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  • 6 Compliments That Land Every Time

    6 Compliments That Land Every Time

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    On a recent weekday afternoon, Xuan Zhao popped into the post office shortly before it closed. The man helping her was incredibly patient and went out of his way to assist her with a pile of packages. So before she left, she handed him a compliment card she had designed. “Your willingness to go the extra mile never goes unnoticed,” it said on the front. The flip-side read: “You’re receiving this compliment because your awesomeness deserves a big shoutout,” along with a reminder that kind words have the power to brighten other people’s day more than we might expect, and a suggestion to pay it forward. “He had such a big smile on his face,” she recalls.

    Zhao, a behavioral scientist at Stanford University who’s the CEO and co-founder of the well-being start-up Flourish Science, has spearheaded research that suggests we tend to underestimate the positive impact compliments have on both ourselves and the receiver. As a result, we don’t give as many as we should. “The compliment is one of these really powerful, small actions that brighten your day and brighten someone else’s day,” she says. “And it costs nothing.”

    Why is a compliment so impactful? One of the most important things to humans is to feel valued and respected by others, and like we belong, says Vanessa Bohns, a social psychologist and professor of organizational behavior at Cornell University, who has researched compliments. “We’re always attuned to any scraps of information we get about how we’re viewed by other people,” she says, but rarely do we receive any. “When we get a compliment, it gives us that feedback we want to know so badly about what other people think of us.” An expression of admiration provides a “sliver of hope” that we’re viewed positively in some attribute, she adds, like work or fashion—which activates the reward center of the brain and bolsters our spirits. According to Bohns’ research, people feel “significantly better” after both giving and receiving a compliment, compared to how they felt beforehand.

    With that in mind, we asked experts to share some of their favorite compliments—and why they resonate.

    “You handled that situation so well.”

    Bohns recently used her favorite compliment when she saw a server navigate a difficult situation with a customer at the bar. “I like it so much because you use it in fraught moments where the other person is often unsure of whether they handled a situation OK,” she says. “It reassures the person that they did and shows them that their efforts to defuse a situation or help someone out have not gone unnoticed.”

    In situations that call for a compliment, don’t second-guess yourself. Dole them out generously. People sometimes worry that they’re going overboard with compliments and will start to sound insincere. That concern is unfounded, Bohns says. “Our threshold for how many compliments we think we should be giving is lower than what people find acceptable,” she points out. “You don’t need to go crazy, but you could probably be giving compliments more frequently than you think.” As long as you genuinely mean what you’re saying—versus making something up in hopes of personal gain—consider compliment permission granted.

    “You make even ordinary moments feel extraordinary.”

    This compliment—one of Zhao’s favorites—works well among romantic partners and close family members. “It’s a beautiful and profound way to highlight how their presence turns life into something meaningful and worthwhile, despite mundane routines and the ordinariness of our everyday lives,” she says.

    Read More: 7 Low-Stress Ways to Start Decluttering

    If you’re afraid that giving a compliment like this will feel weird, you’re not alone. People tend to be overly concerned about how to give a compliment competently. We feel pressure to perform well—like if we don’t word our kind words perfectly, we’ll be laughed at. One way to overcome this fear is to do a practice run, says Erica Boothby, a social psychologist at the Wharton School of the University of Pennsylvania, and co-author of Bohns’ compliment research. “If it makes you personally feel like the bar is lowered for you to give a compliment if you write it down, or if you practice saying it out loud or giving your pet cat the compliment first, do that,” she says. Making yourself feel comfortable—by reciting compliments into the mirror, if that’s what it takes—is worth the effort.

    “I’m really impressed with your ability to work under pressure.”

    Respect is essential when delivering compliments. Most women can recall so-called “compliments” that didn’t land—think catcalling and other unwanted remarks about physical appearance. “These aren’t really compliments because they aren’t showing respect,” Bohns says. Before you say something nice to someone, make sure you’re doing so in a thoughtful, appropriate way. If a colleague has just finished an impressive work presentation, for example, don’t compliment her looks. To do so “wouldn’t be saying, ‘We value you in this work context, where work is the important attribute,’” Bohns explains. “It’s like, ‘Nice try, but you looked pretty doing it.’” It’s also important to avoid backhanded compliments, which may appear innocuous but actually contain hidden criticism or insults—and to ensure your language isn’t sneakily comparing two people.

    “I love the way you bring out the best in people.”

    Be specific. Details can elevate a so-so compliment to a great one, so make it a point to highlight specific qualities or actions. Zhao likes this one because “it acknowledges an individual’s willingness, effort, and growth mindset in recognizing and cultivating the potential in others—often before these individuals see it in themselves,” she says. “This is high praise for anyone seeking to make a positive impact, such as a leader or a teacher.”

    Read More: Want to Give Your Life More Meaning? Think of It As a ‘Hero’s Journey’

    If you just watched someone deliver a compelling talk at a conference, for example, tell them which part resonated with you the most. Instead of a generic “good job,” say, “Your talk was really inspiring,” Zhao suggests. “If you can say a bit more about how it inspired you to think about something in a new way, that’s even better.” You can also tailor a compliment by, for example, acknowledging someone’s progress in an area they’ve been working hard on—like slowing their pace or cutting filler language out of their sentences—-which shows you value their progress and effort.

    “Hey, great earrings!”

    Feel free to compliment strangers. In Bohns’ research, students on a college campus were told to approach a stranger of the same gender and compliment them—about, for example, their nice shirt. Before heading out, the study participants were asked to guess how good the compliment would make the other person feel, and it turned out they underestimated the positive effect—while overestimating how annoying it would be to be stopped by a random stranger. “Across all contexts, it makes people feel better than we expect,” Bohns says. Strangers are more likely to be flattered than befuddled. Plus, who knows? You might make a new friend in addition to making someone’s day.

    “Your performance was brilliant.”

    People rarely tire of receiving kudos, so if you’re with a friend who’s considering paying a compliment, encourage them to do so. “If you’re not the one who has to figure out the right wording and go talk to a stranger, you can see more clearly that it’s going to make someone feel good,” Bohns says. Say something like, “You really enjoyed that person’s talk—go tell them how great it was.” And if they demur, saying the speaker has probably heard it a million times? Remind them that once more might be the icing on the cake.

    And when you receive one: say “thanks.”

    Many of us feel awkward accepting compliments—we might blush, avert eye contact, start mumbling in embarrassment, or even disparage ourselves. If that’s you, remember how good the person complimenting you stands to feel—and smile while responding, “Thank you, that means a lot,” Boothby suggests. Though it might be hard to think outside of yourself in the moment, consider it an “opportunity for building or enhancing your connection with the other person,” she adds. Both of you will leave the interaction happier—and it will fuel the rest of your day.

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    Angela Haupt

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  • What It’s Like to Have a 4-Day Workweek

    What It’s Like to Have a 4-Day Workweek

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    To many people in corporate America, working five days a week—Monday to Friday, 9 to 5—feels as habitual as brushing their teeth. But it wasn’t always that way. In the late 1800s, a full-time manufacturing worker could easily spend 100 hours per week on the job. It wasn’t until around 1940, after a concerted push from labor unions, that the 40-hour workweek became standard in the U.S.

    Now, almost a century later, there’s growing momentum for an even more condensed schedule, with major companies—including Panasonic, Kickstarter, and the online thrift store ThredUp—trying out four-day workweeks. “We’ve all been working far too hard, and we’re missing out on life,” says Charlotte Lockhart, co-founder of 4 Day Week Global, a group pushing for shorter workweeks worldwide. “It’s affecting our health and our planet and our communities.”

