Children’s mental health tops list of parent worries, survey finds | CNN



CNN
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Forty percent of US parents are “extremely” or “very” worried that their children will struggle with anxiety or depression at some point, a new survey finds.

The Pew Research Center report said mental health was the greatest concern among parents, followed by bullying, which worries 35% of parents. These concerns trumped fears of kidnapping, dangers of drugs and alcohol, teen pregnancy and getting into trouble with the police.

Concerns varied by race, ethnicity and income level, with roughly 4 in 10 Latino and low-income parents and 3 in 10 Black parents saying they are extremely or very worried that their children could be shot, compared with about 1 in 10 high-income or White parents.

Nearly two-thirds of the respondents said that being a parent has been at least somewhat harder than they expected, about 41% say that being a parent is tiring, and 29% say it is stressful all or most of the time.

The report captured the perceptions of a nationally representative sample of 3,757 US parents whose children were younger than 18 in 2022.

Experts say mental health issues among children and adolescents have skyrocketed in recent years.

“I would say over the last 10 years, since I’ve been practicing as a general pediatrician, I have seen a shift both in the amount of patients and of all ages dealing with anxiety and depression. And their parents being concerned about this is a key issue,” said Dr. Katherine Williamson, a pediatrician and spokesperson for the American Academy of Pediatrics. “Even before the pandemic, we were seeing skyrocketing numbers of kids and adolescents dealing with mental health issues, and that has increased exponentially since the pandemic.”

Suicide became the second leading cause of death among children 10 to 14 during the Covid-19 pandemic, according to the US Centers for Disease Control and Prevention. Mental health-related emergency room visits among adolescents 5 to 11 and 12 to 17 also jumped 24% and 31%, respectively.

Many parents feel helpless when their children have mental health issues because they don’t feel equipped to offer support in this area.

“They are unable to relieve [mental health issues] and address that as they could if they were struggling with their grades or other things that seem more traditional to for kids to struggle with,” said Allen Sabey, a family therapist at the Family Institute at Northwestern University.

Parents trying to “work out and look at and connect with their own feelings will give them important information about what feels off or OK for their kid,” he said.

When it comes to anxiety and depression in children, pediatricians say, parents can watch for signs like decreased interest or pleasure in things they previously enjoyed, poor self-esteem and changes in mood, appetite or sleep.

Experts also say parents should consider the amount and content of social media their child consumes, as research has found that it can have negative effects on their mental health.

But, they say, having more parents recognize the importance of mental health in children is a step in the right direction.

“I have always felt there’s been so much resistance to seeking care for mental health among the population that I serve. And I am actually happy that since the Covid pandemic, at least people now are recognizing this as a very key and important health need,” said Dr. Maggi Smeal, a pediatrician at Stanford Medicine Children’s Health.

Smeal hopes that “all people that are interacting with children can be aware of these issues and feel empowered to identify and advocate for these children, to tell them to go to their primary care provider and have an assessment just like you do if your kid has a cough or a fever or ear infection.”

The number of parents concerned about gun violence reflects the fact that guns are the leading cause of death among children in the US, research has showed. From 2019 to 2020, the rate of firearm-related deaths increased 29.5% – more than twice the increase as in the general population.

“Gun violence is a real risk to our kids today. And that is both being killed by somebody else as well as suicide in the face of the mental health issues that we’re seeing today,” Williamson said.

The survey found that Black, Hispanic and lower-income parents were most likely to be concerned about gun violence, a finding that’s consistent with the communities most affected. Research has shown that from 2018 to 2021, the rate of firearm-related deaths doubled among Black youth and increased 50% among Hispanic youth. Another study found that children living in low-income areas are at higher risk of firearm-related death.

Direct and indirect exposure to gun violence can contribute to mental health problems.

“Even if they hear gunshots in their community, they hear adults talking, there’s all different ways that children are traumatized and victimized by gun violence. And what we see is all the symptoms of anxiety in even the youngest of children. We see children with somatic complaints – stomachaches, headaches. They have post-traumatic stress disorder,” Smeal said.

Most of the parents in the survey said parenting is harder than they expected, and that they feel judgment from various sources.

“The findings of this of this report were, as a pediatrician and a parent, just exactly what you would expect. Parenting is the hardest thing you’ll ever do, and there are very high levels of stress and fatigue, especially in the parents of young children,” Smeal said.

One of the best things parents can do is lean on fellow parents, experts say.

“The main challenge for parents is our siloed independent nature sometimes, and so we want to find people who we trust and kind of work towards being more vulnerable and open with,” Sabey said. “To where it’s like not just you and your kid, but it’s a kind of a group of people caring and working together.”

Pediatricians emphasize that no parent is perfect and that the most important thing you can do is to just be there for your child.

“We know that the best chance for a child to be successful and happy is for them to have at least one person in their life who believes in them and advocates for them. So I think it’s important for parents to know that there’s no such thing as a perfect parent, because we are all human, and humans are imperfect by nature, but that is OK,” Williamson said.

A parent’s job is to “really make sure that they know how important they are and they have a voice in this world,” she said. “Every child will have their own unique struggles, whether it is academically, emotionally, physically. Our job is to help them with the areas [where] they struggle, but even more, help them recognize their strengths.”

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Many women underestimate breast density as a risk factor for breast cancer, study shows | CNN



CNN
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Dense breast tissue has been associated with up to a four times higher risk of breast cancer. However, a new study suggests few women view breast density as a significant risk factor.

The study, published in JAMA Network Open, surveyed 1,858 women ages 40 to 76 years from 2019 to 2020 who reported having recently undergone mammography, had no history of breast cancer and had heard of breast density.

Women were asked to compare the risk of breast density to five other breast cancer risk factors: having a first-degree relative with breast cancer, being overweight or obese, drinking more than one alcoholic beverage per day, never having children and having a prior breast biopsy.

“When compared to other known and perhaps more well-known breast cancer risks, women did not perceive breast density as significant of a risk,” said Laura Beidler, an author of the study and researcher at the Dartmouth Institute for Health Policy and Clinical Practice.

For example, the authors report that dense breast tissue is associated with a 1.2 to four times higher risk of breast cancer compared with a two times higher risk associated with having a first-degree relative with breast cancer – but 93% of women said breast density was a lesser risk.

Dense breasts tissue refers to breasts that are composed of more glandular and fibrous tissue than fatty tissue. It is a normal and common finding present in about half of women undergoing mammograms.

The researchers also interviewed 61 participants who reported being notified of their breast density and asked what they thought contributes to breast cancer and how they could reduce their risk. While most women correctly noted that breast density could mask tumors on mammograms, few women felt that breast density could be a risk factor for breast cancer.

Roughly one-third of women thought there was nothing they could do to reduce their breast cancer risk, although there are several ways to reduce risk, including maintaining a healthy, active lifestyle and minimizing alcohol consumption.

Breast density changes over a woman’s lifetime, and is generally higher in women who are younger, have a lower body weight, are pregnant or breastfeeding, or are taking hormone replacement therapy.

The level of breast cancer risk increases with the degree of breast density; however, experts aren’t certain why this is true.

“One hypothesis has been that women who have more dense breast tissue also have higher, greater levels of estrogen, circulating estrogen, which contributes to both the breast density and to the risk of developing breast cancer,” said Dr. Harold Burstein, a breast oncologist at the Dana-Farber Cancer Institute who was not involved in the study. “Another hypothesis is that there’s something about the tissue itself, making it more dense, that somehow predisposes to the development of breast cancer. We don’t really know which one explains the observation.”

Thirty-eight states currently mandate that women receive written notification about their breast density and its potential breast cancer risk following mammography; however, studies have shown that many women find this information confusing.

“Even though women are notified usually in writing when they get a report after a mammogram that says, ‘You have increased breast density,’ it’s kind of just tucked in there at the bottom of the report. I’m not sure that anyone is explaining to them, certainly in person or verbally, what that means,” said Dr. Ruth Oratz, a breast oncologist at NYU Langone’s Perlmutter Cancer Center who was not involved in the study.

“I think what we’ve learned from this study is that we have to do a better job of educating not only the general public of women, but the general public of health care providers who are doing the primary care, who are ordering those screening mammograms,” she added.

Current screening guidelines recommend women of average risk of breast cancer undergo breast cancer screening every one to two years between ages 50 to 74 with the option of beginning at age 40.

Because women with dense breast tissue are considered to have higher than average cancer risks, the authors of the study suggest women with high breast density may benefit from supplemental screening like breast MRI or breast ultrasound, which may detect cancers that are missed on mammograms. Currently, coverage of supplemental screening after the initial mammogram varies, depending on the state and insurance policy.

The authors warn that “supplemental screening not only can lead to increased rates of cancer detection but also may result in more false-positive results and recall appointments.” They say clinicians should use risk assessment tools when discussing tradeoffs associated with supplemental screening.

