Pattayacalendar

Get expert advice on gathering safely from Harvard Health Publishing. Spoiler alert: vaccination is key to helping keep everyone healthy. Below, our faculty contributors share their own plans and advice for safely enjoying the holidays this year while answering three important questions.

Roger Shapiro, MD

Associate professor of immunology and infectious diseases, Harvard T.H. Chan School of Public Health, Boston

What are your plans this year for gathering — or not gathering — with family or friends during Thanksgiving and other winter holidays, and why?

Unlike 2020, my family will be gathering for Thanksgiving in 2021. Everyone in the family is vaccinated, and most are now boosted as well. We are all comfortable with the protection that being vaccinated brings, and there is agreement that if a COVID-19 exposure were to occur, it is unlikely to cause severe illness.

What advice can you offer people planning to gather in person to reduce the chance of getting or spreading the virus that causes COVID-19?

Everyone who can get vaccinated should be vaccinated, and those who qualify for a booster should get one. Children 5 to 11 may not have their second shot by Thanksgiving but can certainly be fully vaccinated by Christmas. If there are unvaccinated members of your family, your situation is no different than in 2020: gathering is unsafe for the unvaccinated because the first exposure to this virus can be lethal without protection from a vaccine. Additionally, people who are unvaccinated are more likely to be infected before traveling, so they are more likely to bring the virus to the table, possibly causing illness (even if mild) among those who are vaccinated. For families that are all vaccinated and wishing to further reduce the possibility of transmission, taking a rapid antigen test prior to gathering can add a layer of protection.

For people planning to travel to gatherings, what would you advise?

If you are all vaccinated, enjoy the return to a normal holiday season. Vaccines are your main source of protection. If you want to add additional protection, you can consider using rapid antigen tests just before gathering to confirm that everyone is negative. If there are immunocompromised members of your family who may not be fully protected by a vaccine, you should discuss the risks case-by-case with your doctor.

Suzanne Salamon, MD

Chief of clinical programs in gerontology, Beth Israel Deaconess Medical Center, Boston

What are your plans this year for gathering — or not gathering — with family or friends during Thanksgiving and other winter holidays, and why?

Let me start by saying my 99-year-old mother lives with us, and even though she’s had her third shot of the COVID vaccine, I’m very concerned about immune status. I also have a two-year-old granddaughter who cannot yet get the vaccine. So, everyone’s immune status is not equal. Certainly older people, even those who’ve had their third shot, may not have the same immune status as a 35-year-old.

We have really curtailed the size of our Thanksgiving dinner to under 10 people, since the CDC recommends smaller groups. Nobody wants to see people sitting at home alone during the holidays, but we have to make it as safe as possible for those who are there.

What advice can you offer people planning to gather in person to reduce the chance of getting or spreading the virus that causes COVID-19?

COVID cases are on the rise now in many places, even though a month ago the numbers were trending down. Unfortunately, we need to be more vigilant once again.

Many people are afraid to insult family and friends by asking them about vaccine status before they come. Tell people that you really want to see them, but some family or friends may be immune-suppressed or at higher risk if they get COVID-19, and you’re trying to make the gathering safe for everyone. That’s why I’d ask people to let you know their COVID vaccine status. Even after the two-vaccine series, research is showing diminished antibodies after six months, which may put people at higher risk for getting and/or spreading the virus. I would ask people who are not vaccinated not to come.

When people gather, ventilation is really important in reducing the concentration of any virus that might be present. Have the gathering outside or on a screened porch, if at all possible. We hosted Thanksgiving last year in our garage. We left the garage doors open and set up small tables and little space heaters for warmth. People could be social yet stay separated, and ventilation was great. You can decorate small tables with colorful plastic tablecloths and candles, even put down a rug. If you’re inside, windows and doors can be kept open, which will help move the air around. Have some small space heaters and sweaters available.

Ask everyone to bring a mask, or keep a box of masks available. Wear masks while you’re all chit-chatting until you sit down to dinner. In the bathroom, have a roll of paper towels or paper guest towels rather than a cloth towel, and leave the fan on for ventilation.

For people planning to travel to gatherings, what would you advise?

Planes are thought to be very safe. In the air terminal, sit apart from people. Keep your mask on during the flight.

Traveling by car is pretty safe. If you get out to go to the bathroom or get coffee, wear a mask and wash your hands. Traveling by bus or train is tricky, because even though there is a mask requirement, people will take off their masks. Be sure to wear your own mask. I personally double-mask. Two surgical masks block out a lot and can be a bit more comfortable than the N95 masks we wear in the hospital. A plastic face shield over the mask may be a good idea for added protection.

John J. Ross, MD

Hospitalist with specialty in infectious diseases, Brigham and Women’s Hospital, Boston

What are your plans this year for gathering — or not gathering — with family or friends during Thanksgiving and other winter holidays, and why?

We are having an unmasked, multigenerational, fully-vaccinated, traditional Thanksgiving dinner at my in-laws, just like the Before Times.

What advice can you offer people planning to gather in person to reduce the chance of getting or spreading the virus that causes COVID-19?

Everyone in attendance should have a primary COVID vaccination. Getting vaccinated against COVID reduces the risk of hospitalization or death due to COVID by more than 90%. It also reduces your risk of death from any cause. People who are eligible for booster shots should get them. That includes anyone over 65, and people over 18 with underlying medical conditions, high occupational risk, or those who live in high-risk settings such as group homes, shelters, and long-term care facilities.

