Category: SPORT

As a neurologist working in the COVID Survivorship Program at Beth Israel Deaconess Medical Center, I find that my patients all have similar issues. It’s hard to concentrate, they say. They can’t think of a specific word they want to use, and they are uncharacteristically forgetful.

Those who come to our cognitive clinic are among the estimated 22% to 32% of patients who recovered from COVID-19, yet find they still have brain fog as part of their experience of long COVID, or post-acute sequelae of SARS CoV-2 infection (PASC), as experts call it.

What is brain fog?

Brain fog, a term used to describe slow or sluggish thinking, can occur under many different circumstances — for example, when someone is sleep-deprived or feeling unwell, or due to side effects from medicines that cause drowsiness. Brain fog can also occur following chemotherapy or a concussion.

In many cases, brain fog is temporary and gets better on its own. However, we don’t really understand why brain fog happens after COVID-19, or how long these symptoms are likely to last. But we do know that this form of brain fog can affect different aspects of cognition.

What is cognition?

Cognition refers to processes in the brain that we use to think, read, learn, remember, reason, and pay attention. Cognitive impairment is a reduction in your ability to perform one or more thinking skills.

Among people who were hospitalized for COVID, a wide range of problems with cognition have been reported. They include difficulties with

• attention, which allows our brains to actively process information that is happening around us while simultaneously ignoring other details. Attention is like a spotlight on a stage during a show that allows performers to stand out from the background.
• memory, the ability to learn, store, retain, and later retrieve information.
• executive function, which includes more complex skills such as planning, focusing attention, remembering instructions, and juggling multiple tasks.

People struggling with the effects of long COVID may have noticeable problems with attention, memory, and executive function. Studies report these issues both in people who were not hospitalized with COVID and in those who were, as well as in people who had severe cases. These findings raise some important questions about how COVID-19 infection affects cognition.

Less obvious lapses in memory and attention may occur even with mild COVID

A recent study published by a group of German researchers suggests that even people who don’t notice signs of cognitive impairment can have problems with memory and attention after recovering from a mild case of COVID-19.

The study involved 136 participants who were recruited from a website advertising the study as a brain game to see how well people could perform. The average age was around 30 years old. Nearly 40% of the participants had recovered from COVID that did not require hospitalization, while the rest had not had COVID. All participants reported having no problems with their memory or thinking.

However, testing showed that performance on an attention task was not as good among the group that had COVID compared with those who did not. Likewise, participants who had COVID had significantly worse performance on a memory task. Both of these effects seem to improve over time, with the memory problem becoming better by six months and the impairment in attention no longer present at nine months.

This study suggests that problems with memory and attention may occur not only in people who are sick enough with COVID to have been hospitalized and in those who develop long COVID, but also to some degree in most people who had COVID. These findings should be interpreted with caution, however. The study included mostly young patients recruited through a website, none had long COVID, and the participants’ cognitive abilities before COVID were not known.

What does this study tell us about cognition and COVID?

Further research is needed to confirm whether attention and memory difficulties occur widely with COVID-19 infections — across all age groups and no matter how mild or severe the illness — and to consider other factors that might affect cognition. Better understanding of why some people have noticeable problems with attention and memory after having COVID and others do not may ultimately help guide care.

Recovery in memory within six months and improvement in attention within nine months of COVID infection was seen in this study, suggesting that some cognitive impairments with COVD, even if widespread, are potentially reversible.

About the Author

Tamara Fong, MD, PhD, Contributor

Dr. Tamara Fong is an assistant scientist in the Aging Brain Center at the Hinda and Arthur Marcus Institute for Aging Research, and associate professor of neurology at Harvard Medical School. She directs the cognitive clinic within the Beth Israel Deaconess Medical Center COVID-19 Survivorship Program. View all posts by Tamara Fong, MD, PhD

Most people want to feel energized and experience a sense of vitality. In the 1970s, Dr. John Travis created a spectrum of wellness, with illness on one side, a point of neutrality in the middle (when a person has no signs or symptoms of disease), and on the other side wellness.

Wellness is a state of health and flourishing beyond simply not experiencing illness. In this state people feel confident, open to challenges, curious, and thirsty for action. They are thriving. People who experience wellness may seek to hike a mountain, read a new book, learn how to play a new instrument, or actively connect with new people.

