ReportWire

Tag: Freelance

  • How Doctors Can Get Better at Recognizing Munchausen Syndrome by Proxy

    How Doctors Can Get Better at Recognizing Munchausen Syndrome by Proxy

    [ad_1]

    Whether fictional or fact-based, Munchausen syndrome by proxy grips the public. Media depictions in The Sixth Sense and Sharp Objects and real-life news coverage of Gypsy Rose Blanchard’s December 2023 release from jail are hard to look away from. The most well-known cases—real or dramatized—are often the starkest ones, but Munchausen by proxy comes in subtler, harder-to-detect forms too.

    “The media are fascinated, but they tend to depict the most extreme cases,” says Dr. Marc D. Feldman, distinguished life fellow of the American Psychiatric Association and author of Dying to Be Ill: True Stories of Medical Deception.

    So how do more health care providers develop the skills to recognize this form of medical child abuse and report it to the appropriate authorities? 

    What Is Munchausen by proxy?

    Munchausen by proxy “is a form of abuse in which a caregiver feigns, exaggerates, or induces illness in another person. Typically, the caregiver is the mother, and the victim is her child,” Feldman says.

    While this deception may result in tangible benefits—like disability funds or opioid medications the caregiver then abuses—the perpetrator’s primary motivation is typically attention, says Mary Sanders, a clinical psychology professor at Stanford University School of Medicine.

    You may hear this type of abuse referred to by many names. While it was once primarily called Munchausen syndrome by proxy, many experts now leave out the word “syndrome” because it implied there was a neat-and-tidy checklist for diagnosing a perpetrator. There are some commonalities among the caregivers who inflict this type of abuse, but not everyone matches the same criteria, Sanders says.

    Increasingly, the phenomenon is called Munchausen by proxy (MBP) abuse to emphasize the negative effects on the victim or a type of medical child abuse, says Brenda Bursch, a professor of clinical psychiatry and biobehavioral sciences and pediatrics at the David Geffen School of Medicine at UCLA.

    Medical child abuse doesn’t specify why a caregiver is overmedicalizing a child, Sanders explains. But if the caregiver is being intentionally deceptive about an illness in a child, they are also said to have factitious disorder imposed on another (FDIA), according to changes made in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, a glossary of mental health diagnoses. Whatever the behavior is called, it’s pernicious—and often hard to spot.

    “In the past, making a diagnosis of Munchausen by proxy was challenging because understanding the motivations of the caregiver was part of the definition,” says child abuse pediatrician Dr. Amy Gavril, a past member of the American Academy of Pediatrics (AAP) Council on Child Abuse and Neglect and an associate professor at West Virginia University School of Medicine. “The motivation of an adult is an incredibly challenging thing to figure out, and, as a pediatrician, when it’s not your patient, it makes it even harder.”

    Experts believe this form of abuse is largely underreported because it’s so difficult to recognize. The official incidence is about 0.5 to 2.0 cases in every 100,000 children under the age of 16, according to a 2013 Pediatrics report, but things might be much more serious than that.

    “My sense is it’s vastly underrecognized by doctors because many haven’t even heard the term Munchausen abuse or medical child abuse, or they don’t really know what it is,” Feldman says. “You can’t diagnose something you don’t understand or have never heard of.”

    Read More: 6 Things to Do if Your Doctor Isn’t Listening to You

    Deception is central to Munchausen by proxy

    It makes sense that MBP abuse is hard to recognize, considering the perpetrator has set out to fool everyone. “If the parent is really trying to be deceptive, they’re going to get away with it for a while,” Sanders says.

    To skate by for as long as possible, caregivers frequently change medical practices before a health care provider has time to grow suspicious, Feldman says. But even qualified experts can have difficulty spotting MBP abuse. “The foundation of it is fabrication, and it’s very difficult to identify when a caregiver is not telling you the truth because we’re trained to listen to and take very seriously what a child’s caregiver has to say,” Gavril says. 

    Sometimes, seemingly harmless instances of deception may be an early tipoff. “I had a mother who said her child was born premature at 4 pounds, 3 ounces. But when I get the birth records, it says 8 pounds, so that’s clear falsification,” Sanders says.

    A host of red flags

    MBP abuse remains confusing to health care providers, legal professionals, and the public, per a 2020 review article in Annals of Pediatrics & Child Health authored by Bursch. But this isn’t the fault of any physician or specialty; it’s a problem with the medical education and child welfare systems. “Most clinicians lack the training and guidance needed to professionally, ethically, and skillfully protect victims of MBP,” she wrote.

    Even without intensive training, however, it’s possible to become more alert to the red flags, the most common of which is inconsistency. “You’re looking for this mismatch between what you’re being told is going on with the child and what you’re objectively seeing,” Gavril says. “It’s those ongoing inconsistencies rather than a particular symptom” that raise suspicions, she adds, because the caregiver might claim any number of medical issues afflict the child.

    Munchausen by proxy perpetrators are often very involved in the child’s medical care. They might be active in advocacy organizations for the rare condition they say the child has, or they might try to act like they are friends with you as the child’s doctor, Sanders says.

    Another telltale sign is if symptoms ease when the child is separated from the abusive caregiver. “I often hear from fathers who say, ‘My former wife is presenting the child as autistic, but when he’s with me on vacation, he’s perfectly fine,’ or ‘His dietary limitations are severe and imposed by his mother. When he’s with me, he eats whatever he wants.’ That kind of information is invaluable,” Feldman says.

    A 2007 Pediatrics article from the AAP’s Council on Child Abuse and Neglect suggests clinicians ask themselves the following three questions to help determine if a child may be a victim of MBP abuse:

    • Are the history, signs, and symptoms of disease credible?
    • Is the child receiving unnecessary and harmful or potentially harmful medical care?
    • If so, who is instigating the evaluations and treatment?

    Any suspicion is enough to report

    Physicians are mandated to report suspicions of child abuse. But that doesn’t mean doctors have to be sure of what they’re seeing. “You don’t have to know for certain that this abuse is going on. If you have a reasonable suspicion, it’s not a choice; you are a mandated reporter,” Sanders says.

    Still, it’s not uncommon, Feldman says, for him to “come across cases where 20 pediatricians were consulted in a very obvious case, and no one documented any suspicions of abuse.”

    That’s a problem because “the longer it goes undiagnosed, the more likely it is that permanent or severe harm is going to occur to the child,” Gavril says.

    Pediatricians and mental health care providers may be most likely to notice something out of the ordinary. But every practitioner should at least be aware of the possibility of MBP abuse because victims often toggle among many different specialists, such as gastroenterologists, pediatric neurologists, and infectious disease physicians, Gavril says. These experts likely have even less training in recognizing medical child abuse than pediatricians.

    Too often, health care workers are “a little frightened of documenting their concern because they’re lawsuit-averse, and they fear it’s going to be provocative if the caregiver finds out,” Feldman says. For example, in the high-profile Munchausen case of Olivia Gant, who died at age 7 in 2017, many care providers had suspicions, but none voiced concerns because “they were afraid of the bossy, domineering mom and what she might do if they made a report to child protective services,” he says. Gant’s mother is now serving 16 years in prison.

    “Most doctors say ‘I didn’t report because I couldn’t prove it.’ That’s the job of child protective services or the police. We have to recognize our professional duties to the patient, and that patient is the child,” Feldman says.

    Read More: Why It Takes Forever to Get a Doctor’s Appointment

    Systematic issues prohibit further advancements

    Child protection services don’t currently have a specific code or label for MBP abuse, so it typically gets lumped into medical neglect, Feldman says. This makes it hard to track prevalence, Bursch says.

    But if advances can be made in that coding system, it could open the door for better training and education. “If we are successful in advocating for a specific category for child/adult protective services to use to correctly label and track MBP, then mandatory training will be required to educate caseworkers about proper investigation approaches and management of suspected cases,” Bursch says. “This support would help clinicians who have a duty to report suspected abuse even when they do not feel certain it has occurred.”

    A more universal approach to electronic medical records could help, too. “We all should advocate for electronic health records to be standardized such that we can easily look at records from other facilities,” Feldman says, making it easier to recognize patterns of deception.

    As Sanders emphasizes, it’s essential for doctors to trust their intuition when a situation feels off. “If something is just not making sense, look further,” she says. “And not in the sense of doing more invasive investigations, but recognizing that you may not be getting accurate information.”

    [ad_2]

    Sarah Klein

    Source link

  • Ozempic Hurts the Fight Against Eating Disorders

    Ozempic Hurts the Fight Against Eating Disorders

    [ad_1]

    It’s impossible to escape the soaring popularity of Ozempic and similar drugs these days—daily headlines, celebrity “success” stories, and apparent ease in procuring prescriptions (even Costco sells them now) abound. But the cumulative effect of all of this has many experts in the eating disorder field worried about how this might affect their patients. This makes sense—even for those without eating disorders, these drugs can feel both triggering and enticing. After all, research tells us about 90% of women are dissatisfied with their bodies. This sounds like a quick fix.

    Then, I started hearing reports—first anecdotal, then published—that some doctors were prescribing weight loss drugs like Ozempic to their patients with eating disorders. As in, to help treat them.

    As a journalist who has extensively researched the harms of eating disorders and the barriers to recovery—and as a woman who had suffered from eating disorders on and off for much of my own life—I thought I must have misunderstood. Yes, we as a society are in the midst of Ozempic Fever—and by “fever,” I’m referring to excitement, rather than a possible side effect of the drug (which it is). Researchers are continuing to find new potential applications for these drugs, initially developed to treat type 2 diabetes. In March, the FDA approved a new indication for the weight-loss drug Wegovy (which has the same active ingredient as Ozempic), allowing it to be used as a treatment to reduce the risk for heart attack and stroke. Ozempic, a diabetes drug, used off-label for weight loss, is also being studied to treat anxiety and depression, polycystic ovary syndrome, substance abuse, Alzheimer’s, and now—eating disorders.

    Read More: Ozempic Exposed the Cracks in the Body Positivity Movement

    It’s early days and research hasn’t yet caught up with the enthusiasm.  But our cultural misunderstanding of eating disorders, even by well-meaning practitioners, could exacerbate the illnesses for those who suffer from them—and have dire consequences.

    The new class of weight loss drugs mimics the body’s GLP-1 hormone, stimulating insulin production, and lowering blood sugar levels, helpful to those with type 2 diabetes. The drugs also curb appetite and slow the speed that food moves into the small intestine—you feel full more quickly and eat less. Many patients without eating disorders who take these drugs, have reported a reduction of “food noise” in their minds—referring to obsessive thoughts and preoccupation with food. (Though, as philosopher Kate Manne wisely posited in a recent New York Times piece, isn’t “food noise,” simply, hunger?)

    For folks suffering from binge eating disorder (BED) or bulimia nervosa (BN), a drug that decreases appetite may seem to make sense. Both illnesses are characterized by eating large amounts of food, eating until uncomfortably full, and feeling distress around that (bulimia is distinguished by purging after a binge).

    Binge eating often emerges as part of a cycle of restriction—dieting, fasting, or eliminating entire food groups—like carbs, for example. “Many people struggling with BED view the binge episodes as the problem and the restriction as something to strive for,” said Alexis Conason, a psychologist specializing in the treatment of binge eating disorder. “When people with BED take a GLP-1 medication that dampens their appetite, many are excited that they can be ‘better’ at restriction and consume very little throughout the day.” Subsequently, Conason adds, there is a dangerous potential for BED to then morph into anorexia, starving oneself with possibly life-threatening complications.

    Eating disorders are complex illnesses that aren’t yet fully understood, even by experts in the field. Underneath the behaviors around food is often an intricate web of trauma, anxiety, and even genetic predisposition, all set against the backdrop of a culture that prizes thinness. Low weight is frequently (incorrectly) conflated with good health, and people in larger bodies are often subjected to bullying, negative stereotypes, and discrimination in the workplace.

    Read More: Ozempic Gets the Oprah Treatment in a New TV Special

    Emerging research strongly supports that for many, eating disorders are brain-based illnesses and in most cases, there exists a co-morbidity like anxiety, mood disorders, or substance abuse.

    “GLP-1’s can’t help someone deal with their stress, anxiety, [and] trauma-history,” said psychologist Cynthia Bulik, one of the world’s leading eating disorder researchers, and Founding Director of the University of North Carolina Center of Excellence of Eating Disorders. “All of that background distress—fundamental distress that might be driving the BED in the first place—is temporarily bypassed by removing the desire to eat.”

    Nearly 30 million Americans will have an eating disorder in their lifetime, but only about 6% of those are medically diagnosed as “underweight,” according to the National Association of Anorexia Nervosa and Associated Disorders. This means that a person may exhibit all of the diagnostic hallmarks of anorexia, for example, extreme restriction and even malnourishment, but still present as average weight or even overweight. They may even be told by a physician to lose weight, despite the fact that they are already going to dangerous extremes to chase that “goal.”

    “We tend to think that everyone in a larger body with an eating disorder must have BED and everyone in a smaller body must have anorexia, but this couldn’t be further from the truth,” said Conason. “So many people with BED seek help in weight loss settings instead of seeking eating disorder treatment; many view the problem as their weight and think they need more help sticking to their diet” when in reality, an end to the restriction would more likely regulate their eating.

    It’s much easier to get weight loss treatment than help for an eating disorder. There is no standard of care for eating disorders in this country and treatment is unregulated. While there are some promising, evidenced-based treatments (cognitive behavioral therapy for adults, and family-based treatment for children and teens), they don’t work for everyone. If a person is fortunate to be diagnosed and receive adequate treatment, relapses are common and full recovery can be elusive.

    Further, these drugs are often intended to be taken for a person’s entire life. “When they go off the drug, or can’t access it due to supply problems, the urge to binge comes right back and they have not developed any psychological (or) behavioral skills to manage the urge,” Bulik told me. Just like with a diet, any lost weight will likely be regained when a person stops taking the drugs. Weight fluctuations, themselves ,may increase a person’s risk of chronic illnesses like type 2 diabetes, according to multiple studies.

    “The focus on weight and erasing the desire to eat could indeed do harm,” cautioned Bulik. “The potential for abuse is high and will become higher with new preparations that don’t require an injection … Remember, these drugs are ‘for life.’ Stop them, and everything comes rushing back.”

    The long-term side effects of GLP-1’s are not yet known. But the harms of eating disorders are: eating disorders have one of the highest mortality rates of any mental illness (second only to opioid overdose). People with eating disorders are more likely to attempt suicide, and during COVID-19, emergency room visits and inpatient admissions for eating disorders at pediatric hospitals skyrocketed, particularly for young women. According to the CDC, emergency room visits for 12-17 year old girls who suffer from eating disorders doubled during the pandemic. Those numbers, as shown by recent studies, have not returned to pre-pandemic levels.

    An even greater concern is that the gaps in comprehensive care for eating disorders invite experimental, potentially harmful treatments and leave patients vulnerable. GLP-1’s may seem like a short-term “fix,” but they won’t graze the deeper issues nor will they diminish the eating disorder crisis in this country. And it is a crisis—every year, eating disorders cost the U.S. more than $65 billion.

    I know too well that if a doctor advises their patient with an eating disorder “here’s something to make you eat less” most patients would happily oblige. That’s part of the pathology of the illness. It’s the eating disorder talking. Ideally, it wouldn’t be your doctor’s voice, too.

    [ad_2]

    Cole Kazdin

    Source link

  • The U.S. Defended Israel. Now Israel Must Listen to the U.S.

    The U.S. Defended Israel. Now Israel Must Listen to the U.S.

    [ad_1]

    That was astoundingly unprecedented. American, British, French, and an assortment of Arab countries’ warplanes and air defenses teamed up with Israel to block Iran’s massive wave of missiles and drones.

    Now let’s recognize that Joe Biden deserves credit for his immediate follow-up. The President saved the world from coping with an awful war in the Middle East, by calling Prime Minister Benjamin Netanyahu and twisting Israel’s arm so that it didn’t immediately retaliate against Iran.

    While Israeli war cabinet consultations are secret, we can confirm that the group of five top decision-makers was moving toward ordering a powerful retaliation against sites in Iran—some connected with that country’s nuclear program—that have been on Israel’s standby target list for years. This seemed to be an ideal opportunity: Iran, for the first time from its own territory, brazenly attacked Israel without just relying on shadowy terrorists or other proxies. Surely the world would understand the legitimacy of Israel striking back.

    Yet Biden, in that phone call late Saturday night, told Netanyahu to take the win; to be thrilled that the unique combination of allies, including even Saudi Arabia, protected Israel.

    Biden wisely praised Israel’s own air force and anti-missile defenses, such as the Iron Dome, David’s Sling, and Arrow systems that have enjoyed bipartisan financial support from Congress and are partially manufactured by American contractors.

    And then came the sting: Biden said that if Israel attacks Iran’s territory, then Israel is doing that on its own. No American participation. And the instant alliance with Arabs and Europeans might fade away like a desert mirage. We should note that for years, U.S. officials have privately said they think Netanyahu is trying to maneuver America into joining a destructive attack on Iran’s nuclear program, while the U.S. consistently counsels restraint.

    Biden’s verbal arm-twisting should not be taken lightly. Israel has again been reminded how it needs Washington’s support. The colossal failure of Iran’s missile and drone attack, and the instant alliance’s success at swatting it out of the skies, is the result of intimate cooperation between the Israel and the U.S. For years, Israeli and American warplanes have trained together and took part in unannounced joint operations against ISIS. Just last week, the head of U.S. Central Command, General Michael Kurilla, visited from Florida and spent long hours at Israel’s military headquarters in Tel Aviv. American spy satellites furnished Israel with precise data about Iran’s missile sites and monitored all the launches on Saturday. Israel was able to tell its citizens to prepare to take shelter.

    Read More: How the U.S. Rallied to Defend Israel

    A lot of vital data came from a hush-hush U.S. installation in southern Israel: a huge radar facility, not far from Israel’s nuclear reactor at Dimona, tasked with monitoring the skies to the East of Israel. Inside the Hatzor air base, 25 miles south of Tel Aviv, there is a permanent joint control room where Israeli and American air force officers sit side-by-side. The U.S. does not help the Israel Defense Forces in most of IDF’s missions, and there is no U.S. role in hitting Hamas in the Gaza Strip, but for defense against long-range missiles—with Iran as the most potent threat—the intelligence cooperation is seamless.

