Lifestyle Changes, Medications, and More

Several prescription medications are used to treat RLS. They’re typically taken at night, one or two hours before symptoms begin, says Preeti Devnani, MD, a staff physician at the Cleveland Clinic Sleep Disorders Center and a fellow of the AASM. Some are taken only when symptoms tend to crop up, such as before a long flight. Others are taken daily. Each medication comes with its own set of potential side effects.

“Ask your healthcare provider what medication may be best for you given the severity and timing of your symptoms,” Dr. Devnani says.

Gabapentinoids as First-Line Treatment

The updated AASM guidelines recommend gabapentinoids as the first-line treatment for adults with RLS. Gabapentinoids are part of a drug class called anticonvulsants or antiseizure-antiepileptic drugs. They include:

  • gabapentin (Neurontin, Gralise)
  • gabapentin enacarbil (Horizant)
  • pregabalin (Lyrica, Lyrica CR)
These drugs work by affecting the chemical messengers in your brain and nerves, reducing abnormal levels of excitation in the brain. Gabapentinoids come as tablets, capsules, and oral solutions.

Although it’s not entirely clear how they work to treat RLS, gabapentinoids have shown significant efficacy in reducing RLS symptoms without significant side effects.

“Most patients tolerate these medications well,” says Alon Avidan, MD, MPH, professor of neurology at UCLA and director of the UCLA Sleep Disorders Center in Los Angeles.

“However, as with most medications that work on the brain, the side effects may be a limitation and may include dizziness, sleepiness, fatigue, swelling of the legs, and weight gain. The side effects may be reduced when patients begin therapy at low doses and increase to higher doses slowly over time.”

Patients should also be evaluated for misuse risks, adds Devnani, as some patients may become addicted to the drugs. “Side effects can also include respiratory depression in patients with untreated obstructive sleep apnea,” she says.

Dopaminergic Drugs May Do More Harm Than Good in the Long Run

A key change in the guidelines is that the AASM now advises against the long-term use of dopaminergic drugs such as:

  • ropinirole (Requip)
  • pramipexole (Mirapex)
  • rotigotine (Neupro)
Dopaminergic drugs work by either helping the brain release more dopamine (an important neurotransmitter or brain chemical) or replacing it altogether. While these drugs can help treat RLS in the short term, new evidence shows that in the long term, they can worsen the symptoms through a phenomenon called augmentation.

This doesn’t mean that dopaminergic drugs are completely off the table. The guidelines note that the drugs may still be used to treat people for whom immediate short-term relief is more important than the long-term effects.

Your healthcare provider should carefully advise you of the short- and long-term risks and side effects of these drugs.

Switching From Dopaminergic Drugs to Gabapentinoids

If you’ve been taking dopaminergic drugs for a long time, your doctor may now recommend switching you to gabapentinoids in light of the new guidelines. “Educating patients about their lower risk of augmentation [with gabapentinoids] and long-term efficacy of medication outcomes is vital,” says Devnani.

However, abruptly stopping dopamine medications can produce withdrawal symptoms. “To minimize this side effect, it’s often recommended that we introduce the new medication while the patients are still using their dopamine-type drugs. Patients are instructed to slowly wean off the dopamine medications over time (four to six weeks),” says Dr. Avidan.

“Another suggestion is to introduce the gabapentinoids medication to an effective dose before tapering off the dopaminergic medication. Dopamine agonist tapering, done slowly over the course of a month, is generally well-tolerated and successful,” says Avidan. “My experience shows that in some patients, complete discontinuation of the dopaminergic medication may not always be possible.”

Devnani adds that opioids may be used carefully during the weaning process to manage any breakthrough symptoms. It’s also very important to schedule regular follow-ups to monitor symptoms or side effects during this time.

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What It Is, Tools, and How to Do It

The benefit of seeing a massage therapist, as opposed to rubbing down your own legs and feet, is that professionals will have anatomy and physiology knowledge that most of their clients don’t, Juchli says. “A good therapist should be able to name what structure they are working on and suggest what could be going on,” Juchli says.

A massage therapist can also teach you individualized techniques that you can then replicate at home, Loncar says. But self-massage can be effective, too, particularly if symptoms are in early stages, Juchli says.