Certain vaccinated people are more likely to get breakthrough COVID. This includes people of advanced age, and those with serious medical conditions or weak immune systems. These people should be extremely cautious around those who are not vaccinated or partly vaccinated. I would recommend that they mask around unvaccinated people, physically distance, and use extra ventilation (opening windows, or ideally moving the whole shebang outdoors). Rapid antigen tests may also be helpful in the setting.

For people planning to travel to gatherings, what would you advise?

For those who have long distances to travel, I would recommend flying if possible. Airplanes have excellent ventilation, and masks are mandatory. While masks are also required on trains, they are not as well ventilated as planes, and train travel has been associated with significant COVID risks.

Amy Sherman, MD

Division of infectious diseases, associate physician, Brigham and Women’s Hospital, Boston

What are your plans this year for gathering — or not gathering — with family or friends during Thanksgiving and other winter holidays, and why?

This Thanksgiving, my fiancé and I are driving to New Jersey and New York (with our dog!) to visit our families. We will have dinner with 14 others from my close family — larger than last year’s Thanksgiving, but smaller than pre-COVID years. Everyone has been vaccinated, and most have received a third dose. We will then visit with my fiancé’s 94-year-old-grandma, choosing to see her independently instead of bringing her to a large gathering.

Although no measures can absolutely make an indoor gathering 100% safe, we will apply layers of protective measures to reduce risk, with vaccinations as the base layer. Additionally, everyone will get tested for the virus that causes COVID-19 before gathering, limit exposure risks in the week before Thanksgiving, avoid public transportation, and drive instead of flying. When we’re together, we’ll spend time outdoors as much as possible. Maybe this year will bring new traditions — an outdoor bonfire instead of nighttime movie marathons, or Friday morning jogs instead of Jazzercise with my aunt!

What advice can you offer people planning to gather in person to reduce the chance of getting or spreading the virus that causes COVID-19?

We are in a much better place this year compared to last year. Connecting with family and friends is important for our mental health and well-being. However, we still need to be cautious, especially when gatherings include people who are older, immunocompromised, or at risk of severe COVID-19. We also have seen recent outbreaks in school-age kids who are not yet vaccinated. I would encourage your family and friends to get vaccinated if they haven’t already. For those family members at higher risk, consider smaller and more intimate gatherings, or do hybrid in-person/Zoom meetings. And layer up with the other risk reducing strategies I suggested!

For people planning to travel to gatherings, what would you advise?

Avoid public transportation if possible. If this is not possible, wear a mask on the bus, train, or airplane, even if you’ve been vaccinated. Vaccinations decrease the severity of disease, but you still could become infected and transmit the virus to others.

Read more advice on gathering for winter holidays this year, such as who can and should get a COVID-19 vaccine booster, whether to take a rapid test or PCR test before spending time with family or friends, how to navigate tricky relationships, and healthy eating through the holiday season.

Last winter, my wife shooed the dog and visiting toddlers away from our poinsettia plants, saying "they’re poisonous, you know."

I did not know. But it turns out that the belief that poinsettias are deadly is widespread. The same could be said for mistletoe and holly. But are their reputations for danger well-deserved? Since these plants are especially popular to brighten up homes or give as gifts during the holidays, I decided to look into it.

The risks of poinsettia

Could a plant so common and so well-liked in the winter holidays also be so dangerous? If it is dangerous, what problems does it cause? Must it be eaten to cause problems, or is it harmful to just be nearby? And if it’s not dangerous, why does the myth live on?

The answers to these questions are not easy to find. In fact, the bad reputation may have started in 1919, when an army officer’s child reportedly died after eating part of a poinsettia plant. It is unclear if the plant was responsible, though: many other reports describe mild symptoms, such as nausea or vomiting, but no deaths.

Decades ago, a study in the American Journal of Emergency Medicine analyzed nearly 23,000 cases of people eating poinsettia and found

• no fatalities
• nearly all cases (96%) required no treatment outside the home
• most cases (92%) developed no symptoms at all.

According to one estimate, a 50-pound child would have to eat more than 500 poinsettia leaves to approach a dose that could cause trouble. Similarly, pets may develop gastrointestinal symptoms after eating poinsettia, but these plants pose no major threat to animals.

The risks of mistletoe

The story is much the same for mistletoe. It’s not particularly dangerous, but may cause an upset stomach if eaten. In fact, mistletoe has been used for centuries as a remedy for arthritis, high blood pressure, infertility, and headache. The evidence isn’t high-quality for any of these uses, though.

Interest also centers on this plant’s potential as an anticancer treatment. Some extracts of mistletoe contain chemicals shown to kill cancer cells in the laboratory and to stimulate human immune cells. For example, a substance called alkaloids has similar properties as certain chemotherapy drugs used in the past to fight leukemia and other forms of cancer. However, a two-part 2019 review found that adding mistletoe extracts to conventional cancer treatments did not improve survival or quality of life.

No one suggests it's a good idea to eat this plant, accidentally or otherwise. But eating one to three berries or one or two leaves is unlikely to cause serious illness, according to the authors of a 1986 review of multiple studies. And no significant symptoms or deaths were described in one report of more than 300 cases of eating mistletoe. However, some sources warn that serious problems or even death may occur if enough is ingested. The specific dose required to cause death is unknown but, fortunately, it appears to be so high that consuming enough to be lethal is extremely rare.

The risks of holly

This plant can be dangerous to people and pets. The berries of holly plants are poisonous. If eaten, they may cause crampy abdominal pain, drowsiness, vomiting, and diarrhea. While no one would recommend eating holly, it is unlikely to cause death. And for at least one type of holly, knowing the Latin name would be enough to discourage ingestion: the yaupon holly is also called Ilex vomitoria.