The most common health conditions facing people today include heart disease, stroke, diabetes, and cancer. When people are experiencing these (and other) conditions, they fall into the illness side of the spectrum. Lifestyle factors that put you at risk for developing these conditions include smoking, alcohol substance use disorder, lack of exercise, sleep deprivation, and a diet rich in processed foods, sugar, saturated fat, and artificial flavors. An unhealthy weight is another factor that can put one at risk for these conditions, especially carrying extra weight around your midsection.

To move to the wellness side of the spectrum, you can include more movement in your day; enjoy a whole-food (unprocessed), plant-predominant style of eating; avoid smoking; sleep seven to nine hours a night; practice stress reduction techniques like deep breathing, yoga, meditation, tai chi, and mindfulness; and spend time with family and friends.

Think about what your body can do for you — and what you can do for your body

People of many sizes and shapes can be healthy and well, especially when they are connected to a calm mind that is practicing mindfulness, self-compassion, and a growth mindset. A body that is in the neutral point on the wellness spectrum can move to the side of thriving and flourishing when healthy lifestyle habits are adopted and sustained, and that has little to do with your body’s shape or size.

The body neutrality movement emphasizes the incredible functions, actions, and physiology of our bodies without regard for how our bodies look. We can see, hear, smell, taste, and feel. We can jump, skip, sing, hug, and dance. Our muscles have mitochondria that give us energy.

Our digestive system is one example of the wondrous process of the body. The digestive system has billions of microbes living in it that help us to ferment fiber from vegetables, fruits, and whole grains, and create short-chain fatty acids that help us with energy metabolism, glucose metabolism, lipid metabolism, inflammation, immunity, and more. This is why it’s important to eat fiber, including whole grains, vegetables, and fruits.

Connected to our bodies are our brains, and they are full of neurons (brain cells), synapses (connections), neurochemicals, and hormones that help to protect brain cells and make new ones. Moving our bodies helps to increase these chemicals. In addition, moving our bodies regularly helps us to increase serotonin, which may help us feel less anxious and depressed. Hugging increases oxytocin in the brain, and this “love hormone” helps us feel a sense of belonging and bonding. The body’s actions have a powerful impact on the brain, and vice versa.

Body positivity versus body neutrality

Body positivity is a movement that invites people to appreciate the body size and shape they have now without worrying about unrealistic body standards. With body positivity, society’s unhealthy standards for body shapes and sizes are challenged. It’s also important to remember that cultural norms and what’s considered an ideal body change with time.

The goal with body positivity is to honor and appreciate all body types, especially your own body. Feeling confident about the way you look feels good and can be empowering.

With body neutrality, the focus is on the function of your body: finding happiness and fulfillment, appreciating the power of our muscles, the strength of our bones, the protection our skin offers, and the rewards of the dopamine system in our brains. Connecting with friends and family, reaching small, meaningful goals, and enjoying physical activity are healthy ways to approach your body. A focus on finding pleasure in the wellness journey will serve your body — at any size — and your brain.

Remember all the things your body can do for you

• Transport you from one place to another (quickly or slowly)
• Release neurochemicals that give you pleasure, like from hugging a loved one
• Move your arms and/or legs with joy following the rhythm and beat of music
• Take deep breaths to calm your mind
• Perform stretches that release endorphins
• Practice yoga, tai chi, or qigong, which can help calm the body and mind.

