Long-lasting healthy changes: Doable and worthwhile

Graphic of the words "old habits" and "new habits" on torn blue paper

I’ve been a physician for 20 years now, and a strong proponent of lifestyle medicine for much of it. I know that it’s hard to make lasting, healthy lifestyle changes, even when people know what to do and have the means to do it. Yet many studies and my own clinical experience as a Lifestyle Medicine-certified physician have shown me a few approaches that can help make long-lasting healthy lifestyle changes happen.

What is lifestyle medicine?

In the US, lifestyle medicine is built around six pillars: eating healthy foods; exercising regularly; easing stress; getting restful sleep; quitting addictive substances like tobacco and limiting alcohol; and nurturing social connections.

How will this help you? Here’s one example. A study published this summer in the Journal Neurology followed over 70,000 health professionals for more than two decades. Those who reported eating a diet high in colorful fruits and vegetables had a significantly lower risk of subjective memory loss — which is a sign of dementia — compared with those who did not.

A multitude of studies over many years have mined health data on this same cohort. Harvard T.H. Chan School of Public Health nutrition expert Dr. Walter Willett observed that, based on these studies, four combined healthy lifestyle factors — a healthy diet, not smoking, engaging in moderate activity, and avoiding excess weight — could prevent about 70% to 80% of coronary heart disease and 90% of type 2 diabetes. The catch, he noted, is that only about 4% of people participating in these studies attained all four.

Abundant research shows healthy lifestyle factors protect us against serious, often disabling health problems: diabetes, high blood pressure, dementia, heart disease, strokes, cancer, and more. Clearly, taking steps toward a healthier lifestyle can make a big difference in our lives, but it can be hard to change our habits. Below are a few tips to help you start on that path.

Find motivation

What motivates you? Where will you find good reasons to change? Yes, studies show that being at a healthy weight and shape is associated with a longer life and lower risk of many chronic diseases. However, in my experience, only emphasizing weight or waist size isn’t helpful for long-term healthy lifestyle change. Indeed, studies have shown that focusing too much on those numbers is associated with quitting a health kick, whereas small goals related to positive actions were associated with successful long-term lifestyle change.

Examples of this include aiming for at least 21 minutes of activity per day and/or five servings of fruits and vegetables per day. (These activity and nutrition goals are actually recommendations of the American Heart Association, FYI!) If we strive to live healthy so that we can live a long, healthy life, we have a greater chance of long-term success — which typically will result in weight and waist loss.

Put healthy habits on automatic

Healthy choices can become more automatic if you remove the “choice” part. For example, take the thinking out of every eating or activity decision by planning ahead for the week to come:

  • Choose a basic menu for meals and build in convenience. Focus on simple, healthy recipes. Frozen produce is healthful, easy to keep on hand, and sometimes less expensive than fresh. Shopping the salad bar costs more, but could help on busy nights.
  • Jot down your activity schedule. Choose some physical activity most days — the more vigorous and the longer the better, but anything counts! Even as little as 10 minutes of light to moderate activity per week has been associated with a longer life span.
  • Track food and activity choices each day. Using an app or notebook for this can help you become more aware and accountable. Try noting barriers, too, and brainstorm workarounds for overly busy days and other issues that push you off track.

Understand how emotions affect you

If feeling stressed, angry, or sad is a trigger for overeating or another unhealthy activity, it’s important to recognize this. Writing down triggers over the course of a week can enhance your awareness. Building better stress management habits can help you stick to a healthy lifestyle plan. Getting sufficient restful sleep and scheduling personal time, regular activity, and possibly meditation, therapy, or even just chats with good friends are all steps in the right direction.

A healthy lifestyle is key to a long, healthy life, and is attainable. Success may require some thoughtful trial and error, but don’t give up! I have seen all kinds of patients at all ages make amazing changes, and you can, too.


New Harvard tool helps fact-check cancer claims

A word cloud illustrating "myth" and "reality" in blue words against white background with silver pen; contrasting phrases include "urban legend," "data, "fake," and "proof"

The internet is full of warnings about things that cause cancer. Watch out for antiperspirants, scented candles, and bras, dubious web sites or sensational posts on social media warn. Steer clear of disposable chopsticks, microwaves, radon gas, and more. Scary or misleading claims are so plentiful that it’s hard to know which ones to take seriously. "We’ve seen that a lot of people have unnecessary fears about things that might cause cancer, or they’re overly cautious about things that aren’t based on science," notes Timothy Rebbeck, a cancer researcher and the Vincent L. Gregory, Jr., Professor of Cancer Prevention at the Harvard T.H. Chan School of Public Health.