The bottom line

No one should eat poinsettias, mistletoe, and holly, but if small amounts are consumed, they are unlikely to cause serious illness. It seems to me that the dangers of these plants appear to be vastly overestimated.

Perhaps the most dangerous thing about mistletoe and poinsettias is the choking hazard the berries pose for young kids, although that risk is not unique to plants: any small object poses similar risks. Try to keep holiday plants out of the reach of small children and pets. And keep in mind that berries may fall from these plants and wind up on the floor.

If a child or pet eats leaves or berries from these holiday plants, or any other plants, check in with poison control, your pediatrician, or your veterinarian. But unless a particularly large "dose" is consumed, don’t be surprised if the recommendation is to simply watch and wait.

Still concerned even if you know the risks are low? You can always regift holiday plants you receive to friends with no children or pets, or find other ways to decorate your home for the holidays.

In the US, breast cancer is the most commonly diagnosed cancer in women, and the second leading cause of cancer-related deaths. Each year, an estimated 270,000 women — and a far smaller number of men — are diagnosed with it. When caught in early stages, it’s usually highly treatable.

A promising new form of targeted treatment may expand options available to some women with early-stage breast cancer linked to specific genetic glitches. (Early-stage cancers have not spread to distant organs or tissues in the body.)

The BRCA gene: What does it do?

You may have heard the term BRCA (BReast CAncer) genes, which refers to BRCA1 and BRCA2genes. Normally, BRCA genes help repair damage to our DNA (genetic code) that occurs regularly in cells throughout the human body.

Inherited BRCA mutations are abnormal changes in these genes that are passed on from a parent to a child. When a person has a BRCA mutation, their body cannot repair routine DNA damage to cells as easily. This accumulating damage to cells may help pave a path leading to cancer. Having a BRCA1 or BRCA2 mutation — or both — puts a person at higher risk for cancer of the breast, ovaries, prostate, or pancreas; or for melanoma. A person’s risk for breast cancer can also be affected by other gene mutations and other factors.

Overall, just 3% to 5% of all women with breast cancer have mutations in BRCAgenes. However, BRCA mutations occur more often in certain groups of people, such as those with triple negative breast cancer (TNBC), Ashkenazi Jewish ancestry, a strong family history of breast and/or ovarian cancer, and younger women with breast cancer.

Inherited BRCA mutations and breast cancer types

Certain types of breast cancer are commonly found in women with BRCA gene mutations.

• Estrogen receptor-positive, HER2-negative cancer: Women with a BRCA2 mutation usually develop ER+/HER2- breast cancer — that is, cancer cells that are fueled by the hormone estrogen but not by a protein known as HER2 (human epidermal growth factor 2).
• Triple negative breast cancer: Women with a BRCA1 mutation tend to develop triple negative breast cancer (ER-/PR-/HER2-) — that is, cancer cells that aren’t fueled by the hormones estrogen and progesterone, or by HER2.

Knowing what encourages different types of breast cancer to grow helps scientists develop new treatments, and helps doctors choose available treatments to slow or stop tumor growth. Often this involves a combination of treatments.

A new medicine aimed at early-stage BRCA-related breast cancers

The OlympiA trial enrolled women with early-stage breast cancer and inherited BRCA1/BRCA2 mutations. All were at high risk for breast cancer recurrence despite standard treatments.

Study participants had received standard therapies for breast cancer:

• surgery (a mastectomy or lumpectomy)
• chemotherapy (given either before or after surgery)
• possibly radiation
• possibly hormone-blocking treatment known as endocrine therapy.

They were randomly assigned to take pills twice a day containing olaparib or a placebo (sugar pills) for one year.

Olaparib belongs to a class of medicines called PARP inhibitors. PARP (poly adenosine diphosphate-ribose polymerase) is an enzyme that normally helps repair DNA damage. Blocking this enzyme in BRCA-mutated cancer cells causes the cells to die from increased DNA damage.

Results from this study were published in the New England Journal of Medicine. Women who received olaparib were less likely to have breast cancer recur or metastasize (spread to distant organs or tissues) than women taking placebo. Follow-up at an average of two and a half years showed that slightly more than 85% of women who had received olaparib were alive and did not have a cancer recurrence, or a new second cancer, compared with 77% of women treated with placebo.

Further, the researchers estimated that at three years:

• The likelihood that cancer would not spread to distant organs or tissues was nearly 88% with olaparib, compared to 80% with placebo.
• The likelihood of survival was 92% for the olaparib-treated group and 88% for the placebo group.

The side effects of olaparib include low white cell count, low red cell count, and tiredness. The chances of developing these were low.

The bottom line

Olaparib is already approved by the FDA to treat BRCA-related cancers of the ovaries, pancreas, or prostate, and metastatic breast cancer. FDA approval for early-stage breast cancer that is BRCA-related is expected soon based on this study. These findings suggest taking olaparib for a year after completing standard treatment could be a good option for women who have early-stage breast cancer and an inherited BRCA gene mutation who are at high risk for cancer recurrence and, possibly, its spread.

Follow me on Twitter @NeelamDesai_MD

If you have trouble losing weight despite your best efforts, this is because obesity is a complex disease with many causes. A family history of weight issues can make it more likely that you’ll have the same issues managing your weight. A diet high in ultra-processed foods, sugar, and fat and being sedentary also contribute to weight gain. Stress and struggles with mental health, including medications to treat certain mental health conditions, poor sleep, and hormonal changes, are all factors that further contribute to weight gain.

