treating substance abuse, including alcohol, hard drugs and nicotine. For addiction, says NYU psychiatrist Michael Bogenschutz, “The old rule of thumb is that one-third of people get better, one-third stay the same, and one-third get worse.”
But for 15 smokers in an early Johns Hopkins study, psilocybin had a 80% success rate—compared with 35% for those helped by the leading antismoking drug Chantix. The success, according to some experts, is that psilocybin also helps treat smokers’ psychological needs, for example, as a stress release valve. Said one participant at Johns Hopkins, “Now I understand why I smoked…and I don’t need to do that any more.”
“What’s fascinating to me about this whole process [of taking psychedelics] is how many different kinds of experiences people can have, which ultimately help them make these profound changes in their behavior,” said Bogenschutz. For now, however, full-dose psychedelic therapy requires the presence of one or two therapists during the five or so hour-long “trip,” making it too expensive for widespread use or for larger research projects.
A better alternative with similar goals for some people is virtual reality, which has the advantages of increased control of the experience via dose and timing; of not ingesting a chemical; and of creating effects that come from outside the mind with no therapeutic claims. On the other hand, writes Matt Fuchs in the Washington Post, VR “is being used to ease patients into psychedelic-assisted therapy, which overwhelms some people at first.”
Microdosing might be a good way for interested beginners to dip their toes into these experiences—with the hope of enhancing mindfulness and creativity. But uncertainties about dose and timing can make it helpful, even advisable, to have a sympathetic companion on hand, at least in the beginning.
—Mary Carpenter regularly reports on need-to-know topics in health and medicine.
REINFECTIONRISKS and Long Covid have become topics of unreliable Covid public health messaging in the U.S. — mostly because the virus is relatively new and continually evolving, which has confounded large, long-term research efforts. The emphasis on hospitalization and death as the greatest risk of Covid infection appears increasingly misplaced—along with the contention that lasting Covid symptoms afflict mostly those who had not received vaccinations, or who had severe infections or pre-existing medical conditions.
“We failed in our health messaging,” writes Carnegie Mellon University ethics and philosopher professor Danielle Wenner and colleague. Lack of publicity about the high risk of Long Covid symptoms “deprives the public of the knowledge necessary to…make informed decisions about risk-taking and understand what is happening to them if they feel sick for an extended period.”
And while reinfection may be a buzzword for early-summer 2022 Covid, getting sick continues to surprise those who fall ill, despite having had vaccinations and previous infections. South African epidemiologist Juliet Pulliam told the New York Times,“Omicron and its many descendants seem to have evolved to partially dodge immunity [leaving] everyone – even those who have been vaccinated multiple times – vulnerable to multiple infections.”
“A striking jump in transmissibility” is how Scripps molecular medicine professor Eric Topol characterized Omicron—beginning with the dominance of the Omicron BA.1 variant that had “at least a threefold increase in reproductive number beyond Delta.” Next came a quick transition to a BA.2 wave with at least another jump of about 30% transmissibility. Now the U.S. is heading to a “dominant subvariant known as BA.1.12.1, which is another 25% more transmissible than BA.2 and already accounting for about 50% of cases.”
The best Covid news comes from Japan, which has long emphasized avoiding sanmitsu, or the 3Cs: closed environments, crowded conditions and close-contact settings. Through six waves of Covid-19 and despite having the world’s oldest population, the number of cases and deaths per capita in Japan has been consistently lower than in the U.S., beginning even before masks became common and vaccines became available—though Japanese vaccination rates are now high.
The CDC defines Long Covid as “the occurrence of new, returning or ongoing health problems four or more weeks after an initial infection with SARS-CoV-2.” Symptoms vary from person to person and may include breathing problems, extreme fatigue, cognitive and memory issues — along with loss of smell or taste, heart palpitations, sleep difficulties, mood changes and tremors. For the WHO definition, symptoms must last at least two months.
[Long Covid is] “generating a pandemic of people who were not hospitalized but who ended up with this increased disability,” infectious disease epidemiologist at Penn State Paddy Ssentongo told the New York Times. A recent analysis of 78,252 privately insured patients in the U.S. found that 76% of Long Covid patients had not required hospitalization for their initial infection; and nearly a third of patients had no pre-existing health conditions in their medical record.”
And “there was no difference between the vaccinated and unvaccinated” in studies that included 33,940 people by the Department of Veterans Affairs, for longer term risks of neurological issues, gastrointestinal symptoms, kidney failure and other conditions—although being vaccinated seemed to reduce the risk of blood clotting and lung complications clotting disorders, according to the Washington Post.
But inconsistencies have plagued research and undermined conclusions, writes Elizabeth Yuko in Rolling Stone: “Studies are measuring Long Covid at different intervals and capturing different populations within Long Covid.” In addition, most published results to date come from studies on Delta and earlier variants of the coronavirus, rather than on the currently dominant Omicron. “Long Covid has yet to be adequately defined,” according to Jaime Selzer, director of an advocacy organization focused on myalgic encephalomyelitis/chronic fatigue syndrome—which estimates that 10 to 12 % of those with Covid infections will develop the condition. And disagreement persists on the name for Long Covid, with the new diagnostic code U09.9 for “Post covid-19 condition, unspecified”— recently added by the International Classification of Diseases but not yet widely adopted —after endless earlier iterations, such “post-acute sequelae of Sars-CoV-2 (PASC).”
In addition to Long Covid, acute infection appears to increase risk of cardiovascular problems, such as stroke and heart failure. And recent studies have found post-infection cases of hepatitis in children and of diabetes in adults, although researchers are still sifting through the variables such as pre-existing health issues.
Increased availability of the antiviral medication Paxlovid initially relieved fears of Long Covid, which appears more likely when infections are severe or long-lasting. According to Yale immunologist Akiko Iwasaki, “The quicker one can eliminate the virus, the less likelihood of developing persistent virus or autoimmunity, which may drive Long Covid.”
But in recent cases of infections halted by Paxlovid, Covid symptoms have reappeared within a few days, with tests positive once again. While attributed to a “rebound” effect of the drug, these experiences have raised fears of viral resistance —“the hobgoblin of antiviral medicine,” according to STAT, which has occurred with “nearly every new virus-killing infusion or pill in history… either immediately or eventually.”
“We’re not going to normal 2019,” University of Pennsylvania Provost of Global Initiatives Ezekiel Emanuel told Stat. For the future, the most optimistic scenario has deaths from Covid reduced to between 15,000 and 30,000 per year— but a more virulent virus and waning immunity could bring that toll to nearly ten times as high. On the other hand, improvements in indoor air quality could help reduce total numbers of deaths from influenza and other flu-like illnesses as well as Covid.
With H.I.V., the CDC eventually shifted its prevention strategy away from broad-scale public awareness campaigns to focused H.I.V. testing in populations at highest risk, writes epidemiologist and infectious disease professor Jay Varma at Cornell Weill Medical Center in a New York Times article titled “The Answer to Covid Fatigue is Creativity, not Surrender.” As H.I.V. fears began to ebb, the CDC embraced what’s known as structural approaches to prevention —making “testing, treatment and condoms so widely accessible and acceptable that individuals would have to actively choose not to use them.”
For now, though, the Japanese way may be the best path forward, following the 3C’s—plus masking. Even as much of the population relaxes precautions, the new mantra of “one-way masking” will provide additional protection for people worried about risks of Covid, and especially of persistent symptoms—whatever the official label—that last long after the infection has subsided.
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