Month: July 2021

Ahem! Ahem! Ever feel the need to move the mucus that annoyingly sits all the way at the back of your mouth? Most of us do at one time or another. The sensation usually lasts for just a few days when dealing with symptoms of a common cold.

But what happens if throat clearing lingers for weeks or months? That nagging feeling may be uncomfortable for the person who has the problem, and might also bother friends and family who hear the characteristic growling sound.

So what causes all that throat clearing? There are many causes, but I’ll focus here on four of the most common culprits. It’s important to know that throat clearing lasting more than two to three weeks deserves an evaluation from a medical professional.

Post-nasal drip

Post-nasal drip is probably the most common cause of throat clearing.

Your nose makes nasal mucus to help clear infections and allergens, or in response to irritants such as cold weather. A frequently runny nose can be quite disturbing. Just as mucus can drip toward the front of the nose, some mucus may also drip from the back of the nose toward the throat, sometimes getting close to the vocal cords. If the mucus is too thick to swallow, we try to force it out with a loud AHEM!

Solutions: The best solution to this problem is to treat the cause of post-nasal drip. An easy way to do it without medications is to try nasal irrigation with a neti pot. If you notice no improvement, different types of nasal sprays may help. It is best to discuss these options with a health professional, because some sprays may cause your symptoms to worsen. The key is to understand what is causing excess mucus production.

Reflux

Another common cause of throat clearing is laryngopharyngeal reflux (LPR). Acid in your stomach helps digest food. But excess stomach acid sometimes flows backward up the tube called the esophagus that links throat to stomach. This may splash on the vocal cords or throat, causing irritation and throat clearing.

Not everyone with acid reflux experiences a burning sensation in the throat. Nor does everyone have heartburn, which is a classic sign of a related condition called gastroesophogeal reflux disease (GERD). Some people merely feel an urge to clear their throat or have a persistent cough.

Solutions: Eating an anti-reflux diet and not lying down shortly after eating may help in some cases. Often, people have to use medications for several weeks or months to lower stomach acid production.

Medications

A common class of heart and blood pressure medicines can also cause throat clearing. These are called ACE inhibitors. The funny thing is that these medications can trigger the urge even after years of people taking them daily without experiencing that symptom. If that’s the cause there is an easy fix. The sensation would be completely gone after stopping the medication, although in some cases it can take several weeks to abate. It is very important to talk to your doctor before stopping a prescribed medicine, so you can switch to something else.

Nerve problems

Damaged nerves responsible for sensation around the throat area is another possible cause. These issues are more difficult to treat, and are usually diagnosed after most of the other possibilities are ruled out. People often have this type of throat clearing for many years.

Solutions: A multidisciplinary team with ear, nose, and throat doctors (otolaryngologists) and neurologists may need to investigate the problem. Medicines that change how a person perceives sensation can help.

There are many other reasons for throat clearing. Some people, for instance, just have a tic of frequently clearing their throat. Noticing any clues that point to the root cause can help. Maybe constant throat clearing happens only during spring, pointing toward allergies, or perhaps after drinking coffee, a reason to consider reflux.

An observant eye and jotting notes in a diary may help shine a light on the problem and its possible solutions. Very often, when the cause remains elusive, your primary care doctor may recommend a trial of treatment as a way to diagnose the problem.

About the Author

Marcelo Campos, MD, Contributor

Dr. Marcelo Campos works as a primary care doctor at Atrius Health. He is a lecturer at Harvard Medical School and a clinical assistant professor at Tufts University School of Medicine. Dr. Campos completed medical school in Brazil and a family medicine residency at Baylor College of Medicine in Houston, TX. He is the chief of internal medicine and family medicine at the downtown Boston location of Harvard Vanguard. His interests are immigrant health, LGBTQ health, opioid use disorders, and lifestyle medicine. View all posts by Marcelo Campos, MD

The creamy, pale green flesh of an avocado is full of nutrients closely tied to heart health. Now, a long-term study finds that eating at least two servings of this popular fruit per week is linked to a lower risk of cardiovascular disease.