There are many ways to combat excess weight, but there is no single solution. If you are trying to lose or maintain your weight, you may want to try yoga. There is good research that yoga may help you manage stress, improve your mood, curb emotional eating, and create a community of support, all of which can help with weight loss and maintenance.

Yoga can also help you burn calories, as well as increase your muscle mass and tone. Yoga may reduce joint pain, which in turn allows you to exercise more and increase your daily activities. These are only some of the many benefits of yoga.

Yoga can help you manage stress that can impact weight gain

Yoga is derived from the Sanskrit word yuj, which means to unite the body, mind, and emotions. It is a holistic mind-body practice that improves many of the causes of weight gain.

Some people may experience stress as physical pain or sleep deprivation, or it may be psychological and cause feelings of anxiety and agitation. Stress leads to an increase in the hormone cortisol. Cortisol increases abdominal fat, decreases muscle mass, causes cravings for fat and sugar-rich food, and thus can lead to obesity.

Yoga can decrease stress and cortisol levels, enhance mood, decrease anxiety and depression, improve sleep, and improve chronic conditions such as hypertension and diabetes, reducing the need for medications that can cause weight gain.

Yoga is not a band-aid for excess weight, but it may work on the underlying causes. Its benefits extend beyond the calories-in-versus-calories-out equation.

Yoga can improve mindfulness related to eating behaviors

Most of us who crave ice cream after 9 pm or can’t stop eating potato chips know that these behaviors hurt our chances of losing weight. We all know that eating vegetables, whole grains, lean protein, etc. is good for our health and weight. While this knowledge is necessary, it seems insufficient to help us stick to our healthy eating plans.

One of yoga’s benefits is that it improves mindfulness of the body and awareness of body sensations. This is why yoga is called “moving meditation.” Research shows that you don’t have to do any formal sitting meditation to get the mindfulness benefits of yoga.

By improving mindfulness, yoga decreases emotional eating, stress eating, and binge eating. These habits sabotage our weight loss efforts and can cause a negative spiral of guilt and shame, which often leads to giving up.

A study published in 2015 showed that practicing yoga led to healthier eating, including lower fat intake and an increase in vegetables and whole grains.

The bottom line: the best diet plan is the one that you can stick with over the long term, and by improving mindfulness, yoga can help you make healthier food choices.

A yoga community can provide acceptance and support

Going to a gym can be intimidating, and may provoke feelings of not belonging for some people with larger bodies. By contrast, yoga culture embodies kindness, support, and self-acceptance.

Yoga teachers and advanced practitioners can serve as role models and inspire newer students to live a healthier lifestyle. Research shows that social networks influence behaviors that affect weight. The yoga network encourages positive health behaviors, and being a part of such a community can make a meaningful difference for weight loss. This type of community can be hard to find with other types of exercise.

Practitioners should look for a safe, comfortable environment. A welcoming yoga group may help you improve your self-esteem and confidence. Find a local studio that feels nurturing and not overwhelming, with other practitioners at your level. Teachers can help beginners or those with physical limitations by modifying poses. You might have to try a few different classes before you find an instructor or a class that you like. Don’t give up after the first one!

If you can’t find a local studio, there are always online options on YouTube and Instagram, with classes at all levels. There are instructors who understand what it is like to be a larger size, and having an inclusive, body-affirming attitude shows that yoga is not just for “skinny people.” Some share inspirational stories of how yoga helped them overcome their own weight struggles, depression, and binge eating. If you are a beginner, consider signing up for a short challenge to get committed to the practice.

The benefits of yoga are universal — no matter what your shape or size. It can take weeks or months to establish a yoga practice, and frequent practice is key for long-lasting benefits.

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Neurodiversity describes the idea that people experience and interact with the world around them in many different ways; there is no one “right” way of thinking, learning, and behaving, and differences are not viewed as deficits.

The word neurodiversity refers to the diversity of all people, but it is often used in the context of autism spectrum disorder (ASD), as well as other neurological or developmental conditions such as ADHD or learning disabilities. The neurodiversity movement emerged during the 1990s, aiming to increase acceptance and inclusion of all people while embracing neurological differences. Through online platforms, more and more autistic people were able to connect and form a self-advocacy movement. At the same time, Judy Singer, an Australian sociologist, coined the term neurodiversity to promote equality and inclusion of “neurological minorities.” While it is primarily a social justice movement, neurodiversity research and education is increasingly important in how clinicians view and address certain disabilities and neurological conditions.

Words matter in neurodiversity

Neurodiversity advocates encourage inclusive, nonjudgmental language. While many disability advocacy organizations prefer person-first language (“a person with autism,” “a person with Down syndrome”), some research has found that the majority of the autistic community prefers identity-first language (“an autistic person”). Therefore, rather than making assumptions, it is best to ask directly about a person’s preferred language, and how they want to be addressed. Knowledge about neurodiversity and respectful language is also important for clinicians, so they can address the mental and physical health of people with neurodevelopmental differences.

Neurodiversity and autism spectrum disorder

Autism spectrum disorder (ASD) is associated with differences in communication, learning, and behavior, though it can look different from person to person. People with ASD may have a wide range of strengths, abilities, needs, and challenges. For example, some autistic people are able to communicate verbally, have a normal or above average IQ, and live independently. Others might not be able to communicate their needs or feelings, may struggle with impairing and harmful behaviors that impact their safety and well-being, and may be dependent on support in all areas of their life. Additionally, for some people with autism, differences may not cause any suffering to the person themself. Instead, the suffering may result from the barriers imposed by societal norms, causing social exclusion and inequity.