    Lockhart’s group advocates for what she calls the “100-80-100 rule”: workers hit 100% of their productivity targets in 80% as many hours, while earning 100% of their regular pay. For some companies, getting there is as simple as canceling some meetings and making better use of technology to free up time, while others need to completely overhaul their workflows and scheduling systems. But, Lockhart says, employers in fields ranging from hospitality to law enforcement have seen success with shortened schedules.

    Read More: I Tried to Cure My Burnout. Here’s What Happened

    Pilot studies in countries including the U.K., Spain, Portugal, and South Africa suggest that shorter workweeks can help employees reduce burnout, manage stress, get more sleep and exercise, spend additional quality time with loved ones, and feel all-around happier and healthier. Employers see perks, too, including lower rates of turnover and absenteeism. The study in Spain even tracked a drop in fuel emissions due to fewer commuting trips.

    Additional trials are underway in countries including Germany, Brazil, and the Dominican Republic. Much of the research on shorter workweeks, however, has been done by advocacy groups like Lockhart’s. Independent surveys, like one conducted by Gallup in 2022, sometimes show a more complex picture.

    In the Gallup survey, people who worked four days a week were slightly more likely to report feeling burned out, compared to those with traditional schedules—potentially because they had to cram the same amount of work into less time. That result is in direct conflict with the results of pilot studies run by groups like 4 Day Week Global; in fact, Lockhart identified burnout reduction as one of the largest benefits of a condensed schedule.

    Lawmakers in states including Maryland, Massachusetts, Hawaii, and California seem to be focusing on the positive, introducing bills that would encourage four-day workweeks or at least enable further research on them. Bernie Sanders, chair of the U.S. Senate Committee on Health, Education, Labor, and Pensions, has pushed for four-day weeks as well.

    Read More: Ambition Is Out

    It’s hardly a new phenomenon for people to want to work less, says Juliet Schor, a sociology professor at Boston College who studies working hours. But with growing support from employers and lawmakers, she believes a sea change is coming. “Pre-pandemic, it felt like something that would be great but was unrealistic,” Schor says. “Once the pandemic came, the thinking switched because people felt so beleaguered and stressed and burned out. It became common sense that we should do this.”

    Companies that have already gotten on board have taken different approaches to implementing a shorter workweek. Some achieve the full 100-80-100 system, while others take more modest steps, such as asking employees to clock in for four 10-hour shifts per week or giving half days off. TIME spoke with employees at four companies trying out these schedules to learn more about the real-world effects of a shorter workweek—and if they’re as life-changing as the hype suggests.


    Courtesy Ashya Majied

    Name: Ashya Majied
    Age: 37
    Location: Cleveland, Ohio
    Job: Brand and marketing lead at Be Equitable, a company that partners with organizations to advance equity and inclusion in workplaces.
    Schedule: Monday to Thursday, with Fridays off for the entire company.

    That very first Friday that we had off, I woke up and moseyed downstairs to make myself some tea. It happened to be a sunny day. I looked out the window, smiled, and thought, ‘I’m so happy. This is what the research was talking about. I get why this works.’ It makes me want to go harder the other days of the week to have this feeling on Friday.

    Do I have to be really intentional about my time during the week? Yes. But everything can get done in four days. It always could.

    Having a weekday to handle your business—to call the doctor’s office, to call the mortgage company, to clean the house—has been huge. This Friday, I’m going to get my nails done in the morning. Before, I would try to squeeze it in at lunch, because my nail tech only works during the week. Now, I don’t have to have that guilty feeling or work late to make up the time; I just schedule my appointments on Fridays. That peace of mind is priceless. I’m also Muslim, and the day we go to the mosque is Friday. The other major religions in our country are off on their important days, and now I am, too. Fridays off means I can better support my spiritual well-being, and I love that for me.

    I really feel like I needed an extra day to rest. The state of the world, to me, feels like the weight of the world, and it takes a toll on me. The four-day workweek takes just a little of that weight off. It gives me a little bit of energy, a nice little boost in a world that is suffering.

    I wouldn’t want to go back to working five days a week, but I would if I had to. To any role that you have, there are pros and cons. This is a really big pro.


    Courtesy Greg and Kelsey Brown

    Names: Greg and Kelsey Brown
    Ages: 36 and 33, respectively
    Location: Missoula, Mont.
    Jobs: Greg is the vice president of operations at Linehaul Logistics, a freight brokerage. Kelsey is a counselor at a public school.
    Schedules: The Browns, a married couple, both have four-day workweeks. At Greg’s company, employees have different days off (Greg’s is Friday) and work 10-hour shifts on the days they are scheduled. Kelsey’s school has a Monday to Thursday schedule for students, faculty, and staff. She works nine-hour shifts.

    Kelsey: As mundane as it sounds, it’s nice that we get chores done on a Friday so we can enjoy the weekend fully. I also really look forward to working out for an hour on Fridays. I go to classes at Orangetheory Fitness. That small piece alone has helped my overall health and well-being. I also use my three-day weekends to catch up on sleep, because I have to get up at 5:30 a.m. to get to school on time when I’m working. Sometimes I think, ‘Man, it would be nice if I didn’t have to be at work until 8 or 8:30 a.m. like other schools,’ but I don’t think that in any way outweighs the other benefits of my schedule.

    I do so much more with my personal time, compared to when I worked five days a week in previous jobs. By the end of the three days that I have off, instead of having the Sunday Scaries, I’m ready to go back because I feel refreshed and recovered. I believe it makes me better at my job, because I feel ready to go on Mondays. Before, it was like, ‘Holy smokes, where does the weekend go?’

    It’s awesome that Greg and I are both on a four-day schedule, too. We spend that extra time together, or we will be spontaneous and go out of town.

    Greg: It definitely helps with traveling with our daughter, too. We love to go camping, and it extends the camping weekends.

    I don’t always take Fridays off because I’m a manager, and because I have to leave work early some weeks to meet my daughter at the bus stop after school. I feel bad taking the four days when I have to leave early, because I’m not doing my full 10-hour shifts.

    When it’s someone’s day to be off, someone else has to cover for them. That’s hard, because you’re doing two jobs. It can be kind of stressful to be out, too, handing that baton off and making sure that when you get back it’s not all dented or destroyed. But when I can do it, taking Friday off gives me that extra time to decompress. It’s very common to work long hours and weekends in this industry, so having that extra time to myself 100% helps me manage stress.

    As a manager, I’ve seen how this schedule helps my employees, too. I know that we’ve seen less turnover because of it. It’s easier to hire as well. We do have one person that does the five-day workweek voluntarily because she didn’t like a four-day schedule, but that is an outlier. Every single other person would not want to go back to five days. It can be hard to implement a four-day workweek and hard to keep it going, but it is definitely worth it.


    Courtesy Siobhan Stewart

    Name: Siobhan Stewart
    Age: 36
    Location: Richmond, Va.
    Job: Marketing communications manager at Pixite, a company that makes creative apps.
    Schedule: Monday to Friday afternoon, for a 4.5-day week.

    A five-day schedule honestly feels arbitrary to me. It didn’t, and doesn’t, seem balanced. You’re supposed to be on top of your steps and drinking enough water and your social life and your mental health and self-care. How do you fit that into a five-day workweek? In previous jobs, I couldn’t in a way that felt restful. I’m also a writer, and that wasn’t something I had energy for when I worked five days a week.

