PAGE TYLER PERRY: ‘THE BEST HEALTH OF MY LIFE AT 50’ 61

MAR/APR WEBMD.COM 2019

THE LATEST CAR SEAT CURIOUS GUIDELINES ABOUT DNA PAGE 29 TESTS? READ THIS FIRST PAGE 45 TOP CHEF HOST PADMA LAKSHMI SHEDS LIGHT ON ENDOMETRIOSIS PAGE 35

OPEN-FACE SANDWICHES 3 WAYS PAGE 51 WEBMD MAGAZINE Contents MARCH/APRIL 2019

FEATURES

35 RECIPE FOR ACTION Author, advocate, activist, and reality show host “I JUST Padma Lakshmi leads the charge for endometriosis WANT awareness and action 41 YOUNG THE POWER OF RESILIENCE Can you learn to WOMEN bounce back?

TO KNOW 45 DNA DECODER What you should know THEY’RE about at-home DNA Tests NOT before you try one

ALONE.” CHRISTIAN WITKIN / TRUNK ARCHIVE TRUNK / WITKIN CHRISTIAN

1 WEBMD.COM WEBMD MAGAZINE Contents MARCH/APRIL 2019

THE SPRING ISSUE 6  FACTS & STATS The benefits of getting outside 12 MENTAL MAINTENANCE How feeling young can lead to better health 26 EXPERT PICKS Ease into spring with masks for every skin concern 50 GOOD FOR YOU ‘Tis the season for fresh peas GETTY IMAGES

2 WEBMD.COM WEBMD MAGAZINE Contents MARCH/APRIL 2019 19 33 51 55 CHECKUP

55 CUTTING EDGE New research on pain relief 56 EXPERT Q&A What are biosimilars? 57 HEALTH HIGHLIGHTS Tips for avoiding flare-ups of 26 54 irritable bowel syndrome 58 INSIGHT Can infrared saunas benefit your health? 59 LIVING WITH Strategies to manage multiple 31 sclerosis 60 WHO’S WHO An intro to orthopedic surgeons LIVING FAMILY FOOD

13 MEN’S HEALTH 27 FUN & GAMES 51 3 WAYS: OPEN-FACE The benefits of smaller The power of play SANDWICHES weight loss goals Put the top down 61 28 PREGNANCY for lunch 14 WOMEN’S HEALTH 21 The risks of pregnancy Why a hysterectomy in older women 53 FOOD 101 could put your heart The varied world of rice KIDS’ HEALTH at risk BEAUTY 29 The latest guidelines 54 BUILD A BETTER 15 HIGH-TECH 20 MAKEUP on car seat safety Gail Simmons’ tips for Artificial intelligence Tips for clump- and flavorful stews in health care bacteria-free lashes 30 TEEN HEALTH The links between 18 WORK WISE 21 BEAUTY SMARTS sleep and heart health IN EVERY ISSUE Manage MS on the job The most popular 31 BABY CURRENTS dermatological 4  EDITOR’S NOTE 19 Four steps to making Why you should tell treatments, decoded UPFRONT shots less painful 6 your doctor about your 24 ANATOMY OF . . . News about the Mediterranean bucket list The scoop on 32 PARENTING diet, booster shots, and more The impact of tech deodorant 61  TAKE 10 devices on parenting 25 DERM Q&A Tyler Perry on Madea’s farewell, ON THE COVER The skin-supporting 33 PETS success, and achieving the best PHOTOGRAPHY BY: benefits of probiotics Managing your pet’s pain Scott McDermott/CPi health of his life

3 WEBMD.COM Editor’s Note

FROM THE WEBMD TEAM Who Is Your Health Hero?

My mother, Kay Wilder, is my health hero. About a decade ago, she did

Kristy Hammam a healthy 180 with her Editor in Chief diet and joined the local [email protected] YMCA. As a result, she’s KIM RICHARDSON lost more than 100 SHANNON WebMD Blogs Editor WILDER pounds and kept it off. WebMD Senior ach year, WebMD celebrates visionaries who To me, our readers are the Talk about a role model! Health Editor change the health care landscape in America by real health heroes. As I read Emeeting a health challenge and giving back to the experiences that they others. Our most recent WebMD Health Heroes are share on our message boards ALEXANDER focused on improving outcomes and care for people and Facebook page, I’m HADJIDAKIS with cancer through research, science, caregiving, constantly in awe of their WebMD Photo Editor and advocacy. We had the honor of recognizing these resilience, perseverance, My health hero is amazing individuals not only in the pages of the January/ and resourcefulness in the my stepfather, Gary February issue of this magazine but also in person at our face of health challenges. Walklin. He was the sole WebMD headquarters in New York City in January (see Our readers advocate for caretaker of my mother until she passed below). Their ingenuity, dedication, and humble spirits themselves, they support and away this summer from multiple system were an inspiration to us all. encourage each other, and, atrophy, a progressive brain disorder. We each know people who overcome adversity and even when there’s no solution I know how much work was involved and use their own difficult situations to improve the lives of in sight, they courageously what sacrifices were made, and words those around them. We asked our staff to share their choose to have hope— cannot even describe my appreciation personal health heroes. they’re true heroes. and admiration.

WebMD Health Heroes Awards recipients honored

Back row (left to right): WebMD CEO Bob Brisco; presenter William G. Nelson, MD, PhD, professor of oncology at Johns Hopkins School of Medicine; Margaret Cuomo, MD (Trail- blazer Award); presenter Joan Lunden, journalist and author; singer/composer Rufus Wainwright (Ambassador Award); co-host Sandra Lee, filmmaker and advocate; Nobel laure- ate James P. Allison, PhD (Lifetime Achievement Award) Front row (left to right): Co-host Amy Robach, 20/20 co-anchor and ABC News correspondent; Elizabeth Jaffee, MD (Scientist Award); Lillie Shockney, RN, MAS (Caregiver Award); presenter Judy Ochs; Karen M. Winkfield, MD, PhD (Advocate Award); presenter Clifford Hudis, MD, CEO of the American Society of Clinical Oncology (ASCO); presenter Sung Poblete, Stand Up To Cancer president and CEO; award-winning actor Kathy Bates (Game Changer Award); presenter Padmanee Sharma, MD, PhD

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WebMD Magazine is distributed to doctors’ offices throughout the U.S., online at WebMD.com, and by download from the App Store.WebMD Magazine is not responsible for advertising claims. WebMD Magazine (ISSN 1553-9946), Vol. 15, No. 2, is published by WebMD LLC and may not be reproduced in whole or in part without written permission of WebMD LLC. All editorial content is reviewed by our board-certified physicians, is for informational purposes only, and is not intended to be a substitute for professional medical advice, diagnosis, or treatment. WebMD does not endorse any specific product, service, or treatment. Always seek the advice of your health care provider with any questions regarding a medical condition and never disregard professional medical advice or delay seeking it because of something you have read in WebMD Magazine. If you think you have a medical emergency, call your doctor or 911 immediately. © 2019 WebMD LLC. All rights reserved. TIMELY TOPICS Upfront NEWS YOU CAN USE

Get Out MOVE IT MOVE Rising temperatures make spring the perfect season to embark on an outdoor sport or fitness program. Working out in the fresh air has its advantages, including a boost in mood and more calories burned.

Percentage faster you’d need to run on a treadmill 5 MINUTES to burn the same number of 30 MINUTES 9% TO 15% Time to improve your mood when calories as you would running Additional time each week older Percentage outdoor activities like you exercise in a park, nature outdoors, in part because of adults spent exercising when they biking and gardening might reduce trail, or other green space. 15% factors like wind resistance. were outdoors versus indoors. the risk for a heart attack. GETTY IMAGES

6 WEBMD.COM Upfront

IN THE NEWS Press Pause Would you spit into a tube or swab your cheek and send either piece of yourself off for analysis? Maybe you want to learn about your risk for developing certain diseases based on your DNA. Or maybe you’re after details about your ethnic makeup or looking for people who may be related to you. You’d be one of some 12 million people in the U.S. who have ordered so-called direct-to-consumer genealogy tests, according COLLEEN to the CDC, and the trend shows no signs of slowing. But wait a PARETTY minute—what about downsides to these tests, or at least caveats Editorial Director, colleen@ you should be aware of? To find out, we took a deep-dive into webmd.com how these tests work, what information they deliver, and how to interpret the results. Bottom line: “It’s only the first step in a process,” says an expert we consulted. Before you order a test for yourself, read “DNA Decoder” on page 45 first. — 20 LONG-TERM COSTS Sexual harassment and sexual assault may have serious health MILLION consequences for victims. Researchers surveyed 304 non-smoking IN women ages 40 to 60 who had no signs of heart disease. Those who Number of 1 7 reported past workplace sexual harassment were more than twice Number of adults who Americans as likely as the others to have high blood pressure and almost twice may have diabetes. A third living with of them don’t know it. chronic pain as likely to have poor sleep. The women who reported past sexual SOURCE: CDC that interferes assault had almost three times the risk of depression and more than with daily life. two times the risk of anxiety and poor sleep.

SOURCE: CDC SOURCE: JAMA Internal Medicine BOOSTER EFFECT Booster shots don’t bring the same risk of bad reactions as initial immunizations do. When 1,350 kids got boosters of vaccines that had caused unpleasant side effects the first time, just 215—about one in six—had the reaction again. For most of the 215 children, the reaction was less severe the second time.

SOURCE: The Pediatric

GETTY IMAGES Infectious Disease Journal

7 WEBMD.COM Upfront

YOUR WALKER CLOUD Everything you DANGERS are exposed to forms a unique Those infant walkers that let babies roll across hard floors on tip-toe aren’t safe. From 1990 to cloud of bacteria 2014, about 230,676 babies under 15 months and chemicals old went to the ER for walker-related injuries. that surrounds you Nine in 10 had head or neck injuries. Three in at all times. This four fell down stairs in a walker. Among the discovery could be babies admitted to the hospital—just under 5% of those ER visits—nearly 40% had a skull the first step toward fracture. Despite warning labels, education understanding campaigns, and pediatricians’ call for a ban on how environment infant walkers, many families still buy them. affects health. SOURCE: JAMA Pediatrics SOURCE: CELL Upfront

RISKS OF CLUB MED ANTIBACTERIAL The Mediterranean diet—rich in fruits, vegetables, whole grains, and healthy fats like those that come CLEANING from fatty fish, nuts, and olive oil—could reduce You want to keep harmful stroke risk for women. Researchers tracked 23,232 bacteria away from your men and women ages 40 to 77 for 17 years. The baby, but antibacterial women who stuck closest to the diet were more than cleaning products could bring unexpected health 20% less likely to have a stroke during that time than consequences. In homes those who deviated most from the plan. Researchers where families use these don’t know why men didn’t see the same benefits, cleaners, infants ages 3 to 4 but they note that many other risk factors for stroke months had higher levels of vary between the two sexes as well. an obesity-related gut bacteria called Lachnospiraceae. By SOURCE: Stroke the time they were 3 years old, these kids were more likely to be overweight than toddlers UTI? WATER TO whose families didn’t use bacteria-killing products. THE RESCUE SOURCE: Canadian Medical Association Journal Do you seem to get one urinary tract infection (UTI) after another? Try drinking more water—a lot more. In a study of 140 women who GATEWAY TO TOBACCO typically get more than three UTIs per year, those Teens who use e-cigarettes now are more likely to smoke tobacco who added six cups of water a day to their usual cigarettes later, says a survey that tracked 2,039 young people ages 16 to 20 for two years. intake cut infection frequency in half.

SOURCE: JAMA Internal Medicine SOURCE: Nicotine and Tobacco Research

PINPOINTING PRESSURE PROBLEMS High blood pressure increases risk for heart attack, heart failure, and death from sudden cardiac arrest. That’s why it’s so important to treat the condition. New research could lead to more precise medications for different types of high blood pressure. In a study that included one million people, scientists uncovered over 500 different genes related to high blood pressure. The discovery could help drug developers design medications that go straight to the problem and regulate gene activity that raises blood pressure.

SOURCE: Nature Genetics GETTY IMAGES

9 WEBMD.COM Upfront

POT PREVALENCE AMONG TEENS More than one in three teens has tried marijuana. Just more than three in 10 have smoked it, two in 10 have eaten it in food, and one in 10 has vaped it—that is, inhaled the vapor through a battery- powered device. Most users have tried at least two of these methods.

SOURCE: JAMA

THE FUTURE OF ALZHEIMER’S As the U.S. aging population grows, so will the number of people with Alzheimer’s disease— almost 14 million by 2060. That’s three times today’s number.

SOURCE: CDC Upfront

THE DIABETES- SAFETY CHECK DEMENTIA The newest car safety features could drive you down the road to danger. Most CONNECTION drivers believe blind-spot monitoring Do you care for an systems detect cars passing at high speeds as well as pedestrians and bicycles in their older person with blind spot. But the system only identifies both diabetes and motorized vehicles holding steadily in that dementia? Then spot. One in four drivers feels comfortable keeping blood sugar skipping over-the-shoulder and rearview- mirror checks because of this system. in check is especially Four in 10 drivers think forward collision important. In a study warning systems automatically apply the of 19,995 adults with car’s brakes. But it only pings when you get too close to a car. diabetes older than SOURCE: AAA Foundation age 65, those who had for Traffic Safety dementia were more likely to die from an THE MORE episode of extremely MINIMAL SCREEN TIME + low blood sugar during MAXIMUM SLEEP = SMARTER KIDS YOU KNOW a five-year timespan Pediatricians recommend that youth ages 8 to 11 get an hour of daily Calorie-counts printed on than those who did not exercise, no more than two hours of recreational screen time, and nine to restaurant menus led to 11 hours of sleep. Researchers tested the benefits of following this advice a reduction of 45 calories have dementia. The in 4,520 kids. Compared to children who met none of the guidelines, per meal, according to a researchers suggest kids who met all three performed far better on a thinking skills test that study of 5,500 diners. that people with both included language, memory, attention, brain function, and speed. Kids SOURCE: National Bureau of dementia and diabetes who hit only the screen time benchmark or the screen time and sleep Economic Research goals also saw higher scores on their tests. avoid medications

SOURCE: Lancet that could cause low blood sugar and MEAT use continuous glucose monitoring. MODERATION Two in three adults cut SOURCE: Alzheimer’s Society down on meat in the last three years, says a survey of 1,112 people. Red meat IN and processed meat were 1 3 the first to go. Health and Number of Americans finances were the most who ate fast food today. common reasons.

GETTY IMAGES SOURCE: CDC SOURCE: Public Health Nutrition

11 WEBMD.COM HEALTHY HABITS Living MEANINGFUL CHANGE

AS THE EXPRESSION GOES, “YOU’RE ONLY AS OLD AS YOU FEEL.” According to researchers in South Korea, people who feel younger than their real Brain Age age also have a more youthful brain. MRI scans of people ages 59 to 84 FEELING YOUNG AT HEART revealed higher gray matter volume in those who perceived themselves COULD BE A SIGN THAT YOUR as younger. Loss of gray matter has been linked to mental decline. Those MIND IS YOUTHFUL, TOO who felt younger also scored higher on memory tests and considered themselves to be in better health overall. The authors say a more rapidly aging brain can make you feel older by limiting your ability to perform mental tasks. —STEPHANIE WATSON MENTAL MAINTENANCE MENTAL GETTY IMAGES

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Search for the slideshow Foods to Boost Male Beyond the Numbers Health at WebMD.com. WHEN YOU DO THE WORK TO LOSE WEIGHT, FOCUS ON HOW MUCH BETTER YOU FEEL RATHER THAN THE NUMBER ON YOUR SCALE MEN’S HEALTH MEN’S BY Matt McMillen REVIEWED BY Michael W. Smith, MD, WebMD Chief Medical Editor QUESTIONS FOR YOUR HAVE YOU RESOLVED TO SHED SOME EXCESS Intermittent fasting, which requires you to POUNDS? You need a plan that leads to a sus- restrict eating to certain times. In one version DOCTOR OR tainably healthier and trimmer you, so you’re called 16:8, you eat your normal diet during an DIETITIAN not back where you started this time next year. eight-hour window, say from 10 a.m. to 6 p.m., Some men tend to fixate on numbers and lose then you fast for 16 hours. One theory behind Q What’s the best sight of other factors. If you weigh 300 pounds the diet: By limiting your meals to daytime plan for me? and want to shed half your weight, for example, hours, your body is better able to metabolize That depends on your goals, you just might get overwhelmed by the task what you eat. The result? Some recent studies your motivation, and your ahead before you get started. suggest benefits like weight loss, improved health. If one plan does not Here’s a better approach: Break your big weight blood pressure, and reduced appetite, and, in work for you, keep looking loss goal into smaller, more realistic steps you can men at high risk of diabetes, it countered some until you find the right fit. take to improve your quality of life, says Seattle- of the risk factors that lead to the disease. based registered dietitian and nutritionist Angel Q How do I stay Planells, MS, RDN. Diet breaks, a different intermittent approach motivated? “Aim first to drop from 300 to 270,” he says. “The that a 2017 study found to work well for health benefits of that 10% drop are tried and true.” men. Over four months of dieting, men who Focus on the potential Blood pressure and cholesterol will likely improve alternated every two weeks between a low-cal- benefits of weight loss. You significantly, and back and knee pain may ease as orie diet and a normal-size healthy diet lost 11 eventually may need fewer well, which allows you to be more active, further pounds more than those who dieted non-stop. medications, for example, improving your health. “Small increments can lead to No matter what plan works for you long-term, strive or have more energy for amazing quality-of-life improvements,” says Planells. for more than just a number or quick fix, says Planells. your kids and grandkids. Not sure where to start? Here are two plans “Your goal should be life change, not just pound to consider. change,” he says. “Be patient and focus on the process.” Q Do I have to change everything right away? No. Gradual shifts may make long-term change more likely. So, if you drink a sug- ary soda or a sweet coffee drink every day, slowly wean yourself off of it.