Study co-author Dr. Frank Hu, the Frederick J. Stare Professor of Nutrition and Epidemiology at the Harvard T.H. Chan School of Public Health (HSPH), puts this finding in perspective. "This study adds to the evidence to support the benefits of healthy fat sources like avocados to help prevent cardiovascular disease," he says. A key take-home message is to substitute avocados for less-healthy foods such as butter, cheese, and processed meats, he adds.

Who was in the study?

The study included more than 110,000 people involved in two long-running Harvard studies: the Nurses’ Health Study and the Health Professionals Follow-up study. Most of the participants were white; they ranged in age from 30 to 75 and were free of heart disease and cancer when the study began.

Researchers assessed the participants’ diets via questionnaires given at the start of the study and then every four years. One question asked how much and how often people ate avocado. A serving was considered a half an avocado or one-half cup, cubed.

What were the findings?

During the 30-year follow-up, researchers documented 9,185 heart attacks and 5,290 strokes among the participants. Compared with people who never or rarely ate avocados, those who ate at least two servings each week had a 16% lower risk of cardiovascular disease and a 21% lower risk of experiencing a heart attack or related problem due to coronary artery disease. (Coronary artery disease refers to a narrowing or blockage in the blood vessels that supply the heart; it’s the most common type of cardiovascular disease.)

What makes avocados a heart-healthy choice?

Hass avocados, which have dark green, nubbly skin, are the most popular variety in the United States. They’re abundant in healthy fats, fiber, and several micronutrients associated with cardiovascular health:

• Oleic acid. This monounsaturated fat is also plentiful in olives. Half an avocado has around 6.5 grams of oleic acid, or about the same amount found in a tablespoon of olive oil. Research shows that replacing foods high in saturated fat (such as butter, cheese, and meat) with those rich in unsaturated fats (such as avocados, nuts, and seeds) helps lower blood levels of harmful LDL cholesterol, a key culprit in coronary artery disease.
• Fiber. One serving of avocado provides up to 20% of the daily recommended dietary intake of fiber, a nutrient that’s often lacking in the typical American diet. Fiber-rich diets may lower heart disease risk as much as 30%, probably because fiber helps lower not only cholesterol, but also blood pressure and body weight.
• Vitamins, minerals, and more. Half an avocado provides 15% of daily recommended intake of folate (vitamin B9), 10% of potassium, and 5% of magnesium, as well as various plant-based compounds called phytochemicals. All of these nutrients — along with oleic acid and fiber — have been independently linked to better heart health.

The good news is that there are so many delicious ways to add avocado to your meals, says Dr. Hu. "I make avocado toast for breakfast, use avocado as a spread for sandwiches, and add them to salads," says Dr. Hu. Some people add avocado to their smoothies — and of course, there’s always guacamole (try this recipe from the HSPH’s Nutrition Source).

About the Author

Julie Corliss, Executive Editor, Harvard Heart Letter

Julie Corliss is executive editor of the Harvard Heart Letter. Before working at Harvard, she was a medical writer and editor at HealthNews, a consumer newsletter affiliated with The New England Journal of Medicine. She is co-author of Break Through Your Set Point: How to Finally Lose the Weight You Want and Keep it Off. Julie earned a BA in biology from Oberlin College and a master’s certificate in science communication from the University of California at Santa Cruz. View all posts by Julie Corliss

Depending on your age and generation, you might not remember a time when single parenthood wasn’t considered a conscious choice for women. Yet years ago, women most often became single mothers due to divorce, the death of a spouse, or an accidental pregnancy. Today, if you’re considering becoming pregnant and having a child on your own, you are certainly not alone — you may know others who have taken this path to parenting, and you’ve certainly seen celebrities do so.

While this path is increasingly common and more widely accepted than in the past, deciding to pursue it can be lonely. This blog post attempts to reduce some of the isolation you may feel and to address some questions you may be asking yourself. (As a therapist, my experience has centered on women choosing single motherhood, and some of my wording reflects this.)

Why choose this path to single parenting?