“Usually, it’s a discussion between the patient, the clinical team, and the radiologist. And it’ll be affected by prior history, by whether there’s anything else of concern on the mammogram, by the patient’s family history. So those are the kinds of things we discuss frequently with patients who are in such situations,” Burstein said.

Breast cancer screening recommendations differ between medical organizations, and experts say women at higher risk due to breast density should discuss with their doctor what screening method and frequency are most appropriate.

“I think it’s really, really important that everyone understands – and this is the doctors, the nurses, the women themselves – that screening is not a one size fits all recommendation. We cannot just make one general recommendation to the entire population because individual women have different levels of risks of developing breast cancer,” Oratz said.

For the nearly one-third of women with dense breast tissue that reported there was nothing they could do to prevent breast cancer, experts say there are some steps you can take to reduce your risk.

“Maintaining an active, healthy lifestyle and minimizing alcohol consumption address several modifiable factors. Breastfeeding can decrease the risk. On the other hand, use of hormone replacement therapy increases breast cancer risk,” said Dr. Puneet Singh, a breast surgical oncologist at the MD Anderson Cancer Center who was not involved in the study.

The researchers add that there are approved medications, such as tamoxifen, that can be given for those at significantly increased risk that may reduce the chances of breast cancer by about half.

Finally, breast cancer doctors say that in addition to appropriate screening, knowing your risk factors and advocating for yourself can be powerful tools in preventing and detecting breast cancer.

“At any age, if any woman feels uncomfortable about something that’s going on in her breast, if she has discomfort, notices a change in the breast, bring that to the attention of your doctor and make sure it gets evaluated and don’t let somebody just brush you off,” Oratz said.

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Pediatricians are giving out free gun locks to approach the gun violence epidemic as a public health crisis | CNN



CNN
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In a triage waiting room of St. Louis Children’s Hospital in Missouri, a clear basket filled with gun locks sits near the walkway, just noticeable enough to those passing by.

The hospital staff calls it the “No Questions Asked” basket, to encourage gun safety without having to confront gun owners about what can be a sensitive and divisive topic. It holds an assortment of cable gun locks free of charge, available to those who need them, alongside pamphlets explaining how to properly and safely store firearms.

The initiative, aimed at reducing the stigma of addressing gun safety, is part of a growing effort by medical professionals who are treating the country’s gun violence epidemic as a public health crisis.

“It takes standing at the bedside of one child who has been shot to realize that we all have to do more and as the leading cause of death for children in this country, pediatricians need to be front and center of the solution, of all the solutions,” said Dr. Annie Andrews, a professor of pediatrics at the Medical University of South Carolina and an expert on gun violence prevention.

Over the course of two years, thousands of gun locks have been taken from the basket, according to Dr. Lindsay Clukies, a pediatric emergency medicine physician at the hospital.

In the coming weeks, baskets filled with free gun locks will be available at more than 17 locations operated by BJC HealthCare, an organization serving metro St. Louis, mid-Missouri and Southern Illinois, Clukies said. It’s a low-cost and effective way to easily distribute firearm safety devices.

“We’ve had employees as well as patients take our locks, also their families and even a grandmother who took one for her grandson. It’s for anyone who needs them,” Clukies told CNN. In recent years, a rising number of pediatricians across the country have been engaging with the topic of gun safety in medical settings by focusing on safety and prevention, already a natural aspect of their work.

During patient visits, it’s increasingly common for pediatricians to ask the patient’s parents if there are guns at home, and if so, how they are stored. Some hospitals then offer free gun locks, often sourced from donations or police departments and paired with safe storage education.

Some pediatricians, who bear witness to the effects of gun violence on children in their workplace every day, told CNN they see it as their obligation as medical professionals to be part of the solution to the epidemic.

In 2022, 1,672 children and teenagers under 17 were killed by gun violence and 4,476 were injured, according to the Gun Violence Archive, a nonprofit organization tracking injuries and deaths by gunfire since 2014.

“We have just as an important voice in this conversation as anyone else because we’re the ones who have invested our entire careers to protecting children and ensuring that children can grow up to be the safest healthiest version of themselves,” said Andrews.

“It is only natural that we see these things that we understand that they’re preventable, and we want to get involved in finding the solutions,” she added.

So far in 2023, high-profile incidents of children accessing firearms have heeded calls for stronger, more consistent laws nationwide, requiring adults to safely secure their guns out of the reach of children and others unauthorized to use them. They have also highlighted a lack of public education on the responsibility of gun owners to store their guns unloaded, locked and away from ammunition, CNN previously reported.

In early January, a 6-year-old boy was taken into police custody after he took a gun purchased by his mother from his home, brought it to school and shot his teacher at Richneck Elementary School in Newport News, Virginia, police said. Just over a week later, a man was arrested in Beech Grove, Indiana, after video was shown on live TV of a toddler, reportedly the man’s son, waving and pulling the trigger of a handgun, CNN previously reported.

Hundreds of children in the US every year gain access to firearms and unintentionally shoot themselves or someone else, according to research by Everytown for Gun Safety, a leading non-profit organization focusing on gun violence prevention. In 2022, there were 301 unintentional shootings by children, resulting in 133 deaths and 180 injuries nationally, Everytown data showed.

Firearm injuries are now the leading cause of death among people younger than 24 in the United States, according to the Centers for Disease Control and Prevention. The American Academy of Pediatrics released an updated policy statement in October 2022, stating firearms are now the leading cause of death in children under the age of 24 in the US.

The Academy’s statement urged a “multipronged approach with layers of protection focused on harm reduction, which has been successful in decreasing motor vehicle-related injuries, is essential to decrease firearm injuries and deaths in children and youth.”

The Academy has free educational modules for pediatricians to guide them on how to have what can be challenging or uncomfortable conversations about firearms with families, according to Dr. Lois Kaye Lee, a pediatrician and the chair of the Academy’s Council on Injury, Violence and Poison Prevention.

“This shouldn’t be considered as something extra; it should be considered as part of the work that we do every day around injury prevention, be it around firearms, child passenger safety and suicide prevention,” Lee said.

Dr. Georges Benjamin, executive director of the American Public Health Association, told CNN the public health approach to addressing gun violence removes the politics from the issue and “puts it into a scientific evidence-based framework.”

“Physicians have a unique opportunity to engage their patients, the parents of kids or the parents themselves as individuals to make their homes safer,” Benjamin said. “We already do this for toxins under our kitchen cabinets, razor blades and outlets in the wall.”

In the emergency department at St. Louis Children’s Hospital, all patients are screened for access to firearms and offered free gun locks, as well as safe storage education, Clukies said. Gun locks can also be mailed to families, free of cost, through the hospital’s website.

“Every patient that comes into our emergency department, whether it’s for a fever or a cold or a broken arm, is asked about access to firearms,” said Clukies, adding 5,000 locks have been given out since the initiatives were started in 2021.

In a collaborative effort between trauma nurses, physicians, social workers, violence intervention experts and family partners, the hospital created a “nonjudgmental” script for doctors to follow as they ask patients about access to firearms, Clukies said.

During the screening process, pediatricians will ask parents or caretakers questions such as: Do you have access to a firearm where your child lives or plays? How is it stored? Is it stored unloaded or loaded?

“When I first started doing this, I would say, ‘Are there any guns in the home? Yes, or no?’ But I have found and learned from other experts that if you just say, ‘If there are any guns in the home, do you mind telling me how they’re secured?’ it takes away the judgment,” said Andrews, a pediatrician whose hospital, the Medical University of South Carolina, also offers free gun locks to patients.

An assortment of cable gun locks offered free of charge by the Medical University of South Carolina.

Families are asked about firearms in the “social history” phase of a patient visit, during which pediatricians will ask who lives in the home, what grade the child is in, what activities they engage in and where the child goes to school, according to Andrews. When parents indicate their firearms are not safely stored, like on the top of a shelf or in a nightstand drawer, Andrews said those are important opportunities for intervention and education about storage devices such as keypad lockboxes, fingerprint biometric safes and other types of lock systems.

It’s also important for pediatricians to understand the parents’ or caretakers’ motivation for owning a firearm to “inform the conversation about where they’re willing to meet you as far as storage goes,” she added.

Andrews and Clukies said they were pleasantly surprised by the willingness of families to discuss firearm safety, most of whom recognize it is an effort to protect their children.

“I expected more pushback than we received, which is attributed to us really focusing on how we properly word these questions,” Clukies said. “I think it’s because we turn it into a neutral conversation, and we focus on safety and prevention.”

Andrews added it is uncommon for medical schools or residencies to discuss gun violence prevention, which she says is due to the “politics around the issue.”

“Thankfully, that has evolved, and more and more pediatricians are realizing that we have to be an integral part of the solution to this problem,” Andrews said.

