WEBMD MAGAZINE Contents OCTOBER 2019
FEATURES
30 MOORE, PLEASE Mandy Moore focuses on hiking and healing
35 “I’M TRYING THE SECRETS OF SLEEP If you have insomnia, TO ENJOY sleep hygiene may not be enough THINGS AND CHALLENGE MYSELF. I’M KIND OF STEPPING INTO MY POWER.” PEGGY SIROTA / TRUNK ARCHIVE TRUNK / SIROTA PEGGY
1 WEBMD.COM WEBMD MAGAZINE Contents OCTOBER 2019
CANCER UPDATE 6 FACTS & STATS Fewer Americans are dying from cancer
12 MEN’S HEALTH What you should know about common cancers
13 WOMEN’S HEALTH Screenings you might be missing
14 WORK WISE What to tell your boss about your diagnosis
39 FIGHTING CANCER FROM WITHIN The promise—and limitations—of immune therapy
50 BY THE NUMBERS Facts and stats on breast cancer
52 HEALTH SMARTS How to minimize chemotherapy side effects
59 FOCUS ON Tips for managing chronic lymphocytic leukemia GETTY IMAGES
2 WEBMD.COM WEBMD MAGAZINE Contents OCTOBER 2019 17 25 43 49 CHECKUP
49 THE LATEST What is the microbiome— 28 and how does it prevent disease? 51 INSIGHT The difference between palliative care and hospice care 53 DOCTOR Q&A 46 How to tell if you’re depressed— and what to do about it 54 SPOTLIGHT Living liver donations by the numbers 18 55 QUIZ Cold & flu 101 57 SPOTLIGHT Tips for managing rheumatoid FAMILY FOOD arthritis 60 HEALTH HIGHLIGHTS How to live with sleep apnea 23 RELATIONSHIPS 43 GOOD FOR YOU How to keep your stress Pear perfection from affecting your kids 44 3 WAYS 11 24 PREGNANCY New ways to enjoy 61 Your risk for depression a fall favorite LIVING BEAUTY during pregnancy 46 BUILD A BETTER 11 SLEEP SOLUTION 17 SKIN CARE 25 BABY Tips for your A simple change A couple of key steps can Exercising with your next casserole that could improve make all the difference in little one IN EVERY ISSUE your slumber your nighttime routine 47 FOOD 101 26 PARENTING Flour power 4 EDITOR’S NOTE 16 FITNESS 18 EXPERT PICKS The truth about sugar 7 UPFRONT Cardio workouts to get At-home teeth-whiteners and irritability News on dementia blockers, your blood pumping— coffee benefits, probiotics, without leaving home 19 DERM Q&A 27 KIDS’ HEALTH and more Expert tips for Why kids don’t get stronger nails enough exercise 61 TAKE 10 Marie Osmond on joining 20 BEAUTY SMARTS 28 PETS The Talk, her exercise ON THE COVER Your winter skin Acupuncture for philosophy, and why she PHOTOGRAPHY BY:
GETTY IMAGES survival guide pain relief Nino Munoz / CPi feels grateful
3 WEBMD.COM Editor’s Note
FROM THE WEBMD TEAM What foods do you most look forward to now that fall is here?
When days get colder, it’s time for hot tea. It smells wonderful (good morning, Earl Grey), and cupping a warm mug in your hands while you sip arm-to-table may be on trend, but makes it even cozier. DAVID WILLIAMS the truth is, seasonal cooking never Not to mention all WebMD Photo Editor Fgoes out of style. Using locally or those antioxidants! It’s regionally sourced ingredients means I’m a creature of habit, a simple pleasure that you’re dining on the season’s bounty MICHELLE BOURG really warms you up so I reluctantly let go of that not only tastes delicious but also WebMD helps you connect with your community. Health Editor from the inside out. my seasonal favorites. And, of course, sharing a meal is one of The flavors of summer the ultimate communal experiences. Nothing says fall like a berries fade by fall, So when you turn the pages of this issue and see casseroles, pears, and soothing bowl of soup but tart apples and butternut squash, one thing is clear: with a slice of sweet pomegranates are Fall is here. We’ve got your meal plans potato pie or a caramel tempting replacements covered with seasonal recipes that are apple for an occasional healthy and easy to make. We also asked on oatmeal. Sweet potato treat! I’m convinced they our staff which foods they most look turkey chili on a brisk forward to this season. Enjoy! taste best on a brisk weekend afternoon? Yes, autumn day just before NICOLE HOLLIMON please—followed with a a hayride at twilight or WebMD Health Writer and Editor Kristy Hammam while basking in the creamy wedge of paleo Editor in Chief [email protected] warmth of a bonfire. pumpkin pie!
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Good
FACTS & STATS News CANCER RESEARCHERS ARE ENCOURAGED: FEWER AMERICANS ARE DYING FROM CANCER, AND IMPROVEMENTS IN CANCER DETECTION AND TREATMENT HAVE HELPED DRIVE THIS DROP IN CANCER DEATHS
Percentage by Percentage of which the cancer newly diagnosed death rate for cancers in men and women 2.6 MILLION 18 MILLION the United fell from its peak Number of deaths avoided The expected number of States that are 27% in 1991 to 2016. thanks to this decline. cancer survivors in 2020. 42% preventable. GETTY IMAGES
6 WEBMD.COM Upfront
IN THE NEWS A Good Night’s Rest Can’t sleep? Join the rest of the nation, from kids to teens to adults of every age and stage. Lights out presents a serious challenge for millions of people. Why is this so, and what can you do about it if you’re wide-eyed in bed most nights (or your kids are)? As you’ll learn in “The Secrets of Sleep,” page 35, sleep hygiene isn’t enough. Measures like avoiding caffeine late in the day and banning
COLLEEN screens from the bedroom do help, but what you really need PARETTY to do is shut off your busy brain. A few ways to do that involve Editorial Director, cognitive behavioral therapy specifically for insomnia, meditative colleen@ webmd.com movement like tai chi, and mindfulness training. The idea, one of our experts says, is that “if you have to focus on your breathing, you can’t focus on tomorrow’s doctor’s appointment or what the future holds.” Give one of these approaches a try to get the sleep DEMENTIA you need and deserve. — BLOCKERS? Blood pressure meds, POST-HEART ATTACK DEPRESSION STAY ON including beta-blockers, calcium channel Still depressed after your heart attack? Get help. Feeling down in SCHEDULE blockers, angiotensin II the weeks after a heart attack is normal and may even motivate you A yo-yo sleep schedule can receptor blockers, and to make lifestyle changes. But new research shows people who are wreak havoc on your health. angiotensin-converting chronically depressed a year later are about 50% more likely to die Among 2,003 middle-aged enzyme inhibitors, may over the next five years than those who have no post-heart attack and older adults, those who lower the risk of depression. The ones who have depression for a few months don’t went to bed and rose at the dementia, according to have increased risk of death. Ongoing depression, the researchers a study of 24,810 adults same time every day were say, could prevent you from adopting the healthy lifestyle that can older than 60. help you live longer. far less likely to develop SOURCE: Journal of Alzheimer’s Disease SOURCE: European Journal of Preventive Cardiology high blood pressure, high cholesterol, and obesity over a six-year period. Variability in time to bed, time to wake, and hours slept raised the risk for all of these conditions.
SOURCE: Diabetes Care 65% Percentage of U.S. adults who say smoking marijuana is acceptable.
GETTY IMAGES SOURCE: Gallup
7 WEBMD.COM Upfront
SCAR OPTIONS FOR BREAST CANCER SURVIVORS Most women who have a lump or a breast removed because of breast cancer are unhappy with the look or location of their scar. Yet, one in three women didn’t know at the time of their surgery about options that could help, a new study finds. A third of women who had a lumpectomy or mastectomy say their doctors didn’t tell them about hidden-scar procedures and nipple-saving surger- ies. If you are planning breast cancer treatment, talk to your doctor about these options. Already had surgery? It may not be too late. Some cosmetic PREGNANCY PRESSURE options are available long after your treatment. About one in 10 women develops high blood pressure during SOURCE: BMC Cancer pregnancy that later goes away. But that might not mean you’re out of the woods. A study that followed nearly 6.5 million women for 18 years found that those who had high blood pressure during pregnancy, or the more serious condition pre-eclampsia, had increased risk for HEALTHY OUTLOOK heart attack and stroke throughout life. This is a warning for women Eighty-three percent of U.S. adults said in a survey to watch their blood pressure during pregnancy. Women who already that they were in good or excellent mental health. had high blood pressure during pregnancy should be aware of their That’s most people, but it’s close to the survey’s all- increased risk and maintain a heart-healthy lifestyle. time low of 81% in 2002. The high was 89% in 2012.
SOURCE: Heart SOURCE: Gallup THE SLEEP AND 72,947 The number NUTRITION CYCLE of calls to poison control Many people who don’t get enough sleep centers about also don’t eat well. The two problems—poor liquid laundry sleep and poor nutrition—may actually feed detergent each other. In a large study of adults’ diets pods in 2017. and lifestyles, researchers found that those This number who slept the least also consumed the least continues to magnesium, niacin, vitamin D, calcium, rise among and fiber. Lack of sleep could push people older children to snack on empty calories and miss out on and young these nutrients. But, the researchers say, it’s adults despite also possible that poor nutrition is what’s recent safety keeping people awake at night. campaigns.
GETTY IMAGES SOURCE: American Society for Nutrition SOURCE: Gallup
8 WEBMD.COM Upfront
FIBER PREVENTING AFIB FIGHTS RISK Atrial fibrillation, or afib, is the most common type of irregular heartbeat. The OF CELIAC condition, which happens sporadically and affects up to 6.1 million mostly older DISEASE adults, raises stroke risk up to five times For each 10-gram above average. Stress and anger are common increase in daily fiber afib triggers, but beta-blockers (a common intake during pregnancy, blood pressure medication) might help. moms-to-be lower their Researchers tracked 100 people with afib babies’ risk for celiac for a year. Half took beta-blockers; the other disease by 8%. Women half did not. During the year, both groups who get more than 45 grams a day could lower had just as many episodes of stress and risk by 34% compared anger, but the beta-blocker group was five to those who eat 19 times less likely to go into afib. grams or less. SOURCE: Heart Rhythm
SOURCE: European Society of Paediatric Gastroenterology, Hepatology and Nutrition FALL FACTS 16.9 Deaths from falls in people older than age 75 are on the rise in the U.S. $22 In 2000, falls caused 8,613 deaths among older adults. In 2016, more MILLION BILLION than 25,000 people died after falls. Researchers don’t completely Number of cancer Total amount seniors understand this sharp increase, though they say underreporting in survivors alive in the U.S. today. Survivors withdrew from long- the past could be partially to blame. Certain health conditions and term savings to pay could surpass 22 medications can increase risk for falls, too. Talk to your doctor about for health care in million by 2030. your risk and prevention. the last year. SOURCE: American Cancer Society
SOURCE: Gallup SOURCE: JAMA
VEGGIE 3 IN 4 POWER The number of One in 12 heart-related Americans who deaths worldwide could believe they be due to not eating pay too much enough vegetables. One in seven arise from too for health care little fruit. Adults need relative to the 2.5 cups of veggies and quality of care 2 cups of fruit each day. they receive.
SOURCE: American Society
GETTY IMAGES for Nutrition SOURCE: Gallup
9 WEBMD.COM Upfront
KIDS AND SUPPLEMENTS Do you leave a chewable multivitamin next to your child’s cereal bowl every morning? Many parents do, but kids may take other—riskier—supplements, too. New research finds that children and young adults take supplements for weight loss, muscle building, and extra energy. These products bring almost three times greater risk of severe medical problems— including hospitalization, disability, and death—than vitamin supplements. Kids and young adults take supplements for sexual performance and colon cleansing, too. COFFEE BENEFITS These double the risk of serious medical That morning cup of Joe might help you in more ways than you think. In a study that problems compared to vitamins.
tracked 4,000 people, those who drank a cup or more of unsweetened black coffee SOURCE: Scientific Reports every day were 37% less likely than those who didn’t to develop type 2 diabetes or prediabetes over 15 years of follow-up. Those who saw the greatest reduction in their diabetes risk were people born with a gene that predisposed them to diabetes.
SOURCE: American Society for Nutrition
PEDIATRIC PNEUMONIA POINTERS Antibiotics treat bacterial, not viral, infections. Yet, three in four preschoolers get unnecessary antibiotics for viral pneumonia, which can lead to antibiotic- resistance. Nearly half of them get chest X-rays—against national guidelines. Numerous X-rays throughout life can increase risk for cancer.
SOURCE: Journal of Pediatric Infectious Disease
PICKING THE HARASSMENT RIGHT PROBIOTIC HAPPENS Almost three- Probiotics are “good bacteria” that are similar to microbes that live quarters of women inside your body—especially in your gut. Probiotic supplements may and just over half of help improve the balance of healthy bacteria in your gut. But it might men say workplace be hard to choose the best one. Researchers analyzed 93 different sexual harassment bottles of probiotics and found that only 33 had proven health benefits. is a major problem. Lower-cost products, with fewer bacterial strains, that provide names of strains on the label, such as Lactobacillus Acidophilus, tend to be best. About half of women The researchers suggest consumers do their homework before buying a say they have been product to find one that has proven benefits. sexually harassed.
GETTY IMAGES SOURCE: Journal of General Internal Medicine SOURCE: Gallup
10 WEBMD.COM HEALTHY HABITS Living MEANINGFUL CHANGE
IF YOU’RE ONE OF THE NINE IN 10 AMERICANS WHO USE A CELL PHONE, LAPTOP, TABLET, OR OTHER SCREEN BEFORE BED, HERE’S The Night A GOOD REASON TO PUT IT DOWN—it’s likely ruining your sleep. Experts have long thought that the blue light emitted from most screens can suppress the secretion of melatonin, the sleep-regulating Shift hormone, but a new study finds that the unending entertainment SLEEP SOLUTION SLEEP offered by electronics is also pushing back bedtimes—and causing WANT TO SLEEP BETTER? HEALTH EXPERTS people who use them at night to be less alert during the first hour SUGGEST THIS SIMPLE CHANGE TO YOUR after waking. The solution? In the evenings, simply switch out your BEDTIME ROUTINE. beloved device for a book, magazine, or newspaper so you fall asleep
GETTY IMAGES earlier—and get the full night of rest you need. —COLLEEN OAKLEY
11 WEBMD.COM Living Search for the article Cancer Screening Tests That Men Should Get at WebMD.com.
Finding lung cancer early could save your life. (Just being around cigarette smoke or someone who smokes—even if you don’t—increases your risk.) The number-one cause among non-smokers is radon, a radioactive chemical that can accumulate indoors. Inexpensive tests can alert you to dangerous levels in your home.
COLORECTAL CANCER Improve your lifestyle. Being overweight or obese, lack of exercise, smoking, and a diet heavy on red meat, pro- cessed meats, and moderate to heavy alcohol use all raise your risk of cancers that begin in the colon and rectum. Equally important: Get screened beginning at age 50, the CDC recommends. Early detection makes effective treatment much more likely. Review your own and your family’s health history with your doctor to ID other potential red flags, like inflammatory bowel disease and polyps, benign growths that can become cancerous.
BLADDER CANCER Need another reason to quit tobacco? Smoking signifi- cantly boosts your odds of bladder cancer. Other risk factors include exposure to certain industrial chemicals. Some, but not all, studies suggest that eating lots of fruits and vegetables can help protect you. Common Another potential preventive measure: Drink lots of water. “The thinking is that you will urinate out a lot of the toxins that may be in your bladder,” says Kalidas. “Not just any fluids, but specifically water MEN’S HEALTH MEN’S Cancers might be helpful.” PAY ATTENTION TO YOUR PROSTATE CANCER RISK, BUT DON’T FORGET: THERE ARE OTHER CANCERS OUT THERE. LEARN WHAT THEY MELANOMA ARE AND WHAT YOU CAN DO TO PREVENT THEM. This type of skin cancer can be deadly, but it’s highly treatable in its early stages. And it often can be BY Matt McMillen prevented. Protect yourself by wearing sunscreen REVIEWED BY Michael W. Smith, MD, WebMD Chief Medical Editor that blocks the sun’s UV rays—and stay away from tanning salons and sun lamps. Also, scan your skin FOR MEN, THE TOP FOUR CANCERS AFTER PROSTATE CANCER ARE LUNG, (ask your partner or someone else you’re comfortable COLORECTAL, BLADDER, AND MELANOMA, according to Houston oncologist with to check your back). Mamta Kalidas, MD, a medical editor for the American Cancer Society and Do you have lots of moles? If so, have a dermatolo- a volunteer faculty member in hematology-oncology at Baylor College of gist evaluate them regularly. Between exams, keep Medicine. Here’s what men need to know. an eye on them. If any moles change color, size, or shape, that’s a warning sign. Other risk factors: fair LUNG CANCER skin, red or blond hair, and abundant freckles. Quit smoking. It causes at least four in five lung cancer deaths. Current and “We want men who have these risk factors to see former smokers: If you’re 55 to 74, ask your doctor about an annual screening. their doctor regularly,” says Kalidas.