To cut through the confusion, Rebbeck and his colleagues have developed a free tool to help.

What is the Cancer FactFinder?

The Cancer FactFinder was developed jointly by experts at the Zhu Family Center for Global Cancer Prevention at Harvard T.H. Chan School of Public Health and the Center for Cancer Equity and Engagement at the Dana-Farber/Harvard Cancer Center. It offers reliable information about whether certain cancer claims are true. "It’s a place to go when you’ve heard something and you’re not sure what to make of it," Rebbeck says.

Log on to Cancer FactFinder and you can:

  • Search cancer claims. Type in a particular term (such as "scented candles") or simply scroll through all of the claims the team has investigated. "We have about 70 right now. We’ll continue to update them and add more over time," Rebbeck says.
  • Learn how claims are fact-checked. The Cancer FactFinder team uses expert opinion from leading scientists and health organizations, as well as scientific evidence from human studies. Note: animal studies are not considered. "It could be that cancer is induced in lab animals by feeding them a particular compound or rubbing it on them. That doesn’t mean it causes cancer in humans," Rebbeck says.
  • Learn who’s on the Cancer FactFinder team. In addition to Rebbeck and his colleagues, there’s a mix of scientific experts and community advocates from groups including
    • BayState Health
    • Boston Cancer Support
    • Boston University
    • Men of Color Health Awareness
    • Silent Spring Institute
    • Yale University.

What can you look up?

Vetted claims on Cancer FactFinder range from A to almost Z — from an acidic diet to wax that’s sprayed onto fruit and vegetables.

Each listing gives you an immediate idea if there’s something to the claim, based on the balance of evidence in humans. A green checkmark means the claim is most likely true. A red X means the claim is probably false. A question mark indicates that there isn’t enough evidence yet to determine if there’s a cancer link. You’ll learn what the science says, how to reduce risk for a particular cancer, and where you can get additional trustworthy information on a topic.

A cancer fact-check in action

Let’s say, for instance, that you plan to join friends on a hike through a park, and you stop by the store for bug spray to ward off mosquitoes and ticks, which you know can cause illnesses like West Nile disease and Lyme disease. As you peruse the options, you remember someone mentioning that bug spray is linked to cancer.

Instead of worrying, you can go to Cancer FactFinder and type in "bug spray." You’ll see a red X signaling that bug spray hasn’t been found to cause cancer in humans. You’ll also see

  • which chemicals have sparked bug spray concerns
  • how to use bug spray properly
  • how to avoid concerns about certain ingredients by using alternative repellents.

Or say you just want to educate yourself about various cancer claims. Remember the ones mentioned so far? Turns out that claims of cancer linked to bras, antiperspirants, disposable chopsticks, microwaves, acidic diets, and wax sprayed on fruits and vegetables are false. Claims of cancer from radon gas and the frequent use of scented candles are true.

The ultimate goal, Rebbeck says, is empowerment.

"We want everyone to start asking questions, learn how to get reliable information, think about what it means for them, and talk to their families and doctors about lifestyle choices. We’re hoping that’s the endpoint of this."


Summer camp 2022: Having fun and staying safe

A boy and three girls walking in the woods with hiking sticks; out of focus trees are leafy green, suggesting summertime

It’s time to make summer plans, and for many families those plans include summer camp. After the past couple of years, the idea of getting out of the house, being active, and seeing other children sounds very appealing.

While COVID-19 is still with us, vaccines and the fact that so many people have gotten sick and developed some natural immunity has made activities like summer camp less treacherous. Unfortunately, this doesn’t mean that families don’t need to think about COVID-19 as they make their plans, because they still do.

What to do before signing up for summer camp this year

Before even thinking about camp, take into account your family’s particular risk factors. If children are 5 or older and haven’t been vaccinated, now is the time to get the vaccine. If you have any questions or concerns about the vaccine, please talk to your doctor. While you are at it, make sure that children are up to date on routine childhood vaccinations. Many children have gotten behind because of the pandemic.

Talk to your doctor about the pros and cons of camp if your child

  • isn’t or can’t be vaccinated, since it’s important to think about factors that might make getting COVID riskier.
  • has health problems like asthma or congenital heart disease that put them at higher risk of complications of COVID-19.
  • has a weakened immune system for any reason. Whether or not your child is vaccinated, it’s always important to check in with their doctor before sending them to camp, or any group activity.

Questions to ask any camp you’re considering

These days, most communities have dropped mask mandates. While it’s certainly nice to not have to wear one — and to see people’s faces — masks do make a difference when it comes to preventing the spread of infection. COVID-19 is still causing illness and is likely to be with us beyond this summer. Before signing up for camp there are things parents should think about — and questions they should ask.