    Now that I’m on a 4.5-days-per-week schedule, I feel lighter. I feel happier. I don’t have the Sunday Scaries anymore, and I attribute that, in part, to feeling like I’ve had enough time to rest and recharge over the weekend. On a Friday afternoon I might read, work on my novel, journal, catch up on some chores, go on a walk with my husband, or just relax. We will do long weekends, take off and go somewhere. Even having an extra handful of hours, you feel like you have a little extra space. During the winter, getting outside for that extra daylight is also a big thing.

    In general, if you are less stressed and overwhelmed and feeling better, I think you’re a better, more productive worker. That’s been the case for me. It’s hard to imagine leaving this job. Being a middle-class American means you have to trade your time for money, and when a company gives you time it’s almost like an existential gift—like you’re getting a chunk of your life back.

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    Jamie Ducharme

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

    What Happens to Your Body If You Don’t Stretch

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    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.”

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    Emma Yasinski

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  • How to Tell if Someone Is Lying to You, According to Experts

    How to Tell if Someone Is Lying to You, According to Experts

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    It’s fortunate that liars’ pants don’t really catch on fire. If they did, much of the world’s population would be ablaze at any given moment. “People lie most days,” says Kevin Colwell, a professor of psychology at Southern Connecticut State University who researches deception. The majority of fibs are the sorts of harmless white lies that don’t hurt anyone. (You don’t actually like Aunt Mildred’s new haircut? She’s not going to be any worse off believing otherwise.) “Lying is a very important social skill,” he says. “It greases the wheels of society and makes our relationships work better.”

    More harmful lies, however—those that are intentional misrepresentations of material facts—have the opposite effect. Being lied to or about can deteriorate someone’s mental health and lead to a ripple effect of outcomes in their life, Colwell notes, including destroying their relationships. That’s why many of us play detective, trying to separate fact from fib.

    So how can you tell if someone is lying to you? The key is to enter the conversation without assumptions, says Colwell, who has trained law enforcement officers and investigators with groups like the National Counterterrorism Center in deception detection. “You have to not go into it assuming they’re lying to you, because if you do, it’s going to change how they interact with you,” he says. “You have to be engaging and connect with them in a way that makes the conversation easy for them.”

    You won’t always be able to tell for sure. But here’s what to look and listen for if you’re trying to figure out if someone is lying to you.

    There will likely be physical signs

    To know whether someone’s lying, you must have a baseline understanding of what’s normal for that person, explains Jim Clemente, a former New York State prosecutor and retired FBI special agent. The more time you spend with them, the better you’ll be able to recognize changes in behavior and communication. Some people, for example, might struggle to make eye contact in every conversation; for others, it will be a tell that something is amiss. Once you know what their norm is, pay attention to physiological changes caused by the fight-or-flight response: someone who is lying might start sweating, or their pulse will visibly pound in their neck. As their heart rate and blood pressure shoot up, their salivation will decrease, which means you might notice they’re gulping or licking their lips. Some people will begin fidgeting. “Shifting their torso, moving the chair away from the person talking to them, standing or attempting to leave—I’ve seen all of that,” Clemente says. “You might see rubbing or wringing of the hands, pinching parts of the body, clearing the throat, pulling on the hair. All these things can be stress and tension releases.”

    They’ll repeat the same story over and over

    Let’s say you ask your partner what they were doing on Wednesday night. After they fill you in, respond: “That sounds neat. I wish I had been there—tell me more about what happened.” People who are telling the truth tend to talk in a natural, free-flowing way, Colwell says—they aren’t worried about getting caught. So they’ll supply new, relevant details they didn’t include the first time around.

    Read More: How to Respond to an Insult, According to Therapists

    People who are lying, on the other hand, tread carefully. They might talk a lot, but “they’ll tell you the same thing they just told you, the same as how they already said it,” Colwell says. “They’re making sure they don’t contradict themselves and give information that could lead to them getting caught.” If you’re hearing a whole lot of the same thing, continue asking specific questions—and it will likely soon become obvious that you’ve discovered a lie.

    They’ll be oddly chronological

    People who are lying tend to tell stories chronologically, Colwell notes—as opposed to those who are being truthful, who will go from the most important parts to the least important. If you don’t have anything to hide, “the first thing you’re going to remember is the most important piece of that event, and then the rest of it will come back,” he says. “If you know you’re going to lie, you’ve practiced and you have a script—and scripts start at the beginning and end at the end. Scripts don’t start in the middle.”

    They’ll speak more eloquently

    Surprisingly, people often speak better when they’re lying than they do when they’re telling the truth. “They’re engaging in impression management,” Colwell says. That might mean using a more complex and sophisticated vocabulary than you would expect, with words you didn’t even realize they knew. So if you’re marveling at your friend’s newfound language mastery? “It’s a clue that they’re lying to you at that moment,” he says.

    They’ll drop or change pronouns

    When a woman asks her lying husband about his day, he might reply: “I went to the park. Ate lunch.” Notice that he dropped the “I” in front of “ate lunch,” Clemente says. That could be because he’s covering up that he and another person—“we”—ate lunch. Similarly, he recalls suspects who said: “Left my house. It was on fire.” His response: “You left your house because you discovered it was on fire, or because you lit it on fire?”

    Their sentences may be full of qualifiers

    Some lies are indirect: People omit crucial facts or feign forgetfulness. In these cases, they’ll often answer questions with questions, Clemente says. Consider the famous scene in Seinfeld where Elaine’s friend asks her if she’s having an affair with George. “Why would you think I was having an affair with George?!” a frazzled Elaine responds. (Spoiler alert: She wasn’t, but she was covering for George, who had gone on a date with Marisa Tomei.) Or, when asked if he killed his brother, a murderer might respond: “Why would I want to hurt Jack?” If you ask a yes-or-no question, Clemente says, pay close attention if you don’t get a straight response.

    Read More: Are Personality Tests Actually Useful?

    People who are lying by omission also tend to be vague or evasive by using phrases like “I think,” “probably,” “sort of,” “maybe I was,” and “I started to,” Clemente points out. “If somebody says, ‘I started to drive to work, and then when I got there….,’ they probably edited out what happened in between,” he says.

    They’ll sound different

    Paying attention to non-linguistic verbal cues—like tone, volume, pace, and pitch—can be revealing. People who are telling the truth usually speak in a consistent way, Clemente says; those who are lying are likely to have a broken rate, with variations in pitch and amplitude. “If somebody’s under stress, their pitch might go up quite a bit,” he says. “Their pace might slow down because they’re trying to think, or it might be really fast because they’re so nervous.”

    Their eyes might hold secrets

    There’s a common assumption that people look away when they’re lying—but actually, research suggests that gaze aversion is common when we’re thinking, which doesn’t necessarily equate to telling a fib. “People who have a lie ready to go often look at you straight in the eye, because they want to know if you’re going to buy it,” says Wendy Patrick, a longtime prosecutor and author of Red Flags: How to Spot Frenemies, Underminers, and Ruthless People. “They’re trying to see if you’re buying what they’re selling.”

    Plus, people who are lying usually don’t smile with their eyes, she adds. Generally, if someone is telling the truth, “you’ll see their crow’s feet as their eyes relax into their smiles.” It’s probably a safe bet to trust what they’re saying.

    Their mannerisms won’t match the situation

    When people are truthful, their mood and mannerisms should match the message, Patrick says. If you detect a visual-verbal mismatch, consider it a red flag. That might mean smiling or giggling while discussing a serious subject—like Christopher Watts famously did in 2018 when police interviewed him about whether he murdered his missing wife. (Though Watts initially maintained his innocence, he later confessed to killing his pregnant wife and their two daughters.) “It doesn’t always have to be something so sensational,” she adds. “But it is the dynamic of how our emotions belie our words, and indicate that we’re lying.”