BY THE NUMBERS
Ranking of lung cancer Percentage increase in deaths The number of times more 4,740 in deaths in men. An from colorectal cancer—the likely men are to develop Estimated number of men who will die from estimated 76,750 number-three cancer killer for bladder cancer than women melanoma this year, nearly twice the number men will die from lung men—in younger adults each this year. Nearly three times of women. Men’s melanoma rates outpace GETTY IMAGES #1 cancer in 2019. 1% year from 2007 to 2016. 3x as many men will die from it. women’s starting at age 50. 12 WEBMD.COM Living Search for the article 15 Cancer Symptoms Women Shouldn’t Ignore at WebMD.com.
Many women also miss out on recommended screenings for cervical cancer, according to new research presented Screen Time at this year’s ASCO meeting. One-third of women 30 to 65 were behind on cancer screening tests (which involves a BEYOND MAMMOGRAMS AND BREAST EXAMS, THESE ARE Pap test) for the human papillomavirus (HPV); HPV causes THE CANCER SCREENINGS YOU MIGHT BE MISSING most cases of cervical cancer. And only 54% of women in BY Gina Shaw their 20s had been screened on schedule.
WOMEN’S HEALTH WOMEN’S REVIEWED BY Neha Pathak, MD, WebMD Medical Editor One of the best ways to prevent cervical cancer is the HPV vaccine. HPV infection is so common that nearly all men and women will get one at some point in their lives, MOST WOMEN KNOW ABOUT MAMMOGRAMS AND PHYSICAL most without knowing they have it. To protect against EXAMS TO CHECK FOR EARLY SIGNS OF BREAST CANCER, but HPV, the CDC recommends that vaccination begin in early many may not be getting recommended screening exams to adolescence, before teens reach puberty or start having sex. help detect and prevent other types of cancer. As of 2017, only about half of all teenagers in the United Lung cancer is the leading cause of cancer deaths among States were up to date with an HPV vaccination. women, far outpacing breast cancer. If you have a history In 2018, the FDA also approved the vaccine for young of heavy smoking, either smoke now or have quit within the adults ages 20 to 45; even if you have already been exposed past 15 years, and are between 55 and 80 years old, the U.S. to a few strains of HPV, it can still offer protection against Preventive Services Task Force and the American Society of the strains you have not encountered. Clinical Oncology (ASCO) recommend that you get a yearly At your next visit with your primary care doctor, be sure computed tomography (CT) scan to assess your risk of lung to ask these questions: cancer—a strategy that can cut lung cancer death risk by 20%. • Based on my family history, personal health history, and According to research published by ASCO, however, just exposure to smoking, what is my risk for lung cancer? 1.9% of current or former heavy smokers have been getting • Do you recommend that I get lung cancer screening? those screenings. Early detection is particularly important for If so, how often? women. While the rate of new lung cancer cases in men has • What is my risk of cervical cancer? dropped 35% over the past four decades, among women it • How often should I be screened for cervical cancer? has risen 87%. And women who smoke have twice the risk of • Should I (or my child) receive the HPV vaccine? On
GETTY IMAGES developing lung cancer as men who smoke the same amount. what schedule?
13 WEBMD.COM Living Living
of the most important tools for individuals to either work through “Some health care treatments or to return to work after treatment.” TALK TO professionals will only Reasonable accommodations, as the ADA calls them, are exactly fill out the Department that: accommodations, so long as they are within reason, that will YOUR of Labor form, so they’re help you do your job when you’re sick. The things you might need CANCER only sharing information depend on many factors. A big factor is what kinds of side effects CARE TEAM that the employer is legally you have from treatment, such as fatigue, nausea, pain, or trouble entitled to,” says Bryant. thinking clearly. You won’t know what accommodations would be BEFORE YOU TALK TO The federal form simply helpful to you until you need them. And, that may change over time. YOUR EMPLOYER, ASK requires certification from “What somebody needs soon after treatment is likely going to be dif- YOUR CARE TEAM HOW a health care provider that TREATMENT MIGHT ferent three months out, five years out, and 10 years out,” says Bryant. you have a medical reason AFFECT YOUR ABILITY Some accommodations could include a change in working hours; TO WORK. YOU MIGHT to request leave. If you don’t the option to work from home; dictation software on your computer; WANT TO ASK THESE want to share your diagno- or a more comfortable workstation. You can ask for these things as QUESTIONS, SAYS EXPERT sis, tell your provider before issues arise and make changes as you go. MONICA BRYANT. you complete the forms. “It’s very flexible, and it’s beneficial for both employees and That way, the provider will employers,” says Bryant. “The employer doesn’t want to lose a valued • How much time omit your diagnosis from the paperwork and avoid employee [because they can’t work in the current conditions] and go off will I need for words such as chemother- through the process of hiring someone else, so they benefit, too.” surgery, recovery, apy and oncology. If you or your company don’t meet the criteria for you to get leave chemotherapy, or accommodations, all is not lost. State laws may protect you or the “One sticking point is radiation, or other employer may have a policy for workers who need sick leave. “Many where the form asks for your treatments? How much employers are much more generous than that bare minimum that the provider’s specialty,” says law requires,” says Bryant. time do other people Bryant. “If you don’t want usually take? to disclose, the provider can IF YOU’VE JUST LEARNED YOU HAVE CANCER, YOU MAY BE THINK- Don’t I have to tell the boss? write ‘internal medicine’ ING ABOUT HOW YOU’LL TELL THE PEOPLE IN YOUR LIFE. You But how, you might wonder, can you get the time off and the adjust- rather than ‘oncology.’ It’s probably want to tell those closest to you, but what about your employer? • What immediate side Cancer ments you need without telling your boss you have cancer? absolutely true without “At a time when you may feel that you have lost so much control effects could I have For most people, it’s the side effects of treatment, not the cancer inadvertently disclosing.” because you have cancer, you do have a choice about this,” says Monica from my treatment? WORK WISE WORK itself, that keep you from working. It’s chemotherapy-related pain or Bryant, a lawyer and chief operating officer at Cancer Triage. “If you grogginess that might make it hard to do your job the way you usually But why not tell? decide you’d like to keep your privacy, you can still access all the rights and the Some research shows do. You may choose to tell your employer about these symptoms and benefits you’re entitled to without disclosing that you have cancer.” • How might these rather than your diagnosis. For example, “I need medical treatment side effects affect my that people whose cancer that will require me to take time off.” history is known in their What are your rights? ability to do my job? You and a health care provider will fill out a few forms for your leave workplace may face Workplace If your employer has at least 50 employees, the organization must fol- and accommodations. It’s important to know that your employer might stereotyping and discrim- YOU MIGHT BE ENTITLED TO TIME OFF AND SPECIAL low a law called the Family Medical Leave Act. The law gives employ- give you a company-based form that asks for a diagnosis, but federal forms • Could I have new and ination. People who share ADJUSTMENTS AT WORK TO HELP YOU THROUGH YOUR ees who are seriously ill 12 work-weeks of leave during a 12-month don’t ask that. on a job application or in CANCER TREATMENT, BUT THAT DOESN’T MEAN YOU period. If you’ve been at your job at least 12 months in the last 7 different side effects an interview that they are HAVE TO TELL YOUR EMPLOYER WHY years, and you’ve worked the equivalent of about 24 hours a week per over time? cancer survivors may be year, you’re probably eligible. Leave can give you the time you need DISCLOSURE DILEMMA Consider your own less likely to get the job. BY Sonya Collins for treatment, including surgery, recovery, and chemotherapy. needs before you share • Will I be able to predict Before you choose REVIEWED BY Brunilda Nazario, MD, WebMD Senior Medical Editor But you might need more than time off to help you through treat- your diagnosis. certain side effects, whether to disclose, it ment. The Americans with Disabilities Act (ADA) makes sure that such as when I might might be important to organizations with at least 15 employees help make the necessary adjust- feel nausea, fatigue, consider these possibilities. ments for employees to do their job during and after serious illness. But, ultimately, you know “Not enough people know about reasonable accommodations or pain? your workplace and and utilize them to their full benefit,” says Bryant. “They’re one colleagues, and you should decide what is best for
BY THE NUMBERS Check out you. Whether you tell your the Cancer employer that you have Message Board cancer is 100% your choice. Percentage Percentage at WebMD.com. You might feel empowered of people of cancer 855 diagnosed with 20% survivors who Number of cancer-related dis- sharing your diagnosis cancer who are Percentage of cancer survivors who have say their work crimination claims filed with the with others, but that power of working age work-related limitations due to cancer up routine helped Equal Employment Opportunity comes from knowing that it 46% (20 to 64). to five years later. 69% their recovery. Commission in 2017. GETTY IMAGES GETTY IMAGES is your decision. 14 15 WEBMD.COM WEBMD.COM FITNESS with theseat-home cardioworkouts. workout like runningorbiking,make itsimple down with calf and quadriceps stretches. down withcalfandquadricepsstretches. both feet. running inplace,andtakingofflandingon jumps, split-legwide-to-narrow Mix itupwithacombination ofsingle-leg of jumps,followedby15to30secondsrest. littleand takes space. upvery elasticity, Plus,it’s andbrain function. fun,easy, rate,heart andimprovescoordination, muscle Jumping ropeburnscalories,elevates your to threetimes. twofor threetofourminutes.Repeat thiscircuit ofeach 30-secondbursts Doshort, ing exercises. and squats. abdominal crunches,tricepdips,wallsits,lunges, strength-training like exercises push-ups,planks, choosethree burpees, andjumpingrope.Then mountainclimbers, inplace,step-ups, jogging likethree tofourcardioexercises jumpingjacks, amountof time. builds strength inashort rate training pumpsupyourheart and Circuit Home Moving—at Get BY TO THE GYM FOR DAYS WHEN YOU DON’T FEEL LIKE GOING NO MACHINERY OR COMMUTE REQUIRED. COMMUTE OR MACHINERY NO WORKOUTS. AT-HOME CARDIO THESE OF ONE TRY GYM? THE FOR TIME ZERO JUMP ROPE CIRCUIT TRAIN Bump up the time as you get better.Bump upthetimeasyouget Cool warmup,do30-secondintervals ashort After Alternate cardioandstrength-train between - To choose first create anat-home circuit, Kara Mayer Robinson orgearing upforanoutdoor REVIEWED BY
Michael W. Smith,MD, CPT, WebMD ChiefMedicalEditor return to your starting positionandrepeat. toyourstarting return yourbodyasfaryoucan,then can. Lower use yourcalfmusclestoraise upashighyou raises. then Put ononestep, theballsofyourfeet workoutsstair-climbing asyoufeelstronger. minutes, thenworkyourway upto longer afew withjust and repeat untilit beeps.Start workout length, walkupanddownyourstairs, atimerforyourpreferred Set simple asitgets. at-home workout stair-climbing isaboutas “Include theminyourcardioworkout.” An inyourhome?” somestairs “Got asksRoberts. like achampion,” says. Roberts feel you’ll inbetween, rounds withone-minuterests “If youcanworkyourway uptothree 12-minute intervals. Gradually increasethetimeofyouractive inplace,orskippingrope. shadow boxing, jogging like recovery ofactive kicks andone-minuteintervals ofjabs, crosses,and one-minute intervals between along withat home.Or, create your own.Alternate range ofboxing andkickboxing workouts tofollow stress. andrelieving inner aggressor you caneasilydoat homewhilechannelingyour conditioningworkoutskickboxing arestellar Boxing and Eva Levi. andZachary Longoria fitness trainer whoworkswithcelebslike Internal Medicine Sports Association-certified insidethebox,”“Think says an Grant Roberts, CLIMB STAIRS BOX OR KICKBOX Strength-training bonus:Take breaksforcalf Fire upYouTube oron-demandTVforawide
3. 4. 1. 2. esteem, andconfidence. energy, mood, self- stress, chronic fatigue, is itfun,canhelpwith for your psyche. Notonly and helpyou loseweight. andbloodpressuredisease your riskofcoronary heart cardio workout. Itcanlower “I CAN’T THINK OF OF THINK CAN’T “I says Roberts. a dancingfool ofyourself,” favorite playlist andmake is watching, sohityour dancers whennobody or style. “We’re allamazing matter your age, skilllevel, and balance. and balance. strength, coordination, with bonedensity, muscle activity. Translation: It helps Dancing isaweight-bearing YOU WHY. YOU TELL WE’LL STYLE—BUT OWN GOT THEIR TO IT—EVERYONE’S DO HOW YOU TELL WON’T ROBERTS GRANT TRAINER SAYS FITNESS DANCING,” AS MUCH RATE AS HEART YOUR AND SPIRITS YOUR THAT LIFTS ANYTHING DANCING BOOSTER: MOOD AT-HOME WebMD.com. at Workout No-Gym The slideshow the for Search Dancing works no IT’S UNIVERSAL Dancing counts as a Dancing countsasa IT’S LEGIT CARDIO LEGIT IT’S BEARING IT’S WEIGHT- Dancing isgreat IT’S ABLAST IT’S Living . WE . WE
BEHIND THE SCIENCE Beauty INSIDE OUT
WHILE NO REGIMEN IS SUPERIOR TO ANOTHER, A COUPLE OF P.M. PRACTICES HAVE BEEN SCIENTIFICALLY PROVEN TO HELP After-Dark KEEP SKIN HEALTHY, according to Fayne Frey, MD, a dermatologist in West Nyack, New York. “If your skin is flaky, scaly, or dry, apply
SKIN CARE SKIN a moisturizer with hydrating ingredients,” says Frey. Science shows Improvements that consistent moisturizer application (especially one that contains ceramides) increases skin water content that optimizes skin health. DOES YOUR CURRENT NIGHTTIME ROUTINE The next step is to get a good night’s sleep. Researchers at University INVOLVE AN ELABORATE SEVEN-STEP PROCESS? Hospitals Case Medical Center found that poor sleepers had increased OR DO YOU CALL IT A VICTORY IF YOU CAN JUST signs of skin aging and slower recovery from environmental stressors, WASH YOUR FACE? such as sun exposure. —AYREN JACKSON-CANNADY GETTY IMAGES
17 WEBMD.COM Beauty Bright Smile Basics WHITEN YOUR TEETH AT HOME WITH THESE PRO PICKS THAT ACTUALLY WORK, AS RECOMMENDED BY ALFRED BOVE, DMD, A DENTIST IN FORT LAUDERDALE, FLORIDA EXPERT PICKS EXPERT BY Ayren Jackson-Cannady REVIEWED BY Eric Yabu, DDS, WebMD Medical Reviewer
1. BRUSH WITH GREATNESS Oral-B 3D White Luxe Toothbrush with Stain Eraser, $7 “Look for an American Dental Association-approved soft or even very soft toothbrush. Believe it or not, this cleans better than the harder-bristled toothbrushes.” 2. MAIN SQUEEZE Sensodyne True White Toothpaste, $7 “This super-gentle toothpaste has the benefits of whitening for surface stains, and its ingredients diminish tooth sensitivity.” 3. SHOW AND GEL Colgate Optic White Gel Professional Whitening Take-Home Kit, $40 “For more intense stains, this gel kit provides a step up from strips in whitening power, yet it’s still gentle enough for most people.” 4. STICK IT Crest 3D Whitestrips, $45 “Beyond convenient, these strips are great to use at home, especially after a professional dental cleaning when teeth are at their cleanest.” 5. DO THE FLOSS Listerine Healthy White Whitening Dental Floss, $3 “For in-between-teeth stains, good old-fashioned effective flossing keeps the discoloration to as much of a minimum as any good toothbrush.”
THE OPINIONS EXPRESSED IN THIS SECTION ARE
PHOTOGRAPHY: RICK LOZIER RICK PHOTOGRAPHY: OF THE EXPERTS AND ARE NOT THE OPINIONS OF WEBMD. WEBMD DOES NOT ENDORSE ANY SPECIFIC PRODUCT, SERVICE, OR TREATMENT. 18 WEBMD.COM Beauty
Nailed It! WANT STRONGER, HEALTHIER NAILS? CHECK OUT THESE EXPERT TIPS. DERM Q&A DERM
BY Kara Mayer Robinson REVIEWED BY Mohiba K. Tareen, MD, WebMD Medical Reviewer Search for the article What Your Nails Say About Your Health at WebMD.com. WHETHER YOU PREFER YOUR NAILS PERFECTLY chemicals used in nail salons, like formaldehyde POLISHED OR BARELY THERE, KEEPING THEM and toluene. Prolonged exposure isn’t safe. HEALTHY PAYS OFF. They’ll look sharper and hold Regulations vary from state to state. Personally, 4 TIPS up better. I recommend an eye test and smell test. Check We asked Lynn McKinley-Grant, MD, assistant for cleanliness. Ask for new instruments that are KEEP YOUR NAIL HEALTH professor of dermatology at Howard University only used by you. Make sure they use a new plastic IN CHECK WITH THESE HANDY TIPS. Hospital in Washington, DC, for tips. liner when soaking your feet. You can also request to see your nail technician’s license.” CLIP WITH CARE Q Can certain foods make my nails healthier? 1. Cut your nails straight McKINLEY-GRANT “Foods high in protein and Q What can I do about an ingrown nail? across with sharp clippers or nail scissors. Round omega-3 fatty acids, like salmon, eggs, and bio- McKINLEY-GRANT “An ingrown nail starts with them slightly at the tips for tin, contribute to stronger nails. Dark, green, trauma to your cuticle, hands, or feet—from an better strength. leafy vegetables like collard greens and spinach aggressive mani-pedi to shoes that are too tight, also help them grow.” or when your nail is cut too short or at an angle. KEEP THEM SMOOTH Try soaking it daily in lukewarm water and gently 2. Use an emery board to Q Are nail polish and remover safe to use lifting it out of the skin if possible. After a few shape nails and prevent regularly—or do my nails need a rest? weeks of new growth, it’ll be above the skin and snags. Don’t bite your McKINLEY-GRANT “Your nails definitely need a grow in a normal path.” nails or use them as rest from prolonged chemical use. I recommend impromptu can openers.
removing nail polish with acetone-free remover Q What can I do about cracked, brittle, or KEEP THEM CLEAN to decrease yellowing. If you see damage, stop weak nails? 3.AND DRY using the polish until your nails start to regrow McKINLEY-GRANT “Eat more green, leafy foods. Keep your nails clean to normally. Be aware that each time you remove Try using creams and moisturizers on your hands. avoid bacterial or fungal nail polish, it dries out and destroys keratin in Schedule an appointment to see a board-certified infections. Keep your toenails off the ground your nails.” dermatologist for a routine checkup.” and away from fungus by wearing flip-flops at public Q Are salon-applied gels OK for my nails? Q When should I see a doctor for a nail pools or showers. McKINLEY-GRANT “Newer nail gels are designed problem? TREAT THEM WELL to last longer. However, we’re seeing more people McKINLEY-GRANT “Your nails reflect the health 4. Use moisturizer on come down with allergic reactions, especially of every organ in your body. Health problems like your hands and cuticles around the cuticles. In some cases, they’re dam- diabetes, hair loss, psoriasis, eczema, melanoma, every day. If your nails are aging their nails permanently. If gels are applied and allergies have signs that appear in the nails. thick and tough to cut, soak correctly, there’s less chance of permanent damage.” With any changes in your nail health—like them in warm saltwater for 10 minutes first. growth, color, pain, weakening, easy breakage, or Q How safe are nail salons? redness around a nail—consult a dermatologist
GETTY IMAGES McKINLEY-GRANT “There are a lot of toxic trained in skin, hair, and nails.”