Q What’s a good first step for making this work? Get your spouse or partner involved. When you reinforce each other’s efforts and hold each other accountable, you both improve your chances of success. GETTY IMAGES

13 WEBMD.COM Living The Heart-Hysterectomy Connection A NEW STUDY FINDS THAT HYSTERECTOMY RAISES RISK FOR NUMEROUS HEART PROBLEMS LATER IN LIFE, WOMEN’S HEALTH WOMEN’S YET MANY WOMEN HAVE THE SURGERY BEFORE IT’S NECESSARY

BY Sonya Collins REVIEWED BY Brunilda Nazario, MD, WebMD Senior Medical Editor

Looking for a doctor? Use WebMD’s Physician Directory. Go to WebMD.com/findadoctor.

ASK YOUR DOCTOR IF YOUR DOCTOR RECOMMENDS HYSTERECTOMY FOR YOUR CONDITION, ASK SOME QUESTIONS.

Q What alternatives exist and which symptoms would they treat? Not every woman is a YOUR DOCTOR RECOMMENDED A HYSTEREC- Risks were even greater for women who had the candidate for all available TOMY, BUT IS IT REALLY NECESSARY? surgery before age 35. options. Some alternatives Removal of the uterus is the second most to hysterectomy are best common surgery women undergo—second What about other options? suited to treat abnormal to Cesarean sections—but, in most cases, you A hysterectomy is sometimes the only option to treat bleeding, while others have other options. This matters because new uterine, ovarian, or cervical cancer. “Unfortunately,” work better to relieve pain research shows that the procedure could raise says Laughlin-Tommaso, “cancer is one of the least and discomfort. your risk for other health problems later in life. common reasons that hysterectomies are done.” The most common, she says, are fibroids, uncontrolled Q What are the risks? bleeding, and uterine prolapse. Doctors might also Can I get pregnant Doctors have known for some time that removal recommend the procedure for endometriosis. after treatment? of the ovaries, also called oophorectomy, comes Women who have fibroids or endometriosis have Some treatments for fibroids, with increased risk for heart disease, dementia, and multiple options that don’t require removal of their for example, can raise risk osteoporosis later in life. “As soon as you remove the uterus. Medicine, radiologic procedures, or minor, for pregnancy complications ovaries, women go into menopause, which raises minimally invasive surgery can treat the pain and or make it difficult to get these risks,” says Shannon Laughlin-Tommaso, a bleeding that these conditions cause. pregnant later on. gynecologist and expert in uterine fibroids at Mayo For women who have a prolapsed uterus— Clinic in Rochester, Minnesota. “When we found when the uterus slips down into the vagina that out, we vastly reduced the number of ovarian because weak pelvic muscles can’t support it— Q What are the risks removals we did.” Kegel exercises can strengthen pelvic muscles of each option? New research, however, finds that hysterectomy and relieve minor symptoms. A device inserted Except for hormonal- without removal of the ovaries ups some of those in the vagina can support the uterus and relieve replacement therapy, same risks. In a study of 4,188 women, those who symptoms, as well. Surgery to repair the pelvic alternatives to had a hysterectomy without ovarian removal floor may also be an option. hysterectomy are not were more likely to develop high cholesterol, “These alternative treatments have much lower known to raise risk for high blood pressure, irregular heartbeat, and risks,” says Laughlin-Tommaso. “So we want to heart problems, but every heart disease and to become obese later in life reduce the number of women who have hysterec- medical treatment comes

GETTY IMAGES than those who had their reproductive organs. tomies and try these alternative treatments first.” with some risks.

14 WEBMD.COM Living

Thrive in the Brave New World of Health and The End of Illness. He believes or penalize an entire hospi- AI’s potential to improve health care is “staggering.” FEELING tal’s—or even an individual “We have lots of data that we’ve been collecting over decades,” he says. WIRED surgeon’s—performance. “For the first time, computing power allows us to use the data in a way SOME EXAMPLES OF Such measurements can to benefit patients.” TECH INNOVATIONS IN affect how, when, or even if The challenge, he says, is that “an individual has hundreds of thousands HEALTH CARE INCLUDE a patient is treated, writes THE FOLLOWING: of health care data points, if not millions. So when you have data sets of Jerry Muller, author of 2018’s hundreds of thousands of patients, and each patient has a million data The Tyranny of Metrics. ROBOTIC REFLECTIONS points, the data need to be collected appropriately and correctly for the “Nowhere are metrics more Sometimes, robots are in power of machine learning” to bear fruit. play. A 2017 University of in vogue than in the field of He offers an example. “A study came out recently that showed that if Bristol study found that medicine,” he says. And with you have ovarian cancer, and you happen to also be on a beta blocker—a children with autism have lives on the line, he con- drug that [can be] used for blood pressure—you lived four-and-a-half difficulty distinguishing cludes, “the stakes are high.” facial expressions. That years longer,” he says. “This is an observation we would never have come same year, Dell Technol- Muller points to the up with through biology. Big data shows us. Now [this finding] needs to ogies launched Milo, a problem of human nature: go to a big trial to see if it’s real.” 2-foot tall, visually expres- People and bureaucracies, From a patient’s perspective, “what’s exciting is AI allows [doctors] to per- sive robot that teaches he says, have been known autistic kids ages 5 to 17 sonalize care, something we’ve dreamed of doing for decades,” he adds. to “game” the numbers out how to identify signs of Agus can now take an individual patient and immediately find other emotion, now used in of self-preservation. patients with similar symptoms. “I pull them out of a database,” he says, educational facilities in 27 He cites sourced examples “and I can say, ‘Here are their reactions.’ Machine learning and AI allow U.S. states. of in-demand surgeons main- me to [access] all of the information and have a very educated discussion taining high patient survival with the patient” sitting in the exam room, “unlocking data [on health CONNECTING rates by refusing to take on conditions] that historically we’ve made simple decisions about. AI allows ALS PATIENTS riskier cases, thereby poten- Eye-tracking glasses us to get much deeper and look for associations the human brain isn’t able tially eliminating nonstandard WHEN MANY OF US HEAR THE TERM ARTIFICIAL INTELLIGENCE (AI), WE that use AI technology IMAGINE ROBOTS DOING OUR JOBS, RENDERING PEOPLE OBSOLETE. to do . . . but a computer can.” known as brain-computer treatment approaches—and And, since AI-driven computers are programmed to make decisions There are, of course, detractors regarding the use of analytics in health interface (BCI) enable possible deaths after any kind Health Care’s care, but concerns tend to focus less on AI, machine learning, and predic- people who’ve lost the of medical intervention—from with little human intervention, some wonder if machines will soon ability to speak or move

HIGH-TECH tive tracking and more on how big data can be used to measure, reward, overarching data trends that AI make the difficult decisions we now entrust to our doctors. to communicate again. According to David B. Agus, MD, professor of medicine and engineering Patients “type” with their might detect. Rates of success Hard Drive at the University of Southern California Keck School of Medicine and Viterbi eyes onto a monitor that are then artificially inflated, too. ARTIFICIAL INTELLIGENCE AND BIG DATA ARE School of Engineering, it’s important to separate fact from science fiction, “AI ALLOWS vocalizes their thoughts Still, Agus believes that tap- through computerized TRANSFORMING HOW DOCTORS APPROACH because AI is already here—and it’s fundamentally changing medicine. ping data’s power will bring big decoding, plus use email, innovation. “Algorithms and AI DIAGNOSIS AND TREATMENT, WITH MANY PATIENT Rather than robotics, AI in health care mainly refers to doctors and [DOCTORS] TO read books, and stay con- have been around for a while, BENEFITS—AND SOME POTENTIAL PITFALLS hospitals accessing vast data sets of potentially life-saving information. nected to the world. This includes treatment methods and their outcomes, survival rates, and PERSONALIZE CARE, but we’re learning how to better BY Lauren Paige Kennedy speed of care gathered across millions of patients, geographical locations, SOMETHING WE’VE DETECTING AFIB collect and organize the data,” REVIEWED BY Arefa Cassoobhoy, MD, MPH, and innumerable and sometimes interconnected health conditions. New Some types of cardiac he says. “This past decade was WebMD Senior Medical Editor computing power can detect and analyze large and small trends from DREAMED OF DOING arrhythmias, particularly about molecular biology: We the data and even make predictions through machine learning that’s atrial fibrillation, increase sequenced DNA and looked at risk of heart attack or stroke. its associations, and that was designed to identify potential health outcomes. FOR DECADES.” Research from Stanford Machine learning uses statistical techniques to give computer sys- University shows that AI exciting. This is going to be the tems the ability to “learn” with incoming data and to identify patterns software can more accu- decade of data.” and make decisions with minimal human direction. rately identify arrhythmias With top hospitals across from an electrocardiogram Armed with such targeted analytics, physicians may be better able the nation adopting AI and (ECG) than a human expert. to assess risk, make correct diagnoses, and offer patients more effective metric analyses with the aim treatment options, says Agus, the author of The Lucky Years: How to of improving and streamlin- ON THE HORIZON ing care, Agus may be right. In Magnetic resonance imag- our increasingly wired world, BY THE NUMBERS ing (MRI) and computer- ized axial tomography (CT) data and destiny are becom- scans provide detailed, ing irrevocably intertwined. Number of Americans of all ages with Reduction in patient wait time Percentage of accuracy, non-invasive views of the long QT syndrome, a deadly heart before admittance, reports Johns using a special microscope, inner body. AI may soon 1 in disorder, who could one day be helped Hopkins Hospital, after it launched with which a deep-learning replace the need for addi- tional tissue samples with by Kardio Pro, an AI-powered, at-home 30% a new digital command center in 95.5% computer program identified Search for the slideshow next-generation radiology heart monitor that detects serious and 2016 with 22 monitors to improve patient experience, cancer cells with precision, according to a 2016 study How to Put Tech to tools, enabling virtual 7,000 benign arrhythmias. reduce risk, and streamline flow. from UCLA published in Nature Scientific Reports. Work for Your Health GETTY IMAGES biopsies of tumors. on WebMD.com.

15 16 WEBMD.COM WEBMD.COM Living

ISOLATION RISKS Chronic loneliness could be a recipe for chronic stress, which in turn wreaks havoc on your health. BY THE NUMBERS “The term lonely often implies that you’re somehow Search for the slideshow a social failure, but that’s Don’t Let Loneliness Harm All the Lonely not the case,” says Julianne Your Health at WebMD.com. Holt-Lunstad, PhD. Everyone feels lonely sometimes. appointments, eating right, and taking medications. Or, chronic loneliness could be a recipe for MIND MATTERS MIND People NOT JUST THE SUBJECT OF SAD SONGS, LONELINESS IS AN chronic stress, which in turn EPIDEMIC WITH REAL CONSEQUENCES FOR YOUR HEALTH wreaks havoc on your health. “Having close connections BY Sonya Collins 1 in 4 makes you feel safe,” says Holt- REVIEWED BY Patricia A. Farrell, PhD, WebMD Medical Reviewer Number of Americans who Lunstad. “When you’re alone, rarely or never feel as though you are more reactive to the there are people who under- YOU’RE BUSY: YOU WORK, YOU GO TO THE GYM, YOU MANAGE YOUR stresses in your environment, stand them. HOUSEHOLD. So you may feel you just don’t have time to get which can lead to problems together with your friends. But the truth is, you may not have such as high blood pressure or time not to. People who are lonely are up to 32% more likely to Proportion of [heart] disease.” die early than their more connected peers, research shows. Americans who Some studies show that “Lack of social connection has a significant effect comparable have meaningful, continual loneliness can to other leading indicators of risk for early death,” says Julianne in-person social lead to inflammation, which Holt-Lunstad, PhD, a professor of psychology at Brigham Young ½ interactions, such makes the body susceptible to University. Feeling alone, she says, ranks up there with smoking, as long conversations with numerous illnesses. It may also obesity, and physical inactivity in terms of its effects on your health. friends or quality time with affect sleep quality, which is family, on a daily basis. Social isolation isn’t just a problem for the elderly or homebound. connected with increased risk In a survey of 20,000 Americans, nearly half reported always or for a range of diseases as well. sometimes feeling lonely or left out. Young adults ages 18 to 22 are No matter why loneliness is the loneliest generation of all, the survey found. bad for your health, “You have “All of us fall somewhere on the loneliness continuum,” says to take it seriously,” says Holt- Holt-Lunstad, “so these risks apply to all of us.” 1 in 5 Lunstad. “Just as you make As for why the socially connected may live longer, researchers have Number of Americans who time in your busy schedule to several theories. It could be as simple as having people around who rarely feel close to people. be physically active, you need to encourage you to make healthy choices, such as keeping doctor’s make time to be socially active.” GETTY IMAGES

17 WEBMD.COM Living

set-up right for me? What modifications may work better for me?” Arrange materials like files so you can easily find what you use the MS and the most and store what you don’t use very often, she says. Try some of these assistive devices and suggestions to make working easier with MS. WORK WISE WORK Paperwork or notetaking: Try Y-shape pens that are easier Workplace to grip or automatic staplers that don’t require a hard push to RETHINK YOUR WORKSPACE, SCHEDULE, AND SUPPLIES operate. “Also, install voice-activated software for dictating TO MATCH YOUR NEEDS memos or apps that let you take notes or scan items with your phone,” Dobyns says. Scan items and store them on the digital BY Susan Bernstein cloud to reduce the need for so many papers or files. REVIEWED BY Brunilda Nazario, MD, WebMD Senior Medical Editor Comfy cubicle: “Make sure your desk setup is ergonomic,” says Dobyns. Raise your computer keyboard so you don’t have to lean NO MATTER WHAT PROFESSION YOU’RE IN, multiple sclerosis over, stoop, or reach to use it. Adjustable-height desks can let (MS) symptoms can make your job more challenging at times. Assis- you work while you sit or stand so you can change your position tive devices or adaptive office equipment can make tasks easier so you as needed. “Also, place a footstool or footrest under your desk to can get your work done. You can find ways to adapt your workspace make working more comfortable for your body or back,” she says. or schedule to suit your physical abilities or energy-level dips. Bathroom breaks: If you need to urinate often, “wear adap- “Mobility and energy conservation are both huge issues for peo- tive clothing that’s easier to take on or off to use the bathroom,” ple with MS. Every day, you need to have an energy budget. Think Dobyns suggests. Garments with fastening strips like Velcro of what each task will cost as you plan your work day,” says Karen instead of buttons may help. Ask for an office or desk near the Dobyns, OTD, OTR/L, an occupational therapist in San Diego, restrooms, “or look at your daily routine. Forecast when you may California. Fatigue, motor or sensory deficits, heat sensitivity, need to take breaks,” she says. unsteady gait, dizziness, and the need for urgent, frequent bath- Clear your paths: Poorly lit corridors and clutter could room breaks are also common MS symptoms that may affect you be tripping hazards in your workplace. “Make sure you think at work. MS symptoms fluctuate in unpredictable ways, she adds. about your safety. If your MS symptoms flare, it’s easier for you “There are many generic adaptations you can make to your to stumble,” says Dobyns. Move any trash cans, file boxes, or workspace, and there are so many more office supplies available equipment cables that you might trip over. “With MS, you have now to help with fatigue or other MS symptoms,” says Dobyns. to become an efficiency expert! But these modifications will be

GETTY IMAGES “First, monitor your whole work environment. Think, Is this work helpful for everyone else in your workplace too,” she says.