    While some skeptics about the seriousness of the weekend’s extremely brief missile war say it was simply a piece of geopolitical theater, as though Iran never intended to cause much damage in Israel, we urge them to consider what might have happened if the defensive shield had been punctured. If even one Iranian ballistic missile—with, typically, a thousand pounds of explosives in its warhead—had struck an Israeli air base or a residential neighborhood, the deaths of Israelis would have made a powerful retaliation by Israel inevitable.

    True, the Iranians had telegraphed for days that they were going to fire missiles at Israel for the first time, as a response to the airstrike that killed top Iranian officers, including the deputy commander of the terrorist-backing Quds Force, in Damascus on April 1.

    But still, it was no mean feat to intercept almost all of those missiles and drones. Israel claims 99 percent of about 320 were downed, almost all of them far from the Jewish state, over Iraq, Syria, Yemen, and Jordan. Based on intentionally vague official announcements, we credit the U.S. with at least 40 percent of the kills.

    Frankly, for the air forces and ground-based radars of over half a dozen nations, the Iranian attack was a brilliant opportunity for a real-world test of state-of-the-art high-tech capabilities: air to air missiles, electronic warfare jamming, and other systems that the Pentagon is reluctant to discuss publicly. American sensors, some on satellites orbiting far above, were a key to monitoring every step: the Iranian launches, and then controlling the allies’ response so that friendly planes wouldn’t knock each other out of the skies.

    Israelis have strong reasons to be grateful, and it is the Biden Administration that organized this anti-Iran coalition. Netanyahu and his cabinet would be unwise to risk shattering that international backing. He is, however, under pressure from the extreme rightwing ministers who say it would be humiliating weakness for Israel not to retaliate directly against Iran.

    Benny Gantz has carved out a middle ground that seems sensible. Gantz is leading in Israeli political opinion polls, and his views are respected, as he is a former military chief of staff and served as defense minister to Netanyahu before turning against the prime minister. Gantz says Israel clearly has the right to retaliate and should plan to do so—but at a wise time of its own choosing. First, he suggests, build up the international coalition against Iran. Don’t spoil it. Eventually, good opportunities to harm Iran will become apparent.

    “We have a rare opportunity,” retired Major General Nimrod Sheffer, who was deputy head of the Israeli air force, told us. “We can take advantage of the sympathy and good will showered on Israel. We can tell the U.S. and the Europeans that we have all the justification in the world—at least to step up attacks on [Iran’s Shiite Muslim proxy] Hezbollah in Lebanon, but now we want you to exert pressure on Iran and its proxies to bring calm to the region.”

    If a new anti-Iran coalition does not take effective action, such as far stronger sanctions aimed at strangling the Iranian economy—with clear demands that Hezbollah pull back in Lebanon, and the Houthis in Yemen stop attacking merchant ships in the Red Sea—then Israel retains all its options. Vengeance against Iran for the attempt to rain missiles on Israel would not necessarily be done with obvious, kinetic force. Israel’s cyber capabilities are so advanced, that tech experts believe many parts of Iranian modern society could be paralyzed by an attack.

    We endorse the direction that Israel’s leaders seem to be choosing: to heed the notion that striking back much later, at a strategically chosen time and not at a red-hot moment of anger, will be the smartest thing to do. Let’s remember the famous aphorism that revenge is sweeter, when served cold.

    [ad_2]

    Yossi Melman and Dan Raviv

    Source link

  • What Happens to Your Body If You Don’t Stretch

    What Happens to Your Body If You Don’t Stretch

    [ad_1]

    Be honest: do you stretch before and after your workouts? If you don’t, you actually might be onto something. Most physically active adults with reasonable fitness goals may not need to stretch at all.

    Here’s what every busy person should know about stretching—and how little you can get away with doing.

    What is stretching, anyway?

    There are two main types of stretching: static and dynamic. Static is when you hold a stretch for at least 10 to 30 seconds. Reach toward your toes for half a minute, and you’re doing a static stretch. “That’s the stuff you can do at home when you’re on your own in the evening to maintain flexibility,” says Kieran O’Sullivan, a lecturer who studies musculoskeletal pain and injury at the University of Limerick in Ireland.

    The second type is dynamic stretching. This is a faster, “bouncy” type of stretch repeated multiple times. This type of stretching is common among athletes preparing for a game or a race because it helps warm up the muscles more than static stretching does, O’Sullivan says. A dynamic stretch is never held; the person stretching is always in motion. (Imagine swinging your leg up in front of you, then touching your toe with your opposite hand and repeating.) It’s a great way to get warm, which helps bring oxygen to the muscles, activating them so they’re ready to work.

    Why do people stretch?

    There’s a scientific reason. During a stretch, you temporarily reduce the amount of blood flowing to your muscles, explains Judy Delp, a professor of biomedical sciences at the Florida State University College of Medicine. “That’s actually a good signal for the muscle and for the blood vessels to stimulate changes in metabolism in the muscle,” she says, and stretching triggers the growth of capillaries that deliver blood, oxygen, and nutrients to your muscles to help them function more efficiently.

    Read More: Why Walking Isn’t Enough When It Comes to Exercise

    But mostly, we stretch because it feels good, says Nicolas Babault, a professor who studies the physiology of exercise at the University of Burgundy in France. “Sometimes that’s the reason why people do some stretching at the end of a very exhausting training session,” he says. “After that, they feel better.” However, stretching either before or after your workout does little to impact muscle soreness over the next few days, according to a Cochrane review of 12 randomized controlled trials.

    The limitations of stretching

    As you stretch, it might seem like your muscles are getting longer over the course of a few minutes, but that’s not really the case. While long-term regular stretching could have this effect, O’Sullivan says that if you can’t touch your toes when you start stretching but you can after two minutes, what’s really happening is that your muscles become more tolerant of stretching. “Your body relaxes and lets you go a little further,” he says. After you’re done, your muscles pretty much go back to normal.

    For athletes whose sports require major flexibility—such as dancing, gymnastics, and ice skating—regular stretching over months and years can elongate muscles and greatly increase range of motion. But some casual stretching before or after a workout probably isn’t going to make you any more flexible than the workout itself does.

    What happens if you never stretch?

    If you’re completely sedentary—forgoing both stretching and physical activity—your muscles won’t be able to use oxygen as effectively, meaning you’ll lose strength and endurance, says Delp. You’ll also start to lose range of motion over time. Stretching is a good way for people who have become inactive to start working their muscles and rebuilding the blood vessels they need to deliver nutrients that can help them get moving again, she says.

    However, “if you walk regularly and you’re taking your joints through that range of motion, you are [stretching] without realizing it,” Delp says. “With every phase of your gait, you are actually lengthening different muscles, and you are actually stretching muscles.”

    Read More: Your Brain Doesn’t Want You to Exercise

    You can also get some stretching in by doing muscle-strengthening sessions. “Strength training done well will also increase your flexibility,” O’Sullivan says. To get the greatest flexibility gains from weightlifting, make sure you’re working through your full range of motion. That means if you’re doing a bicep curl, once you reach the top and your hand is near your shoulder, you should slowly let the weight back down rather than immediately dropping and releasing the weight.

    Stretching has its benefits and can have a place in your exercise routine, but it’s not the most important piece of the fitness puzzle.

    “Most people I know say, ‘I have about 45 minutes about four to five times a week,’ or some variation of that,” O’Sullivan says. “And in that period of time, the value of stretching relative to other workouts becomes much less.”

    [ad_2]

    Emma Yasinski

    Source link

  • How to Talk to Your Family About Their Heart Health History

    How to Talk to Your Family About Their Heart Health History

    [ad_1]

    Hypertrophic obstructive cardiomyopathy (HOCM) is the most common genetic heart disease, affecting about 1 in every 500 people, according to the American Heart Association (AHA). In people with HOCM, genetic variants cause the heart’s walls to thicken and stiffen, blocking blood from flowing freely from the left ventricle to the aorta. This, in turn, results in shortness of breath and chest pain (especially during physical activity), abnormal heart rhythms, lightheadedness, dizziness, and fainting, and can worsen over time.

    If a parent has HOCM, offspring have a 50% chance of inheriting it. That means knowing your family’s heart health history is crucial: If your doctor is aware that you have relatives with HOCM, they can “screen family members early on, before they get sick or have any cardiac complications” using EKG and echocardiogram, says Dr. Ali Nsair, co-director of the Hypertrophic Cardiomyopathy Clinic at UCLA Health.

    About 60% of the time, genetic testing can identify a specific change in a gene that causes HOCM. Even if you (or your kids) test negative for the particular genetic variant your parent with HOCM has, you can still be screened every few years with EKGs, echocardiograms, and visits to a cardiologist to make sure complications haven’t popped up, Nsair says.

    And it’s not only HOCM that can cluster in families. “A lot of what ails us is in some sense heritable,” says Dr. Daniele Massera, associate director of the Hypertrophic Cardiomyopathy Program at NYU Langone Health. “Whatever affects your family members might directly affect you.” Other heart conditions, like familial hypercholesterolemia (high cholesterol) and high lipoprotein (a) (proteins and fats that carry cholesterol), can be inherited, and a family history of heart disease that isn’t genetic puts you at higher risk, too.

    But no single risk factor—including genetics—is a guarantee that heart disease will develop down the line: “For me, the most important reason to know your family history is prevention,” says Dr. Svati Shah, a member of the American Heart Association’s National Board of Directors and director of the Duke Adult Cardiovascular Genetics Clinic. If you know you have an increased risk for heart disease due to your genes or family history, which you can’t control, you can take heart-healthy steps to improve the lifestyle factors you can control, such as getting plenty of sleep, eating a balanced diet, and staying active, according to the AHA.

    To make sure you get access to the testing, treatment, and information on lifestyle changes that can help you avoid or delay inherited heart health complications, it’s important to stay on top of your family’s medical history. Here’s how to have those conversations with honesty and compassion while still getting the potentially life-saving answers you need.

    Read More: What It Means if You Have Borderline High Cholesterol—And What to Do About It

    Start with broad questions

    You might open the conversation with a question as simple as “Do you have any kind of heart disease?” or as general as: “Have you ever had any chest pain?” Shah suggests.

    If your relative isn’t entirely sure about their diagnosis or past procedures, consider asking if a doctor has ever told them they had any of the following, according to the Centers for Disease Control and Prevention (CDC):

    • Coronary artery disease or atherosclerosis
    • Heart attack
    • Arrhythmia
    • Atrial fibrillation
    • Cardiomyopathy
    • Heart failure
    • Aortic aneurysm
    • Stroke

    Also ask if they have a pacemaker or have ever had heart bypass surgery. If they’ve given birth, Shah suggests adding: “Did anything happen [to your heart] when you had your babies? Did you get really high blood pressure?” And whenever possible, ask what age they were when they experienced these conditions or complications for the first time, according to the CDC.

    The details might get fuzzier as you go back generations. “Often people say [things like], ‘My dad died at 47 from a heart attack,’ but it’s actually that they didn’t wake up from sleep, and it may not have been a heart attack,” Massera says.

    Try to get as many details as you can, because those specifics can help your doctor determine the best next steps for you. For example, you might need different testing if your 47-year-old father died of sudden cardiac arrest (when the heart suddenly stops beating) rather than a heart attack (when an artery to the heart is blocked). “To distinguish between the two is really critical: A heart attack is common, but if we identify sudden cardiac death as the real mechanism, then we’re homing in on a more narrow group of conditions that will require testing that you wouldn’t necessarily do if you’re talking about a heart attack,” Massera says.

    While heart attacks, strokes, and sudden cardiac death might stand out the most in your relatives’ memories, make sure to ask about heart disease risk factors too, like high blood pressure, high cholesterol, and diabetes. “There is a strong predictor among those factors that can lead to heart disease and heart failure,” Massera says.

    Talk to three generations on both sides of your family

    Ideally, aim to include three generations on both sides of your family in your discussions about heart health: your grandparents, your parents and their siblings, and your siblings.

    “Backwards more than three generations, people don’t really know what happened to those relatives,” Shah says. But any information you can collect is still better than nothing, especially if you continue to gather knowledge over time. “[Learn] as much as you can, and it can be over the course of many years that you fill in the details,” she says.

    If you or your siblings have children, note any known heart health information about them, too, per the CDC.

    Be gentle

    These discussions may not go as well if your brother feels interrogated or your mother feels blamed. “These can be really laden conversations,” Shah says. “Especially when you start talking about weight, high cholesterol, blood pressure—people can get sensitive about that.”

    If a family member remains standoffish, don’t press: “If that person isn’t ready, it’s OK, circle back to it,” Shah says. Your relatives might feel more comfortable in a group setting. “Sometimes one on one, people ask: ‘Why are you calling me? Why are you worried about my health? Why aren’t you worried about other people’s health?’” Group conversations have the added benefit of helping to nudge everyone’s memory in the right direction, too. “Sometimes one person remembers one thing, another person remembers another thing, but if you spoke with each one independently, you wouldn’t have made the connection,” Shah says.

    These conversations don’t have to be done in person, but face-to-face discussions allow you to pick up on a relative’s body language more easily and change the subject if you can tell they’re uncomfortable.

    Record the information somewhere you can access it easily

    You can use digital tools like the Surgeon General’s My Family Health Portrait or the Global Alliance for Genomics and Health’s Family History Toolkit to record and store your family’s heart health history.

    Don’t feel pressured to use software: Typing notes into your smartphone or jotting them down on paper is fine, too. As long as it’s a system that works for you and you know where the information is, you’ll be less likely to forget any details when you’re actually sitting in front of your doctor.

    “I love it when patients come in with a printout,” Massera says. He makes sure to devote plenty of time to walk through all of a patient’s relatives and their relevant health history, but recognizes a typical primary care doctor might not have that luxury. “You can’t do this if you see a patient in five minutes,” he says. If you feel like your doctor isn’t giving you enough time to cover your family history thoroughly, it’s OK to ask for a longer appointment to address your concerns, he adds.

    Read More: How Stress Affects Your Heart Health

    Report back to your doctor

    Simply knowing your family’s heart health history isn’t enough to prevent your own heart issues. Sharing what you’ve learned with your doctor is key to determining the screenings, treatment, or lifestyle changes that might benefit you.

    To that end, share “broadly” with your primary care doctor once you’ve asked your family about their heart health, Nsair says. Your doctor will dig deeper into the information that’s most relevant to your individual health, but it’s always better to provide too much than too little.

    A history of heart failure, heart rhythm disorders, stroke, and sudden death, especially in relatives younger than 40 or 50, will likely prompt your primary care doctor to refer you to a cardiologist. That person or your primary care doctor can help you identify modifiable risk factors that you can change, such as quitting smoking, adopting a balanced diet, starting an exercise routine, and maintaining a healthy weight.

    You won’t have to do this every time you visit the doctor: Once you’ve shared your family heart health history, that information is entered into your medical records, so anyone who is a part of your care team will have access to the same details.

    Chat again whenever big changes occur

    Your family’s heart health will continue to change over time—after all, many heart issues, including HOCM, are more common in middle age—so it’s hard to say exactly how often to ask your relatives about their heart health.

    In general, it’s a good idea to collect more information whenever a family member experiences a major heart-related health issue, like a sudden death, cardiac arrest, or having a defibrillator implanted. “This is not a conversation you need to have every year. But every few years, reassess,” Shah advises.

    Remember, these conversations may be challenging, but they’re empowering you with the information you need to live well for longer. “Genetics is not destiny. There’s a saying that genetics loads the gun, but the environment pulls the trigger,” Shah says. “You have control over this.”

    [ad_2]

    Sarah Klein

    Source link

  • Breaking Up Can Be Easier If You Have a Ritual

    Breaking Up Can Be Easier If You Have a Ritual

    [ad_1]

    In his song “Hearts and Bones,” Paul Simon, describing the dissolution of his marriage to Carrie Fisher, sang, “You take two bodies and you twirl them into one . . . And they won’t come undone.” The pomp and pageantry of love and commitment—whether that of a traditional wedding or a conventionally romantic night out with red roses and candles—looms large in our collective imagination. These rituals offer couples emotional generators to affirm their shared reality and identity. But rituals can also provide opportunities for much-needed transitions when ending relationships, whether we call it breaking up, divorcing, or separating.

    Can couples craft new rituals to help them decouple—to acknowledge that their once-shared reality is now fragmented?

    This is precisely where Ulay and Marina Abramović found themselves in the spring of 1986, despite their cosmic connection and shared birthdays. They had just performed a show together at the Burnett Miller Gallery in Los Angeles. The show, for her, was symbolic of their love and their artistic vision. It represented what she describes in her memoir, Walk Through Walls, as “creating this third element we called that self—an energy not poisoned by ego, a melding of male and female that to me was the highest work of art.”

    Ulay, on the other hand, felt their performances and interactions with the spectators afterward were becoming routine. The business and networking aspect of their art had become a habit he wasn’t sure he wanted to cultivate. Whereas Abramović was ready to embrace the life of a world-famous art star—with its requisite duties and attendant inconveniences—Ulay longed to live a more itinerant and anarchist existence. Instead of attending celebrity parties and art pavilions, he was eager to return to his nomadic life traveling across Europe in a van.

    “Oh, you know how to deal with people,” he told Abramović while she worked the room at the show’s after-party. “I’m just going to have a walk.” During his lengthy absence, Abramović later found out that Ulay was cheating on her with a beautiful young gallery assistant. It was (another) tale as old as time.