Some people in their 20s and early 30s prefer to become pregnant, have a child, and parent without a partner. Other people in their late 30s and early 40s who had hoped to enjoy pregnancy and parenting with a partner may not have found the right partner. They may find themselves worrying more and more about declining fertility, which makes dating increasingly stressful. As one woman put it, “Every first date became a ridiculous job interview. I didn’t say it outright but I was thinking, ‘Will you marry me in five minutes and have a baby right away?’”

Do I want to be a single parent?

In my experience, women who consider single motherhood are clear that they want to be mothers. Most tell me that being pregnant and having a genetic child is a priority for them. For this reason, they are willing to consider going it alone. The wanting to be a mom is clear; it is the single part that is not. You may be asking yourself, “Will the challenges of being a single mom outweigh the joys I anticipate in parenthood?”

Years ago, a colleague told me that choosing to become a parent is like jumping off a cliff. It’s hard to clearly envision where or how you’ll land. Like everyone who becomes a parent, you will be jumping off a cliff not knowing the child you will get. As a single, the leap can feel more perilous because there is no one beside you to help cushion your landing.

Can I do it on my own?

When asking this question, people tend to focus on two things: financial security and the support of family, friends, and community.

While one need not be rich to be a parent, raising a child is expensive, and a single-parent household is a single-income household. It makes sense to look at your income, job security, current costs, and anticipated additional costs to see if the math works as you hope it will. Not surprisingly, single mothers report that they feel much more confident moving forward if they have confirmed as best they can that they will not be financially stressed and stretched.

Confirming that you will have help and support from family and friends may be more complicated than tallying up your finances. While some people exploring single parenthood begin the process by checking in with those closest to them, others postpone telling family and friends until they feel secure with their plan. There is always the fear that people you care about will respond negatively.

If you’re concerned about the response, you can’t know for sure whether or how others will be there for you. However, you can probably make some good predictions based on how close you live to them, how much time and energy they have, and whether any family members might have the resources and inclination to help out financially.

What are my next steps?

In most instances, when you feel ready to move forward toward becoming a single mother through pregnancy, it makes sense to begin with a doctor before a donor.

Your fertility is probably on your mind. Hopefully a physical exam, imaging tests, and blood tests will yield reassuring information. You can find a reproductive endocrinologist through your local branch of Resolve, a national organization that offers guidance, advocacy, and support to people experiencing infertility. Another option is the Society for Assisted Reproductive Technologies (SART). This organization assembles yearly statistics for fertility clinics throughout the US. While their website won’t direct you to a specific doctor, it will help you choose your program, and then you can follow up by seeing who is recommended within that program.

It may feel odd to contact a doctor who specializes in infertility when there is no evidence that you are infertile. It is important to know that infertility clinics treat large numbers of women whose only fertility "issue" is being in need of sperm. Your doctor will be able to guide you a bit in your decision-making regarding your donor.

For example, a doctor can explain medical and legal issues to be aware of if you decide to choose a known donor. If you are going through a sperm bank, your doctor can advise you on which cryobanks to contact and what is important to know. This will include cytomegalovirus (CMV) status and genetic and medical conditions of your donor, and how sperm should be processed for the IVF procedure you will receive.

Companionship for the journey

Making the decision to become a single parent should not mean that you go it alone. You will want support and companionship along the way. I suggest choosing a few close family members and friends who you feel will “get it” and be there for you in the ways that you need them. Be aware that a wider circle may expose you to too much input and interest at times when you may need privacy.

You can also find companionship in fellow travelers. One organization I encourage you to check out is Single Mothers by Choice (SMC). It serves “thinkers,” “tryers,” and “mothers” throughout the US, Canada, Europe, and beyond through local chapters and a 24/7 online private discussion forum. If that feels too big, ask your health team if they can connect you with other single women going through IVF.

Choosing to become a single parent is a huge decision. Be prepared to move slowly, to take one step forward and another backward. Expect questions, doubts, and anxiety along the way. This all goes with the territory and is part of the process. Give yourself a lot of credit for having the courage to begin to explore this path.