Where is the camp, and where are the campers and staff from? A local day camp with children and staff mostly from a town with low numbers of COVID cases is going to be lower-risk than one in a community with higher numbers, or one that draws from many different communities, including some with higher numbers. The Centers for Disease Control and Prevention has a database of case numbers by county.

What is the vaccination status of the staff and campers? Ideally, all eligible staff and campers should be vaccinated — with not just their primary series, but any booster doses they are eligible to receive.

How is the camp screening for symptoms or exposures, and what guidelines do they have in place? This is most important when there are unvaccinated staff or campers, or in areas of higher case counts. The camp should have a plan for screening campers and staff for symptoms, with appropriate plans for staying home, testing, and quarantine based on the results of those screenings. Find out how exposures outside of camp will be handled for campers and staff. Sleepaway camps should have designated quarantine space, and access to testing. Ask about their testing requirements, as well.

Are activities mostly indoors or mostly outdoors? The more outdoor activities, the better. Indoor activities are safest in well-ventilated spaces.

What is the policy on wearing masks? Wearing a mask for 10 days after testing positive for COVID or being in close contact with someone who has it is essential to help others stay healthy. (Also follow recommendations for quarantine or isolation described in this tool from the CDC.) Masks may also be a good idea for indoor situations where people are close together — and some staff and campers might simply feel more comfortable wearing a mask. The camp should have a culture that allows those who choose to wear masks to feel comfortable doing so.

What is the plan for shared equipment and surfaces? One is far more likely to catch an infection from a person than a surface, but it’s important that anything that multiple people touch be wiped down regularly.

What is the plan for hand washing? Regular hand washing with soap and water or hand sanitizer is important to limit the spread of germs, including the virus that causes COVID-19. Parents should ask how often campers will be washing their hands, and about the availability of hand sanitizer.

What is the plan for meals? Eating together increases the risk of transmission of COVID-19. The risk is lower if people eat outdoors or have some space to spread out — and if they bring their own food rather than sharing.

As much as we may all feel done with COVID-19, the reality is that COVID-19 isn’t done with us. Children need the experiences camp can bring, especially after their lives have been so disrupted — and with just a few precautions, they can have fun and be safe too.

Follow me on Twitter @drClaire


LATE: A common cause of dementia you’ve never heard of

photo of human brain scans on a computer screen

If dementia is a general term that means thinking and memory has deteriorated to the point that it interferes with day-to-day function, what are the top three disorders that cause dementia in older individuals?

Did you think of Alzheimer’s disease? Good! Alzheimer’s is the most common cause of dementia. Did you also think of vascular dementia or strokes? Excellent! Vascular dementia is the second most common cause. What about the third?

It’s not Lewy body dementia, although Lewy body dementia (encompassing both dementia with Lewy bodies and Parkinson’s disease dementia) is the fourth most common cause. Individuals with this disorder often have features of Parkinson’s disease, visual hallucinations of people and animals, fluctuations in attention and alertness, and they may act out their dreams in bed.

It’s not frontotemporal dementia. Individuals with this disorder are often in their 60s or younger. They generally have problems with behavior or language.

So what’s the answer? It’s LATE, which stands for limbic-predominant age-related TDP-43 encephalopathy.

What’s LATE?

In LATE, a protein called TDP-43 (which stands for transactive response DNA binding protein of 43 kDa) accumulates in brain cells. Once it accumulates, it injures and ultimately destroys the cells.

LATE generally damages many of the same areas affected by Alzheimer’s disease. These regions include

  • the amygdala, involved in emotional regulation
  • the hippocampus, involved in learning and memory
  • the temporal lobe, involved in words and their meanings
  • portions of the frontal lobes, involved with keeping information in mind and manipulating it.

What are the symptoms of LATE?

Because LATE affects many of the same brain regions as Alzheimer’s disease, it often presents with similar symptoms, including

  • memory loss (impairment in episodic memory)
  • trouble finding and understanding words (impairment in semantic memory)
  • trouble keeping information in mind (impairment in working memory)

How common is LATE?

By itself, LATE is estimated to cause about 15% to 20% of all dementias. Many people with dementia also have LATE pathology in addition to one or more other pathologies in their brain. For example, an individual may have the plaques and tangles of Alzheimer’s pathology, plus LATE pathology, plus ministrokes (vascular pathology). It turns out that about 40% of people with dementia have at least some LATE pathology in their brain. All of this means that LATE is, indeed, very common.

How is LATE diagnosed and why haven’t you heard of it before?