    How do two people who have spent more than a decade making work about becoming inextricably linked find a way to call it off? The artists did the most reasonable thing they could think of doing given the circumstances: they devised their own unique ritual for breaking up. They decided to take the better part of a year to walk the Great Wall of China together—each starting from an opposite end of its 13,171 miles—and meet in the middle to say goodbye. The project—initially called The Lovers and conceived of as a kind of wedding—had turned, over years of waiting and broken trust, into a meditation on their incompatibility and separation. On March 30, 1988, after close to a decade of cutting through bureaucratic red tape from the Chinese Communist Party, the artists were finally granted permission to perform their walk. Abramović started at the Bohai Sea, a part of the Yellow Sea, which sits between China and Korea. Over months of trekking, she walked the more treacherous path through eastern China’s elevations and along parts of the path that had been destroyed to only shards of crumbling rock and stone under Mao’s Communist diktats. She and her guides had to walk hours from the wall each night just to reach the villages where they slept.

    Ulay set out 700 miles to the west in the Gobi Desert. While Abramović had the mountains to conquer, much of Ulay’s journeys took him through hundreds of miles of desert dunes. Instructed to lodge in the nearby villages and hostels, he characteristically broke the rules and spent many of his nights sleeping under the stars on the broken stones of the Great Wall. Both of them invested extreme effort in putting their bodies in motion to prepare for the moment of meeting again and severing all ties to each other.

    After each walking for 90 days and covering around twelve and a half miles a day, the artists reunited on a stone bridge in Shaanxi Province. Ulay arrived first and sat down to wait. Abramović eventually approached toward the end of the day. They looked at each other as they had once done so many years ago in that Amsterdam airport, and they embraced. They then parted ways and did not speak again for 22 years.

    Read More: This Is the Best Way to Break Up With Someone, According to Experts

    Ulay and Abramović might be an extreme example, but we can still glean guidance from them when facing our own breakups. Colleen Leahy Johnson, an expert in the psychological impact of divorce, uses the wonderful phrase “socially controlled civility” to describe how former couples can move past their acrimony by engaging in patterned, symbolic ceremonies—that is, rituals—that help them to keep their emotions in check. One divorcing couple chose to have their dissolution ceremony in their church and created reverse vows: “I return these rings which you gave me when we married, and in so doing I release you from all marital responsibilities toward me. Will you forgive me for any pain I have caused you?” The ceremony was so moving that one attendee later had an epiphany: “Too often I see a ritual as an ending to a process without realizing at the same time it is a new beginning.”

    The philosopher and public intellectual Agnes Callard crafted her own, unique new beginning. She now lives with her ex-husband, Ben Callard, a fellow philosopher, as well as her former graduate student, now husband, Arnold Brooks, in one household. The three adults have shared domestic and caretaking duties with their three children—two from her marriage with Callard and one from her current marriage with Brooks. Because she and her ex-husband are still close, the two of them celebrate their divorce every year with their own unique ritual. “Happy Divorciversary to us! This is a big one: #10,” she wrote on her Twitter feed with a picture of her beaming next to Ben. They went out to dinner and savored the joys of growing old together—over a decade of successful divorcing is nothing to sneer at. “Remember kids, marriages come and go but divorce is forever so choose your exes wisely,” she quipped on social media.

    The equanimity of the domestic situation of these three might be hard for many people to emulate, but luckily there’s a ritual for less amicable former couples, too: the “annivorcery.” An investment banker named Gina noted, “I’ve been divorced for three years, and each year I throw a big party to celebrate my separation. I make my ex look after the kids while I invite all my best single boyfriends and girlfriends.”

    Paul Simon felt that once couples were twirled into one, there was no undoing the bond. And moving on from meaningful relationships is, for sure, one of the hardest transitions we have to make in our lives. Given the pain involved, it’s no wonder that people have devised so many different means of moving on. Think of Gwyneth Paltrow and Chris Martin’s stated plan to engage in “conscious uncoupling” when announcing their divorce. The pair met with some ridicule, but in its essence, conscious uncoupling is a guided ritual that helps couples let go of each other without burning bridges. Though, in a pinch, a little fire can help as well—we could simply borrow from Taylor Swift’s relationship-ending ritual of striking a match on the time she spent with her ex, who’s now “just another picture to burn.”

    Excerpted from THE RITUAL EFFECT: From Habit to Ritual, Harness the Surprising Power of Everyday Actions, copyright © 2024 by Michael Norton, PhD. Reprinted by permission from Scribner, an imprint of Simon & Schuster, LLC. All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.

    [ad_2]

    Michael I. Norton

    Source link

  • Mapping America’s Birthweight Crisis

    Mapping America’s Birthweight Crisis

    [ad_1]

    Americans are increasingly at risk of having lower incomes, poorer health, and a worse shot at opportunity even before they are born. More babies are now born with low birthweights than in the last 30 years. This has caused growing inequalities that can persist if not properly addressed. In certain parts of the country, that risk may be ten-times greater.

    Underweight newborns are at an increased risk of long term health challenges, lower IQ scores, and developmental delays. New data shows that the frequency of this problem is rising with more than 300,000 newborns now experiencing low birthweight. This public health and equity issue is increasingly common in low-income communities, communities with poor access to healthy foods, and homes that are near high-polluting sites. 

    Emily Oster, a professor of economics at Brown University and author of Expecting Better writes, “Babies that are born in this group are much more likely to have complications. These include difficulty breathing, difficulty regulating blood sugar, and abnormal neurological signs… Some studies suggest that babies who are born SGA [Small for their Gestational Age] have more long-term issues, including a higher risk for diabetes and lower cognitive skills.”

    Lower birth weight can also predict career trajectory and earning power. In a paper published in the American Journal of Epidemiology, researchers looked at thousands of government officials in England and found that even after controlling for other factors like parental education that people born with low birthweight tended to have lower wages and lower ranking roles.

    Our team at American Inequality wanted to see how pervasive the issue of low birthweight is not just nationally but within specific communities. We found 29 counties, largely in the South and Midwest, where babies are twice as likely to be born with lower birthweights than the national average.

    Pollution during pregnancy

    A new report from Human Rights Watch found that babies in Louisiana’s “Cancer Alley” are three times more likely to experience low birthweight. This 85-mile stretch that runs along the Mississippi River between New Orleans and Baton Rouge contains over 200 fossil fuel and petrochemical plants—reportedly the highest density in the Western Hemisphere. Americans living in the area are exposed to higher concentrations of harmful substances. This current generation is paying the price.

    The role of food deserts

    Low birthweight is a product of many compounding factors including inadequate nutrition. In the 29 counties we looked at, all had elevated levels of obesity and were considered food deserts. Many Americans who don’t have access to healthy foods often turn to fast food as an alternative. In two of the counties, 50% of residents were food insecure, with some residents sharing that when the only grocery store in town closed, they would have to drive 130-miles round-trip to find the next nearest place to purchase food for their family.

    I spoke with Dr. Gillian Goddard at ParentData who shared this, “Low birth weight infants are at increased risk of developing insulin resistance in adulthood, which can progress to type 2 diabetes. This results in varying health challenges, which aren’t always diagnosed promptly.”

    Low incomes and poor healthcare

    In the 29 counties we looked at, median household income was $35,830 and 1 in 3 families lived in poverty. Healthcare is deeply connected to income in America, meaning low income communities often had poor health outcomes and inadequate care.

    No place struggles with low birthweight more than Issaquena County in Mississippi. This rural county of 1,100 people has no hospitals, one of the highest poverty rates in the country, and 1 in 4 babies is born weighing less than 5 pounds 8 ounces. Taneria Williams has lived in Issaquena for years, and has given birth to three children with low birthweight, despite her best efforts to avoid it. “As a mother you try to nourish your body as much as you can when you are pregnant. You try to do all the necessary things you have to do to have a healthy baby and I felt because I don’t have the proper health care, I am not able to do that.”

    Black families routinely receive worse healthcare in America, and this impacts Black babies too. Black babies are twice as likely to be born with low birthweight as white babies. Babies born to college-educated Black women are more likely to have low birthweight than are babies born to white women who dropped out of high school. This indicates that race seems to be a much stronger factor than education in contributing to this social issue.

    Economists from the National Bureau of Economic Research found that the U.S. spends more than $5 billion each year addressing challenges emerging from low birthweights.

    The trend is getting worse

    The preterm birth rate is now at its highest point since 2014. One of the main drivers of this is that food insecurity in America has also risen to its highest point over that same period. 

    In 2022, 1 in 12 babies in America was born with a low birthweight. This rate puts the U.S. in a similar ranking with Hungary, Turkey, and Brazil. Nordic countries, on the other hand, have half the rate of low birthweights as is seen in the U.S., largely due to strong healthcare systems, low pollution, healthier foods, and higher incomes.

    Preterm babies account for the vast majority of low birthweight babies. 1 in 10 babies is born preterm (born before 37 weeks of the typical 40 week gestational period), which can often come with its own set of health and developmental challenges. The World Health Organization explains that most preterm births happen spontaneously. But, increasingly, health issues for parents like diabetes, pre-eclampsia or heart disease (which are far more common in low-income communities) are driving more preterm births.

    Stopping the low birthweight epidemic 

    Regular doctor visits are the best method for warning pregnant women about low birthweights, but some lesser known factors can also make a difference. Safer environments and better nutrition can address the low birthweight challenges that the nation is facing. Specifically, this can be done by reducing the exposure pregnant women have to pollution, while also increasing the adoption of the Supplemental Nutrition Program for Women, Infants, and Children (WIC), which is far too low in certain states.

    Promoting healthy habits through WIC: WIC is eligible to low-income women who are pregnant all the way up until their infant’s first birthday, but most women don’t know about it. Women who enrolled in WIC saw an 11% reduction in babies born with low birthweight, and this number could rise to 65% if they enrolled early in pregnancy. Children whose mothers participated in WIC while pregnant scored higher on mental development assessments. However, in California, 65% of families that are eligible for WIC participate in the program, whereas in 8 states (Louisiana, South Carolina, Tennessee, Illinois, Montana, Utah, and Arkansas) the participation rate is only half that figure. Encouraging more parents to make use of the service in these low uptake states is a data-driven way to ensure that children face fewer challenges throughout their lives. 

    Reducing exposure to hazardous environments: A study of 32 million births in the U.S. found that high exposure to pollution is a direct cause of low birthweight. In Cancer Alley, expansion is underway with at least 19 new fossil fuel and petrochemical plants in regions with the highest poverty rates and highest percent of Black residents. Reducing just 5 micrograms per cubic meter (µg/m3) of fine particle pollution can decrease the risk of low birthweight by 15%. Polluting factors should not be developed near vulnerable communities, and in the meantime, pregnant women would benefit from staying away from polluting sites (like downwind of highways) as much as possible. The EPA has a free app to help monitor this, and you can buy some in-home devices too.

    The next generation deserves basic nutrition and clean air; and expectant parents deserve the same. We just have to determine how best to ensure they are actually receiving these key factors for success.

    [ad_2]

    Jeremy Ney

    Source link

  • Why Heart Disease Research Still Favors Men

    Why Heart Disease Research Still Favors Men

    [ad_1]

    Published in partnership with The Fuller Project, a nonprofit newsroom dedicated to the coverage of women’s issues around the world.

    Katherine Fitzgerald had just arrived at the party. Before she could even get a drink, she threw up and broke out in a sweat. “I was dizzy. I couldn’t breathe. I had heart pain,” Fitzgerald says.

    She knew she was having a heart attack.

    What she didn’t know then was that the heart attack could have been prevented. Fitzgerald, a health-conscious, exercise-loving lawyer, should have been taking statin drugs to stop the buildup of plaque in her arteries that caused the heart attack and two others that followed.

    Fitzgerald’s case illustrates a dangerous gap in medical care between men and women. While they are equally likely to suffer heart attacks, women are more likely to die from theirs. It’s one of the many symptoms of the medical system’s neglect of women.

    Life-saving statins, like so many other medications, have been developed based on clinical trials that primarily recruited men. As a result, many women like Fitzgerald don’t receive prescriptions for the drugs that could help them the most, says Dr. Laxmi Mehta, director of Preventative Cardiology and Women’s Cardiovascular Health at The Ohio State University.

    “There were a lot of trials. But women weren’t included as much,” says Mehta, who serves on the American Heart Association’s Research Goes Red Science Advisory Group. When women need treatment for heart conditions, she says, “we are assuming we are providing the best care based on data from men.”

    Read More: What It Means if You Have Borderline High Cholesterol—And What to Do About It

    More than 30 years ago, Congress directed the National Institutes of Health to include as many women as men in clinical trials. But while some progress has been made, equity remains elusive. And that’s dangerous for women. “Since 2000, women in the United States have reported total adverse events from approved medicines 52% more frequently than men, and serious or fatal events 36% more frequently,” research firm McKinsey & Company said in a report released in January.

    Now, the Biden administration is taking a run at it.

    Last year, the administration established a White House Initiative on Women’s Health Research and, in February, it announced it would be dedicating $100 million to the newly formed Advanced Research Projects Agency for Health (ARPA-H) to spearhead efforts to increase early stage research focusing on women.

    “For far too long, scientific and biomedical research excluded women and undervalued the study of women’s health. The resulting research gaps mean that we know far too little about women’s health across women’s lifespans, and those gaps are even more prominent for women of color, older women, and women with disabilities,” Biden said in an executive order signed in March.

    Heart disease should be a bright spot in this black hole of medical research. It was the recognition in the 1980s that heart disease was killing women at similar rates to men that kickstarted passage of the 1993 law requiring equity in clinical trials. The American Heart Association has spent decades funding research and leading awareness campaigns about women’s risks.

    But gaps persist, says Dr. Martha Gulati, president of the American Society for Preventive Cardiology and a cardiologist at Cedars-Sinai Hospital in Los Angeles. “We don’t get represented in trials,” Gulati told a seminar sponsored by the Society for Women’s Health Research in February.

    Read More: Why Are So Many Young People Getting Cancer?

    One example: Dr. Safi Khan of West Virginia University and colleagues reviewed 60 trials of cholesterol-lowering drugs conducted between 1990 and 2018. Not even a third of the people enrolled—28.5%—were women, they reported in JAMA Network Open in 2020. The trials’ findings likely did not accurately represent the public as a whole, they say.

    “Medical research is several steps behind on women and heart disease, and that is a major contributor to ongoing ignorance about the problem on the part of both the public and a range of medical professionals,” says Dr. Harmony Reynolds, a cardiologist at NYU Langone Health. “Everywhere along the way, there is different treatment for women, and there is some bias there.”

    Statins have been widely described as wonder drugs, lowering the risk of major heart events such as heart attack or stroke by about 25%. Women are less likely than men to be offered these drugs. And when they do take them, women are more likely to stop using them because of perceived side effects. But no major study digs into the actual rate of side effects among females, or what might lie behind such differences.

    Further studies might uncover additional benefits, says Dr. JoAnn Manson, professor of medicine at Harvard Medical School and Brigham and Women’s Hospital. There are hints that statins might lower a woman’s risk of dying from cancer, including ovarian cancer.

    Failure of recognition

    Fitzgerald was 60, had higher-than-optimal blood pressure, unhealthy cholesterol levels, and a family history of heart disease, says Reynolds, Fitzgerald’s new cardiologist. “Katherine had multiple risk factors. Many of my patients are told their blood pressure and cholesterol are ‘borderline’ when really they should be treated,” she says.

    Doctors often blame women for failing to recognize their own heart disease symptoms, but the evidence shows medical professionals miss them, too. 

    The symptoms of heart attacks in men are widely known: crushing chest pain, a telling sensation in the left arm, or sudden collapse. Women, on the other hand, often feel nausea, jaw pain, or lightheadedness,

    Fitzgerald did recognize her symptoms. At the party where she suffered her first heart attack, she begged for an ambulance. But other guests, including a physician friend, said they didn’t think she needed medical attention.

    When paramedics finally arrived, they, too, dismissed her fears and diagnosed a panic attack. They sent her home. “If I had been a man, there is no way the paramedic wouldn’t have taken me to the hospital and I wouldn’t be in the mess I am now,” Fitzgerald says.

    Fitzgerald waited two days to visit an emergency room. By then, some of her heart muscle had died. She received two stents to hold open clogged arteries, but suffered two more heart attacks in the following months. She now stays out of the courtroom and sticks to less-stressful desk work.

    “I take care of all these young women with heart attacks and I hear so many stories about people saying they were ignored,” says Reynolds.

    Waiting for attention

    The problem is not just anecdotal. Reynolds and colleagues studied the problem by looking at more than 29 million emergency room visits by people under 55 reporting chest pain. 

    “In that study we show young women coming in with chest pains and they are waiting longer to be seen,” Reynolds says. “The women are waiting too long and women of color were waiting even longer. So we know there is some subtle bias there.”

    Read More: What the Science Says About the Health Benefits of Vitamins and Supplements

    Doctors can use risk calculators to try to forecast a patient’s future likelihood of heart disease and treat accordingly. But Dr. Stephanie Faubion, medical director of the Menopause Society, says they do not work well for women.

    “That is because we are still using those that were developed and made for men,” says Faubion, who is also director of the Mayo Clinic Center for Women’s Health in Jacksonville, Florida.

    Women have many specific heart risks. They have smaller coronary arteries, thinner heart walls, and suffer more heart damage from diabetes. Pregnancy can raise risks in various ways. Autoimmune diseases such as rheumatoid arthritis also add heart disease risks, and women are far more likely than men to have these conditions. 

    Women who start menstruation early, or who reach menopause early, have higher heart disease rates. Birth control pills can raise the risk for blood clots, strokes, and heart attacks.

    Perhaps the most recent instance of women being left out of heart disease research can be seen in the trials of highly popular diabetes drugs such as semaglutide, sold under the brand names Ozempic and Wegovy.

    The drugs cause dramatic weight loss, which made researchers wonder if they might lower heart disease rates, too. They do, according to several studies, and the U.S. Food and Drug Administration now approves their use to prevent heart disease.

    But none of the weight-loss trials, published in prestigious medical journals such as the New England Journal of Medicine and the Journal of the American Medical Association, break out separate data on men and women. And while the weight-loss studies did include far more women than men, many of the follow-on heart disease trials did not.

    “They report the sex. They report ‘we have this many men, this many women,’” says Faubion. “They didn’t disaggregate the data on sex so they don’t know if it works better, the same, or worse in women than it did in men.”

