Category: RECIPES

Perhaps you’ve seen this ad about a drug for thyroid eye disease. If so, you may be wondering what thyroid eye disease is — and why the woman in the ad is wearing five pairs of sunglasses at once. Read on for answers.

What is thyroid disease and how does it affect the eyes?

The thyroid gland is a small, butterfly-shaped organ at the front of the neck. It releases thyroid hormone, which helps control many functions in the body. If it releases too much thyroid hormone (hyperthyroidism) or too little (hypothyroidism), bothersome and sometimes serious symptoms may develop, including changes in muscle strength, bowel function, and heart function.

An overactive thyroid gland can cause thyroid eye disease, prompting swelling and inflammation in tissues surrounding the eyes. The condition causes bulging eyes, a dry, gritty sensation in the eyes, tearing, pressure or pain behind the eyes, and blurring or double vision.

As many as half a million people in the US have thyroid eye disease. It affects up to half of people with Graves’ disease, an autoimmune illness marked by an overactive thyroid.

Thyroid eye disease ad: The pitch and the evidence

The ad opens with a woman wearing large, dark sunglasses, identified as a real patient named Jeanne. “With thyroid eye disease,” she explains, “I was always wearing sunglasses to hide my bulging eyes. I wore them just about everywhere.”

She removes her sunglasses to reveal that she’s wearing another pair underneath. In fact, she’s wearing three pairs of sunglasses and later will be wearing five!

As the music turns upbeat, she continues: “But then my doctor recommended Tepezza, a prescription medicine for thyroid eye disease, and I didn’t have to hide so much.”

A drawing of a bulging eye morphing into a more normal eye accompanies her next words: “In a clinical study, more than eight out of 10 patients taking Tepezza had less eye bulging. And nearly seven out of 10 saw improvements in double vision.”

Warnings about this medicine

You know what comes next: a fast-talking voiceover warning of possible side effects. For Tepezza, these include:

• Infusion reactions. Now we learn that Tepezza is an intravenous (infused) medicine. A course of treatment is eight 90-minute infusions, each separated by three weeks. Infusion reactions may be mild or severe, including allergic reactions (such as itching or hives) and other side effects that occur during or just after the infusion (such as fever or sweats).
• When to call for advice. “Tell your doctor right away if you have symptoms such as high blood pressure, fast heartbeat, shortness of breath, or muscle pain,” the voiceover instructs. Keep in mind that most people with high blood pressure have no symptoms, but if severe it can cause headaches, blurry vision, or chest pain.
• Before starting treatment. If you have diabetes or inflammatory bowel disease, or if you are pregnant or planning to become pregnant, you should tell your doctor before starting treatment. That’s because Tepezza may harm a developing fetus or worsen other diseases.

A big finish: Controlling thyroid eye disease

As the commercial winds down, Jeanne is back, removing her fifth consecutive pair of sunglasses to reveal normal-appearing eyes. “I look more like my old self again. Now I wear sunglasses because I want to.”

“Ask your doctor if Tepezza is right for you,” the narrator advises before suggesting a visit to the website for before and after pictures of Jeanne. I checked; they’re impressive.

What the ad gets right

The ad accurately describes

• thyroid eye disease symptoms
• how the condition alters appearance and can cause embarrassment
• results of a single, small study investigating the risks and benefits of Tepezza.

What else do you need to know about treatments for thyroid eye disease?

• You must treat thyroid disease as well as your eye condition. Medicines or surgery are often good options. Radiation therapy may be effective, but sometimes makes thyroid eye disease worsen.
• Selenium, a mineral supplement, is recommended by some experts.
• Quitting smoking is always recommended, partly because smoking may worsen thyroid eye disease.

If thyroid eye disease is mild, moisturizing eye drops, eye shades or patches, or dark sunglasses may be sufficient.

If thyroid eye disease is moderate to severe, options include:

• medicines that suppress inflammation or an overactive immune response. Examples include glucocorticoids, teprotumumab (Tepezza), mycophenolate mofetil (Cellcept), tocilizumab (Actemra), or rituximab (Rituxan).
• surgery to remove excess tissue around the eyes.

Small studies, like the one cited in the ad, may not detect all side effects, especially rare ones.

Last, but certainly not least: Tepezza is expensive. The price for a year of treatment can be $300,000 or more — and insurance coverage varies.

The bottom line

I still don’t know why the woman in the ad wears multiple pairs of sunglasses at the same time. Maybe it’s to emphasize how serious she is about hiding her eyes. Or maybe it’s just a way to grab our attention. Direct-to-consumer drug marketing strategies can be even more mysterious than the illnesses they hope to treat.

If you’re concerned you may have thyroid disease or thyroid eye disease, talk to your doctor. A costly new drug may be an option for some people, but it pays to learn about all options. Academic medical centers, the NIH, or a medical society are more likely to give you reliable and balanced information than a drug ad.

About the Author

Robert H. Shmerling, MD, Senior Faculty Editor, Harvard Health Publishing; Editorial Advisory Board Member, Harvard Health Publishing

Dr. Robert H. Shmerling is the former clinical chief of the division of rheumatology at Beth Israel Deaconess Medical Center (BIDMC), and is a current member of the corresponding faculty in medicine at Harvard Medical School. … See Full Bio View all posts by Robert H. Shmerling, MD

Trauma can register within our bodies on a cellular level. What that means to an individual — and how best to heal from serious traumas encountered in life — is the focus of a newer form of mental health counseling known as somatic therapy.

The resounding success of The Body Keeps the Score — a fixture on the New York Times bestseller list for more than four years running — testifies to mounting public awareness that trauma affects people deeply. Thus far, though, somatic therapy hasn’t caught up to cognitive behavioral therapy (CBT) and related techniques in understanding, use, or research proving its worth, a Harvard expert says.

What is somatic therapy?