About the Author

Ellen S. Glazer, LICSW, Guest Contributor

Ellen S. Glazer, LICSW, is a clinical social worker whose practice focuses on infertility. pregnancy loss, third-party reproduction, and adoption. She is the author or co-author of six books in the field, most recently Having Your Baby Through Egg Donation, which she wrote with Dr. Evelina Sterling. View all posts by Ellen S. Glazer, LICSW

An operation called a radical prostatectomy has long been a mainstay of prostate cancer treatment. Offered most often to men whose cancer has not yet begun to spread, it involves removing the entire prostate gland, and can be performed in different ways. With the traditional "open" method, surgeons remove the prostate through an 8-to-10-inch incision just below the belly button. Alternatively, surgeons can perform a robot-assisted radical prostatectomy. With this approach, miniaturized robotic instruments are passed through several much smaller incisions in the patient's abdomen. Surgeons control these instruments remotely while sitting at a console.

At least 85% of all radical prostatectomies in the United States today are performed robotically. But how do those high-tech surgeries compare with the traditional open method?

Most studies show no major differences between the procedures in terms of patient survival or their ability to control prostate cancer over the long term. Robotic prostatectomies ostensibly offer quality-of-life advantages for urinary function and sexual health. However, the supporting evidence comes mostly from doctors' reports, insurance claims-based data, or studies too small to generate definitive conclusions.

Now, results from a much larger comparative study provide needed clarity.

During the study, researchers from Harvard-affiliated hospitals and other academic medical centers in the United States followed 1,094 men who were treated with radical prostatectomy between 2003 and 2013. All the men had newly-diagnosed cancer that was confined to the prostate gland. Among them, 545 men had an open radical prostatectomy, while the remaining 549 men had a robot-assisted operation. Then at two-, six-, 12-, and 24-month intervals, the men responded to questions about their urinary and bowel functioning, ability to engage in sexual activity, energy levels, and emotional state.

What the study found

According to the results, both methods were equally effective at removing cancer from the body, and post-surgical complications between them occurred relatively infrequently. However, there were some short-term differences between the two approaches. For instance, the robotically-treated men had shorter lengths of hospital stay (1.6 days versus 2.1 days on average), and they also reported lower pain scores after surgery. Men who underwent robotically-assisted surgery also reported fewer complications such as blood clots (10 men versus three men), urinary tract infections (33 men versus 23 men), and bladder neck contracture, which is a treatable condition that occurs when scarring in the bladder outflow makes it hard to urinate. In all, 45 men experienced a bladder neck contracture after open surgery, compared to nine men treated with the robotic method.

"With regard to urinary and sexual health, there were no appreciable average long-term differences between the two approaches," said Dr. Peter Chang, a urologist at Harvard-affiliated Beth Israel Deaconess Medical Center in Boston, and the study's lead author, in an email. "This suggests that with high-volume providers in academic centers, quality-of-life outcomes between open and robotic prostatectomy are similar."

Dr. Marc Garnick, the Gorman Brothers Professor of Medicine at Harvard Medical School and Beth Israel Deaconess Medical Center, and editor of Harvard Health Publishing Annual Report on Prostate Diseases, agreed with Dr. Chang's conclusions. "This important study adds clarity to ongoing debates over the superiority of open versus robotic prostatectomy, and confirms little differences between the two methodologies, both in terms of patient satisfaction/outcomes and efficacy of cancer treatment," he said. "The skill and familiarity of the surgeon in performing either method of prostate removal by open or robotic approaches should guide the specific treatment choice."

About the Author

Charlie Schmidt, Editor, Harvard Medical School Annual Report on Prostate Diseases

Charlie Schmidt is an award-winning freelance science writer based in Portland, Maine. In addition to writing for Harvard Health Publishing, Charlie has written for Science magazine, the Journal of the National Cancer Institute, Environmental Health Perspectives, Nature Biotechnology, and The Washington Post. View all posts by Charlie Schmidt

Discovering the cause of a disease is not easy. One reason is that the vast majority of diseases do not have a single cause. Instead, most diseases occur because multiple factors combine to cause the disease.

One factor is genes. Some people are born with one or more genes that make them vulnerable to a disease. Other factors come from your environment and behavior: what you eat, the air you breathe, the amount of physical activity you engage in, and habits such as smoking. Recent research finds that certain viruses may also be important contributing factors in causing multiple sclerosis (MS).