    Left out

    Dr. Robert Kushner, a professor of medicine at Northwestern University who led some of the weight-loss studies, says he was surprised at the discrepancy between the enrollment of women in the obesity trials of semaglutide—in which about three-quarters of volunteers were women—and in the heart disease trials, in which women represented fewer than 28% of participants.

    He says researchers recruited people already being treated for heart disease. “Predominantly, the ones who are getting care and being seen around the world were men,” Kushner says.

    Kushner says he has yet to analyze results in his trial of semaglutide and weight loss by sex.

    Missing out on breakthroughs

    Harvard Medical School’s Manson has been sounding the alarm on discrepancies in medical research for decades.

    “Raising more questions is what leads to the major breakthroughs,” she says.

    Yet she has been mostly ignored, even though she helped lead the largest-ever study looking specifically at women’s health—the Women’s Health Initiative, which involved more than 160,000 women over 15 years.

    The study was initially designed to see if hormone therapy in women past menopause could reduce their rising rates of heart disease and breast cancer. It also later looked for evidence of effects on bone strength, other cancers, dementia and quality of life.

    The first results were startling. The hormone therapy used in the trial raised the risk of breast cancer and failed to reduce heart disease.

    Read More: Menopause Is Finally Going Mainstream

    “Many clinicians stopped prescribing hormone therapy altogether. Many women tossed their pills and patches,” Manson says. When the trial started, an estimated 40% of menopausal women used hormone therapy. Now, Manson estimates, only about 4% do.

    The study has since been shown to have been flawed. The average age of the women in the study was 63—well past menopause. And the hormone therapy used was a high-dose hormone distilled from horse estrogens.

    Later studies have indicated that lower doses and different formulations such as patches, given to women as they start menopause, may be much less harmful while reducing hot flashes, sleep loss and other symptoms. “These formulations don’t go to the liver and should be safer,” Manson says. There’s also tantalizing evidence they may lower the risk of heart disease.

    Meanwhile, the lack of data means that many women who would benefit from hormone therapy are not getting it, says Faubion. 

    Back in 1993, it took the considerable efforts of Dr. Bernadine Healy, the first female director of the NIH, to persuade Congress to directly fund medical research on women and heart disease.

    “They are just not going to do that again. It’s too expensive,” says Faubion.

    Biden asked Congress for $12 billion to improve research planning and to set up a network of research centers to focus on women’s health. And NIH has encouraged requests for money to study women in particular.

    But when Congress passed a last-minute spending bill in March, it kept health funding flat. The Republican-led House did not address Biden’s request or allocate any cash for additional research into women’s health.

    Sign up for the Fuller Project’s newsletter, and follow the organization on X or LinkedIn.

    [ad_2]

    Maggie Fox

    Source link

  • Monkey Man’s Political Critique Misses the Point

    Monkey Man’s Political Critique Misses the Point

    [ad_1]

    Cinema isn’t a science, but a number of political films are distinctly Newtonian: they contain equal and opposite forces, resulting in inertia. Adam McKay’s 2021 climate change satire Don’t Look Up blames the public’s disinterest in politics on its obsession with fame, all while flaunting a celebrity ensemble; this isn’t the gravest offense, but it calls the movie’s message and self-awareness into question. Gualtiero Jacopetti and Franco Prosperi’s 1971 Italian mockumentary Addio Zio Tom (Goodbye Uncle Tom), which seeks to lampoon American slavery, but does so by dehumanizing hundreds of poor Haitian extras on camera; a horrific hypocrisy. The list goes on. 

    Monkey Man—the action-packed, politically-volatile directorial debut of actor Dev Patel—is plagued with a similar problem, but it’s neither as fluffy as McKay’s faux pas, nor as materially harmful as Jacopetti and Prosperi’s exploitation. Patel’s revenge film exists between these two extremes, with contradictory optics stemming from images whose creation is well-intended, but whose meaning grows more incongruous and disconcerting as the current events of India’s thorny political climate fades into view.

    While Monkey Man is set in the fictional, Mumbai-esque city of Yatana, Patel is hardly subtle about his aims and influences. His character (referred to as “Kid”) dons an ape mask and embarks on a vengeful mission against the men who wronged his family—men deeply entrenched in Indian politics. Chief among them is the fictitious yogi Baba Shakti (played by Marakand Deshpande), a revered religious leader whose name, “Shakti,” means “power” in Hindi. Patel even briefly employs video footage of real protests against India’s current regime under the BJP (the Bharatiya Janata Party) and Prime Minister Narendra Modi, albeit without invoking their names. 

    As the Indian government cracks down on dissent, a film that takes even nominal aim at its right wing stronghold is arguably an act of bravery. But Monkey Man’s opposition to India’s growing Hindu nationalism—the Hindutva movement, about which alarm bells have been sounding for some time—is marred by a paradoxical approach: Patel’s nameless bare-knuckle brawler implicitly reclaims tenets of Hinduism, like the monkey-god Hanuman, by using them as spiritual fuel for a bone-crunching offensive. But while the Kid’s fury may be righteous, it transmutates these images into symbols of sanctimonious violence, echoing India’s contemporary political milieu in uncomfortable ways.

    The Preamble to India’s Constitution emphasizes secularity. However, a rampant Hindu supremacy has taken hold since Modi’s 2014 rise to power, from the lynchings of religious minorities, to the recent Citizenship Amendment Act, which, in combination with India’s National Register of Citizens, leaves many of the country’s 200 million Muslims vulnerable to internment and deportation. After years of anti-Muslim pogroms, these issues came to a symbolic head in January, with Modi’s public inauguration of the Ram Mandir, a controversial Hindu temple built atop the ruins of the Babri Masjid, the mosque demolished by Hindu extremists in 1992.

    Read More: India Is Unveiling Its Controversial Temple of Ram. Here’s What to Know

    For supporters of the temple, their primary justification is a claim that many historians agree has no evidence: that the Masjid was built atop the birthplace of Lord Ram, a chief figure in Hindu scripture. In recent years, chants of “Jai Shri Ram” (“Praise Lord Ram”) have become a rallying cry for acts of extremist violence against minorities, making the act of weaponizing Hinduism in fiction inseparable from real atrocities. Notably, the central Hindu epic about Lord Ram, the Ramayana—a common influence in Indian storytelling—features Hanuman in a pivotal role, as Ram’s loyal devotee. For many Western viewers, their first exposure to the Ramayana’s influence was the Oscar-winning, crossover Tollywood hit RRR, whose climax transformed real-world freedom fighters Alluri Sitaram Raju (Ram Charan) and Komaram Bheem (N.T. Rama Rao Jr.) into avatars for Ram and Hanuman respectively. But that film, too, was not without its troubling optics.

    Hanuman, like Ram, has also been invoked during mob violence in recent years. In June 2023, the release of the Ramayana-based movie Adipurush involved a campaign to leave one seat empty at each screening to represent Hanuman’s presence; at least one patron didn’t get the memo, and was allegedly physically assaulted when he sat in the empty chair. Even movie theaters aren’t immune to the weaponization of Hindu deities. And like “Jai Shri Ram,” the slogan “Jai Bajrang Bali” (another name for Hanuman) has been hurled during attacks on Muslims and other minorities, and was even adopted by Modi as punitive catchphrase, making its inclusion in the film—a crowd member chants it in support of Kid during a fight—disorienting at best.

    Read More: India’s Ayodhya Temple Is a Huge Monument to Hindu Supremacy

    Monkey Man not only sees “Kid” don the ape god’s likeness, accompanied by flashbacks of his mother (Adithi Kalkunte) regaling him with tales of Hanuman’s bravery, but the movie uses the Ramayana as a structural influence too. In the original epic, Hanuman assists in rescuing Ram’s wife, Sita, from the clutches of the demon king Ravana. Monkey Man features a similar subplot in which Kid tries to rescue an escort named Sita (Sobhita Dhulipala) from a brothel frequented by the evil police inspector Rana (Sikandar Kher), one of his primary targets. Further similarities between Kid and Hanuman arise in an avant-garde detour, when the drug-induced Kid has a vision and rips open his chest to reveal light emanating from within. This image is commonly seen in depictions of Hanuman, who opens his heart to reveal images of Ram and Sita, symbolizing his dedication.

    The reclamation of such images appears to be Patel’s goal—one he shares with numerous Hindu leaders who have continued to battle Hindu nationalism. But the use of Hindu imagery as a call to violence, reminiscent of the Hindutva project, is central to Kid’s mission, resulting in narrative dissonance. In comparison, the movie’s villains only use Hinduism as a façade for violence and financial gain, rather than as a sincere fixture of their fanaticism. They represent Hindutva only in the abstract, echoing its power structures without its ideology. Kid, meanwhile, perhaps inadvertently, embodies it in both belief and action.

    In a key flashback, Rana—acting on Shakti’s orders—clears out Kid’s forest-adjacent village so the land can be used for industrial growth. This bears a striking resemblance to the Indian government’s recent attempts to evict thousands of Muslims along India’s Eastern border and millions of indigenous people from tribal lands. The BJP’s political opponents believe these land seizures are an attempt to transfer tribal resources to corporate allies, not unlike Shakti’s plan for Kid’s village. However, the metaphor is muddled. Rather than framing Kid’s community as an oppressed caste, religion, or tribe, the only visible culturally specific moment involves the villagers enjoying a marionette re-telling of the Ramayana, which is interrupted by incendiary violence. In the movie’s purview, Hinduism is under attack from something non-Hindu, or falsely Hindu, rather than from dangerous factions of Hinduism itself. This grants Kid permission to weaponize it freely, sans conflict or spiritual reckoning—a thematic tension the movie never reconciles.

    As Monkey Man neared its April 5 U.S. release, its villains were further stripped of key details tying them to real-world Hindutva. The movie’s first trailer, released in January, featured shots of Shakti’s political supporters brandishing saffron-orange flags and party posters, a color closely linked to Hindu nationalism. However, by the time Monkey Man premiered in March, these posters had been edited to appear red, a change which can be glimpsed in a more recent trailer. (Distributors Universal Pictures did not respond to a request for comment.) If these changes were made to avoid political ire, it wouldn’t be the first time the studio has had to contend with this. In July of last year, a scene in Universal’s Oppenheimer, which involved the sacred Hindu text the Bhagavad Gita, was met with right-wing religious backlash and calls for boycotts.

    Monkey Man is also yet to release in India, with its scheduled April 19 date—a placeholder, according to a source in distribution—having been delayed (a recent update from Universal Pictures India on X simply listed it as arriving “in cinemas soon”.) The film hasn’t undergone the censorship certification required of all theatrical releases, a lengthy process which could see key scenes stripped away—if it’s granted a release at all.

    Notably, April 19 also marks the beginning of India’s six-week long general election, the road to which has already been paved with the jailing of the BJP’s political opponents and the alleged freezing of their funds as Modi seeks his third term in office. Should Monkey Man be released in the coming months, the timing could also result in increased scrutiny and heated sentiments, despite its muddled critique. Patel’s good intentions may be obscured by novice storytelling and last-minute studio measures, but at a time when Indian industries like Bollywood increasingly toe the party line, Monkey Man is buoyed by enough political gusto to still ruffle a few feathers.

    [ad_2]

    Siddhant Adlakha

    Source link

  • How to Talk to Kids When a Parent Has Cancer

    How to Talk to Kids When a Parent Has Cancer

    [ad_1]

    The U.S. is expected to hit a bleak milestone this year: For the first time, more than 2 million people will be diagnosed with cancer. More than 600,000 will die, according to projections from the American Cancer Society.

    Yet when you consider how many people are affected by a single diagnosis, those numbers balloon. As people with cancer grapple with fears about their health, they often describe being equally anxious about how their news will affect their family. When Catherine, Princess of Wales, revealed on March 22 that she was being treated for cancer, she emphasized that she and her husband had “taken time to explain everything” to their three young children “in a way that is appropriate for them.”

    Whatever your treatment might entail, it’s helpful to know how to discuss your prognosis with your loved ones so you can prepare them for the road ahead, as variable and unknown as the future may be. That’s especially true with children, who are often more intuitive than you may realize. 

    “Kids are incredibly perceptive on picking up that something is off,” says Dr. Amishi Y. Shah, a genitourinary medical oncologist and associate professor at the University of Texas MD Anderson Cancer Center in Houston. “In general, being transparent about what’s going on with kids is a good policy.”

    Of course, each family will talk about a cancer diagnosis with children differently. “There’s not necessarily a one-size-fits-all [approach],” says Amanda L. Thompson, chief of pediatric psychology and director of pediatric programs at Life with Cancer, a northern Virginia nonprofit providing support and education for people affected by cancer. “What you’re going to disclose is going to depend on the age of your child, their maturity, their own experience with or exposure to illness within the family or close friends, and more.” 

    Here, cancer experts and mental health professionals share tips for approaching this conversation with care and compassion.

    Read More: Kate Middleton Had to Tell Her Kids About Her Cancer Diagnosis. These Parents Know What That’s Like

    Plan ahead

    This probably isn’t the best time for an off-the-cuff, improvised conversation, notes Shannon Coon, children’s program coordinator at the cancer support organization CancerCare. “Write down what you want to say before the conversation happens, and practice prior,” she says. That might make it easier to speak in a calm and reassuring voice when the time comes, she says.

    Think about who you might want to have with you, as well, Coon adds: Do you want to speak with your children individually? Do you want your partner to be there? Should any other adults in their lives be present?

    Create a welcoming environment for the conversation

    Choose a calm, safe space and time to bring up your diagnosis with childrens. Make sure you have plenty of time to answer questions without having to rush off to another part of your day, says Thompson.

    Picking your moment counts in other ways too. It might help to identify when your family already comes together in a way that feels “connected, comfortable, and normal,” says Max McMahon, a licensed independent clinical social worker at the Lank Center for Genitourinary Oncology at Dana-Farber Cancer Institute in Boston. “Is the dinner table when good conversations happen? Is it when you go out for bagels on Saturday mornings? When do your kids seem to want to talk about things or process their day?” he asks.

    Whatever the setting, your goal should be to welcome discussion. “We’re creating an environment where it’s OK to talk about the hard things out in the open,” Thompson says.

    Stick to age-appropriate terminology

    Tailor the language you use based on the age of the child you’re talking to. For a young child, that might look like: “‘Mommy is sick. She has something called cancer. The doctors are doing everything in their power,’” Coon says. You might even point to the sides of your back and explain the cancer is in your kidneys.

    Older children will be able to understand more, so the conversation may be more detailed, but they’re also in a different emotional space. “I’ve found the most difficult [scenario] is when the kids are teenagers,” says Dr. Toni K. Choueiri, director of the Lank Center. “They’re going through a lot of changes, and now you add to it.”

    Use concrete language

    It can be tempting to gloss over unnerving topics, but using the word “cancer” can actually help defuse the situation, Thompson says. “Harry Potter said ‘Voldemort.’ He gave the big bad villain his name to take away some of his power. We have to use that word matter-of-factly. It is important for children to know it’s something they’re going to hear.”

    Similarly, it’s helpful for children to hear clear language about death, “even though it is incredibly difficult … especially if you’re the parent who is ill and facing your own mortality,” she adds.

    That doesn’t mean you have to state simply, “I’m dying,” McMahon says. You might say something like, “This is a serious, advanced disease, and I’m getting treatment for it, [but] this disease can’t be cured, and I will die from it,’” he says.

    Using euphemisms or otherwise prettifying language can lead to children interpreting things too literally. “Sometimes children think ‘heaven’ is a place they can visit,” Coon says, or that they can go find a loved one who has been “lost,” Thompson adds.

    Discuss visible physical changes

    Immunotherapy and targeted drug therapy for cancer can cause side effects like joint and abdominal pain, diarrhea, loss of appetite, and fatigue, all of which children might notice. And if they do, it’s better to be upfront about it. “Otherwise, they’re wondering in silence,” McMahon says.

    Some changes will be more obvious than others. For example, Choueiri says, if you’re dealing with diarrhea and your home has only one bathroom, it would be nearly impossible to hide the fact that you’re using it every hour.

    But even if side-effects are more nuanced—maybe you’re walking more tenderly because you’re in pain, or you’re losing weight because you’re not hungry—embrace opportunities to explain where you can. You might try: “‘Dad is in pain. Do you want to know what’s happening inside Dad’s body?’” McMahon advises. Some parents worry this will create more anxiety for a child, “but kids often have anxiety about what they don’t know, so information is helpful for most children.”

    Read More: Kate Middleton Is Receiving Preventative Chemotherapy. Here’s What That Is

    Explain how their lives may change

    Consistency generally makes children feel secure, and cancer can certainly disrupt your schedule. Aim to explain to children what you expect to shift in your routine. “They’re going to want to know, ‘What does this mean for my family and what we do? Does this mean someone else picks me up from school? Are we still going on the trip we take every year?’” Shah says.

    Reassure kids that even if someone else will handle school pick-up, their needs will be met and they’ll still be cared for and loved. Consider sharing your treatment calendar with older children, so they can anticipate some of those changes on a weekly or monthly basis.

    Answer questions honestly

    After you’ve disclosed your diagnosis for the first time, lean on a child’s curiosity to shape your ongoing conversations. Answer questions as they come up, then pause for a moment to see what other questions arise (if any). Kids will likely come up with questions about a parent’s cancer that you don’t know the answers to. “The reality is, we probably won’t have all the answers. Often our physicians don’t even have all the answers,” Thompson says.

    In those cases, it’s OK to tell a child you don’t know. “Let them know that when you do know, you’ll get back to them as soon as possible,” Coon says. You can show them you mean it by keeping a running list of unanswered questions and bringing it to your next visit with your oncologist.

    Check in

    Just as you’ll need more than one visit with your oncologist over the course of treatment, you’ll likely need more than one conversation with a child to fully discuss their feelings about your prognosis. Touch base with specific questions that welcome their curiosity rather than broad questions like asking how they’re doing, suggests the American Cancer Society. You might start with a question like, “‘What changes have you noticed with Dad lately?’” Choueiri suggests, or “‘You’ve noticed Mom has had to go to the hospital more. Do you have any questions about that?’” McMahon says.