Most people likely haven’t heard of somatic therapy, says Amanda Baker, director of the Center for Anxiety and Traumatic Stress Disorders and a clinical psychologist in the department of psychiatry at Massachusetts General Hospital. Unlike other mind-body approaches such as mindfulness meditation, mind-body stress reduction (MBSR), and mindfulness and self-compassion (MSC) — which are steadily growing in use — somatic therapy hasn’t hit the mainstream.

What’s the fundamental concept? “It’s a treatment focusing on the body and how emotions appear within the body,” Baker explains. “Somatic therapies posit that our body holds and expresses experiences and emotions, and traumatic events or unresolved emotional issues can become ‘trapped’ inside.”

Who might benefit from somatic therapy?

Since disturbing feelings often show up in the body in debilitating ways, somatic therapy aims to drain those emotions of their power, relieving pain and other manifestations of stress, such as disrupted sleep or an inability to concentrate.

These types of emotions can stem from a variety of conditions and circumstances that somatic therapy may potentially help alleviate. They include

• post-traumatic stress disorder (PTSD)
• complicated grief
• depression
• anxiety
• trust and intimacy issues
• self-esteem problems.

“Anxiety can lead to muscle tension, particularly in the neck, shoulders, jaw, and back,” Baker says. “It can cause a lot of discomfort, pain, stiffness, and trouble with daily activities. If we’re experiencing chronic anxiety or distress, it’s almost like we have our foot on a gas pedal. It’s not a panic attack, but we’re never feeling a reprieve and there’s a constant wear and tear on the body.”

How does somatic therapy differ from talk therapies?

Typical talk therapies such as CBT engage only the mind, not the body, encouraging people to become aware of disturbing thoughts and behavior patterns and work to change them.

But in somatic therapy, the body is the starting point to achieve healing. This form of therapy cultivates an awareness of bodily sensations, and teaches people to feel safe in their bodies while exploring thoughts, emotions, and memories.

“Cognitive behavioral therapies focus on conscious thought and work on challenging thoughts in relation to anxiety and behaviors, helping desensitize people to uncomfortable sensations,” Baker says. “But somatic therapy is more about relieving the tension, as opposed to desensitizing people to it.”

Even mindfulness meditation, which some experts consider somatic in nature, differs in one key way from somatic therapy, Baker says. “Mindfulness meditation lets any feeling or emotion come into our minds without judgment, as opposed to homing in specifically on bodily sensations that are happening,” she says.

How is somatic therapy carried out?

A somatic therapist helps people release damaging, pent-up emotions in their body by using various mind-body techniques. These can vary widely, ranging from acupressure and hypnosis to breathwork and dance.

Other techniques are just as integral but aren’t household terms. Some on this list include:

• body awareness, which helps people recognize tension spots in the body as well as conjure calming thoughts
• pendulation, which guides people from a relaxed state to emotions similar to their traumatic experiences and then back to a relaxed state
• titration, which guides people through a traumatic memory while noting any accompanying physical sensations and addressing them in real time
• resourcing, which helps people recall resources in their lives that promote feelings of calm and safety, such as special people and places.

What to know if you’re considering somatic therapy

Scant scientific research has focused on somatic therapy and its benefits, Baker notes. That’s one reason why she always recommends cognitive behavioral therapy, which has proven benefits, as at least a starting point.

“Anecdotally, I’ve heard people do find tremendous benefit from somatic therapy, but it doesn’t have the same research backing yet as CBT and some other forms of therapy,” she says.

Health insurance may be more likely to cover somatic therapy, she says, when a person is dealing with extreme symptoms of mental trauma, such as seizures. Otherwise, insurers are more apt to cover established therapies such as CBT.

Additionally, finding an experienced somatic therapist can be challenging. “I think fewer folks are going to be trained in somatic therapies than CBT, so finding an experienced practitioner is definitely a tricky process,” Baker says. One useful resource is the US Association for Body Psychotherapy, which offers a Find a Therapist search tool online.

About the Author

Maureen Salamon, Executive Editor, Harvard Women's Health Watch

Maureen Salamon is executive editor of Harvard Women’s Health Watch. She began her career as a newspaper reporter and later covered health and medicine for a wide variety of websites, magazines, and hospitals. Her work has … See Full Bio View all posts by Maureen Salamon

About the Reviewer

Howard E. LeWine, MD, Chief Medical Editor, Harvard Health Publishing

Dr. Howard LeWine is a practicing internist at Brigham and Women’s Hospital in Boston, Chief Medical Editor at Harvard Health Publishing, and editor in chief of Harvard Men’s Health Watch. See Full Bio View all posts by Howard E. LeWine, MD

There are warnings just about everywhere you look: The coffee you're about to drink is hot! Construction ahead! This product may contain peanuts!

In many cases, the reasons for these warnings are clear. But sometimes warnings raise more questions than they answer. When I was at the gym recently, these warnings on the exercise bike and treadmill were hard to miss in a bright red font:

• Obtain a medical exam before beginning any exercise program.
• Overexercise may result in serious injury or death.
• If you feel faint, dizzy, or have pain stop exercising immediately.

What exactly did the warning writers mean by "any exercise program"? What constitutes overexercise? Does having any pain anywhere mean you should stop working out?

Finally, I wonder: might these warnings cause unnecessary worry that actually discourages people from exercising?

Is it safe to start exercising without checking with a doctor?

A doctor's approval isn't necessary for most of us. Most people can safely begin a low-intensity exercise program and slowly increase their efforts over time. Choose activities that would allow you to carry on a conversation, such as:

• using light weights that are easy for you to lift
• walking at a leisurely pace
• biking at a leisurely pace (less than 5 mph)
• stretching and balancing activities
• light housework or yard work.

If you're starting at a low fitness level, make small increases in your workout over time. For example, if you start out walking 10 minutes a day, add one minute to your walk every week or two. Once you're walking 20 minutes a day, try picking up the pace a bit.