19 WEBMD.COM Beauty Search for the article Taking Care of Your Skin at WebMD.com.
their favorite products; follow their summer. Two of my winter favorites are like La Roche-Posay Lipikar Balm ($15), expert tips to keep complexions calm the Fraxel Dual to peel off summer sun which offers perfect deep hydration for and smooth during the coldest months. damage and the Vbeam Prima to remove wintertime. I basically use it everywhere.” uneven skin tone and rosacea.” RACHEL PRITZKER, MD, Reduce retinoids DERMATOLOGIST, CHICAGO LAUREL GERAGHTY, MD, “I tend to reduce the frequency of my Start early DERMATOLOGIST, MEDFORD, OREGON prescription retinoid during the winter “The winters hit hard in Chicago, so it is Gentle wash because my skin doesn’t tolerate it as important for me to increase hydration in “I only use gentle cleansers, but I know well. Sometimes I swap it out for a my skin as early in the season as possible it’s especially important to do so during gentler alternative until the spring thaw.” so I’m not playing catch-up. I like to the winter. I buy the Dove Sensitive change to a heavy hydrating moisturizer Skin Beauty Bar in bulk ($4.50 for two) as early as October to prepare for winter. because I know it won’t dry or irritate PAPRI SARKAR, MD, I look for more emollient moisturizers my sensitive skin. If a cleanser has DERMATOLOGIST, BROOKLINE, and treatment-oriented options like terms like ‘purifying,’ ‘deep cleansing,’ or MASSACHUSETTS, AND PRESIDENT OF THE Avène XeraCalm Balm ($48).” ‘toning’ on the label, I run away from it! NEW ENGLAND DERMATOLOGICAL SOCIETY Those often imply harsh ingredients that Make the most of moisturizer Don’t skip SPF will strip away skin’s natural moisture. I “I have eczema that tends to flare in “Sun protection is important all year long. might be able to tolerate those formulas the winter. But if I’m really good about People tend to forget SPF for their lips in in warmer months, but the skin’s barrier moisturizer, I can avoid a flare-up. the winter. I like Colorescience Lip Shine is innately more vulnerable when it’s One of my tricks is to make sure my SPF 35 ($29) because it adds a bit of glossy cold and dry.” skin is damp so I have an extra layer of color. I use ISDIN Eryfotona Actinica hydration for my lotion to seal in. I’ll ($55) sunscreen on my entire face and Wear your layers apply moisturizer right after the shower hands—it has an ultralight formulation “I’m a skin care minimalist, but lately or I pat some water on my hands, wipe and is easy to spread.” I have been using Beauty Pie’s Super it on my skin, and immediately put Active Capsules with Hyaluronic Acid moisturizer on top. It makes a huge Treat yourself and Bioactive Microspheres ($12 plus difference. I’ve been using the Alba “I always tell my patients that winter $10 membership). I love how silky my Botanica Very Emollient Body Lotion is a good time to seek in-office laser skin feels after slipping on the serum. At ($8) because I’m more likely to use a treatments that you might put off in the bedtime, I layer it under a moisturizer moisturizer if it’s easy to pump out.”
Continued on page 22
THE SCOOP
THE SCIENCE OF SERUMS FROM AGE SPOTS TO ZITS, THERE SEEMS TO BE A SERUM FOR EVERY SKIN CONDITION Winter Skin UNDER THE SUN. BUT ARE THEY WORTH THE EXTRA STEP IN YOUR REGIMEN? MANY SKIN CARE EXPERTS SAY YES—HERE’S WHY.
Survival Guide THEY WORK THEY ARE THEY ARE THEY GO A
BEAUTY SMARTS BEAUTY BELOW YOUR HIGHLY DIFFERENT FROM LONG WAY DERMATOLOGISTS REVEAL THEIR TOP PRODUCTS AND INSIDER TRICKS SKIN’S SURFACE CONCENTRATED FACE OIL You only need a FOR AVOIDING IRRITATION AND DRYNESS IN COLD WEATHER Sure, you probably Serums have a higher “Oils are used to pea-size amount to already exfoliate, concentration of hydrate skin and get results over time. cleanse, tone, and active ingredients (up mimic our skin’s And the best part? BY Liesa Goins REVIEWED BY Mohiba K. Tareen, MD, WebMD Medical Reviewer moisturize, but what to 70% versus 5% to natural sebum; You can use more than makes serums so special 10% in other products while serums treat one serum at a time, is that they target like cleansers and pigmentation, aging, depending on the specific concerns by moisturizers) that acne, and other skin issues you are trying THE IRONY OF WINTER IS THAT outside, blasting heaters inside, and low winter skin irritation either.” penetrating deeper into help with anti- concerns,” says to resolve (think: acne IT’S THE SEASON WE’RE THE MOST humidity can really dry out the skin,” says Dermatologists, however, have a wealth skin than other products, aging, pigmentation Sperling. Plus, serums on the chin or fine lines including cleansers changes, and acne. are lighter in weight BUNDLED UP AND SHOWING THE Laurel Geraghty, MD, a dermatologist in of knowledge and access to products to help on your forehead). and moisturizers, says and can be applied LEAST SKIN, but it’s also the time Medford, Oregon. “Dermatologists see a their skin survive the harsh winter weather. Shari Sperling, MD, a under moisturizer. our skin can feel the most irritated. significant uptick in rashes every winter for Consider this your peek inside some top dermatologist in Florham
“The colder temperatures these reasons—and we’re not immune to dermatologists’ medicine cabinets to see GETTY IMAGES GETTY IMAGES Park, New Jersey.
20 21 WEBMD.COM WEBMD.COM Beauty
Continued from page 21 AISLE DO Do some lip service Treat your feet “In winter I like to keep some brown “My feet get really dry, so I’ll occasionally MUD MAGIC sugar in a small container in my do a foot peel mask like the Patchology SHEET MASKS MAY BE A NEW bathroom to use as a yummy lip scrub PoshPeel Pedi Cure ($20). It causes your FAVORITE, BUT THE CLASSIC when my lip balm isn’t doing the trick. feet to shed tons of dead skin. It’s best CLAY MASK—WHICH EXFOLIATES, Also, I like the Laneige Lip Sleeping to do this in the winter or early spring BRIGHTENS, AND REDUCES BREAKOUTS—IS HERE TO STAY. HERE Mask ($20), but I wear it all day. It’s because the peeling happens for a week— ARE THE EXPERTS’ FAVORITES. sheer and really effective at beating a so you won’t want to expose your feet. But
dry lip.” it leaves your feet so soft and smooth.” PRODUCT PICK AHAVA TIME TO CLEAR PURIFYING MUD MASK ($35) “The unique blend of minerals pulls out impurities and DIRTY SECRET contains lactic acid, which “I don’t go to a dermatologist” gently exfoliates as well. You can use this weekly or as a spot treatment, and it will gently and effectively reduce breakouts without leaving your skin dry.” Elena Duque esthetician and owner of BodyBrite, Bayside, New York
PRODUCT PICK MICHAEL TODD KAOLIN CLAY DETOXIFYING FACIAL MASK ($34) “This clarifying treatment mask for oily and blemish-prone skin helps to remove pore-clogging impurities, promote balance for a healthier-looking complexion, and soothe irritated skin with organic aloe vera leaf juice.” Gretchen Frieling, MD dermatologist, Boston
PRODUCT PICK BLISSOMA CLAY EXTRA EXPERTISE MATTERS RENEWAL TREATMENT “When it comes to the successful treatment of skin conditions, especially when there’s the ($40) “This organic mask has a possibility of cancer, it’s important to get the right diagnosis and treatment started quickly— Rhassoul clay base to draw that’s why it’s worth it to put in the time and the effort to find a dermatologist. Board-certified out impurities and improve dermatologists spend an extra three years of training after medical school specializing in skin’s health with vital minerals the diagnosis and treatment of skin conditions. That experience, along with years of seeing and nutrients. It is exfoliating similar cases, means they have invaluable insight.” with natural salicylic acid from willow bark and celery juice DON’T SKIP THE SKIN CHECK enzymes to clear out pores. “At a minimum, you’ll need to see a dermatologist for an annual skin exam to detect skin And rose, echinacea, and olive cancer. This is crucial because early detection of skin cancer can make all the difference— leaf improve tone and firmness. whether that means a smaller surgical scar or a lifesaving early diagnosis of melanoma.” It’s like a mini-spa experience you can enjoy at home.” SEEK A SPECIALIST Roxanne Daniel esthetician and owner of RZD “If you need treatment for a localized skin infection, a rash like poison ivy, or mild acne Beauty, New York City or eczema, your general practitioner is a good place to start. But for chronic or more
complicated conditions, it’s best to seek a dermatologist. Having a specialist can prevent you THE OPINIONS EXPRESSED IN THIS SECTION ARE OF THE from enduring uncomfortable symptoms and limit the risk of skin scarring.” EXPERTS AND ARE NOT THE OPINIONS OF WEBMD. WEBMD DOES NOT ENDORSE ANY SPECIFIC PRODUCT, SERVICE,
GETTY IMAGES —Rajani Katta, MD, dermatologist and clinical assistant professor of medicine, Baylor College of Medicine, Houston OR TREATMENT.
22 WEBMD.COM HEALTHY TOGETHER Family SMARTER LIVING
RESEARCH SHOWS PARENTS’ WORK WORRIES CAN HARM THEIR CHILDREN’S HEALTH. Having a high-stress job—especially if Don’t Bring you have little say in decision-making—weakens your ability to control your emotions and behaviors elsewhere. This lack of self-control in parents is linked to worse health outcomes for kids. Practice mindfulness after quitting time to create a
RELATIONSHIPS It Home built-in work-life buffer. Sit quietly and bring your thoughts CLOCK OUT FROM JOB STRESS BEFORE PUTTING into the present. You’ll lower stress levels, stop your brain from ON YOUR PARENTING HAT stewing, and tame your emotions so you’re back in the self- control saddle before plunging into parenting. —RACHEL REIFF ELLIS GETTY IMAGES
23 WEBMD.COM Family Your Depression Risk POSTPARTUM DEPRESSION ISN’T THE ONLY ISSUE— YOUR MENTAL HEALTH MAY TAKE A HIT WHILE YOU’RE WAITING FOR BABY PREGNANCY
BY Rachel Reiff Ellis REVIEWED BY Nivin C.S. Todd, MD, WebMD Medical Reviewer
4 QUESTIONS
VEERLE BERGINK, MD, PhD, OFFERS THESE QUESTIONS AS A WAY TO DETERMINE WHETHER YOU OR SOMEONE YOU KNOW MAY BE DEPRESSED DURING PREGNANCY.
Q Do you enjoy the things you normally enjoy? If you’re not finding happiness in your usual pleasures, that’s a clue something’s off.
Q How’s your mood POSTPARTUM DEPRESSION AWARENESS IS ON you’ll develop depression during pregnancy, so most days? THE RISE, AND WITH GOOD REASON—one in knowing your risk going in can help you be on high It’s called depression for nine women deal with it after giving birth. But alert. The biggie? Previous rounds of depression a reason—feeling low or depression during pregnancy is still often over- or anxiety. “The number-one risk factor for both “flat” is typical looked, even though it happens just as frequently depression during and after pregnancy is women of depression. as the postpartum variety. who have had a mood episode before,” says Bergink. One of the biggest reasons for this is that Thyroid disorders can up your chances, as can Q What kinds of many of the physical symptoms of pregnancy illness, preeclampsia, or finding out about abnor- symptoms have you and depression are the same, such as a change malities on an ultrasound. Non-physical risk been dealing with lately? in appetite, problems concentrating, fatigue, factors include financial problems, a history of Insomnia, fatigue, loss insomnia, even aches and pains, says Veerle trauma or sexual abuse, an unstable relationship, of appetite, trouble Bergink, MD, PhD, professor in the departments or an unwanted pregnancy. concentrating, aches, and of psychiatry and obstetrics, gynecology, and Though realizing you’re dealing with depres- even crying spells can reproductive science at the Icahn School of sion can be a hurdle, Bergink says once you crop up in both pregnancy Medicine at Mount Sinai. do, it’s very treatable. “Because all medication and depression. “The complicated thing about depression during passes through the placenta, we prefer to look pregnancy is that your body is changing so much for non-medication options first, such as exercise Q Do you feel depressed? and behavioral changes through psychotherapy,” already,” she says. “You’re already feeling atypical.” Often the simplest question she says. But for more serious bouts, medications Another complicating factor is that though is the most accurate. some practitioners may make a point to ask like antidepressants can be safe options. questions about your mood, depression screen- Also key to both recognizing and working ing isn’t a routine part of prenatal care. “There through depression: being open and honest has been much more attention on postpartum about how you’re feeling. “So many women feel depression,” says Bergink. “It’s much more com- guilty, especially during pregnancy, because they mon to screen for that than prenatal depression, think they should be feeling happy,” says Bergink. even though it would actually it be more logical But, she says, depression isn’t something you Search for the article Pregnancy to start screening when women first come into choose to have, and you can’t blame yourself for and Depression the office during pregnancy.” having it. The more women share their struggles, at WebMD.com.
GETTY IMAGES Your health history can increase the likelihood the less hidden prenatal depression will be.
24 WEBMD.COM GETTY IMAGES BABY Or, liebaby on your and belly dobridges to work your deadlifts or hip hinges,squats, or lunges,” Kellysays. weight. “You can his against head cradle you and do you dolight squats or biceps curls with exercise bands. Kelly. Or, put baby inaswing or car seat nearby while for astroller Your walk. baby is just going to sleep,” says has cleared them. exercises first inthe three months, or untiltheir doctor momsnew to avoid or running other high-impact Colorado, and owner of MomTrainer.com. She advises prenatal and postpartum fitnessDenver, in specialist long to wait. Either way, it take slow. Forbirth. delivery, aC-section ask your doctor how may able be to exercising start afew days aftergiving physical aboost. skills increase yourwill bonding and time give your baby’s post-pregnancy fitness routine? Working out together months by your side, why not make of himpart your Workouts With Baby Workouts With REVIEWED BY BY AGAIN. ERY, AND YOU MAY BE ITCHING TO GET ACTIVE YOU’VE MADE IT THROUGH AND DELIV LABOR READY TO START EXERCISING AGAIN? INCLUDE BABY WHEN YOU DO. YOU WHEN BABY INCLUDE AGAIN? TO START EXERCISING READY Once you get go-ahead, the your use baby as extra “Once you to start feel OK, is fine. walking You can go “Don’t asuperhero,” be says Sarah Ann Kelly, a If you had an uncomplicated delivery, vaginal you Stephanie Watson Since your baby spend alot of will early these
Hansa Bhargava, MD, WebMD SeniorMedicalEditor
- yourself abreak and skip workout. the rate. Ondays you when feel totally exhausted, give squats as you can in30seconds to bring up your heart exercises. than Rather doing 20squats, doas many making most the of your workouts with timed limited for first the months.few Kelly recommends keep your eyeon him. you dokeep baby by your side, create asafe spaceand Irecommendwhen starting naptime workouts.” If exercise is chasing after your child,” “That’sKellysays. together gets alittle more complicated. “Half of the stroller or on ablanket next to you you while work out. country. Infants are who young too to participate sit ina camp, stroller fitness, yoga, barreand acrossclasses the baby-and-me fitness program. You’ll find boot baby squats and lunges Imake facesat while him,” Kelly says. front of amirror with my daughter facing out. We’ll do lunges lifting him while up and down. standwill in “I (at around 4months), dooverhead presses or side practice using his neck muscles. giveglutes. also your Thiswill baby tummytime to Babies alot need of attention, your be so will time Once your baby becomes acrawler, exercising If you’re craving adult company, enroll inastructured When your baby is old enough to hold up his head 3. 1. 2. strain onit. without putting too much tones your abdominalwall your navel. Thisexercise while gentlypullingin out through your mouth in through your noseand first few weeks, breathe your For abmuscles. the long-term damageon you deliver couldinflict or twiststoo soonafter type ofdelivery. work out,basedonyour soon you to canstart exercise together. infant’s whenyou head hand toyour support first few weeks. Use your good neckcontrol intheir EXERCISE TOGETHER. TOGETHER. EXERCISE YOU WHEN SAFE BABY YOUR AND YOU BOTH KELLY ANN SPECIALIST FITNESS POSTPARTUM AND PREGNANCY FROM ADVICE THIS FOLLOW 3 TIPS Ask your doctor how GET CLEARANCE GET Doing crunches AVOID ABS AVOID Babies don’t have BE SUPPORTIVE Family TO KEEP TO KEEP SARAH SARAH WEBMD.COM 25 Check out the Parenting Family Message Board at WebMD.com. Sugar Crash Course RESEARCHERS NOTE A LOSS OF SENSITIVITY TO THE HORMONE THAT REGULATES APPETITE AND FAT STORAGE IN OBESE PARENTING CHILDREN. DOES THIS EXPLAIN SUGAR BINGES AND THE SO-CALLED “CRASH” THAT COMES SOON AFTER?