About the Author

Elizabeth Pegg Frates, MD, Contributor

Elizabeth Pegg Frates, MD (Beth) is a pioneer in lifestyle medicine education, and an award-winning teacher at Harvard Medical School as well as Harvard Extension School. She currently practices lifestyle medicine through her health and wellness coaching company, Wellness Synergy, LLC. Beth graduated magna cum laude from Harvard College, majoring in both psychology and biology. She then attended Stanford Medical School, interned at Massachusetts General Hospital, and completed her residency in the department of physical medicine and rehabilitation at Harvard Medical School, where she served as chief resident. After residency, Beth focused on stroke and specifically stroke prevention. After co-authoring a book titled Life After Stroke: The Guide to Recovering Your Health and Preventing Another Stroke, Beth spent a great deal of time lecturing and writing about health and prevention topics, including nutrition and exercise. Fascinated by how to empower people to adopt healthy habits, Beth pursued further training in behavior change through coaching programs and motivational interviewing courses. Beth has co-authored papers and book chapters on behavior change. In 2008, Beth developed the concept of a lifestyle medicine interest group (LMIG) and has been successfully running one at Harvard Medical School since that time. These LMIGs offer a parallel curriculum for students interested in healthy habits to learn about basic concepts in lifestyle medicine through “lunch and learn” lectures. As board liaison for the Professionals In Training (PiT) program at the American College of Lifestyle Medicine (ACLM), Beth has created standardized PowerPoints on Lifestyle Medicine Basics, Exercise Prescription, Nutrition, and Behavior Change for faculty and students wanting to launch their own LMIG at their school. These are available on the ACLM website. Since 1996, Beth has been on faculty at Harvard Medical School and has won multiple teaching awards for her work in many different pre-clinical core courses including nutrition, musculoskeletal system, central nervous system, endocrine system, and introduction to the professions. She is an assistant professor (part-time) at the Harvard department of physical medicine and rehabilitation. Most recently, Beth created an entire college curriculum on lifestyle medicine for a Harvard Extension School undergraduate and graduate-level course, which many physicians and pre-meds have taken each year. This is the first full-semester lifestyle medicine course offered at Harvard University. Beth received an award for her teaching in this course as well, and the course was chosen as a case study for successful courses at the Harvard Extension School. Merging her training in physical medicine and rehabilitation with her training in lifestyle medicine and coaching, Beth has developed novel wellness programs for stroke survivors and their caregivers based on lifestyle medicine principles (nutrition, exercise, stress reduction, connection). Currently, Beth serves as the director of wellness programming at the Stroke Institute for Research and Recovery at Spaulding Rehabilitation Hospital, a Harvard Medical School affiliate. View all posts by Elizabeth Pegg Frates, MD

Robbed of ancestral lands, American Indian and Alaska Native tribal communities face an unparalleled housing crisis that pleads for national housing reforms. As victims of centuries of intentional government policies to remove and reallocate lands and resources, many live in third-world conditions that have led to sky-high rates of health problems, ranging from diabetes and cardiovascular disease to chronic liver disease, obesity, unintentional injuries, substance use disorders, violence, and suicides. This paves a path to extremely high rates of disability and prematurely shortened lives.

Poverty and poor housing harm health and drive disability

The stark reality of poverty became obvious when I traveled to my reservation home in Mescalero, New Mexico as a child. There I saw discolored, fractured, or weather-tattered homes, and yards littered with old, rusted, and abandoned cars. According to the National Congress of American Indians, substandard housing makes up 40% of on-reservation housing compared to just 6% of housing outside of Indian Country. On reservations, almost one-third of homes are overcrowded.

In 2019, an estimated 20% of American Indian and Alaska Native people lived in poverty compared to an 11% national poverty rate. Poverty, low education levels, and harsh conditions mean that many American Indians and Alaska Natives lack the foundation for basic survival: stable, secure, adequate, affordable housing.

As historian Claudio Saunt so eloquently wrote, an “invasion” of approximately 1.5 billion acres occurred in the United States from 1776 until the present. This loss of traditional homelands has had devastating, lifelong effects on housing and living conditions. Poor health outcomes soared among the millions displaced over the past 300-plus years.

Today, as a result of poor housing conditions, American Indians and Alaska Natives struggle from environmental ills that include lead exposure, asthma from poor ventilation, infectious diseases due to contaminated water, sanitation issues, and overcrowding. Mental distress is common. Exposure to pollutants raises risk for lung disease, cardiovascular events like heart attack and stroke, and many other illnesses.

Disability and housing

American Indians and Alaska Natives have disability rates 50% higher than the national average, and among people ages 55 and older mobility and self-care disability rates are especially high. Housing that is old, in poor repair, or crisscrossed with physical barriers may not be accessible for many people, preventing them from living independently within their homes and participating fully in community life. This can cause isolation and exacerbate distress and despondency. In addition, unreliable electricity could pose life-threatening risks to people with disabilities requiring ventilator support, and threaten the safety of power wheelchair users (wheelchair batteries must be kept well-charged).