LATE can only be diagnosed with certainty at autopsy. However, we can get a hint that LATE might be present when an older individual shows the memory loss and word-finding problems common in Alzheimer’s disease, but special tests used to confirm the diagnosis of Alzheimer’s come up negative.

The reason that you — and most clinicians — haven’t heard about LATE before is that we didn’t realize just how common it is. It was only when we began obtaining results of special tests to diagnose Alzheimer’s disease in living individuals (such as with a lumbar puncture or amyloid PET scan) that we began seeing the prevalence of LATE.

Can LATE be treated?

Because LATE was (and still is) often confused with Alzheimer’s disease, it is almost certain that when the main drugs that are FDA-approved to treat Alzheimer’s disease were evaluated, individuals with LATE were included in those studies. This means that there is every reason to believe that drugs like donepezil (brand name Aricept), rivastigmine (Exelon), memantine (Namenda), and galantamine will all be effective for individuals with dementia due to LATE.

How can you find out more about LATE?

There has been an explosion of scientific papers about LATE in just the last few years. If you have a science background, you might want to peruse them or watch the wonderful scientific symposium on this disorder held by the National Institute on Aging (NIA). If you don’t have a science background, take a look at the NIA or Wikipedia pages on LATE.


Gyn Care 101: What to know about seeing a gynecologist

A female doctor discussing care with a woman in a health care office with charts on the wall

When should you see a gynecologist? The answer is simple in some ways, more complicated in others. If you’re a woman or a person with female reproductive organs, experts recommend that you start seeing a gynecologist when you become sexually active, or at least once before the age of 21.

Good gyn care, as this type of health care is known, is important for many reasons. Depending on your needs and insurance plan, you may receive gyn care from a gynecologist, or a primary care provider (PCP) such as a doctor or nurse practitioner. Think of this post as Gyn Care 101. In it, I’ll describe basic reasons for a gyn care visit and how to decide whether to see a gynecologist or PCP. I’ll also explain what happens during a visit to a gynecologist, what to discuss, and how to be as comfortable as possible throughout the visit.

Common types of gyn care

Good reasons to see your health care team or a gynecologist for gyn care include:

  • a Pap smear to help prevent cervical cancer (this screening test checks cells on the cervix for abnormalities or precancer)
  • discussion of birth control options
  • solutions for painful, heavy, or irregular periods
  • changes in vaginal discharge, which could be a sign of a vaginal infection (for example, a yeast infection or bacterial vaginosis)
  • testing for sexually transmitted infections (STIs), such as chlamydia, gonorrhea, or trichomoniasis
  • symptoms of a urinary tract infection (UTI), such as burning when you urinate, cloudy or bloody urine, urinating more often than usual, or feeling an intense urge to urinate
  • pain or discomfort during sex
  • rashes, bumps, or irritation on the vulva (outside portion of the vagina)
  • perimenopause or menopause symptoms, such as irregular periods, hot flashes, or vaginal dryness.

Should you see a primary care provider or a gynecologist?

Many primary care teams, especially family medicine providers, are well equipped to handle basic gynecology care. They can perform Pap smears and STI testing; prescribe medicine or advice for UTIs, vaginal infections, and urinary tract infections; and help you decide which birth control methods are a good choice for you.

However, certain concerns are best handled by a doctor who specializes in gynecology. For example, you should see a gynecologist if you have

  • painful or irregular periods
  • severe pelvic pain or pain during sex
  • recurring vaginal infections, such as yeast infections or bacterial vaginosis
  • recurring urinary tract infections
  • experienced sexual assault.

It’s also helpful to see a gynecologist about birth control if you’d like to use long-acting methods, such as an intrauterine device (IUD) or a birth control implant, or if you have health issues like high blood pressure or lupus that make some methods of birth control unsafe for you.

What happens during a visit for gyn care?

Like any doctor, a gynecologist will ask questions about your medical history. They’ll also ask about sexual activity — such as when you started having sex and whether you’re sexually active — and whether you hope to have children.

When I see a new patient for a gyn exam, I do a full exam including a breast exam, belly exam, and pelvic exam. A pelvic exam involves examining the vulva and labia (lips) that form the outer genitals, inner thigh, and buttocks. I then use a speculum to examine tissues inside the vagina. This exam can be slightly uncomfortable, with a pressure-like sensation, but should not be painful. You should always tell your provider if you are having pain during any part of the exam.

If you are experiencing symptoms, you may be tested for vaginal infections, STIs, or urinary tract infection. Any vulvar skin issues may require a small skin biopsy or sample of a lesion or bump.

What should you discuss during your visit?

