Sunday, January 26, 2020

How to avoid smoking to stay away of Harm to the health and body

Are you taking care of someone who seems to be against you? This can be the experience of taking care of a family member with post-traumatic stress disorder — PTSD — and it can take a huge toll on everyone involved. At the same time, caring for a person with PTSD can be an act of love and courage. PTSD can develop when people experience massively stressful events that involve childhood physical or sexual abuse, being sexually assaulted, or narrowly escaping getting killed or severely injured, whether from accidents or violence or military combat. PTSD can also be caused by witnessing these kinds of things, by them happening to a close friend or relative, or by learning about them in the course of one’s work, such as being a first responder or a social worker helping victims of abuse.

Whether caused by experiences during military service, abuse as a child, being the victim of the assault as an adult, or as a side effect of jobs that deal with trauma, the effects can be lifelong. It’s a medical problem, not a weakness. Adrenaline levels stay elevated, causing anxiety, irritability, and hypervigilance (being on guard even in safe places). People with PTSD may become snappy and even physically aggressive. Little, everyday sounds may make the person jump. The ability to feel positive emotions like love and happiness is diminished, and people with PTSD may drink or use drugs to avoid painful feelings and memories. People with severe PTSD may isolate themselves, lashing out and showing little affection toward people they care about, and who care for them. Conflict with family members and coworkers is common.
Caring for a person with PTSD

It It can be hard for caregivers not to take it personally. They feel that their loved one doesn’t love them anymore (and indeed it’s difficult for some people with PTSD to feel and express love). The fun is gone, and in romantic relationships so is intimacy. The family member with PTSD may not be comfortable going out in public or being touched. Caregivers can feel lonely and abandoned, and divorce is common in relationships where a partner has PTSD. Watchwords for caregivers are self-care, limits, and realistic expectations. It’s a balance: you want to help your loved one but you can’t do that if you’re impaired yourself. So, self-care is important. Figure out what you need to have a happy and healthy life and make an effort to keep those things in your life. Eat right, get exercise, take time off from caregiving, see friends. When you’re healthier, you’ll be better able to help your family member to be healthier. Set limits. You want to offer gentle support, but not tolerate things that are out of bounds for you in any other relationship, such as abusive language or actions, or heavy substance abuse. Couples therapy can be tremendously helpful when one member of the couple has PTSD.

Expectations need to be realistic. Just as other medical disabilities can limit the activities of people who have them, you may need to adjust your expectations about your loved one’s engagement in“regular” family things like going on outings, to restaurants, to parties, to your kids’ games. You may need to take more of a lead in the relationship than you used to or expected to, such as in managing finances, making plans, and getting things done. The good news is that we live in a time when effective PTSD treatment exists. PTSD is best treated through cognitive behavioral therapies, particularly exposure therapy and cognitive processing therapy. These are specialty treatments and not all mental health clinicians are trained in them. A loved one with PTSD may be reluctant to seek treatment, and gentle encouragement can be helpful. You can find therapist referrals at the International Society for Traumatic Stress Studies and the Association for Behavioral and Cognitive Therapies.

PTSD symptoms may not completely go away, but they can be reduced. Just like turning down a volume knob, constantly high levels of anxiety or irritability can be lowered, and the power of memories and reminders of trauma can be reduced. Just like in the rest of your body, advancing years can take a toll on your brain function. Much of this slowing down is predictable and can be chalked up to normal aging. However, when thinking skills become increasingly fuzzy and forgetfulness gets to be a way of life, an early form of dementia known as mild cognitive impairment may be setting in.

Often, the first reaction is to attribute these changes to the beginning of Alzheimer’s disease. But blood flow problems may be to blame, as well. “An estimated one-third of all cases of dementia, including those identified as Alzheimer’s, can be attributed to vascular factors,” says Dr. Albert Hofman, chair of the department of epidemiology at the Harvard T.H. Chan School of Public Health.
Heart health and brain health are connected Vascular — blood vessel — problems include atherosclerosis (the buildup of fatty plaque in the arteries) and arteriosclerosis (the stiffening of arteries with age). Both are well-known contributors to heart disease. These same processes can also damage brain function by interfering with the steady supply of oxygen-rich blood that nourishes brain cells.