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    Angela Haupt

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

    How to Talk to Your Family About Their Heart Health History

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    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 MoreHow 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.”

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    Sarah Klein

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  • Taylor Swift Is Embracing the 5 Stages of Grief. Should You?

    Taylor Swift Is Embracing the 5 Stages of Grief. Should You?

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    Call it the Five Stages of Grief (Taylor’s Version). Last week, ahead of the release of her album The Tortured Poets Department, Taylor Swift shared five new playlists that sort her old songs into stages: denial, anger, bargaining, depression, and acceptance. “These songs represent making room for more good in your life,” she says in a brief audio message accompanying the final playlist, acceptance. “Making that choice. Because a lot of time when we lose things, we gain things too.”

    In the two months since Swift announced her new album, which comes out April 19, fans have speculated that it will explore themes related to coming to terms with the loss of a long-term relationship. (The pop star revealed the end of her six-year relationship with actor Joe Alwyn last April; she’s now dating Kansas City Chiefs tight end Travis Kelce.) “She’s doing the same thing with grief that she did with the NFL,” introducing the concept to a new audience, says Jason Holland, a clinical psychologist in Nashville who has researched grief, loss, trauma, and stress. “Grief isn’t a topic that gets talked about a lot—so anything that someone can do to bring more attention to it, and get people thinking about it and talking about it, is a good thing.”

    But the “five stages of grief” is a contested concept among psychologists, as not everyone experiences them the same way. We asked experts what they like about the theory—and which limitations and caveats to keep in mind.

    Grief is less predictable in reality

    The five stages of grief were introduced by psychiatrist Elisabeth Kubler-Ross in her 1969 book On Death and Dying. The theory, born out of her work with terminally ill patients, initially focused on how people grapple with their own mortality. “She was a pioneer at the time,” says Mary-Frances O’Connor, an associate professor of psychology at the University of Arizona and author of The Grieving Brain: The Surprising Science of How We Learn from Love and Loss. “She described what people were telling her, and those descriptions are still accurate. Many people do feel angry; many people do feel depressed.”

    Read More: 7 Low-Stress Ways to Start Decluttering

    Kubler-Ross later expanded her work to apply to people grieving a loved one—and, clearly, it resonated, evolving into a cultural touchstone. The problem, O’Connor says, is that “it became used not as a description, but as a prescription.” People interpreted the stages strictly, assuming that mourners had to pass through each one sequentially. (That thinking has persisted, though in a book Kubler-Ross wrote shortly before her death in 2004, she noted it was not her intention, and that the stages do not have to happen in one particular order.)

    Though little research has examined the theory, the studies that do exist offer mixed results. One study, for example, found that during the two years after someone lost a loved one, their experiences of grief did tend to follow Kubler-Ross’s predicted order. Other research found that the pattern of grieving depended on the circumstances of how someone died, and that grief and acceptance rose and fell in an unpredictable way. “We know now that it is a much more variable path, and that there isn’t an end point where we stop feeling grief,” O’Connor says.

    Not everyone goes through all of them

    While many people experience some or all of the five stages of grief, others only relate to one—or none. Grief is complex, O’Connor points out, and not a one-size-fits all process. Some people might skip a step, jumping straight from denial to bargaining (when you try to make deals with God or torment yourself with “what if” statements, no matter how irrational). Others will experience depression before they move on to anger. Research suggests that most people do eventually achieve some form of acceptance, but “it’s like the stock market,” O’Connor says. “It goes up and down.”

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

    Grief hits us in all different ways and at different times, staying with us indefinitely and surging when we least expect it to, says Gina Moffa, a grief therapist in New York City and author of Moving On Doesn’t Mean Letting Go. “The idea that it can be wrapped up in a neat bow and that it has a clear beginning, middle, and end is a real disservice to people going through the grieving process,” she says. “Grief is messy. It’s important to know that there’s no timeline.”

    Grief isn’t just emotional

    The five-stages theory doesn’t acknowledge the physical symptoms and anxiety that can accompany grief, Moffa points out. People who are bereaved often experience panic attacks, brain fog, sleep issues, a weakened immune system, gut issues, and headaches, among other issues, she says. After her mother died, she landed in the hospital with pancreatitis and a thyroid problem. “This experience of five stages doesn’t account for the fact that grief is a trauma to our bodies and to our nervous system,” she says.

    Read More: How Grief Upsets Your Gut Health

    What particularly bothers Moffa is that when some people feel like their experience doesn’t conform to the five stages, they become distressed. “They think they’re doing it wrong,” she says. “When we talk about the five stages of grief, it becomes a ‘right and wrong’ thing. And grief is not something that can be right or wrong.”

    A different way of thinking about grief 

    Many people who specialize in grief work prefer the dual process model of grief, which posits that grieving involves two tasks that can mostly only be handled one at a time: working through the emotions of grief itself—whatever they are and whatever order they come in—and rebuilding a life. The person grieving will oscillate between both modes—at times mourning, and at times setting aside emotions to nurture new relationships or figure out the logistics of a different life without their loved one. “Spending some time coping with the grief, and some time coping with the restoration, is actually a sign of mental health,” O’Connor says. “Being able to put your grief aside for a time so that you can attend to your life is a mentally healthy thing to do.”

    Read More: Want to Give Your Life More Meaning? Think of It As a ‘Hero’s Journey’

    That’s not to say there isn’t a place for the five stages of grief. Holland’s clients often bring it up, explaining that it resonates with them. “It’s a simple model that people can understand,” he says. “If you’re in the midst of grief, you’d like to think that there’s some predictable road ahead.” If people feel that the theory fits them, he says, why not talk about it in those terms? “If it gives them hope, and a sense of empowerment, then I think that’s very positive,” he says.

    Having a roadmap like the five stages provides a sense of comfort, he believes. Plus, it fits with our idea of a classic story—and Swift, of course, famously loves a good tale. “It’s this idea that we’re battling grief, that we go through this journey where we have to do battle with denial and bargaining and anger and depression, and we come out this renewed person with insight or knowledge we can share with others,” he says. “It fits with the way that we see human struggle.”

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    Angela Haupt

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  • Young Adults May Soon Be Able to Get an RSV Shot

    Young Adults May Soon Be Able to Get an RSV Shot

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    Pfizer Inc.’s RSV shot produced immune reactions in young adults at higher risk of severe illness just as well as in older people, spurring the company’s plans to apply for wider U.S. approval.

    A single dose of the vaccine, called Abrysvo, produced a strong immune response in adults ages 18 to 59 with conditions such as asthma, diabetes, or chronic lung disease, Pfizer said. Based on the final-stage trial results, the company plans to ask the Food and Drug Administration to extend the shot’s approval to adults 18 and older.

    RSV, or respiratory syncytial virus, is a flu-like illness that affects elderly adults and babies most severely. The market for adult vaccines alone could reach $11 billion by 2032, according to Bloomberg Intelligence, making it a lucrative target for drugmakers like Pfizer as sales of COVID-19 shots fade. Last year, Pfizer and GSK Plc were the first companies to reach the US market with RSV vaccines, and another made by Moderna is expected to gain U.S. approval next month.

    Read More: How to Get RSV Vaccines to Those Who Need Them Most

    Pfizer’s vaccine is now approved for adults 60 and up, as well as for use in pregnant women to protect newborns for up to six months after birth; sales were $890 million last year. Pfizer Chief Executive Officer Albert Bourla said in January that he was committed to stepping up efforts to take more market share for the vaccine in 2024.

    No shots have yet been approved to prevent RSV in high-risk adults ages 18 and up, though Moderna is also running a trial in a similar population. Generally, these young adults don’t get as seriously ill from the virus as older people and babies do. The company is also conducting a study in immunocompromised patients 18 and older and expects to share results later this year. 