    Older children can take even more ownership in shaping these conversations. “I often recommend asking how they want to be updated along the way,” Thompson says. “Do they want to know the details? Do they want to talk about it in the morning or the evening? What would be most helpful for them?”

    Lean on the services meant to help

    Your medical team can likely connect you with support services at your treatment center to assist you in navigating these difficult conversations. You might have oncology social workers, nurse navigators, and other experienced staff members available to you and your children. “It’s our job to guide you to the resources that can help. You don’t have to do it alone,” Shah says.

    That’s especially true if children start exhibiting any signs that they need more support than you’re equipped to give them, such as experiencing changes in sleeping or eating patterns, social withdrawal, fighting with their siblings or friends more often, or more frequent bedwetting.

    Organizations like the American Cancer Society have information and support groups for parents and caregivers. Nonprofits like CancerCare offer children’s programs free of charge. And there are even Facebook groups for people with specific types of cancer where you can find comfort in knowing you’re not alone.

    Talking about a parent’s cancer with children is never easy, but it’s helpful for your kids and your relationship. “In general, know it’s going to be difficult and emotional in the moment,” Coon says, “but it’s so important to have open and honest conversations throughout the cancer journey.”

    [ad_2]

    Sarah Klein

    Source link

  • The Perks of Being a Sociopath

    The Perks of Being a Sociopath

    [ad_1]

    “Don’t take things personally,” my professor warned my class. “Therapists have a responsibility to compartmentalize social emotions like shame and guilt. Try to ignore them,” he added. “What a patient is feeling toward you is not about you.”

    It was day one of Clinical Practicum, a graduate-level psychology course meant to teach us how to work as clinicians. In addition to practical skills like assessment and treatment methods, we were introduced to the concept of transference, the inevitable unconscious process of patients redirecting their feelings onto their therapists. Negative transference was something that evidently contributed to a great deal of clinical burnout, as many therapists have a difficult time separating themselves from the emotions layered upon them by those they’re counseling.

     “What’s the benefit in ignoring social emotions,” I asked.

    “It allows you to observe your patient’s feelings,” he replied, “instead of absorbing them.”

    That sounded like an advantage.

    It wasn’t the first time I’d considered the upside of not connecting with guilt and empathy, social emotions which most people learn in early childhood. As a sociopath, these feelings come less easily to me than inherent emotions like joy and sadness. Dealing with this has certainly been a challenge, but I’ve also come to believe that some atypical traits of my personality type can be beneficial.

    The American psychologist George E. Partridge suggested in 1930 that the term “sociopathy” be used to refer to the condition of the subset of individuals exhibiting atypical, antisocial tendencies. Current estimates indicate the prevalence of my personality disorder to be about 5% of the population. That means roughly 15 million people in America could reasonably be considered sociopathic. Yet any Google search on the topic will yield a who’s-who of serial killers and monsters. Like many sociopaths, I can assure you I’m neither. Though, I always knew something about me was different.

    Read More: The Evolution of a Narcissist

    I’ve never been able to internalize remorse. I started stealing in kindergarten, and my behavior worsened in elementary school. I had urges of violence and struggled with impulse control. By junior high, I was breaking into houses after school to relax. As my personality grew, so did my obsession with the word I’d heard used to describe it. “Sociopath.” Even as a teen I recognized some version of myself in its description. Except I never felt like a monster. And I didn’t want to be destructive.

    My rebelliousness was not against parents, or teachers, or authority. It was more of a compulsion, my brain’s desperate way to jolt itself out of a suffocating apathy I had no way to convey to others. My struggle with feeling was like an emotional learning disability.

    I knew I lacked empathy and wasn’t as emotionally complex as everyone else. But that was the point: I noticed these differences. This contributed to a unique type of anxiety, a stress associated with the inner conflict some believe compels sociopaths to behave in a way that is damaging. Unlike many on the sociopathic spectrum, I was fortunate to have a support system that enabled me to learn how to cope with this anxiety. That meant I was capable of both self-awareness and evolution, key milestones of emotional development that sociopaths supposedly can’t achieve.

    It didn’t add up for me. Why did conventional wisdom, mainstream media, even college-level psychology courses, all pigeonhole such a significant portion of the population as irredeemable villains? There is nothing inherently immoral about having limited access to emotion. Millions of people spend billions every year in an attempt to free their mind and elevate their consciousness through meditation (or prayer) with the goal that is—for me, at least—my default state. Because it’s not what we feel or don’t feel. It’s what we do.

    Of course, some sociopathic traits can be used destructively. I’m not trying to minimize the negative aspects of sociopathy or any of the anti-social personality disorders. But they can also be used constructively.

    In pursuit of my PhD in clinical psychology, I spent thousands of hours counseling patients. My apathetic baseline enabled me to help people process their complex “big” feelings. I was able to act as an impartial container into which they could pour their deepest secrets, and I reflected no judgment about what they told me. I could better function as a neutral witness instead of a reactive participant because of my personality type. I recognized when negative transference occurred in my sessions, but it didn’t affect me the way it did other clinicians.

    Secure in the knowledge that my psychological well-being isn’t something they need to protect, my friends and family, too, spare no details when looking to me for advice, support, or encouragement. This transparency allows me to be impartial when helping them confront often overwhelming feelings of indecisiveness, inferiority, shame, or guilt. Because I don’t experience those learned social emotions the way most people do, I can usually offer an insightful, helpful point of view.

    I feel fortunate to have been spared the downside of these societal constructs. While research on sociopathy may still be sparse, there is no shortage of resources detailing the harmful effects of shame and guilt. From low self-esteem and a propensity toward anxiety and depression, to problems with sleep and digestion, the negative aspects of these emotions seem, to me, to far outweigh the positive.

    Society would undoubtably fall to pieces if nobody ever felt bad about doing bad things. I get that. I acknowledge that “good” behavior is beneficial to society, just as I know there are tremendous benefits to living in a harmonious community. But, contrary to popular belief, it’s quite possible to make good choices even without the burdens of guilt and shame.

    As someone whose choices are not dependent on these constructs, I like to think I can offer a helpful perspective. I’ve found that lending this point of view to people I care about lets them see their obligations through a more objective lens. This allows for healthy boundary-setting and self-advocacy, which can be just as helpful to overall well-being. Conversely, I’ve been able to adopt pro-social perspectives offered by others, enabling me to learn how they interpret things and better internalize empathy and compassion.

    Like so many psychological conditions, sociopathy exists on a severity spectrum. For more than half a century we have identified sociopaths based solely on the most extreme negative behavioral examples, which only further alienates those living on the less extreme end of the scale. But there are millions of us who would prefer to peacefully coexist, who have accepted our own apathy, and have learned how to be valuable members of our families and community. We’ve learned to do this while living in the shadows. My hope is that one day we can step into the light.

    [ad_2]

    Patric Gagne

    Source link

  • The Walking Dead is building to something — but it’s not clear what

    The Walking Dead is building to something — but it’s not clear what

    [ad_1]

    For a little while, it seemed like The Walking Dead was eager to use its popularity as a platform to create an entire universe of zombified television. First, there was the spinoff/prequel Fear the Walking Dead, followed by The Walking Dead: World Beyond and then the anthology series Tales of the Walking Dead. Each one intermingled with the original show, but for the most part, they were intent on telling their own stories. Fast-forward to 2024, and the former two series have ended, while Tales got an order for another season last year with no further news.

    This leaves us with the question: What do we want out of The Walking Dead now? Because it seems like whatever plans AMC had for a sprawling empire have been whittled back down to focusing on what the central characters of the main show have been up to. Dead City looks at Negan and Maggie, Daryl Dixon is concerned with the titular badass, and The Ones Who Live reunites Rick and Michonne, the franchise’s power couple who previously departed The Walking Dead, leaving it to end in a rudderless, underwhelming fashion. Is the future of The Walking Dead… The Walking Dead divided into three shows?

    If it’s a ploy to regain a dwindling audience, it makes sense. At its height, The Walking Dead was a ratings behemoth. Its peers in the “prestige TV” boom of the 2010s might have eaten its lunch in terms of sustained critical appraisal, but at its height, the fifth-season premiere scored 17.29 million viewers. To put that in perspective, the finale of Breaking Bad had 10.28 million.

    Going back to the “glory days” with a handful of the characters most associated with them seems to be a good idea in perhaps luring back the viewers that absconded from the show due to its exhausting length or unpopular creative decisions. The debut of The Ones Who Live nabbed 3 million viewers, a far cry from the massive numbers it once landed a decade ago, even considering TV viewership being down in general. However, it’s a marked improvement from the relatively measly audience of the final season. And AMC is happy with the show’s performance on its streaming service, AMC Plus.

    As a way to reignite its narrative potency, it’s a more questionable direction. Dead City, in particular, suffers from a “been there, done that” feeling — didn’t Maggie already sort of forgive Negan for whacking her beloved Glenn with a baseball bat back in the original? Do we really need another series where they have to play an apocalyptic odd couple and go through the same emotional arc again?

    Photo: Emmanuel Guimier/AMC

    Maggie (Lauren Cohan) holding a knife to Negan’s (Jeffrey Dean Morgan) throat

    Photo: Peter Kramer/AMC

    Michonne (Danai Gurira) and Rick (Andrew Lincoln) standing and looking at some zombies in the woods in a still from The Ones Who Live

    Image: AMC

    Daryl Dixon thrives on Norman Reedus’ bottomless well of likability and an engaging atmosphere. And with best pal Carol co-headlining the upcoming season 2 of his spinoff, we’re likely to get something at least somewhat watchable. However, with franchise overseer Scott Gimple seemingly set on one day reuniting the gang, will it eventually feel like Daryl ’n’ Carol are just spinning their (motorcycle) wheels until we can get the Avengers of Walking Dead side projects? And aren’t all of these Walking Dead spinoff leads coming together just… The Walking Dead?

    And considering that The Walking Dead ended with a look toward the future, what wider meaning is there for them to reunite aside from a nostalgic group hug? The zombies have become a bit of an afterthought as the world moves toward rebuilding itself, and they mostly serve as a fleshy obstacle course in 2024. There is always some terrific gruesomeness to be mined from The Walking Dead’s consistently stellar makeup and practical effects, but piecing the cast back together for the sole purpose of seeing them beside one another, squaring off against undead hordes, feels a little empty. The Walking Dead managed to shock us in its early years thanks to its commitment to going the distance in showing that no one is safe from the zombies, but a reunion tour of all the people that were clearly safe misunderstands the “glory years” that the creators want to return to.

    Luckily, The Ones Who Live is tapping into some much-needed emotional territory and making it seem like the event that it wants to be (even if the zombie horror aspect has long since rotted). Rick Grimes, now an established soldier of the paramilitary group CRM, must reconcile with his guilt and survival instincts when Michonne, his sword-wielding partner and the mother of his youngest child, comes back into his life to corral him and bring him home. It’s something that Grimes wrestles with, as heading off might put him and the people he loves in the line of fire from the CRM, who has some serious dirt on him and the community he left behind.

    “What We,” the fourth episode of the new show, might be one of the best in the franchise’s history that doesn’t focus on undead bloodshed. A good chunk of it is devoted to Rick and Michonne arguing and finally getting to reflect upon the world-weariness that an experience like this would instill. In particular, Rick finds it hard to return to his family because of what happened with his late son Carl, and The Ones Who Live gives him a chance to properly grieve for the ones who don’t. He doesn’t want anyone to have to go through that kind of pain again, nor does he believe that he’d be able to. They’d all be much safer if he bore the weight of their tragedy alone. It is misguided patriarchal martyrdom, but it makes sense for Rick.

    Michonne (Danai Gurira) standing above Rick (Andrew Lincoln) holding his chin in her hand

    Photo: Gene Page/AMC

    Of course, Michonne is able to convince him of the fact that he’s Rick Grimes, that he shouldn’t give up, that there’s more out there for the pair, etc. But Rick Grimes being reduced to an anxious, melancholy shell of a man and giving him an ultimate redemption makes The Ones Who Live feel like a fitting narrative follow-up to The Walking Dead and the closest thing the show has gotten to a proper epilogue. It could have very easily been a hollow attempt to draw in the unconvinced crowd with “Hey, it’s that sheriff guy that you liked!” Instead, it competently grapples with Rick as a character that’s been through so much trauma rather than Rick as a returning action hero.

    On a wider level, The Ones Who Live can also serve as a fitting cap to the escalating threats of the show. The “We are the Walking Dead” mindset, where the physical menace of the zombie (amid a pop culture saturation of zombie media at the time) was no match for the terrifying specter of your fellow man, produced bad guys like the unstable Governor, the brutal Negan, and a host of other antagonists that ranged from wannabe cults to cannibals. The CRM, an army equipped with massive firepower that is willing to adjust the world to its specific definition of law by force, is the logical “final boss” of The Walking Dead. By fighting back against them, Rick and Michonne aren’t just taking on a rival group but helping decide the order of the future.

    Where this leaves the end goal of The Walking Dead remains to be seen. It could all be pointing toward some eventual grand reunion, given that the original show concluded with Michonne and Daryl both running off to find Rick. But the first seasons of both Dead City and Daryl Dixon end with the shows spiraling off further into their own specific plots, so it will be a while before the gang gets back together again.

    Until then, The Walking Dead franchise is in, essentially, its DLC era. What you want out of The Walking Dead depends on how attached you are to certain characters, and luckily, there’s now DLC side quests available for a few of them. It remains to be seen if these threads will ever interconnect again (now that every actor is on their own show, AMC would also have to deal with a truckload of contractual issues if it wanted to then push them back into the same series), so until then, The Walking Dead survives entirely on audience interest in the solo exploits of characters it worked to build together. With 11 seasons of the main show, AMC did plenty of asking for you to wait for plots to be resolved and character arcs to be fulfilled. And now, with the hint of bigger things to come and a host of orbiting spinoffs, it’s asking you to wait just a little while longer. For what? We’ll just have to see.

    The Walking Dead: The Ones Who Live is now streaming on AMC Plus.

    [ad_2]

    Daniel Dockery

    Source link

  • As a Captive, I Learned that Violence Is What Terrorists Use for Music

    As a Captive, I Learned that Violence Is What Terrorists Use for Music

    [ad_1]

    I was held prisoner in Syria for two years by a group that included both Al Qaeda and ISIS, though one of the things I learned in my captivity was that there’s no real difference between them. Another thing I learned was the purpose of the violence the jihad inflicts on those who live within it. You’re supposed to withdraw yourself from earthly time right now. You’re supposed to live every moment of your life as if the ancient dream—the caliphate, the invulnerability, God’s ongoing, bloody revenge against the infidels—is coming true this instant. Will you sit idly by? If you have the courage and the physical capacity, you are meant to act.

    In my view, the outside world must learn what this dream looks like and sounds like. Though the dreamers are all around us, their dreams are as uninterpretable as hieroglyphs. We glimpse them only after it’s too late —on the day after October 7th, for instance, and now, as we wonder over the lifepaths of the Moscow attackers.

    In the early days of the Syrian civil war, when ISIS and al Qaeda still belonged to one big quarrelsome family, there were times when several squads of investigators, to borrow the Syrian euphemism for torturers, would interrogate multiple prisoners in a single room. The din on these occasions was much too overwhelming for anything like an inquiry to occur. I know about everyday practices in those interrogation rooms because in October of 2012, the Syrian al Qaeda faction accused me of spying for the CIA, then locked me into a cell in the basement of what had once been, before the war, the Aleppo eye hospital. In fact, my purpose in coming to Syria had been to write essays about the war’s music, photographers, and artists—and thus to make myself into this conflict’s go-to cultural correspondent. But no matter how I pleaded—and I was desperate for my life—I couldn’t make a single member of this sprawling terrorist family believe a word I said.

    One night, after a squad of fighters had inflicted one of their investigations on me, I found myself lying face down at the feet of the hospital’s chief investigator. It was some time in early winter of 2013. I wore a bloody pair of hospital pants. The cement floor was the temperature of a sidewalk, back home, in winter.  My hands were cuffed behind my back. Perhaps I had lost consciousness at some point during the proceedings? I’m not sure. Anyway, I remember that it occurred to me, quite suddenly, that a second victim was being interrogated only feet from me. Evidently, this person was hanging by his wrists from a pipe beneath the ceiling. It occurred to me that this person’s feet were bicycling through the air, and that instead of engaging his interrogators, who were shouting at him at the tops of their lungs, he screamed upward, into the ceiling. There is no God but Go, he called out, over and over. I remember that the power in this person’s voice struck me as unnatural.  He seemed to scream as if all that remained to him on earth was his voice, as if it were a rope by which he meant to lash himself to the world of the living. 

    In the midst of this cacophony, the chief investigator knelt down, then pushed his face into mine. He grinned. “Do you hear what that man is saying?” he shouted to me in his idiotic way. “Do you know these words?”  Of course, I did know them. They were inscribed on every black flag. They were in the air, over and over, at every prayer. How could I not?

    “Good,” said the interrogator, screaming at me though his face was practically touching mine. “This noise you are hearing. This is our music.”

    Read More: Islamist Terrorism Is Not Done With Us, Warns Former al Qaeda Hostage Theo Padnos

    Over the following days lying alone on the floor of my cell, I contemplated this remark. Having known the interrogator for about three months by this point, I felt I had a handle on his character. He was an impish, boastful brute. Also, a bit of a showman. He loved to swish about the interrogation room in his black velvet cape, to speechify, and to promise me that one day, when the spirit moved him, as it surely would, he himself would kill me. For him, the interrogations were quite obviously performances. He often invited little crowds of fellow fighters to observe from the shadows. Now he ordered his squad of underlings to inflict pain, now he ordered them to hold off. Often, he shrieked at them. All of these underlings were Aleppo teenagers. Every once in a while, he commanded, by means of a glance, a teenager to stir his beloved maté tea.

    In those days, before I had any inkling of how a terrorist organization functions, I assumed that because this man only presided over a ring of teenagers, and because I remained alive despite his threats, he was a mere flunky in the al Qaeda hierarchy.  