BY Lauren Paige Kennedy REVIEWED BY Roy Benaroch, MD, WebMD Medical Reviewer
SWEET TRUTH
ROBERT H. LUSTIG, MD, REFUSES TO SUGARCOAT THE FACTS.
Sugar harms health Most doctors, researchers, and nutritionists agree that too much sugar in the diet can lead to health conditions in both children and adults, such as unwanted weight gain, diabetes, and heart disease, plus liver, metabolic, and dental issues.
Read the label MAYBE YOUR OLDEST CHILD CAN TAKE OR LEAVE “Leptin goes to the base of the brain and A surprising amount of added CANDY. Your middle child is averse to anything signals a response, telling the body it’s eaten sucrose and high-fructose sweet. Yet your youngest binges on sugary foods enough—to go and burn off that caloric excess,” corn syrup is in condiments, and struggles with his weight. You feed all three he says. “This is why you might see fidgeting. beverages, granola bars, kids a balanced diet and parent the same way. You don’t see a sugar ‘crash.’” True hypoglyce- yogurt, and sports drinks. What gives? mia, he says, is when blood glucose levels dip According to Robert H. Lustig, MD, MSL, beneath 60 milligrams per deciliter (mg/dL), How much is enough? professor emeritus of pediatrics, division of which your typical sugar binge comes nowhere endocrinology, and an obesity specialist at the close to causing. According to Lustig, kids University of California, San Francisco, both Sugar consumption, much like certain drugs should not consume more genetics and what’s known as leptin resistance and behaviors, triggers the release of dopamine than 12 grams, or three may factor into how some kids react to the in the brain’s reward center. “Obese kids eat sugar teaspoons, of added sugar simple sugars glucose and fructose, as well to try to stimulate a dopamine response,” Lustig per day. That includes no as to sucrose (the chemical name of cane or explains. “They can’t get it because they’ve devel- more than 24 ounces of beet sugar) and high-fructose corn syrup oped leptin-resistance, so they eat more. It’s not sugar-sweetened drinks (HFCS, glucose and fructose derived from that they’re ‘crashing.’ They can’t get the reward per week. corn starch), all found in processed foods. response. It’s more like withdrawal, which can Sugar research can He adds that what parents swear are sugar trigger irritability.” “crashes”—irritability a few hours after over- Lustig, who is the lecturer behind the seminar cause confusion indulging in sugar-laden treats—are not the “Sugar: The Bitter Truth,” which viewers have Lustig asserts that while result of fluctuating blood glucose levels, as is seen more than 8.3 million times on YouTube, research shows no conclusive commonly, and mistakenly, believed. says leptin-resistance is a chronic condition—and or direct causative connection Research shows no direct causation between doesn’t develop overnight. Parents should keep a between sugar consumption dietary sugar and behavior, says Lustig. “At most, close eye on their kids’ sugar intake. When kids cut and health detriments, dozens we see fidgeting,” he says, as an aversive response down on sugar, leptin-resistance slowly improves. of independent studies— to sugar consumption. Lustig says that the body’s Not every child reacts to sugar in the same way, those not sponsored by the response to sucrose and HFCS is to make insulin, and some may be more susceptible to its sweet food industry—nearly all which delivers sugar into fat cells for storage. Fat pull than others. “There may be genetic reasons show correlation, citing a cells then make leptin, a hormone produced by fat for this,” he says. Researchers are still trying to 2016 meta-analysis of 60
GETTY IMAGES cells to regulate appetite and fat storage. determine how genes may play a role. sugar studies.
26 WEBMD.COM GETTY IMAGES KIDS’ HEALTH Move It, Kid It, Move BY EXPLAINS WHY—AND WHAT PARENTS CAN DO. CAN WHAT PARENTS WHY—AND EXPLAINS EXPERT OUR EXERCISE. ENOUGH GET DON’T CHILDREN SUGGESTS RESEARCH RECENT in weight and body mass index (BMI), which (BMI),which in weightandbodymassindex tize childrenandkeep theminonespot. are moreavailable andcheaper—screenshypno- playor even withthem.And,ofcourse,electronics are nothometotake theirchildrentoparks/sports enough parks.Parents areworkingmoreandthey in urbanareasdon’t have backyards. aren’t There keep theirchildreninsidemore.People wholive areperceivedaslesssafe,soparents streets The aswell. but thereareothercontributingfactors don’t getenoughexercise? screen time? Isitsimplyamatteroftoomuch activity? witnessed thistrendinhismedicalpractice. Santa Monica, California,says he’s “absolutely” at Providence SaintJohn’s Health Centerin young as7. S.DanielGanjian,MD, pediatrician —and researchersseethedeclineinchildrenas recommended amountofdailyphysical activity yes. Up tofour-fifths ofkidsaren’t getting the GANJIAN GANJIAN AND DINGS OF VIDEO GAMES? ING IN THE PARK BEEN REPLACED BY THE BEEPS HAVE THE HAPPY SOUNDS OF CHILDREN PLAY Q Q
What’s causingthisdeclineinphysical What are whenchildren theconsequences Colleen Oakley
In term,itcancausean increase theshort increaseinscreensdoesn’t help, The REVIEWED BY A new study says study A new
Hansa Bhargava, MD, WebMD SeniorMedicalEditor -
less likely to be active as adults. asadults. less likely tobeactive formsofcancer. certain even Inactive kidsarealso strokes, and highcholesterol, pressure, diabetes, disease,highblood chronic diseases,suchasheart in thelongtermcanleadtoanincreasedriskof learn tofollowrulesandhave better self-control. their socialskillsandplaying helpschildren sports better. Plus,playing withotherchildrenincreases more energy, whichallowsthemtolearnandfocus have they’ll recommended amountofexercise, per day sixdays the aweek.Whenkidsdoget and upneedat onehourofphysical least activity hours ofphysical perday. activity ages 6 Children keep themselvesbusywithscreens. stay just homeand enough tojoinateam,sothey arenotgood butthey children willingtoexercise good butwanttostay at healthy. sports see Ioften not to kids,especiallyolderchildrenwhoarejust more schoolsports/activities shouldbeoffered for thecommunity schoolhours.And touseafter be getting? ority for kids? happen tohelpmake physical activityapri- GANJIAN GANJIAN Q Q
How muchphysical activityshouldkids What’s onechangethatyou’d like tosee
Until age 6,kidsshouldhave at two least School playgrounds should be left open open School playgrounds shouldbeleft 3. 4. 1. 2. or interactive bowling. like dancecompetitions for exercise-based games, do allow screen time, look to dootherthings.” Ifyou willforce“This your child weekend,” says Ganjian. only onehourduringthe during theweek and ortelevisiongames “I recommend novideo use them. likely your children will are available, themore (you that gettheidea) bats, nets,baskets, goals skateboards, Pogo sticks, footballs, roller blades, The more soccerballs, what they see.” says Ganjian.“Kidsmirror about itwiththeirchildren,” excited aboutit,andtalk exercise themselves, be with them. kick thecan—andplay hopscotch, hula-hoop, EQUIPMENT S. DANIEL GANJIAN, MD. FROM PEDIATRICIAN TIPS THESE WITH HEALTH BETTER TO ROAD THE ON AND COUCH THE OFF KIDS YOUR GET 4 TIPS “Parents should LEAD BYLEAD EXAMPLE Newsletter Health Children’s and for up Sign ON SPORTS UP STOCK Teach your kidstag, GO OLD SCHOOL SCREEN LIMITS SCREEN ENFORCE Family the Parenting the
at WebMD.com. at WEBMD.COM
27 Family
Search for the article Treat Your Dog’s
PETS Pain and Lameness Pain Points at WebMD.com. ACUPUNCTURE CAN HELP GIVE ACHING PETS COMFORT
BY Jodi Helmer REVIEWED BY Will Draper, DVM, WebMD Medical Reviewer
4 QUESTIONS
LEARN MORE ABOUT ACUPUNCTURE FROM YOUR VET, SAYS AMELIA MUNSTERMAN, DVM.
Q Is my pet a good candidate? Acupuncture might not be the best option for older pets or those with serious illnesses or injuries, Munsterman says. It is most effective for pets with orthopedic conditions such as arthritis and back pain.
Q What about side effects? While your pet could get an infection at a needle site, “it’s very, very rare IF YOUR PET HAS ARTHRITIS, ALLERGIES, “We’ll actually feel along the meridians to to see a reaction to DIGESTIVE ISSUES, HIP DYSPLASIA, OR CERTAIN see if the animal is sensitive to touch,” says acupuncture,” she says. NEUROLOGICAL DISORDERS, YOUR VET MAY REC- Munsterman. “If they’re not even letting you Q How long will it take OMMEND ACUPUNCTURE. touch them, it’s going to be really difficult to get to get results? The ancient Chinese practice is often recom- needles into them.” The number of sessions mended as a complement to conventional vet- Massaging trigger points—called acupressure your pet may need to erinary treatments such as medication and sur- —can be a good alternative for pets that dislike find relief depends on gery, according to Amelia Munsterman, DVM, needles. In addition, laser therapy, a noninvasive the diagnosis. In general, veterinary acupuncturist and assistant clinical treatment that uses light to improve blood circu- improvements come after professor at the University of Wisconsin. lation and regenerate cells, is an option for pets three to four sessions. Research shows that acupuncture can help with significant pain. reduce pain and inflammation and improve a Veterinary acupuncturists are licensed veteri- Q What additional pet’s quality of life. narians with additional training in acupuncture. During a session, a veterinary acupuncturist Your vet might do the sessions in the office or pro- therapies might help? will insert thin needles into areas such as mus- vide a referral to another provider. The Interna- Veterinary acupuncturists cles, tendons, fascia, and nerve fibers to alleviate tional Veterinary Acupuncture Society maintains might recommend electro- symptoms by altering the perception of pain or a list of certified veterinary acupuncturists. acupuncture, which sends stimulating neurotransmitters in the brain. Although the idea for acupuncture for pets is mild electric currents The alternative therapy, while effective, is not catching on, many pet owners are still unfamiliar through the needles right for every pet. Munsterman doesn’t recom- with the idea. “Keep an open mind,” Munsterman for more stimulation, mend it for acute conditions such as infections says. “Acupuncture can provide another way to or they may suggest and admits that some pets might not cooperate help our pets and improve their conditions that herbal supplements to when an acupuncturist wants to insert needles complements the treatments we’re providing with complement acupuncture
GETTY IMAGES and remain still during the 20-minute sessions. Western medicine.” and speed healing.
28 WEBMD.COM Last May, between seasons of her megahit NBC television SINGER, SONGWRITER, series This Is Us, actor Mandy Moore, who plays mother-of- three Rebecca Pearson, took on Mount Everest. AND THIS IS US STAR On a weeklong excursion with a group of hikers led by a professional guide, Moore, 35, trekked through the MANDY MOORE RECLAIMS Himalayas to reach Everest Base Camp (elevation: 17,500 feet). No, she didn’t climb to the top of the world’s highest peak—that’s an endeavor that takes two months and serious HER POWER, TAKING ONE mountaineer training—but it was monumental for someone who’s spent the last five years reclaiming her life. “I’m trying STEP AT A TIME to enjoy things and challenge myself,” Moore says. “I’m kind of stepping into my power, owning who I am and what it’s taken to bring me here.” BY KARA MAYER ROBINSON REVIEWED BY MICHAEL W. SMITH, MD, CPT STANDING STILL WEBMD CHIEF MEDICAL EDITOR For the better part of a decade, Moore felt like she was drifting. At 14, she was “discovered” for her singing talent and was quickly signed by Epic Records. When her first single, “Candy,”
KAI Z FENG / TRUNK ARCHIVE TRUNK / FENG Z KAI sped to the top of the Billboard charts, she burst into the
30 WEBMD.COM 31 WEBMD.COM “Going up too fast, which many uptoofast, peopledo,significantly“Going altitude.descending andthephysical demandsofextreme takes serioustraining toprepareforlongdays climbingand for acardioworkout. calves,glutes,andcoreraiseshamstrings, yourheartrate physicalalso astellar workout. It strengthens yourquads, It’s stress. youremotionalwell-beingandrelieves restores cure-all.”of theperfect surroundings. Ifind itsomeditative andgrounding.It’s sort I’m slowlywalkinguphillandenjoyingthe tojust sticking Mount RainierandMount Baker,” shesays. “Butfornow, technical sideofclimbingandbeingabletogo onpeakslike to alocaltrail. their three cats and two dogs, she loves lacing up and heading and Angeles homewithGoldsmith lolling aroundherLos that draw Moore tohiking.Onweekends, whensheisn’t trekked throughNew spring,they Zealand. Last it thelast. first alreadyscaledMount time:They’d Kilimanjaro. Nor was duohiked—andnewly-hitched hiked andhiked. It their wasn’t man Taylor the toChile, Ontheirhoneymoon Goldsmith. November,Last Moore marriedmusicianandDawes front OFF ON THE RIGHT FOOT things,” shesays. is.“I’m itstill them waskey—and examining constantly onherchoicesandwhat motivated andreflecting struggles rebuildingherselfandherlife.Talkingshe started about her todigmyselfsteps out.” wanted toreclaim my life,I had to do the work and take the was and how deeply unhealthy the situation was and that if I and shefeltrudderless:“IrealizedhowdeeplyunhappyI going like this,” shesays. Moore missedmusicandacting, kindofabandonedit.”he wasdoing,soIjust allow asmuchroompossibleforthisotherpersonandwhat my lifetobediminishedbecauseIwasintimidated. Iwantedto the ideaofmusicandmy roleinmusicandthe roleofmusicin make theotherpersonmorecomfortable,” shesays. “Iallowed ship whereIallowedmyself tobeasinsignificant aspossibleto emotional healthandonhermusic.“Ifoundmyself inarelation didn’t immediately realizeit,buthermarriage tookatollonher foot off Iallowedmyself thegasandcoast. tobeadrifter.” inmy mid-tolate 20s,Iallowedmyself totake my she says. “Then keptjust putting onefootinfrontoftheotherandworkinghard,” in movieslike Spears.NotBritney longafter, landingroles shetackledacting, spotlight alongside teen-pop idols like Aguilera Christina and Note: Ifyou’re uptoMoore’s consideringstepping it level, She’s innature exercising Studiessuggest ontosomething. “I’m really interested in getting into the slightly more sky-highIt just isn’t summitsandfar-flung destinations With thehelpoffriends,family, journaling,andtherapy, Six yearslater, splitup.“IrealizedIcouldn’t keep they In 2009,Moore marriedsinger-songwriter Ryan Adams.She I into an adult world that“I was thrust was really unexpected. The Princess Diaries Diaries Princess The and A Walk to Remember to Walk A - - . often leadstobloating, gas,andlethargy.often digestive issues and gluten sensitivity, which She alsowatches what sheeats. Moore has thebloodflowing,”week toget shesays. todoitat threetofourtimesa least “I try classes. with trainer-led workouts andgym To stay fit, Moore supplements her hikes ALONG THE WAY 11peoplediedonMountleast Everest. yearalone,atbecome abigproblem.This tions arehazardous,andovercrowdinghas condi youtothesummitandback.The get to and can’t simplyrelyonaguideservice technical mountainsabove5,000meters He says you’d climbing needexperience attempting before set Everest,” says Weiss. therequisitemountaineeringskillacquire prepare bothphysically andmentally entirely. “At aminimum,onewouldneedto world’s mountainisanotherlevel highest Stanford University SchoolofMedicine. MD, medicineat aprofessorofemergency illness, whichcanbefatal,” Weiss, says EricA. altitude increases yourchancesofdeveloping Attempting toreachthesummitof -
GETTY IMAGES THIS IS US US IS THIS HONORED WITH WALK OF FAME IN 2019. IN FAME OF WALK THEIR SCREEN ACTORS TOP LEFT: TOP RIGHT: ON THE HOLLYWOOD MILO VENTIMIGLIA. MILO BOTTOM: WITH GUILD AWARD. GUILD AND CREW OF OF CREW AND CELEBRATES MOORE WAS WAS MOORE
CASTMATE THE CAST CAST THE
MOORE A
STAR
in her small intestine, forwhichshetakesin hersmallintestine, supplements,she’s vent symptoms.” may be sensitiveto.Eliminating themcanimproveorpre sensitivity panelscan helpidentify specific foodsaperson InstituteGastroenterology of Southern California. “Food ing, andgas,” says Peyton Berookim,MD, ofthe director that’s helpedisafoodsensitivity panel,” shesays. onlything sureofthecause.“The isn’t disease. Butshestill upper endoscopyandcolonoscopy, sheknowsit’s notceliac doingbloodwork, andhaving seeingvarious doctors, After an Moore overgrowth discoveredthat alongwithabacterial “Food sensitivitiesareacommoncauseoflethargy, bloat - - CURE-ALL. OF THE PERFECT SORT IT’S GROUNDING. AND MEDITATIVE SO HIKING FIND I
sensitive to several of her favorite foods, like salmon. “I was a which premieres in November and stars huge salmon fan—I had it pretty much every day! No wonder Dennis Quaid. “It’s a big, sweeping, epic war I felt bad all the time,” she says. Salmon is now out of the equa- saga about the Battle of Midway, a pivotal naval tion, along with dairy, beef, gluten, and soybeans. battle that took place in the Pacific Ocean mid- Her new staples are eggs, chicken, cod, and halibut. She way through World War II,” she says. and Goldsmith are big snackers, so they often reach for With her acting career on solid ground, almonds, cashews, macadamias, and nut cheeses. She also Moore is setting her sights on doing more loves homemade gluten-free chocolate chip cookies, which she of what she’s passionate about. “I can’t wait makes with almond flour. Plus, it’s easy to find healthy options to have a family. I can’t wait to continue around town. “We live in Los Angeles, the land of salads and this career trajectory that I started 20 years green juices,” she says. ago,” she says. One week after Everest, for the first time in years, Moore returned to LIFELONG EXPEDITION the recording studio. Staying healthy helps Moore deliver the goods onscreen. “In Nepal I was thinking a lot about the Simply sitting in the makeup chair to prepare for This Is Us things that scare me. I was thinking about requires endurance. “It takes about three and a half hours to the rest of the year, about the next five years, be present-day Rebecca. It took six hours to be Rebecca in like, ‘What do you want to do? What’s hold- the future,” she says. ing you back?’” she says. One of the hallmarks of the show is its use of timelines, Moore had an epiphany: Instead of letting jumping between flashbacks, present day, and flash- other people’s definitions of her as a musician forwards. Moore plays Rebecca at different ages, from her hold her back, it was time to reclaim own- mid-20s to her mid-80s, which she says is the most gratifying ership of her music. “I was thinking, What experience she’s ever had. prevents me from just getting out there and It’s also a role that landed Moore her first Emmy nomina- having some small performances here in Los tion—for Outstanding Lead Actress in a Drama Series this Angeles? It doesn’t have to be the end-all-be- year. (The winner will be announced Sept. 22.) all,” she says. The way to scale a mountain, Moore hints we’ll see more of “future Rebecca,” who first after all, is one step at a time. appeared in last year’s season finale, but not necessarily right “It’s taken me to this point to recognize I away. “I think they’re going to parse it out and save it for a little have the power to control the narrative, the bit later,” she says. (The show was recently renewed for three projects that I want to do, the people I want seasons.) This season, she says, will focus on the courtship of to work with, and how I choose to spend my young Jack and Rebecca, which she’s thrilled about. “We get to time,” she says. “I haven’t put out a record in go back to the ’70s,” says Moore. “I love those happy-go-lucky over a decade, but I’m not nervous anymore. days working with Milo [Ventimiglia]. And the fun clothes!” I’m invigorated and excited to put that behind Moore is also excited about her upcoming movie, Midway, me and plow forward into the future.”