Fair housing feeds health equity

Housing is a well-known contributor to health outcomes and a meaningful lever for health equity. Despite the United States’ promise to assume responsibility for housing and health for American Indians and Alaska Natives in exchange for billions of acres in conceded land, little has been done to achieve positive change. Outsiders may assume that Indians are getting rich from tribal casinos, but that is far from the truth. Many tribes do not have casino revenue. Those who do often struggle to break even, with any earnings canceled out by their tribe’s needs.

Conditions on tribal lands sadly reveal the consequences of historical trauma, poverty, and insufficient federal government support. Each sovereign nation must create sustainable housing projects for its members as determined by its tribal government and housing departments. Federal support varies depending on tribal financial status, resources, and competition from bordering communities.

Seeking national support for these measures could go far:

• The most viable way of improving environmental conditions on American Indian and Alaska Native lands is through Congress and the Native American Housing Assistance and Self-Determination Act (S.2264). This act provides guaranteed, inflation-adjusted funding to our nation’s tribal communities. All of us can lobby Congress to reauthorize this Act through 2032 by contacting our congressional representatives. Funding from this Act has been available for years, but the meager increases have not matched inflation rates.
• Tell Congress and state representatives that new housing on tribal lands must support health through structural features such as good ventilation and temperature controls, reliable and clean water throughout, and eliminating barriers that impede access into and within the home. Given high disability rates of American Indians and Alaska Natives, housing must be designed to support independent living needs of all residents. Following universal design principles in developing new housing benefits people of all ages and abilities by acknowledging changes that can occur over a lifespan.

The US government has a moral obligation to ensure that American Indians and Alaska Natives are allowed to acquire lost tribal lands, and afforded the best housing possible to be successful, join fully in community life, and remain healthy. Last year the US Interior Department reauthorized the regional directors of the Bureau of Indian Affairs to review and approve applications to place land into trust. This represents one important step forward, though hopefully not the last.

About the Authors

Nicole Stern, MD, Contributor

Dr. Nicole Stern is currently a Commonwealth Fund Fellow in minority health policy at Harvard University. She is completing a master of public health degree in health management. Dr. Stern is board certified in internal medicine and sports medicine, and is a past president of the Association of American Indian Physicians. A critical focus for Dr. Stern's work is to increase the number of American Indian and Alaska Native health care professionals who can best reverse health care disparity trends common in American Indian and Alaska Native tribal communities. View all posts by Nicole Stern, MD

Lisa I. Iezzoni, MD, MSc, Contributor

Lisa I. Iezzoni, MD, MSc, is a professor of medicine at Harvard Medical School, and is based at Massachusetts General Hospital in Boston. Dr. Iezzoni studies health care experiences of persons with disability. She is a member of the National Academy of Medicine in the National Academies of Sciences, Engineering, and Medicine, and the author of Making Their Days Happen: Paid Personal Assistance Supporting People with Disabilities Living in Their Homes and Communities. View all posts by Lisa I. Iezzoni, MD, MSc

Concussions are very common — in fact, they are the most common kind of traumatic brain injury (TBI). While most people recover completely, concussions sometimes lead to lifelong problems, as we’ve learned from the experiences of former National Football League players.

That’s why it’s important that we do everything we can to not just prevent concussions in children and teens, but to give them the right treatment when a concussion happens.

The problem for doctors, parents, and coaches has been that while we want to do the right thing when a child gets a concussion, it’s not always easy to know what the right thing is. To help, the Centers for Disease Control and Prevention (CDC) reviews all the research and makes recommendations to help guide us as we care for children with concussions.

Every child is different, and concussion care should reflect that

The recommendations reflect the fact that every child who has a concussion is different. Every injury is different, obviously, but it’s more than that. Some children are more likely to have trouble, such as those who have had prior concussions or have learning problems, mental health problems, or neurological problems.

Interestingly, children whose families are stressed for reasons such as poverty can take a longer time to recover from concussions. And there is a bit of a wild-card factor too: sometimes children unexpectedly take a long time to recover — or, conversely, recover very quickly.