Who should be careful about exercising?

Of course, exercise is riskier if you have certain health conditions. It makes sense to ask a health care professional to make exercise recommendations if you're concerned about your health or have any of these conditions:

• Coronary artery disease, including symptoms of angina or a previous heart attack. Exercise that's too much too soon could stress the heart and trigger a heart attack or dangerous heart rhythm. Lower-intensity workouts (such as short walks at a comfortable pace) may be preferable, at least until it's clear that you can tolerate more.
• Exercise-induced asthma. Your doctor may recommend inhaled treatment to open up airways in your lungs just before or during exercise.
• Muscle disease, such as a metabolic myopathy. Your doctor may discourage you from engaging in certain exercises, such as sprinting or long-distance running.
• Back pain. Low impact exercise, such as biking or swimming, may be a better choice for people with back pain than higher-impact options, such as jogging or basketball.

If exercise is so good for you, why the warnings?

Let's review possible reasons for certain warnings:

• Having a medical examination before starting an exercise program might uncover a condition that makes exercise risky. The best example is probably coronary artery disease, which could trigger a heart attack during intense exercise. Fortunately, sudden heart problems during exercise are relatively rare (though you might think otherwise based on TV and movies, including an episode from the Sex and the City reboot).
• Overexercise is not a well-defined medical term. But it's true that suddenly exercising at high intensity when you're not used to it might be hazardous.
• Stopping exercise if you're feeling faint or dizzy presumably refers to concerns about severe dehydration or other causes of low blood pressure.
• Warnings about pain could refer to chest pain that might be a sign of heart trouble. Or it could be a warning about a type of severe muscle damage called rhabdomyolysis (which may complicate prolonged or intense exercise).

Of course, it's also possible these warnings have little to do with your health and everything to do with lawyers! That is, the equipment manufacturers might hope these warnings will ward off lawsuits from people who suffer a medical problem while using their equipment.

Are these warnings helpful?

Probably not.

All the warnings, alerts, and cautions in our everyday lives can become background noise. Despite red letters and bold fonts, warnings like these are easily overlooked.

Nor do they add much. My guess is that most people experiencing significant dizziness or pain during a workout will stop what they're doing even without reading a warning label. And serious medical conditions arising during exercise are rather rare, so the impact of warning everyone about them is likely small.

The bottom line

Don't be overly alarmed by alerts slapped on exercise equipment. True, it's best not to drop weights on your foot or exercise way too hard or long. If you are worried about workout risks or have been advised to be especially careful about exercising, it's reasonable to talk about it with your doctor.

But that conversation isn't necessary for most people, including those with well-controlled chronic illness such as high blood pressure, diabetes, or coronary artery disease. In fact, regular exercise helps treat many illnesses.

Exercise is among the most important things you can do to improve your health. And inactivity is a generally a much bigger risk than exercising.

So, if you see warnings on the gym equipment at your next workout, keep this in mind: there are much riskier things to worry about. Like hot coffee.

About the Author

Robert H. Shmerling, MD, Senior Faculty Editor, Harvard Health Publishing; Editorial Advisory Board Member, Harvard Health Publishing

Dr. Robert H. Shmerling is the former clinical chief of the division of rheumatology at Beth Israel Deaconess Medical Center (BIDMC), and is a current member of the corresponding faculty in medicine at Harvard Medical School. … See Full Bio View all posts by Robert H. Shmerling, MD

I admit it: I’m not a fan of drug ads. I think the information provided is often confusing and rarely well-balanced. Plus, there are just so many ads. They show up on TV and streaming programs, on social media, on billboards and the sides of busses, on tote bags, and in public bathrooms. Yes, there’s no refuge — even there — from the billions spent on direct-to-consumer ads in the US.

I’ve often wondered how highly-promoted, expensive new drugs stack up against other available treatments. Now a new study in JAMA Network Open considers exactly that.

Many advertised drugs are no better than older drugs

The study assessed 73 of the most heavily advertised drugs in the US between 2015 and 2021. Each drug had been rated by at least one independent health agency. Researchers tallied how many of these drugs received a high therapeutic value rating, indicating that a drug had at least a moderate advantage compared with previously available treatments.

The results? Only about one in four of these heavily advertised drugs had high therapeutic value. During the six years of the study, pharmaceutical companies spent an estimated $15.9 billion promoting drugs on TV that showed no major advantage over less costly drugs!

Why drug ads are not popular

Only the US and New Zealand allow direct-to-consumer medication marketing. The American Medical Association recommended a ban in 2015. While I’ve often written about reasons to be skeptical, let’s focus here on three potential harms to your wallet and your health.

Drug ads may

• raise already astronomical health care costs by increasing requests for unnecessary treatment and promoting much costlier medicines than older or generic drugs.
• create diseases to be treated. Everyday experiences, such as fatigue or occasional dryness in the eyes, may be framed in drug ads as medical conditions warranting immediate treatment. Yet often, such symptoms are minor, temporary experiences. Another example is “low T” (referring to low blood testosterone). While it’s not a recognized illness on its own, ads for it have likely contributed to increased prescriptions for testosterone-containing medicines.
• promote new drugs before enough is known about long-term safety. The pain reliever rofecoxib (Vioxx) is one example. This anti-inflammatory medicine was supposed to be safer than older medicines. It was withdrawn from the market when evidence emerged that it might increase the risk of heart attack and stroke.

Four questions to ask your doctor if you’re curious about a drug ad

Wondering whether you should be taking an advertised drug? Ask your doctor:

• Do I have a condition for which this drug is recommended?
• Is there any reason to expect this drug will be more helpful than what I’m already taking?
• Is this drug more expensive than my current treatment?
• Do my health conditions or the medications I already take make the drug in the ad a poor choice for me?

The bottom line

The AMA recommended banning drug ads nearly a decade ago. But a drug ad ban seems unlikely, given strong lobbying by the pharmaceutical companies and concerns about violating their freedom of speech.