18 WEBMD.COM Living Make Your CURRENTS Bucket List THEN TELL YOUR DOCTOR, WHO CAN HELP YOU ACHIEVE YOUR GOALS BY Lauren Paige Kennedy REVIEWED BY Brunilda Nazario, MD, WebMD Senior Medical Editor

YOU WANT TO RUN THE NEW YORK CITY MARATHON BEFORE YOU DIE. Tour they have planned for the coming the architecture of Turin. Plan for a secure financial future. Or simply dance year. For example, a patient of mine at your daughter’s wedding next year. Have you created your bucket list yet? who was a skilled guitarist refused More important, have you shared it with your doctor? to take a certain chemotherapy One recent survey published in the Journal of Palliative Medicine shows that agent that might have injured the 91% of people had, in fact, made so-called bucket lists of big and small aims—and nerves in his fingertips. Knowing that doing so helps people to achieve their goals. this about him allowed the oncology “A bucket list is not about waiting until you’re close to death to accomplish team to tailor his treatment. Later cherished goals,” says the study’s author, VJ Periyakoil, MD, director of palliative that year, he was able to attain his care education and training at Stanford University School of Medicine. “It’s about cherished goal of jamming with his being aware of the fact that life is finite, time is precious, and having clear plans friends in a jazz concert, a key item will allow us a reasonable chance of attaining them while we still can. Some goals on his bucket list.” are less ambitious, but no less important.” For the best results, Periyakoil advises that you clue in your doctor about your dreams. He or she can help tailor your health care to up your odds of success, because many objectives, from traveling to remote lands or even writing a novel, require sound health and even endurance to complete. She reminds physicians how important their role is in this regard. “Doctor-patient interactions have become overly transactional,” Periyakoil says. “We can get carried away in our zeal to cure and control disease and lose sight of our patients and what matters most to them. I tell my patients what they need to know about their illness, and then I ask them what

“IT’S ABOUT BEING AWARE OF THE FACT THAT LIFE IS FINITE, TIME IS PRECIOUS, AND HAVING CLEAR PLANS ABOUT WHAT WE WANT TO DO IN OUR LIFETIME.” GETTY IMAGES

19 WEBMD.COM HEALTHY HABITS Beauty MEANINGFUL CHANGE

MASCARA IS ONE OF THE HARDEST-WORKING PRODUCTS IN YOUR MAKEUP BAG. BUT FOR BEST RESULTS, you want to minimize clumping, At Long says Erum Ilyas, MD, a dermatologist in King of Prussia, Philadelphia. In

MAKEUP addition to overloading the applicator brush and applying too many coats (you only need two), one of the biggest offenders leading to lumps on lashes Lash is expired mascara. “Once a new container is opened, it’s best to write the date on the side with a black permanent marker and toss it in three PUT YOUR BEST LASH FORWARD months,” says Ilyas. Mascara past its prime dries out and clumps. What’s WITH THESE CLUMP-REDUCING more, once you open a new mascara, bacteria can start to enter the tube APPLICATION SECRETS gradually. If the mascara is particularly old it could be harboring eye- GETTY IMAGES irritating bacteria. Plan to swap often. —AYREN JACKSON-CANNADY

20 WEBMD.COM Beauty Sign up for the Skin & Beauty Newsletter at WebMD.com.

Fractional laser: The laser beam is broken up pigmentation. “KTP lasers can be used to treatments can reach living skin cells rather into thousands of microscopic columns of light treat stubborn blood vessels, especially on than sit on dead surface cells.” Wiener often that treat a fraction of the skin rather than the face and nose,” Sra says. The recovery dermaplanes a patient’s skin before a chem- the entire surface. As a result, healing often period involves a few hours of pinkness. ical peel to increase its effectiveness. You can requires less time. One of the increasingly also find at-home dermaplaning razors that popular options is Clear + Brilliant because MEDICAL FACIALS achieve similar results. it helps with collagen stimulation, clearing While the drugstore is packed with masks brown spots, and reducing fine lines, Sra says. and serums that allow anyone to do their HydraFacial: “There’s lots of buzz around “Patients leave looking a little sunburned, but own facial, professional techniques refresh the HydraFacial because it is gentle and that resolves within 48 hours.” skin and aid in regeneration beyond the keeps the skin well-balanced and glow- DIY options. “People are taking control ing,” says Pritzker. The device performs Picosecond laser: Devices like the PicoSure of managing their skin both at home and a medical-grade facial using a device to deliver energy in ultra-fast picosecond bursts. in our office,” says Rachel Pritzker, MD, suction out debris from pores and water The vibration stimulates collagen production a dermatologist at Chicago Cosmetic to exfoliate, says Joely Kaufman, MD, a to reduce pigment, smooth scars, treat Surgery and Dermatology. The often dermatologist in Miami. “This is an inno- wrinkles, and create more even-textured skin, instant gratification makes these medical vative solution for those with sensitive says Robert Anolik, MD, a dermatologist and facials popular in dermatologists’ offices. skin and rosacea who may not tolerate clinical assistant professor of dermatology at other methods of exfoliation.” New York University. “Since the laser works Dermaplaning: In this method of physical at a deep, dermal level without damaging the exfoliation, a doctor gently shaves the skin’s Microneedling: Also known as collagen- surface, there is no downtime to heal aside surface with a surgical scalpel to remove a induction therapy, this treatment creates from some mild pinkness in the hours after layer of dead skin and fine vellus hair, says micro punctures to the skin, says Wiener. treatment,” he adds. Gregory Wiener, MD, a cosmetic surgeon “This procedure is extremely effective and owner of The Art of Plastic Surgery in at triggering the body’s natural immune KTP laser: This laser, known under Chicago. “Dermaplaning is quick, painless, response to heal itself by releasing the brand names Excel V, Gemini, and and leaves your skin brighter and smoother,” growth factors and stimulating collagen NewSurg, uses green light to target larger he says. “The procedure triggers the cell- and elastin.” He says the practice can help blood vessels to reduce redness from regeneration process and allows products with issues including fine lines, wrinkles, rosacea and lighten patches of uneven to better penetrate the skin because the hyperpigmentation, scarring, and stretch Continued on page 23 Derm Terms THE SCOOP DON’T KNOW THE DIFFERENCE BETWEEN KTP AND PRP? TOP DERMATOLOGISTS DEFINE SOME OF How to Prevent Broken Capillaries THE MOST POPULAR TREATMENTS THEY OFFER IN THEIR PRACTICE. SPIDER VEINS MAY NOT HURT, BUT THEY CAN STILL PUT A CRIMP IN YOUR COMPLEXION. SUSAN BARD, MD, A NEW YORK CITY DERMATOLOGIST, SHARES TIPS ON TREATING AND PREVENTING BEAUTY SMARTS BEAUTY BY Liesa Goins REVIEWED BY Mohiba K. Tareen, MD, WebMD Medical Reviewer BROKEN CAPILLARIES.

HAVE YOU EVER FELT LIKE YOU and neuromodulators, there are many great Neuromodulators: These injections use LIMIT SUN EXPOSURE VISIT YOUR NEEDED A TRANSLATOR DURING A choices—I don’t expect my patients to know all of the botulinum toxin to smooth wrinkles and As more sun rays hit the top DERMATOLOGIST VISIT WITH YOUR DERMATOLOGIST? the nuances between the options,” says Sarkar. She include Botox, Dysport, and Xeomin. “Botox layer of skin, elastin fibers The only way to treat them is with a laser to destroy the capillaries,” says All the acronyms and jargon can weaken and blood vessels move explains that dermatologists usually offer a variety is the brand patients ask for, but there are closer to the surface of the skin, Bard. How it works: A concentrated sound like a different language. of injectables in their practice and mix and match several different neuromodulators that all becoming more visible. The best wavelength of light that specifically Plus, “the terms and practices in to achieve specific results for each patient. contain the same muscle-relaxing molecule. way to prevent the formation of targets blood vessels is focused on the cosmetics change often and there’s The difference is the protein surrounding broken capillaries—or making vein. The laser transmits energy that is a lot of nuance to the field,” says Fillers: Dermal fillers are injectable sub- the molecule that makes each option slightly them more prominent—is absorbed by the blood cells within the with sun protection. A broad- vessels, which generates heat-causing Papri Sarkar, MD, a dermatologist stances used to help reduce the appearance different,” Sarkar says. spectrum UVA and UVB destruction. The body reabsorbs the in Brookline, Massachusetts. of facial lines and restore fullness in the face. sunscreen will do the trick. damaged vessels over a series of weeks We asked top experts in the field One category uses hyaluronic acid, a naturally ‘LUNCHTIME’ LASERS as the vessels continue to fade. of cosmetic dermatology to define occurring substance in the skin, to plump skin. Using beam energy to rejuvenate the skin CAMOUFLAGE WITH some of the most talked about Brand names include Juvéderm products, isn’t a new idea, but the focus on lasers now is COVER-UP CUT BACK ON ALCOHOL terms so you can speak your doctor’s For a quick fix, use your fingertip Researchers find that alcohol can trigger Restylane products, and Belotero. Another getting the best results with the least amount of to dab a bit of creamy concealer telangiectasia (the official name for language at your next appointment. option is Radiesse, which contains calcium downtime, says Karan Sra, MD, a dermatologist over dark capillaries. One that broken capillaries). To help prevent some hydroxylapatite and is a naturally occurring at Houston Skin Associates in Houston. These dermatologists like, says Bard, is capillary issues, skip alcohol or drink INJECTABLES substance found in bones. It tends to be thicker options are some of the prevalent approaches GETTY IMAGES Cover Fx Total Coverage Cream no more than one glass of wine, beer, or “When it comes to injectable fillers than hyaluronic acid fillers. for addressing skin concerns. Foundation SPF 30 ($42). cocktail a night, says Bard. 21 22 WEBMD.COM WEBMD.COM Beauty

Continued from page 22 AISLE DO PRP HELPS ADDRESS THE SIGNS OF AGING AND CAN STIMULATE HAIR GROWTH. SPRING BEAUTY BUYS marks. This may be paired with PRP CoolSculpting: Known generically as ADD THESE EXPERT-APPROVED (see below). cryolipolysis, this freezes fat cells which PRODUCT PICKS TO YOUR SPRING are eliminated through natural excretion BEAUTY ROUTINE FOR AN ALL-OVER Platelet-rich plasma or PRP: Also known (such as urine and sweat) without FRESH GLOW. as a plasma therapy or Vampire Facial, this damaging other cells. The procedure is involves drawing a patient’s blood, spin- especially effective on the chin, thighs, ning the cells in a centrifuge to extract the and abdomen, Gohara says. PRODUCT PICK plasma, and applying it to the patient’s skin L’OCCITANE ONE MINUTE after microneedling, says Kaufman. “The Emsculpt: High-intensity focused HAND SCRUB ($24) “This exfoliating gel cream plasma contains the patient’s own growth electromagnetic energy stimulates is made with organic shea factors and cytokines that are involved in muscle contractions—20,000 in 30 butter, brown sugar, and growth and healing.” PRP helps address minutes—to tone abdominal muscles walnut husks to gently the signs of aging and can be applied to the and the buttocks. The device destroys fat exfoliate. With allantoin and scalp to stimulate hair growth. cells and builds muscle fibers to define apricot oil to protect the hands from drying out, this is the stomach and butt. a dream combo and a quick NON-SURGICAL BODY SCULPTING fix for extra-dry hands.” “Noninvasive options for body sculpting SculpSure: This is the brand name for a Erica Marton manicurist, have gained popularity,” says Mona type of laser fat reduction, the process of St. Petersburg, Florida Gohara, MD, vice president of the Women’s breaking down fat cells with the heat from Dermatologic Society and an associate a laser. “The device allows for more flexibil- clinical professor at Yale School of Medicine. ity to target smaller, specific areas like the “Patients often inquire about them as alter- chin and around the bra,” Anolik says. PRODUCT PICK natives for liposuction or a tummy tuck.” TRUFORA NIGHT Gohara explains that these are designed UltraShape: Pulses of ultrasound energy tar- SERUM 85 ($80) to contour and tighten areas of stubborn get fat cells on the abdomen to destroy them. “If I had to choose one face fat. “These aren’t weight-loss techniques,” product to add to a spring she says, “but are ways to lose inches in Vanquish: This procedure heats fat cells routine, this is it. It helps with fine lines, collagen targeted areas like the lower abdomen with targeted radiofrequency, such as those production, discoloration, and thighs.” in the abdomen, Gohara says. and skin laxity with multiple peptides, retinols, and antioxidants.” Fran Cook Bolden, MD dermatologist, New York City DIRTY SECRET “I peel off my nail polish. Am I ruining my nails? POLISH SHOULDN’T BE PICKED STAY HANDS-OFF “It’s never a good idea, but peeling regular “Chipping, tugging, and peeling gel polish in PRODUCT PICK polish won’t cause as much trauma as gel sheets will likely lift the nail—with enough force MOROCCANOIL versions because the curing process causes you can cause the nail to completely detach TREATMENT ($44) “Made with hydrating gels to adhere more tightly to the nail plate. from the nail bed. I’ve seen it many times. argan oil and vitamin E, this The stronger bond means you’re more likely Without a nail you risk infection and scarring of workhorse of a product helps to cause trauma to the nail.” the nail bed.” tame humidity-induced frizz, condition and finish a style, SOAKING IS THE SAFEST OPTION and protect hair before and “Dissolving polish with acetone can cause dryness, but this is much less damaging than after lightening it.” peeling. To remove gel polish and make the process as efficient as possible (and minimize the Aida Valenzuela, hair stylist, time acetone sits on your skin and nails), soak a cotton ball in acetone, place it on the nail, and Occoquan, Virginia then wrap the finger in foil. The polish should slide off in about 10 minutes, saving you from scraping and peeling the polish. If you can’t resist the urge to pick, schedule another manicure before your polish chips so you don’t feel the rough edges.” THE OPINIONS EXPRESSED IN THIS SECTION ARE OF THE EXPERTS AND ARE NOT THE OPINIONS OF WEBMD. WEBMD DOES NOT ENDORSE ANY SPECIFIC PRODUCT, —Chris Adigun, MD, dermatologist, founder of Dermatology & Laser Center of Chapel Hill, Chapel Hill, North Carolina SERVICE, OR TREATMENT.