Medical evaluation and treatment is important for individuals with ASD. For example, establishing a formal diagnosis may enable access to social and medical services if needed. A diagnostic explanation may help the individual or their family understand their differences better and enable community connections. Additionally, neurodevelopmental conditions may also be associated with other health issues that require extra monitoring or treatment. It is important that people who need and desire behavioral supports or interventions to promote communication, social, academic, and daily living skills have access to those services in order to maximize their quality of life and developmental potential. However, approaches to interventions cannot be one-size-fits-all, as all individuals will have different goals, desires, and needs.

Fostering neurodiversity in the workplace

Stigma, a lack of awareness, and lack of appropriate infrastructure (such as office setup or staffing structures) can cause exclusion of people with neurodevelopmental differences. Understanding and embracing neurodiversity in communities, schools, healthcare settings, and workplaces can improve inclusivity for all people. It is important for all of us to foster an environment that is conducive to neurodiversity, and to recognize and emphasize each person’s individual strengths and talents while also providing support for their differences and needs.

How can employers make their workplaces more neurodiversity-friendly?

• Offer small adjustments to an employee’s workspace to accommodate any sensory needs, such as
  • Sound sensitivity: Offer a quiet break space, communicate expected loud noises (like fire drills), offer noise-cancelling headphones.
  • Tactile: Allow modifications to the usual work uniform.
  • Movements: Allow the use of fidget toys, allow extra movement breaks, offer flexible seating.
• Use a clear communication style:
  • Avoid sarcasm, euphemisms, and implied messages.
  • Provide concise verbal and written instructions for tasks, and break tasks down into small steps.
• Inform people about workplace/social etiquette, and don’t assume someone is deliberately breaking the rules or being rude.
• Try to give advance notice if plans are changing, and provide a reason for the change.
• Don’t make assumptions — ask a person’s individual preferences, needs, and goals.
• Be kind, be patient.

Resources to learn more about neurodiversity

Neurodiversity in the Workplace

That recurring sound that you hear but nobody else does? It’s not all in your head. Well, not exactly.

You may be one of the estimated 50 million-plus people who suffer from tinnitus. The mysterious condition causes a sound in the head with no external source. For many it’s a high-pitched ringing, while for others it’s whistling, whooshing, buzzing, chirping, hissing, humming, roaring, or even shrieking.

The sound may seem to come from one ear or both, from inside the head, or from a distance. It may be constant or intermittent, steady or pulsating. One approach to managing this condition is different forms of sound therapy intended to help people tune out the internal soundtrack of tinnitus.

What causes tinnitus?

There are many possible causes of tinnitus. Long-term exposure to loud noises is often blamed. But other sources include middle ear problems like an infection, a tumor or cyst pinching nerves in the ear, or something as simple as earwax buildup. Tinnitus also can be a symptom of Meniere’s disease, a disorder of the balance mechanism in the inner ear.

Even old-fashioned aging can lead to tinnitus, which is common in people older than age 55. As people get older, the auditory nerve connecting the ear to the brain starts to fray, diminishing normal sounds.

“Neurons (nerve cells) in areas of the brain that process sound make up for this loss of input by increasing their sensitivity,” says Daniel Polley, director of the Lauer Tinnitus Research Center at Harvard-affiliated Massachusetts Eye and Ear. “The sensitivity knobs are turned up so high that neurons begin to respond to the activity of other nearby neurons. This creates the perception of a sound that does not exist in the physical environment. It’s a classic example of a feedback loop, similar to the squeal of a microphone when it is too close to a speaker.”

At times, everyone experiences the perception of a phantom sound. If it only lasts for a few seconds or minutes, it’s nothing to worry about. However, if it pulsates in sync with your heart rate, it’s definitely something to get checked out by a physician, says Polley. If it’s a relatively continuous sound, you should see an audiologist or otolaryngologist (ears, nose, throat specialist).

Can sound therapy help tune out tinnitus?

There is no cure for tinnitus, but it can become less noticeable over time. Still, there are ways to ease symptoms and help tune out the noise and minimize its impact. Treatments are a trial-and-error approach, as they work for some people but not others.

One often-suggested strategy is sound therapy. It uses external noise to alter your perception of or reaction to tinnitus. Research suggests sound therapy can effectively suppress tinnitus in some people. Two common types of sound therapy are masking and habituation.

• Masking. This exposes a person to background noise, like white noise, nature sounds, or ambient sounds, to mask tinnitus noise or distract attention away from it. Listening to sound machines or music through headphones or other devices can offer temporary breaks from the perception of tinnitus. Household items like electric fans, radios, and TVs also can help. Many people with tinnitus also have some degree of hearing loss. Hearing aids can be used to mask tinnitus by turning up the volume on outside noises. This works especially well when hearing loss and tinnitus occur within the same frequency range, according to the American Tinnitus Association.
• Habituation. Also known as tinnitus retraining therapy, this process trains your brain to become more accustomed to tinnitus. Here, you listen to noise similar to your tinnitus sound for long periods. Eventually your brain ignores the tone, along with the tinnitus sound. It’s similar to how you eventually don’t think about how glasses feel on your nose. The therapy is done with guidance from a specialist and the time frame varies per person, usually anywhere from 12 to 24 months.

Additional approaches may help with tinnitus

Depending on your diagnosis, your doctor also may recommend addressing issues that could contribute to your tinnitus.