Experiment a bit to find the types of self-massage that work best for you, Loncar says. In general, she adds: “Anything that loosens that whole posterior chain, which is all the muscles on the back of the leg, is going to be really helpful.”

Here are some different massage techniques to try.

1. Frozen Water Bottle Massage

Perhaps the most-recommended tool for plantar fasciitis is also among the cheapest: Freeze a plastic bottle of water, and then roll your foot back and forth over the makeshift device. Do it while you’re reading a book or watching TV, Dr. Kamble says. “That helps a lot for everybody because it does two things: It ices the area and helps stretch the area.”

2. Tennis Ball Rolling

The same technique can be applied with a tennis ball: Simply roll the ball under your foot while seated for a few minutes, up to twice a day. Juchli says any ball with a bit of give can be used to roll out the calves and feet.

3. Wooden Roller Massage

You can also try a tool, like a wooden roller, to achieve the same aim. Melissa Prestipino, DPT, a physical therapist who owns Maize & Blue Rehab in Sparta, New Jersey and treats athletes and other people with plantar fasciitis, says wooden foot rollers, as well as vibrating plastic rollers, can help release the plantar fascia. As with the water bottle and tennis ball, she recommends using these sorts of tools while seated. “Standing and rolling out the foot can potentially aggravate the injury more, especially if a heel spur is present,” she says.

4. Massage Kit–Assisted Massage

Prestipino says she’s a fan of massage kits that include a roller, a ball without spikes, and a ball with spikes. Experiment with rolling your foot gently over the various tools. “The ball with spikes can be a little bit too abrasive for people to use,” she says. “The kit allows people to use the device that feels the most comfortable.”

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How to Get Over a Breakup: 7 Tips from Therapists

7 Tips for Coping When a Relationship Ends

The pain you feel may be temporary, but that doesn’t make it easy. We asked psychologists for advice on how to cope. Here are seven tips to help you get through.

1. Keep Taking Care of Yourself

When you’re bogged down with feelings of despair, it can be hard to think clearly. It’s likely you aren’t thinking about your own well-being at all. But this is when it’s most important. Some older research shows that breakups can lead to insomnia and compromised immune function. Harding suggests focusing on the basics. Keep up with your exercise routine, sleep well, eat a healthy diet, and maintain positive social connections.

2. Write a Letter to Your Ex

“I often have clients write a letter to their ex-partner thanking them for what they gained in the relationship and saying goodbye,” Leader says. This exercise is adapted from the book Conscious Uncoupling by Katherine Woodward Thomas, and it could give you the closure you need.

Leader says she has couples share the letter when they’re in couple’s therapy for separation, but it doesn’t have to be shared with your ex. For most people, the benefit comes from writing out your thoughts and closing that chapter. It’s about putting your thoughts and feelings down on paper for yourself, in order to help you move on.

3. Surround Yourself With People You Love

Your heart may be telling you to stay in bed and ignore the world outside, but getting out will likely make you feel better. One study found social interactions can protect against feelings of loneliness and depression. It’s important to note that this study looked at a general population sample, rather than specifically people in a post break-up state.

“Lean on your support system,” Leader says. Let your friends support you so you can have extra love around you. Say yes to invitations, whether it’s to catch up over lunch or a coffee, or just to hang out on the couch.

4. Expect Healing to Take Time

The harsh truth is that feeling better is probably going to take some time. You may even have a string of good days before something triggers you and puts you right back where you started. “Recovering doesn’t always happen linearly, and sometimes strong emotions show up out of the blue,” Harding says. “Please know this is to be expected.” Emotions may come in waves, with a good few days leading way to a tough one.

It’s also possible you won’t ever get over this person completely, and that’s normal too, Harding says. The key is to learn to carry on. “Loss is a part of the education of the human heart,” Harding says.

5. Feel the Feelings

“Whatever you experience, just please know it’s okay to have the feelings you have,” Harding says. And if you think about it, simply having those feelings shows your openness to love. “The fact that you have the capacity to feel so deeply is a wonderful prognosis for your next relationship,” Harding says. “Breakups, rejection, and loss are painful, and they make us more empathetic to others.”

Rather than push the negative feelings away, talk about them head-on with a friend, therapist, family member, or mentor. “Writing your feelings out, even for 10 to 15 minutes at a time several days in a row, can make a world of difference,” Harding says. “You can even tear up the piece of paper afterwards if you like.”