There are a few important things to remember to discuss during your visit. It is best to write these down ahead of time, as people often feel nervous and anxious during these types of sensitive visits:

  • your sexual history (number of partners, any concerns for exposure to STIs)
  • problems with leaking urine or difficulty controlling your urine
  • low sex drive or desire to have sex
  • discomfort or pain during sex
  • heavy or irregular periods
  • any vaginal odor, discomfort, or abnormal discharge
  • rashes or bumps in the pelvic area
  • concerns about or plans for having children in the future.

How can you make yourself as comfortable as possible during gyn visits?

It is normal to feel nervous. You’re discussing sensitive topics and may feel vulnerable and even uncomfortable during the exams. Here are a few strategies to try to maximize your comfort during these visits:

  • If you are anxious or nervous at gyn visits, let your provider know.
  • Ask all your questions before the start of the physical exam.
  • Tell the provider if this is your first pelvic exam.
  • If you have experienced sexual assault or trauma in the past, tell your provider that these types of exams may be difficult for you given your history.
  • Practice mindful breathing or other relaxation techniques during your exam.

Additional ways to help make gyn visits a better experience

You can also ask your provider

  • what to expect from the exam before they begin to help you feel more prepared
  • to explain why each portion of the exam is necessary and tell you about any tests or labs that they plan to perform
  • to let you know when a portion of the exam may feel uncomfortable or when to expect a sensation of pressure.

You have the right to refuse any part of the exam, and your desires should be respected by your provider. You also have the right to ask for a chaperone during the exam if this makes you feel more comfortable.

Trust your gut. If your experience with a particular provider feels uncomfortable or you didn’t connect with them, seek out a different provider. Ask friends if they have anyone to recommend.


What is a successful mindset for weight loss maintenance?

older man being weighed in a medical setting

In today’s calorie-rich, ultra-processed, movement-sparing, chronic stress-inducing, so-called “toxic” environment, losing weight is hard work. But implementing a healthy and sustainable approach that keeps the weight off is even harder.

Short-term weight loss can be easier than long-term weight maintenance

Most of us can successfully achieve weight loss in the short term. But those who hop from one fad diet to the next often experience the metabolic roller coaster known as yo-yo dieting that jacks up our hunger hormones, plummets our metabolic rates, and causes a vicious spiral of weight loss followed by regain. Even most medical interventions to help treat obesity produce the typical trajectory of rapid weight loss followed by weight plateau and then progressive weight regain. In a meta-analysis of 29 long-term weight loss studies, more than half of the lost weight was regained within two years, and by five years more than 80% of lost weight was regained. This means that based on our best estimates, only one in five individuals who is overweight is successful in long-term weight loss.

What is so special about weight loss maintainers?

Based on studies from the National Weight Control Registry, a database of more than 4,000 individuals who have maintained at least 10% body weight loss for at least one year, we have insight into some tried and true tactics. These include various energy intake-reducing behaviors — limiting calorie-dense foods and sugar-sweetened beverages, portion control and a consistent eating pattern across days, increased fruit and vegetable consumption — as well as being physically active for at least an hour per day.

This makes sense and is consistent across the scientific literature. Any successful weight loss necessitates tipping and keeping the scale toward greater energy expenditure and less energy intake (a net negative energy balance). But how do these people actually sustain those weight loss-promoting behaviors over time, in order to build a lifestyle that does not leave them feeling persistently deprived, lethargic, and hangry (hungry + angry)?

The most important determinants of weight loss maintenance are those that cement changes in behavior. As more recent evidence confirms, the proper psychology for weight loss is critical for regulating the physiology that supports weight loss.

Self-regulation and self-efficacy are key to long-term success

Only recently have we started to evaluate the psychological and cognitive determinants of weight loss maintenance. We all have anecdotal evidence from family, friends, and colleagues. But systematically collecting, processing, and analyzing the qualitative experiences, strategies, and challenges from successful weight loss maintainers is difficult.

The data to date confirm the importance of self-regulation, and in particular self-monitoring of the day-to-day behaviors that drive energy intake and energy expenditure, especially eating behaviors. Those who have high self-efficacy (belief in your capacity to execute certain behaviors) for exercise in particular are more successful at sustaining weight loss. And more recently, researchers have been decoding elements of the proper mindset that instills high self-efficacy for the larger constellation of important weight management behaviors.

One recent study used machine learning and natural language processing to identify the major behavioral themes — motivations, strategies, struggles, and successes — that were consistent across a group of over 6,000 people who had successfully lost and maintained over 9 kilograms (about 20 pounds) of weight for at least a year. Among this large group, they consistently advised perseverance in the face of setbacks, and consistency in food tracking and monitoring eating behaviors, as key behavior strategies. And most of them stayed motivated by reflecting on their improved health and appearance at their lower weight.