At the St. Louis Children’s Hospital, pediatricians followed up with patients who received a free gun lock in a research study roughly two months after they launched the initiative in the fall of 2021 to see if their storage practices changed.

The study found two-thirds of families reported using the gun lock provided to them by the hospital and there was a “statistically significant decrease” in those who didn’t store their firearms safely, as well as an increase in those who stored their firearms unloaded, according to Clukies.

But there is still much more work to be done in the medical community to fight the gun violence epidemic and scientific research on the issue is “woefully underfunded,” Andrews contended.

According to the American Public Health Association’s Benjamin, a multidisciplinary approach by policymakers, law enforcement and the medical community is essential to fostering a safer environment for children.

“Injury prevention is a core part of every physician’s job,” Benjamin said. “It’s clearly in our lane.”

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Millions have the same ‘bendy body’ disease as my daughter. Why isn’t the medical profession paying more attention? | CNN



CNN
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One day in July 2021, my then 15-year-old daughter Poppy stumbled and fell while walking down some stairs, grazing her knee. It wasn’t a serious wound, but over the weeks it didn’t heal.

Around the same time, her wrists and knees became sore; her ankles started rolling when she walked; her hands began shaking; her headaches and stomach aches became more frequent and intensely painful. She was always exhausted.

Before her health declined, Poppy had enjoyed horse riding and gymnastics, she’d competed in cross country races and been a fearless goalkeeper for the school hockey team.

But within a couple of months, as walking became increasingly difficult, she asked me for a walking stick. We found one that folds up and fits neatly in her school bag.

I took Poppy to doctors who conducted tests, but they couldn’t find out what was wrong with her. Then, in October, a breakthrough.

A podiatrist who was measuring Poppy for insoles to support her aching feet asked if Poppy could bend her thumb to reach her forearm. She could. Could she pull her little finger back to form a 90-degree angle with the back of her hand? She could do that, too.

“Have you heard of Ehlers-Danlos syndrome?” the podiatrist asked me. I hadn’t – so as soon as I got home, I went looking on the internet.

There are 13 types of Ehlers-Danlos syndrome (EDS), according to research and advocacy organization The Ehlers-Danlos Society. Most types are very rare, and can be diagnosed using genetic tests. However, the genes that cause hypermobile EDS (hEDS) – the most common form, accounting for about 90% of cases – are unknown, so diagnosis is based on a checklist of symptoms. The list includes a hypermobility rating, known as the Beighton Score.

Poppy had enough symptoms to qualify for hEDS, and the diagnosis was confirmed by a doctor one year ago, on Christmas Eve. He told us that although we can do our best to alleviate some symptoms, there is no cure.

Poppy reacted to the news better than I did. She had known for some time that something was fundamentally wrong. The diagnosis was upsetting but identifying her illness also gave her a sense of relief. I felt shocked and overwhelmed, and I cried for weeks.

Reading about EDS was like a dreadful slow reveal.

I learned that it’s a genetic disorder that causes the body to make faulty connective tissue, and connective tissue is everywhere – in the tendons, ligaments, skin, heart, digestive system, eyes and gums.

Weak connective tissue leads to hypermobility, which may sound like a good thing, but some people with bendy bodies suffer a mind-boggling array of symptoms, including joint dislocations and subluxations (like a mini dislocation, when the joint partially slips out of place), soft stretchy skin, abnormal scarring, poor wound healing, gastrointestinal disorders, chronic pain and fatigue.

The severity of symptoms varies wildly. Patients with milder cases can lead relatively normal lives, while others become housebound, and some can’t digest food and must be fed through tubes.

What’s more, people with hEDS are prone to other conditions, including POTS (postural orthostatic tachycardia syndrome, which makes you dizzy when you stand up) and MCAS (mast cell activation syndrome, which gives you allergy-type symptoms).

I learned a lot of new acronyms and they all spelled bad news.

I initially thought hEDS was rare, because all forms of EDS are commonly referred to as rare. But within a few weeks, I felt like I was seeing references to hEDS everywhere. Actor, writer and director Lena Dunham; actor and presenter Jameela Jamil; and drag queen Yvie Oddly live with it. I deep dived into EDS Twitter and EDS Instagram, while Poppy found it comforting to watch TikTok videos made by teenagers with the condition.

I discovered multiple patient groups on Facebook, each with tens of thousands of members, which turned out to be great sources of support. I asked questions (what kind of shoes are best for weak ankles? Which knee braces are easiest to pull on and off?) and kind strangers sent helpful advice. At the same time, scrolling through countless personal stories of pain, despair and shattered dreams made me feel terrified about what might lie ahead.

I noticed common themes. Many EDS patients had spent years seeking the correct diagnosis; others felt they’d been neglected and gaslit by doctors.

There was also a lot of talk of zebras.

Linda Bluestein, a Colorado-based physician who specializes in EDS and other hypermobility conditions, and has hEDS herself, explains why.

“I was told in medical school, ‘when you hear hoofbeats think horses, not zebras,’” she says. Many trainee doctors receive the same advice – when a patient presents with symptoms, “look for the common thing.” That’s why EDS patients commonly refer to themselves as zebras – and also use the fabulous collective noun “dazzle.” The name represents rarity and evokes the stripy stretch marks that are a common feature on EDS skin.

But if people with hEDS are medical zebras, why am I encountering so many of them?

Bluestein says that for many years it was thought that one in 5,000 people had Ehlers-Danlos syndrome. But she says the limited research that’s been carried out into the prevalence of hEDS suggests the true number of cases is “much, much higher” than that.

Dr. Linda Bluestein has treated hEDS patients  who have been searching for a diagnosis for decades.

Bluestein points me to a 2019 study carried out in Wales – a country of 3.1 million people. An examination of primary care and hospital records from 1990 to 2017 found that one in 500 people there has either hEDS or joint hypermobility syndrome (a similar condition with a slightly different set of symptoms). She says it’s “a good study” but believes it’s still an underestimate. The Ehlers-Danlos Society says more population studies need to be done to give a more accurate view of its incidence elsewhere.

But despite this possible prevalence, and how debilitating hypermobility disorders can be, the average time to diagnosis from the onset of symptoms is 10 to 12 years, according to The Ehlers-Danlos Society.

Bluestein has firsthand experience of this. Growing up, she wanted to become a ballet dancer and trained six days a week. When puberty hit, she started experiencing joint pain and migraines, and at 16 had her first orthopedic surgery. She realized she wouldn’t succeed in the ballet world and instead pursued her “back-up plan,” to become a doctor. But despite her career choice, Bluestein only received her hEDS diagnosis when she was 47 – more than 30 years later.

“I told my doctor on numerous occasions, ‘there is something wrong with me, I don’t heal well, I get injured more easily than other people’,” she says. “And he just never, never listened.”

Why, for so many patients, does it take so long to get diagnosed?

In 2014 a leading EDS expert, Professor Rodney Grahame, remarked at a conference that “no other disease in the history of modern medicine has been neglected in such a way as Ehlers-Danlos syndrome.”

Far more women than men are diagnosed with EDS, which could help to explain the neglect, because the medical profession has a long history of overlooking health complaints made by women.

A 2009 study, conducted by the European Organisation for Rare Diseases, surveyed 414 families of EDS patients from five countries and found that the average delay to an EDS diagnosis was four years for men – but 16 years for women.

The report states that women with EDS tend to be “diagnosed later because their pain and hypotonia (poor muscle tone) aren’t considered as physical symptoms but rather as psychological symptoms or common complaints.”

“We tend to get dismissed a lot more easily,” says Bluestein. “People jump to the conclusion that we’re histrionic females.”

Anxiety is very common in patients with hypermobility issues, says Bluestein, which can cloud the picture. “When people with anxiety present to a physician, it can suck all the air out of the room, so that the physician almost can’t see anything else.”

This can ramp up the patient’s anxiety further “because people aren’t validating our symptoms, and then we start to doubt ourselves,” she says.

What’s more, medicine is divided into silos which creates the “worst possible model” for EDS patients, says Bluestein.

VIDEO THUMBNAIL Ehlers-Danlos Syndrome 1

‘We’re born with this and will never be free:’ Hear stories from people with Ehlers-Danlos syndrome

She explains that undiagnosed patients might consult a neurologist for their migraines, a rheumatologist for joint pain, a cardiologist for palpitations, a gastroenterologist for digestive issues and a urologist for bladder symptoms. Each doctor focuses on the symptoms that fall within their specialty but doesn’t consider the other ailments. “Nowhere along the way does somebody realize that there are certain conditions that could tie all of these things together and explain everything,” says Bluestein.

The 2009 rare diseases study found that during the quest for a diagnosis, 58% of EDS patients consulted more than five doctors, and 20% consulted more than 20.

The consequences of not getting diagnosed for years can be devastating.

Melissa Dickinson, a psychotherapist in Atlanta, Georgia, says she experienced symptoms of a “mystery illness” since childhood. Then in 2013, she “went on honeymoon to Mexico, relatively healthy, and came back disabled and with a dislocated neck.”