Check the weather. Not sure what you need? Go at your own pace. If a rainstorm is in the The American Hiking Society Take rest breaks when you forecast, reschedule. suggests good footwear, need them. a map and compass or Always tell someone where GPS, water, food, extra Start easy and work your TAKE you’re going and when you clothes or raingear, a safety way up with distance, time, plan to return. light and whistle, first and hills. Wear good hiking shoes aid, a multipurpose tool, Mix it up. Try converted to avoid aches, pains, sunscreen, and a daypack. railway trails, dirt paths, city and blisters. Carry tape Bring easy-to-carry, non- parks, or wilderness trails. or moleskin for blisters perishable snacks like trail Ready for the next level? A HIKE! and hotspots. mix, nuts, seeds, dried fruits, Pick up your pace, try steeper INSPIRED TO HIT THE TRAILS energy bars, and dried jerky. trails, or carry a backpack LIKE MANDY MOORE? GET OFF ON THE Stay hydrated. Drink water with weight in it. before a hike and carry two RIGHT FOOT WITH THESE TIPS. cups for every hour. KAI Z FENG / TRUNK ARCHIVE TRUNK / FENG Z KAI
33 WEBMD.COM SLEEP OF THE SECRETS advice. the wrong gotten you’ve just be It might every night? shut-eye enough getting Trouble
WebMD MedicalEditor Reviewed byNehaPathak, MD, By SonyaCollins
GETTY IMAGES
GETTY IMAGES University Angeles. So ofCalifornia,Los behavioral at sleepmedicinespecialist the enough,” says Jennifer Martin, PhD, a insomnia, sleep hygiene never is almost You’ve gotten just thewrongadvice. day—and nothingworks. time every bed, getting into and out of bed at the same noscreensin your bedonlyforsleepandsex, keeping yourbedroomcoolanddark,using the familiar sleephygiene rules, including thatthe rest youshould. way, thebottom lineisyou’re notgetting problem isfallingasleeporstaying that a couplein the just of hours. Whether only tofind yourselfwideawake again asleep. Ormaybe youdozeoff rightaway, You liethereforhoursinafight tofall you andyourbed? showdown between Is nighttimea “For someone who is suffering with Don’t worry, you’re not doing it wrong. triedeverything—all And maybe you’ve NEVER ENOUGH.” IS ALMOST “SLEEP HYGIENE
about physical orpsychological dependence treatment forinsomnia,includingconcerns sons why sleeping pills are not the first-line are many rea is pills, think again. “There treating thoseotherconditions.”not directly better, ifweare quality oflifeimproves,even better,insomnia, depressiongets paingets other,” says wetreat Martin. the “When other conditions tend to exacerbate each right away. That’s because“insomniaand toworkonyourinsomnia willstart They treat thosepossiblecausesfirst.while they won’t make youwaitaroundpain—doctors sickness, yourmedications, anxiety, chronic ments forit.No matter what’s causingit— months, that’s insomnia,andtherearetreat asleep at threenightsaweekfor least If youhave troublefallingasleeporstaying Getting helpgetting to sleep It’s treatment notthebest wehave tooffer.” gotten, giveup. don’t the onlyadvicethey’ve oneofthemwillhelp. least apy totaichi—areavailable. are,at Chances Numerous provenoptions—fromtalkther you probably people imagine. for insomnia—orCBTI—isnot what most for insomnia.Cognitivebehavioral therapy on-the-sofa talktherapy adaptedspecifically agree,isaformofstretch-out- experts most treatment best forlong-terminsomnia, The forHungry sleep as adeath inthefamilyoramajorillness.” have such event insomniacaused byastressful use and mayshorter-term be helpful if you SleepingpillshaveClinic. arole,shesays, “for of behavioral sleepmedicineat Cleveland effects,” says Michelle Drerup,PsyD, director on themedications andthepotentialforside If your idea of treatment for insomnia “For anyone whofeelsthat sleep hygiene is haven’t
“tried everything.” - - - night weeks. for a If,few foryou example, spendasleepevery number ofhoursthey spendinbedandthe number ofhoursthey Zhou asks patients to keep a record of the maypist askyoutogo tobedvery, late. very likeslept—just hunger.” when it’s beenlongenoughsinceyoulast It happenscontrol whensleepoccurs. night,” says Zhou.“You can’t consciously should go tobedat thesametimeevery earlier. What’s more,“it’s amyth that you gobedtime. And,no,youshouldn’t tobed you’re sleepingtheway youshould—isyour might helpyouchange—at until least self tofallasleep. help youtake someofthepressure off your way could understanding foryears.That that this youhave beenfunctioning infact think about sleep, a therapist may point out awake,” says Martin. To change theway you pressure in and of themselves keep you sohardtosleepthat theeffort andtrying intobed:You’re whenyou get vicious cycle to be worthless tomorrow and think, it. who try more than70%ofpeoplewithinsomnia (behavior)act in relation to sleep. It helps thewayto adjust youthink(cognition)and Medical School.ButCBTIissimplyaway Division ofSleepMedicine at Harvard says EricZhou,PhD, apsychologist inthe or anxietyPTSD.Idon’t needtherapy So to make you hungry forsleep,athera So tomake youhungry behaviorsOne ofseveral atherapist When youcan’tsleep,may panic “People think, If Idon’t get tosleep,I’mgoing I don’t havedepression . “It becomesthis WEBMD.COM 36 ,” ,” - - “ 37 WEBMD.COM YOU WOULD FOR TWO TO THREEHOURSADAY ... IN YOUR LIFETHAT YOU IF THEREWERE HATE THAT ACTIVITY. slow, fluid movements,may give sleepless that involves art martial ancient Chinese ments that candisruptsleep.Tai chi, an troubles because and of treat anxiety groupcanbeprone tosleep This survivors. CBTI tocombat cancer insomniain breast aseffectivements oftaichiwerejust as aseffective.free orcheap,couldbejust that otherstrategies,research suggests some CBTI isn’t your only option. Emerging Being inthemoment person’s situation.” “It’s individualized and tailored to each follows,”rules that everyone says Martin. to sleep.“It’s of onemagicalset notjust with some ways toovercomethosebarriers awake. Your therapist may helpcomeup with the issues that may be keeping you asleep,” hesays. yourbodytofallasleepandstayretrain bed earlierandearlier. “You essentially bereadytogo tothe nightandeventually sleep through so sleep-deprivedthat you’ll to stay upuntil,say, become 3a.m., you’ll only sleepingforfive.” better thanbeinginbedforeighthoursbut five hours,” hesays, “that’s amilliontimes you sleep five hours and you’re in bed for you have to be up for work or school. “If it’s five notproductive—until hoursbefore up—doing anything youwant,aslong youtostaynight, Zhouwouldinstruct would hate that activity.” to threehoursaday, singleday, every you inyourlifethatactivity youfailedat fortwo in bed,” hesays. “Iftherewereany other spend two hours teaching your body to fight inbed,“Every night,youyou spendseven sleep anaverage offive hoursanight,though In aclinicaltrial,themeditative move In CBTI sessions, you might also deal Within aboutaweekofforcingyourself If youmanage tosleepforfive hoursa ANY OTHER ACTIVITY FAILED AT - - promising treatment option.” fulness meditation,” says Drerup. “It’s a ofmind the principlesandpractices behavioral treatments forinsomniawith therapy forinsomnia, orMBTI,integrates orthefuture.“Mindfulness-basedthe past go ofworriesaboutin themomentandlet meditation challengestobe practitioners insomnia. Similartotaichi,thisformof which is pretty difficult not to think about.” growing inmybody? she says, “I’m not thinking, it wasover.” taichi, Whenshepractices come backandthinkingthat lifeasIknew [my cancer]would breast says, “worrying because shewouldlay awake at night,she ininsomniasymptoms.reduction after, womeninbothgroupshadasimilar program andcontinuingfor15months at home.Attheendof practiced they sessions,for threemonths.Between two hours ofCBTI ortai chi per week cancer wererandomly assignedtoeither the taichistudy. wholedchiatrist andprofessorat UCLA, moment,” says Michael Irwin, MD, apsy is on being in thefocus presentup. “The other thantheworriesthat keep them onsomethingpeople a chancetofocus In asmallclinicaltrial,olderadultswith Mindfulness meditation may also relieve Dianne Wilburn,66,enrolledinthetrial In theclinicaltrial,womenwithbreast for Better Sleep slideshow the for Search at WebMD.com. at or ” Why didIget it? 20 Tips Tips 20 Are cancer cells
- -
GETTY IMAGES longer and longer to fall asleep at night. dementia, Winnickfoundthat ittookher them all,butnowIamaconvert.” skeptic offrom the’70s.Iwasbiggest tation waswoo-woo craziness, hippystuff people withdementia.“Ithoughtmedi mindfulness meditation incaregiversof that thebenefitsa recentstudy tested of in whotookpart says ArleneWinnick,71, appointment orwhat thefutureholds,” ontomorrow’syou can’t focus doctor’s move on. sensation andthentake ofevery stock those emotions;andscantheirbody to anxiety, off andthentake thefocus of onunpleasantemotions,suchasfocus were on their asked breathing; to focus Research Center, inwhichparticipants online at UCLA’s Mindful Awareness guided meditations, available forfree the hygiene group. ment intheirsleep,comparedtothose itation groupsaw asignificant improve At theendofcourse,thoseinmed sleep hygiene ormindfulnessmeditation. sleep troublesreceivedtraining ineither After her partner wasdiagnosedwith herpartner After “If you have on your breathing, to focus mindfulnesstraining includedThe SLEEP HYGIENE HABITS BETTER, ONCE YOU ARESLEEPING MEDICAL SCHOOL. AT HARVARD A SLEEPPSYCHOLOGIST ERIC ZHOU, P THAT SLEEP TO HELPMAINTAIN
ADOPT GOOD , SAYS SAYS ,
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- - -
that youwon’t beabletosleep.” make yourself hyper-aroused is toworry says ways Zhou,“andoneofthebest to bad sleepishyper-arousal ofthemind,” sleep itself. “A bigcontributortoanightof them awake—even ifthat concernisabout go oftheconcernsthatsleepers let keep elsego canhelptroubled everything let away. That’s what itdid forme,” shesays. the moment,alotofotherstuff goes just youstay inreaches hershoulders.“When sheNow fallsasleepbefore Winnickoften downtotheirtoes. their nose,andsoforth, their forehead, theirthe bridge eyelids, of firstfocus onthetop of their head,then 13-minute recordingthat to tellslisteners meditation when into she bed. gets It’s a her mindisracing, toaguided shelistens the presentmoment.Onnightswhen backtoherbreathing, herbody,focus or concerning thoughtandthenbringingher aWinnick repeated in observing practice am Igoing tohandlethis? to happennextweek?Next month?How my fill mindwouldjust with going tobring.WhenI’d go tobedat night, “You don’t know what just thefuture’s Learning to focus onthemomentand tofocus Learning Mindfulness meditation training gave
during theday See enoughsunlight during sleepinghours could causeheartburn Avoid foodsthat Exercise daily to bedtime nicotine, close like caffeine and Avoid stimulants, to 30minutesorless Limit daytimenaps ” shesays. What’s going
HOLDS.” FUTURE WHAT THE ON ... FOCUS YOU CAN’T BREATHING, ON YOUR FOCUS HAVE TO “IF YOU electronics out keep screensand cool anddark Keep yourbedroom even weekends! time everyday— up atthesame Go tobedandget time towinddown tells yourbodyit’s bedtime routinethat Set arelaxing WEBMD.COM
38 Search for the article How Immunotherapy for Cancer Works at WebMD.com.
cancer FROM WITHIN
IMMUNE THERAPY IS A PROMISING TOOL FOR TREATING SOME TYPES OF CANCER TUMORS, THOUGH LIMITATIONS STILL EXIST
BY KAREN WEINTRAUB REVIEWED BY BRUNILDA NAZARIO, MD, WEBMD SENIOR MEDICAL EDITOR
Not long ago, only about five in 100 people were expected to be alive five years after a diagnosis with an advanced form of lung cancer. Today, up to four times more people live that long, thanks to treatments that help unleash the immune system to attack cancer. The results are even more impressive for late-stage patients with melanoma, a type of skin cancer. These so-called immune checkpoint blockades have revolutionized cancer care, putting immune therapy on par with chemotherapy, radi- ation, surgery, and targeted therapies as a cornerstone of treatment for many tumor types. “Without this, many, many, many more patients would have died,” says Allison Betof Warner, MD, PhD, an oncology fellow soon to be on the melanoma faculty at Memorial Sloan Kettering Cancer Center in New York City. “It’s a complete game changer for the diseases for which it works.”