Studies about successful weight loss miss many people

The evidence suggests that age, gender, and socioeconomic status are not significant factors in predicting weight loss maintenance. But most weight loss studies oversubscribe white, educated, and midlevel income-earning females. Given that the prevalence of obesity and its related comorbidities is disproportionately higher in more socially disadvantaged and historically marginalized populations, we need richer, more representative data to paint a full and inclusive picture of a successful weight loss psychology. We need to better understand the lived experience of all people so that we can determine the most powerful and unique motivations, effective behavioral strategies, and likely challenges and setbacks, particularly the environmental determinants that dictate the opportunities and barriers for engaging in and maintaining a healthier lifestyle.

Maintaining weight requires multiple tools, training, and support

What we can say for certain is that for any and all of us, maintaining weight loss necessitates getting comfortable with discomfort — the discomfort of occasionally feeling hungry, of exercising instead of stress eating, of honestly deciphering reward-seeking versus real hunger, and resisting the ubiquitous lure of ultrapalatable foods. This is no easy task, as it often goes against environmental cues, cultural customs, family upbringing, social influences, and our genetic wiring. In order to help each other achieve health and weight loss in our modern environment, we need to learn and practice the psychological tools that help us not only accept, but eventually embrace, this inevitable discomfort.


Repeating the story: What to expect in the emergency department

Red and white sign outside a hospital with the word "Emergency" pointing toward the emergency department; it's nighttime and an ambulance is parked outside

Hospitals across the country are still scrambling to recover from the toll of an ever-shifting pandemic. What does that mean if you wind up in an emergency department (ED) due to an illness or accident? What should you know and what can you expect? As an emergency medicine doctor at a large teaching hospital, here are some key points to help you navigate a visit to the ED.

The starting line

In the chaos of an emergency department, odds are high that you will encounter a rotating crew of clinical and administrative staff. Their initial goal is to get each person registered for the visit, assess how urgently they need a clinician, and determine which treatment and diagnostic tests are needed. Usually, this is not a simple or quick process. Getting you the care you need hinges on first gathering the information you can provide, and then applying our skills and a range of tools to interpret it. Throughout this process you will be asked to repeat your story several times.

What brings you to the emergency room?

The opening question “What brings you to the emergency department?” is the portal of entry that allows emergency room clinicians to explore your ailment or concerns. The first time around, you’ll probably be eager to answer. The difficulty is the second, third, and fourth time the same question is asked. Yes, everyone is asking the same question, and you are telling the same story.

Good communication is key. We need correct, clear, and comprehensive information from you to guide your care in the emergency department. Seeking and getting accurate information reassures clinicians that informed and complete care is being delivered. Every discussion should welcome you into the conversation so that you may participate while clinicians make decisions.

Throughout your care, you should always be able to say, “Can you please explain what is happening?” or “Could you say that in a different way, because I’m not understanding you.” You can also ask “Is it possible to do this another way?” or “Can I take a break?” (In some instances, of course, that may not be possible.)

Who will you see?

Waiting in the emergency department is itself a journey, particularly at academic medical centers with deep health resources and personnel. At an academic ED like the one I work in, you might first speak with the triage nurse, who asks screening questions that will inform how quickly you need to be seen, then an assigned nurse, who might provide care for you for the entire visit, and later a resident or medical student.

The resident or student ultimately presents your case to me, an attending physician. Some EDs have physician assistants or nurse practitioners who work independently, or in collaboration with attendings. So you might see as many as five clinicians. Often when I ask people to repeat their story I hear, “I’m sorry, I’ve already told the story multiple times. Do we have to go through the process again?” I understand their preference to move the visit forward, not backward. But yes, I have them tell it again, even if it is a shorter version, hoping to glean details that help build a diagnosis.

Why will you wait?

There are many reasons for lengthy waits, which grew still longer at many EDs during the pandemic. First, uniting the team into one conversation is often difficult. Our patients arrive sporadically, procedures need to be performed, phone calls occur, family meetings arise, and so forth. Staggering the team is usually the most efficient way to function.

Teaching hospitals at academic medical centers train future doctors. By seeing you without supervision and discussing their medical decisions with experienced physicians like me, residents and students learn to form their own clinical judgment. Their independence during training helps keep our healthcare system afloat.

Equally important, spacing out interviews can help us find missed information to reach the correct diagnosis. In one case I vividly recall, a nurse initially thought a patient reporting pelvic pain had a urinary tract infection. Later, a junior resident and I asked clarifying questions, hoping to further uncover the root of her illness. We closely examined the location of pain and noticed extensive infection — a severe skin infection called necrotizing fasciitis. We immediately called the surgeons and radiology suite for an imaging scan to confirm the diagnosis and treat her as quickly as possible.