Still, cigarette commercials were banned in 1971, so it’s not an impossible dream. Meanwhile, my advice is to be skeptical about information in drug ads, and rely on more reliable sources of medical information, including your doctor. Consider contacting the Federal Communications Commission if you have complaints about these ads — a step few Americans seem to take. And try this: mute the TV, fast-forward your podcast, and close pop-ups as soon as drug ads appear.

About the Author

Robert H. Shmerling, MD, Senior Faculty Editor, Harvard Health Publishing; Editorial Advisory Board Member, Harvard Health Publishing

Dr. Robert H. Shmerling is the former clinical chief of the division of rheumatology at Beth Israel Deaconess Medical Center (BIDMC), and is a current member of the corresponding faculty in medicine at Harvard Medical School. … See Full Bio View all posts by Robert H. Shmerling, MD

It’s hard to care about anything when you feel exhausted, burned out, or ragged around the edges. Your once-fiery enthusiasm may seem more like charred rubble due to overwhelming family responsibilities, a job that drains you, or financial struggles. Or maybe an illness, the uncertainty and disruptions of the age we live in, or a combination of factors has left you feeling as if you have precious little to give.

“What you’re experiencing is burnout. It’s real and it can lead to depression, anxiety, relationship damage, and an inability to function at home or at work,” says Dr. Marni Chanoff, an integrative psychiatrist with Harvard-affiliated McLean Hospital.

Take heart: With time and effort, you can refill your cup, slowly adding back a bit of the energy and joie de vivre you’ve been missing. Here are three ways to start.

1. Carve out time for yourself

Taking time for yourself isn’t a luxury; it’s essential to self-care. “You need to slow down and give yourself the opportunity to rest and rejuvenate,” Dr. Chanoff says, “Schedule it if you have to, starting with 10 or 15 minutes, a couple of times a day.”

How can you reclaim precious minutes in an overly full schedule? “Look at your day, week, or month, and be discerning about how many things you say ‘yes’ to in one period of time. Give yourself permission to say ‘no thank you’ to things that deplete you or don’t serve you,” Dr. Chanoff says.

Make small moments count: choose what makes you feel at peace. For example, have a cup of tea, or simply lay a blanket or mat on the floor at home or work and lie on your back. Don’t look at your phone or email. “You want to tell your body to take a break. It helps you reset and back away when stress draws you in,” Dr. Chanoff explains.

2. Commit to better health

A strong body helps balance the stressful situations that have caused your burnout. The basic recipe for good health includes:

• Exercise. Moderate intensity exercise, the kind that works the heart and lungs, releases important chemicals that help regulate mood, sleep, and many body systems. Aim for at least 150 minutes of exercise per week, which amounts to about 22 minutes a day. Start with just a few minutes a day if it’s all you can do. It doesn’t have to be fancy. “It can be any movement that brings you joy, like dancing, yoga, or brisk walking,” Dr. Chanoff suggests.
• A good diet. Eating lots of junk food (typically full of sugar, salt, and unhealthy saturated fat) fuels chronic stress, fatigue, depression, and anxiety. Choose more unprocessed foods such as vegetables, fruits, whole grains, legumes, lean proteins (fish or poultry), and unsaturated fats (such as avocados or olive oil). If time is an issue, Chanoff suggests batch-cooking simple, healthy foods you can have several days of the week. (Lentil or bean soup is a good one-pot meal. Throw in as many vegetables as you can.)
• Sleep. Insufficient sleep affects overall health, concentration, and mood. Try to sleep seven to nine hours per night. “It helps to wind down an hour or two before you fall asleep. And practice good sleep hygiene: turn off your phone, keep your room cool and dark, and go to sleep and wake up at the same time each day,” Dr. Chanoff advises.

3. Surround yourself with comfort

Hygge (pronounced HOO-ga) is the Danish concept of cozy comfort that brings happiness and contentment. Folks in Denmark know a thing or two about finding sunshine in cold dark months.

To practice hygge, surround yourself with people, activities, and things that make you feel cozy, loved, happy, or content. Go simple: spend time with your favorite people, add a small vase of flowers to your space, don fuzzy slippers once home, eat a treasured comfort food, or listen to a favorite song.

More ideas to try:

• Light a candle.
• Get under a heated blanket.
• Frame a photo of a happy time.
• Have breakfast in bed.
• Use pretty table linens.
• Indulge in art (check out various works at museums online).
• Stand still outside to listen to the sounds of nature.
• Curl up in a cozy chair.
• Window-shop in your favorite store.
• Wear a soft sweater that feels good on your skin.
• Use a silk or satin pillowcase on your bed pillow.
• Take a warm bath.
• Get an oil diffuser with a scent that reminds you of a place you love, like the beach or a pine forest.

Turn up the effect by savoring cozy comfort. How does it feel, taste, smell, or sound? “Engaging the senses with soothing stimulation can be nourishing. It counteracts ongoing stress that the nervous system endures, and may help to elicit the relaxation response — the opposite of the fight or flight [stress] response,” Dr. Chanoff explains. Breathing deeply will help, too.

Eventually, these bits of hygge, health, and personal time will give you something you probably haven’t allowed yourself in a while, and that’s compassion. Be gentle with yourself. Pamper your soul and replenish your cup, so you can continue being there for the important people and tasks in your life.

About the Author

Heidi Godman, Executive Editor, Harvard Health Letter

Heidi Godman is the executive editor of the Harvard Health Letter. Before coming to the Health Letter, she was an award-winning television news anchor and medical reporter for 25 years. Heidi was named a journalism fellow … See Full Bio View all posts by Heidi Godman

Here’s a new fact about spring, summer, fall, and sometimes even winter, now that climate change has blurred seasonal boundaries: sizzling heat may be on the way, or currently blanketing your community.