    Over time, however, I came to understand what real power in the jihad is. It is derived from the obvious sources, to be sure—cold bloodedness, access to ready cash, fluent command of the sacred literature. But it also comes from the ability to entrance audiences. The natural born leaders conjure fantasies to life in an instant, then hold people and places under their spell indefinitely. This particular commander, who called himself Kawa, after a mythical Kurdish warrior, was poor. He rode around on a humble Chinese motorcycle, as no actual authority in the jihad would do. Yet he certainly had a knack for summoning an Islamic fantasy to life—for him it was a caliphate—with a few softly uttered phrases. Over the minds of the many teenagers who hung around in the eye hospital basement, he certainly exercised sovereign control.

    Down there, over time, I learned that music really does help the fantasy come to life. 

    Allegedly, Muslims of the kind who make jihads despise music. It is thought to derange the senses and to distance the listener from God. But the Koran is music. The call to prayer is music, and praying itself is a musical experience since it involves collective recitation of an explicitly musical text, and then, at the end, when the imam conveys the community’s wishes to God, a few minutes of call and response and, well, singing. Of course, in a jihad, there are also hymns. They play in the background in every conveyance, office, and corridor. In the evenings in the eye hospital basement, the fighters often gathered in the prayer room to sing the al Qaeda hymns in full throated unison. Sample lyric: “bin Laden is our leader/ we destroyed the trade towers, with civil airplanes we did it/ reduced them to dust.”

    I have no doubt if he is still alive, as I hope he is not, Kawa would say of the film the ISIS fighters made of their Crocus City Hall attack just what he said of his own violence: this is our music. How happy the fighters are, he would say, what unity of purpose they exhibit, and how boldly they make the ancient dream live. There is no difference between the dream the Moscow attackers inflicted on the Crocus City Hall and the one with which Kawa bludgeoned his hospital prisoners, almost all of whom were Syrian Muslims, by the way. The dream is of invulnerability before the enemies of Islam, of simple families living in harmony with the Koran, while every day, in some far flung corner of the globe, the soldiers of the caliphate bring another one of the infidel’s capitals to its knees.

    In the Syrian jihad, the authorities made this dream live through singing, prayer, and hour after hour of recitation, as one would expect. Mostly, however, they made it live through violence. When the walls of an interrogation room rang with screams, or when a roomful of young men were watching some atrocity occur on a video screen, and, now and then, when twenty-five young men ran out into the hospital parking lot to fire their Kalashnikovs at the stars, the emotion of the occasion went straight to everyone’s brain stems. I knew roughly what was happening then because it was happening to me, too. 

    When violence of this order is on every screen, lies behind every door, and hides, just beneath the surface, in the eyes of everyone you meet, you stop being yourself. That person dies. Under such circumstances, in my opinion, you’re grateful for the life you have, but because you expect to leave it soon, you do everything you can to relinquish your attachments to the here and now. You say goodbye. Over time, your thoughts are bound to turn to the future. I don’t see how they could not. Perhaps, you hope, life, of some kind, will somehow continue. Perhaps you will be surrounded by love at last? So the hymns tell you. The jihad is a loveless place, I’m sorry to say. Everyone dreams of being in love. So maybe it will come? Who can say that it will not? Certainly, new life—and with it, new power—will come to some. So the hymns say.

    For whatever it’s worth, in Syria, I found that many of the younger terrorists I came to know were adept at slipping into the dream when they were inside the hospital, and adept at slipping out of it, in the evenings, when they went home to mom and dad. Outside, in the streets, as these young men often told me themselves, they looked and spoke like everyone else. Inside, they were  like zombies. They talked, automatically, of their longing for glorious death. Even when they were by themselves, they sang the hymns they were meant to sing. When the order came to torture, they threw themselves at their “work,” to borrow their word. Afterwards, I’m pretty sure, they had only the vaguest notion of why they did what they had done. 

    The jihad needn’t be as impenetrable as all that. In fact, summonses to the dreams are audible in a thousand war hymns to be heard right now on YouTube. They’re visible in the many videos people who sympathize with the jihad produce. Often these videos seem innocuous enough because they consist mostly of a cappella singing and shots of young men thumbing through the Koran in a forest. To believers across the world, however, and to those who would like to believe, they give direct documentary evidence: the dream is real, the videos say. To make it live in London or Paris or wherever you happen to be, all you really have to do is to believe.

    The organizers of the Paris Olympics are surely aware that as ISIS was planning out its 2015 attack on a Paris concert venue, it was also preparing to blow up the spectators at a soccer game in the Stade de France, just north of Paris. Is the outside world aware that the leaders of the international jihad feel about sporting events in the west roughly as they feel about rock concerts? These are soporifics, they believe, with which we drug ourselves by the millions. Meanwhile, every hour, somewhere on earth, our airplanes slaughter Muslim families. Are the authorities in Paris aware that their counterparts in the jihad mean to wake us from our stupor?

    The news itself is a problem. When the violence in Gaza is spliced up, set to music, then sent out over the social networks, this material is powerful enough to do to a certain class of vulnerable young men—roughly what screaming in an underground room in Aleppo does. It entrances. It horrifies. It reveals the enemy for who he really is. It has a way of bringing all those who feel they’ll never have much hope into a dangerous kind of alignment. Are the Paris authorities aware of this? I hope so. The Olympic opening ceremony is set to occur along the banks of the Seine on what will surely be a balmy but tense Friday night this coming July.

    [ad_2]

    Theo Padnos

    Source link

  • Why Walking Isn’t Enough When It Comes to Exercise

    Why Walking Isn’t Enough When It Comes to Exercise

    [ad_1]

    Walking is often thought of as a mere mode of transportation: a way to get from point A to point B. Few of us consider the fact that it’s one of the most fundamental, accessible physical activities a person can do.

    What’s so great about walking? 

    Walking might not be as impressive as holding a plank or doing mountain climbers, but “it’s considered a bodyweight exercise, because your large muscle groups are working to move the weight of your body,” says Dr. Marie Kanagie-McAleese, a pediatric hospitalist at University of Maryland Upper Chesapeake Health and the leader of the Bel Air, Md. chapter of Walk With a Doc.

    As you walk, “your quadriceps, hamstrings, calves—even your abdominals, biceps, and shoulders—are all using oxygen to contract,” says Ali Ball, an exercise physiologist and outpatient cardiac rehab/wellness coordinator at OSF HealthCare in Urbana, Ill. That also makes walking a form of aerobic exercise, she adds, which means it keeps your heart rate elevated for a sustained amount of time. One study published in the Journal of the American College of Cardiology found that 15 minutes of walking was as beneficial as five minutes of running.

    From a physiological perspective, that’s a one-two punch of health benefits.

    “First, walking improves the health of our cardiovascular system,” says McAleese. “With improved oxygen delivery to our organs, we see a decrease in the risk of heart disease, stroke, obesity, metabolic syndrome, diabetes, high blood pressure, and high cholesterol.” 

    Read More: Your Brain Doesn’t Want You to Exercise

    Research bears this out. In a 2021 study published in JAMA Network Open, people who logged at least 7,000 steps per day had a 50 to 70%lower risk of early death, compared to those who walked less than 7,000 steps per day. Meanwhile, a 2023 meta-analysis published in the British Journal of Sports Medicine concluded that doing moderate-intensity physical activity—like brisk walking—for just 11 minutes a day is enough to lower the risk of diseases such as heart disease, stroke, and a number of cancers.

    Plus, it’s the easiest way to counter the risk of a sedentary lifestyle, says McAleese. “Walking more throughout the entire day, even if you’re not doing it at a moderate-intensity level, is critically important,” since sitting too much increases the risk of getting—and dying from—many chronic diseases.

    But is just walking enough exercise? 

    It can’t do everything. Federal physical-activity guidelines recommend at least 150 minutes of aerobic physical activity a week, plus two or more sessions of muscle-strengthening activities involving all major muscle groups per week. Both types of physical activity have to be of at least moderate intensity. 

    With a few tweaks, your walk can fulfill the first aerobic category. “Most people just don’t do it hard enough because they don’t think about it as exercise,” says Ball. If you’re used to a casual stroll, it’s easy to increase your intensity and get into that moderate range: You can increase the pace, walk on an incline, walk on a different terrain, or add weight via a vest or pack.

    Read More: Forget 10,000 Steps. Here’s How Much Science Says You Actually Need to Walk

    Not so much for the second category. “Walking does provide a low level of bodyweight exercise, but there are a lot of other muscle groups that we’re not really exercising when walking,” says McAleese. Strength training comes with a lot of additional health benefits, like lowering your risk of injury and improving mobility and flexibility.

    How to make your walk count as a workout 

    Wearable devices have made mainstream the idea that everyone needs to hit 10,000 steps per day, but “that’s an arbitrary number not based in science,” says McAleese. A more important metric than steps, she says, is time. When it comes to the recommended 150 weekly minutes of moderate-intensity physical activity, “you can break that up however works for you,” she explains. “If you can only fit in 10 minutes here and 10 minutes there, it all counts.”

    For walking to really qualify as “moderate-intensity” exercise, you need to be moving a little more intentionally than you would during a casual stroll from one meeting to the next. The guidelines consider walking briskly—where you could walk a mile in 15 to 24 minutes—to be moderate-intensity physical activity. That’s a purposeful, I-have-somewhere-to-be pace.

    The best way to tell if you’re in that moderate-intensity range is the talk test. “If you’re able to speak in complete sentences and can carry on a conversation—but if you were to try to sing, you would become out of breath—that counts as moderate-intensity aerobic exercise,” says McAleese.

    Read More: I Used ChatGPT as My Personal Trainer. It Didn’t Go Well

    You can also check your heart rate. An approximate (but easy-to-remember) way to find your maximum heart rate is to subtract your age from the number 220, says Ball. During moderate-intensity exercise, your heart rate should be at about 50 to 70% of that maximum heart rate, according to the American Heart Association.

    And to make sure you’re getting the most out of this type of physical activity, you also need to think about your form. (Yes, there’s proper form for walking.) “Focus on staying upright and keeping your abdominals engaged,” says Ball. Squeeze your butt, and let your arms swing naturally rather than exaggeratedly pumping them. Leaning forward, especially if you increase your intensity, can cause back pain.

    For many people, embracing walking as exercise might just require a slight shift in perspective. “We focus a lot on scheduling exercise as a very specific activity that happens at a certain place at a certain time during our day,” says McAleese. “But we really should be expanding our definition of exercise to include all levels and amounts of physical activity that we perform throughout the entire day.” 

    [ad_2]

    Ashley Mateo

    Source link

  • How Hypertrophic Cardiomyopathy Progresses in Adults

    How Hypertrophic Cardiomyopathy Progresses in Adults

    [ad_1]

    Hypertrophic cardiomyopathy is the most common form of genetic heart disease worldwide. Researchers have estimated that up to 1 in 200 people have the condition, which is characterized by an abnormal thickening of the walls of the heart. This thickening can make it difficult for the heart to pump blood.

    Hypertrophic cardiomyopathy can be a deadly disease, and there was a time when it was largely untreatable. But the last 20 years have witnessed a sea change in the condition’s management—a change that has led to an estimated 10-fold decrease in deaths.

    “Hypertrophic cardiomyopathy has this reputation that it’s difficult to live with, and that the outlook is grim,” says Dr. Barry Maron, a cardiologist and hypertrophic cardiomyopathy specialist at Beth Israel Lahey Health in Burlington, Mass. “That used to be true, but there have been huge advances in clinical care and clinical research, and hypertrophic cardiomyopathy is now characterized very differently.”

    “The reality,” he adds, “is that very few people die of the disease, and fully half of patients belong in a group we consider benign and stable.”

    Here, Maron and other experts describe what it’s like to live with hypertrophic cardiomyopathy. They explain the different stages or forms of the disease, how and why it progresses, and how treatment may evolve over time. They also talk about the outlook for people who are diagnosed with the condition.

    An unpredictable disease

    Some medical conditions—certain forms of cancer, for example—are characterized by different stages. Those stages help determine treatment, and they also reflect a patient’s prognosis.

    Experts say hypertrophic cardiomyopathy is different; it doesn’t play by such tidy rules. “It’s an incredibly heterogeneous disease, and the more we learn about it, the more complex it gets,” says Dr. Christopher Kramer, distinguished professor and chief of cardiovascular medicine at the University of Virginia School of Medicine. The condition can affect the physical properties of the heart in different ways, he says, and trying to anticipate how it will behave over time is difficult. “To say to a patient, ‘You’re going to do this, and this is your likely outcome’—that’s fraught,” he adds.

    Maron agrees that “there is no average” when it comes to hypertrophic cardiomyopathy. However, he says that the disease can be broken down into four general pathways. “The first pathway is the benign and stable course, and thankfully this is the most common of the four,” he says. These are patients whose disease tends to be caught incidentally sometime in midlife; for example, they undergo some type of medical imaging and their doctor notices an irregularity in their heart function—a heart murmur, for example. This leads to follow-up testing that reveals hypertrophic cardiomyopathy. In these cases, a person’s myopathy may not be obstructive, meaning it’s not limiting blood flow, and it may require little more than follow-up monitoring to ensure it’s not getting worse.

    “The second pathway involves heart failure due to some kind of obstruction,” Maron says. In these obstructive cases, a person’s cardiomyopathy restricts the flow of blood out of the heart. These patients often have symptoms such as chest pain or shortness of breath. Symptoms can range from severe to very mild—so mild that a person may live with them for years without thinking much of them. “Patients will say they have no symptoms, but once you start asking questions, you find they’ve never been able to keep up with friends during exercise, or they’re often short of breath,” says Dr. Milind Desai, a cardiologist and hypertrophic cardiomyopathy specialist at the Cleveland Clinic. “A lot of people don’t realize how they’ve adapted their lifestyles to the condition over the years.”

    Fortunately, this obstruction-related heart failure is often reversible with the help of either medication or some type of procedure, such as surgery to remove part of the thickened heart muscle. In rare and severe cases, a person’s myopathy may not respond to these treatments; or they may respond well initially, but then the condition eventually grows worse. “A small subset of patients develop advanced hypertrophic cardiomyopathy where the muscle of the heart is thick and stiff and non-complaint, and the only option might be a heart transplant,” Desai says. “But that, mercifully, is only the case in 3% to 5% of patients.”

    The third pathway involves people whose hypertrophic cardiomyopathy leads to atrial fibrillation—a condition where the rhythms of the upper and lower chambers of the heart are misaligned. Atrial fibrillation can lead to a stroke if left untreated, and many of these patients will require anticoagulant drugs (such as blood thinners), and perhaps medication or surgery.

    “The fourth pathway is someone who is at risk for sudden cardiac death,” Maron says. While identifying these cases still involves some educated guesswork, he says the latest diagnostic tools are very good at identifying at-risk patients. Treatment typically involves implanting a small defibrillator, or ICD, to correct irregular heart rhythms. “Implantable defibrillators have saved countless lives,” he adds.

    While these four pathways can help sort people with hypertrophic cardiomyopathy into four rough groups, experts reiterate that the course of the disease is hard to anticipate. However, with proper care, they also say that most people diagnosed with hypertrophic cardiomyopathy will not die of the disease. “At this point, most well-managed patients can expect to live a normal lifespan,” Desai says.

    Read More: What to Know About Hypertrophic Cardiomyopathy in Kids

    How and why the condition progresses

    Here again, experts stress the unpredictability of the disease. “Progression of hypertrophic cardiomyopathy is highly variable,” Kramer says. “It may progress and it may not, and we’re doing studies to understand who is most likely to progress and why.”

    People with genetic forms of the condition—meaning those who have inherited one or more of the genetic mutations associated with hypertrophic cardiomyopathy—may have more severe and aggressive disease that often manifests earlier in life. But this isn’t always the case. “There is a portion of patients who have a genetic mutation but never develop the overt disease, and we’d never know they had it if we didn’t look for it,” says Desai. However, among patients with obstructive forms of hypertrophic cardiomyopathy—either with or without symptoms—experts say the condition is likely to get worse if left untreated. The muscle thickening will advance, symptoms will develop or become more severe, and the risk of a person developing atrial fibrillation or other life-threatening complications will increase, he says.

    While predicting the course of the disease can be difficult, experts say that people who are symptomatic and diagnosed with the condition at a young age tend to face more challenges than people who are older at the time of diagnosis. “If you’re diagnosed at age 50 or 60, your prognosis is usually good—probably similar to age-matched controls,” Kramer says. “But if you have a family history of the disease and you’re diagnosed at 25, that’s less optimal.”

    Other health issues can also advance the disease. Experts say obesity, high blood pressure, and diabetes can make underlying hypertrophic cardiomyopathy worse. “It’s important to stay on the ball with your health,” Desai says.

    How treatment may evolve

    At the time of diagnosis, most people with hypertrophic cardiomyopathy will have no symptoms and no evidence of an obstruction. Apart from follow-up monitoring, most won’t require treatment.

    If the disease progresses—meaning, an obstruction or other threat to the heart arises—treatment may involve an implantable defibrillator, or medications intended to manage symptoms or reduce the risks of complications. For example, the latest anticoagulant drugs have “come close to obliterating” the risk of stroke in people who develop atrial fibrillation as a result of hypertrophic cardiomyopathy, Maron says. Meanwhile, a newer drug called mavacamten can help reduce symptoms, and possibly even reverse some heart-muscle thickening, in people with obstructive forms of the disease. Experts say this drug has helped improve quality of life for many patients, but it’s not a cure-all. “Mavacamten has made a beneficial contribution, but so far there’s nothing about this class of drug that will have a direct effect on mortality,” Maron says.

    If a person responds well to the drug, they must stay on it indefinitely and undergo quarterly monitoring to ensure the heart’s functioning is stable. If their heart’s condition worsens or symptoms persist, experts say the next step in treatment is likely to be some kind of procedure. For patients who are younger or those experiencing severe obstruction, doctors may recommend a septal myectomy—an open-heart surgery to remove the thickened muscle. “This surgery is a one-time thing,” Maron says. Research has found that greater than 90% of people who undergo this surgery have significant improvement of symptoms and enjoy a long-term survival benefit. However, the procedure can be risky if not performed at a top medical institution. In patients for whom open-heart is too dangerous, such as among older seniors, experts may recommend a procedure called an alcohol septal ablation. This involves injecting a small amount of alcohol into the heart, which can shrink the thickened muscle and improve blood flow.