• Musculoskeletal factors. Jaw clenching, tooth grinding, prior injury, or muscle tension in the neck can sometimes make tinnitus more noticeable. If tight muscles are part of the problem, massage therapy may help relieve it.
• Underlying health conditions. You may be able to reduce the impact of tinnitus by treating conditions like depression, anxiety, and insomnia.
• Negative thinking. Adopting cognitive behavioral therapy and hypnosis to redirect negative thoughts and emotions linked to tinnitus may also help ease symptoms.
• Medication. Tinnitus can be a side effect of many medications, especially when taken at higher doses, like aspirin and other nonsteroidal anti-inflammatory drugs and certain antidepressants. The problem often goes away when the drug is reduced or discontinued.

Migraine is a common and disabling headache disorder. Painful migraine headaches frequently affect people between the ages of 18 and 44. Many common medication treatments for migraine may cause side effects that are difficult to tolerate, and can lead people to not take their medications as recommended, or to stop taking them altogether. A recent study suggests that up to 20% of patients with migraine have used opioids to treat their pain in the past year. Therefore, there is a great need for better and more tolerable treatments for people who have migraines.

Research has shown that combining behavioral treatments with preventive medication treatments works better for preventing headaches than medications alone. Mindfulness practice has also been associated with improvements in individuals with chronic pain, including migraine. Mindfulness is the mind-body treatment that involves purposely focusing one’s attention on the present momentary awareness and accepting it without judgment.

Stress is a well-known trigger for migraine. Moreover, stressful events have been associated with people experiencing more frequent or chronic migraines versus having them occasionally. Mindfulness can result in stress reduction, reduced emotional response to stress, and improved general happiness. In patients with migraine, pain severity and unpleasant symptoms can be reduced with this treatment.

Mindfulness can potentially strengthen emotional and cognitive control of pain by helping to train someone with migraine to reassess their pain in a nonjudgmental way and modify their evaluation of the pain. In addition, mindfulness practices can help to control depression, anxiety, and pain catastrophizing (an exaggerated negative feeling toward pain experiences), which can play a role in chronic migraine.

The study

In a recent study published in JAMA, a group of researchers investigated whether mindfulness-based stress reduction may provide benefit for people experiencing migraine. The study randomly assigned half of participants with migraine to the mindfulness treatment and the other half to only headache education.

The mindfulness-based stress reduction treatment incorporated eight weeks of two-hour, in-person classes, which included sitting and walking meditation, body scanning (sequential attention to parts of the body), and mindful movement (bodily awareness during gentle stretching using hatha yoga), bringing attention back to the natural rhythm of the breath. In addition, the study participants were encouraged to build their capacity to address physical and mental perceptions of their pain, and they were provided audio files for at-home practice.

The headache education treatment included a standardized protocol of eight weeks of two-hour, in-person classes that contained education about the biological, psychological, and environmental processes associated with migraines, headache triggers, and stress. The patients were also given time for questions, answers, and discussion during each class.

The results

The researchers demonstrated that mindfulness-based stress reduction treatment significantly improved people’s disability, quality of life, self-efficacy, pain catastrophizing, and depression compared to patients who only had headache education. Reductions in monthly migraine days were observed in those with mindfulness-based stress reduction treatment, but were not significantly different from those receiving headache education. The authors of the study explain that the reason they could not demonstrate improvement in the headache frequency could be the use of an active control group such as headache education, which itself may result in improvement of headache frequency.

Most importantly, the study demonstrated that mindfulness-based treatments can reduce the burden of migraine. With mindfulness, the participants of the study may have learned a new way of processing pain that may have a significant effect on their long-term health. The results of this study have major implications for both patients and clinicians, and the research can support a holistic, integrative treatment plan for patients with migraine, with less emphasis on nonmedical treatments.

What you can do

Many healthcare providers, including headache specialists, pain specialists, neurologists, and primary care physicians, have started to incorporate mindfulness-based treatment in their practices, or they have sought mindfulness-based programs or specialists for their patients.

There are also many ways for patients with migraine to practice mindfulness at home. Patients with migraine can integrate some of the following mindfulness-based practices in their daily life, including during a migraine headache:

• Accept yourself, your present moment.
• Lie on your back or in a comfortable position with no distractions, and direct your awareness to your body and breathing. Scan your body and observe your feet, legs, hands, arms, and other parts of your body.
• Try to sit down in a comfortable and quiet place, close your eyes, take a deep breath. Try to do breathing exercises, paying attention to the sensations of your breath while inhaling and exhaling.
• Sitting or walking meditation done outside in nature may be very relaxing. Focus on the experience of walking, being aware of the sensations of standing and the subtle movements that keep your balance.

Resources

There many are apps and quality resources for mindfulness and migraine learning and practice. Here are few online resources to explore:

Body scan mindfulness exercise for pain (Harvard Health Publishing)

Mindfulness Meditation for Migraine (American Migraine Foundation)

Mindfulness series for Migraine & Headache Disorders (Miles for Migraine)

Mindfulness and Migraine (National Headache Foundation)

During the first year of life, naps are crucial for babies (who simply cannot stay awake for more than a couple of hours at a time), and crucial for parents and caregivers, who need breaks from the hard work of caring for an infant.

But as children become toddlers and preschoolers, naps aren’t always straightforward. Children often fight them (following the “you snooze you lose” philosophy), and they can conflict with daily tasks (such as school pick-up when there are older siblings) or lead to late bedtimes.

Here are some tips for making naps work for you and your child — and for knowing when they aren’t needed anymore.

Making naps work for your baby

Most infants will take at least two naps during the day, and early in toddlerhood most children will still take both a morning nap and an afternoon nap. Naps are important not just for physical rest and better moods, but also for learning: sleep allows us to consolidate new information. As children get older, they usually drop one of the naps, most commonly the morning nap.