    Read More: The New RSV Drug Keeps Babies Out of the Hospital

    Usage in younger adults would ultimately depend on the recommendation of the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices. If the vaccine were approved, the committee would have the flexibility to modify recommendations as appropriate, said Iona Munjal, executive director of clinical vaccines R&D at Pfizer.

    GSK is exploring the possibility of running a clinical trial in patients younger than 50, but is currently focused on adult populations with the highest risk of RSV, according to a spokesperson. The company has already filed for FDA approval to extend RSV vaccination to adults 50 to 59 years old who are at increased risk of disease.

    Pfizer’s trial included 681 people, roughly two-thirds of whom got one dose of the vaccine while one-third received a placebo. 

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    Madison Muller and Robert Langreth/Bloomberg

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  • Why Your Head Hurts After the Eclipse

    Why Your Head Hurts After the Eclipse

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    If you have a headache or eye pain after viewing the solar eclipse—even if you wore eclipse glasses—you’re not alone. But don’t panic. Experts say it’s probably not a sign of serious damage.

    Looking straight at the eclipse without protective glasses can potentially cause permanent damage to your vision. It’s dangerous to look directly at an eclipse—except during the period of “totality,” when the sun is entirely covered by the moon—for the same reason it’s never a good idea to stare at the sun: its light can burn your retina, a risk that’s formally known as solar retinopathy.

    But if you suffered this kind of damage, you’d be more likely to experience visual disruptions—such as blurriness, light sensitivity, or dark spots—over the following hours, rather than eye pain. The retina doesn’t have pain nerves, according to the American Academy of Ophthalmology (AAO).

    Headaches can be a symptom of solar retinopathy, AAO says. But in most cases, someone develops a headache because of other vision issues, rather than as a primary symptom, says Dr. Lucia Sobrin, a retina specialist at Massachusetts Eye and Ear.

    A viewer of the solar eclipse looks to the sky at Main Street Garden Park in Dallas, Texas on April 8, 2024.Jake Dockins for TIME

    Read More: How Cities Around the U.S. Are Celebrating the Eclipse

    If you have a headache without accompanying visual issues, you’re almost definitely in the clear, particularly if you wore protective glasses as directed, says Dr. Avnish Deobhakta, an ophthalmologist at New York Eye and Ear Infirmary of Mount Sinai. Most likely, he says, you’re experiencing regular old eye strain, which can make your head hurt.

    Focusing on something far in the distance can strain the eyes, Deobhakta says, particularly after wearing dark eclipse glasses that cause the pupils to dilate. “It’s very similar to when people stare at a screen for a long time in the dark,” he says.

    Or, Sobrin adds, you could just be feeling the effects of light sensitivity after staring at the sky in a way you usually don’t.

    In most cases, headaches and eye pain should fade within a few hours of viewing the eclipse, Deobhakta says, though you can always consult a physician if you’re worried. Like the eclipse, “this too shall pass,” he says.

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    Jamie Ducharme

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  • Evidence of Dangerous ‘Forever Chemicals’ Found in Bandages

    Evidence of Dangerous ‘Forever Chemicals’ Found in Bandages

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    Many brands of bandages may contain PFAS chemicals, according to a new report commissioned by Environmental Health News (EHN) and the consumer watchdog site Mamavation. Of the 40 bandages they analyzed in a lab, 65% contained signs of PFAS chemicals.

    Also known as “forever chemicals,” because that’s approximately how long they linger in the environment, there are at least 12,000 types of PFAS. The health consequences of PFAS exposure are unclear. But this class of chemicals has been linked by the Environmental Protection Agency (EPA) to increased risk of certain cancers, decreased fertility, high blood pressure in pregnant people, developmental delays and low birthweight in children, hormonal disruption, high cholesterol, reduced effectiveness of the immune system, and more. According to the U.S. Centers for Disease Control and Prevention and the National Institute of Environmental Health Sciences,  97% of Americans have PFAS in their blood. The chemicals are found in thousands of common products, including food packaging, adhesives, carpeting, clothing, furniture, varnish, cleaning products, shampoo and cosmetics. They are also widespread in the water supply and food chain, and even in the rain.

    Mamavation and EHN have made it something of a mission to conduct regular checks of various products, sending samples to laboratories to test them for the presence of organic fluorine, which is found in the presence of PFAS and is easier to detect than the chemicals themselves. A positive result for fluorine is considered a presumptive indicator that PFAS are there as well. In recent years, the two groups have made news with their discovery of PFAS-related chemicals in contact lenses, tampons and sanitary pads, dental floss, diapers, condoms, and sports bras.

    Read More: Why Heart Disease Research Still Favors Men

    To conduct the current analysis, the investigators selected 40 different bandage products from a variety of brands and sent them to a laboratory certified by the EPA. Bandages, of course, typically have two parts: the absorbent pad, which goes directly over the wound, and adhesive flaps. PFAS chemicals are sometimes added to the pads of bandages to help resist moisture, and to the flaps as an adhesive ingredient. Both were tested by the lab for fluorine levels at or exceeding 10 parts per million (ppm).

    “Ten parts per million is the limit of detection, and that’s a large amount,” says Terrence Collins, professor of chemistry at Carnegie Mellon University and one of the scientists involved in the study. “We know that with endocrine disruption, there is no safe dose. They fiddle with hormonal control.”

    Of the 40 bandages tested, 26 had fluorine levels ranging from 10 PPM to 374 PPM. Of 16 bandages manufactured in black or brown skin tones for people of color, 10 fell into that contamination range.

    Products varied widely in the amount of fluorine they contained, even within the same overall brand. Bandages from CVS Health and BAND-AID, for example, fell into all three categories—those with the lowest, middle, and highest levels of fluorine—depending on the exact product tested.

    Among the products that fared the worst were BAND-AID OURTONE Flexible Fabric BR65 Bandages, which weighed in at the peak of 374 PPM on the adhesive portion and 260 PPM on the absorbent pad. Bandages on the lower end of fluorine contamination included BAND-AID Water Block Tough Strips, at 13 PPM on the flaps and nothing detected on the pad; and CVS Gentle Fabric Hypoallergenic Bandages, with 10 PPM on the pad and fluorine-free flaps.

    In an email to TIME, a spokesperson for CVS said, “We’re in the process of reviewing and evaluating the information in Mamavation’s bandage report.” Kenvue, makers of BAND-AID, did not immediately respond to a request for comment.

    The bandages without evidence of PFAS tended to come from smaller brands, such as Patch Bamboo Bandages for Kids With Coconut Oil, with nothing detected on the pad or the flaps; and dark brown TRU COLOR Skin Tone Bandages, which also had no detectable fluorine.

    Read More: Hormonal Birth Control Doesn’t Deserve Its Bad Reputation

    While the pad, which makes direct contact with an open cut, would seem to present the greater contamination danger, mere contact with the skin via the adhesive flaps may be enough to allow PFAS to leach into the body, says Collins. “You have to assume that the body will have an affinity for a multitude of PFAS compounds.”

    Bandages are just one possible route of exposure to PFAS. Our homes and personal care products are teeming with them. Though some PFAS may be excreted in urine and menstrual blood, once the chemicals get into the body, they can accumulate in the blood and tissues including the brain, liver, lung, bone, and kidney. 