ILLUSTRATIONS: STUART BRIERS RESISTANCE TRAINING For well over a century, doctors dreamed of using the 1.54% immune system to fight off cancer. If the immune sys- ESTIMATED PERCENTAGE 43.63% tem, once trained to recognize a virus like the measles, OF PEOPLE WITH PERCENTAGE OF PEOPLE WHO WERE CANCER WHO WERE can protect against it for a lifetime, why can’t it do the ELIGIBLE FOR THIS TREATMENT IN 2018. ELIGIBLE FOR IMMUNE same with cancer cells? CHECKPOINT INHIBITOR The answer, scientists realized after decades of research, TREATMENT IN 2011. is that cancers can manipulate the body’s immune system. Sometimes, tumors trick the immune system into step- of money for these immune therapies. According to one 2015 estimate, for ping on the brakes instead of attacking when faced with Instead, improvements over instance, one of the more recent blockade drugs costs just over $100,000 cancer cells. the last five years have been for a typical patient. With a 20% copay, that would run a patient $20,000. Checkpoint blockades may remove this brake, help- more gradual. In advanced And side effects happen nearly as often in people who get little benefit from ing the body’s defenses mount a successful and long- melanoma, for example, about the drugs as those who benefit long-term, Awad says. “We really have no lasting attack. The FDA has approved seven checkpoint 30% to 40% of patients still get way of predicting who’s going to develop which toxicity, but almost every blockades that treat more than a dozen types of cancer, no benefit at all from checkpoint organ has the potential to be involved,” he says, including the thyroid, nerves, including melanoma, non-small-cell lung cancer, kidney inhibitors, says Keith Flaherty, skin, and digestive system. The vast majority of these side effects are reversible with early rather than pushing the science 6MONTHS cancer, and some types of colorectal cancer. Given alone, MD, a melanoma specialist at treatment or, in more serious cases, stopping the immune therapy, he adds. forward. Other studies are sim- HOW LONG PEOPLE WITH the drugs haven’t been shown to help many patients with Massachusetts General Hospital in ply pointless, he says. LATE-STAGE MELANOMA advanced tumors of the pancreas, brain, and prostate, Boston. Roughly another third of THE RIGHT COMBINATION What needs to happen, says If a single checkpoint blockade drug doesn’t work, it may be because the cancer has Flaherty, is more careful research com- WERE EXPECTED TO LIVE though they may eventually be part of a cocktail of melanoma patients get great early treatments for these tumors. results, but then the drugs stop stepped on more than one brake. To get around this, some patients are given two bining these blockade drugs with other treatments—such A DECADE AGO. The checkpoint drugs took off in the early years of working, Flaherty says. The tumor checkpoint blockades. The side effects are multiplied, though—and often terrible—and as chemotherapy, targeted therapies, and other immune this decade, beginning with the apparently figures out how to take a the combo doesn’t seem to do much for melanoma patients, Flaherty says. For them, approaches like vaccines—to see what works and how the approval of Yervoy for different path to shutting down the each checkpoint blockade alone is better approaches work at the molecular level. The results are likely However, the success of melanoma in 2011. The immune system. than the two together, though it’s hard to to be different for different cancers—and maybe different stages these drugs has raised second type of blockade tell in advance who will benefit from of cancer, he says, noting that most research so far has focused patients’ expectations drugs provided more which drug. on end-stage cancer. about how much than double the ben- Other drugs and combinations may they will benefit. efit of Yervoy. The 12.46% help deliver more gas to the immune GRADUAL IMPROVEMENTS And if 20% to 30% assumption then was PERCENTAGE OF PEOPLE system or push on its metaphoric gas Pardoll says the scientific understanding of cancer and the are given a long- that improvements WHO RESPONDED TO THIS pedal, revving it up to kill tumor cells. immune system continues to improve and will eventually lead term reprieve, that TREATMENT IN 2018. would keep on at The so-called microenvironment right to better results for patients—both in terms of longer life and means 70% to 80% that rate—helping around the tumor seems to affect the fewer ineffective therapies. “Science is creating a huge number still die of their 20% of patients, No one understands why. New immune system’s ability to fight, and of very promising new targets, new approaches, and also new disease. Being a then 40%, 60%, research suggests this recurrence researchers are still figuring out how insights in what I like to call precision immunotherapies,” he says, patient today is and 80%, says Drew strikes patients whose tumors to read and manipulate that ecosys- 3 including indicators that will help doctors identify which patients “certainly better Pardoll, MD, PhD, direc- shrank at first while taking check- tem, Betof Warner says. YEARS are most likely to respond to a given combination of treatments. than it was five tor of the Bloomberg- point inhibitors but didn’t disap- Padmanee Sharma, MD, PhD, a pro- HOW LONG MORE THAN But it isn’t easy to be a patient in the current climate, he years ago—but defi- Kimmel Institute for pear completely. fessor and researcher at the University HALF OF PEOPLE WITH and other doctors say, because it’s not known which drugs nitely a lot of work Cancer Immunotherapy Regardless of their results on of Texas MD Anderson Cancer Center ADVANCED MELANOMA will help which patients and for how long. Hope can be still needs to be done at Johns Hopkins the therapy, patients and insur- in Houston, says scientists have so far crucial for someone getting cancer treatment, but irrational and a lot of progress REMAIN ALIVE TODAY Medicine in Baltimore. ance companies are charged a lot focused on manipulating T cells, often hope can be damaging. needs to be made,” described as the soldiers of the immune AFTER TREATMENT WITH If people are disappointed in immune therapy’s results says Mark Awad, system. But the immune system is IMMUNOTHERAPY. now, it’s mainly because these checkpoint blockades “have MD, PhD, clinical incredibly complex, with different been the most impactful [treatments] in the history of cancer director of the Lowe routes for turning itself on to fight off therapy,” Pardoll says. “But you don’t hit a grand slam every Center for Thoracic invaders and off to prevent overreactions that can lead to autoimmune disease. time you come to bat.” Oncology at the Dana- “We shouldn’t assume that we’re done understanding the basic science,” says Farber Cancer Institute and an assistant pro- 2,250 Sharma, whose husband and colleague, James Allison, shared a Nobel Prize fessor at Harvard Medical School. Providing MORE THAN last year for work that led to the development of the first checkpoint inhibitor, THE NUMBER OF patients with “realistic expectations is by far THE NUMBER OF CLINICAL TRIALS EVALUATING Yervoy. The immune system may also react differently, depending on where the PD-1/L-1 DRUGS THAT the most important thing that we can do as PD-1/L-1 CHECKPOINT INHIBITOR DRUGS IN 2019. tumor started, so a patient whose cancer started in the skin might need a different HAVE BEEN APPROVED oncologists,” adds Betof Warner. “Immune immune therapy than one whose cancer started in their bones, she says. therapy is an incredible tool. But it’s not a Yet another current hurdle: A lot of the research attention on checkpoint blockades AS OF THIS YEAR. magic bullet.” has been redundant, Pardoll says, proving the same basic findings again and again 6
41 42 WEBMD.COM WEBMD.COM DELICIOUS BITES Food MEALS MADE EASY
APPLES MAY GET ALL THE ATTENTION THIS TIME OF YEAR, BUT IT’S ALSO PEAK SEASON FOR PEARS. These succulent super foods stand The Ripe out for their fiber content—one medium pear contains 22% of an adult’s daily value of fiber, which may help protect against both heart disease and type 2 diabetes. One study found that people who ate pears and apples on a regular basis were less likely to develop
GOOD FOR YOU FOR GOOD Stuff type 2 diabetes, and research suggests that the antioxidants in pears PICK A PERFECTLY RIPE PEAR, may increase insulin sensitivity. Pears come in a host of colors, WHICH OFFERS A LOW-CALORIE shapes, and flavors, so sample a variety this season to choose your COMBO OF BENEFICIAL FIBER AND favorites. Slice them into salads, slip them into smoothies, or savor FANTASTIC FLAVOR them poached or roasted. —ERIN O’DONNELL GETTY IMAGES
43 WEBMD.COM 3 WAYS Food 44 WEBMD.COM before you begin the recipe. the begin you before above directions roasting the follow and squash 2 lb a with Start balsamic. white of instead vinegar cider or cherries dried the of place in cranberries use You also can instead. grain whole another or rice brown try can you but wheat, of atype farro, use we example, For substitutions. to try free feel flexible; fantastically is bowl grain This Kale and Squash Butternut with Bowl Grain LUNCH THE LUSCIOUS Squash Butternut Roasted BY NEW WAYS TO ENJOY THIS DELECTABLE FALL FAVORITE. WAYS DELECTABLE NEW THIS TO ENJOY FLAVOR ROASTED. CARAMELIZED WHEN RICH, DEVELOPS WE THREE OFFER PACKED Erin O’Donnell WITH DISEASE-FIGHTING ANTIOXIDANTS, BUTTERNUT SQUASH at WebMD.com. at Carbs of Veggies That Are Healthy Sources Search for the slideshow RECIPES BY
Kathleen Zelman, MPH,RD, LD
evenly over each bowl. bowl. each over evenly vinaigrette remaining Drizzle of avocado. slices 2 and chickpeas, pecans, feta, cherries, squash, 1/3 butternut farro, cup kale, arrange 6bowls, of each In dressing. 2tbsp with kale toss bowl, um amedi In to taste. pepper and salt and mustard, ½tsp juice, lemon 1tbsp vinegar, 2tbsp oil, olive 3tbsp together Whisk dressing: the For MAKE IT Calories from fat: 49% fat: from Calories sodium. mg 356 8gsugar, 8gfiber, cholesterol, mg 11 fat), (4 gsaturated gfat 21 gcarbohydrate, 42 369 calories, 8 g protein, 8gprotein, calories, 369 2CUPS) (ABOUT SERVING PER MUSTARD, BABY KALE, COOKED ROASTED BUTTERNUT SQUASHROASTED BUTTERNUT VINEGAR, LEMON JUICE, DIJON + OLIVE OIL, WHITE BALSAMIC BALSAMIC WHITE OIL, + OLIVE
FARRO, DRIED CHERRIES, FETA CHEESE, PECANS, PECANS, CHEESE, FETA CHICKPEAS, AVOCADO THE MIX THE SERVES 6
and lightly browned. minutes or until tender and roast for another 20 25 minutes. Gently stir for 425ºF at Roast pieces. the crowd not Do spray. cooking with coated pan single layer on a roasting a in squash Place pepper. and salt, oil, olive with Toss flesh into 1-inch pieces. dice and seeds the Discard apeeler. with skin the 3 minutes, then remove for microwave the in fork. Heat whole squash a with skin squash Prick Squash Roast Butternut HOW TO HOW
-
PHOTOGRAPHY: RICK LOZIER; FOOD STYLING: CHARLIE WORTHINGTON Butternut Squash Apple Flatbread THE PIZZA TREATMENT THE PIZZA This flavorful flatbread combines two fall favorites: squash and apples. (Fuji, (Fuji, apples. and squash favorites: fall two combines flatbread flavorful This honeycrisp, or Braeburns work well here.) Use a prepared pizza crust, crust, pizza aprepared Use here.) well work Braeburns or honeycrisp, flatbread, or our favorite, naan bread! Serve with salad or as an appetizer. an as or salad with Serve bread! naan favorite, our or flatbread, 23 g carbohydrate, gcarbohydrate, 23 5 g sugar, 384 mg mg 384 5 gsugar, 0 mg cholesterol, sodium. Calories Calories sodium. (ABOUT 1½ CUPS) CUPS) 1½ (ABOUT OLIVE OIL, RED APPLE, BABY MAPLE SYRUP,MAPLE FRESH SAGE, saturated fat), fat), saturated MAKE IT IT MAKE 2 PREPARED FLATBREADS, from fat: 39% fat: from 188 calories, 188 calories, SPINACH, GOAT CHEESE E SERVING PER Preheat oven to 450ºF. In a large bowl, toss roasted squash squash roasted toss bowl, alarge In to 450ºF. oven Preheat 9 g protein, 9 gprotein, SQUASH + RED ONION, ROASTED BUTTERNUT ROASTED BUTTERNUT 8 g fat (2 g g (2 8 gfat and chopped onion with 2 tbsp maple syrup and and syrup maple 2tbsp with onion chopped and 3 g fiber, 3 gfiber, 1 tbsp chopped sage. Place flatbreads on 2 pizza stones stones 2pizza on flatbreads Place sage. chopped 1 tbsp or baking trays. Brush tops with olive oil. Add butternut butternut Add oil. olive with tops Brush trays. baking or THE MIX THE squash mixture, apple slices, chopped spinach, and and spinach, chopped slices, apple mixture, squash cheese crumbles. Bake 10 to 12 minutes or until edges edges until or to minutes 12 10 Bake crumbles. cheese are browned and toppings are heated through. Cut Cut through. heated are toppings and browned are each flatbread into 6 slices. into 6slices. flatbread each PER SERVING (ABOUT 2 SLICES) 2SLICES) (ABOUT SERVING PER 426 mg sodium. Calories from fat: 40% fat: from Calories sodium. mg 426 8gsugar, 3gfiber, cholesterol, 6mg fat), (4 gsaturated gfat 11
seeds and pomegranate arils (as shown) or thyme. or (as shown) arils pomegranate and seeds pumpkin as well as yogurt of adrizzle with Garnish into 6bowls. Ladle consistency. desired to achieve stock or water additional Add processor. food or blender immersion an using soup Purée sprigs. thyme and leaf bay Remove minutes. 30 simmer and Stir leaf. 1bay and stock, chicken 6cups pieces, squash roasted Add 2to 3minutes. ginger. Cook and nutmeg each 1tsp powder, and curry 1tbsp thyme, 3sprigs garlic, chopped Add golden. until or 5minutes about cook and leeks chopped Add heat. medium over oil olive 1tbsp heat pot, heavy-bottom alarge, In IT MAKE department). supermarket produce your in them (find arils pomegranate tangy and seeds, pumpkin herbs, yogurt, Greek nonfat plain with We like garnished it soup. golden like this evening fall achilly on nourishes Nothing Soup Squash Butternut Curried THE SUPPER STARTER gcarbohydrate, 33 6gprotein, calories, 249
SERVES 6
SERVES 6 SQUASH + OLIVE OIL, LEEKS, LEEKS, OIL, + OLIVE SQUASH CURRY POWDER, NUTMEG, NUTMEG, POWDER, CURRY GINGER, CHICKEN STOCK, GARLIC, FRESH THYME, THYME, FRESH GARLIC, ROASTED BUTTERNUT ROASTED BUTTERNUT THE MIX THE BAY LEAF BAY WEBMD.COM 45 Search for the slideshow Best and Worst Italian Dishes for Your Food Health at WebMD.com. Casserole THIS DISH MAY JUST BE THE ULTIMATE COMFORT FOOD
BY Matt McMillen REVIEWED BY Hansa Bhargava, MD, WebMD Senior Medical Editor
CASSEROLES RANGE FROM ONE-POT WONDERS quickly concocted from leftovers and whatever you find in the fridge to involved kitchen projects that require plenty of planning, time, and attention. “A casserole can be what you want it to be, and that’s the beauty of it,” says Heather Pelletier, executive chef at Chumley’s in New York City. Incorporate her tips for your next casserole.
MAKE IT • Bake in a heavy-duty pot • Choose a nice gooey that allows for slow, even melting cheese to top your cooking, such as stoneware casserole, like mozzarella, or cast iron. Gruyére, or raclette. • Blend in something fruity or • Load it with your favorite acidic to give the casserole fresh herbs. If your base is a little pop, like cherries, something as simple as canned apricots, lightly pickled pearl soup and leftover chicken, onions, or lemon. fresh herbs like parsley, • Braised meats belong in a cilantro, and mint can make it casserole. Use beef short taste a lot more homemade. ribs, duck legs, lamb, or pork • Bake in advance when your shoulder with the braising schedule allows, then reheat liquid, thickened, it. Wait a day or two before for the sauce. serving to allow the flavors • Pre-cook vegetables that to meld. contain lots of water, like • Make more than you need. mushrooms and leafy Double or triple your recipe and greens. That water can freeze the extra before baking. otherwise thin the That way, you’ll only have to casserole or change its prep once to have multiple flavor significantly. casseroles for the weeks ahead. • Undercook the pasta by • Serve it simply. Bring the pot three to four minutes. to the table and dish it out It will finish in the casserole there, along with a light salad while absorbing more of to balance the richness of the sauce. the casserole.
VINEGARS POPULATE YOUR PANTRY WITH THESE FIVE VINEGARS, SELECTED BY HARRY ROSENBLUM,
AUTHOR OF SEWALL’S CIDER ACETAIA SAN GIACOMO CEPA VIEJA O-MED WINE VINEGARS MADHOUSE MALT VINEGAR REVIVAL VINEGAR BALSAMIC VINEGAR SHERRY VINEGAR “Depending on the VINEGAR AND FOUNDER “Made in Maine, aged “Dark, fruity, caramel “Made from Spanish variety—Chardonnay, “Made from beer and OF THE BROOKLYN for three months, notes with a hint of grapes and aged Cabernet, rosé—the classically paired with KITCHEN. and tasting of acidic sharpness, even their in oak barrels for a flavors range from fish and chips, it also and tart apples, it’s young balsamics are deep, complex flavor, fruit to mineral to shines in potato dishes THE OPINIONS EXPRESSED IN THIS made from organic miles beyond what this vinegar belongs rounded sweetness. and long-cooked brais- SECTION ARE OF THE EXPERTS AND ARE apples and is great you find on most in salad dressings Choose what you like es like stewed lamb. NOT THE OPINIONS OF WEBMD; WEBMD to drink and add to Available in both light DOES NOT ENDORSE ANY SPECIFIC for pickling, sauces, grocery store shelves. and soups as well as PHOTOGRAPHY: RICK LOZIER RICK PHOTOGRAPHY: FOOD STYLING: CHARLIE WORTHINGTON CHARLIE STYLING: FOOD PRODUCT, SERVICE, OR TREATMENT. and marinades.” Delicious on salad, myriad egg dishes.” braises, marinades, and dark versions.” fruit, and ice cream.” and dressings.” 46 WEBMD.COM Food HARD WHITE WHEAT FLOUR “A middle ground between all-purpose flour and whole wheat flour, it’s great for essentially any baked good, but it’s particularly nice in waffles for its nutty flavor and crispy texture.” DARK RYE Flour “Deeply earthy and BREAD, BISCUITS, COOKIES, CRACKERS, CAKE.