Every child is different when it comes to napping. Some need long naps, some do fine with catnaps, some will give up naps earlier than others. Even within the same family, children can be different. A big part of making naps work is listening to and learning about your child’s temperament and needs. Otherwise, you can end up fighting losing battles.

The needs of a parent or caregiver are also important: everyone needs a break. Sometimes those breaks are particularly useful at specific times of the day (like meal prep time). While you can’t always make a child be sleepy at the most convenient time for you, it’s worth a try — which leads me to the first tip:

Schedule the naps. Instead of waiting for a child to literally drop and fall asleep, have a regular naptime. We all do better when our sleep routines are regular, even adults. If you can, put the child down awake (or partially awake). Learning to fall asleep without a bottle or a breast, or without being held, is a helpful skill for children to learn and can lead to better sleep habits as they grow.

A couple of scheduling notes:

• If you need a child to fall asleep earlier or later than they seem to do naturally, try to adjust the previous sleep time. For example, if you need an earlier morning nap, wake the child up earlier in the morning. It may not work, but it’s worth a try.
• Naps later in the afternoon often mean that a child won’t be sleepy until later in the evening. That may not be a problem, but for parents who get tired early or need to get up early, it can be. Try to move the nap earlier, or wake the child earlier. If the problematic afternoon nap is in daycare, talk to the daycare provider about moving or shortening it.

Create a space that’s conducive to sleep. Some children can sleep anywhere and through anything, but most do best with a space that is quiet and dark. A white noise machine (or even just a fan) can also be helpful.

Don’t use screens before naptime or bedtime. The blue light emitted by computers, tablets, and phones can wake up the brain and make it harder for children to fall asleep.

When is it time to give up naps?

Most children give up naps between the ages of 3 and 5. If a child can stay up and be pleasant and engaged throughout the afternoon, they are likely ready to stop. Some crankiness in the late afternoon and early evening is okay; you can always just get them to bed earlier.

One way to figure it out, and ease the transition, is to keep having “quiet time” in the afternoon. Have the child go to bed, but don’t insist on sleep; let them look at books or play quietly. If they stay awake, that’s a sign that they are ready to stop. If they fall asleep but then end up staying up very late, that’s another sign that the afternoon nap needs to go.

Whether or not your child naps, having some quiet time without screens every afternoon is a good habit to get into. It gives your child and everyone else a chance to relax and unwind, and sets a placeholder not just for homework but also for general downtime as children grow — and just like naps for babies, downtime for big kids is crucial.

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When I was on the junior varsity basketball team in high school, I wasn't surprised when I developed a case of itchy, flaky athlete's foot. After all, I was an "athlete," so I assumed it was a sign of dedication and hard work.

I was shocked when my mother told me the truth: it was due to poor foot hygiene, not my dribbling skills.

Fast-forward almost four decades, and I’m much more diligent about skin care. Still, some skin issues plague me at times, like they do many men. Here is a look at two common problems and solutions.

Dry skin

Symptoms of dry skin include scaly patches (with or without redness), itching, and overall dryness. You can get dry skin year-round — from the heavy heat of summer to the bitter cold of winter. Sun exposure damages skin, leaving it thinner and less likely to hold in moisture over time. Also, aging skin produces less of the natural oils that keep skin lubricated.

Treatment. The first line of defense is a moisturizer that softens and smooths skin with water and lipids (fats). Some moisturizers attract water to the skin and seal it in. Others prevent moisture loss by coating skin with a thick, impermeable layer.

• Petroleum jelly. This waxy, greasy substance stops water loss without clogging pores. It can be used by itself but is also an ingredient in many moisturizers and ointments. Because petroleum jelly doesn’t contain water, it’s best used while the skin is still damp after bathing to seal in moisture.
• Mineral oil. Mineral oil has the same effect but without a greasy feeling. It also should be used while skin is damp.
• Moisturizing lotions and creams. These products contain both water and oils. They’re less greasy and more cosmetically appealing than petroleum jelly or oils. Look for moisturizers with at least one of the following ingredients: glycerin, urea, pyroglutamic acid, sorbitol, lactic acid, lactate salts, or alpha hydroxy acids.

Prevention. Try a few changes to help prevent dry skin:

• Add moisture to the air with a humidifier or a pan of water set atop the radiator.
• In the shower or bath, use lukewarm water (hot water can dry the skin by stripping it of natural oils).
• Choose nondrying soaps with no abrasives or irritants. Super-fatted soaps or cleansing bars are less drying than regular, liquid, or antibacterial soaps.
• To retain the water your skin absorbs while showering or bathing, apply jelly, oil, or moisturizer immediately afterward.

Athlete’s foot

Athlete’s foot is caused by dermatophytes, a group of fungi on the surface of the skin. Tell-tale signs include intense itching; cracked, blistered, or peeling areas of skin, especially between the toes; and redness and scaling on the soles. Dermatophytes thrive in warm, moist environments like pools, showers, and locker rooms where people walk with bare feet. The warm, moist environment of sweaty socks and shoes encourages them to grow.

Treatment. First, try an over-the-counter antifungal ointment, cream, or powder, such as clotrimazole (Lotrimin AF, Mycelex, generic), terbinafine (Lamisil AT, Silka,), or miconazole (Lotrimin AF spray, Micatin). It can take weeks for an infection to improve, and recurrences are common. If symptoms don't improve after several weeks, consult a doctor, who may prescribe antifungal pills.