    There’s not much consumers can do, and fixing the PFAS problem will not be easy. In February, the EPA tightened limits on nine varieties of PFAS that had previously been less regulated. Additionally, legislation is pending or has been passed in seven states—California, Colorado, Maryland, Washington, Rhode Island, Minnesota, and Connecticut—to limit or prohibit PFAS in a range of consumer products, as well as in firefighting foam. But they are already ubiquitous in the environment.

    “Once you make them, you can’t just crack a whip and call them back,” says Collins. “The stuff that’s out there will accumulate in living things that die and get covered up with sediment. A few thousand years from now,” he predicts, “you’ll be able to dig back and find the fluorine layer.”

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    Jeffrey Kluger

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  • COVID-19 ‘Radically’ Changed the Leading Causes of Death

    COVID-19 ‘Radically’ Changed the Leading Causes of Death

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    COVID-19 became the second leading cause of death globally in the year after it was declared a pandemic, according to a study published in the Lancet.

    While heart disease remained the top killer, COVID “radically altered” the main five causes of death for the first time in 30 years, displacing stroke, the publication said. In 2021, 94 in every 100,000 people died from COVID, on an age-standardized basis.

    Since 1990, global life expectancy increased by 6.2 years, mainly due to reductions in death from diarrhea and lower respiratory infections and better outcomes for people suffering from a stroke or ischemic heart disease.

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

    “Our study presents a nuanced picture of the world’s health,” said Liane Ong, co-first author of the study and a lead research scientist at the Institute for Health Metrics and Evaluation. “On one hand, we see countries’ monumental achievements in preventing deaths from diarrhea and stroke. At the same time, we see how much the COVID-19 pandemic has set us back.”

    From 2019 to 2021, progress was made in preventing deaths for most other top causes of death except for Alzheimer’s disease and other dementias and malaria.

    The study is thought to be the first that compared deaths from COVID to deaths from other causes. It tracked 288 causes of death in 204 countries and territories and 811 subnational locations.

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    Alex Tanzi/Bloomberg

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  • Is It Safe to Eat Eggs and Chicken During the Bird Flu Outbreak?

    Is It Safe to Eat Eggs and Chicken During the Bird Flu Outbreak?

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    The ongoing outbreak of bird flu has infected at least one person in the U.S. and has raised questions about how safe poultry and eggs are to eat right now.

    So far, there have been no reported cases of spread among people, or of a person contracting this strain of avian influenza (also known as H5N1) from contaminated egg or poultry products, according to the U.S. Centers for Disease Control and Prevention (CDC). The CDC says that the current public health risk is “low.”

    Here’s what scientists know right now about bird flu and food safety.

    Eggs

    The largest producer of eggs in the country, Cal-Maine Foods in Texas, temporarily stopped production at one of its facilities on Apr. 2 after H5N1 was identified there. The company also culled more than 3% of its flock in response to the outbreak.

    Eggs from infected chickens are unlikely to be on supermarket shelves, the FDA says. That’s because in the time that it takes to detect an avian flu virus in a flock of egg-laying chickens, 99.99% of eggs would not have reached store shelves yet, since they would still be in the process of being distributed. That prediction comes from a model for estimating the risk of human exposure from avian flu outbreaks that was developed by the U.S. Department of Agriculture (USDA) and the U.S. Food and Drug Administration (FDA) in 2010. According to that assessment, even if an infection among chickens was discovered after eggs had hit supermarket shelves, more than 98% of potentially contaminated eggs could be removed from stores after a recall was issued.

    Read More: Is Eating a Plant-Based Diet Better For You?

    Another safeguard: pasteurization inactivates viruses in eggs and therefore eliminates most risk to human health. Properly handling eggs—including avoiding cross contamination of any raw products with other foods—and cooking them at least until the yolks and whites are firm will further reduce any risk of infection.

    Poultry

    Like it is with eggs, the risk of buying infected chicken at the grocery store is very low, according to the USDA and FDA. The model predicted a 95% probability that infected poultry would not make it to stores, since the virus would lead to relatively high mortality among the chickens, and farmers would be aware of the infection before the poultry was prepared for sale. However, the scientists determined that there is a 5% chance that infected chickens reaching market size would be slaughtered and sold before the virus was detected.

    Read More: Why Your Diet Needs More Fermented Pickles

    The best way to prevent that from happening is to increase testing of flocks on farms, the risk assessment concluded. Farmers can also detect illness in their flocks by monitoring how much feed the birds eat, since birds tend to eat less when they’re sick. According to the risk assessment, keeping track of feed consumption can lead to a 96% chance that an infected chicken is not processed for market, and can reduce the risk of human disease by 23 fold, while checking for signs of sickness leads to a 95.5% chance that infected chickens are not processed for market and reduces the risk of human illness by 8-fold.

    As an added safety measure, keep raw chicken away from uncooked foods and cook chicken to 165°F, which likely inactivates any virus that could make people sick.

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    Alice Park

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  • Why Heart Disease Research Still Favors Men

    Why Heart Disease Research Still Favors Men

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    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.

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  • Scientists Find New Genetic Variants for Obesity

    Scientists Find New Genetic Variants for Obesity

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    Researchers believe they have discovered a new biological mechanism for obesity, pointing to rare variants on two genes that dramatically increase the risk of carrying excess weight.

    Research published in the journal Nature Genetics on Thursday points to variants that raise the chance of being obese by as much as six times. Unlike other known variants that affect weight gain in children, these only appear to play a role in adults.

    Unraveling obesity’s mechanisms could help scientists develop new drugs, or tailor existing ones, for a condition that now affects one in eight people. For the first time, patients can now take highly effective medicines to shed unwanted weight. The revolution, led by drugmakers Novo Nordisk A/S and Eli Lilly & Co., carved open a market that could surpass $100 billion globally by 2030.  

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

    Using data from over 500,000 people, scientists from the Medical Research Council at the University of Cambridge found variants in two genes called BSN and APBA1 that increased the risk of obesity in adults. 

    The variants in BSN, also known as Bassoon, were associated with an increased risk of diabetes and fatty liver disease. The Bassoon variants affect about 1 in 6,500 adults, the researchers said.  

    The hypothesis is that as people who have these gene variants get older, neurons in their brain start to degenerate, removing “some of the key circuits within the brain controlling food intake and therefore you end up with obesity,” said Giles Yeo, one of the authors of the study and a professor at the MRC Metabolic Diseases Unit.

    The Bassoon variant may one day help drugmakers develop preventive medicines, according to Yeo. The question would be, “can we actually slow down the process, prevent the process from happening to begin with, so that then we prevent more people from ending up with obesity, particularly in adulthood.” 

    The researchers used the UK Biobank database and worked with AstraZeneca Plc to check that their findings applied beyond people of European ancestry, using data from Pakistan and Mexico.

    Astra is one of the latest drugmakers to join the obesity race, having clinched a deal last year to buy an experimental pill that’s still in early-stage tests.

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    Ashleigh Furlong/Bloomberg

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  • How to Talk to Kids When a Parent Has Cancer

    How to Talk to Kids When a Parent Has Cancer

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    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.”

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    Sarah Klein

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  • A Person in the U.S. Tested Positive for Bird Flu

    A Person in the U.S. Tested Positive for Bird Flu

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    In a rare case, the U.S. Centers for Disease Control and Prevention (CDC) confirmed on April 1 that a person in the U.S. has tested positive for avian influenza, also known as bird flu. Despite the positive test, however, the CDC says risk to the general public remains low.

    Health officials have been tracking an outbreak of highly pathogenic avian influenza since a new variant emerged and began killing birds on multiple continents in 2020. Sixty-seven countries reported outbreaks in 2022, according to the World Health Organization (WHO), followed by another 14 in 2023. Human cases, however, remain rare. Only 11 infections resulting from the currently circulating strain have been reported globally since 2021.