23 WEBMD.COM Deodorant ARM YOURSELF WITH KNOWLEDGE ABOUT THIS FAMOUS FRESHENER

ANATOMY OF ... OF ANATOMY BY Liesa Goins REVIEWED BY Mohiba K. Tareen, MD, WebMD Medical Reviewer

GET YOUR STICK We’re talking two main categories: Deodorant prevents body odor; antiperspirant also inhibits sweating. The FDA classifies most deodorants as cosmetics, but antiperspirants are over-the-counter drugs because they affect the sweat glands. SMELL OF SUCCESS Throughout history, people primarily took baths and wore cologne to keep fresh. That changed in 1888 when Mum, a treatment to kill odor- causing bacteria, was trademarked. The wax-like cream was used to treat armpit and foot odor. ON A ROLL Inspired by the design of the ball-point pen, Helen Barnett developed the roll-on applicator in 1952. The convenient application technique helped popularize what would become a personal-care staple. WHAT MAKES IT STICK Antiperspirants usually contain a form of alumi- num salts that form a temporary plug in sweat glands to prevent perspiration from escaping. In addition, these formulas contain a gelling agent—a waxy material used to carry the active ingredient and form a solid stick—like stearyl alcohol, cetyle alcohol, or glyceryl stearate. CAUSING A STINK Clever marketing made people really sweat their body odor. Inventor Edna Murphey hired a copywriter to write advertising for her anti- perspirant Odorono. The 1919 ads in women’s magazines portrayed sweating as an embar- rassing social faux pas—within a year sales increased 112%. SWEAT DREAMS For the longest-lasting results, apply deodorant before bed. Since you are less likely to perspire at night, the sweat-stopping aluminum salts can more effectively form a plug while you’re sleeping. PHOTOGRAPHY: RICK LOZIER RICK PHOTOGRAPHY: Beauty Small Defenders THE KEY TO SKIN HEALTH MAY BE LETTING GOOD BACTERIA THRIVE Search for the article DERM Q&A DERM What Are Probiotics? BY Liesa Goins REVIEWED BY Mohiba K. Tareen, MD, WebMD Medical Reviewer at WebMD.com.

3 TIPS DERMATOLOGIST WHITNEY BOWE, MD, SUGGESTS STRATEGIES TO KEEP YOUR SKIN BIOME HEALTHY.

CONSIDER A 1. PROBIOTIC “I take a probiotic supplement every day to nourish my skin from the inside out. Look for one YOU’VE LIKELY HEARD ABOUT THE BENEFITS barrier function of the gut and skin. You can make that contains at least 10 OF TAKING PROBIOTICS FOR YOUR DIGESTIVE them part of your diet and include them as ingre- billion colony-forming units (CFUs) and lactobacillus HEALTH, but some research shows good bacteria dients in your topical skin care to help stimulate and bifidobacterium.” may also benefit your skin. Whitney Bowe, MD, renewal, boost your natural defenses, and calm a clinical assistant professor of dermatology inflammation.” WASH WITH A at Icahn School of Medicine at Mount Sinai Q What should you look for in a 2. GENTLE CLEANSER Medical Center and the author of The Beauty of probiotic supplement? “Excessive cleansing and Dirty Skin, believes these little organisms may be BOWE “Not all probiotics are created equal. exfoliating strips away skin’s natural oils and upsets your the unsung heroes of beautiful skin. Different strains serve different purposes and “Studies thus far have been small and prelimi- skin’s healthy barrier and some are more effective than others. The key balance of good microbes. nary, but the results are very promising,” she says. factors to consider are diversity—look for at least A soap-free cleanser like “More research is needed to definitively inves- 10 strains; a “delayed response” delivery to ensure La Roche-Posay Toleriane tigate the effects of probiotics on skin health.” they are the most effective; and a dose between 10 Hydrating Gentle Cleanser Here’s what has Bowe excited about the potential won’t alter your skin’s and 15 billion colony-forming units or CFUs.” pH and will keep your benefits of probiotics and the skin. Q What foods have probiotic benefits? biome intact.” Q Why do we want bacteria on our skin? BOWE “Probiotic-rich foods include kombucha, BOWE “There are more than one trillion bacteria miso soup, kefir, and sauerkraut. There is also USE RETINOIDS WISELY in the skin. The good bugs combat environmental 3. emerging recognition of prebiotic foods. These “Retinoids have multiple damage and keep skin hydrated and radiant. Our include a dietary fiber that promotes the growth benefits, but their antiseptic cleaning styles and obsession with anti- of beneficial microorganisms and can maximize exfoliating effects can be bacterial cleansers have stripped skin of its healthy a probiotic’s benefits. Dandelion greens, aspara- irritating and disrupt your bacteria. When our skin’s microbiome is disrupted skin barrier. Slowly work a gus, and garlic are a few examples.” retinoid into your routine it causes breakouts, rosacea flares, psoriasis, Q How can probiotics defend against prema- two or three times a week. eczema, and even sensitive skin. A healthy biome ture skin aging? Dermalogica Overnight supports the skin’s barrier function that protects Retinol Repair is a good BOWE “Some probiotics create free-radical- from irritation and inflammation.” starting point because it fighting chemicals to support the skin’s own has a buffer cream.” Q How do probiotics benefit the skin? antioxidants. In doing so, they protect cellular BOWE “Probiotics—both oral and topical—fight DNA from potential mutations that could give THE OPINIONS EXPRESSED IN THIS SECTION ARE OF THE EXPERTS AND ARE bad bacteria, help regulate the immune system by rise to skin cancer, safeguard collagen, and even NOT THE OPINIONS OF WEBMD. WEBMD DOES NOT ENDORSE ANY SPECIFIC

GETTY IMAGES controlling inflammation, and support the healthy offer UV protection. PRODUCT, SERVICE, OR TREATMENT. 25 WEBMD.COM Beauty Beauty

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THE OPINIONS EXPRESSED IN THIS SECTION ARE OF THE EXPERTS AND ARE NOT THE OPINIONS OF WEBMD. WEBMD DOES NOT ENDORSE ANY SPECIFIC PRODUCT, SERVICE, OR TREATMENT.

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PHOTOGRAPHY: RICK LOZIER RICK PHOTOGRAPHY: radicalsturnover. whileilluminated alsoThis helpingwill and leave glowing.”with your cellular skin THE FIXER“Thisand mask F, whichdelivers help three shield peptides and protect and vitamins skin from A,26 C,free E, WEBMD.COM HEALTHY TOGETHER Family SMARTER LIVING

PLAYING, WHETHER SELF-DIRECTED OR GUIDED BY AN ADULT, IS AN ESSENTIAL PART OF A CHILD’S HEALTHY DEVELOPMENT, Child’s Play according to a clinical report recently published in the journal Pediatrics. Child psychologist Eileen Kennedy-Moore, PhD, THIS ENDURING KIDS’ ACTIVITY IS FUN agrees with the academic assessment, saying that while there is no AND OFTEN SPONTANEOUS—AND HELPS

FUN & GAMES & FUN “right number” of hours a child should play each day, the activity BUILD A BETTER BRAIN of playing promotes emotional, cognitive, language, and self- regulation skills that build executive function and a pro-social brain. Even more, play supports the formation of the safe, stable, and nurturing relationships with caregivers that children need to thrive. Go play! —LAUREN PAIGE KENNEDY GETTY IMAGES 27 WEBMD.COM GETTY IMAGES PREGNANCY you starttrying. you’re healthybefore toensuregynecologist Visit yourobstetrician/ Late Arrivals any age, but are more common in mothers older than any age, butaremore commoninmothersolderthan to disorderslike Downsyndrome,whichcanhappenat errors,” says. errorslead Lamale-Smith Chromosomal “Your age withyou,sothey’re morelikely eggs tohave overtheyears,buttheirquality drops. depleted only get given cycle. 5%inanyBy your40s,chancesdroptojust each month.In your30s,oddsareabout20%. 20s, youhave a25%to30%chanceofconceiving increasinglybecomesanissue.Ininfertility your San Diego. in theUCSDDivisionofMaternal-Fetal Medicine in gynecology,of obstetrics, sciences and reproductive Smith, MD, professor aperinatologist andassistant need toputmorethoughtintoit,” Lamale- says Leah pregnant?Notto get necessarily. thinkyou “Ijust orhighbloodpressure. as diabetes more likely tohave complications such pregnancy increase.Oldermomsarealso defects and birth weight,miscarriage, lowbirth of premature birth, risks.Onceyoureachyourmid-30s,theodds extra decades ago. Butwithlater pregnanciescome BY PLAN AHEAD PLAN 30 TODAY, MORE FIRST-TIME MOMS ARE IN THEIR OR MAKE IT HARDER FOR YOU TO YOU CONCEIVE? FOR HARDER IT MAKE OR PREGNANCY TO ARISKY LEAD TO HAVE ACHILD WAITING COULD You’re not have. They you’ll bornwithalltheeggs pregnantismoredifficultGetting asyouage, as Should theserisksmake womenreconsiderwaiting Stephanie Watson s AND 40 s — compared totheaverage age REVIEWED BY

Nivin C.S. Todd, MD, WebMD MedicalReviewer plan soyou’re ashealthy aspossible.” pregnancies,” says. Lamale-Smith “But youwantto well and have“Most wonderful olderwomendovery body, especiallyifyou’re notingreat shapetostart. tofallbackon.Yetexperience itcanbehardonyour including amoresolidfinancial footingandgreater life need. screenings you’ll family healthhistory, vaccinations and anddiscuss sure you’re healthy. over your personal Go and forapreconceptioncheckuptomake gynecologist you don’t have apartner. ifyou’reinclude freezingyoureggs notreadyor have you can them.plan ahead,Then which could children youwanttohave—and whenyouwantto lifeplan.”“reproductive abouthowmany Think says. creating aLamale-Smith Shesuggests slightlymoredangerous,” pregnantanditgets get slightly harder to year it gets shoots up, but every considering.“It’sbecome worth notthat therisk pregnancy, but it is the age when your risks other multiples. ovulation, increasing yourchanceofhaving twins or during the simultaneousreleaseofmorethanoneegg age35. Also,hormonalchanges 35cantrigger after Waiting pregnantdoeshave toget itsupsides— seeyour obstetrician/ trying, youstart Before Thirty-five isn’t themagiccut-off pointfor

try to conceive?try birth defects.birth acid to prevent neural tube a prenatal withfolic vitamin pressure undercontrol. Take diabetes andhighblood get chronic conditions like lose any extra weight and Before you trying, start Q fertility specialist. more see a withnoluck, pregnant for six monthsor you’ve to get beentrying If you’re older than35 and Q cy specialist. visiting ahigh-riskpregnan- chronic disease, consider family. Ifyou have asevere, or cystic fibrosis runinyour conditions like thalassemia See ageneticcounselor if Q risk for defects. birth your baby isatincreased (CVS) oramniocentesis if chorionic villussampling drome. You may also need conditions like Down syn - DNA testing for genetic nal muscular atrophy and like cystic fibrosis andspi- for inherited conditions Consider carrier screening Q will Ineed? pregnancy? my oddsof ahealthy specialist? DOCTOR ASK YOUR

ShouldIsee a How longshouldI How can Iincrease What extra tests at WebMD.com. at 35 After Pregnancy article the for Search Family

GETTY IMAGES Family

4 WAYS BEN HOFFMAN, MD, ADVISES PARENTS ABOUT ENSURING A CHILD IS BUCKLED UP CORRECTLY. Why the change? ANCHOR ONCE There wasn’t enough data Safer Rides 1. Install your seat with a to back up age 2 as a safety THE AMERICAN ACADEMY OF PEDIATRICS REVAMPS ITS seat belt or lower anchors, benchmark. In fact, the study on RECOMMENDATIONS ON CAR SEAT SAFETY not both. They’re equally which the 2011 guidelines were good choices, so pick the KIDS’ HEALTH KIDS’ based was eventually retracted BY Rachel Ellis one you understand best. because of inconsistencies in the REVIEWED BY Hansa Bhargava, MD, WebMD Senior Medical Editor ways they modeled statistics. DON’T BUNDLE “At that point, 2 was a fairly arbi- 2.UNDER THE BUCKLE trary point in time, but it was all CAR SEAT GUIDELINES HAVE CHANGED, AND THEY’LL KEEP YOUR Coats and car seat straps we had,” says Hoffman. CHILD SAFER, LONGER. Ben Hoffman, MD, American Academy don’t mix—the added layer Bottom line: Sitting in a of Pediatrics (AAP) chair of the Council on Injury, Violence, and between the restraints and your child reduces his rear-facing seat is the safest way Poison Prevention and lead author of the new AAP statement on safety. Use a blanket over for anyone to ride in a car, even car seat safety, explains what’s changed and why. the straps instead. adults. “In a crash, all the force Shifting focus away from age is spread literally from head to AAP’s 2011 policy on car seat safety mentions age 2 as a minimum MODEL SEAT toe, over half your body, which age for switching a child to a forward-facing seat. But Hoffman 3. BELT SAFETY is the widest possible surface Kids do what parents do, so area you can get,” says Hoffman. says naming a specific age overshadowed much of the rest of the be sure you click in for every statement, which was meant to be more broadly applied. “The key ride. Strap other kids in The cushion the seat provides message was that parents should delay transitions for as long as safely for their size, too. protects the head, neck, and they possibly can,” says Hoffman. spinal cord, the most vulnerable The latest policy zeroes in on this largely missed point and leaves parts of the body. SEE Hoffman says the new out age as a benchmark. The important takeaway: “Kids should stay 4.A PRO rear-facing to the limit of the seat, which is defined by the manufac- Check out the National policy helps change parent, turer in terms of weight and length,” says Hoffman. This goes for all car Highway Traffic Safety family, and community seats, not just rear-facing ones. As you move a child from rear-facing Administration website behaviors, spurs innovation (NHTSA.gov) for a list of and development of products, to forward-facing and then on to a booster, you lose some degree of certified child passenger protection. So, keeping kids in the “youngest” seat they can safely ride safety technicians in and also paves the way for new in is best—even if their second birthday has long since come and gone. your area. laws: “We know that especially “It runs counter to how most parents think, because we tend to for injury-prevention behaviors, look at reaching milestones as an exciting, positive thing,” Hoffman Search for the article having laws on the books is says. “This is one of the few places where a milestone isn’t necessarily Baby Safety at the single most effective tool WebMD.com. GETTY IMAGES something to reach for.” for change.” 29 WEBMD.COM Family

Search for the article How the Heart Works Healthy Zzzs at WebMD.com. YOU ALREADY KNOW THAT LACK OF SLEEP MAKES YOUR TEEN CRANKY. BUT DID YOU KNOW THAT IT COULD ALSO PUT HER AT TEEN HEALTH TEEN INCREASED RISK OF HEART DISEASE? 4 TIPS HELP YOUR TEENS BY Gina Shaw REVIEWED BY Roy Benaroch, MD, WebMD Medical Reviewer GET THE SLEEP THEY NEED WITH SOME POINTERS FROM SLEEP: WE ALL NEED IT, ESPECIALLY GROWING poor sleep was still linked to worse measures of KAROL WATSON, MD. CHILDREN. Health experts recommend that kids heart health. ages 14 to 17 get more than eight hours of sleep “The metabolic consequences of not getting ISOLATE THE per day, and that 11- to 13-year-olds get more than enough sleep are huge,” says Karol Watson, 1. ELECTRONICS nine hours. But the vast majority of kids aren’t MD, professor of medicine at the David Geffen Power down devices 30 getting nearly that much, and a new study says it’s School of Medicine at UCLA and director of the minutes before bedtime and have your teen putting their heart health at risk. UCLA Women’s Cardiovascular Health Center, put her phone, laptop, Researchers from Kaiser Permanente Northern who was not involved with the study. “Our tablet, and any other California assessed sleep duration and efficiency— circadian rhythms tell our bodies to make certain devices somewhere else how long they slept each night and the total hormones when we’re awake and asleep in a besides her room. “Just amount of time spent asleep between first falling coordinated, beautiful ballet. With poor sleep, the knowing that a device is there and that they can asleep and waking up for good—in a group of 829 body gets confused and goes into a self- reach over and look at it adolescents. They didn’t rely on what the teens preservation mode, which means making more of can keep them awake,” told them; instead, they used a device worn on the the substances your body needs when it’s under says Watson. “Also, wrist to measure sleep and physical activity. They stress. For example, your blood sugar levels rise, light-emitting screens block the release of the also measured the teens’ body fat, blood pressure, which makes you insulin-resistant and puts you sleep-promoting hor- lipids, and insulin resistance. at greater risk of diabetes.” mone melatonin.” Inadequate sleep was common—only 2.2% of About five years ago, Watson noticed a worri- the study participants were getting the recom- some trend—more and more teens were coming GO CAFFEINE- mended amount of sleep each night, and 31% slept to see her with high blood pressure and high cho- 2.FREE AFTER 3 P.M. “Make sure your teen less than seven hours each night. The teens with lesterol. So she created UCLA’s Teen Heart Health knows that means not just shorter sleep duration and lower sleep efficiency Program, in which teens educate their peers about coffee, but things like teas were also the least heart-healthy, with increased heart-healthy behaviors. “We’ve found that teens and energy drinks,” Watson body fat, higher blood pressure, and lower levels of already know what to eat, how much they should says. “Most caffeine is out of your system after HDL (“good”) cholesterol. Even after the research- be exercising, and not to smoke,” Watson says, “but about four to five hours, ers adjusted for the teens’ physical activity level, the thing they don’t usually know about is how to but in some people it amount of reported TV watching, and diet quality, get the right amount of sleep.” lingers longer.”