6. Do Something Kind for Someone Else

Sometimes it can be helpful to get out of your own head and focus on someone or something else. One study found that distraction was an effective post-breakup strategy, especially for increasing positive emotions.

  Harding suggests that doing something kind for someone else can deliver an instant mood boost and put your troubles in perspective.

“For example, volunteering is a great way to help recover from a breakup,” she suggests. “You can also organize volunteering with a friend who is going through a breakup if they are willing.”

7. Seek Professional Help

While it’s normal and necessary for it to take time before you feel like yourself again, not improving as time passes can be worrisome. “If days turn into weeks that you’re having trouble functioning at work or in school, please go talk to someone,” Harding says.

Seek out a counselor or therapist to talk things through. Harding also suggests calling a free and confidential warmline, which is a listening phone service staffed by people who are recovering from mental health issues, if you don’t have anyone in your life you can share openly with. “Just remember you are not alone, and talking to someone can help,” Harding says.

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What Is Histamine Intolerance

Holistic nutritionists are taking to social media to spread the word about histamine intolerance (HIT). This is a somewhat controversial proposed diagnosis in which a person may have difficulty breaking down the compound histamine in food, leading to a range of symptoms, from bloating to brain fog. Read on to learn more about what histamine intolerance is, what mainstream medicine has to say about it, and whether a low-histamine diet can make a difference.
Overview Overview What Is Histamine Intolerance? Histamine intolerance is not an official diagnosis in mainstream medicine, but some complementary and integrative medicine practitioners support it. They define it as a condition in which a person has difficulty metabolizing histamine in food, leading to stomach problems, allergy-like reactions like hives, and other issues. Histamine is a naturally occurring molecule in the body that plays a key role in the immune system and digestion. Foods can also contain histamine. The thinking goes, if you eat too much high-histamine food (such as aged Parmesan, tomatoes, or processed meats), or your body can’t properly break down histamine, it can lead to problems. “When we balance the body and lower the histamine, these symptoms become more in control, and you just feel better,” explained Lisa Kilgour, a registered holistic nutritionist, on TikTok . As of now, mainstream medicine has not fully accepted histamine intolerance as a valid diagnosis. The American Academy of Allergy, Asthma, and Immunology, for instance, doesn’t currently recognize histamine intolerance as a condition.e60dc2a1-f33c-4a05-9b50-8e3e8e5976295ce717f6-0f51-4402-8a87-0f841769d6fe “When patients first come to me to find out whether or not they have histamine intolerance, I explain that histamine intolerance is not a well-established disease, and there are no clear diagnostic criteria,” says Ross Tanis, MD , an allergist and immunologist at Loyola Medicine in Chicago. “I also discuss the fact that most food intolerances do not have clear diagnostic criteria, unlike food allergies that do,” says Dr. Tanis. There is research to suggest that what many people attribute to histamine intolerance may in fact be gastrointestinal problems, food allergies, or food sensitivities.e60dc2a1-f33c-4a05-9b50-8e3e8e597629027321eb-3ba5-471b-92e1-0e05464a30d2
Signs and Symptoms of Histamine Intolerance Symptoms The proposed symptoms of histamine intolerance can vary widely, and they may overlap with those of other conditions. Some nutritionists and advocates for the field assert that the following symptoms are potentially linked to histamine intolerance: Gastrointestinal (stomach) issues, including bloating, diarrhea, and nausea Skin symptoms, such as itchy skin, flushing, hives, and swelling Headaches or migraines Respiratory symptoms, including shortness of breath, stuffy or runny nose, sneezing, wheezing, or tightness in the chest Swelling of the lips, tongue, or throat Heart irregularities, such as racing heart or palpitations Low blood pressure or dizzinesse60dc2a1-f33c-4a05-9b50-8e3e8e597629effb6579-6e6d-4d36-81a5-3be3e21c7632 “Often people perceive having increased symptoms, particularly GI-related symptoms, after consumption of histamine-rich foods. However, the symptoms often do not abate [decrease or stop] when histamine rich foods are avoided, which would suggest against this diagnosis,” says Tanis. Additionally, there is a normal resting amount of histamine that the body naturally produces every day, so you could never eliminate all the histamine completely, he adds. If symptoms worsen or you experience severe reactions, consult your doctor immediately.