    For “a very small number of patients”—and for reasons that are not well understood—Maron says the condition will continue to worsen despite treatment. In these cases, he says a heart transplant may ultimately be necessary.

    A positive outlook

    While some new medications have helped advance the treatment of hypertrophic cardiomyopathy, experts say improvements in their knowledge of the disease and its clinical management deserve most of the credit for reducing mortality. “When I started 40 years ago, mortality was 6% per year, and treatment was inadequate at best,” Maron says. Nowadays, the annual risk of death for a patient is below 1% percent, his research has estimated.

    Experts are also looking ahead to further advancements—and maybe even early interventions that could neutralize the disease before it takes hold. Desai mentions gene editing as, perhaps, the “next frontier” in hypertrophic cardiomyopathy care. “This would involve removing the abnormal piece of genetic material that causes hypertrophic cardiomyopathy,” he says. Gene therapies that aim to replenish certain protein deficiencies are also an area of active research. “If the concept works, in the future patients could walk into the clinic, get an infusion, take immunosuppressants for a few weeks, and potentially be cured or significantly improved,” he says. In the near term, experts are also exploring how the newest medications, if taken early, might be able to reduce or arrest the condition’s progression. “A lot of exciting things are happening in this space,” Desai says.

    Hypertrophic cardiomyopathy remains a shifty and unpredictable foe. But experts say they’ve learned to roll with its punches. “Things have moved in the direction we hoped,” Maron says. “This is now a very treatable disease.”

    [ad_2]

    Markham Heid

    Source link

  • ‘The Caged Magistrate’ quest walkthrough in Dragon’s Dogma 2

    ‘The Caged Magistrate’ quest walkthrough in Dragon’s Dogma 2

    [ad_1]

    “The Caged Magistrate” is one of several quests you receive from Captain Brant in the early stages of Dragon’s Dogma 2. Brant tells you about one Magistrate Waldahr, someone who has stood his ground against Disa and refused to change the Code of Vermund to her benefit when asked, leading to him now sitting in a cell in Vernworth jail — ahem, gaol.

    So Captain Brant has one very simple request of you: set Magistrate Waldahr free. He’ll give you a gaol key so you can let yourself into his cell, but you’ll find that Waldahr needs some convincing first.

    In this Dragon’s Dogma 2 guide, we’ll walk through the entire “Caged Magistrate” quest, including where to find Magistrate Waldahr and how to set him free.

    Where to find the Magistrate in Dragon’s Dogma 2

    Image: Capcom via Polygon

    Enter the palace grounds and head to the objective marked on your map. This is the entrance to Vernworth Castle Gaol Tower. Otto will greet you and allow you through, so make your way downstairs and aside from a couple of rooms to explore and loot, the main area here is the long corridor with pillars in the middle and cells on each side, for a grand total of eight.

    Magistrate Waldahr is in the first cell on the right-hand side, as soon as you enter. Wait until the two guards are facing away from you then use the Gaol Key given to you by Captain Brant to unlock the cell.

    Head in and talk to Waldahr, then when the option arises, urge him to escape. He explains that he’s perfectly happy in the cell because he can spend his days “perusing the Code and deciphering old texts.” However, if you can find “a place with a mountain of tomes,” Waldahr will reconsider escaping. Leave the gaol and return to Captain Brant.

    Where to find ‘a place with a mountain of tomes’ in ‘The Caged Magistrate’

    A Dragon’s Dogma 2 hero talks to the magistrate in jail in “The Caged Magistrate” quest.

    Image: Capcom via Polygon

    Brant suggests talking to a chap named Kendrick, found by The Gracious Hand in the slums. He’s a balding chap wearing a blue robe, wandering around the tents and dilapidated houses on the outskirts of Vernworth. He’ll ask you for a charitable donation of gold, so pay up and he’ll explain a local boy named Malcolm has gone missing.

    This starts an entirely separate quest named “The Heel of History,” where you must find Malcolm by speaking to the children of the slums. Look for a girl called Aimee who will be somewhere nearby and she’ll tell you Malcolm went into the vaults underneath the slums. Return to Kendrick and the pair of you will enter the vaults to find the runaway kid.

    A Dragon’s Dogma 2 hero walks into a library underground in “The Caged Magistrate.”

    Image: Capcom via Polygon

    Explore the vaults in their entirety and you’ll find Malcolm, followed by a huge underground library. Kendrick makes Malcolm promise to keep his mouth shut about the discovery, but you can return to Waldahr in the gaol and tell him about this wonderful place where he can study in peace. Escort Waldahr out of his cell and to the slums, then return to Captain Brant for your reward: 7,000 gold and a ferrystone.

    Make sure you also return to Waldahr in the vaults a few days later, as he’ll have another quest for you: “A Magisterial Amenity,” which involves finding his confiscated spectacles.

    For more Dragon’s Dogma 2 walkthroughs, here’s who to give the Jadeite Orb to, if you should buy the Ornate Box, how to buy a house in Vernworth, where to find Rodge, and the best order for Captain Brant’s quests.

    [ad_2]

    Ford James

    Source link

  • How to Manage Anxiety and Depression Associated With Kidney Cancer

    How to Manage Anxiety and Depression Associated With Kidney Cancer

    [ad_1]

    When Katie Coleman was diagnosed at age 29 with a softball-sized tumor on her right kidney and a host of smaller growths in her liver, she was stunned. That astonishment quickly gave way to feelings of hopelessness. “I felt like my entire world was being pulled out from under me,” Coleman, now 32, says. “I went into a very dark spiral.”

    Though her surgeon removed all the tumors, it wasn’t clear what her long- or even short- term prognosis was. What she found on the internet just freaked her out more. “One night I spiraled so deep I didn’t know whether life was worth living anymore.”

    Coleman knew she needed help dealing with her depression and anxiety, but she didn’t form a strong connection with any of the therapists she met with. “I never found one who really understood what it was like to be 29 and looking fate in the face,” the software engineer from Austin says.

    At her darkest point, Coleman started browsing Instagram posts, “looking for anyone who had what I had,” she remembers. “I needed to see someone else who was still alive.”

    She eventually found a match, a man in the U.K. She wrote to him: “I’m sorry to be a random stranger on the internet. I was hoping you would share your story.”

    The next morning, she discovered a stream of voice memos from someone with a British accent. “First, you need to get the idea of dying out of your mind,” the voice said.

    “He told me how full of a life he felt he was living,” Coleman says. “It was the first time I connected with another patient and the amount of hope it brought me is indescribable.”

    Coleman started putting together her own internet-based support group. “Folks pulled me out of some very dark places,” she says. “I always had someone to go to to talk things over.”

    The value of short-term goals

    The National Cancer Institute estimates that there were nearly 82,000 new kidney cancer diagnoses in 2023. Anywhere from 10% to 50% develop symptoms of anxiety and/or depression after diagnosis, experts say.

    Because of that, many cancer centers have added psychiatrists, psychologists, and counselors to their treatment teams. “Anxiety and depression are common complications in oncology,” says Dr. Jon Levenson, an associate professor of psychiatry at the Columbia University Vagelos College of Physicians and Surgeons. “One major stressor is the uncertainty about the course their cancer will take. Patients may have surgery to remove the cancer and be physically asymptomatic for many months, or even longer, but still know there’s a high likelihood of recurrence.”

    More From TIME

    The stress from all that uncertainty can ramp up to full blown depression and/or anxiety, Levenson says. 

    For Coleman, the uncertainty was initially paralyzing. “At 29, I was very ambitious,” she says. “I was used to setting long-term goals. Now I didn’t know what next week would look like.”

    But Coleman found a way to cope. She started to concentrate on short-term goals—small ones that she could accomplish in the three months between scans. Early on she set a goal of designing a health records app that could help others with cancer keep track of their care. She accomplished that in one of the three-month periods between scans. As time went on and her scans remained clear, Coleman decided to take a chance and started writing a memoir.

    Read More: 7 Myths About Kidney Cancer, Debunked

    Talking helps—but don’t share everything with everyone

    Support groups of any kind can make a person with cancer feel less alone, says Shannon La Cava, director of the Simms-Mann/UCLA Health Center for Integrative Oncology. Sometimes patients say they don’t want to attend a support group, but “I say try two or three sessions,” she adds. “A lot of times after dipping a toe in people say ‘Oh wow, finding people like me gave me a lot of support.’” 

    That doesn’t mean patients need to share everything with everyone.  

    Patients often struggle with questions of “who to tell, when to tell, and what to tell,” says Dr. Asher Aladjem, medical director of psychological services at the NYU Langone Perlmutter Cancer Center. “If it makes a patient more anxious to have everybody involved in their experience, I advise them to be very selective about who to tell. I tell patients, ‘Pick a small group of people to tell and choose how much detail you want to give.’”

    Aladjem says he tries to help patients draw boundaries and stick with them. In some cases, that may mean telling people you’d rather talk about something enjoyable, like movies. 

    It’s important, Aladjem says, for patients “to maintain control over what their experience is. There’s already a sense of loss of control with the illness. I think empowerment is very important.”

    On the other end of the spectrum, some patients don’t want to talk to anyone. 

    When Travis Ferguson was diagnosed with kidney cancer at age 40, he kept everything to himself. While he felt empowered enough to leave the medical center in Indiana where he was diagnosed to seek care at a center that specialized in cancer, Fox Chase Cancer Center in Philadelphia, he didn’t know what to do with his fears, anxiety, and depression.

    “When I first found out, I went into a real depressive state because I have two grandparents who died from cancer,” he remembers. “It felt like a death sentence. I thought talking about it would make it even more real.”

    Although Ferguson had a therapist he’d been seeing to figure out how to deal with some other big life changes, including a recent breakup with his girlfriend, he initially didn’t bring up cancer during their sessions. “I finally brought it up with her because I realized I needed help,” he says. “I had been sliding deeper and deeper into the abyss.”

    The therapist increased the dosages of the anxiety and depression medications he was already taking. Then she pushed him to start talking to his family. “They helped tremendously,” says Ferguson, now 41.

    Read More: The Latest Breakthroughs That Could Improve Kidney Cancer Treatment

    Who am I now?

    As Jay Wells knows, the diagnosis can steal a patient’s sense of self. He’d been a park ranger for 30 years and saw himself as a rescuer of others until he was diagnosed with advanced kidney cancer at 68.  

    “I went from feeling strong and invincible to weak and fragile overnight,” says Wells, now 72. “I had been in a profession that was counted on to go in and rescue people in a bind, after a climbing accident or falling into a river. Now the roles were reversed. Everything was out of my control. It was a hard adjustment.” 

    Wells started worrying about dying and how his death would impact his wife. “She couldn’t take care of the house and 11 acres alone,” he says. “And who was going to take care of my dog?” 

    Depression and anxiety set in. At first, Wells resisted going to see a therapist. Then, “I started showing signs of depression,” he remembers. “I’d start thinking about stuff, and sometimes I’d break out crying in front of my wife, and even good friends. They could see I was in emotional pain.”

    Eventually, Wells took the advice of those who loved him. He found a therapist who specialized in treating patients with cancer. “She suggested a bunch of things that helped, like meditation and breathing exercises to calm my anxiety. She had me do exercises where I would write about my fears of dying, what I was leaving undone, who I would leave behind, and how I would want to be remembered.”

    The writing and conversations with the therapist made a big difference. “It was a way of getting at the anxiety and fears that were lurking just below the surface,” says Wells, who now lives in Ashland, Oregon. “Though it seemed like every time emotions were evoked that choked me up, I felt so much better afterwards.”   

    A kidney cancer diagnosis often comes as a shock because there haven’t been any obvious symptoms, says Dr. George Schade, a surgeon, associate professor at the University of Washington, and physician with the Fred Hutchinson Cancer Center in Seattle. So it shouldn’t be a surprise that many are shaken by it, he says, adding that some 70% to 80% of patients experience symptoms of anxiety and/or depression.

    Those who need help with their emotional distress are generally referred to in-house team members, Schade says. But many patients don’t live close enough for weekly or biweekly appointments. “Patients might be five minutes away or from Alaska or Montana,” Schade says. “So telemedicine has been a huge game changer for us.” 

    Not every cancer center has mental health professionals on their teams, which means patients need to seek help in their local community, says Dr. Rafael Tamargo, an assistant professor in the department of psychiatry and behavioral sciences at Vanderbilt University Medical Center. 

    Unfortunately, there is a nationwide shortage of people in these professions now. 

    While patients look for someone, Tamargo recommends a few self-help methods—such as breathing techniques—to calm anxiety and soothe depression. For example, he suggests an exercise where one breathes slowly through the nose for four seconds, then holds their breath for four, then exhales through the mouth for four, and then waits another four before repeating.

    Another way to calm down, he says, is to lie on your back with your eyes closed on a flat surface with your legs and arms extended.  Then starting with your toes and working up to your head, focus on relaxing the muscles in each area until they go limp.

    Another technique: Imagining a calm scene, such as a babbling brook, and hearing the sound of it and the scent of the surrounding grass, can also bring relaxation.

    These kinds of techniques occasionally come in handy for Wells, the senior in Oregon. Even though he’s O.K. much of the time, there’s still some lingering anxiety lurking below the surface. “Before I go to see one of my doctors, or the dentist, or even an eye doctor, I can feel the anxiety building in me,” he says. “Sometimes I use the techniques I learned. I do a breathing exercise and think, ‘Wait a minute, Jay, this is nothing. Just calm down.’”

    [ad_2]

    Linda Carroll

    Source link

  • I Used ChatGPT as My Personal Trainer. It Didn’t Go Well

    I Used ChatGPT as My Personal Trainer. It Didn’t Go Well

    [ad_1]

    I love running. I will happily jog for hours (and often do, during marathons). But ask me to perform a push-up, and I might cry. I truly detest strength training.

    Unfortunately for me, it’s extremely good for you—and for runners who want to get faster. So I decided to add in two strength-training sessions per week in preparation for running the Boston Marathon this spring. 

    I wanted exercises designed to improve my pace, but didn’t want to spend money on a personal trainer. Unsure of how to start, I turned to ChatGPT.

    The chatbot did not give me the workout regimen I was hoping for—and after following its recommendations for nearly a month, I was no closer to liking strength training. But I learned some things along the way that might end up helping me become a better runner.

    Lesson 1: ChatGPT is not much of a coach 

    OpenAI’s free AI chatbot is trained on vast amounts of data from sources around the Internet so it can answer prompts with human-like text. To test out its workout recommendations, I first asked it to create a marathon training plan.

    As a running coach who’s finished more than a dozen marathons, I have a good sense of what a solid training schedule looks like. The ChatGPT results were—not that. Although it told me to run about six days a week at various speeds and distances (so far, so good), it listed hill sprints and intervals without essential details like how fast or far. It also gave me no runs longer than 14 miles, aside from the suggestion to run a full marathon a week before the end—something no legitimate coach would ever advise, since that’s far too taxing on the body to be beneficial, especially so close to race day. I asked the question twice more, adding details about my fitness level and goals. Now, it only told me to run up to 12 miles. In comparison, the longest run on most respectable marathon plans is 18 to 22 miles.

    Read More: Your Brain Doesn’t Want You to Exercise

    It’s not hard to find a decent training plan online. So although I didn’t expect ChatGPT to invent a mindblowing regimen, I was surprised that the plans it spat out were so underwhelming and at times incomprehensible. But maybe I shouldn’t have been. What ChatGPT does so well is generate “a human-like, natural language output,” explains Richard Bayly, vice president of product, AI, and data at PEAR Health Labs, which owns the AI-powered fitness app Aaptiv. But while the chatbot is designed to sound like it knows what it’s talking about, it doesn’t.

    ChatGPT’s primary skill lies in sounding human, not in giving expert recommendations. The website even include a disclaimer to “check your facts,” stating that the chatbot is not intended to give advice. Even so, people are already using the site for workout suggestions. (OpenAI didn’t respond to a request for comment for this piece.)

    Lesson 2: ChatGPT generated decent exercise ideas 

    Although it failed my marathon plan litmus test, I still wanted to see if ChatGPT could give me some ideas for strength training. After asking “which body weight–only strength training exercises will help me run faster,” it listed 12 exercises that seemed fairly solid, hitting almost all the major muscle groups used in running. But as I started to do the workout, I realized I didn’t have any information on sets, reps, or whether I should do each exercise one at a time versus in a circuit. 

    I’m not the only one who has discovered ChatGPT’s workouts are missing fundamental details. One January 2024 study evaluating ChatGPT-generated workouts found its exercise recommendations were only 41% comprehensive—meaning its answers didn’t include all of the American College of Sports Medicine’s six components of exercise prescription: frequency, intensity, time, type, volume, and progression.

    Read More: This Is the Best Time of Day to Work Out

    Yet the researchers did find the workouts to be 90% accurate. Most of the inaccuracies involved telling people to get medical clearance to exercise when they didn’t need it. That might seem innocuous, but Linda Pescatello, a professor in the department of kinesiology at the University of Connecticut and one of the study’s authors, says this could discourage people from exercising altogether. “Requiring someone to get medical clearance is a major deterrent to undertaking an exercise program,” she says.

    Done right, AI has real potential to get more of us moving. In a recent report funded by the sportswear company ASICS, 62% of women named the high cost of trainers as a major barrier to exercising. A free, easily accessible chatbot offering targeted, on-demand workout advice on a mass scale could be a boon to public health.

    Lesson 3: The chatbot’s workouts are boring and uninspired

    Two weeks into my strength-training plan, I found myself skipping certain moves and swapping in others instead. The problem was, I didn’t trust Coach ChatGPT. Did I really need to do burpees, or had the chatbot simply come across them in some random “workout for runners” article? The answers hadn’t given me any information on why I was doing the moves, or links to learn more, so I kept questioning the efficacy of the exercises.

    Also, the workout was boring, made up of basic American gym-class exercises that felt cookie-cutter, despite all the personal info I’d included in my prompts. 