In the case of a stroke, sometimes called a “brain attack,” large swaths of brain tissue die when a blood clot in a major brain artery abruptly halts the flow of blood. In addition to suffering immediate damage from a stroke, roughly one in three stroke survivors will eventually develop dementia. More subtle injuries are caused by tiny blockages in the small vessels deep within the brain. These silent strokes are 10 to 20 times more common than overt strokes. The microscopic damage they leave behind also raises the risk that dementia will emerge at a later date. Having blood vessels compromised by plaque buildup can also pave the way for Alzheimer’s. The accumulation of deposits of a protein known as beta-amyloid — the hallmark of the disease — is a direct consequence of what doctors call hypoperfusion. This means the brain is not getting a sufficient supply of blood over the long term. Because of these overlaps, says Dr. Hofman, it doesn’t make sense to draw sharp distinctions between Alzheimer’s and vascular dementia.
Protect your heart and your brain

As with heart health, a key step in maintaining your cognitive abilities is to reduce your major cardiovascular risks. This includes getting regular physical activity, quitting smoking, managing blood sugar and blood cholesterol levels, eating a healthy diet, and maintaining a healthy weight. Of particular importance is keeping high blood pressure in check, especially in middle age. High blood pressure is the leading cause of stroke. It is also thought to stimulate the growth of micro-injuries in the white matter of the brain. The presence of these lesions can slow thinking and hasten the loss of cognitive function that accompanies Alzheimer’s. When I talk to teens in my practice about cigarettes, what I hear from lots of them is that the smell is what keeps them from smoking. They don’t want to smell like cigarette smoke, and they don’t want that taste in their mouth, either.

E-cigarettes and tobacco are different, of course. E-cigarettes do not have many of the carcinogens that cigarettes do, and could be useful for smokers who are trying to quit. But for teens that have never smoked, it’s a different story. The “vapor” of e-cigarettes doesn’t have to contain nicotine, but it can (it does contain chemicals such as formaldehyde that could have long-term health consequences) — and nicotine is addictive. Using e-cigarettes is physically close enough to smoking cigarettes that moving from smoking one to smoking the other could easily happen.
One of the more typical reasons for a trip to the emergency department on Thanksgiving Day (and most days, frankly) is accidental cuts to the hands. Be careful cutting up that turkey! Always use a carving fork, and although the household might be busy, try to avoid distractions when working with knives. Thankfully most such injuries can be repaired in the ED, but occasionally are bad enough to warrant being seen by a hand surgeon. For simple cuts to the hand, we generally place non-absorbable stitches that need to be removed in about 10 days. Most of the time, antibiotics are not needed — just a really good washout and cleaning prior to stitching.

Everyone “knows” about the dangers of cooking turkey, yet somehow nationwide, each year, the rate of residential fires more than doubles during this time frame. Never leave the house with the oven on, and check on the turkey frequently. If you choose to deep-fry a turkey, always do this outside, and always make sure the turkey has thawed first. Placing a frozen turkey into a deep fryer can cause explosions of hot oil, which can lead to third-degree burns and other serious injuries. If you’re frying a turkey, always wear good footwear, practice fire safety, and monitor children in the area. Most birds carry bacteria, and the turkey is no exception. The most common pathogen is Salmonella. If cooked properly, this poses no harm. Under-cooked, the bacteria can cause diarrhea, vomiting, fever, and general illness that ranges from uncomfortable to life-threatening. The recommended temperature for a cooked turkey is at least 165° F, and should be checked by thermometer. Did you know that if you have any questions about cooking your turkey, you can call the Butterball hotline? Even on Thanksgiving Day