High temperatures stress the body, leading to thousands of heat-related illnesses and deaths every year in the US. Creating a personal heat plan can help you stay safe when the heat index soars.

Caleb Dresser, MD, MPH, is the health care solutions lead for C-CHANGE, the Center for Climate Health and the Global Environment at the Harvard T.H. Chan School of Public Health, and an emergency medicine doctor at Harvard-affiliated Beth Israel Deaconess Medical Center. Below we interview him about who, how, and why heat harms. Then we’ll help you create your personal heat safety plan.

Interview edited for clarity

Who is especially vulnerable during hot weather?

High temperatures can affect anyone. But some people — children, outdoor workers, people who are pregnant or have health problems or disabilities, and older people — are more likely to experience harm when temperatures rise. For example:

• Young children, especially babies, have less physical capacity to deal with very high temperatures.
• People working outdoors may not have access to shade and could be performing physically intensive labor. They need adequate hydration, adequate breaks, and access to a cool space during break time, as OSHA guidelines spell out.
• People with chronic medical conditions, such as kidney disease or heart disease, may have difficulty adapting physiologically to hot weather, or may be more susceptible to its health impacts.
• And some people living with disabilities or certain neurological conditions may have difficulty with thermoregulation — that is, controlling the temperature of their bodies — or may not be able to take actions that keep them safe, such as taking off layers or moving to a cool area.

Which weather patterns create dangerous levels of heat?

Dangerous heat is the result of both high temperatures and high humidity, which interfere with our ability to cool off by sweating. In dry areas, extremely hot temperatures can be dangerous on their own.

Danger zones vary across the United States and around the world. But hospital use and deaths rise once we get above threshold temperatures. The threshold varies in different places depending on whether bodies, cultures, and architecture are adapted to heat.

For example, here in New England, where some people (particularly those of limited means) may not have access to air conditioning, we see increases in healthcare use and deaths at a lower temperature than in the American South, where people and organizations may be more used to dealing with hot weather.

When does hot weather become dangerous to our health?

Risk goes up the longer hot weather sticks around.

One hot day can put some people at risk. A stretch of several hot days in a row during a heat wave is particularly dangerous because it can overwhelm people’s ability to adapt. Eventually people run out of physiological reserves, leading to greater health harms and greater need for medical care.

Surprisingly, spring and early summer are particularly dangerous times because people and organizations aren’t as prepared for hot weather.

How to create your personal heat safety plan

Five key points to help you create a personal heat plan are below. Americares offers further information through heat tip sheets developed with the Harvard C-CHANGE team that are tailored to people in different health circumstances.

Planning is important because intense heat is occurring more often: a Climate Central analysis found 21 additional risky heat days, on average, for 232 out of 249 locations between 1970 and 2022.

• Stay ahead of hot weather. Check apps, websites, TV, or radio for updates on weather today and in coming days. If local weather alerts are available by phone or text, sign up.
• Have a cooling plan. When temperatures soar, you need to spend as much time as possible in cool spaces. Plan options if your home is likely to be too hot and unsafe to stay in. You may be able to stay with a neighbor or family member who has air conditioning until a heat wave passes. Many cities and towns have neighborhood splash pads for children, and open cooling centers or air-conditioned libraries, public buildings, or community centers to everyone — sometimes even overnight. Spending time in air-conditioned businesses or malls, or in a shady green space like a park, may help too.
• Sip plenty of fluids. Water is the best choice. Skip sugary drinks and avoid caffeine or alcohol.
• Use fans correctly. Fans help if surrounding air is relatively cool. If air temperatures are very high, it’s important to dampen your clothes or skin to help keep your body from overheating, and move to a cooler location, if possible.
• Know your personal risks and the signs of heat-related illness. If you have health problems or disabilities, or take certain medicines such as diuretics, talk to your doctor about the best ways for you to cope with heat. It’s also essential to know the signs of heat-related illnesses, which range from heat rash and sunburn to heat cramps, heat exhaustion, and heat stroke. This chart from the Centers for Disease Control and Prevention describes the signs to look for and what you can do, particularly when heat becomes an emergency.

About the Author

Francesca Coltrera, Editor, Harvard Health Blog

Francesca Coltrera is editor of the Harvard Health Blog, and a senior content writer and editor for Harvard Health Publishing. She is an award-winning medical writer and co-author of Living Through Breast Cancer and The Breast … See Full Bio View all posts by Francesca Coltrera

About the Reviewer

Howard E. LeWine, MD, Chief Medical Editor, Harvard Health Publishing

Dr. Howard LeWine is a practicing internist at Brigham and Women’s Hospital in Boston, Chief Medical Editor at Harvard Health Publishing, and editor in chief of Harvard Men’s Health Watch. See Full Bio View all posts by Howard E. LeWine, MD

Editor’s note: in honor of Pride Month, we’re re-publishing a 2019 post by Dr. Cecil Webster.

Generally speaking, discussing what happens in our bedrooms outside of the bedroom can be anxiety-provoking. Let’s try to make your doctor’s office an exception. Why is this important? People in the LGBTQ+ community contend not only with a full range of health needs, but also with environments that may lead to unique mental and physical health challenges. Whether or not you have come out in general, doing so with your doctor may prove critical in managing your health. Sexual experiences, with their impact on identity, varied emotional significance, and disease risk, are a keystone for helping your doctor understand how to personalize your healthcare.

Admittedly, talking about your intimate sexual experiences or your gender identity may feel uncomfortable. Many LGBTQ+ patients worry that their clinicians may not be knowledgeable about their needs, or that they’ll to have to educate them. Finding a LGBTQ+ adept doctor, preparing ahead of time for your next appointment, and courageously asking tough questions can give you and your health the best shot.