    Since January 2022, bird flu viruses have been detected among more than 82 million birds in the U.S., according to the CDC. More recently, mammals in the U.S.—including dairy cows and goats—have tested positive.

    According to the CDC’s April 1 announcement, the person who tested positive had contact with cows in Texas presumed to have bird flu. Their only reported symptom was conjunctivitis-like eye redness. They were told to isolate and are recovering after being treated with flu antivirals, which seem to work against the virus, the CDC says. (Seasonal flu vaccines do not protect against avian flu, however.)

    Read More: Is COVID-19 Still a Pandemic?

    The U.S.’ last human case of avian flu was reported in 2022, after someone was exposed to infected poultry in Colorado. They went on to recover.

    The CDC maintains that risk to the general public is low, although people who are in prolonged close contact with birds and livestock may be at increased risk of infection. The agency advises avoiding direct contact with sick or dead animals, as well as any materials that may have been contaminated by an animal infected with avian flu. People who may have been in contact with infected animals should be monitored for symptoms including eye redness, fever, cough, sore throat, congestion, muscle aches, fatigue, and shortness of breath. The disease’s severity can range from mild to fatal.

    Food safety is not a major concern at this point, according to the U.S. Department of Agriculture (USDA). Poultry products are inspected for signs of disease before being made available for purchase, and dairy farms have been directed to destroy milk from infected cows. The pasteurization process also removes viruses from milk, and properly cooking eggs and poultry kills bacteria and viruses.

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    Jamie Ducharme

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  • Tuberculosis Is the Highest It’s Been in a Decade

    Tuberculosis Is the Highest It’s Been in a Decade

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    NEW YORK — The number of U.S. tuberculosis cases in 2023 were the highest in a decade, according to a new government report.

    Forty states reported an increase in TB, and rates were up among all age groups, the Centers for Disease Control and Prevention said Thursday. More than 9,600 cases were reported, a 16% increase from 2022 and the highest since 2013.

    Cases declined sharply at the beginning of the COVID-19 pandemic, but have been rising since.

    Most U.S. TB cases are diagnosed in people born in other countries. Experts say the 2023 number is in part a combination of a surge in TB cases internationally—the World Health Organization said TB was behind only COVID-19 in infectious fatal diseases worldwide in 2022. And there are also increases in migration and post-pandemic international travel.

    But other factors are also at play, including other illnesses that weaken the immune system and allow latent TB infections to emerge.

    CDC officials expected TB numbers would rise, but the 2023 count “was a little more than was expected,” said Dr. Philip LoBue, director of the agency’s Division of Tuberculosis Elimination.

    Despite the jump, the number and rate of new TB cases each year remains smaller than it was in the past, and the U.S. has a lower rate of new TB cases than most countries.

    Read More: Ticks Carry More Diseases Than Just Lyme

    Tuberculosis is caused by bacteria that usually attack the lungs, and is spread through the air when an infectious person coughs or sneezes. If not treated properly, it can be fatal. In the late 1800s, TB killed one out of every seven people living in the United States and Europe. But the development of antibiotics and public health efforts succeeded in treating infections and tracking down those they infected, leading to cases falling for decades.

    The new CDC statistics are not a count of how many people were newly infected in 2023, but rather of how many people developed a cough or other symptoms and were diagnosed.

    An estimated 85% of the people counted in 2023 were infected at least a year or two earlier and had what’s called latent TB, when the bacteria enters the body and hibernates in the lungs or other parts of the body. Experts estimate as many as 13 million Americans have latent TB and are not contagious.

    When the immune system is weakened—by certain medications or other illnesses like diabetes and HIV—the TB wakes up, so to speak. Nicole Skaggs said she was infected in 2020, but didn’t develop symptoms until 2022—after she got sick from COVID-19.

    “Anything that can take out or lower your immune system can put you at risk,” said Skaggs, 41, a property manager in Bothell, Washington.

    CDC officials called the idea that COVID-19 has played a role in increased reactivation of TB “an important question.” Scientists are still learning what causes latent TB to reactivate and “I would consider it an unknown at this point,” LoBue said.

    “It’s too early to tell” what will happen to TB trends in the next few years, he also said.

    There are TB vaccines being developed, and public health workers that were focused on COVID are now back to trying new approaches to preventing TB. New York City, which saw cases jump 28% last year, is hiring TB case managers and community health workers and increasingly using video monitoring of patients taking medications to keep treatment rates high, said Dr. Ashwin Vasan, the city’s health commissioner.

    On the other hand, federal TB funding for state and local health department efforts has been flat, and one of the key antibiotics used against TB has been in short supply in recent years. Plus, drug-resistant TB infections have popped up in a fraction of cases.

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    Mike Stobbe/AP

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  • A Rare Bacterial Disease Is Rising in the U.S.

    A Rare Bacterial Disease Is Rising in the U.S.

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    NEW YORK — U.S. health officials are warning of an increase in rare bacterial illnesses than can lead to meningitis and possible death.

    The Centers for Disease Control and Prevention issued an alert to U.S. doctors on Thursday about an increase in cases of one type of invasive meningococcal disease, most of it due to a specific strain of bacteria.

    Last year, 422 cases of it were reported in the U.S.—the most in a year since 2014. Already, 143 cases have been reported this year, meaning infections appear to be on track to surpass 2023, the CDC said. Most of the cases last year did not involve meningitis, though at least 17 died. The cases were disproportionately more common in adults ages 30 to 60, in Black people and in people who have HIV, the CDC said.

    The bacteria can cause a dangerous brain and spinal cord inflammation called meningitis, with symptoms that may include fever, headache, stiff neck, nausea, and vomiting. The bacteria also can cause a bloodstream infection with symptoms like chills, fatigue, cold hands and feet, rapid breathing, diarrhea, or, in later stages, a dark purple rash.

    The infection can be treated with antibiotics, but quick treatment is essential. An estimated 10% to 15% of infected people die, and survivors sometimes suffer deafness or amputations.

    There also are vaccines against meningococcal disease.

    Officials recommend that all children should get a meningococcal conjugate vaccine, which protects against the rising strain, at around the time they enter a middle school. Since vaccine protection fades, the CDC also recommends a booster dose at age 16. Shots also are recommended for people at higher risk, like those in a place where an outbreak is occurring or those with HIV infection or certain other health conditions.

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    Mike Stobbe/AP

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

    Why Walking Isn’t Enough When It Comes to Exercise

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    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.” 

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    Ashley Mateo

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  • Why So Many Dogs Have Allergies Now

    Why So Many Dogs Have Allergies Now

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    Every day, itchy dogs shuffle into Elizabeth Falk’s veterinary office. Some can’t stop chewing their feet or scratching their bellies. Others have red, smelly ears, or rashes on their skin. All are intensely uncomfortable because of environmental allergies. “They’re sitting in the waiting room, and everyone else is backing away out of fear that it’s contagious,” she says. “It’s super busy helping as many as we can.” Until recently, Falk was a veterinary dermatologist at Cornell University Veterinary Specialists, where she saw about 15 allergic pets a day and was booked up to six months out. Demand is so high that in April, she’ll open her own pet dermatology practice.