FOOD 101 FOOD nutty in WHAT DO THESE AND OTHER BAKED TREATS HAVE IN flavor, it’s COMMON? FLOUR IN ONE OF ITS MANY FORMS. often used in breads, BY Matt McMillen especially combined REVIEWED BY Hansa Bhargava, MD, with WebMD Senior Medical Editor molasses SEMOLINA or honey FLOURS COME FROM MYRIAD SOURCES, including wheat, and nuts, grasses, and legumes. And they play a variety of roles FLOUR seeds like caraway, in the kitchen. In fact, no two flours perform the same. “Milled from pumpkin, “All flours have different characteristics and different uses, durum wheat, and and they are specific to what you want to make,” it’s very sunflower. says Margarita Manzke, the James Beard versatile and A particular Award-nominated chef/owner of should be used treat: by more home République in Los Angeles and honey rye bakers and author of Baking at République. bread.” Here are her five essential cooks. It’s most flours for your pantry. commonly used in pastas and breads for a slightly sweet and rich flavor.”
ALMOND FLOUR “This versatile nut flour can be substituted for some or all of the wheat flour in a EINKORN variety of recipes, “The most ancient wheat, with such as gluten- lots of fiber, iron, and protein, free cookies, einkorn has a complex and almond cakes, and nutty flavor. Use it for pie tart doughs.” and tart doughs and in a fall favorite: scones.” PHOTOGRAPHY: RICK LOZIER; LOZIER; RICK PHOTOGRAPHY: WORTHINGTON CHARLIE STYLING: FOOD
Search for the slideshow Guide to Non-Wheat Flours at WebMD.com.
47 48 WEBMD.COM WEBMD.COM HEALTHY TOGETHER Checkup SMARTER LIVING
The Human
CUTTING EDGE CUTTING Microbiome BACTERIA OUTNUMBER HUMAN CELLS IN THE BODY. JUST THE RIGHT MIX OF THEM MAY PREVENT A HOST OF DISEASES.
THE HUMAN BODY IS TEEMING WITH BACTERIA. In fact, suggests that bacteria in the gut change very early in your body is home to more bacteria than its own cells. the development of colon cancer. This finding could Researchers estimate that your 30 trillion cells live help doctors diagnose the disease at its earliest stages alongside some 39 trillion bacterial cells. They grow on through a stool sample. skin and in your mouth, nose, intestines, and genitalia. Scientists at New York University recently found a All these bacteria combined form the microbiome. strong link between gut bacteria and lupus—a disease With so many of them, it’s no wonder microbes play a in which the immune system attacks the body and role in your health. A healthy mix of bacteria seems to causes pain and damage to joints, skin, and kidneys. be beneficial to health, while an imbalance or lack of In the study, women with lupus had five times more diversity can have consequences. Some research suggests Ruminococcus gnavus bacteria in their intestines than that an off-kilter microbiome can lead to inflammation, women of the same age and race who didn’t have lupus. which may open the door to many diseases. The researchers found that periodic increases in this Because most of the microbiome resides in the gut microbe coincided with lupus flares. The finding intestines, a great deal of research focuses on “gut could lead to treatments for lupus that aim to rebalance bacteria.” A new study from Osaka University in Japan the gut biome. —SONYA COLLINS GETTY IMAGES
49 WEBMD.COM Checkup Breast Cancer BY Jodi Helmer REVIEWED BY Brunilda Nazario, MD, WebMD Senior Medical Editor
Search for the slideshow A Visual Guide to Breast Cancer at WebMD.com. BY THE NUMBERS NUMBERS THE BY
268,600 IN Estimated number of new cases of breast cancer 1 expected to be diagnosed in women in 2019. 8 The chance of a woman developing breast cancer 62 YEARS in her lifetime. Median age at diagnosis. 64% Decline in breast Percentage of women cancer death rates in the U.S. who reported from 1989 to 2016 having a mammogram in 40% thanks to early detection. the past two years.
145.6 PER <5% 100,000 Percentage of women Incidence of breast cancer under 40 diagnosed diagnoses in New Hampshire, with breast cancer. the state with the highest incidence of breast cancer % in the nation. 89.9
Estimated number Percentage of women #1 of women who will who survive more Breast cancer is the die from breast than five years after number-one cancer cancer in 2019. being diagnosed with diagnosis in women. 41,760 breast cancer. GETTY IMAGES
AMERICAN CANCER SOCIETY, SUSAN G. KOMEN FOUNDATION, NATIONAL CANCER INSTITUTE, CDC 50 WEBMD.COM Checkup
INSIGHT Care Choices BOTH HOSPICE CARE AND PALLIATIVE CARE CAN BE BENEFICIAL. UNDERSTAND SOME IMPORTANT DIFFERENCES.
AS WE GET OLDER AND TAKE CARE OF OUR harder decision to consider other therapies, LOVED ONES it’s important to know about all our such as hospice, to help a loved one have the options because diseases sometimes get harder to best quality of life possible with whatever treat and manage. Hospice and palliative care are remaining time he or she has left. words that many people misunderstand or simply do not want to talk about. Much of this is because 3. IT DOES NOT HASTEN DEATH. Hospice many do not know what these types of care entail and palliative care are in no way associated and when it might be a good idea to discuss the with some of the physician-assisted suicide topic with a doctor. Keep these five points in mind. legislation discussed in some states. They are BY John Whyte, MD, MPH, not at all related. Palliative and hospice care are WebMD Chief Medical Officer 1. THERE ARE SOME DISTINCTIONS BETWEEN about making patients comfortable and trying HOSPICE CARE AND PALLIATIVE CARE, though to minimize pain. The pain medications given the terms are often used interchangeably. do not speed up any processes but rather focus Palliative care can begin any time after on maximizing comfort. a diagnosis. It usually starts when one’s condition has few treatment options and 4. YOU CAN SPEND TIME IN YOUR OWN HOME. A gets to a point where one will not likely long time ago, hospice was primarily performed recover or improve. It does not replace other in hospitals or nursing homes. But that is not the treatments but instead is one more strategy case anymore. Many hospice and palliative care to help manage conditions such as end- services are done in a person’s home. For many stage renal or liver disease, heart failure, family members, this provides a certain level of dementia, or cancer. peace. My father participated in hospice care, Hospice care usually starts when the and he died in his home surrounded by his fam- decision to stop treatment of the disease ily. I know that is what he would have preferred, has been made. Palliative care is often a and I am grateful my family was able to provide component of hospice care. him that comfort.
2. GUILT CAN BE PARALYZING. I find that 5. DON’T WAIT FOR SOMEONE TO SUGGEST IT many people feel if they choose hospice TO YOU. Many doctors aren’t familiar with hos- or palliative care, it means they are giving pice care or palliative medicine. Therefore, they up on a loved one. That is simply not do not mention or adequately describe it. true. I have often told patients and family members that it is easier to say, “Doc, do Always remember hospice is not a place, but everything,” which sometimes inflicts rather a journey.
GETTY IMAGES needless pain and suffering. It is often a Questions? Comments? Email me at [email protected].
51 WEBMD.COM Checkup
Search for the article Chemotherapy: How It Works and How You’ll Treatment Tips Feel at WebMD.com. A CANCER SPECIALIST RECOMMENDS FOUR HABITS TO HELP YOU STAY STRONG THROUGH YOUR CHEMOTHERAPY REGIMEN
HEALTH SMARTS HEALTH BY Erin O’Donnell REVIEWED BY Brunilda Nazario, MD, WebMD Senior Medical Editor 4 TIPS FOR CAREGIVERS CARING FOR A LOVED ONE WHO IS UNDERGOING CANCER TREATMENT IS HARD WORK. CANCER SPECIALIST KIM BARKER, MD, OFFERS THIS ADVICE FOR PEOPLE IN A CAREGIVER ROLE.
FIND YOUR 1. OWN SUPPORT Ask your loved one’s medical team if they can recommend support groups for caregivers. These can be a useful source of information, a place to share ideas, and a way to talk with others who “get” the challenges of this role. WHEN YOU UNDERGO CHEMOTHERAPY, SOME to problematic weight loss. Barker encourages HABITS MAY HELP MINIMIZE SIDE EFFECTS and patients to eat when they can and think beyond TALK TO LOVED even speed your recovery once your treatment is milkshakes (a fallback food for many of her 2.ONES ABOUT complete, says Kim Barker, MD, a cancer rehabil- patients). Make protein-rich foods such as THEIR NEEDS These may change from itation specialist at University of Texas Southwest- chicken and dairy part of your diet when possible day to day. “People going ern Medical Center. These are some of the habits and consider seeing a cancer-savvy dietitian if through cancer are going to she recommends to her patients. you need additional advice, Barker says. have ups and downs,” Barker Sip water regularly throughout the day. “A says. “Sometimes they want Stay active lot of people have low blood pressure or kidney someone to listen, and sometimes they just want Some people undergoing chemotherapy report problems with cancer treatment, and staying someone to be their coach that well-meaning loved ones will confine them well-hydrated can help prevent both of those or taskmaster.” Check in to the couch, urging them to rest. While rest things,” she says. periodically to ensure you is important, Barker also recommends daily are on the same page. physical activity during cancer treatment. Stay in touch with your doc KEEP PHONE Certain symptoms warrant a call to your “There’s so much evidence that exercise and 3.NUMBERS HANDY physical activity actually decrease fatigue, oncologist’s office, Barker says. These include Find out which people at help people sleep better, and just improve the a fever of 100.5°F or higher, chills, dizziness, the oncologist’s office can chance of a fast recovery once cancer treatment confusion, or new pain or weakness. Ask your supply answers when you oncologist if there are any other warning signs have questions, including is done,” Barker says. those that crop up at night Consider walking or riding a recumbent bike, you should call about. or on weekends. for example. “Even doing it 15 minutes a day is better than nothing,” she says. Swimming and Ask before you supplement water aerobics in a warm pool can also help ease Many people with cancer may be tempted to try 4.EXERCISE herbs or other supplements during treatment. Physical activity is just as achy muscles and swelling related to treatment, important for the caregiver Barker adds. Swimming is off-limits for some Check with your oncologist first, Barker says. “A as it is for the person patients who have a port for their chemo drugs; lot of patients think supplements are benign and with cancer, Barker says. check with your doctor before diving in. are not going to hurt anything, but some of them Caregivers sometimes feel can actually with cancer medicines,” she says. To guilty about taking time for themselves. “But you can’t Eat and stay hydrated increase your chances of a successful treatment, care for someone else if Nausea and vomiting are common side effects have an honest conversation with your doctor you’re not healthy yourself,” of chemotherapy, which can sometimes lead before adding supplements to your routine. she says. GETTY IMAGES
52 WEBMD.COM GETTY IMAGES DOCTOR Q&A Faces of Depression depression, alternated withabnormally uporelated periods or anotherillness. depressionisaconsequenceofdruguse outwhether need tosort difficulty concentrating, youhave adepressivedisorder. you Then life, plusyouhave symptomslike poorsleep,low energy, and theability lost toenjoy day andyou’ve if youfeelloworblueevery thetwoboundaries between conditionsarepermeable.Generally, explains thedifferenceexplains andhowtotreat depression. University of Pennsylvania Perelman SchoolofMedicine, THASE THASE BY DISEASE. EVERYDAY SADNESS AND MEDICAL CONDITIONS LIKE THYROID DEPRESSION CAN BE HARD TO DISTINGUISH BETWEEN HOW TO TELL IF YOU’RE DEPRESSED—AND IMPROVE YOUR MOOD IF YOU ARE YOU IF MOOD YOUR IMPROVE DEPRESSED—AND YOU’RE IF TO TELL HOW Q Q
How canyou tellwhetheryou’re sadordepressed?
What isbipolardepression? tpai Watson Stephanie
It’s atype ofdepressivedisorderinwhichpeople have peoplecan’t tellthedifferenceSometimes because the Michael Thase, MD,Michael at Thase, the professorofpsychiatry REVIEWED BY
Neha Pathak, MD, WebMD MedicalEditor after treatment? after nine months. treatmentof depressionepisodesinpeoplewhoget issix to average treatmentepisodes don’t get forthem.The duration outfromnormalsadness.Manysort peoplewhohave these kindofdepression ishardto—four toeightweeks.That switch intomania. lizer first, becauseantidepressantscouldcausethedepressionto People withbipolardepressionaretreated- withamoodstabi called maniasorhypomanias, dependingontheirseverity. for depression. Alzheimer’s disease,andotherdementiasalsoincreasetherisk involve thebrain, includingbrain tumors,multiplesclerosis, Conditionsthatless resilientandabletodealwithstress. arelow, Whenthyroidsystems. hormonelevels people are thetoneforalotofbody’sthyroid helpsset response stress and you’re ofyourdepression. notapassive victim Work onsolvingyourproblemsandgetting helpsoyou feelbetter resilience-enhancing, energizing effects onthebrain andspirit. morningwiththesunon yourface.Exercisehasnatural every cognitive therapy. original treatment, switchtoanotherantidepressant,oradd types ofstressors. responses tocertain ofbeingdepressedchanges thebrain’sthink theexperience chance ofhaving asecondepisodewithinfive years.Some people feels like natural themost fit. bothtreatments. may Orthey try chotherapy (talktherapy) orantidepressants, dependingonwhat life, that’s help. thetimetoget ifit’sparticularly totake atollonyourworkorpersonal starting goingif thedepressionisstill on,day day after weeks, forseveral contemplating endingyourlife,youneedprofessionalhelp.And THASE THASE THASE THASE THASE THASE Q Q Q Q Q Q
When does depressionWhen does warrant acalltodoctor? If depression does return, people caneitherstay ontheir If depressiondoesreturn, Which medical conditions often coexistWhich medicalconditionsoften withdepression? What are somelifestyle tipstomanagedepression? What happensifdepression back comes How depression longdoes typicallylast? How isittreated?
The most commononeisprobablythyroid most disease.The The Get moving. Do light- to medium-intensity aerobic exercises moving.Dolight- tomedium-intensity aerobicexercises Get A fairnumberofdepressiveepisodesareshort-lived Most depression eventually returns. There’sMost returns. depressioneventually abouta50/50 outwitheitherpsy- I usuallyrecommendthat peoplestart Any timeyou’re having suicidalthoughts.Ifyou’re Depression of Types article the for Search Checkup
at WebMD.com. at WEBMD.COM
53 This content is created and controlled by WebMD’s editorial staff and brought Checkup to you by the UPMC Living-Donor Liver Transplant Program. Living-Donor Liver Transplant
BY Matt McMillen REVIEWED BY Neha Pathak, MD, WebMD Medical Editor
SPOTLIGHT SPOTLIGHT Nearly 1989 Year the first Total number of 14,000 living-donor anonymous living Number of people in the U.S. currently liver transplant liver donations on the waiting list for a liver transplant. was performed. since 1989.
OUT 40% to 60% 3 Percentage of a living donor’s liver that OF is transplanted to a recipient.
Number8 of weeks until the donor and 4 recipient livers People who know that have nearly the liver regenerates Number of people who have fully regrown. after transplant. died while waiting for a liver 38,000 transplant since 1995.
Number of U.S. medical centers that perform more than 10 living- 39% donor transplants in a year. 6,990 Percentage of people willing to Number of living liver be a living donor Number of U.S. donor transplants for a stranger. medical centers completed during that perform the last 30 years. living liver donor transplants. 4% Percentage of Percentage of people willing to be a living liver transplants donor for someone 1,824 from living donors Number of people in the U.S. who have been waiting for a they know. since 1989. liver transplant for more than five years as of 2019.
GETTY IMAGES ORGAN PROCUREMENT AND TRANSPLANTATION NETWORK, UCSF HEALTH, UPMC/MEDSCAPE SURVEY, UW HEALTH.
54 WEBMD.COM Checkup
QUIZ Cold & Flu ACCORDING TO THE CDC, ADULTS GET TWO TO THREE COLDS A YEAR, AND AS MANY AS 43 MILLION AMERICANS CAUGHT THE FLU DURING THE MOST RECENT FLU SEASON. THAT’S A LOT OF MISERY. HOW MUCH DO YOU KNOW?
BY Matt McMillen REVIEWED BY Michael W. Smith, MD, WebMD Chief Medical Editor
1 2 3 LIKE MANY ANTIBIOTICS WILL I AM SICK, BUT I OTHER VACCINES, NOT TREAT MY SHOULD TOUGH I ONLY NEED TO COLD OR FLU. IT OUT AND GO GET A FLU TO WORK. VACCINE ONCE. TRUE TRUE TRUE
FALSE FALSE FALSE
4 5 I FEEL AWFUL BUT THE FLU CAN DON’T HAVE A BE MUCH MORE FEVER, SO IT’S SERIOUS FOR LIKELY A COLD. SOME PEOPLE THAN FOR OTHERS.