While on vacation, Dickinson says she got food poisoning and was prescribed ciprofloxacin, an antibiotic that can pose a serious risk of aortic aneurysm to people with EDS. Instead, she says it triggered significant nerve damage, digestive issues that almost made her go blind because her body wasn’t absorbing nutrients, and put her in a wheelchair.

Dickinson, who finally received her hEDS diagnosis in 2014, says taking the wrong medication “wrecked me from head to toe.” Now that she’s receiving treatment, “I can walk with mobility aids, but most of my body has to have constant support to function.”

Lara Bloom, president and CEO of The Ehlers-Danlos Society, who herself has hEDS, says many patients have “medicalized PTSD.”

“They have had to stop their careers, they’ve had to drop out of school, their relationships have broken down.” The delay inevitably results in worsening symptoms and a declining quality of life, she says. In worst-case scenarios, patients “are dying by suicide, they’re self-harming.”

Sometimes, the failure to diagnose EDS has led to children being taken away from their parents.

In 2010, Americans Rana Tyson and her husband Chad were falsely accused of harming their 4-week-old twin daughters, who had unexplained fractures in their legs.

Along with their older sister, the baby girls were taken by state authorities in Texas and sent to live with relatives. “It was the worst day of my life,” Tyson tells me in a phone call.

Five months later, a geneticist identified the twins as having a connective tissue disorder, and they were subsequently diagnosed with EDS and a vitamin D deficiency. The family was reunited but “12 years later, it still hurts,” says Tyson.

Bloom says some other parents of children with EDS have been wrongly accused of “fabricated or induced illness (FII)” – a rare form of abuse, formerly known as Munchausen’s syndrome by proxy, in which a parent or care giver deliberately causes symptoms or tries to convince doctors that a healthy child is ill.

Ellie Pattison, who has hEDS, has been repeatedly misdiagnosed as having an eating disorder.

Ellie Pattison, a 19-year-old student who lives in County Durham, England, suffers from severe digestive issues linked to hEDS.

Throughout her childhood, Ellie was repeatedly misdiagnosed as having an eating disorder, she says, while her mother Caroline was accused of FII on three separate occasions. Caroline successfully fought to keep her daughter at home, says Ellie, but the ordeal has left the whole family with “an unimaginable amount of trauma.” Ellie says she suffered from PTSD and endured years of horrific nightmares, triggered by living with the fear from a young age that she could be forcibly separated from her family.

This underlines why prompt diagnosis is so important, says Bloom. “Our hope and dream is for people to get diagnosed when their symptoms begin.”

In the case of hEDS, a crucial first step is to find out what causes it.

Cortney Gensemer, a biomedical scientist in the Norris Lab at the Medical University of South Carolina’s department of Regenerative Medicine and Cell Biology, is trying to solve this mystery. She and research mentor Russell Norris, head of the lab, have been studying a gene mutation they believe causes hEDS (the results of the study are currently under peer review).

Like Poppy, Gensemer was diagnosed with hEDS as a teenager. She says the disease affects every aspect of her work. Looking down a microscope is particularly painful at times – her neck is unstable because of her hEDS, and she’s had metal screws put into some of her neck vertebrae to fuse them.

Cortney Gensemer working in the Norris Lab and recovering from neck surgery earlier this year.

Norris kitted the lab out with special equipment, including motion sensor doors (standard lab doors are very heavy), adjustable chairs and ergonomic pipettes that are gentle on the hands. “If I didn’t have all that stuff, I don’t think I’d be able to do it,” says Gensemer.

To find a hEDS-causing gene, Gensemer says she and Norris sampled DNA from a large family with cases spanning four generations and looked for a mutation that appears only in relatives who have the disease. They identified a “strong candidate gene” and inserted it into mice using gene editing tools.

Gensemer and Norris found that the hEDS mice had significantly more lax tissues, and floppier tails than regular rodents. “You can tie a loose knot into the mutant mouse tail. With a normal mouse tail, you can (only) bend it into a circle,” Gensemer says.

The gene that Gensemer and Norris found won’t account for all hEDS cases, she says. They believe that eventually multiple genes will be identified, and hEDS may be split into different subtypes. This would help to explain why different patients have different symptoms. Crucially, if genetic information sheds light on how the connective tissue is “messed up,” it could lead to effective treatments, says Gensemer.

The Ehlers-Danlos Society is also looking for genes as well as blood markers, working with a team of experts to sequence and analyze the DNA of 1,000 hEDS patients from around the world. And at the UK’s University of Warwick, Ph.D. candidate Sabeeha Malek, another scientist with hEDS, has proposed that EDS might be caused by a fault in the way that collagen binds to cell membranes in connective tissue. If she’s right, she hopes her work will lead to a skin biopsy test that could identify all forms of the disease.

Sabeeha Malek is working to identify biomarkers that could make EDS diagnosis easier.

Progress is being made but on a very small scale. “If you look at any major academic institution, there are multiple labs studying cancer, multiple labs studying heart disease. When you look at a disease that affects one in 500 people, and probably more than that, there should be a lab studying it at every single academic institution,” says Gensemer.

Gensemer hopes that as more discoveries are made and data is accumulated it will “change the way the medical community looks at the disease” – and that it will be taken more seriously.

A year has passed since Poppy’s diagnosis. The initial shock has subsided, and while I’m still grieving the loss of her health, we’ve both learned to accept our new reality and have adjusted to living with EDS.

I’ve assembled a team of supportive doctors and therapists and acquired an arsenal of paraphernalia to fight pain and manage symptoms, including braces and kinesiology tape to hold her joints in place; ice packs, heat pads, tiger balm and arnica gel for sore muscles; and a cupboard full of medications and supplements.

With Poppy often stuck at home, I also got her a giant kitten that she calls Bagel, and he provides the best therapy.

Poppy with Bagel.

Writing this article has taught me a lot more about EDS: It’s been upsetting to report on the terrible experiences some have suffered, but I’ve been awestruck by the dedication of people, many with the condition themselves, who are working to find solutions.

I don’t know what the future holds for Poppy. Some patients’ symptoms improve with age; others experience an increase in pain and a loss of mobility. I’ve learned there’s a limit to what we can control but there’s a lot we can do, to tackle symptoms and make life easier. And I believe that change is coming.

With a better understanding of the condition and diagnostic tools on the horizon, my biggest hope is that there will be a cure one day – and that it will come in time for Poppy.

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Decreasing rates of childhood immunization are a major concern. Our medical analyst explains why | CNN



CNN
— 

Vaccine rates for measles, polio, diphtheria and other diseases are decreasing among US children, according to a new study from the US Centers for Disease Control and Prevention.

The rate of immunizations for required vaccines among kindergarten students declined from 95% to approximately 94% during the 2020-21 school year. It dropped further — to 93% — in the 2021-22 school year.

That’s still a high number, so why is this drop in immunization significant? What accounts for the decline? What might be the consequences if these numbers drop further? If parents are unsure about vaccinating their kids, what should they do? And what can be done on a policy level to increase immunization numbers?

To help us with these questions, I spoke with CNN Medical Analyst Dr. Leana Wen, an emergency physician, public health expert and professor of health policy and management at the George Washington University Milken Institute School of Public Health. She is also author of “Lifelines: A Doctor’s Journey in the Fight for Public Health.”

CNN: Why is it a problem that childhood immunization rates are declining?

Dr. Leana Wen: The reduction of vaccine-preventable diseases is one of the greatest public health success stories in the last 100 years.

The polio vaccine was introduced in the United States in 1955, for example. In the four years prior, there were an average of over 16,000 cases of paralytic polio and nearly 2,000 deaths from polio each year across the US. Widespread use of the polio vaccine had led to the eradication of polio in the country by 1979, according to the CDC, sparing thousands of deaths and lifelong disability among children each year.

The measles vaccine was licensed in the US in 1963. In the four years before that, there were an average of over 500,000 cases and over 430 measles-associated deaths each year. By 1998, there were just 89 cases recorded — and no measles-associated deaths.

These vaccines are very safe and extremely effective. The polio vaccine, for example, is over 99% effective at preventing paralytic polio. The measles vaccine is 97% effective at preventing infection.

We can do this same analysis for other diseases for which there are routine childhood immunizations.

It’s very concerning that rates of immunization are declining for vaccines that have long been used to prevent disease and reduce death. That means more children are at risk for severe illness — illness that could be averted if they were immunized. Moreover, if the proportion of unvaccinated individuals increases in a community, this also puts others at risk. That includes babies too young to be vaccinated or people for whom the vaccines don’t protect as well — for example, patients on chemotherapy for cancer.

CNN: What accounts for the decline in vaccination numbers?