Delicious holiday foods are usually well seasoned …with salt. For most adults this does little more than make you thirsty, but for people with congestive heart failure or chronic edema (water retention), extra salt can place increased stress on the body. If you have these conditions, please be careful with what and how much you eat. Inevitably, we will see a few patients with episodes of worsening heart failure in the emergency department … usually the day after a holiday. Last but not least, be careful about driving. It’s all too common to see drunk drivers during Thanksgiving time. It is historically the most dangerous time of the year for car accidents and subsequent fatalities. Monitor how much you drink, and remember that even if you are sober, unfortunately not everyone else out there is. Be extra attentive. Drive safe! When we think of anxiety disorders, we generally think of them as uncomfortable emotional responses to threat. These responses may include symptoms such as palpitations, shortness of breath, sweating, trembling, or absolute paralysis. While there is nothing inherently wrong in thinking about anxiety this way, a recent study pointed out that there is an entirely different way of thinking about anxiety that may be even more helpful. According to psychologist Kalina Christoff and her colleagues, anxiety may be more appropriately thought of as “mind-wandering gone awry.”

In your brain, there are circuits that promote mind-wandering and they are not all bad. In fact, these very circuits help you maintain a sense of self, understand what others are thinking more accurately, become more creative, and even predict the future. Without your mind-wandering circuits, your brain’s ability to focus would become depleted, and you would be disconnected from yourself and others too. In addition to the natural and frequent tendency for your mind to stray, it also has automatic constraints too, to ensure that it does not stray too far. When daydreaming during a boring lecture, for example, your brain may jerk you back into reality.

One of the things that a wandering mind is in search of is meaning. By connecting the past, present, and future, it helps you compose a narrative to connect the dots in your life. This narrative is constantly being updated. But sometimes, the wandering mind can encounter threats. Rather than proverbially “whistling in the dark,” the brain can overreact to these threats. In the brain of an individual with generalized anxiety disorder, for example, the anxiety processor (the amygdala) is disrupted. Although it has strong connections to the “inner eye” (attention), it lacks a connection to the brain circuits that signal how important or significant a threat is. Without the ability to assess the significance of threats, they can all feel the same.

As a result, the “inner eye” gets fixated on negative thoughts. This fixation is a way of constraining the mind too, but it is not actually helpful. Anxious people focus more on external threats in an exaggerated way. They become glued to the threats. Anything from being teased to being ticked off feels much more troubling than it would to someone without an anxiety disorder. And it’s not just conscious threats that grab your attention. It’s subliminal threats too! Threats, of which you are completely unaware, capture your brain’s attention. A mind, once free to wander, is desperately forced to stop in its tracks in what can be construed as a catastrophic confusion of constraints.
Let your mind wander away from perceived threats

Practically speaking, there are a few ways to do this. First, identify the negative spiral that has occurred like a pothole into which you have fallen on a mind-wandering journey. Simply name the feeling you are feeling and recognize that you need a mental reset. Rather than deliberately trying to suppress the feeling, accept that your mind is wandering, and that the fixation on threat is not the constraint solution you are looking for. To counter this constraint, up the ante on the mind wandering — wander even more. If you’re at work, you could keep a knitting kit and start using it just when anxiety strikes, or if at home, you could go out and do some gardening. Meditation is also an effective way to get out of the fixed threat hole.

So when you’re next feeling anxious or wired, try allowing your mind to do what it naturally does — wander! You can bring it back to task gently, without fearing that you have lost your way. Or you can expect that it is wired to switch between wandering and focused states, and it will eventually come back on its own. The more you mindfully interact with this switch, the more adept your brain will become at initiating it. A pair of recent studies provides useful information to men facing challenging decisions about what to do after being diagnosed with early prostate cancer. Researchers tracked men for 10 years and found that virtually none died of the illness, even if they decided against treating it.

In one of the studies, British researchers randomly assigned 1,643 men with early prostate cancer into three groups: one group had surgery to remove the prostate, another had radiation treatment, and a third had “active monitoring,” meaning that doctors tried to predict if the cancer was spreading by measuring their prostate-specific antigen (PSA) levels every few months. Treatment could start if PSA levels jumped by 50% or more over the course of a year. It’s important to note that active monitoring differs from “active surveillance” for early prostate cancer, which relies on routine biopsies as well as PSA measurements to monitor for spreading cancer.