Why is teamwork so essential?

Often nurses, junior residents, or midlevel providers such as physician assistants catch details attending doctors miss during brief histories and physicals. No matter who identifies the diagnosis or orders the correct test, we work as a team. We gather information as a team and compare the data together. The benefit of repeating a history or exam is that gaps close and the best care becomes clear.

A part of the history that was previously skipped is covered. A part of the exam that wasn’t done can be performed. Perhaps you’ll remember enlightening details you had previously forgotten to tell us. Or, as time ticks by, initially mild abdominal pain that offered a hazy clue progresses during repeat exams to severe abdominal pain, and now an imaging study can help make a final diagnosis.

When you’re a patient, it’s hard to wait. It's hard to repeat your story. We know it; we’ve been patients, too. But the system, while not perfect, is built to protect you from the impact of missed information. And in some hospitals, the systems we rely on help train future clinicians — the highly skilled doctors, nurses, and specialized practitioners who will help care for you and many others throughout the years to come.


An action plan to fight unhealthy inflammation

A large yellow arrow clearing a path on a chalkboard by pushing through many smaller white arrows coming from the other direction; concept is taking action

Although inflammation serves a vital role in the body’s defense and repair systems, chronic inflammation can cause more harm than good. And that may make you wonder: what can I do about it?

In fact, there’s a lot you can do. And you may already be doing it. That’s because some of the most important ways to fight inflammation are measures you should be taking routinely.

Let’s take a look at key elements of fighting chronic inflammation: prevention, detection, and treatment.

Six ways to prevent unhealthy inflammation

Six of the most effective ways to ward off inflammation are:

  • Choose a healthy diet. Individual foods have a rather small impact on bodywide inflammation, so no, eating more kale isn’t likely to help much. But making sure you eat lots of fruits and vegetables, whole grains, healthy fats, and legumes — sometimes called an anti-inflammatory diet — may reduce inflammation and lower risk for chronic illnesses like diabetes and heart disease. Not only can these diets help reduce inflammation on their own, but replacing foods that increase inflammation (such as sugary drinks and highly processed foods) benefits your body, too.
  • Exercise regularly.Physical activity may help counter some types of inflammation through regulation of the immune system. For example, exercise has anti-inflammatory effects on white blood cells and chemical messengers called cytokines.
  • Maintain a healthy weight. Because excess fat in cells stimulates bodywide inflammation, avoiding excess weight is an important way to prevent fat-related inflammation. Keeping your weight in check also reduces the risk of type 2 diabetes, a condition that itself causes chronic inflammation.
  • Manage stress. Repeatedly triggered stress hormones contribute to chronic inflammation. Yoga, deep breathing, mindfulness practices, and other forms of relaxation can help calm your nervous system.
  • Do not smoke. Toxins inhaled in cigarette smoke trigger inflammation in the airways, damage lung tissue, and increase the risk of lung cancer and other health problems.
  • Try to prevent inflammatory conditions, such as
    • Infection: Take measures to avoid infections that may cause chronic inflammation. HIV, hepatitis C, and COVID-19 are examples. Practicing safer sex, not sharing needles, and getting routine vaccinations are examples of effective preventive measures.
    • Cancer: Get cancer screening on the schedule recommended by your doctors. For example, colonoscopy can detect and remove polyps that could later become cancerous.
    • Allergies: By avoiding triggers of asthma, eczema, or allergic reactions you can reduce the burden of inflammation in your body.

Do you need tests to detect inflammation?

While testing for inflammation is not routinely recommended, it can be helpful in some situations. For example, tests for inflammation can help to diagnose certain conditions (such as temporal arteritis) or monitor how well treatment is controlling an inflammatory condition (such as Crohn’s disease or rheumatoid arthritis).

However, there are no perfect tests for inflammation. And the best way to know if inflammation is present is to have routine medical care. Seeing a primary care physician, reviewing your medical history and any symptoms you have, having a physical examination, and having some basic medical tests are reasonable starting points. Such routine care does not typically include tests for inflammation.

How is inflammation treated?

At first glance, treating unhealthy, chronic inflammation may seem simple: you take anti-inflammatory medications, right? Actually, there’s much more to it than that.

Anti-inflammatory medicines can be helpful to treat an inflammatory condition. And we have numerous FDA-approved options that are widely available — many in inexpensive generic versions. What’s more, these medicines have been around for decades.