Wen: There are probably many factors. First, there has been substantial disruption to the US health care system during the Covid-19 pandemic. Many children missed routine visits to the pediatrician during which they would have received vaccines due to pandemic restrictions. In addition, some community health services offered also became disrupted as local health departments focused on Covid-19 services.

Second, disruption to schooling has also played a role. Vaccination requirements are often checked prior to the start of the school year. When schools stopped in-person instruction, that led to some families falling behind on their immunizations.

Third, misinformation and disinformation around Covid-19 vaccines may have seeded doubt in other vaccines. Vaccine hesitancy and misinformation were already major public health concerns before the coronavirus emerged, but the pandemic has exacerbated the issues.

According to a December survey published by the Kaiser Family Foundation, more than one in three American parents said vaccinating children against measles, mumps, and rubella shouldn’t be a requirement for them to attend public schools, even if that may create health risks for others. This was a substantial increase from 2019, when a similar poll from the Pew Research Center found only 23% of parents opposed school vaccine requirements.

CNN: What are some consequences if immunization rates drop further?

Wen: If immunization rates drop further, we could see more widespread outbreaks. Diseases that were virtually eliminated in the US could reemerge, and more people can become severely ill and suffer lasting consequences or even die.

We are already seeing some consequences: Last summer, there was a confirmed case of paralytic polio in an unvaccinated adult in New York. It’s devastating that a disease like polio has been identified again in the US, since we have an extremely effective vaccine to prevent it.

There is an active measles outbreak in Ohio. As of January 17, 85 cases have been reported. Most of the cases involved unvaccinated children, and at least 34 have been hospitalized.

CNN: If parents are unsure of vaccinating their kids, what should they do?

Wen: As parents, we generally trust pediatricians with our children’s health. We consult pediatricians if our kids are diagnosed with asthma and diabetes, or if they have new worrisome symptoms of another illness. We should also consult our pediatricians about childhood immunizations; parents and caregivers with specific questions or concerns should address them.

The national association of pediatricians, the American Academy of Pediatrics, “strongly recommends on-time routine immunization of all children and adolescents according to the Recommended Immunization Schedules for Children and Adolescents.”

CNN: What can be done to increase immunization numbers?

Wen: There needs to be a concerted educational campaign to address why vaccination against measles, mumps, rubella, chickenpox, polio and so forth is so crucial. One of the reasons for vaccine hesitancy, in my experience, is that these diseases have been rarely seen in recent years. Many people who are parents now didn’t experience the devastation of these diseases growing up, so may not realize how terrible it would be for them to return.

Specific interventions should be targeted at the community level. In some places, low immunization levels may be due to access. Vaccination drives at schools, parks, shopping centers, and other places where families gather can help increase numbers. In other places, the low uptake may be because of vaccine hesitancy and misinformation. There will need to be different strategies implemented in that situation.

Overall, increasing immunization rates for vaccine-preventable childhood diseases needs to be a national imperative. I can’t underscore how tragic it would be for kids to suffer the harms of diseases that could be entirely prevented with safe, effective and readily available vaccines that have been routinely given for decades.

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Study shows convalescent plasma works for immune-compromised Covid-19 patients, but it can be hard to find | CNN



CNN
— 

Convalescent plasma – a once-celebrated treatment for Covid-19 that has largely fallen out of favor – does work well for people who are immune-compromised, according to a study published Thursday.

The report in the journal JAMA Network Open analyzed the results of nine studies and found that immune-compromised Covid-19 patients were 37% less likely to die if they got convalescent plasma, an antibody-rich blood product from people who’d recovered from the virus.

Although it’s legal to use convalescent plasma to treat Covid patients who are immune-compromised, as inpatients or outpatients, government guidelines are neutral about whether the treatment works, so some hospitals offer it but others do not.

“Our concern is that many patients who need [convalescent plasma] are not getting it,” said Dr. Arturo Casadevall, an infectious disease expert at Johns Hopkins University and a co-author of the new study. “This is really important because these people can be treated, and they could have better outcomes with this material if we can just get the word out.”

He said it’s to everyone’s advantage to treat immune-compromised patients quickly.

Immune-compromised people sometimes have “smoldering Covid” for months because they lack the antibodies to fight it off, which gives the virus plenty of opportunities to mutate in the person’s body.

“These immune-compromised patients are essentially variant factories,” said Dr. Michael Joyner, an anesthesiologist at the Mayo Clinic and another study co-author. “And you do not want a bunch of people running around out there making weird variants.”

There are about 7 million immune-compromised people in the US, and treating them if they contract Covid-19 has proved challenging.

Many of them can’t take the antiviral drug Paxlovid because it interferes with other medicines they take.

Monoclonal antibodies, once popular for prevention and treatment for this group, aren’t used anymore because coronavirus variants have changed over time. One of the advantages of convalescent plasma is that as long as it’s been donated recently, there’s a high likelihood it will have antibodies to currently circulating variants, according to advocates for the treatment.

But the National Institutes of Health’s Covid-19 treatment guidelines say there’s not enough evidence to recommend either for or against the use of convalescent plasma in people with compromised immune systems.

Three times last year – in May, August and December – Casadevall, Joyner and dozens of other doctors from Harvard, Stanford, Mayo, Columbia and other academic medical centers wrote emails to scientists at the National Institutes of Health, sending them research materials and urging them to revise the guidelines. They say they have not received a response.

Joyner said he’s “frustrated” with the NIH’s “bureaucratic rope-a-dope,” calling the agency’s guidelines a “wet blanket” that discourages doctors from trying convalescent plasma on these people.

Some patient advocates say they’re angry.

“This lack of response to the researchers is infuriating,” said Janet Handal, co-founder of the Transplant Recipient and Immunocompromised Patient Advocacy Group.

Several large randomized clinical trials on the general population, including one in India and one in the UK, have found that convalescent plasma did not reduce Covid-19 deaths or prevent severe illness, and the treatment is no longer authorized in the US for people who have healthy immune systems.

The nine studies analyzed in the new report are much smaller and looked only at immune-compromised patients.

Dr. Peter Horby, a professor at the University of Oxford and the co-principal investigator of the large UK study, said that a large randomized clinical trial should be done on immune-compromised patients before clinical practice guidelines for this group are changed.

He said that support for convalescent plasma to treat Covid-19 has been based on “an emotional feeling that something had to be done.”

“We’ve seen time and again that people’s beliefs and emotions about what works can be wildly wrong, and so the best thing to do is to evaluate these things properly in trials,” he said.

At the beginning of the pandemic, there was great enthusiasm for convalescent plasma as Covid-19 survivors sought to save lives, donating antibodies against the virus to people who were sometimes at death’s door.

In August 2020, the US Food and Drug Administration granted emergency use authorization for the treatment, but some questioned whether it was politically motivated and whether the data really showed that it worked.

Then, the large clinical trials suggested convalescent plasma didn’t work.

“We didn’t see a benefit,” said Horby, director of Oxford’s Pandemic Sciences Institute.

But there was one exception.

Horby said his study did find “some evidence of some benefit” in Covid-19 patients who had not developed antibodies against the virus. This would most likely include immune-compromised patients because their faulty immune systems don’t always generate antibodies the way they should, even after infection.

When this group of patients received convalescent plasma, Horby said, they had a slightly shortened hospital stay and a slightly lower risk of ending up on a ventilator compared with similar patients who did not receive convalescent plasma.

Joyner and Casadevall, the Mayo and Hopkins doctors, point to that finding – and a similar one in a large trial in Australia, Canada, the UK and the US, as well as results of smaller studies – as an indication that convalescent plasma is worth trying in immune-compromised patients.

Immune-compromised patients who catch Covid-19 can get convalescent plasma relatively easily if they’re patients at Hopkins, Mayo or several other medical centers.

But many other people might have a difficult time accessing it.

It took Bernadette Kay of Manhattan Beach, California, months to get it, and she had to be “relentless” and call in the help of several “angels” in New York, Maryland, Minnesota and California to finally make it work.

Kay, 64, who has a compromised immune system because of a drug she takes for rheumatoid arthritis, got Covid-19 in July. She took two monoclonal antibodies, as well as remdesivir and Paxlovid – twice. But she still tested positive on and off for months and had fatigue, congestion and headaches.

“I felt like half a person,” she said. “I was not an able-bodied person. I was disabled because of lack of energy. It feels dark – a heavy feeling in your forehead and your face.”

Kay said she saw several doctors and none of them suggested convalescent plasma. That’s where her first angel came in: her daughter, who had signed her up for the Transplant Recipient and Immunocompromised Patient Advocacy Group.

That group, as well as the CLL Society, an advocacy organization for cancer patients, have been helping immune-compromised people when they get infected with Covid-19, connecting them with experts and offering guidance on how to arrange to have the plasma ordered.

Kay says Handal, the co-founder of the immune-compromised patients’ group, was her second angel, because she pointed her to angels No. 3 and 4: Joyner, the Mayo doctor, and Dr. Shmuel Shoham, an infectious disease expert at Hopkins.