TRUE TRUE
FALSE FALSE Answers on page 56 Checkup
Questions on page 55
ANSWERS
1. FALSE 3. FALSE 5. TRUE Different viruses cause the flu, and each Colds and flu spread easily, so stay home Very young children, the elderly, people year a new vaccine must be developed if you can for a day or two when you’re with weakened immune systems, to counter the three to four flu strains that most contagious. For the flu, you’ll likely pregnant or recently pregnant women, experts predict will be the most common. be contagious the day before and for five and those with chronic conditions like Get a flu shot each fall, ideally before to seven days after symptoms start. If you asthma, diabetes, and heart disease have November. It doesn’t guarantee protection, must work, wash your hands frequently, a higher risk of serious flu complications, but even if you do get the flu, the vaccine sneeze and cough into your elbow, and including pneumonia, that could require may curb the severity of your illness. avoid close contact with your coworkers. a hospital stay. For some people at high risk of serious flu complications, an 2. TRUE 4. TRUE antiviral may be an option; this medication Antibiotics treat bacterial infections, not Colds and the flu often share some works best taken within a day or two of the viral infections responsible for colds common symptoms, such as a runny nose, developing symptoms. or the flu. In fact, if you take antibiotics a cough, and a sore throat, but fevers rarely when you don’t need them, they may be accompany colds (though they’re more less effective against bacterial infections common in infants and small children with that you catch in the future. Relieve your a cold). Muscle aches, headaches, and Search for the article symptoms with rest and appropriate over- tiredness also occur more often when the Flu or Cold Symptoms? the-counter medications. flu strikes. at WebMD.com. This content is created and controlled by WebMD’s editorial staff. Checkup Living Well With RA TAKE LIFESTYLE STEPS TO MANAGE THIS AUTOIMMUNE DISEASE SPOTLIGHT
BY Matt McMillen REVIEWED BY Brunilda Nazario, MD, WebMD Senior Medical Editor
knee, or hip joints that prevents it, take daily walks. Start slowly and build up your endurance and distance. Set your sights on 10,000 steps a day. That may be a realistic goal for you.
Q DOES MY WEIGHT AFFECT MY RA? STOHL Yes, it does. The heavier you are, the more effort your joints will have to make to keep you upright. Also, when you carry excess fat, your body produces more cytokines, a type of protein that boosts inflammation and aggravates your RA symptoms. There’s no doubt that individuals with RA who maintain a proper weight do better than those who do not.
Q BEYOND JOINT HEALTH, WHAT OTHER HEALTH CONCERNS SHOULD I BE AWARE OF? STOHL The inflammation caused by RA can damage more than your joints. People with RA have higher odds of having a heart attack, stroke, and other heart problems. That makes it particularly important to keep your RA well-managed. You can also help protect your heart by maintaining a healthy diet and exercising regularly.
Q IF MY RA GOES INTO REMISSION, HOW WILL THAT RHEUMATOID ARTHRITIS (RA) CAUSES YOUR IMMUNE SYSTEM AFFECT MY TREATMENT? TO ATTACK YOUR JOINTS, Unchecked, it can lead to irreversible STOHL One pitfall RA patients often fall into is thinking that joint damage and disability. Sometimes RA can affect other organs once they feel better, they can stop or cut back their medication. like your eyes, skin, and lungs. That’s a bad idea because it can trigger a relapse. If you do feel It has no cure, but treatments help control the symptoms and better, talk to your physician, who may recommend that you slow the progression of the disease. William Stohl, MD, take a lower dose of your medication or take it less frequently. PhD, a professor of medicine and chief of rheumatology at the Your doctor even may recommend you go drug-free. But don’t University of Southern California’s Keck School of Medicine, make those decisions on your own. answers questions about living well with RA. Q ARE THERE ANY PROMISING NEW DEVELOPMENTS IN NON- Q HOW CAN EXERCISE HELP RHEUMATOID ARTHRITIS? DRUG TREATMENTS FOR RA? STOHL Exercise allows you to better maintain your joints’ ability STOHL Recent research into vagus nerve stimulation suggests that to function. Of course, it’s easier said than done when you have RA could be treated not just biologically but electrically. The discomfort. Talk to your doctor or physical therapist to deter- vagus nerve helps control inflammation, and signals sent from mine the most beneficial exercises for you as well as which work- an implanted device, currently being tested in a small number of outs you should avoid. Unless you have damage to your ankle, people, appear to help the vagus nerve do a better job of that.
BY THE NUMBERS
Rheumatoid arthritis doubles $20,000 to $50,000 the risk of heart attack, Estimated annual cost of biologic stroke, and atherosclerosis, Percentage of 1.5 million treatments for an individual with the dangerous buildup of people with RA Number of Americans living with rheumatoid arthritis. GETTY IMAGES 2x plaque in the arteries. 75% who are women. rheumatoid arthritis. 57 WEBMD.COM GETTY IMAGES WHO’S WHO Podiatrist REVIEWED BY BY THIS HEALTH CARE PROFESSIONAL PUTS YOUR FEET FIRST FEET YOUR PUTS PROFESSIONAL CARE HEALTH THIS 11 BY THE NUMBERS Jodi Helmer Jodi Helmer required to become apodiatrist. school degrees andresidencies— undergraduate andmedical and training—including Number ofyears ofeducation
Arefa Cassoobhoy, MD, MPH,WebMD SeniorMedicalEditor
9 in theU.S. of podiatricmedicine Number ofcolleges
75% foot-related symptoms. cause disease,whichoften andheart arthritis, are associated withissuessuchasdiabetes, andanklesand numbnessortinglinginthefeet signs ofhealthproblems:Swelling,stiff joints, professionals arealsoamongthefirst tospotthe highlytrainedsurgeries. medical These physical therapy, andperform fractures, set public healthandprescribemedication, order ofhospitals, nursinghomes,anddepartments Podiatrists workinprivate medicalpractices, better health. treatment canhelpyoutake toward abigstep indiagnosisand expertise toenails. Their ulcers, heelspurs,bunions,calluses,andingrown tumors, includingfractures, ankles andfeet, (DPM), specializesinconditionsthat affect the and podiatrists careforallofthem. next appointment.next of thepodiatrist’s office untilit’s timeforyour likely youaretowalk,run,dance,orskipout goodand practicing foothygiene. suchasworkandsports,right shoesforactivities of maintainingahealthy weight,choosingthe Podiatrists educate patients abouttheimportance Most commonfootproblemscanbeprevented. complications.disease andpreventing ofmanagingthe part a podiatrist isanimportant neuropathy. Making anannualappointmentwith damage knownasdiabeticpermanent nerve that areslowtoheal, andfoot ulcers,infections causing issuessuchastake itstollonyourfeet, can ofroutine care.Diabetes an essentialpart appointmentswithpodiatrists arediabetes, For millionAmericans livingwith the30.3 52 BONES, 38 MUSCLES, AND 214 LIGAMENTS— TOGETHER, YOUR FEET CONTAIN 66 JOINTS, ON THE FRONT LINES OF CARE PRIORITIZING PREVENTION DEVOTED TO DIABETES CARE A podiatrist, or doctor ofpodiatric medicineA podiatrist, ordoctor The better your feet andanklesfeel,themore better yourfeet The their lives. problems in have foot health Americans who Percentage of 250,000 your feet. Number ofsweat glandsin Checkup WEBMD.COM
58 GETTY IMAGES FOCUS ON least and sharesymptomscanbeconfusing,tosay the LymphocyticChronic Leukemia bothering them, or if their red blood cell count is bothering them,oriftheirredbloodcellcountis enlarged lymphnodesthat are orvery infections, lot ofnightsweats orfever, bacterial recurrent —bad fatigue that affects their quality oflife,a haverequire treatment. symptoms “Ifthey severe abnormal whitebloodcells. biopsiesalymphnode,itreveals their doctor when they’re shaving,” Yazdy says. when Then enlarged lymphnodesbyaccident,forexample, be thefirst clue.“In somecases,patients find during anannualcheckupismorelikely to resultwarning signs.Anabnormalbloodtest and weightlosstypically aren’tthefirst (where bloodcellsform). new it’sCLL, mainlyinthebloodandbonemarrow ofthecancerisinlymphnodes.In most SLL, difference The lymphocytes. istheirlocation. In of infection-fighting whitebloodcells called Center DivisionofHematology/Oncology. Hospital ComprehensiveCancer intheLombardi ing physician at MedStar University Georgetown cancer,” says Maryam Sarraf Yazdy, MD, attend - REVIEWED BY BY HAVE CONFOUNDINGLY ACRONYMS SIMILAR AND SMALL LYMPHOCYTIC LYMPHOMA (SLL) THAT CHRONIC LYMPHOCYTIC LEUKEMIA (CLL) YEAR. FOR PEOPLE WHO DO GET CLL, THE OUTLOOK IS FAR DIFFERENT TODAY THAN IT WAS JUST A FEW YEARS AGO. YEARS AFEW WAS TODAY JUST IT THAN FAR IS DIFFERENT OUTLOOK THE CLL, GET DO WHO PEOPLE FOR YEAR. EACH DIAGNOSED NEWLY PEOPLE 61,000 THAN MORE WITH ADULTS, IN LEUKEMIA OF TYPE COMMON MOST THE IS CLL A high white blood cell count alone doesn’t A highwhitebloodcellcountalonedoesn’t Symptoms like afever, chills,nightsweats, withthegrowth Both CLLandSLLinterfere Stephanie Watson . “Technically, they’re boththesametype of
Hansa Bhargava, MD, WebMD SeniorMedicalEditor
exciting era for doctors andpatients erawithCLL.”exciting fordoctors promising results,” Yazdy isavery says. “This in researchtrialsaroundtheworld,“withvery andimmunetherapy targeted drugsare new to treatment shouldn’t despair. Anumberof drug approach. adifferent cantry back. Whenitdoes,doctors comeat somepoint,thediseasewillinevitably a BCL-2inhibitor, thedeath hastens ofcancercells. a kinasethat helpscancercellsdivide.Anotherdrug, ofaproteincalled used totreat CLLblockstheaction Onetype ofdrugcommonly cell that helpitsurvive. use whattherapy.” wecalltargeted allpatientsalmost canavoid chemotherapy and thingshappening,”and exciting Yazdy says. “Now therehasbeensomuchresearch the worldofCLL, haschangedThat dramatically inrecent years.“In and allthesideeffects that comealongwithit. on treatment, whichusedtomeanchemotherapy andbloodtests. for exams that involves regular visitstotheircancerdoctor approach surveillance” take an“active ble. They’ll treatment,- becausetheirdiseasewillremainsta treatment,”reasons tostart Yazdy says. lowandthey’re anemic—thesecouldallbe very People resistant whoseCLLremainsstubbornly Most peoplerespondwelltotreatment, but Targeted specific drugsgo after ofthecancer parts People whosecancercausessymptomswillstart need About 30%ofpeoplewithCLLwillnever 3. 4. 1. 2. into friendsandfamily. boards,message ortap visitonline with CLL, groupsupport for people going through. Joina understand whatyou’re practice canbe. and de-stressing the amazed athow calming minutes aday. You’ll be on your breath for afew close your eyes, andfocus helps to improve sleep. and depression, andit Fitness combatsfatigue rewarded ifyou move. exercise, butyou’ll be makes itharder to your treatment. immune system through strong andfortify your dairy—will keep your body whole grains, andlow-fat vegetables, protein, lean of foods—fruits and DURING TREATMENTDURING BETTER FEEL YOU TO HELP STRATEGIES FOUR SUGGESTS YAZDY, MD, SARRAF ONCOLOGIST CLL. HEMATOLOGIST/ WAYONE TO MANAGE JUST IS MEDICINE 4 TIPS Cancer weariness Cancer STEP UP STEP Sit somewhere quiet, MEDITATE The right mix The rightmix EAT WELL EAT Lean onpeoplewho FIND SUPPORT Checkup
MARYAM . Search for the slideshow Myths and Facts About Obstructive Checkup Sleep Apnea at WebMD.com.
10 TIPS TO COPE
1. SLIM DOWN Lose excess weight to breathe more easily overnight.
REVIEW YOUR 2.MEDICATIONS Ask your doctor if any drugs you take impact sleep.
3.LISTEN UP If your partner says you snore, take it seriously. It could indicate sleep apnea.
4. QUIT SMOKING Tobacco irritates your airway, so ditch the cigarettes to improve sleep.
5. HAVE AN EXAM Get evaluated for heart disease and other conditions affected by sleep apnea.
SEEK 6. COUNSELING Try cognitive behavioral therapy to develop better Sleep Apnea sleep habits. REMOVE TRY THESE TIPS FOR MANAGING YOUR CONDITION AND GET 7. OBSTACLES A BETTER—AND HEALTHIER—NIGHT’S SLEEP Have a specialist check your nose and throat BY Matt McMillen for obstructions.
HEALTH HIGHLIGHTS HEALTH REVIEWED BY Hansa Bhargava, MD, WebMD Senior Medical Editor
8. EASE IN EXPERT “It can take time to adapt “Keep your sleep environment “Sleep apnea is a major risk Create a relaxing pre- TIPS to your continuous positive dark, quiet, and cool, with the factor for heart attack and bedtime routine to airway pressure (CPAP) device. ideal temperature being 68 stroke after age 50. Fortunately, improve your sleep. Set it up in your living room degrees, while you sleep. Try you can improve your for the first few days and use it incorporating regular exercise symptoms—and your sleep. while watching TV or reading. into your mornings or early Exercise regularly and practice 9. FIND FRIENDS Start with 15 to 20 minutes afternoons rather than working yoga to build respiratory Join a sleep apnea then slowly increase the time. out in the evening and avoid strength and encourage oxygen support group to connect Once comfortable with it, alcohol and heavy meals in the flow; take care of your nose, with others. move it to the bedroom and three hours before your bedtime.” sinus, and allergies; and see an
gradually increase how long ASHA SINGH, MD otolaryngologist who specializes you use it overnight.” assistant professor of neurology in snoring and sleep apnea.” 10. ROLL OVER THOMAS KILKENNY, DO and director of the Sleep JORDAN JOSEPHSON, MD Sleep on your side, director of sleep medicine, Staten Medicine Program, Oregon otolaryngologist, Lenox Hill not your back, to Island University Hospital, Staten Health and Science University, Hospital, New York City breathe better. Island, New York Portland, Oregon GETTY IMAGES
60 WEBMD.COM TEN QUESTIONS Take 10 REAL LIFE
AFTER 11 YEARS OF PERFORMING YOU LOST 50 POUNDS AND HAVE 1. WITH YOUR BROTHER DONNY IN 6.KEPT IT OFF FOR MORE THAN A LAS VEGAS, YOU JOINED THE TALK IN DECADE. WHAT INSPIRED YOU TO LOSE SEPTEMBER. WHAT EXCITES YOU MOST THE WEIGHT? ABOUT YOUR NEW HOSTING ROLE? I was taking care of my mom and my Since I married my husband, this will dad and doing a radio show, but in the be the first time that I’ll be able to have process, I had put on 50 pounds, and dinner with him at night. It’s a great on me that’s a lot of weight, because schedule. The ladies are fantastic. The I’m small-framed. As my mother was crew, everybody involved. There could passing away, she said, “Do not do to not be any nicer people on the planet. your body what I did to mine. Take care It’s a dream job! of yourself.” … That’s when I decided I really needed to do something. WHAT ARE YOU MOST LOOKING 2.FORWARD TO TALKING ABOUT? HOW DID THE WEIGHT LOSS That’s the thing that’s wonderful 7. CHANGE YOU? about the show—they talk about I was sitting on the sidelines. I was everything, which is fun. And they the one taking the pictures because include the audience. We’re very I didn’t want to be in them. Now I’m different people, but we respect each on the floor taking selfies with my other’s opinions. grandchildren. It’s wonderful.
WHY DID YOU DECIDE TO RECORD WHAT IS YOUR PHILOSOPHY WHEN 3.AN OPERA/BROADWAY ALBUM WITH 8.IT COMES TO EXERCISE? THE CITY OF PRAGUE ORCHESTRA? I really believe that physical fitness to I continually like to challenge myself. me is a clear mind, and it ripples like a … Throughout my life I’ve done wave to the body. ... You get your body country, I’ve done pop, I’ve done in shape, and it helps your mind think various genres, but this is the first more clearly. time I’ve done an opera with soprano YOU TURN 60 THIS MONTH. HOW DO vocals. I’m singing in Italian, French, 9.YOU FEEL ABOUT GETTING OLDER? and German. It’s just another fun I am totally at peace with it. I have opportunity before my voice will not lived my life every year without be able to do it. … My son who passed regret. … I’m not going to be fanatical away, Michael—it was his favorite trying to look 20 when I’m 80. I’m way that I sing. This album will be going to be very grateful. dedicated to him. Marie Osmond Singer, actor, author, philanthropist, 60 WHEN YOU HAVE FREE TIME, HOW YOUR GRANDDAUGHTER WAS 4.DO YOU LIKE TO UNWIND? Los Angeles/Las Vegas 10. RECENTLY TREATED AT ONE I’m a very hard worker, and I’m a very OF THE CHILDREN’S MIRACLE NETWORK HOSPITALS, AN ORGANIZATION hard-playing person. I try to be as YOU CO-FOUNDED. WHAT WAS THAT balanced as possible. … For relaxing, EXPERIENCE LIKE? it’s definitely [spending time with] my “I’M NOT GOING TO BE When you walk in and you see your children, my grandchildren, and my daughter with tears in her eyes, and husband. I’m looking forward to that. FANATICAL TRYING TO LOOK there’s her little baby she just gave birth to hooked up to all of these machines WHAT HAS BEING A MOTHER TO 20 WHEN I’M 80. I’M GOING 5.EIGHT CHILDREN TAUGHT YOU? that we provide—that’s life changing. … No one is going to know me in 50 Children teach you unconditional TO BE VERY GRATEFUL.” years, but they will know these hospitals love. They teach you sacrifice and because of the service that we do. selflessness. They’re your priority.
ADELA LOCONTE/GETTY IMAGES LOCONTE/GETTY ADELA —STEPHANIE WATSON
61 WEBMD.COM