Finding a skilled clinician who is LGBTQ+ adept

Many large cities have healthcare institutions whose mission centers on care for LGBTQ+ peoples. However, these organizations may prove inaccessible to many for a variety of reasons. Regardless of your location, asking friends, family, or others to recommend a clinician may be a game changer. If your trans friend had a relatively painless experience visiting an area gynecologist, perhaps your Pap smear may go smoothly there as well. If your coworker has a psychiatrist who regularly asks him about his Grindr use, perhaps it may be easier to navigate your gay relationship questions with her.

Word of mouth is often an undervalued method of finding someone skilled and attentive to the needs of LGBTQ+ individuals. Online, many clinicians offer a short bio with their areas of expertise, and there are provider directories featuring trusted clinicians. Further, some doctors regularly write articles and give talks that may offer clues about desired knowledge. A simple Google search of your provider may yield a bounty.

Next, give your doctor or healthcare organization a call. Don’t be shy about requesting someone whose practice matches your specific needs. Your health information is protected, and generally, physicians hold your clinical privacy dear. Keep in mind that not all clinics will know or share whether or not your doctor is, for example, also a lesbian, but they may pair you with someone well suited to your request or point you in the right direction.

Preparing for your appointment

Let’s say you are nervous about coming out to your doctor. A little preparation may ease this burden. Here are some quick tips:

• Let them know you’re nervous at the start of the conversation.
• Be as bold as you can tolerate.
• Write down what you are excited about, nervous about, and/or curious about.
• Go in with a few goals and start with what’s most important.
• Maximize your comfort. If your partner is calming, bring them. If Beyoncé soothes what ails you, bring her along too.
• Lightly correct or update your clinician if they get something wrong.

Ask tough questions, give clear answers

As a psychiatrist who works with kids and adults, I often hear questions like, “I don’t know really how to say this, but I started experimenting with other guys. Does this mean I’m gay?” I may start by asking if you’ve enjoyed it. My colleagues in health care might begin with the same question.

Pleasurable experiences come in all sorts of constellations, and healthy exploration is part of being human. Additionally, clinicians need to assess and address your safety. Many LGBTQ+ people are at higher risk of intimate partner violence. We may ask about your use of condoms, how many partners you’ve had recently, your use of substances during sex, and how these experiences may shift how you see yourself. Give clear answers if possible, but don’t fret if you’re uncertain. Your doctor will not likely provide a label or pry unnecessarily. They may offer constructive information on the use of condoms, reasons to consider using PrEP (which can effectively prevent HIV), and places you can go for more guidance. Physicians enjoy giving personalized information so that you may make informed healthcare decisions.

There is no end to what is on people’s minds. Be bold. Will tucking reduce my sperm count? Maybe. Does binding my breasts come with risk? Likely. Was Shangela robbed of her RuPaul’s Drag Race: All Stars 3 crown? Utterly, but let’s get back to your cholesterol, shall we?

Remember that it is often impossible to squeeze everything into one appointment. Afterward, take time to catch your breath, reflect on what you’ve learned, and come up with more questions for next time. We’re here for that.

About the Author

Cecil R. Webster, Jr., MD, Contributor

Dr. Cecil R. Webster, Jr. is a child, adolescent, and adult psychiatrist in Boston. He is a lecturer in psychiatry at McLean Hospital and Harvard Medical School, and consultant for diversity health outreach programs at the … See Full Bio View all posts by Cecil R. Webster, Jr., MD

Remember childhood summers when you climbed monkey bars, swung from ropes, and jumped over streams? Rain just added to the fun, leaving you soaked and muddy.

You can relive those adventures by signing up for a mud run. These outdoor team events focus on navigating through military-inspired obstacle courses and getting good and dirty in the process.

Tough Mudder and Spartan races are the most well-known mud races. But similar mud runs are available in most states. Some offer shorter distances and levels of difficulty. Others are designed just for women, kids, or families.

How do mud runs work?

Usually these events follow the same basic concept: participants traverse a course that covers anywhere from three to 10 miles (or longer), and tackle 10 to 25 obstacles.

While some mud races can be done solo, most are designed as team-oriented events. Teams are often coed and consist of five to 10 people. There is no time limit, but depending on the distance and number of obstacles, most teams complete the course in anywhere from less than an hour to three-plus hours.

The obstacles are challenging enough that most people need help — physically and emotionally — to navigate over, under, and across them. This is where a “we’re-all-in-this-together” comradery comes into play.

What sort of obstacles are featured in mud runs?

Common obstacles include

• climbing over spider web-like cargo nets
• scaling walls of various heights
• swinging from ropes with handles
• keeping your balance while walking across beams or logs
• carrying logs or sandbags
• slithering under barbed wire.

And then there’s all the mud. Be prepared to trudge through sticky mud pits, crawl through muddy tunnels, and shoot down mud-slick slides.

What are the health benefits of a mud run?

According to Dr. Aaron Baggish, founder of the Cardiovascular Performance Center at Harvard-affiliated Massachusetts General Hospital, the benefits of these events come from how they are constructed.

“Obstacle racing combines large-muscle, whole-body resistance exercises superimposed on a long-distance endurance race,” he says. “They are a snapshot of all-around conditioning, as you need strength, stamina, and mobility.”

Besides the physical benefits, mud races offer psychological challenges, and the emotional rewards, of conquering tasks that require planning, coordination, and strategy.

How can you prepare for a mud run?

Mud races require strenuous exercise, so discuss your safety and capabilities with your doctor before signing up for an event. While almost anyone of any age can participate in these events, they require a certain level of conditioning to complete and to reduce the risk of experiencing injury.

“Training for obstacle races incorporates many aspects of fitness and performance,” says Dr. Baggish. “So it’s best to prepare with a coach or trainer who understands the fundamental skills needed to complete these races.”