Joyner and Shoham pointed Kay to her fifth angel: Chaim Lebovits, a businessman, leader in the New York’s Hasidic Jewish community and co-founder of the Covid Plasma Initiative.

Lebovits reached out to a hospital and blood bank near Kay that could procure the plasma once a doctor ordered it. Kay then reached out to six local doctors, most of them infectious disease experts, inquiring about convalescent plasma, but she didn’t make any progress.

“I think they thought it was quack medicine,” she said.

By this time, it was November, four months after she initially tested positive for Covid. She sought out a seventh doctor, sending him information from plasma experts, including a slide presentation by Joyner and Casdevall. She said that doctor, after conferring with someone at the blood bank that Libovits had suggested, agreed to order the plasma.

That’s where her sixth angel came in: Robert Simpson, vice president for hospital services at the San Diego Blood Bank, who arranged to have the blood flown in from Stanford University Medical Center.

“Robert watched the flight on Flight Tracker and had a courier waiting to bring it to the hospital,” Kay said, adding that she calls her angels collectively her “circle of love.”

Two to three weeks after her infusion, she began to feel better. She tested negative on January 4 and has continued to feel well and test negative since then.

“My energy level is back to normal. I don’t feel like half a person,” she said.

She said she’ll never know for sure exactly what spurred her recovery, but “I think it was plasma that made the difference, because in six months, nothing else made a difference.”

Kay, who works in health care, said most other people wouldn’t have known how to navigate the system like she did or might have given up in frustration.

“With the help of Janet [Handal] and her team of scientists, I’ve been able to get where I am today,” she said. “But it was not easy. This was driven by my bullheaded advocacy, because that’s who I am. I think I’m a total anomaly. No one has the persistence that I have.”

Joyner said that while he and his colleagues wait for a response from their emails to the NIH, they’ve formed the National Covid-19 Convalescent Plasma Project, and they have a phone meeting every Thursday night to discuss their progress.

“We’ve encountered many roadblocks,” said Dr. Liise-anne Pirofski, chief of the Division of Infectious Diseases at the Albert Einstein College of Medicine. “It’s just not viewed as part of the Covid-19 treatment armamentarium, and it should be.”

Pirofski, Joyner and Casadevall say they receive no financial benefit from convalescent plasma. They think one reason convalescent plasma isn’t more widely used is that there isn’t a pharmaceutical company spending money to advocate for it.

Handal, who runs the Facebook group for people who are immune-compromised, said that after she sent several emails to the NIH, agency scientists wrote back, inviting her and other leaders of her group to a meeting next week.

She plans to tell them that they need to review their Covid-19 plasma guidelines and fund more research on the coronavirus and the immune-compromised, as they have few treatment options and so often isolate at home with their families to avoid the virus.

“It is unconscionable that the NIH has let stand for months its guideline on Covid convalescent plasma, which says there is not enough information to make a recommendation, while we who are immune-compromised see our treatments dwindle,” she said. “The NIH needs to speak to the clinician researchers who are experts, prioritize the immune-compromised and fund the research needed to keep us safe.”

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Myths and facts about treating a hangover | CNN

Editor’s Note: Get inspired by a weekly roundup on living well, made simple. Sign up for CNN’s Life, But Better newsletter for information and tools designed to improve your well-being.



CNN
— 

Are you celebrating the first day of 2023 with a hangover?

If so, you might be looking for a method to ease your misery. There are certainly a lot of so-called hangover cures, some dating back centuries.

“The ancient Greeks believed that eating cabbage could cure a hangover, and the Romans thought that a meal of fried canaries would do the trick,” said Dr. John Brick, former chief of research at the Center of Alcohol Studies, Education and Training Division at Rutgers University in New Jersey, who authored “The Doctor’s Hangover Handbook.”

“Today, some Germans believe that a hearty breakfast of red meat and bananas cures hangovers. You might find some French drinking strong coffee with salt, or some Chinese drinking spinach tea,” he said. “Some of the more unusual hangover cures are used by some people in Puerto Rico, who rub half a lemon under their drinking arm.”

In truth, the only cure for a hangover is time, according to the National Institute on Alcohol Abuse and Alcoholism.

“A person must wait for the body to finish clearing the toxic byproducts of alcohol metabolism, to rehydrate, to heal irritated tissue, and to restore immune and brain activity to normal,” according to the institute. That recovery process can take up to 24 hours.

Are there things you can do to ease your transition? Possibly, experts say, but many common hangover “cures” may make your hangover worse. Here’s how to separate fact from fiction.

Having another drink, or the “hair of the dog that bit you,” is a well-known cure for a hangover, right? Not really, experts say.

The reason some people believe it works is because once the calming effects of alcohol pass, the brain on a hangover is overstimulated. (It’s also the reason you wake up in the middle of the night once your body has metabolized alcohol.)

“You’ve got this hyperexcitability in the brain after the alcohol is gone,” said Dr. Robert Swift, a professor of psychiatry and human behavior at Brown University’s Warren Alpert Medical School in Providence, Rhode Island.

“If you look at the brain of somebody with a hangover, even though the person might feel tired, their brain is actually overexcited,” he said.

Consuming more alcohol normalizes the brain again, “because you’re adding a sedative to your excited brain,” Swift said. “You feel better until the alcohol goes away and the cycle repeats in a way.”

The answer is yes, depending on hangover symptoms, Brick said. If you’re a coffee drinker, skipping your morning cup of joe may lead to caffeine withdrawal on top of your hangover.

But coffee can irritate the stomach lining, which is already inflamed by alcohol, Brick said. So if you are queasy and nauseous, coffee may only make matters worse.

“If you have a hangover, have a quarter of a cup of coffee,” Brick suggested. “See if you feel better — it takes about 20 minutes for the caffeine to start to have some noticeable effect.

“If coffee doesn’t make you feel better, don’t drink anymore. Obviously, that’s not the cure for your hangover.”

Forget eating a greasy breakfast in the wee hours after a night of drinking — you’re adding insult to injury, Swift said: “Greasy food is harder to digest, so it’s probably good to avoid it.”

Eating greasy food also doesn’t make much sense. The alcohol we drink, called ethyl alcohol or ethanol, is the byproduct of fermenting carbohydrates and starches, usually some sort of grain, grape or berry. While it may create some tasty beverages, ethanol is also a solvent, Brick said.

“It cuts through grease in your stomach much the same way it cleans grease off oily car parts,” he said.

Instead, experts suggest using food to prevent hangovers, by eating before you have that first drink.

“Eating food loaded with protein and carbohydrates can significantly slow down the absorption of alcohol,” Brick said. “The slower the alcohol gets to your brain, the less rapid the ‘shock’ to your brain.”

Alcohol dehydrates, so a headache and other hangover symptoms may be partly due to constricted blood vessels and a loss of electrolytes, essential minerals such as sodium, calcium and potassium that your body needs.

If you’ve vomited, you’ve lost even more electrolytes, and all of this can lead to fatigue, confusion, irregular heart rate, digestive problems and more.

Replacing lost fluids with water or a type of sports drink with extra electrolytes can help boost recovery from a hangover, Swift said.

Taking over-the-counter pain meds can be dangerous, especially if you take too many while intoxicated, experts say. Taking an acetaminophen, such as Tylenol, can further damage your overtaxed liver, while aspirin and ibuprofen can irritate your stomach lining.

“You should never, never take alcohol with acetaminophen or Tylenol,” Swift said. “You can actually cause liver damage from an overdose of Tylenol.”

But aspirin, ibuprofen and naproxen are “theoretically” OK, he added.

“Even though they tend to be anti-inflammatory in the body, they can cause inflammation in the stomach,” Swift said. “Don’t take them on an empty stomach; always take anti-inflammatories with food.”

While most alcohol is handled by the liver, a small amount leaves the body unchanged through sweat, urine and breathing.

Get up, do some light stretching and walking, and drink plenty of water to encourage urination, Brick said.

“Before you go to sleep and when you wake up, drink as much water as you comfortably can handle,” he said. You can also take a multivitamin “before you hit the shower in the morning (to) replenish lost vitamins, minerals and other nutrients.”

If you would rather have something warm and soothing, Brick suggested broth or other homemade soups.

“These will also help to replace lost salts, including potassium and other substances,” he said, “but will not make you sober up faster or improve impairment due to intoxication or hangover.”

Store shelves are packed with so-called hangover cures. Unfortunately, there’s no proof they work. In 2020, researchers published what they called the “world’s largest randomised double-blind placebo-controlled” trial of supplements containing vitamins, minerals, plant extracts and antioxidants and found no real improvement in hangover symptoms.

Even if one solution works, it likely won’t fix all your symptoms, experts say.