Causes and Risk Factors of Histamine Intolerance Causes The digestive system uses enzymes to help break down food, and the enzyme diamine oxidase (DAO) does this for histamine. People whose bodies make less DAO or produce less-effective DAO may be susceptible to histamine intolerance, though there haven’t been research studies to back this up.e60dc2a1-f33c-4a05-9b50-8e3e8e5976296093c9b7-f930-41c4-8b36-bbdfbb4cfb88 If DAO problems are responsible for histamine intolerance symptoms, possible causes and risk factors include: Genetics Some people are born with genetic mutations that result in lower levels of or less effective DAO. Medications Certain drugs, such as blood pressure medications, may temporarily cause a DAO deficiency. Opioids and narcotics may potentially increase histamine levels. e60dc2a1-f33c-4a05-9b50-8e3e8e5976296093c9b7-f930-41c4-8b36-bbdfbb4cfb88 GI Disorders People with inflammatory bowel disease may have suppressed DAO activity. “To the best of my knowledge, there is no propensity for people with other existing allergies such as asthma , allergic rhinitis, or IgE-mediated food allergies to have a higher reported incidence of histamine intolerance,” says Tanis. IgE-mediated food allergies are a type of food allergy in which the immune system makes the immunoglobulin E (IgE) antibody in response to a specific food.e60dc2a1-f33c-4a05-9b50-8e3e8e59762935e11412-2321-41bc-853d-2a2514c40a50
Can a Low-Histamine Diet Help? Some foods are naturally high in histamine, while others may trigger the release of histamine from your body.e60dc2a1-f33c-4a05-9b50-8e3e8e597629228b2a88-8298-462e-9690-bf29aca2c9f6 Some nutritionists that are supportive of this potential diagnosis may recommend that people with histamine intolerance follow a low-histamine diet. That involves avoiding foods like:e60dc2a1-f33c-4a05-9b50-8e3e8e597629ffb72c69-aecc-4850-a687-20b544f2e8d7 Aged cheese, such as Parmesan, manchego, and Gruyere Fermented foods, including sauerkraut, kimchi, and soy sauce Alcoholic beverages, including wine, beer, Champagne Processed meats, such as salami, pepperoni, and hot dogs Fish and shellfish, for example, mackerel, sardines, tuna, and herring Some vegetables, including tomatoes, spinach, and eggplant Tropical fruits, including bananas, pineapples, papayas, and citrus fruits Chocolate Nuts and peanuts Strawberries Avocados Food additives like colorants and preservatives Working with a nutritionist can help you craft a balanced, low-histamine diet trial that will still meet your nutritional needs to see if it helps your symptoms.
How Is Histamine Intolerance Diagnosed? Diagnosis To help determine if histamine intolerance may be at play, a healthcare provider will typically start by reviewing a patient’s symptoms and medical history. “It’s important to rule out all other medical conditions, including GI pathology [diseases affecting the digestive tract], celiac disease, and GERD [acid reflux], to name a few,” says Tanis. There are no reliable tests for identifying histamine intolerance, he adds. A histamine skin prick test and DAO activity test have been proposed as markers. “Unfortunately, the results are variable and histamine skin prick tests do not show differences in people without histamine intolerance and those with plausible or possible histamine intolerance,” says Tanis. In a prick test, a small amount of a suspected allergen is inserted into the skin to see if a person has any kind of negative reaction. When Tanis has patients who appear to have a food intolerance, he recommends they try eliminating potentially triggering foods to see if symptoms improve. “The best way to do this is to eliminate one food at a time, but this may be more difficult in the case of suspected histamine intolerance,” he says, because so many foods have some level of histamine. “There should be objective improvement in symptoms when eliminating these foods; otherwise you generally assume that it is not the culprit and we recommend these foods are reintroduced, particularly if not eating them impacts quality of life,” he says. Food elimination for suspected histamine intolerance in any child or adolescent requires caution due to the risk of developing food allergies or malnutrition, adds Tanis.