SET SLEEP 3. GOALS Have your teen use an alarm on a smartphone to remind her when it’s time to start settling down for bed. She can also make a pact with a friend to turn SLEEP INTERRUPTED off phones and say good- Light-emitting screens night at the same time. block the release of the sleep-promoting KEEP A REGULAR hormone melatonin. 4.SCHEDULE Don’t count on letting them “catch up” on sleep over the weekend. “Cumulative sleep is important, but you also have to get adequate sleep nightly,” says Watson. GETTY IMAGES GETTY IMAGES Family

BABY Pain-Free Pokes ASK YOUR PEDIATRICIAN TO FOLLOW THIS FOUR-STEP ROUTINE TO MAKE SHOTS LESS PAINFUL FOR YOUR BABY—AND REDUCE HER RISK OF NEEDLE PHOBIA AS SHE GROWS

BY Erin O’Donnell REVIEWED BY Hansa Bhargava, MD, WebMD Senior Medical Editor

Sign up for the Parenting Message Board at WebMD.com. 4 TIPS THIS PAIN-RELIEF ROUTINE MAY BE NEW TO YOUR CHILD’S DOCTOR. STEFAN FRIEDRICHSDORF, MD, OFFERS THESE TIPS FOR TALKING WITH YOUR PEDIATRICIAN.

ASK FOR ALL 1. FOUR STEPS Your provider may agree to use just one or two of the steps of this routine. SHOTS CAN BE A MAJOR CAUSE OF STRESS the cream, the American Academy of Pediatrics But Friedrichsdorf FOR BABIES (AND THEIR PARENTS) IN THEIR suggests a spritz of cooling spray on the skin. Some recommends using all four steps to adequately FIRST YEAR OF LIFE. But they don’t have to be hospitals use a small, buzzy device that combines protect against needle- painful, says Stefan Friedrichsdorf, MD, FAAP, cold with vibration. It’s placed on the skin next to poke pain. medical director of the Department of Pain Med- the injection site, which blocks pain sensations. icine, Palliative Care, and Integrative Medicine BRING YOUR OWN at Children’s Hospitals and Clinics of Minnesota: STEP 2: Give breast milk or sugar water 2.NUMBING CREAM Four percent lidocaine “We know exactly what to do to significantly Research suggests that sweet flavors cause cream is available over- decrease pain caused by vaccination.” the brain to release feel-good brain chemicals. the-counter at most drug He notes that an estimated 25% of U.S. adults are Because breast milk is sweet, breastfeeding moms stores. Bring a tube in afraid of needles, a problem that often starts with should nurse during shots. But if you’re bottle- case the doctor’s office doesn’t keep it on hand, negative childhood experiences. He believes some feeding or a dad, Friedrichsdorf recommends and tell your provider you families skip beneficial immunizations or other dipping baby’s pacifier in a 24% sugar-water want to use it. procedures because they hate to see their baby’s solution available at the doctor’s office or placing discomfort. Friedrichsdorf is out to change that. a drop of the solution on baby’s tongue right DON’T Children’s Minnesota now ensures that all children before the immunizations. 3. ROMANTICIZE PAIN Some parents and undergo a four-step pain-relief routine any time providers hold old- they need a shot or blood draw. STEP 3: Put baby in a comfy position fashioned beliefs that “Never, ever, ever, ever hold a child down” for children will be “wimpy” STEP 1: Numb the skin a shot, Friedrichsdorf says. This can trigger if spared pain from shots or blood draws. Apply a numbing cream that contains 4% lido- anxiety and a long-term fear of needles. If Friedrichsdorf strongly caine to the area where the needle will be inserted you’re not nursing your baby, swaddle her, disagrees. “Pain does not (usually the upper thigh). This inexpensive cream leaving one leg out for the shots. If your baby build character,” he says. is available without prescription, but you must is six months or older and can sit up, hold her. apply it 30 minutes before your baby receives STAND 4.UP the shots. “That means you have to plan ahead,” STEP 4: Offer age-appropriate distraction Medical practices can be Friedrichsdorf says. At his hospital, the cream is Get your baby’s attention by making soothing slow to change routines, applied soon after babies are checked in for their sounds or showing her an interesting toy. At Friedrichsdorf says, so you appointment, then the area is covered with a piece Friedrichsdorf’s hospital, medical teams use may need to insist on pain control for your infant. “You of foam tape to keep it out of reach until shot time. hand-held fan toys with lights. “Babies are totally may get pushback, but do (A piece of plastic wrap laid on the cream also transfixed,” he says. As she grows, options might not fret,” he adds. “Stand

GETTY IMAGES works, Friedrichsdorf says.) As an alternative to include bubbles, pinwheels, or books. up for your child.” 31 WEBMD.COM Family Technical Difficulties TODAY’S PARENTS ARE AMONG THE FIRST TO RAISE CHILDREN IN A HOUSEHOLD FULL

PARENTING OF PORTABLE ELECTRONIC DEVICES. HOW YOU USE THEM MATTERS.

BY Sonya Collins REVIEWED BY Roy Benaroch, MD, WebMD Medical Reviewer

Search for the slideshow How to Break Your Phone Habit at WebMD.com.

CAUSE AND EFFECT Children might escalate their bad behavior to fight for their 3 RULES parents’ attention. IT’S NOT REALISTIC TO BANISH DIGITAL DEVICES FROM YOUR HOME AND FAMILY, BUT YOU CAN SET GUIDELINES FOR HOW YOU’LL USE THEM. FAMILY RESEARCHER BRANDON McDANIEL, PhD, OFFERS THESE TIPS.

ALWAYS MAKE 1. EYE CONTACT If you can’t put the phone down for a legitimate reason, look up from your screen and into your child’s eyes to tell him you need to finish writing that email. “It says, ‘Yes, I was doing something, but you are more important than my device,’” McDaniel says.

YOUR TODDLER IS THROWING A FIT BECAUSE levels, their children’s behavior, and how many OF AN IMPERCEPTIBLE WRINKLE IN HIS SOCK. devices interrupted conversations or activities DESIGNATE 2.TECH-FREE ZONES You try to straighten the sock a dozen times, but with their children on a daily basis. Different areas of the nothing works. Now you just want to tune out The study found that if parents turn to house might make sense the crying and fussing. You grab your phone and their devices when they get stressed out by for different families. watch the cat video your friend just posted. Your their child’s behavior, the little one acts out “Maybe, if you have young children, you decide son screams louder. Sound familiar? even more, which can lead parents to retreat there’s no reason you While the screen might provide temporary even further to their devices. Over time, these should ever enter your stress relief for you, it could make matters worse children might escalate their bad behavior to child’s room with your for your child. “This is the world we live in now, fight for their parents’ attention. Putting the phone,” McDaniel says. so it’s important for us to be strategic in what we device down during interactions with your do with our devices,” says Brandon McDaniel, child might just break the cycle. SCHEDULE PhD, assistant professor of Human Development It doesn’t matter, says McDaniel, how it started: 3. AWAY TIME and Family Science at Illinois State University. Whether you turned to your device when your Discuss with your family McDaniel and co-author Jenny Redesky, MD, child acted up or whether your child acted up certain activities when assistant professor of pediatrics at Michigan because you were engrossed in your device. “It’s a parents agree to stay away from their devices, Medicine, studied 172 sets of parents of young loop. If you can identify the piece that’s the easiest such as dinnertime or a kids up to 5 years old to understand the impact to change, you can often interrupt the entire cycle. family outing. digital devices have on parenting small children. For some families, the easiest piece to change is

GETTY IMAGES The researchers asked parents about their stress how you are interacting with technology.” 32 WEBMD.COM Family

torn ligament or even cancer, which is important to get diagnosed 4 QUESTIONS of Veterinary Surgeons. right away. And though osteoarthritis can’t be cured, you can help Stick to regular leash walks ASK YOUR VET ABOUT your dog feel better and prevent further injury. Here’s what our YOUR DOG’S PAIN that help build muscle veterinary expert recommends. TO GET THE RIGHT around the joints. TREATMENT, SAYS Maintain an optimal weight. “Obesity is associated with an increase ALICIA Z. KARAS, DVM. Consider a supplement. in lameness and problems with mobility,” says Karas. “Part of that is Several small studies show because the dog’s joints are overloaded. Another part is that fatty tis- Q What is causing my that fish oil supplements sue is pro-inflammatory and will make joints hurt more.” Know your dog’s lameness? may be helpful for reducing dog’s body condition score (BCS), which is similar to a body mass pain and lameness in dogs index (BMI) for humans, Karas says. Avoid giving treats and over- Limping could be caused with osteoarthritis. Because feeding to either help your dog lose or maintain an optimal weight. by many conditions, supplements aren’t regu- including osteoarthritis. lated and vary in quality by Trim toenails. “Long toenails are the equivalent of wearing shoes Your vet may order an brand, talk to your vet first that don’t fit,” says Karas. When nails are long, they can affect how X-ray (with or without if you’re considering giving your dog walks, changing the way the muscles and joints work. Keep sedation) and do a a supplement, says Karas. nails trimmed. thorough physical exam to find the underlying cause, Try acupuncture. The Create traction. “Picture the floors in your house being an ice rink,” says Karas. American Animal Hospital says Karas. It’s hard for your dog to get a grip when walking on hard- Association recommends wood floors or those with high-gloss finishes. Put runners, yoga mats, Q Would my dog benefit acupuncture as a safe treat- or carpet tiles down that you can pick up and move, so that your dog from pain medication? ment for pain in animals. Ask has a textured surface to walk on. This will help prevent slipping or your vet for a recommenda- Your vet may prescribe splaying, which can injure muscles as well as joints, says Karas. tion for a veterinary acupunc- anti-inflammatory turist, someone trained to medications to help ease Avoid the weekend warrior syndrome. “Your dog will follow you off a administer needles that may PET HEALTH EXPERTS ESTIMATE THAT ABOUT ONE IN FIVE ADULT your dog’s pain. He or cliff,” says Karas. If you take your dog for a long hike on the weekend, he’s help ease pain and increase DOGS HAS A FORM OF ARTHRITIS CALLED OSTEOARTHRITIS, an she may also recommend PETS often painful condition affecting the joints. But your dog can’t not going to tell you he’s tired and you should turn around, she says. Keep blood flow to muscles. Ways to Treat exercise time within reason for your dog’s fitness and comfort level. blood work to rule out tell you when he’s hurting. abnormalities (such as Also avoid high-impact activities like running and jumping, which See a specialist. Like Maybe you’ve noticed your older dog isn’t as eager to climb elevated liver enzymes) can increase joint pain and inflammation, advises the American College sports medicine doctors the stairs or jump into the car as he once was. Or perhaps she’s that could indicate Pain and in humans, a specialist limping, sleeping more, and playing less. These could be signs of certain medications are trained in canine rehabil- osteoarthritis, says Alicia Z. Karas, DVM, DACVAA, assistant pro- detrimental for your itation could benefit your fessor of clinical sciences at the Cummings School of Veterinary KEEP THEM dog. Never give your dog Lameness Medicine at Tufts University. CLIPPED dog. Rehab might involve human pain relievers, as Long toenails can massage, stretching exer- LIMPING? LETHARGIC? LICKING HIS TOES A LOT? “Osteoarthritis is an inflammatory condition of the joint,” says these may be toxic. Karas. “It can result from overloading the joints or from injury. feel like a pair of cises, or even water therapy. YOUR OLDER DOG COULD HAVE A FORM OF ARTHRITIS. ill-fitting shoes. Then the inflammation persists.” While studies on alternative HERE’S WHAT YOU CAN DO TO HELP. Q Is my dog Osteoarthritis is a chronic disease in which the protective cover- therapies are scarce, body overweight? ing on bones and joints—cartilage—wears down, leading to pain. work done by a specialist Your vet can tell you how BY Christina Boufis Just like in humans, the disease can affect any joint in the body. may help make your dog much your dog should REVIEWED BY Will Draper, DVM, Your dog may have pain or degeneration in the front or back legs, more comfortable. weigh and calculate how WebMD Medical Reviewer hips, elbows, shoulders, spine, and even toes, says Karas. It’s proba- “If you’re helping the many calories he needs bly the most common reason for lameness in older dogs, she notes. muscles to relax, you’re each day for loss or What can you do if your dog shows signs of lameness or pain? going to get them to work maintenance, says Karas. First, get her thoroughly checked out by your vet, says Karas, as better,” explains Karas, “and there could be many reasons for lameness, from muscle pain to a that’s going to support the Q Should I give my joint better, so if the joint dog a supplement? was painful, fixing the mus- BY THE NUMBERS cle might really help.” Not all supplements are created equal, so talk to Percentage of dogs A score of your vet about brands, who are overweight or Total out of 9 on what to expect from obese, according to About 6% TO 8% Percentage of weight the body condition Search for the slideshow supplements, and what the Association for Pet loss in dogs that significantly reduced lameness in obese score that is ideal research there might be to Natural and Alternative Pet Obesity Prevention. dogs with hip osteoarthritis, according to one small study. 4 or 5 for dogs. Remedies That Humans 56% GETTY IMAGES support them, she says. at WebMD.com. Use, Too 33 WEBMD.COM 34 WEBMD.COM 35 WEBMD.COM

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FOR 37 WEBMD.COM A quickly oreasily. the help 12 I years needed.”if I didn’t get continuedtodoTopif Icould’ve Chef for on acouch,” says. Lakshmi “Idon’t know got adressingroomsoIcouldliedown thefirst with me. After seasons, I set few wooden box my woulddrag assistant on from me,I’d sitdown—Ihadalittle asthecamerastanding, wouldpanaway pad underjudges’ table.WhenIwas day. “We usedtopluginmy heating toolbox through the ofresources to get neededashe hadtreatment, Lakshmi constipation, bloating, andnausea. pain, painful bleeding, sex, diarrhea, cramps, chroniclowerbackandpelvic painfulmenstrual bleeds, leadingtovery tissuebuildsup,breaks down,and cycle, of infertility. Duringeach menstrual have acommoncause endometriosis, isinflamed,”everything explains. Lakshmi wantto eatyou don’t heavily because tubes, andotherorgans. of it,inplaceslike theovaries, fallopian the insideofuterusgrowsoutside disorder inwhichthetissuethat lines apainfulgynecological endometriosis, model—it’s has achallenge. Lakshmi an author, entrepreneur, and former job perk, for Lakshmi—who’s also quick-fire challenge.” dayeat becauseI’m forthe thereevery season. “ButIeat doublewhat they a produceroftheseries,nowinits16th challenge,” says 48,who’s Lakshmi, also too—but notnearlyasmuch. GailSimmons,nibble expert culinary fellow judges,Tom chef Colicchioand five-layer weddingcake. Her and co-stars food,fromgoatgourmet cheeseravioli to samplesanabundanceofLakshmi Unfortunately, help didn’t come In theearlydays ofTop Chef About onein10Americanwomen you have“When endometriosis, While thismay seemlike amajor “Tom andGailcomeinforthemain winning title, Padma forthe compete chefs series inwhichamateur Chef ofBravohost TV’s Top s theEmmy-nominated , thetelevision , before biopsies—17 camebackpositiveforendometriosis.” my ovaries, everything,” shesays. onmajororgansand19 “Ihadstitches was all over my fallopian tubes, “Tissue found expected. more than they effective andmay improve fertility. more patches isoften toremoveendometriosis symptoms, butsurgery awoman’sboost chancesofgetting pregnant.Drugtherapy canhelpwith crazy—he tome.” listened was the first one to really give it a name,” she says. “He didn’t think I was [Tamer] “Doctor learnedshehadendometriosis. pain, Lakshmi Seckin month later her symptomsreturned. toldhershe’d they Though blocking hersmallintestine. likely befine, a what thought was they scar tissue tissue endometrial but was actually toremove surgery performed pain andrushedtothehospital.Doctors dismiss symptoms,creating alongdelay indiagnosis,says Sinervo. normalize or often women worldwide have doctors endometriosis, for anunderlyingmedicalcondition. to look her to a specialist referred who removed an ovarian cyst, doctor headaches.Fornauseous andtriggered 23years,nobody, includinga little. madeherfeel Her prescribedpainkillers,butthey gynecologist an individual’s quality oflife—fromschoolingtocareerrelationships.” Care inAtlanta.“It cansignificantly of allaspects andnegatively impact MD,says oftheCenterforEndometriosis KenSinervo, medicaldirector my periodwasdue,” shesays. “It locked meoutofmy ownlife.” I wasembarrassed take tocallinsick,soIwouldn’t modelingjobswhen I’m crazy. Maybe I’mbeingasissy. seemed totake instride. month,” sizeevery mean afullcup shesays. issues, moodiness,swelling,andbloating—and when Isay swelling,I dysmenorrhea,nausea,numbness,lowerbackpain,digestive severe days“I wasbedriddenforseveral amonthwithheadaches,cramping, ascramps atWhat age started 13got progressivelyworseovertime. PERVASIVE Lakshmi had laparoscopic excision surgery in 2006—and her doctors had laparoscopicin 2006—andLakshmi herexcision doctors surgery treatment caneasesymptomsand hasnocure, While endometriosis Finally, decadesof after seeingaspecialist—and suggested adoctor rough day was doubled over in in 2006, Lakshmi On aparticularly issurprisinglycommon.EvenThis thoughanestimated 176 million controltomanage cramps, triedbirth butitonlyhelpeda Lakshmi painful periods and potential is infertility,”more than just “Endometriosis feellike“I didn’t having soitaffected sex, my romanticrelationships. For years,shewonderedwhy handlewhat shecouldn’t otherwomen “I DON’T KNOW“I DON’T I IF THE HELP I NEEDED.” 12 YEARS IF I DIDN’T GET TO TOP DO CHEF COULD’VE PAIN Maybe I’mexaggerating, shethought.Maybe CONTINUED FOR FOR