Whether or not you work with a trainer, you’ll want to focus on:

• Aerobic fitness. While you won’t consistently run as you do in a traditional road race, such as a 5K or a half marathon, you do have to hustle from obstacle to obstacle. “Optimal training for such obstacle races involves a combination of steady-state aerobic base training like jogging or cycling, coupled with interval work that simulates the start-and-stop nature of competition,” says Dr. Baggish.
• Grip strength. You will have to grab, hold, and pull yourself against gravity. Exercises that can help include pull-ups and farmer carries (where you hold dumbbells or kettlebells in each hand while you walk back and forth). Good form is essential during these exercises to help you avoid injury. Remember to start low when working with weights and go slow.
• Plyometrics. Many obstacles require explosive jumps and quick movements. Exercises like box jumps, burpees, and jump squats can help replicate these moves.

How to stay safe in the mud

While being physically prepared can help reduce the risk of injury, you should take other precautions to stay safe. For instance:

• Choose your race depending on level of fitness. Be sure you know what you’re getting into before you go.
• Wear lightweight, moisture-wicking clothing. Avoid cotton, which gets heavy with mud and sweat.
• Wear a headband, protective eyewear, or visor to keep mud out of the eyes.
• Wear long shorts or pants that cover your knees to prevent scraping, or opt for knee pads.
• Consider gloves to protect your hands and provide extra grip.
• Cover your feet with petroleum jelly or an anti-chafing cream before putting on socks to protect wet feet from chafing and blisters.
• Tie shoelaces tightly (but not so tight that they cut off circulation). Mud creates suction and you can quickly lose a shoe.
• Pace yourself. Walk or take a break when needed.

Where can you find a mud run?

It depends on the level of challenge that you seek. Are you ready for a Tough Mudder or Spartan race? Looking for a family first mud run, or a Muddy Princess or Muddy Kids event?

These additional sites also can help you find mud races in your area:

• Mud Run Finder (US)
• Run Guides (Canada and the US)
• Savage Race (US)

About the Author

Matthew Solan, Executive Editor, Harvard Men's Health Watch

Matthew Solan is the executive editor of Harvard Men’s Health Watch. He previously served as executive editor for UCLA Health’s Healthy Years and as a contributor to Duke Medicine’s Health News and Weill Cornell Medical College’s … See Full Bio View all posts by Matthew Solan

About the Reviewer

Howard E. LeWine, MD, Chief Medical Editor, Harvard Health Publishing

Dr. Howard LeWine is a practicing internist at Brigham and Women’s Hospital in Boston, Chief Medical Editor at Harvard Health Publishing, and editor in chief of Harvard Men’s Health Watch. See Full Bio View all posts by Howard E. LeWine, MD

Picture this: you’re with friends in an unfamiliar forest using only a map and a compass to guide you to an upcoming checkpoint. There are no cell phones or GPS gadgets to help, just good old brainpower fueled by a sense of adventure as you wind through leafy trees and dappled sunlight.

This is not an excursion to a campsite or a treasure hunt. It’s a navigation sport called orienteering — a fun way to get outside, exercise, and maybe even help fight cognitive decline, according to a 2023 study.

What is orienteering?

Orienteering combines map and compass reading with exercise. Competitors (“orienteers”) race against a clock to reach checkpoints in outdoor settings that can range from city parks to remote areas with mountains, lakes, rivers, or snowy fields.

“You can go out in a group or on your own. You get a very detailed map and navigate your way to checkpoints that record your time electronically,” says Clinton Morse, national communications manager with Orienteering USA, the national governing body for the sport in the United States.

Because orienteers are racing the clock, they might run on trails, hike up hills, or scramble around boulders. That’s for foot-orienteering events. There are also orienteering events with courses geared for mountain biking, cross-country skiing, or canoeing.

How might orienteering affect thinking skills?

A small 2023 study published online in PLoS One found a potential link between orienteering and sharp thinking skills.

Researchers asked 158 healthy people, ages 18 to 87, about their health, activities, navigation abilities, and memory. About half of the participants had varying levels of orienteering experience. The other participants were physically active but weren’t orienteers.

Compared with study participants who didn’t engage in orienteering, those who were orienteers reported

• having better navigational processing skills (recognizing where objects were, and where participants were in relation to the objects)
• having better navigational memory skills (recalling routes and landmarks).

The study was observational — that is, not a true experiment — and thus didn’t prove that orienteering boosted people’s thinking skills. But the link might be plausible.

“Aerobic exercise releases chemicals in the brain that foster the growth of new brain cells. And when you use a map and connect it to landmarks, you stimulate growth between brain cells,” says Dr. Andrew Budson, lecturer in neurology at Harvard Medical School and chief of cognitive and behavioral neurology at VA Boston Healthcare System.

Where can you find orienteering opportunities?

There are about 70 orienteering clubs across the United States, and many more around the world (the sport is extremely popular in Europe). To find an orienteering event in your area, use the club finder tool offered by Orienteering USA.

How can you get started with orienteering?

People of all ages and athletic levels can take part, because orienteering courses vary from local parks to wilderness experiences. Costs are about $7 to $10 per person for local events, or $25 to $40 per person for national events, plus any travel and lodging expenses.

To make orienteering easy at first, Morse suggests going with a group and taking things slowly on a short novice course. “You don’t have to race,” he says. “Some people do this recreationally to enjoy the challenge of completing a course at their own pace.”

The trickiest part is learning to read the map. Morse’s advice:

• Turn the map as you change directions. Hold the map so that the direction you’re heading in is at the top of the page. For example, if the compass indicates that you’re heading south, turn the map upside down, so the south part is on top and easier to follow.
• Create a mental image of what the map is telling you. If there’s a fence along a field on the map, build a picture of it in your mind so you can recognize it when you see it, even if you haven’t been there before.