  • Corticosteroids, such as prednisone, are the gold standard. These powerful anti-inflammatory medicines can be lifesaving in a variety of conditions, ranging from asthma to allergic reactions.
  • Other anti-inflammatory medicines can also be quite effective for inflammatory conditions. Ibuprofen, naproxen, and aspirin — which may already be in your medicine cabinet — are among the 20 or so nonsteroidal anti-inflammatory drugs (NSAIDs) that come as pills, tablets, liquids taken by mouth, products applied to skin, injections, and even suppositories.

Yet relying on anti-inflammatory medicines alone for chronic inflammation is often not the best choice. That’s because these medicines may need to be taken for long periods of time and often cause unacceptable side effects. It’s far better to seek and treat the cause of inflammation. Taking this approach may cure or contain many types of chronic inflammation. It may also eliminate the need for other anti-inflammatory treatments.

For example, chronic liver inflammation due to hepatitis C infection can lead to liver scarring, cirrhosis, and eventually liver failure. Medicines to reduce inflammation do not solve the problem, aren’t particularly effective, and may cause intolerable side effects. However, treatments available now can cure most cases of chronic hepatitis C. Once completed, there is no need for anti-inflammatory treatment.

Similarly, among people with rheumatoid arthritis, anti-inflammatory medicines such as ibuprofen or steroids may be a short-term approach that helps ease symptoms, yet joint damage may progress unabated. Controlling the underlying condition with medicines like methotrexate or etanercept can protect the joints and eliminate the need for other anti-inflammatory drugs.

The bottom line

Even though we know that chronic inflammation is closely linked to a number of chronic diseases, quashing inflammation isn’t the only approach, or the best one, in all cases.

Fortunately, you can take measures to fight or even prevent unhealthy inflammation. Living an “anti-inflammatory life” isn’t always easy. But if you can do it, there’s an added bonus: measures considered to be anti-inflammatory are generally good for your health, with benefits that reach well beyond reducing inflammation.


The formula shortage is hurting families: What parents should know and do

Parent cradling infant being fed formula with one hand behind head and other hand holding bottle

It’s terrifying to think about not being able to feed your baby — and right now, with the baby formula shortage, parents all over the country are feeling exactly that terror.

The supply chain for baby formula had been tenuous for some time, but when Abbott Pharmaceuticals recalled many of their formula products — and closed down their biggest production facility in the US — it literally caused a formula crisis. Many store shelves are empty of baby formula, and it isn’t easy to find online, either. While formula companies and the government are working to restore the supply, it may take a while before it’s easy to buy a can of formula. In the meantime, here are some do’s and don’ts for parents who use formula.

What parents shoulddo during the formula shortage


  • Try lots of different stores and websites. Most families are already doing this, but it’s worth saying.
  • Put out the word to friends and family — the more people looking, the better.
  • Check out social media. Many organizations, sites, and pages are offering information about where formula is available.
  • Be willing to buy other brands besides your usual one, if your baby uses regular formula. It truly doesn’t matter, they are all remarkably similar. If your baby is on a specialized formula, check with your doctor as to which brands can be substituted.
  • Only buy from reputable sites and sellers. You want to be sure that what you buy is the real thing.
  • If you get formula through WIC or a medical supply company, call them to see if they can help.
  • Call your doctor! This is particularly important if your child is on a specialized formula (in which case you absolutely must call them). But also call if you have any questions about what to give your baby and how to find it.

In a pinch, here are some things you can do for a few days while you look for formula. Please note: This does not apply if your baby is on specialized formula or is less than 6 months old!

  • If your baby is close to a year old (say, 10 months old or older), you could give them toddler formula or soy milk. (If you use soy milk, only use brands that are fortified with protein and calcium.) Do not give toddler formula or soy milk to younger babies.
  • If your baby is more than 6 months old, you can give whole cow’s milk. If you do this, be sure there is plenty of iron in your baby’s diet, and talk to your doctor about giving an iron supplement.

Again, these should only be done for a few days.

What parents shouldn’t do during the formula shortage

  • Don’t dilute your formula. Not only is diluted formula lacking in calories, but it can be dangerous.
  • Don’t buy formula directly from other countries. It’s not regulated by the FDA and may not be safe.
  • Don’t make your own formula. It may not be safe.
  • Don’t give plant-based milks, except soy milk for older babies as noted above. Many plant-based milks, such as almond milk, do not have enough nutrition for babies.
  • Don’t give juice instead of milk. It definitely doesn’t have the nutrition babies need.
  • Don’t hoard formula if you find it. As tempting as it might be, think of all the other families in the same boat you are. The American Academy of Pediatrics recommends buying no more than a 10-to-14-day supply.

If you have any questions, call your doctor.

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