TOP LEFT: MICHAEL HICKEY/BRAVO; TOP RIGHT: GETTY IMAGES/NBC; BOTTOM: GETTY IMAGES/ ROY ROCHLIN THE “FAMILIESBELONG BOTTOM: BOTTOM: JUDGE GAIL SIMMONS RIGHT: TOP RETURNS TO THE TOP CHEF TOGETHER” RALLY IN AT THE 2010 EMMYS. NEW YORK IN 2018. FELLOW FOR SEASON 16 IN JUDGES’ TABLE TOP: TOP: LAKSHMI AND LAKSHMI AT KENTUCKY. TOP CHEF LAKSHMI

enough toseewhat lifewaslike foranormalwoman,” says. Lakshmi more laparoscopicsurgeries. that “It Ireallyhealed wasn’t untilayearafter the first weekinFebruary,” shesays. Later, in2007and 2009,shehadtwo she’s beendoingitsince2009—have inspiredmany MITstudents. Research,addingthat Lakshmi’sfor Gynepathology ongoing visits— working onendometriosis,” says LindaGriffith, ofMIT’s director Center nutrition,and health. theinterplayunderstanding diet, between she’s on now avisitingscholarandworkswithresearchscientists universities like theMassachusetts Institute ofTechnology, where extensively. at schools,private Shegiveslectures companies,and advocates forpatients, raises awareness, andfundsresearch. Foundationcreate the Endometriosis of America (EndoFound), which Tamer Insomething. withhersurgeon, 2009,shepartnered Seckin,to because ofhervisibility asacelebrity, she was inauniquepositiontodo this disease? know herpainwasn’t normal?Why wasn’t anyone speakingoutabout into anger. Why wasn’t she diagnosed sooner? Why didn’t her doctors thoughtabouthowlongshe’d Lakshmi As suffered, morphed herrelief CALL TO ACTION She underwent alongrecovery. She underwent to “IwasbedriddenfromThanksgiving “Padma remains a force of nature to motivate our team of scientists co-founder,As openlyand shetalksaboutendometriosis waslargely undertheradar—andShe realizedendometriosis pharmaceutical companies. pharmaceutical companies. government, universities, hospitals,and more women in higher positions in ifwehavethe attention deserve they women’sbelieves healthissueswillget health andimmigration issues,andshe onwomen’sfocusing reproductive EndoFound: She’s an ACLU ambassador, aboutthedisease. gynecologists, not just ensure medicalschoolsteachalldoctors, education programs and at thestate level awareness include endometriosis insex couple hadbeen separated.) not getting marriedoranything.” (The saysLakshmi she’s “dating again but with Krishna’s father, AdamDell,whom like tocook,rollerskate, andhangout her class,” says. Lakshmi council forin student won the election turned 9.“She’s inthirdgrade andjust a healthy baby girl, Krishna, who just became pregnant.In 2010, shedelivered Butsoonafter,eggs. sheunexpectedly decidedtofreezeher problems, Lakshmi have women withendometriosis fertility In 2009, knowing about onein two LIFE Her beyond extends advocacy She alsoencourages politiciansto They liveinNew YorkThey City, where they

GOES ON GOES WEBMD.COM 38 Their days often begin around 6:30 a.m. and end relatively early. “I’m so busy with Krishna that it’s rare that GET THE I stay awake past 11—and I used to have parties that started at 11,” she FACTS says with a laugh. Like Padma Lakshmi, roughly 6.5 million Her endometriosis symptoms still linger. “I get migraines, I have cramps, women in the U.S. have endometriosis. but it’s nowhere near as bad as it used to be,” she says. She does acupuncture and SOME OTHER FACTS: uses heat for lower back pain. “If you Endometriosis is the leading cause stop me in any airport and look in my of hysterectomies. bag, there’s an electric heating pad,” she says. When filming Top Chef, she sips tea About 40% of women with infertility to soothe cramps and stocks up on heat have endometriosis. wraps, which she hides under clothes— inside jeans or under tights. On average, a woman has symptoms for 10 years Lakshmi eats well, which comes before getting an accurate diagnosis. naturally. “Obviously if you’ve seen the show ever, you know I have to be quite Scientists don’t know what causes endometriosis, omnivorous,” she says, “but I grew but they think it may have something to do with up lacto-vegetarian.” She eats a lot of menstrual flow problems, genetics, immune legumes and beans and avoids wheat, system issues, hormones, or surgery. sugar, alcohol, and fried foods. When she’s home with Krishna, it’s 50% fruits Endometriosis may be linked to allergies, and vegetables, 25% starches, and 25% asthma, chemical sensitivities, autoimmune lean protein. diseases, chronic fatigue syndrome, Exercise depends on symptoms. When fibromyalgia, and certain cancers like breast she doesn’t feel well, she avoids things cancer and ovarian cancer. like Pilates, which she says worsens her pain. On her worst days, working out is When you have endometriosis as a teen, it’s a tall order. “But I do spend a lot of time more likely to get worse over the years. at the gym,” she says. “I think that has to do with my vanity and my occupational If you have a close relative who has hazard of having to eat so much.” endometriosis, you’re five to seven times When you see Lakshmi on Top Chef, more likely to have it. critiquing a chef’s technique or a dish’s flavor profile, she may not strike you You’re also more likely to develop as someone who’s comfortable sharing endometriosis if: personal details about her body. She’s ▪ You don’t have children. just so cool and composed. ▪ Your periods last more than seven days. “It was not my wish to get up in front ▪ Your menstrual cycle is typically of a room and talk about my vagina,” less than 28 days. she says, admitting it was hard at first. “But I had to step up. I just want young ▪ You have a health problem that blocks women to know they’re not alone. When the normal flow of blood when you have you have endometriosis, you’re shut out. your period. It’s like a prison. I feel like I’ve finally unlocked and kicked away the chain Many doctors recommend treating endometriosis that’s been invisibly wrapped around my with laparoscopic surgery, or LAPEX, because it’s ankle for all these decades.” effective and minimally invasive. SCOTT MCDERMOTT / CPI / MCDERMOTT SCOTT

40 WEBMD.COM O

A GROWING BODY OF RESEARCH LOOKS AT RESILIENCE AS A WAY TO RETRAIN YOUR BRAIN FOR BETTER HEALTH AND HAPPINESS

BY JENNIFER CLOPTON

REVIEWED BY BRUNILDA NAZARIO, M D WEBMD SENIOR MEDICAL EDITOR

ILLUSTRATION: GONZALO MARTÍNEZ MORENO

42 WEBMD.COM 43 WEBMD.COM 45 WEBMD.COM DECODER

REVIEWED B REVIEWED WEBMD SENIOR MEDICAL EDITOR MEDICAL SENIOR WEBMD

B Y

Y SONYACOLLINS

BRUNILDA NAZARIO, MD, MD,

GETTY IMAGES GETTY IMAGES

AND WHATAND SHOULD called 23andMe. “That’s why I or direct-to-consumer, DNA test found him through a mail-order, hisbiological father andthenknew about a man like himself who never Cohen says. quite seemedtomatch my face,” photos online.“Butnoneofthem surnames andtriedtofind their in onthosewithtypically Jewish the spermdonation. He zeroed city where hismotherreceived inthelate 1970sintheresidency their whohadcompleted doctors Cohen searchedonlineformale aJewishrequested donor. there—and that hismotherhad a medicalresidentat ahospital came from—thedonorhadbeen the city wherethespermdonation of my life,” hesays. was Allheknew was. “It was always the great mystery wondered whohisbiologicalfather in question,” says Cohen,now40. ofmy identitya part wassuddenly under his bed and cried. “I felt like was nothisbiologicalfather, hehid through a sperm donor and his dad years old that he had been conceived When Joshua Cohenlearnedat 10 DO WHAT

BEFORE YOU TRY ONE? REALLY SAY In 2016, Cohenheardastory his20sand 30s,Throughout For nearly30years,Cohen AT-HOME TESTS DNA

BU YU HEALTH YOUR ABOUT cancer. can access customers Before Alzheimer’s, Parkinson’s, andbreast raise hisriskfordiseasesincluding variationsfor genetic that might offer one or moreof those features. Heritage, National Geographic— DNA, Mycompetitors—Ancestry and hisethnicity. Most ofthebig information abouthishealth relatives. It alsoincludedsome potential information about DNA 23andMe offered more than that test he got fromwebsite. The were available on the company’s In weeks, Cohen’s a few results WORK? IT HOW DOES and may berelated toyou. share identicalsegmentsofDNA you withsome people connect who in— piece Cohenwasinterested a person’s makeup. And—the ethnic provide anestimated breakdown of diseases basedontheirDNA. They certaintheir risksofdeveloping provide peopleinformation about tests genetic direct-to-consumer adecadeago.provider just Some fromahealthcarehad torequest informationget you would have youcanorderonyourowntotests dozen companiesthat DNA market and waitedformy results.” in atube,droppeditthemail, decided todoit,” Cohensays. “Ispit Cohen’s analyzedhisDNA test 23andMe isoneofat acouple least KNOW YOU WebMD.com. You at About Say Genes 11 Surprising Things Your slideshow the for Search

WEBMD.COM ­­— 46 8GERMAN% their results, they must opt in and But, according to 23andMe, the history of breast cancer. Your doctor go through educational modules vast majority of customers can would order a test that looked for % 20BRITISH to make sure they understand the understand the information they the specific risk-increasing variant information they could receive. receive on their own. The company that runs in your family. “I had my husband, Kit, look $99 had to prove that to get FDA at the health section first to see if approval of the tests. “As part of the ONLY THE FIRST STEP JEWISH % there was anything in there that I MILLION FDA review process, we conducted If you’re after health information— % 50 wouldn’t want to know,” he says. comprehensive user testing across particularly if you have a strong 4.5LEBANESE VALUE OF THE GLOBAL “I didn’t have any of the gene a wide demographic—age, sex, family history of a certain disease—a DIRECT-TO-CONSUMER [variations] they tested for at the education, ethnicity—and were doctor or genetic counselor can TESTING MARKET IN 2017. time, so that was a big relief.” able to demonstrate more than point you toward the right test. Experts warn, however, that 90% comprehension of the genetic Direct-to-consumer tests might not people should be neither too concepts conveyed in our reports,” be the answer. If you’ve already done 8% relieved nor too alarmed about $310 MILLION says a company spokesperson. one, or have your heart set on trying FRENCH their health results in these one- PROJECTED VALUE OF THE The test for breast cancer risk, it out, understand that the health size-fits-all tests. The test for MARKET BY 2022. while less of a concern for men, information is not a diagnosis and Parkinson’s risk, for example, is far from thorough. More than offers limited risk information. isn’t comprehensive and doesn’t 1,000 variations in the BRCA1 “It’s only the first step in the screen for all of the more than 41 and 2 genes could increase risk for process,” says Kirkpatrick. Results DNA variations associated with 12 MILLION breast cancer. 23andMe tests for from these tests require confirmation. the disease. What’s more, if Cohen just three of those variants, which “Taking the next step, to see a doctor NUMBER OF PEOPLE had a variation in his DNA, his risk are most common in Ashkenazi or genetic counselor, can cost extra Joshua Cohen learned of disease would vary based on his WORLDWIDE WHO HAVE Jewish people. A 23andMe report and leave you in a period of limbo, about his genetic ethnicity, which variation he has, SUBMITTED THEIR DNA FOR that says you don’t have those where you don’t know for some time makeup through an SOME at-home DNA test. and numerous lifestyle factors. It’s DIRECT-TO-CONSUMER variants doesn’t mean you don’t whether to be worried or not.” SOUTHERN a lot for a regular person to figure ANALYSIS. have any of the 1,000 variants that Some testing companies, such as EUROPEAN out on his own. could raise your risk. Color, Veritas, and Helix, attempt “Who knows how many people It’s not enough information, for to bridge that gap between the from people with a generations- his genetic makeup meant a lot. are out there living with the belief example, to determine whether you traditional method of ordering tests long history in a certain place, such “I was crossing my fingers that I’d that they have some devastating should start mammograms earlier through your doctor and the direct as Finland or Nigeria. The company find out more than that,” he says, genetic variant when they actually 1 IN 25 and have them more frequently. approach. You choose the test online, provides a chart that shows what “but this was interesting enough.” don’t,” says Brianne Kirkpatrick, NUMBER OF U.S. ADULTS It’s not the type of clinical genetic and a doctor who works with the percentage of your DNA is similar to But there was more. a licensed and certified genetic WHO HAVE ACCESS testing that your doctor would company physically orders that test. that of people from regions around One of the most popular features counselor in Crozet, Virginia. TO THEIR GENETIC DATA. order if you had a strong family “Because a physician is ordering the world. of direct-to-consumer genetic tests the test, it’s not subject to the That’s how Cohen discovered is a social media platform that same FDA regulations as the that the hospital had not honored connects people with relatives— strictly direct-to-consumer tests his mother’s request for a Jewish other customers in the database WHAT TO KNOW ABOUT RAW DATA are,” says Robert Green, a medical donor. His test showed that he was who share bits of identical DNA. Some direct-to-consumer genetic tests include access to your raw data—a downloadable geneticist at Brigham and Women’s only half-Jewish. He got that part On average, your siblings and document containing a long list of letters and numbers that represent your genetic code. Hospital and Harvard Medical from his mother. As for the rest, parents share about 50% of your You don’t need to do anything with this document, but here’s what some people do: School in Boston. “But it’s not he says, “I’m about 20% British, DNA. Half-siblings, aunts, uncles, just a regulatory workaround. In 8% French and German, some nieces, and nephews share about Upload to third-party sites, such as Upload to third-party sites, such as Promethease, some cases, the doctor raises smart Southern European, and about 4.5% 25%. First cousins share about GEDMatch and DNA.land, to find more LifeX Code, and Genetic Genie, to learn what scientific questions about your family history Lebanese. Maybe the Lebanese is 12.5% of your DNA. Fourth relatives than those available in your research says about the individual health risks that and the appropriateness of this where my coloring came from,” he cousins share .2%. The service testing company’s database. your specific gene variants may pose. particular test versus a different says of his olive complexion. attracts adoptees, donor-conceived test.” The physician-mediated For Cohen, learning about his children, and others who hope to companies market their tests as health and that unknown half of find unknown relatives. A FEW THINGS TO CONSIDER BEFORE YOU PROCEED: tools that patients can use with their doctors to guide their care. THE HEALTH INFORMATION IN Third-party sites are open platforms Sites that interpret the health implications of your genetic that lack the same privacy policies and makeup only match your genes to those found in a LONG-LOST RELATIVES AT-HOME DNA TESTS regulations that govern the big companies. database of scientific literature. The analyses are only as Some direct-to-consumer IS NOT A DIAGNOSIS AND OFFERS Read the terms of use carefully. good as the site’s most recent research update, and they companies compare your DNA to are notorious for false positives. PHOTOGRAPHY: HARMONY PATRICIO HARMONY PHOTOGRAPHY: “reference” DNA known to come LIMITED RISK INFORMATION.