    “There’s the science of exercise prescription, and there’s the art,” says Pescatello. A robot might have completed my prescribed workout and gotten results, but I’m far too human to pump out the same 12 bland moves with gusto—especially without a trainer to hold me to it. “It doesn’t account for humanity at all,” says Kristie Larson, a New York–based personal trainer. “Sure, it might write a very good training plan—if you were also a machine.”

    Lesson 4: Turn to a human if you get injured 

    At one point, my sartorius muscle in my thigh started to act up. I asked ChatGPT, “Can I still run if my sartorius muscle hurts?” It gave me a vague, long-winded answer that wasn’t exactly “no,” but suggested I stick to low-impact activities like walking if the “pain is mild and improving.” 

    I brought this up with New York-based adidas running coach Jessica Zapotechne. Was this sound or overly conservative advice? “That question makes me think about a topic that I talk with athletes about a lot, which is distinguishing between pain and discomfort,” she tells me. There are different types of hurting, and determining what is simply part of training versus signs of an injury requires “a list of questions to go through,” she says. That’s another problem with AI coaches: They don’t ask questions, the way a human coach typically would.

    Read More: Should I Use a Foam Roller?

    “You’ve got to be very careful about your inputs, because if you have bad inputs, you’re going to have bad outputs,” says Bayly of PEAR Health Labs. “A generative AI chatbot is relying largely on information that’s widely available. I don’t think there’d be a lot of difference between a generic program that you might be able to download off the Internet versus something the chatbot might return if you are not specific enough.” AI-based workout apps like Aaptiv have users answer several questions about their goals, experience, age, and more upfront in order to generate personalized recommendations, which are then refined further by tracking what the user does on the app, à la Netflix. 

    The trouble is, someone who’s looking to AI for exercise ideas probably doesn’t know exactly what details they’d need to share to get the most helpful answer. 

    “The person who has the skill to write a great command probably has enough skill to just write the workout,” says Chicago-based strength coach Elisabeth Akinwale. On the other hand, she adds, if someone is asking ChatGPT for workout help, they might not have the knowledge to realize when it spits out something wacky, like my marathon training plans. “They don’t have the discernment to say, no, that doesn’t sound right,” she says.

    So what is ChatGPT good for, in the world of fitness?

    In a word: “Variety,” says Pescatello. “One of the capabilities AI has in any profession is it can be a great search tool. With careful prompting, you could specify your preferences and an output could be generated that gives you more options than you feel there are now.” Larson echoes that sentiment, saying it would be best used by someone experienced who’s just looking to mix things up with a new idea to add to their rotation. 

    Still, you’d have to fit within a narrow population to get the best results. Pescatello says her team found that ChatGPT’s recommendations are currently biased toward adults and lack cultural awareness or considerations for disabilities. Their analysis also scored the readability at the college level.

    Read More: The 3 Most Effective Exercise Moves That Don’t Require Equipment

    Despite ChatGPT not turning out to be the free personal trainer I wanted, I’m still doing some of its recommended strength-training exercises regularly. I haven’t gotten faster yet, though we’ll see what happens on marathon day. 

    I find I keep going back to ask ChatGPT my 3 a.m. workout questions that feel too silly or inconsequential to bother another human with. It’s proven most useful after a session talking to a sports dietitian, when I needed a simple explanation of “anabolic potential.” The first few results Google brought up were too sciencey, but when I asked ChatGPT to define it for an eighth grader, I got exactly what I was looking for: “the body’s ability to build and repair tissue, especially muscles.” I’m finally using it for what it’s designed to do: not to give exercise advice, but to generate natural-sounding, easy-to-understand language.

    [ad_2]

    Jennifer Heimlich

    Source link

  • The Most Exciting New Advances in Managing COPD

    The Most Exciting New Advances in Managing COPD

    [ad_1]

    The Global Initiative for Chronic Obstructive Lung Disease, or GOLD, is the world’s preeminent COPD research and advocacy organization. Founded in 1997 in collaboration with the U.S. National Institutes of Health and the World Health Organization, one of GOLD’s stated aims is to “improve prevention and treatment of this lung disease.”

    In its 2023 global strategy report, GOLD changed its definition of COPD—which many in the profession viewed as overdue. Specifically, the new definition emphasized the heterogeneity of COPD in terms of its underlying drivers and long-term disease course.

    “If you look at the new GOLD guidelines, they’re really acknowledging that there’s more of an inflammatory component to COPD than we initially thought,” says Dr. Laren Tan, a pulmonary disease and critical care specialist and chair of the Department of Medicine at Loma Linda University Health in California.

    Tan says the recognition that COPD can take unconventional forms is crucial to tailoring appropriate care to the individual patient. “We’re now approaching COPD in terms of trying to identify subgroups of patients that have this underlying inflammatory state,” he says. “If we don’t uncover this inflammatory component, that can lead to worse outcomes.”

    Here, Tan and other experts in the field describe how this new understanding of inflammation is informing treatment. And it’s just one of several recent advances in COPD care and management. From innovative new lung valves to refinements in the deployment of inhaled therapies and vaccines, the landscape of COPD care and treatment is changing.

    The newest drug therapies

    Arguably the most buzzed about advancement in the COPD treatment landscape is the emergence of new biologic therapies, says Dr. Meilan Han, a professor of medicine in the Division of Pulmonary and Critical Care at the University of Michigan. Biologics are injected medications derived from living cells or other biologic material that are able “to target very specific immune pathways,” Han explains.

    Essentially, these drugs are intended to narrowly shift or block the operation of the immune system, thereby switching off or moderating the types of inflammation or other immune reactions that drive some COPD exacerbations while simultaneously leaving the remainder of the immune system unaffected. The drugs are already used to treat related pulmonary conditions, like asthma, and there’s reason to believe they’re about to enter the COPD arena.

    “The exciting news is that there is a drug that looks like it will work for COPD, and that may soon have [U.S. Food and Drug Administration] approval,” Han says. That medication, dupilumab, is already approved for the treatment of asthma. In July 2023, a study published in the New England Journal of Medicine found that patients with so-called Type 2 inflammation—defined by the elevated presence of blood eosinophils—benefited from dupilumab. The patients experienced “fewer exacerbations, better lung function and quality of life, and less severe respiratory symptoms than those who received placebo,” the study found.

    “What we’d seen in the last few years prior to this was that companies were fleeing respiratory drug development because a lot of studies had failed,” Han explains. “Dupilumab is just one drug, but it opens up the door for a lot more research and exploration of biologics for the treatment of COPD.” She notes that there are multiple trials examining additional biologics that target new pathways. “I’m hoping this is just the tip of the iceberg, and soon we’ll have many more new therapies,” she adds.

    While biologics are garnering the most attention, experts say that smaller, more incremental improvements in care are having a greater impact on the day-to-day lives of COPD patients.

    For example, phosphodiesterase inhibitors have long been used to help treat the mucous production and accumulation that so many COPD patients experience, Tan says. “The new phosphodiesterase inhibitors help relax airway smooth muscle and also help to clear out mucus from airways,” he says. “But patients take this as a tablet, which unfortunately comes with a lot of side effects, such as GI issues.” To prevent these side effects and improve the drug’s efficacy, researchers have looked into the development of inhalable forms of these drugs, and Tan says there’s promising data that these work.

    Staying in the inhaler space, one of the greatest challenges in COPD care—and, for that matter, in the care of asthma and other lung conditions—is the problem of poor patient adherence to medications. Inhalers are often a mainstay of symptom management, but it can be a struggle for people to use an inhaler consistently, especially when treatment involves more than one type of inhaled drug.

    This problem of adherence led to the development of combination inhalers—a single device that allows a patient to take two or even three medications simultaneously. “They’ve taken all these inhalers and put them into one device,” Han says. “This makes it easier for patients to take their medications, and this has led to a reduced frequency of exacerbations.”

    In parallel with the emergence of combination inhalers, research has revealed that, for some COPD patients, the blend of three inhaled medicines may be superior to the old two-drug approach. “For most patients, we prescribe two long-acting bronchodilators,” says Dr. Peter Barnes, a professor of thoracic medicine at the National Heart and Lung Institute in the U.K. These are a long-acting muscarinic antagonist, or LAMA, coupled with a long-acting β2-agonist, or LABA. While this LABA/LAMA combination is nothing new, Barnes says that adding a third medicine—an inhaled corticosteroid—has proven helpful in patients with high blood levels of eosinophils. “These three can now be combined in single inhaler, called a triple inhaler,” he says.

    Plus, some of the first research studies on the long-term benefits of these triple inhalers have found that they may reduce mortality among patients who use them. “When used appropriately in combination, these drugs can save lives,” Han says.

    Read More: Severe Asthma Patients on Ways Their Doctors Could Improve Treatment

    Valves, telemedicine, and other advances

    Lung volume reduction surgery, or LVRS, is one of the most common surgical procedures for the treatment of COPD. The procedure, which has been around since the 1950s, involves the removal of the most diseased parts of lung tissue in order to allow better, less-restricted lung expansion during breathing. “When you take that diseased part out, that helps to restore the lung’s natural mechanics,” Han says.

    But this surgery comes with downsides. “It’s a major surgery with a long recovery time, and the risk for complications is high,” Tan says. These complications include unintended air leakages, pneumonia, and heart issues such as arrhythmias.

    In just the past few years, a new and milder intervention has emerged. Two different companies have developed valves that can be placed in the airway using a minimally invasive procedure, and that allow trapped air to escape the damaged lung. “These are essentially a one-way valve that allows air to go out of the affected areas of the lungs,” Tan explains. “This helps improve ventilation and breathlessness.” The procedure, known as bronchoscopic lung volume reduction, mimics the effects of the older surgery, but is reversable.

    Aside from new drugs and surgical procedures, vaccines are another area that should lead to better symptom management. “With COPD, a lot of common viruses—things like respiratory viruses—can contribute to periodic flare-ups or exacerbations,” Han says. Vaccines can help prevent these viral infections, and more are becoming available all the time. “The ramp-up of vaccine development we saw during the pandemic—I’m hopeful we’ll continue to see new vaccines for things like rhinovirus that have a major impact on COPD,” she says.

    Experts say there have also been helpful advances in the way COPD patients and their care providers interact. 

    “Pulmonary rehab doesn’t get much buzz, but we know it’s critical for a patient’s daily functioning,” Tan says. Pulmonary rehab often involves group education courses that teach people with COPD how to adjust their lifestyles—for example, by incorporating safe forms of exercise, or learning to prepare healthier meals—in order to improve their symptoms and functionality.

    Unfortunately, reimbursement and insurance coverage for pulmonary rehab is poor. Plus, attending the group sessions can be difficult or inconvenient for people who don’t live close to their center of care. “But during the pandemic, we found that we can offer pulmonary rehab remotely through telehealth, and I think that’s been a gamechanger,” Tan says. While many of those pandemic-era telehealth programs have since been suspended, they acted as a proof-of-concept—a demonstration that pulmonary rehab courses can be offered virtually—that Tan hopes will eventually increase access and reduce costs for people with COPD.

    Smoking cessation is another area that has witnessed some noteworthy advancements, Tan says. A majority of COPD patients are current or former smokers, and a lot have trouble quitting despite the help of medications and patches or other nicotine-replacement aids. “Now we’re starting to see people using an AI-powered app to help them quit,” he says. 

    Earlier this year, the Fred Hutchinson Cancer Center launched a free QuitBot AI app. The app offers personalized smoking cessation support—answering questions and providing evidence-based pre- and post-quit-date education materials—that can help people stick with it.

    Meanwhile, researchers at Johns Hopkins University have found that combining psychedelics with cognitive behavioral treatments can lead to remarkable cessation rates. One study found that 80% of people were able to stay cigarette-free six months after the treatment—an unheard-of success rate for smoking cessation therapies.

    Read More: How Alternative Medicine Can Help People With Asthma

    What’s next?

    In many branches of medicine, researchers and providers have turned their attention to better, more comprehensive diagnostics. With the help of advanced genetic testing, blood analyses, and other cutting-edge assessment tools, doctors can get a clearer picture of a patient’s underlying disease state, which can guide them toward the most efficacious and precise treatments—and, as a result, improving outcomes and reducing side-effects or other quality-of-life challenges.

    This, experts say, is where COPD care is headed. “We know now there are multiple subtypes of COPD—that the inflammatory sub-profile differs from patient to patient,” Tan says. “But the inflammatory process is extremely complex.” It will take time to map the different inflammatory pathways and processes at play, and years of work to identify or develop new medicines that treat those specific instigators of inflammation. But all of this is underway. And, as the latest research on biologics suggests, this form of precision medicine is going to be part of the COPD conversation for a long time to come.

    “I’ve been doing this for 20 years, and this is the first time I feel like we’re at an inflection point where I’m anticipating a lot of new therapies within the next five years,” Han says. 

    For people with COPD—and their care providers—the future looks bright.

    [ad_2]

    Markham Heid

    Source link

  • Why Massive Numbers of Farmed Salmon Are Dying

    Why Massive Numbers of Farmed Salmon Are Dying

    [ad_1]

    The popularity of farmed Atlantic salmon on dinner tables worldwide has been a disaster for the king of fish. A new study determined that 865 million farmed salmon have died in mass die-offs in the last decade. The scientists blame the deaths on several factors, from ocean warming caused by climate change to the aquaculture industry’s overuse of antibiotics and pesticides and its aggressive attempts to increase production. Beyond the staggering number of dead fish, the findings raise questions about the future of growing salmon in cages on the ocean—and aquaculture in general.

    Salmon farming has expanded rapidly in the past 25 years into a $20 billion-a-year industry. Farmed salmon are advertised as an environmentally friendly and sustainable solution to the need for animal protein for the world’s growing population. But mass die-offs and other controversies have challenged these claims.

    Salmon are raised in crowded cages floating near coastlines, called open-net pen farms. A single farm can contain a million or more fish, leading to high concentrations of diseases and parasites that kill farmed salmon and endanger nearby marine life and migrating wild salmon. The nets extend 30 feet below the surface and allow currents to sweep excess feed, excrement, and chemicals into the surrounding waters.

    The peer-reviewed paper published this month in Nature was the first to analyze global data on these sudden die-offs. The scientists found that these events are increasingly common and killing more fish. The data came from the four largest salmon-producing countries, Norway, Chile, the United Kingdom, and Canada, as well as two smaller producers, Australia and New Zealand.

    Among the common causes were lax government regulation, competition among companies to meet rising demand, and warming waters caused by the climate crisis, Dr. Gerald Singh, an assistant professor at the University of Victoria in British Columbia and a co-author of the study, told us. “With climate change, I suspect more of these events will occur,” he said.

    Read More: 3 Reasons to Avoid Farmed Salmon

    Ocean temperatures show no sign of cooling. The National Oceanic and Atmospheric Administration said the average temperature of the ocean’s surface in 2023 was the highest since record keeping began in 1850—and 2.21 degrees F above the average for the 20th century. It is a trend with potentially catastrophic consequences, not just for farmed salmon but other marine species and the planet’s ability to avoid extreme weather events.

    Salmon are cold-water fish. Warm water contains less oxygen, making it harder for salmon to breathe. Marine biologists have tracked both Atlantic and Pacific salmon migrating to the Arctic in search of a more hospitable environment.

    Farmed salmon, however, are trapped in cages and cannot make the journey toward colder water. Last year, when a record 17.4 million farmed salmon died in Scotland, processors blamed warming water. The deaths of 100,000 salmon at two farms off the coast of Maine were attributed to low oxygen in the water, likely a result of rising temperatures. At least 2.6 million salmon died at 10 farms along the coast of Newfoundland in eastern Canada in late summer of 2019 during a prolonged spell of warm water. An inquiry into the die-off concluded that the salmon were already under stress from chemical treatments for parasites and suffocated after swimming to the bottom of the pens in search of cooler water.

    Warming waters also allow parasites and viruses to thrive inside the cages, requiring farms to use more chemicals to try to stop outbreaks that can wipe out entire farms. Rising temperatures also contribute to algal blooms, which threaten salmon by further depleting oxygen levels.

    The salmon farming industry has had limited success combatting die-offs, which cost it billions of dollars every year. Instead, it has responded to the losses by increasing production, which has led to greater profits. For instance, Norway’s Mowi ASA, the world’s biggest salmon farming company, reported a record profit of more than $1 billion along with record production in 2023.

    Concerns about fish welfare, threats to endangered wild salmon, and ocean pollution have sparked calls from environmentalists and animal rights activists to remove salmon farms from the ocean. Some groups advocate moving salmon farms to land-based facilities where water temperature and other conditions can be controlled.

    Bill Taylor, president of the Atlantic Salmon Federation, an international organization dedicated to protecting wild salmon, said the salmon farming industry is only accountable to shareholders and is focused on short-term profits. “The only way salmon farmers can really do this is to pump more fish into more cages, accept massive losses, and eke out a few more fillets at the end of a growing cycle,” Taylor said in an email interview. “There is no future for salmon aquaculture in ocean sea cages.”

    But Dr. Charles Mather, a professor at Memorial University in Newfoundland and a co-author of the Nature paper, told us that the highly profitable industry has absorbed mass mortalities for years and that these events won’t be what forces salmon farms out of the water. “I would look to Washington State to see how to get nets out of the water,” he said in an email interview.

    Washington State banned non-native fish farms from its waters after the collapse of a salmon farm in Puget Sound sent 250,000 alien Atlantic salmon into the home waters of Pacific salmon. A state investigation concluded the collapse was caused by negligence, not climate change. But public outrage was so strong that elected officials enacted the ban within weeks.

    Similar attempts to remove or restrict salmon farms in Canada, Scotland, Norway, Chile, and Australia have struggled. But opponents of ocean-based salmon farming hope that the new data on die-offs will buttress their case with consumers and producers that salmon farming on the ocean is unsustainable for the fish and the marine ecosystem.

    “The increasing frequency and size of mass mortality events on open-net salmon farms is the result of an unsustainable industry operating beyond natural limits, in an increasingly unpredictable and uncontrollable environment,” Rachel Mulrenan, Scotland director of the UK environmental charity WildFish, which was not involved in the study, said in an email interview.

    [ad_2]

    Douglas Frantz and Catherine Collins

    Source link