“The effects of alcohol and alcoholic beverages are so complicated, so complex,” Swift said, “that any solution might address one or two of the symptoms but won’t address them all.”

What does work for a hangover? Time. It will take time for your body to release all the toxins causing your misery, experts say. And the only way to prevent a hangover is to abstain.

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Pandemic fueled alcohol abuse, especially among women, but there are treatment options | CNN

Editor’s Note: In the final two episodes of “This Is Life With Lisa Ling,” the series explores alcoholism in America (at 9 p.m. ET Sunday) and interracial marriages (at 10 p.m. ET Sunday).



CNN
— 

Brook was 34 years old when her use of alcohol escalated, a way of coping with a breast cancer diagnosis.

“I just decided I’m not gonna go through this straight,” she told Lisa Lang in an episode of “This Is Life With Lisa Ling,” airing at 9 p.m. ET Sunday on CNN.

“I would drink before I went to my chemo sessions. It became more and more of a coping mechanism,” said Brook, who did not want to use her last name.

Brook survived the bout with cancer but says she became dependent on alcohol — and the pandemic only made it worse.

“When Covid started and I was home, I started drinking more and more and more,” said Brook, now 42. “I started not being able to eat, I started throwing up more often, and then I started throwing up blood.”

She recently ended up in the hospital, diagnosed with cirrhosis of the liver and a bad bleed from ulcers, which doctors said could take her life if not quickly treated.

“When they were talking to me afterwards, they said, ‘If you keep going like this, you’ll be dead in a year,’ ” Brook told Ling.

Alcohol use disorder is defined as compulsively using alcohol despite negative consequences on relationships and one’s ability to function at work, school or in the community. Over time, excessive alcohol use may even rewire the brain, making booze as desirable as natural rewards such as food or sex, experts say.

Researchers at University of California, Los Angeles showed pictures of alcoholic drinks to people who are and are not addicted while scanning their brains. Regions of the brain associated with craving, pleasure and reward lit up significantly more in those with an alcohol use disorder.

“It’s much more of a medical and brain disease than we initially thought,” Lara Ray, a clinical psychologist who runs the UCLA Addictions Lab, told Ling.

In addition, just one pint of beer or average glass of wine a day may begin to shrink the overall volume of the brain. The brains of nondrinkers who began consuming an average of one alcohol unit a day showed the equivalent of half a year of aging, according to a study published in March.

The damage worsens as the number of daily drinks rises, the study found — drinking four alcohol units a day aged a person’s brain by more than 10 years.

Alcohol use disorder is a growing problem in the United States, which experts say has been enhanced by the pandemic, especially among women.

“Last year, I took care of two women who were in their early 20s who had cirrhosis and needed liver transplants, and I’ve never seen that before in my entire career,” Dr. James Burton, medical director of liver transplantation at the University of Colorado School of Medicine in Aurora, told Ling.

A recent study found a significant increase in alcohol-associated liver disease and a 15% higher rate of waiting lists and subsequent liver transplants between 2020 and 2021 — the greatest increase occurred in young adults.

Since the pandemic’s onset, statistics show an overall 14% increase in the number of drinking days per month, but a “41% increase in heavy drinking days among women,” Dr. Sarah Wakeman, medical director of the Substance Use Disorders Initiative at Massachusetts General Hospital, told CNN in January.

Why? Pre-pandemic mom wine culture, which “normalized and even glorified” drinking, is partly to blame, said Dr. Leena Mittal, chief of the women’s mental health division in the department of psychiatry at Brigham and Women’s Hospital in Boston.

In addition, “studies have shown the complexities of balancing home, work and caregiving responsibilities during the pandemic have fallen disproportionately on women,” Mittal said earlier.

Women are especially sensitive to the effects of alcohol, according to the National Institute on Alcohol Abuse and Alcoholism. Alcohol-related problems appear sooner and at lower drinking levels than in men, said the institute, part of the US National Institutes of Health.

Women are more susceptible to alcohol-related brain damage and heart disease than men, and studies show women who have one drink a day increase their risk of breast cancer by 5% to 9% compared with those who abstain.

Pandemic lockdowns also forced many people to live and work from home — sometimes alone. A July study found drinking alone during adolescence and young adulthood can strongly increase the risk for alcohol abuse later in life, especially if you are a woman.

Victoria, who also did not want to use her last name, told Ling she began drinking as a teenager. Now 55, she still “can’t control it. It’s like a tension that builds up. And so then when I do drink, it’s like, ‘Ah! I’m drinking,’ you know, so it’s way too much, way too fast.”

Victoria says she continues to crave alcohol but goes regularly to support meetings for addiction recovery after moving in with her mother during the pandemic.

Binge drinking — defined as more than four drinks for women and five for men within a few hours — is on the rise. According to a study published in June, even older people who consider themselves moderate users of alcohol are downing multiple drinks in one sitting.

People who binged were about five times more likely to experience numerous alcohol problems, including injuries, emotional or psychological issues, and alcohol dependence at work or school or while caring for children, the study found.

“What this means is that an individual whose total consumption is seven drinks on Saturday night presents a greater risk profile than someone whose total consumption is a daily drink with dinner, even though their average drinking level is the same,” study coauthor Charles Holahan, professor of psychology at the University of Texas at Austin, told CNN previously.

The US Food and Drug Administration has approved only three drugs designed to reduce alcohol use since 1951: disulfiram, which causes headaches, nausea and vomiting when mixed with alcohol; acamprosate, which works on the reward centers of the brain to reduce alcohol cravings; and naltrexone, which reduces cravings and appears to help with heavy drinking.

There is help. Find it here

  • The National Institute on Alcohol Abuse and Alcoholism has a tool called the NIAA Alcohol Treatment Navigator that “helps adults find alcohol treatment for themselves or an adult loved one.” For teens, the institute recommends these resources.
  • The Substance Abuse and Mental Health Services Administration has a free, confidential National Helpline active 24/7/ 365 days a year to provide information and treatment referrals to local treatment facilities, support groups and community-based organizations: 800-662-HELP (4357) and 800-487-4889 (TTY option).
  • All three have significant side effects that can deter people from using them consistently.

    Researchers continue to experiment with various drugs to see if they can help cure cravings without major side effects. While not FDA-approved, the anticonvulsant drug topiramate has shown promise in some clinical trials but may affect cognition and memory. Other anticonvulsant drugs, such as zonisamide and gabapentin, and a smoking cessation drug called varenicline have shown mixed results.

    At Ray’s lab at UCLA, small clinical trials have found promising results from the neuromodulator ibudilast, which hindered cravings and reduced the odds of heavy drinking for some people by 45%.

    For Billy Flores, 45, the change happened quickly.

    “In the first two days, I was upset in the stomach, but by the third day I was on it, I was off of alcohol, which is pretty amazing I thought,” he told Ling about using ibudilast.

    Bill has struggled with alcohol but says he has found hope with a clinical trial.

    Additional studies are needed to see if the benefits hold true for larger populations.

    In the meantime, there are gold standard treatments for alcohol use disorder that don’t involve medications. Those include Alcoholics Anonymous and Self-Management and Recovery Training 12-step programs, cognitive behavioral treatments and mindfulness-based approaches.

    A large 2006 clinical trial found behavioral interventions can be as effective as drugs — in fact, most of the medication clinical trials done to date have also included some form of social or behavioral treatment in combination with drugs.

    Having support is critical to keeping a positive mindset that will ultimately win the battle with alcohol, experts say.

    Brook agrees.

    “When I was doing my therapy intake for rehab, one of the questions was, ‘What made you decide to do this?’ And I said, ‘I’m better than this,’ ” she told Ling.

    “I still like to think that even with the relapses, I’m gonna still be that person who gets right back up and tries again.”

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    New treatment for nightmares holds promise, study finds | CNN


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    CNN
    — 

    Heart pounding, I sit bolt upright in bed, flushed, sweaty and utterly panicked. My brain has snatched me from a nightmare — a dream so alarming I wake up.

    I’ve only had one or two such night terrors, but for people suffering from trauma, post-traumatic stress disorder, depression or anxiety, frightening dreams may come night after night, ruining their sleep and ultimately their health.

    Visions from nightmares can also creep like dark shadows into the light of the next day, disrupting a person’s ability to focus and think. Mood plummets, and anxiety rises. Days may be filled with an intense fear of falling asleep and trigger yet another terrifying dream.

    Such symptoms can lead to a diagnosis of nightmare disorder, a sleep condition that affects about 4% of adults, according to the American Academy of Sleep Medicine.

    Treatment can include stress reduction, counseling, gradual desensitization and medications, but the gold standard is imagery rehearsal therapy, a form of cognitive behavioral training that teaches people to reimagine their nightmares with positive endings. Still, not everyone with nightmare disorder responds to the treatment, experts say.

    Now a new study has added a twist — playing a sound the person’s memory has associated with a more positive outcome during REM (rapid eye movement) or the dream stage of sleep. The result was a fourfold reduction in nightmares over the basic therapy alone.