47 48 WEBMD.COM WEBMD.COM Hands trembling, Cohen waited Cohen, Deb broke the news to him: HOW TO CHOOSE A until after he’d reviewed all the Her dad had no interest in meeting other portions of his profile before him. “He said it was just a donation,” LEGITIMATE TEST he clicked on his DNA relatives. “At Cohen says. “He never expected to the top of my list was an anonymous hear from anyone, and there were Before you browse the many person,” he says, “and it said, ‘predicted between three and 10 others like me direct-to-consumer genetic half-sister.’” out there.” test options available, make Because she was anonymous, Cohen had prepared himself for sure you know exactly what you Cohen didn’t imagine he’d ever learn the possibility that the mail-order want to get from a test: Health anything about her, but he took a test could lead him to a father who information? Ethnicity breakdown? chance and sent her a message didn’t want to meet him. “I was Connection with relatives? All of through the website. He told her expecting that. And I expected it the above? Then get started on the few bits of information he had to feel terrible, but it really didn’t,” your homework. about his biological father and asked he says. “Having a picture of him, Brianne Kirkpatrick, a licensed if she knew more. By now it was the knowing his name, and having a and certified genetic counselor, middle of the night. He closed his connection with [my half-sister] suggests narrowing your choices computer and went to bed. felt like a lot.” to companies whose websites offer the following: “AT THE TOP OF MY LIST WAS AN Clear samples of what you’ll get. If ANONYMOUS PERSON, AND IT SAID, you’re after a pie chart that shows ‘PREDICTED HALF-SISTER.’” all the ethnicities reflected in your DNA, make sure you see it on the “When I woke up, she had already A few months later, Deb came company’s website. written back,” he says. to New York. Cohen, his husband, Deb was an American living in and their 2-year-old daughter Description of what their DNA the Middle East. Born and raised in drove to Manhattan to pick her up. tests tell you and the technology the United States, she had no idea “As soon as she got in the car, she they use in “CLIA-certified” that her dad (a doctor) had ever started to cry,” Cohen recalls. “She (Clinical Laboratory Improvement donated sperm, but she asked him said she didn’t expect me to look so Amendments of 1988) and “CAP- and it was true. After exchanging much like her dad.” approved” (College of American several emails with They spent the day together Pathologists) labs. Ideally, the lab’s getting to know each other, learning CLIA and CAP numbers appear on about everything they had in the website. common. “She said to me, ‘You’re the brother I’ve always A toll-free contact number and an wanted,’” Cohen says. email address or online chat platform for customer service.

The names and credentials of employees, which must include a team of scientists with advanced degrees in genetics. Think twice about a company whose marketing team is bigger than its scientific team.

Clear terms of service and privacy policy. People often skip over these when they accept services online. But when your unique genetic information is involved, it’s important to read and understand these.

One last note: If a company’s GETTY IMAGES claims seem too good to be true, they probably are.

49 WEBMD.COM DELICIOUS BITES Food MEALS MADE EASY

YOU’RE LIKELY OVERLOOKING A NUTRITION GOLD MINE IN YOUR FREEZER: that bag of frozen peas. The petite pea offers Easy Peasy an impressive combo of protein (22% of an adult’s daily value WHETHER YOU CHOOSE FROZEN OR FRESH, of protein per cup), heart-protective folate (25% of an adult’s VERSATILE PEAS OFFER INEXPENSIVE daily value), and fiber (35% of an adult’s daily value). Peas also SUPERFOOD NUTRITION WITH DELECTABLE contain multiple cancer-fighting polyphenols. In addition to

GOOD FOR YOU FOR GOOD SPRING FLAVOR the frozen variety, watch for fresh peas, in season now. Toss them with whole-grain pasta or leafy salads, blend them into creamy spring soups, or simply munch a handful of crunchy pea pods. Give peas a chance! —ERIN O’DONNELL GETTY IMAGES

50 WEBMD.COM Food

3WAYS Open-Face Sandwiches BYE-BYE BORING SANDWICHES. THE BEST WAY TO PERK UP THE LUNCH STAPLE IS TO TAKE THE TOP OFF—AND ENJOY THESE FRESH FLAVORS WITH A KNIFE AND FORK.

BY Erin O’Donnell RECIPES BY Kathleen Zelman, MPH, RD, LD

A LOVELY LUNCH Salmon Sandwich With Yogurt Dill Sauce This fish sandwich offers fresh spring flavors and delectable crunch. We like it on dense pumpernickel bread.

THE MIX Nonfat Greek yogurt, chopped fresh dill, fresh lemon juice, honey THE BLT ALTERNATIVE mustard, apple, pumpernickel bread, cooked salmon, cucumber, red onion Avocado, Tomato, and MAKE IT In a small bowl, whisk together yogurt, fresh dill, Egg Sandwich 1 tsp each of lemon juice and honey mustard, and salt and pepper. This delectable sandwich is perfect Set aside. Cut an apple into matchsticks and toss with a little more for brunch. Try it on rye bread, and lemon juice. Spread yogurt sauce on 4 bread slices. Top each one top each sandwich with a thin slice with chunks of salmon, cucumber slices, apple pieces, and sliced of prosciutto, a cured Italian ham red onion. Garnish with dill. SERVES 4 available at the deli counter.

PER SERVING (1 SLICE OF TOAST WITH TOPPINGS) | THE MIX Avocado, fresh lime juice, 239 calories, 16 g protein, 19 g carbohydrate, 11 g hot sauce, eggs, toasted rye bread, fat (2 g saturated fat), 39 mg cholesterol, 2 g fiber, tomato, prosciutto 5 g sugar, 389 mg sodium. Calories from fat: 47% MAKE IT Mash avocado in a small bowl with a squeeze of lime juice and dash of hot sauce; set aside. Coat a nonstick skillet with cooking spray. Cook eggs over medium MEDITERRANEAN FLAVOR high heat for 2 to 4 MAKE IT Preheat grill to medium-high heat. Brush 4 small chicken breasts minutes or until whites Grilled Chicken PER SERVING with olive oil and season with salt and pepper. Arrange chicken on grill over are set but yolks are Caprese Sandwich (1 SLICE OF TOAST medium heat and grill 10 to 12 minutes or until the internal temperature reaches runny. Top each slice This sandwich works well on hearty WITH TOPPINGS) | 165ºF, turning once halfway through grilling. Halve Roma tomatoes lengthwise. of toast with avocado whole-wheat bread. It also features one 223 calories, Brush with olive oil and grill, cut sides down, 2 to 3 minutes or until grill marks spread, a tomato slice, of our favorite condiments—balsamic 11 g protein, appear. Brush bread slices with a little more olive oil and grill 1 to 2 minutes or an egg, salt and glaze—available in the vinegar section 20 g carbohydrate, until lightly toasted, turning once halfway through grilling. Slice grilled chicken pepper, and a sliver of large supermarkets. Just one drizzle 12 g fat and tomatoes. Spread pesto on grilled bread. Top with chicken, cheese, grilled of prosciutto. provides a pop of tangy flavor. (3 g saturated fat), tomatoes, fresh basil, and a drizzle of balsamic glaze. SERVES 4 SERVES 4 185 mg cholesterol, THE MIX Skinless chicken breast, olive 4 g fiber, 2 g sugar, oil, Roma tomatoes, hearty whole-wheat PER SERVING (1 SLICE OF TOAST WITH TOPPINGS) | 316 calories, 28 g protein, 402 mg sodium. bread, pesto, sliced fresh mozzarella, 16 g carbohydrate, 15 g fat (3 g saturated fat), 58 mg cholesterol, 3 g fiber, Calories from fresh basil leaves, balsamic glaze 3 g sugar, 325 mg sodium. Calories from fat: 43% fat: 45% PHOTOGRAPHY: RICK LOZIER; FOOD STYLING: CHARLIE WORTHINGTON CHARLIE STYLING: FOOD LOZIER; RICK PHOTOGRAPHY: 51 52 WEBMD.COM WEBMD.COM Food CAMARGUE RED RICE “This wonderfully colored whole- grain rice from southwest France has a nutty taste and JASMINE a slightly chewy texture. Cook RICE in salted boiling “Also water or stock known and use to elevate as Thai seasonal salads.” fragrant rice, Jasmine has a subtle floral aroma when cooked and is ever- ARBORIO RICE “This plump rice from Northern Italy becomes so-slightly wonderfully creamy when cooked. Most commonly sticky. Cook used to make risotto, it’s also great in a torta di riso in salted or Tuscan sweet risotto fritters.” water, cool, then use to make fried rice dishes.” WILD RICE “High in protein and antioxidants, wild rice has a nutty, smoky taste with a chewy outer layer. Toss in a salad along with roasted vegetables and pesto dressing.”

AMERICAN Search for the LONG-GRAIN RICE slideshow Rice: “An extremely The Essentials at versatile rice WebMD.com. that’s popular all over the world. Use it in dishes from numerous cuisines, such Rice as jambalaya, THE WORLD OF RICE IS MORE Maltese baked rice, and nasi FOOD 101 FOOD VAST AND COLORFUL THAN YOU MAY REALIZE. IT’S TIME TO START EXPLORING. goreng, or Indonesian BY Matt McMillen BASMATI RICE fried rice.” REVIEWED BY Hansa Bhargava, MD, WebMD Senior Medical Editor “A fragrant Himalayan rice that cooks up light and fluffy. RICE HAS LONG BEEN A STAPLE IN KITCHENS ALL OVER THE WORLD, and for Firmer textured whole-grain good reason, says Emily Kydd, the London-based author of the cookbook basmati can be used inter- Posh Rice: “It’s high in nutrition, low cost, easy to cook, and it absorbs changeably with white basma- flavors so well. And it doesn’t just have to play a supporting role; rice can ti. Perfect for a lamb biryani or

be the star of many a dish.” Here are six of her favorite varieties. Moroccan chicken bake.” WORTHINGTON CHARLIE STYLING: FOOD LOZIER; RICK PHOTOGRAPHY: Food

BUILD A BETTER Brew up a Stew MAKE THE ULTIMATE COMFORT FOOD PART OF YOUR FAMILY’S REGULAR DINNER ROTATION

BY Matt McMillen REVIEWED BY Hansa Bhargava, MD, WebMD Senior Medical Editor

“I MAKE STEW ONCE A WEEK BETWEEN NOVEMBER AND MARCH,” says Gail Simmons, longtime Top Chef judge and author of Bringing It Home: Favorite Recipes from a Life of Adventurous Eating. She likes stew for its infinite variability and for the cooking lessons it imparts, such as how to layer flavors, combine ingredients, and develop the value of patience. Incorporate her tips the next time you are in the mood for stew.

MAKE IT • All you need: a sharp knife, • Beans—either canned or dried a cutting board, and a large, beans that you’ve soaked lidded, heavy-bottom pot. overnight—go in next if you’re using them. • To start a meat stew, cube your meat and brown on all • Up next: Liquids. Use sides over medium-high heat, homemade stock if possible, then set aside. but a low-sodium store- bought stock makes a good • Build a base of flavors. Sauté substitute. You can use chopped carrots, onions, water, but you’ll have less and celery. Leeks, shallots, depth of flavor. and garlic are also great choices. Cook gently until • Simmer—patiently. While soft but avoid over-browning; a fish stew may cook in 20 otherwise, you risk adding minutes, a beef stew can take bitterness to your stew. a few hours. Fresh herbs like basil and parsley should be • Hearty herbs like fresh added last. thyme and rosemary go in • Stew tastes better the second the pot next and help define day, so consider cooking yours your stew’s flavor profile. the day before you plan to Also consider spices like Sign up for The serve it. curry powder and turmeric Daily Bite Newsletter if you want an Indian-style • Stew makes great leftovers, at WebMD.com. stew, for example. For a and it freezes well. Double tomato-based stew, spoon in your recipe and you’ll have some tomato paste. lots of stew on hand.

HOT CEREALS FOR A HEALTHY START TO THE DAY, WARM YOUR BELLY WITH THESE HOT CEREALS SELECTED BY REGISTERED DIETITIAN KAREN QUAKER OATS OLD BOB’S RED MILL PURELY ELIZABETH HODGSON MILL ROLAND MEDIUM FASHIONED OATMEAL OLD COUNTRY STYLE VIBRANT OAT CUPS MULTI GRAIN HOT GRAIN POLENTA ANSEL, MS, AUTHOR OF “Oats are one of MUESLI “Quick-cooking hot CEREAL “Often overlooked HEALING SUPERFOODS nature’s top sources of “Traditionally prepared cereals often come “This combo of whole as a breakfast FOR ANTI-AGING: STAY beta-glucan, a unique cold, this blend of loaded with added wheat, quinoa, and cereal, polenta is YOUNGER, LIVE LONGER fiber proven to lower dried fruit, nuts, seeds, sugars. Not these. oats boasts zero incredibly creamy and cholesterol. Stir in pea- and several whole They have only 6 grams of sugar and a comforting. For an THE OPINIONS EXPRESSED IN THIS nut or almond butter grains—whole wheat, grams, plus hunger- healthy dose of blood antioxidant-packed SECTION ARE OF THE EXPERTS AND ARE and sliced banana to rye, barley, oats, and busting protein and pressure-friendly breakfast, mix it with NOT THE OPINIONS OF WEBMD; WEBMD DOES NOT ENDORSE ANY SPECIFIC complement their per- triticale—shines when fiber provided by whole potassium. Sweeten canned pumpkin and a

PHOTOGRAPHY: RICK LOZIER; LOZIER; RICK PHOTOGRAPHY: WORTHINGTON CHARLIE STYLING: FOOD PRODUCT, SERVICE, OR TREATMENT. fect chewy texture.” served hot.” grains and seeds.” with chopped apple drizzle of maple syrup.” and a hint of honey.” 54 WEBMD.COM HEALTHY TOGETHER Checkup SMARTER LIVING

Pain

CUTTING EDGE CUTTING Relief OPIOIDS, INCLUDING PRESCRIPTION DRUGS AND HEROIN, CAUSED MORE THAN 80% OF THE 72,000 DRUG OVERDOSE DEATHS IN 2017. PEOPLE WHO LIVE WITH PAIN DESPERATELY NEED SAFE AND EFFECTIVE ALTERNATIVES TO THESE HIGHLY ADDICTIVE PAINKILLERS. CURRENT RESEARCH EXPLORES NEW OPTIONS.