Prevention. Keeping feet clean and dry is the best way to ward off athlete’s foot. Also, do the following:

• Wash your feet well every day, and wear a clean pair of socks after your bath or shower.
• Take time to dry your feet thoroughly (including each toe and especially the web space between the toes) after you bathe, shower, or swim.
• Wear flip-flops or sandals around public pools and in gym locker rooms and showers.
• Wear moisture-wicking socks that absorb sweat.
• Don’t wear the same shoes two days in a row. Give shoes a 24-hour break between wearings to air out and dry.

As a doctor, I am constantly advising my patients to prioritize their own mental and physical health. Get adequate sleep. Eat healthy. Learn how to say no so you don’t collapse from exhaustion. Love and care for yourself like you do others.

I talk the talk but don’t always walk the walk — even though I know, both intellectually and physically, that self-care is critical to my well-being. When I am run down, my MS symptoms cry out for attention: left leg weakness and numbness, subtle vertigo, a distinct buzzing in my brain like a relentless mosquito that won’t go away no matter how many times I twitch and shake my head. I have become frighteningly good at ignoring these symptoms, boxing them up and pushing them away. Often, I can muscle through; other times it just hurts.

Recently, a friend challenged me to think about my relationship with my illness, to describe MS as a character in my story. This was a useful exercise. I conjured up an image of a stern teacher. She is frighteningly blunt and lets me know, loud and clear, when I disappoint her. She can be mean and scary, and I don’t really like her. But I must admit she is usually right. Still, I often defiantly dismiss her, even when part of me knows this is not in my best interest.

This holiday season, I wanted to do better. I needed to do better. So, as Thanksgiving approached, as I prepared to host 16 family members, many for multiple days, I paused to ask myself, What does MS have to teach me about self-care? I don’t like having this disease, but I do. I can’t change my reality, so I might as well benefit from the lessons MS is forcing on me. I believe they are relevant to all of us, whether we live with chronic illness or not, so I’ll share them here.

The first steps: Listen and observe

When my MS symptoms flare, it’s a message that I am tired, overextended, and stressed. I need to rest. I don’t always listen right away, but eventually I am forced to, and when I listen, I feel better. All of us can benefit from slowing down and tuning in to our physical selves. What sensations are you experiencing in your body, and what does this tell you about your underlying feelings and state of mind? Yes, we should heed our thoughts, but tuning in to our bodies takes us deeper, to feelings that might be hidden, secrets we might not want to acknowledge, a physical truth. If you don’t have a chronic illness, the messages might be more subtle — a vague tightness in your chest, a quick catch in your breath, a barely noticeable tremor in your hands — but they exist, and they signal stress.

The science is clear: the body’s stress response — though potentially lifesaving in a true emergency, when “fight or flight” is essential to survival — can be toxic in our everyday lives. Stress triggers our sympathetic nervous system to kick into overdrive in response to a perceived threat, releasing hormones such as cortisol and inflammatory molecules that, when produced in excess, fuel disease. Conversely, we know that pausing to take notice and interrupting this negative cycle of stress is beneficial. It can be as simple as breathing deeply and counting to 10. Our bodies know what’s up and let us know when we need to take care of ourselves. We must pay attention.

You are not responsible for everyone and everything

The holidays, essentially from mid-November through the end of the year, are a stress test we create for ourselves. The land mines are everywhere: more food, more drinking, more family dynamics, more unfamiliar (or overly familiar) surroundings. Personally, with my overinflated sense of responsibility, I experience a kind of dizzying performance anxiety every holiday season. I believe it is my job to make sure everyone present has a positive experience. For better or worse, I am someone who notices and feels the personal and interpersonal dynamics in a room. I sense and absorb even the most subtle discomfort, frustration, anger, shame, and insecurity, alongside the more upbeat emotions. Importantly, I also I feel the need to step in and make things better, to prop everyone up. It’s exhausting. But MS reminds me of how absurd, and even egotistical, this is. In truth, I can’t possibly care for everyone. Neither can you.

It helps to check our automatic thoughts. More than once on Thanksgiving Day, as the busy kitchen buzzed with activity and conversation, I intentionally stepped back and watched, reminding myself that I didn’t have to hold the whole thing up. Even though I inevitably slipped back into hyper-responsibility mode, these moments of self-awareness impacted my behavior and the dynamic in the room.

It’s okay to say what you need

To take full responsibility for my own well-being, I need to speak honestly and act with integrity. This means asking for what I need, clearly and without apology. Historically, I have been terrible at this in my personal life, burying my own needs in the name of taking care of everyone else’s, even rejecting clear offers of help. “I’m good, I’ve got it,” I might say, while simultaneously feeling bitter and resentful for having to do it all myself. This lack of clarity isn’t fair to anyone. MS reminds me that I need to do better.

This year, when my guests asked me what they could bring, I took them at their word and made specific requests instead of assuring everyone that I had it covered. When my mother started banging around in the kitchen at 7 a.m. with her endearing but chaotic energy, asking for this and that pot and kitchen utensil so she could start cooking, I told her I needed to sit down and have a cup of coffee first. She would need to wait or find things herself. She was okay with that. Family dynamics can be entrenched and hard to change, but clear communication can set new ways of being into motion, one baby step at a time.

I still have a lot to learn, but I am making stuttering progress, learning to listen to my body and honor my needs while also caring for those I love, or at least trying. Undeniably, I experienced some post-Thanksgiving fatigue, exacerbated by my daughter’s early-morning hockey game the next day, requiring a 4:30 a.m. departure. I felt it in my body — the familiar leg weakness, vertigo, and brain cobwebs — and, completely uncharacteristically, I took a nap.