    “As far as I know, this is the first clinical and therapeutic study that uses target memory activation to accelerate and enhance therapy,” said lead author Dr. Lampros Perogamvros, a psychiatrist at the Sleep Laboratory of the Geneva University Hospitals and the University of Geneva.

    “This is a promising development. It does appear that adding a well-timed sound during REM sleep augments the effect of image rehearsal therapy … which is a standard and perhaps one of the most effective non-pharmacologic therapies at this time,” said Dr. Timothy Morgenthaler, lead author of the most recent American Academy of Sleep Medicine guidelines on nightmares.

    “The result should be replicated,” said Morgenthaler, who was not involved in the study. “But I was a bit excited at this new possibility.”

    Imagery rehearsal therapy has four basic steps that can be taught in one day, experts say. First, people are asked to write down every detail of their nightmare. Next, each person rewrites the nightmare with a positive arch, making sure that it ends with a pleasant or empowering solution or resolution.

    Now the practice begins. The reworked dream must be rehearsed five to 20 minutes each day until it’s woven into the memory circuits of the brain. Once that is in place, it’s time to put it into action by rehearsing the new dream just before bed.

    In the new study, published Thursday in the journal Current Biology, researchers added a twist to the therapy. Eighteen people with nightmare disorder heard a neutral sound — a piano cord — while they reinvented their nightmares in more positive ways. A control group of 18 people who also had nightmare disorder heard no additional sound, while they reworked their dreams.

    All 36 people were given a headband called an actimeter to wear at night for two weeks. In addition to monitoring the stages of sleep, the device delivered sound in a way that would not wake the sleeper — via bone conduction.

    “One of the significant things about this study’s intervention is the use of relatively new technology that can more accurately time the stimulus to true REM sleep,” said Morgenthaler, a professor of medicine at Mayo Clinic School of Medicine.

    “Most wearable devices do not accurately measure actual REM sleep,” he added. “Of course, further study might find that the timing is not that critical — but that remains to be determined.”

    The sound was delivered to both groups every 10 seconds during the dream stage of sleep over a two-week period. In this case, “imagery rehearsal therapy worked for all of the participants, including the control group,” Perogamvros said.

    “But in the experimental group, where the sound was positively associated, the decrease was significantly bigger — they had nearly four times fewer nightmares,” he added.

    Imagery rehearsal therapy also lessened overall distress, measures of mood and sleep quality in both groups, but nightmare reduction happened faster in the experimental group and persisted at a three-month follow-up, Perogamvros said. In addition, members of the group who heard the sound reported more joyful dream experiences during their dreams than those in the control group.

    Additional research is needed to verify these results and expand upon the concept, but Perogamvros said he hoped the technique might lead to breakthroughs for the about 30% of patients who are unresponsive to imagery rehearsal therapy, also called IRT.

    “The ideas underpinning the hypothesis that targeted memory reactivation might boost the effects of IRT have merit,” Morgenthaler said, “and this elegant test of that hypothesis strengthens that theory.”



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    1 in 10 Americans over 65 have dementia, study finds | CNN





    CNN
    — 

    One in 10 Americans over 65 had dementia, while 22% experienced mild cognitive impairment, the earliest stage of the slow slide into senility, according to a new study conducted between 2016 and 2017.

    The research, which the authors said is the first nationally representative examination of cognitive impairment prevalence in more than 20 years, was able to measure prevalence of dementia and mild cognitive impairment by age, education, ethnicity, gender and race.

    The results showed older adults who self-identified as Black or African American were more likely to have dementia, while those who identify as Hispanic were more likely to suffer from mild cognitive impairment. People who had less than a high school education were more likely to have both conditions.

    “Dementia research in general has largely focused on college-educated people who are racialized as white,” lead study author Jennifer Manly said in a statement.

    “This study is representative of the population of older adults and includes groups that have been historically excluded from dementia research but are at higher risk of developing cognitive impairment because of structural racism and income inequality,” said Manly, professor of neuropsychology at the Gertrude H. Sergievsky Center and the Taub Institute for Research on Alzheimer’s Disease and the Aging Brain at Columbia University.

    “If we’re interested in increasing brain health equity in later life, we need to know where we stand now and where to direct our resources,” Manly said.

    The study, published Monday in the journal JAMA Neurology, analyzed data from in-depth neuropsychological tests and interviews with nearly 3,500 people over age 65 enrolled in the Health and Retirement Study, a long-term research project sponsored by the National Institute on Aging and the Social Security Administration.

    The research was based on a randomly selected sample of people from the study that completed the core survey and underwent neurological testing between June 2016 and October 2017.

    Fifteen percent of people who identified as Black tested positive for dementia, while 22% had mild cognitive decline, the study found. Ten percent of people who identified as Hispanic had dementia, but the rate of milder issues was higher — 28% tested positive for mild cognitive impairment. Nine percent of White people had dementia, while 21% had mild cognitive impairment.

    Educational achievement, which experts consider to be protective against cognitive decline, showed a significant divide: Nine percent of people with a college degree tested positive for dementia, compared with 13% of those who never received a high school diploma. Twenty-one percent of people over 65 with college degrees had mild cognitive decline, compared with 30% of those with less than a high school degree.

    The extreme elderly had the highest rates of dementia and mild cognitive impairment. Only 3% of adults between 65 and 69 tested positive for dementia, compared with 35% of those 90 and older.

    In fact, every five-year increase in age was associated with higher risk of dementia and mild cognitive impairment, the report said. The study, however, found no differences between men and women in rates of either condition

    Symptoms of mild cognitive impairment can include losing items, forgetting to do things or go to appointments, or struggling to come up with words. A loss of smell and taste and movement issues can also be symptoms, according to the National Institute on Aging.

    People with mild cognitive impairment are fully capable of taking care of themselves, “but what they have to go through to do so is exhausting,” Laura Baker, a professor of gerontology and geriatric medicine at Wake Forest University School of Medicine in Winston-Salem, North Carolina, told CNN in an earlier interview. She was not involved in the current study.

    People with mild cognitive impairment may not remember where they are supposed to be, Baker said. ” ‘Let me check my calendar. Oh, I forgot to write on this calendar. Let’s check another calendar. Oh, I can’t find that calendar. I’ve lost my phone. Where is the key? I can’t find the key.’ They’re able to regroup in the early stages and accomplish things, but the toll is immense.”

    Not everyone with mild cognitive impairment goes on to develop dementia, although many do, experts say. Lifestyle changes may be a key to reversing mental decline. A 2019 study found personalized lifestyle interventions -— such as diet, exercise, stress reduction and sleep hygiene — not only stopped cognitive decline in people at risk for Alzheimer’s, but actually increased their memory and thinking skills over 18 months. Women responded better than men, a follow-up study found.

    A February study found about a third of women 75 years or older with mild cognitive impairment reversed their progression to dementia at some point during follow-up. All of the women, however, had high levels of education and academic performance and excellent written language skills, or what experts call “cognitive reserve.”

    Signs of dementia can differ from one person to the next, and can include memory loss and confusion, difficulty speaking, understanding and expressing thoughts, or reading and writing, according to the National Institutes of Health.

    People with dementia can act impulsively or show poor judgment, and they can have trouble paying bills or handling money responsibly. They may repeat questions, use strange words to refer to familiar objects and take longer than usual to complete daily tasks.

    Wandering and getting lost in a familiar neighborhood is another sign of dementia, as is losing interest in daily activities or events or acting as if they don’t care about other people’s feelings. They may lose their balance or have other problems with movement. At times, people with dementia can hallucinate or experience delusions or paranoia.

    Alzheimer’s disease is the most well-known cause of dementia, but cognitive issues can be caused by vascular problems that block the flow of blood to the brain or via ministrokes caused by tiny blood clots traveling to the brain. Frontal lobe dementia, a rare form thought to be associated with abnormal amounts of the proteins tau and TDP-43, often begins in people younger than 60. Another type of decline, called Lewy body dementia, is thought to be caused by abnormal deposits of the protein alpha-synuclein, which are called Lewy bodies.

    A person with signs of cognitive decline or dementia needs a full workup by a neurologist to determine the underlying cause, the NIH said. Side effects from a number of medications can mimic dementia, as can certain diseases, such as Huntington’s disease.

    If you’ve just been diagnosed with dementia, continue to meet with doctors and specialists and consider asking for a referral to a memory clinic, according to the National Institutes of Health. Reach out to your local Alzheimer’s Disease Research Center and consider joining a clinical trial.

    The Alzheimer’s Association has detailed information on the differences between dementia and Alzheimer’s, and it offers many levels of support for both patients and caregivers.

    Work on staying healthy — exercise helps with mood, balance and thinking, while eating a well-balanced diet and getting quality sleep can improve the brain’s ability to function.



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