    More and more dogs are suffering from atopic dermatitis, otherwise known as environmental allergies: According to a 2018 report from Banner Pet Hospital—the latest U.S. numbers on the subject—there’s been a 30% increase in cases over the past 10 years. In 2021, a teaching hospital in Brazil reported that 25% of dogs they examined suffered from allergies. Though dog allergies aren’t consistently tracked, anecdotally, they’re soaring. “Allergic skin disease is probably the top thing we see,” says Erin Tate, vice president of clinical development at CityVet in Dallas. “I’ve been doing this for 25 years and have definitely seen a dramatic increase in recent years.” Dogs with environmental allergies tend to be “miserable,” she adds, sometimes scratching so aggressively that their hair falls out. Spring is a particularly trying time. “I tell people that if your allergies are flaring up, your dog’s allergies are flaring up, too,” Tate says.

    But what’s driving the increase in itchiness? And what helps relieve allergic dogs’ agony?

    Some dogs are allergy magnets

    There’s a strong genetic component to atopic dermatitis, Falk says. Certain breeds are prone to them, including German Shepherds, Labrador Retrievers, French Bulldogs, English Bulldogs, West Highland Terriers, Shih Tzus, pitbulls, pugs, and Boxers. Allergies look different in different breeds. German Shepherds, for example, tend to get crusts around their lips, Falk points out, while labs develop bumps between their toes.

    Read More: Dog Owners Live Longer, Healthier Lives

    Environmental allergies typically first appear when a dog is 6 months to 3 years old, says Matthew McCarthy, founder of Juniper Valley Animal Hospital in Queens, though there are outliers. Allergies are the result of skin barrier dysfunction, or a defective outer layer broken down by inflammation. “The old-school way we used to think about this was, these guys are inhaling [allergens], and they’re getting into their bloodstream, and they’re reacting, and that’s what’s causing the histamine to be released,” McCarthy says. “Now, we know that’s probably not the case.” Instead, airborne allergens—like pollen from grass or trees—likely get absorbed through the dogs’ skin. That leads to symptoms such as excessive itchiness, which might prompt dogs to constantly lick or chew their feet or rub their faces. In some cases, atopic dermatitis manifests as frequent skin and ear infections rather than itchiness; an especially unlucky group of dogs experience all of the above.

    Climate change plays a role

    The main reason why an increasing number of dogs suffer from allergies has to do with the warming planet. “Allergy season has been extended because of climate change and the dramatic change in temperatures,” Tate says. During the winter where she lives in Texas, there might be a couple cold days in the 30s or 40s, immediately followed by a jump to the 70s or 80s. “Every time we get that warm spell in between the cold, stuff starts to bloom again,” she says. “Nothing ever gets a chance to die.”

    Read More: Why Allergy Seasons Are Getting Worse

    Research suggests that warmer weather and increased carbon dioxide concentrations extend the growing season for mold spores and plants like ragweed, while also worsening air pollution. In North America, pollen seasons now start 20 days earlier and are 10 days longer than they were in 1990. Plus, there’s an average of 21% more pollen during each allergy season. Cue the frantic calls to your pup’s vet. “Climate change is affecting humans and dogs,” Tate says.

    Dogs used to get dirtier than they do now

    Early exposure to microorganisms—through things like dirt, germs, and even dogs—can help protect infants from developing allergies. The same is true of dogs, says Matthew Levinson, a veterinary dermatologist who owns Pet Derm in Chicago. Research suggests that dogs who live in a rural environment, regularly go for walks outside, and have contact with farm animals are less likely to have environmental allergies, while atopic dermatitis is more prevalent in urban environments, where dogs tend to spend a greater amount of time inside.

    “We’re more clean and hygienic—dogs aren’t spending as much time outside anymore,” Levinson says. “It’s not like back in the day, where you’d have a dog house in the backyard, and the dog spent most of the day in the yard.”

    Meanwhile, dogs who live in a household with other dogs also appear to benefit from a protective effect. But that doesn’t necessarily mean you need to adopt another dog—or try to expose your pet to more germs. It’s difficult to tease apart all the genetic and environmental factors that contribute to allergies, Levinson says. There’s simply “too much variation between the individual dogs, and so much that’s subjective,” he says, making wholesale recommendations tricky.

    A silver lining: better treatment options than ever

    On any given day, Levinson treats 14 to 17 allergic dogs. He says he feels so guilty knowing how many more are suffering that he often double-books appointments. When an itchy dog arrives in his office, he first takes a detailed history: What areas of the body are itchy, and what times of the year do they flare up? He’ll do a physical exam, looking for redness in their paws and groin, and might suggest an elimination diet to rule out food allergies. Once he’s certain the dog has environmental allergies, he’ll usually advise allergy testing. That means he injects dozens of small amounts of allergens under the dog’s skin, and if the pup is allergic, a hive will form at the site, pointing to the culprit.

    Managing allergies is a “marathon, not a sprint,” Levinson stresses, and most dogs require lifelong treatment. There’s no cure, but treatment options are far better now than they were even a decade ago. The majority of dogs respond well to immunotherapy: customized injections, just like the allergy shots humans receive, that train the immune system to become desensitized to certain allergens. It could, however, take more than a year to see results.

    Read More: Suffering from Seasonal Allergies? Here’s What Experts Say Works Best

    There are other options. In 2013, an oral medication called Apoquel was approved to control itchiness and inflammation in allergic dogs. “It was like a miracle,” Falk says. “We had been waiting for it for so long.” It’s safe and well-tolerated, she adds, and is a “reasonable long-term medication” for itchy dogs who get skin infections.

    A few years later, in 2016, another treatment option came on the scene: Cytopoint, a targeted therapy that’s administered via injection every four to eight weeks. It’s a monoclonal antibody to an itch signal called interleukin (IL)-31, Falk explains. “It binds to that itch signal,” she says. “It doesn’t affect the rest of the immune system in any way, which makes it very safe.” The downside, she adds, is that it’s only intended to control itchiness—so allergic dogs prone to infections caused by inflammation will still get them. That’s why it’s important to align medication choices with how a dog manifests allergies: Itchy dogs who never get infections usually do best on Cytopoint, while Falk often prescribes Apoquel for those who do develop infections, since it’s a good anti-inflammatory choice.

    However, doggy dermatology doesn’t come cheap, and pet insurance typically only covers treatment if dogs are insured before they become symptomatic. Allergy testing can cost upwards of $1,000 out of pocket, Apoquel is about $90 for 30 tablets, and a Cytopoint injection can range from $50 to $200, depending on the dog’s size.

    Is there any way to prevent allergies?

    Having an allergic dog typically boils down to bad luck. If a dog is born predisposed to itch, he’s going to itch. But if you’re considering buying a puppy from a breeder, it can be helpful to ask them if there are any allergic dogs in a potential pet’s pedigree, Falk advises. Research suggests that when two dogs with atopic dermatitis are bred, 65% of their offspring will have environmental allergies; if just one parent has the condition, that drops to 21% to 57%; and if neither parent has allergies, 11% will go on to develop problems.

    If your dog has allergies (and even if they don’t), make it a point to bathe him regularly—about once a month—to remove potential allergens from the skin, Tate advises. She thinks of dogs as “little dust mops” who pick up a lot when they’re gallivanting around outside. Some people like to wipe their pets down with unscented baby wipes to get the pollen off, she adds.

    And, most importantly, if your dog is suddenly scratching a lot more than usual, take him to the vet. Depending on the severity of the situation, your vet might refer you to a specialist, but many cases can be handled by your regular vet. “The earlier you get started with immunotherapy, the better the success rate,” Levinson says. “When the dog is younger, you can mold the immune system a lot easier, versus if you have a dog who’s had allergic symptoms for several years.” The sooner you get on top of your dog’s health, he stresses, the happier you’ll both be.

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    Angela Haupt

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  • How Hypertrophic Cardiomyopathy Progresses in Adults

    How Hypertrophic Cardiomyopathy Progresses in Adults

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    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.”

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    Markham Heid

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