What are the concussion care recommendations?

Practice guidelines developed by the CDC for health providers include these points:

• Most children with concussions don’t need CT or MRI scans. If there was a severe injury or the child is having severe or unusual symptoms, then it’s worth doing to be sure there isn’t internal bleeding, a fracture, or some other injury. Most of the time with concussions, there is nothing to see — and it’s not worth the risk or expense involved in these imaging studies.
• Use the right tool to make the diagnosis. There are some symptoms we associate with concussion, like bad headache, dizziness, loss of memory of the accident. But because it isn’t always clear, it’s helpful to use a checklist or questionnaire that is validated, meaning that it’s been shown to accurately pick out those with a concussion from those who simply have a bad clunk to the head and not a concussion.
• When a child has a concussion, assess for risk factors for a prolonged recovery. As I said above, some children take longer to get better — and while we can never predict for sure, it’s important to think about that at the time of the injury.

What should parents know about concussions?

• Most children and teens with concussions get completely better within one to three months. But it’s important that children, families, and coaches know what all the symptoms are after a concussion, and understand what’s normal and what is a sign of a problem. For example, trouble sleeping, dizziness, and moodiness can be normal, but if any of those symptoms are getting worse, it’s important to call the doctor.
• Parents can help children return to normal activities after a concussion. Rest — of not just the body, but the mind too — is important for the first two to three days after a concussion, but after that it’s important to start getting back to normal. When people rest completely for longer than that, it actually takes them longer to get better.

Getting back to normal after a concussion

We used to think that total rest of the brain and body after a concussion was the best treatment. Increasingly, research shows that resuming normal activities is the better treatment. For example, recent research analyzing many studies showed that exercise can help speed recovery from concussion. The tricky part is figuring out how best to resume normal activities, because it is different for each child.

The basic idea is to start slow and see how the child does. If they do okay, they can do a bit more schoolwork or exercise. If they don’t do okay — meaning they have more symptoms — they should do less and go more slowly.

The process of getting back to normal life can take a few days, or a few months. It has to be tailored to each child and each situation, which is why collaboration with your pediatrician is so important. It’s also really important not to rush the process, especially when it comes to returning to a sport where concussions are common, such as football, hockey, or soccer. If a child gets another concussion while they are still recovering, it will take them much longer to get better, and put them at risk of permanent disabilities.

To learn more, visit the CDC’s Heads Up page.

Follow me on Twitter @drClaire

About the Author

Claire McCarthy, MD, Senior Faculty Editor, Harvard Health Publishing

Claire McCarthy, MD, is a primary care pediatrician at Boston Children’s Hospital, and an assistant professor of pediatrics at Harvard Medical School. In addition to being a senior faculty editor for Harvard Health Publishing, Dr. McCarthy writes about health and parenting for Boston Children’s Hospital, Boston.com, and the Huffington Post. View all posts by Claire McCarthy, MD

Who are you today? Who were you a decade ago?  For many of us, shifts in our lives — relationships, jobs, friendships, where we live, what we believe — are the only constant. Yet it’s a common misconception that sexual orientation develops at an early age and then remains stable throughout one’s life.

Rather, changes in sexual orientation are a common thread in many people’s lives. People may experience changes in who they are attracted to, who they have sex with, and which labels they use to describe their sexual orientation. Such changes in sexual orientation are called sexual fluidity.

Attraction, identity, and behavior

While anyone can experience changes in their sexual orientation, sexually fluidity is more common in younger people and among people who are LGBTQ+ (lesbian, gay, bisexual, transgender, queer, and additional identities).

Sexual fluidity might include

• changes in attractions: Someone may be attracted to one gender at one time point and attracted to a different gender or more than one gender at another time point.
• changes in identity labels: Someone may identify as lesbian at one time point and as bisexual at another time point.
• changes in sexual behavior: Someone may have a sexual partner at one time point who is a cisgender woman and then have another sexual partner at a different time point who is nonbinary. (A cisgender woman is a person assigned as a female at birth and who identifies as a woman. Someone who is nonbinary was assigned either female or male at birth and identifies as neither a woman nor a man.)