After 10 years, only 1% of the men had died of prostate cancer, regardless of which group they were assigned to. But tumors did spread, or metastasize, more frequently in the active monitoring group. According to the results, the cancer progressed in one in five men being monitored, compared to less than one in 10 men who received surgery or radiation. Some of the men in the monitoring group had what’s known as “intermediate-risk” prostate cancer that has a higher grade and progresses more often than low-risk prostate cancer. Laurence Klotz, a professor at the Sunnybrook Health Sciences Centre, in Toronto, Canada, who was not involved in the study, says it’s likely that most of the men who progressed on active monitoring were in the intermediate-risk category, although the authors did not report this. As time went on, more and more of the monitored men wound up being treated.

Taken together, the studies bolster a growing consensus that men with organ-confined prostate cancer can safely avoid treatment for some period of time. The results show that one case of metastatic cancer was prevented for every 27 men treated with surgery and every 33 men treated with radiation. “These studies again confirm the lack of evidence that treatment interventions for so-called early prostate cancer lead to any meaningful benefits in survival,” said Dr. Marc Garnick, the Gorman Brothers Professor of Medicine at Harvard Medical School and Beth Israel Deaconess Medical Center, and editor in chief of HarvardProstateKnowledge.org. “Additional analyses will be required to see if we can identify those men in each group who did develop metastases and then design treatment programs to see if we can modify that risk.” I come from a long line of skilled soup makers. In the late 1800s, my great-grandmother Enrichetta Cavagnolo, newly arrived from northern Italy, was a soup chef at Delmonico’s in New York City. Enrichetta’s daughter and granddaughters (my grandmother, mother, and aunts) were talented soup makers as well, to the delight of our well-fed family.

It’s also easy to go a step further, and make soup a complete meal. “Add protein such as lentils or beans, fish, extra-lean beef, turkey, or chicken,” says registered dietitian Kathy McManus, director of the Department of Nutrition at Harvard-affiliated Brigham and Women’s Hospital. She recommends increasing the nutrient power and fiber by adding as many vegetables as possible, such as peppers, asparagus, broccoli, spinach, onions, and carrots. Too busy? Beware Knowing the shortcut is important in an age when soup tops the list of culturally cool comfort food. It’s featured in trendy soup “bars,” tiny take-out windows, and all varieties of grocery stores. While it’s tempting to skip the stove and buy prepared soups, you should note that they often contain preservatives and other unhealthy ingredients. In particular, be on the lookout for these

McManus recommends avoiding prepared soups for the most part. “They’re okay in a pinch and on occasion, as long as you set limits. Aim for less than 500 calories, 600 mg of sodium, 5 grams of saturated fat, and 5 grams of added sugar in a bowl of soup,” she says, “and cut that in half for a cup of soup. It’ll take some detective work to stick to those limits and find healthier prepared soups. Look at the nutrition information on a restaurant’s menu or website, or on a product’s Nutrition Facts label. If it’s too much work to hunt down healthy soups, then consider making the soup from scratch, like I do now. You’ll find some healthy soup recipes to get you started here. You can control the ingredients, and you can give it your own special flair. And trust me, it doesn’t take a soup-making pedigree to be good at it.

The use of e-cigarettes among youth has grown tremendously over the past few years — and e-cigarettes are being marketed to them. We don’t know what the consequences of this will be. It could be that we will end up with more smokers — or that we’ll end up with fewer if teens decide to stick with e-cigarettes, especially if they choose to stick with the nicotine-free kind. But we can’t just sit back and wait to see what happens. Recently the Food and Drug Administration extended its tobacco regulations to include e-cigarettes and other nicotine delivery systems, which among other things, requires that there be warning labels and that you have to be at least 18 years old to buy them. This is a good start, and will help us look more carefully at how e-cigarettes are being marketed, too.

All of us who are raising or interacting with teens need to talk with them more about e-cigarettes. We need to understand how teens think about them, and why they might choose to use them; when it comes to teens, listening is really important. And along with listening, we need to help teens understand the risks involved. We can’t let them get distracted or seduced by marketing and flavoring; we need to help them make the best choices for their health.

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