Multiple sclerosis harms cells in the brain and spinal cord — but why?

Multiple sclerosis is a disease of the brain and spinal cord that can cause many neurological symptoms, including arm and leg weakness, loss of vision, and difficulty thinking, as well as severe fatigue. Over the past 50 years we’ve learned that MS is an autoimmune disease: in various ways, the immune system attacks the brain and/or the spinal cord, leading to the symptoms of the illness.

However, we haven’t figured out why:what causes the immune system to go on the attack? Over the years, several viruses have been proposed as causes of MS, only to have subsequent research show that they were not. That led some MS doctors and scientists to discount viruses as possible causes.

Yet growing evidence in recent years points to several viruses that may be triggers of MS. The strongest evidence is for Epstein-Barr virus (EBV). This virus infects most people in developed nations like the US in their teen or young adult years.

Once a person is infected, the virus quietly remains alive in the body for the rest of a person’s life. In most people, it causes no health problems. But, rarely, it can cause certain cancers. Now, it has been linked to multiple sclerosis.

Delving deeper into a link between Epstein-Barr virus and MS

A large, long-term study from Harvard, published in the prestigious journal Science, attracted a lot of attention. Blood samples were repeatedly collected from 10 million US military personnel over 20 years. The samples were tested for evidence of infection with EBV.

Over the 20 years, some people in the study developed MS. The researchers compared two groups: people who were not infected with EBV when they entered military service, but then became infected later on; and people who remained uninfected by the virus. Those in the first group were 32 times more likely to develop MS than those in the second group. On average, symptoms of MS began about five years after a person became infected with EBV.

What do these findings tell us? The study provides strong evidence that a new infection with EBV is one important factor — maybe even a necessary factor — in causing MS. But the story is more complicated than that. Think about this: About 95% of all humans become permanently infected with EBV by early adulthood, but fewer than 1% of people develop MS. So, just being infected with EBV doesn’t mean a person will get MS — far from it. Indeed, other factors besides EBV infection also must be involved in causing MS.

Those other factors almost certainly include being born with certain genes that make you vulnerable to getting MS. Being infected with other viruses, as well as EBV, also may be important factors.

But which viruses? In my opinion, growing evidence indicates that a “cousin” of EBV, called human herpesvirus-6A, also may be important in triggering MS. And the genes of endogenous retroviruses also may be factors.

What are endogenous retroviruses?

About 8% of the genes that we are born with come from ancient viruses called retroviruses. These viral organisms successfully inserted their genes into the genes of the animals that preceded, and led to, humans. Some of those genes can be turned on to make proteins that affect our immune systems. Finally, there is evidence that each of these viruses — EBV, human herpesvirus-6A, and endogenous retroviruses — can activate one another, and gang up to cause a disease.

Going forward: New research may offer new leads for prevention

If the Epstein-Barr virus is one important factor in causing multiple sclerosis, then it is possible that vaccines against EBV might lead to fewer cases of MS. Indeed, several scientific groups around the world are working on such vaccines.

One company that made the mRNA vaccine for COVID-19 is working on an mRNA EBV vaccine. The National Institutes of Health also is developing a vaccine. However, it is unlikely we will know if they are effective against EBV, or against the development of MS, for at least a decade. Still, the linkage with this virus may prove to be an important milestone in ultimately conquering multiple sclerosis.

About the Author

Anthony L. Komaroff, MD, Editor in Chief, Harvard Health Letter

Dr. Anthony L. Komaroff is the Steven P. Simcox/Patrick A. Clifford/James H. Higby Professor of Medicine at Harvard Medical School, senior physician at Brigham and Women’s Hospital in Boston, and editor in chief of the Harvard Health Letter. He was director of the division of general medicine and primary care at Brigham and Women’s Hospital for 15 years, and is the founding editor of Journal Watch, a summary medical information newsletter for physicians published by the Massachusetts Medical Society/New England Journal of Medicine. View all posts by Anthony L. Komaroff, MD