Sexual fluidity happens for many different reasons. For some people, sexual fluidity occurs when they meet people and discover new attractions. For other people, sexual fluidity may occur when they learn a new identity label that better fits their experience.

Misconceptions and stigma about sexual fluidity

Many people may have questions and biases about sexual fluidity. Let’s explore a few.

Are people who identify as bisexual sexually fluid? Some are and others are not. Sexual fluidity is distinct from bisexuality. Sexual fluidity may be experienced by people with any sexual orientation identity, including people who identify as bisexual, lesbian, gay, or heterosexual.

Stigma directed at sexual fluidity (and similar stigma surrounding bisexuality) may stem from misconceptions about changes in sexual orientation. Consciously or unconsciously, some people may believe that anyone who experiences changes in their sexual orientation is promiscuous or incapable of being monogamous. However, such beliefs are untrue.

Misconceptions and stigma can hurt. Growing evidence links different forms of stigma experienced by people who are sexually fluid with more depression and poor mental health. Yet it’s not the change in sexual orientation that raises this risk, nor is it automatic, genetic, or otherwise predestined. The higher risk of mental health concerns among people who experience sexual fluidity is more likely to be related to minority stress — that is, because sexual fluidity is stigmatized, people who experience that stigma may also experience stress that negatively affects their mental health.

Changing misconceptions and stigma about sexual fluidity

We can help normalize sexual fluidity in several ways. First, we can introduce the possibility of changes in sexual orientation as part of sex education in schools and in the doctor’s office. Second, we can work toward responding to sexual fluidity with openness and curiosity rather than making assumptions and viewing these changes as negative. Third, we can move beyond preconceived notions of sexual orientation as stable to expecting change in sexual orientation for some people.

As people experience the world and learn more about themselves, their views, beliefs, and feelings may change. Sexual fluidity reflects one possible change over time, a change that fits into the greater diversity of sexuality. We can all hold space for this diversity by letting go of misconceptions about the stability of sexual orientation over a lifespan and staying open instead to the possibility of change.

About the Author

Sabra L. Katz-Wise, PhD, Contributor

Sabra L. Katz-Wise, PhD (she/her) is an assistant professor in adolescent/young adult medicine at Boston Children’s Hospital, in pediatrics at Harvard Medical School, and in social and behavioral sciences at the Harvard T.H. Chan School of Public Health. She co-directs the Harvard SOGIE (Sexual Orientation and Gender Identity and Expression) Health Equity Research Collaborative. Her research investigates sexual orientation and gender identity development, sexual fluidity, health inequities related to sexual orientation and gender identity, and psychosocial functioning in families with transgender youth. Dr. Katz-Wise also advocates to improve workplace climate, medical education, and patient care for LGBTQ individuals, as co-chair for the BCH Rainbow Consortium on Sexual and Gender Diversity, as an HMS LGBT Advisory Committee member, and as HMS Sexual and Gender Minority Curriculum Development Fellow. View all posts by Sabra L. Katz-Wise, PhD

When I worked at Greenpeace for five years before I attended medical school, a popular slogan was, “Think globally, act locally.” As I write this blog about climate change and hay fever, I wonder if wiping off my computer that I’ve just sneezed all over due to my seasonal allergies counts as abiding by this aphorism? (Can you clean a computer screen with a tissue?)

Come to think of it, my allergies do seem to be worse in recent years. So do those of my patients. It seems as if I’m prescribing nasal steroids and antihistamines, recommending over-the-counter eye drops, and discussing ways to avoid allergens much more frequently than in the past. Are people more stressed out, working harder, sleeping less, and thus more susceptible to allergies? Or, are the allergies themselves actually worse? Could the worsening of climate change explain why the rates of allergies and asthma have been climbing steadily over the last several decades?

There’s more pollen and a longer pollen season

Seasonal allergies tend to be caused disproportionately by trees in the spring, grasses in the summer, and ragweed in the fall. The lengthening interval of “frost-free days” (the time from the last frost in the spring to the first frost in the fall) allows more time for people to become sensitized to the pollen — the first stage in developing allergies — as well as to then become allergic to it. No wonder so many more of my patients have been complaining of itchy eyes, runny nose, and wheezing.