BIOENGINEERS AT THE UNIVERSITY OF CALIFORNIA- without the side effects common to most opioids (like LOS ANGELES CREATED A GEL THAT CONTAINS TINY abuse potential and physical dependence) while also MAGNETIC PARTICLES. The miniscule magnets can affect blocking the brain cells that react to opioids. That means proteins on the surface of cells that play a role in the the drug could potentially prevent opioid abuse in people sensations of touch and pain. Researchers believe this gel who might switch from the controversial medications to could help relieve long-term pain from disease or injury. this potentially safer option. Doctors at Children’s Hospital Los Angeles found Some pain-management research focuses on that virtual reality headsets reduce children’s and cannabis, or marijuana, as a possible treatment. teens’ perception of pain during blood draws. The Cannabis contains two main chemicals, THC and technology consumes a person’s attention and takes CBD, that produce the substance’s effects on the brain. it away from the pain and anxiety he or she would Scientists at McGill University in Montreal have otherwise feel. While the needle prick for a blood draw been working to pinpoint the most effective dose of causes only momentary discomfort, other studies show marijuana plant extract cannabidiol (CBD) for safe pain that virtual reality distracts people from more severe relief without the typical high or euphoria produced and ongoing pain, too. by THC. In laboratory experiments with animals, the Researchers at Wake Forest School of Medicine are researchers determined the exact dose of CBD that developing a new non-opioid medication that could can relieve pain and anxiety without the risk of a high. treat both pain and opioid addiction. In laboratory However, the research is preliminary, the lead scientist experiments (only in primates so far), the new chemical says. Large clinical trials will need to prove that CBD is compound—dubbed AT-121—seems to relieve pain an effective treatment for pain. —SONYA COLLINS GETTY IMAGES

55 WEBMD.COM Checkup Biosimilars 101 LEARN MORE ABOUT THIS TYPE OF MEDICATION EXPERT Q&A EXPERT

MORE PATIENTS THAN EVER BEFORE ARE TAK- both are approved in a way that avoids dupli- ING MEDICATIONS CALLED BIOSIMILARS. cating costly clinical trials. BY THE Michael Kopcha, PhD, RPh, director of the However, biosimilars are not generics. They NUMBERS Office of Pharmaceutical Quality at the FDA, have different requirements regarding, for exam- has answers about these drugs. ple, analytical data and other studies. Regardless, the FDA’s expectations for the quality of a generic Q What is a biosimilar? or biosimilar product are the same as for a brand- KOPCHA Most drugs are made using chemical name drug. reactions in large tanks. However, some drugs 32% are made from living systems—such as micro- Q How does the FDA assure the quality Percentage of the drug filgrastim given organisms, or plant or animal cells—using of biosimilars? to patients as the biotechnology. These drugs are typically KOPCHA Like all drugs, biosimilars must be biosimilar version, as formulated for injection and called biological made so that they are safe and provide their reported in a recent products. A biosimilar is a type of biological intended benefit. To do this, drug manufacturers study in the Journal product that is highly similar to an existing must meet quality standards that ensure every of the American FDA-approved biological product. It has no dose of a drug is of the appropriate strength and Medical Association. clinically meaningful differences from an free of contamination and defects. existing product. The FDA assures that the manufacturer of a biosimilar is capable of meeting quality stan- Q Are biosimilars the same as generic drugs? dards prior to approving the drug. This is why KOPCHA Both biosimilars and generic drugs are you can have confidence in your next dose of medicine, whether it is a biosimilar or not. 73% versions of brand-name drugs that may offer Percentage of people more affordable options to patients by intro- Learn more about biosimilars at taking the filgrastim ducing competition in the marketplace. They fda.gov/biosimilars. biosimilar who had not previously used the brand-name drug. 7 Number of biosimilars approved by the FDA in 2018, the most of any year so far. 2015 Year the first biosimilar drug was approved in the U.S. GETTY IMAGES

56 WEBMD.COM Checkup

10 TIPS TO COPE

1. DOWNSIZE To counter bloating, eat several small meals each day, not three large ones.

TALK 2. ABOUT IT Discuss your IBS with your partner to reduce stress and conflict.

CHOOSE 3. WISELY Identify and avoid the foods that trigger your symptoms.

WORK 4. OUT Exercise helps relieve stress, stimulates normal contractions of your intestines, and can help you feel better.

BULK 5. UP Gradually add fiber to your diet to reduce constipation.

SWITCH 6. TO DECAF Avoid caffeine, which can cause diarrhea.

Fight Flare-ups AVOID 7. BUBBLES FOLLOW THESE EXPERT TIPS TO MANAGE IRRITABLE BOWEL SYNDROME (IBS) Choose non-carbonated beverages to minimize BY Matt McMillen REVIEWED BY Neha Pathak, MD, WebMD Medical Editor bloating. HEALTH HIGHLIGHTS HEALTH DRINK 8. UP EXPERT “Speak with your doctor “See a specialist, such as a “Keep a food diary. This may Consume plenty of water TIPS about depression and gastroenterologist, to be sure uncover patterns between the to counter constipation. anxiety as both can be seen you have the right diagnosis. foods that you eat and your in patients with IBS. Try Such doctors will evaluate IBS. Talk to your doctor about ASK ABOUT exercises like swimming you for any disorders that eliminating certain types of 9. OPTIONS and yoga, which may lessen can have symptoms like food to see if doing so helps Talk to your doctor about the impact of your IBS, help those of IBS, such as an relieve your symptoms. For available medications, reduce stress, ease symptoms inflammatory bowel disease example, milk and other foods which may ease of depression, and improve like Crohn’s or a disorder of that contain lactose often are symptoms. your overall health.” the pancreas.” IBS culprits.” SHERIF ANDRAWES, MD CHRISTINE LEE, MD TARA MENON, MD SET A gastroenterologist, director of gastroenterologist, gastroenterologist, The Ohio State 10. SCHEDULE endoscopy, Staten Island Cleveland Clinic University Wexner Medical Center Eat at set times to help University Hospital regulate your bowels. Search for the slideshow What People With IBS Wish You

GETTY IMAGES Knew at WebMD.com.

57 WEBMD.COM Checkup Sweat Yourself to INSIGHT Good Health CAN INFRARED SAUNAS HEAT UP THE BODY TO HELP FEND OFF A VARIETY OF SYMPTOMS?

OUR BODIES ARE AMAZINGLY EFFICIENT AT Q Is infrared safe? REGULATING BODY TEMPERATURE. In fact, we It’s the same warming principle as getting typically do not change temperature more sunlight outside, so in general, doctors than a couple of degrees. When we do see a consider infrared saunas to be safe. But rise on the thermometer, we often get con- just like with sunlight, you don’t want to cerned about infection. But could there also overdo it. Each session should only be 15 to be a health benefit to warming ourselves up? 20 minutes long—no more than three times Infrared saunas are a technology some a week. BY John Whyte, MD, MPH, people use to help treat various medical con- ditions such as stress, strained muscles, joint WebMD Chief Medical Officer Q Can anyone try it? pain, and headaches. If you currently take any medications, check Instead of warming the air around you like with your doctor to make sure that none a traditional sauna, infrared saunas use radi- ation to heat the body directly. As a result, the affects your ability to sweat. Children (includ- temperature in these types of saunas is not as ing teenagers), pregnant women, and people hot—typically around 140 degrees compared who have had a recent heart attack should to 190 degrees. In addition, infrared radiation not use infrared saunas. penetrates about two inches into the body, through the skin, muscles, and sometimes Q What are the risks? even subcutaneous fat (that’s the jiggly fat Increased heart rate and dizziness are the visible just under the skin). most common side effects—likely from Some researchers believe that heating sweating, which causes dehydration. Drink the body directly and causing sweating may water before starting a session, and drink at increase the production of antioxidants, which least three glasses of water after each session. help get rid of free radicals that cause cell dam- Sweating can also worsen skin conditions age. Increased temperatures might also cause such as acne, eczema, and fungal infections. the release of certain neurotransmitters that If you’re a male wanting to be a dad, think help keep the brain and heart functioning well. twice, since heat raises scrotal temperature Although not a tool for weight loss, each and can decrease sperm count. infrared sauna session can burn up to

GETTY IMAGES 500 calories. Questions? Comments? Email me at [email protected].

58 WEBMD.COM Checkup

the myelin, or substance, that surrounds nerve fibers. Symptoms can range from mild to severe. While MS has no cure, our expert offers tips to help with symptoms.

GET YOUR VITAMIN D “We now understand that vitamin D deficiency negatively affects the immune system in people with MS,” says Mateen. “I recommend they take a vitamin D supplement regularly.” Indeed, one small study showed taking vitamin D supplements helped with the immune system in people with MS, but more research is needed to study this finding.

EAT HEART SMART “There’s no one right diet for MS,” Mateen explains. But eating heart-healthy—more leafy greens and other veggies, as well as grains, nuts, lean protein, and cutting down on fats and processed foods—is key to maintaining good health overall, and it’s especially crucial when you have a chronic condition.

KEEP MOVING “Exercise is important,” says Mateen. “Getting at least 30 minutes of physical activity three times a week (and preferably daily) is good for the nervous system. It helps Take Control maintain muscle strength, balance, coordination, and provides an overall sense of well-being.” Do what feels right for your body, whether that’s LIVING WITH LIVING of MS swimming, walking, or yoga, she advises. MULTIPLE SCLEROSIS IS OFTEN UNPREDICTABLE. HERE BUTT OUT IS WHAT YOU CAN DO TO MANAGE SYMPTOMS. “If you smoke, quitting is one of the most important BY Christina Boufis things you can do,” says Mateen. “Smoking REVIEWED BY Neil Lava, MD, WebMD Medical Reviewer cigarettes worsens disability in MS.” It also increases the risk of infection, heart disease, and cancers and worsens MS symptoms. “I WAS DIAGNOSED WITH MULTIPLE SCLEROSIS (MS) 10 YEARS AGO, at Talk to a smoking-cessation counselor, get medi- the age of 40,” says Rita Fusaro, an antique dealer in Irvington, New York. cation or patches, and find support to help you quit, “Looking back, I’d probably had it for several years before that. I had advises Mateen. many symptoms, like trouble walking, but I just thought I was exhausted As for Fusaro, now 50, she began exercising to because I was working all the time.” help with MS symptoms. “I actually feel like I have “MS is a disease of what I call the central command of the nervous more energy after I exercise. It makes me stronger,” system—the brain, spinal cord, and optic nerves,” explains Farrah J. she says. “Of course, I can’t do what everyone else Mateen, MD, PhD, associate professor, Massachusetts General Hospital does, so I scale the exercises, and I use a cane if I and Harvard Medical School. In MS, the body’s immune system attacks need to.”

ASK YOUR DOCTOR

Q What medication is right for me? Q How does stress affect MS? Q What can I do about fatigue? “There are 15 drugs on the market now for MS,” says While too much stress isn’t good for anyone, it’s Your doctor can prescribe medicines that may Farrah J. Mateen, MD, PhD, ranging from injectable difficult to prove cause and effect with relapsing help, but they don’t work for everyone, Mateen meds to pills and transfusions. Talk to your doctor MS symptoms, says Mateen. Try deep breathing says. Schedule important tasks earlier in the about which medication is best for you and how exercises, meditation, or reaching out to others to day, take naps, change your work schedule if

GETTY IMAGES often you need to follow up to make sure it’s working. combat life stress. possible, and ask for help to battle fatigue.

59 WEBMD.COM Checkup Orthopedic Surgeon AN APPOINTMENT WITH THIS SPECIALIST CAN KEEP YOU LIMBER AND MOBILE WHO’S WHO WHO’S BY Jodi Helmer REVIEWED BY Neha Pathak, MD, WebMD Medical Editor BY THE MUSCULOSKELETAL ISSUES LIKE BACKACHES, fellowship training. Surgeons might focus on BROKEN BONES, AND ARTHRITIC JOINTS affect specific areas of the musculoskeletal system such as NUMBERS more than one in two adults and almost 75% of the spine, hips, shoulders, feet, and ankles or choose those older than age 65. Orthopedic surgeons to work with certain diseases such as arthritis. treat patients with both acute and chronic In addition to completing medical residencies conditions affecting the bones, joints, ligaments, and fellowship programs, earning a license tendons, and muscles. to practice orthopedic medicine also requires 29,613 passing certification exams through the Number of orthopedic MUSCULOSKELETAL CARE American Board of Orthopaedic Surgery and Orthopedic surgeons treat conditions of the surgeons practicing in ongoing continuing education. the U.S. in 2016. musculoskeletal system. They use both surgical and nonsurgical procedures to treat SURGERY: A LAST RESORT musculoskeletal trauma, spine diseases, sports Orthopedic surgeons can do complicated injuries, degenerative diseases, infections, surgeries, but they often prioritize less tumors, and congenital disorders. invasive treatments such as medication, casts All orthopedic surgeons, both generalists or splints, and physical therapy. and specialists, undergo extensive training that If surgery is required, orthopedic surgeons includes earning undergraduate and medical can use bone grafts or metal rods, metal plates, 14 degrees. (Some orthopedic surgeons earn Doctor or pins and screws to hold bones together; Years of formal of Medicine or MD degrees while others earn replace damaged joints; mend tendons, education most Doctor of Osteopathic medicine or DO degrees. ligaments, and other soft tissue; or cut and orthopedic surgeons Both MDs and DOs are licensed to practice reposition bones to correct deformities. undergo to medicine in all 50 states.) practice medicine. More than half of orthopedic surgeons choose Need a specialist? Use WebMD’s Physician to specialize in their fields by completing Directory. Go to webmd.com/findadoctor. 18.8% Percentage of orthopedic surgeons practicing sports medicine, making it the most popular area of specialization. 30 Average number of procedures orthopedists in the U.S. perform each month. GETTY IMAGES TEN QUESTIONS Take 10 REAL LIFE

YOUR NEW FILM, MADEA FAMILY HAS BECOMING A FATHER MADE 1. FUNERAL, WILL BE YOUR SIGNATURE 6.YOU MORE ATTENTIVE TO HOW CHARACTER’S FINAL APPEARANCE. YOU TAKE CARE OF YOURSELF? HOW WILL YOU SAY GOODBYE? I’ve always felt like I was going to I will be on the final Madea tour, the die at 88, so I want to give my farewell tour. I wanted to bring back son 40 good years of my life and some of the original cast that worked be able to pass on the wisdom I with me early on and then go out on have learned. And I want to be an tour to say goodbye. The audiences have excellent example of health to him. been so amazing to me over the years, so I wanted to give them a proper farewell. WHAT’S YOUR WORKOUT? YOU’RE NOTHING IF NOT 7. I’ve been doing Soul Cycle 2.SUCCESSFUL. HOW HAVE YOU religiously since my son was born DEFINED SUCCESS FOR YOURSELF four years ago. I love it. I’ve also OVER THE YEARS? just started Rumble boxing, which Success means different things over is also awesome. Between the two, I time. At first, it meant making enough burn a lot of calories. money to take care of my mother.

Now, it’s about my legacy and about HAVE THERE BEEN ANY how many people I’m employing and 8.ROADBLOCKS ON YOUR WAY TO whether I’m changing people’s lives. A FITTER YOU? Where I grew up, in New Orleans, if WHAT ADVICE DID YOU LEARN you weren’t fat, people thought you EARLY ON THAT HAS SERVED YOU 3. weren’t happy. Understanding that WELL THROUGHOUT YOUR CAREER? that wasn’t good for health took Only say what you can do. It’s so simple, some mental undoing. Once I did but I’ve never forgotten that. I only claim that, weight loss became easier. that I will do what I am able to do. If I can’t do it, I don’t say it. And the mantra WHAT DO YOU MOST LIKE TO DO I live by is Psalm 37:3: Do good and trust ON YOUR DAYS OFF? God. No matter what, do good. 9. I like to fly remote-control planes. I keep them in my barn, and I like YOU’VE MADE IT A PRIORITY TO 4. ACHIEVE AND MAINTAIN A HEALTHY to go out and fly them, just me and WEIGHT. WHAT WORKS FOR YOU? my son. Being a father is the most Knowledge. Once I got educated Tyler Perry important thing, and I’ve got to get about nutrition, it really helped in Actor, playwright, filmmaker, the time in there. every area of my health—with weight and humanitarian, 49, Atlanta loss, feeling good in the morning, and YOU LAUNCHED THE TYLER and Los Angeles feeling younger. 10. PERRY FOUNDATION IN 2006. WHAT INSPIRED YOU?

WHAT HAS HELPED FOCUS I’ve been a giver all my life, and I 5.YOUR EFFORTS? “I WANT TO BE IN THE BEST wanted to make it formal. It’s a I want to be in the best health of my private foundation, so I get to life at 50. I’m on a mission to be at my HEALTH OF MY LIFE AT 50. I’M fund whatever I feel, such as proper body weight, and I’m 15 pounds ON A MISSION TO BE AT MY charity: water, which is dedicated away. It’s taken the last year and a half to improving access to clean water to figure out how to get there, and PROPER BODY WEIGHT, AND for communities in need. now I’m adding the workouts and the weightlifting to make that happen. I’M 15 POUNDS AWAY.” —MATT McMILLEN PHOTO: COURTESY OF TYLER OF PERRY COURTESY PHOTO:

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