Tips for safe and enjoyable orienteering events:

• Dress appropriately. Wear comfortable clothes including long pants, good walking shoes, and a hat.
• Lather up. You’ll be outside for at least an hour, and you’ll need sunblock and possibly tick and bug spray depending on the terrain. Preventing tick bites that can lead to Lyme disease and other tick-borne illnesses is important in many locations.
• Bring some essentials. Pack water, a snack, sunblock, bug spray, and your phone. (Keep the phone turned off unless you need to call for help.)
• Use good judgment. Know that the shortest route on the map won’t always be the best, since it might take you up a hill or through thick vegetation. It might be better to go around those areas.

Once you learn the basics of orienteering, you can make it more physically challenging (and a better workout) by going faster and trying to beat your previous times, or by signing up for a more advanced course that’s longer and requires more exertion and speed.

And no matter which event you take part in, enjoy the adventure. “You’re not just following a path, you’re solving puzzles while being immersed in nature,” Morse says. “It’s a great way to experience the outdoors.”

About the Author

Heidi Godman, Executive Editor, Harvard Health Letter

Heidi Godman is the executive editor of the Harvard Health Letter. Before coming to the Health Letter, she was an award-winning television news anchor and medical reporter for 25 years. Heidi was named a journalism fellow … See Full Bio View all posts by Heidi Godman

About the Reviewer

Howard E. LeWine, MD, Chief Medical Editor, Harvard Health Publishing

Dr. Howard LeWine is a practicing internist at Brigham and Women’s Hospital in Boston, Chief Medical Editor at Harvard Health Publishing, and editor in chief of Harvard Men’s Health Watch. See Full Bio View all posts by Howard E. LeWine, MD

I recently saw a car vanity plate that read “LBODOC” (as in elbow doc). The driver — probably an orthopedic doctor or arthritis specialist — was clearly a fan of the elbow, an unassuming joint and a surprisingly central player in many daily tasks. I could relate: throughout my medical career, the elbow has been my favorite joint.

Here’s why we should give praise to elbows and do all we can to protect them.

What if we didn’t have elbows?

Let’s face it: the human experience would be quite different without elbows.

Imagine your arm without a joint that bends at the elbow. You’d be unable to easily feed yourself, put on makeup, shave your face, or brush your teeth. It’d be tough to get dressed or throw a ball without elbows. And, importantly, wiping yourself after using the bathroom would be nearly impossible.

Yet, when it comes to joints and joint disease, we hear little about elbows; hips and knees get most of the attention. So, let’s consider for a moment what the lowly elbow does and why it deserves more credit.

How do your elbows work?

Three bones come together at the elbow joint: the humerus, which is in the upper arm, and two long bones called the ulna and radius in the lower arm.

Your elbow has two main motions:

• Flexing and straightening. Flexing your arm allows you to bring your hand toward your body (flexion), which you do when bringing food to your mouth or putting your hands on your hips. Straightening your arm (extension) allows such motions as putting your arm in a shirt sleeve or reaching your toes.
• Turning up and down. You can also flip your palms from facing the ceiling (supination) to facing the floor (pronation). These motions are important for many common movements, such as turning a key or a doorknob.

Bumping your elbow: Why is it called the funny bone?

Probably for two reasons:

• The humerus in the upper arm sounds just like the word humorous, meaning funny.
• Bumping your elbow often puts pressure on the ulnar nerve, since it’s located between the bones of the joint. Pressure on this nerve can cause a funny tingling sensation that runs down your arm.

Elbow trouble: Four well-known problems — and a surprising fifth

Like so many overlooked and underappreciated things, most people think little about their elbows until something goes wrong. Here are some of the most common elbow problems:

• Arthritis. Several types of arthritis can affect the elbow, including rheumatoid arthritis, psoriatic arthritis, and gout. Interestingly, the most common type of arthritis, osteoarthritis, doesn’t usually affect the elbow unless there’s been prior damage to the joint.
• Bursitis. The bursa is a saclike structure that surrounds the tip of the elbow. Bursitis develops when it becomes swollen or inflamed, due to infection, gout, or bleeding.
• Tendonitis. Tendon inflammation (tendonitis) may develop on the inside part of the elbow (called “golfer’s elbow”) or the outside (called “tennis elbow”). Despite these names, you don’t have to play any particular sport to develop elbow tendonitis.
• Trauma. Everyday activities and athletic pursuits put the elbow at risk. A bike accident, falling off a skateboard, or just tripping on a curb and falling onto your arm can cause significant elbow injuries. These include ligament damage, broken bones, or bursitis.

And the surprising fifth problem? Cell phone-induced nerve irritation: holding your elbow bent for a long time can lead to “cell phone elbow” due to pressure on the ulnar nerve. This can cause numbness and pain down the arm. The solution? Put the phone down — or at least go hands-free.

How can you protect your elbows?

Considering all our elbows do for us, we need to do our best to protect them. That means:

• Wear elbow protectors when engaging in activities likely to injure the elbows (like skateboarding or roller blading).
• Learn proper technique for activities that can stress the elbow like racquet sports, baseball, weight training, or repetitive motions in carpentry and other types of work. For example, a trainer or coach can help you improve your tennis stroke to avoid overstressing the elbow joint and its tendons or ligaments.
• Use appropriate equipment. For example, avoid using a tennis racquet that’s too heavy for you.
• Train well. Strengthening forearm muscles and stretching can help avoid golfer’s elbow.

The bottom line

As the junction between hand and shoulder, our elbows play a pivotal role in everyday function. It’s high time we recognized them for what they do for us. Even if the elbow isn’t your favorite joint — as it is for me — perhaps it should be in your top five. After all, think of all the things you couldn’t do without them.

About the Author

Robert H. Shmerling, MD, Senior Faculty Editor, Harvard Health Publishing; Editorial Advisory Board Member, Harvard Health Publishing

Dr. Robert H. Shmerling is the former clinical chief of the division of rheumatology at Beth Israel Deaconess Medical Center (BIDMC), and is a current member of the corresponding faculty in medicine at Harvard Medical School. … See Full Bio View all posts by Robert H. Shmerling, MD