In many places in the United States, due to climate change, spring is now starting earlier and fall is ending later, which, yearly, allows more time for plants and trees to grow, flower, and produce pollen. This leads to a longer allergy season. According to a study at Rutgers University, from the 1990s until 2010, pollen season started in the contiguous United States on average three days earlier, and there was a 40% increase in the annual total of daily airborne pollen. More recent research in North America shows rising concentrations of sneeze-inducing pollens and lengthening pollen seasons from 1990 to 2018, largely driven by climate change.

Climate change is increasing the potency of pollen

In addition to longer allergy seasons, allergy sufferers have other things to fret about with climate change. When exposed to increased levels of carbon dioxide, plants grow to a larger size and produce more pollen. Some studies have shown that ragweed pollen, a main culprit of allergies for many people, becomes up to 1.7 times more potent under conditions of higher carbon dioxide. With warming climates, the geographic distribution of pollen-producing plants is expanding as well; for example, due to warmer temperatures, ragweed species can now inhabit climates that were formerly inhospitable.

Other unfortunate consequences of climate change, which we are already witnessing, include coastal flooding as the arctic ice sheets melt, causing the sea levels to rise; and more extreme weather, such as storms and droughts. With the increased coastal flooding, mold outbreaks are more common, which can trigger or worsen allergic reactions and asthma. More extreme weather events, such as thunderstorms, are associated with an increase in emergency department visits for asthma attacks. (It is unclear why this is the case, but one theory suggests that the winds associated with thunderstorms kick up a tremendous amount of pollen.) Allergies and asthma are closely associated, with many people, this author included, having “allergic asthma” that is likely to worsen as climate change progresses.

So what can an allergy sufferer do?

Even as the allergic environment changes in conjunction with our climate, there are steps you can take to manage the impact of seasonal allergies and reduce sneezing and itchy eyes.

• Work with your doctor to treat your allergies with medications such as antihistamines, nasal steroids, eye drops, and asthma medications if needed. If you take other medications that may interact with over-the-counter allergy medications such as Benadryl or Sudafed, let your doctor know.
• Discuss with your doctor whether you would benefit from allergy testing, a referral to an allergist, or prevention methods like allergy injections or sublingual immunotherapy, which, by exposing your body in a controlled manner, slowly conditions your immune system not to respond to environmental allergens.
• Track the local pollen count and avoid extended outdoor activities during peak pollen season, on peak pollen days. However, most doctors would agree that it isn’t healthy to cut back on exercise, hobbies, or time in nature, so this is a less than satisfying solution at best. You could plan for an indoor exercise program on high-pollen days.
• Wash clothing and bathe or shower after being outdoors to remove pollen.
• Close windows during peak allergy season or on windy days.
• Wear a mask when outdoors during high pollen days, and keep car windows rolled up when driving.
• If your house has been flooded, be on the lookout for mold. There are services that you can hire that will inspect your home for mold, and remove the mold if it is thought to be harmful.
• Have as small a carbon footprint as possible and plant trees. Even though they are responsible for some of the pollen that many of us choke and gag on each spring, summer, and fall, trees contribute to their environment by taking in carbon dioxide and producing the oxygen we breathe, thereby improving air quality. We have to protect and plant trees, even as allergy sufferers, as climate change is arguably the biggest threat that we, as a species, now face.

About the Author

Peter Grinspoon, MD, Contributor

Peter Grinspoon, M.D. is the author of the memoir Free Refills: A Doctor Confronts His Addiction. He currently practices as a primary care physician at an inner-city clinic in Boston and is on staff at Massachusetts General Hospital. He teaches medicine at Harvard Medical School. He spent two years as an Associate Director for the Physician Health Service, part of the Massachusetts Medical Society, working with physicians who suffer from substance use disorders. Dr. Grinspoon graduated with honors in philosophy from Swarthmore College. Before medical school, he spent five years as a Campaign Director at Greenpeace, working on the nuclear free seas campaign. He attended medical school at Boston University School of Medicine. His internship and residency were in Internal Medicine at Brigham and Women’s Hospital. Today he is proudly 10 years clean. He lives in Newton, MA with his wife Liz Grinspoon, and his blended family.” View all posts by Peter Grinspoon, MD

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