Treatment and Medication Options for Histamine Intolerance Treatment In addition to dietary changes, your healthcare provider or nutritionist may recommend certain medications to try for a period of time to see if they help with your symptoms. Medications Antihistamines These medications block histamine receptors in the body. Both H1 and H2 antihistamines may be helpful, with H1 antihistamines (like cetirizine and loratadine) targeting allergic reactions and H2 blockers (like ranitidine) helping with digestive symptoms. There is little downside to trying antihistamines due to their excellent safety profile, but keep in mind that improvement of symptoms after taking oral antihistamines doesn’t confirm you have histamine intolerance. “Additionally, there aren’t well=controlled randomized trials that show they are effective,” says Tanis. Mast Cell Stabilizers Drugs like cromolyn sodium prevent histamine release by mast cells, a type of immune cell that responds to “foreign” substances, including some foods, by releasing histamine.e60dc2a1-f33c-4a05-9b50-8e3e8e597629335c1532-78d4-45ee-bdb2-d9d170fafae5 Complementary and Integrative Therapies Supplements Some research suggests that nutrients like quercetin, and N-acetylcysteine (NAC) may help stabilize mast cells or support histamine breakdown. Supplements specifically tailored to DAO may help people with DAO deficiency. Supplementing with vitamin C, copper, zinc, and vitamin B6 may also help support the DAO enzyme and overall health.e60dc2a1-f33c-4a05-9b50-8e3e8e5976298ddd8a44-a8a1-4b3e-bab6-9b94e131bb99 It’s important to discuss any supplements with your provider before you start taking them, and to recognize that this is an active area of research where the current evidence is lacking.
Prevention of Histamine Intolerance Prevention Because histamine intolerance hasn’t been established as a formal condition with a clear cause, there aren’t expert recommendations for avoiding it.
Outlook for Histamine Intolerance Outlook Many people with histamine intolerance are able to manage their symptoms with diet changes. If symptoms remain, medications may help. In some cases, symptoms can improve over time, and some people may even be able to go back to eating the foods they’ve been avoiding. If you suspect histamine intolerance is affecting your life, it’s a good idea to consult a healthcare professional to get a complete workup and the appropriate diagnosis. This may include a referral to an integrative allergy and immunology specialist or integrative gastroenterologist who is familiar with this proposed condition and can rule out other diagnoses. From there, you may be referred to a holistic or integrative nutritionist who has experience in this area and can help guide you through approaches like an elimination diet.e60dc2a1-f33c-4a05-9b50-8e3e8e5976296f4c21b2-2697-4b5f-b4ff-ea34b3e16088
Related Conditions Related Conditions Some experts have observed that histamine intolerance can be accompanied by other diseases, including migraine and irritable bowel syndrome.e60dc2a1-f33c-4a05-9b50-8e3e8e597629ba2e58d9-d068-4485-a7ea-4df774762dfc Histamine intolerance also shares symptoms with mast cell activation syndrome. Mast Cell Activation Syndrome Mast cell activation syndrome (MCAS) is a condition that causes intense episodes of swelling, shortness of breath, hives, diarrhea, vomiting, and other symptoms. In severe episodes, it can cause life-threatening anaphylaxis (an extreme allergic reaction). It’s caused by mast cells mistakenly alerting the immune system that there’s something harmful in your body, which leads to an overreaction. Some people with mast cell activation syndrome may manage episodes with a low-histamine diet.e60dc2a1-f33c-4a05-9b50-8e3e8e597629b522289e-5787-425c-8e87-da53fe0ecebe
The Takeaway Histamine intolerance (HIT) is a controversial proposed diagnosis involving difficulty metabolizing histamine from foods, leading to symptoms like bloating, headaches, skin rashes, and digestive issues. Histamine intolerance is not officially recognized by mainstream medical professionals, and some research suggests other conditions are responsible for symptoms. Managing histamine intolerance typically involves avoiding high-histamine foods and beverages like aged cheeses, alcohol, and fermented items like soy sauce. If you think you have symptoms that fit with those of histamine intolerance, it’s best to see a specialist like an allergist-immunologist or gastroenterologist to evaluate you and guide your next step, which may include consulting with a nutritionist.
Resources We Trust Cleveland Clinic: Histamine IntoleranceJohns Hopkins Medicine: Low Histamine DietAmerican Academy of Allergy, Asthma and Immunology: Histamine Intolerance: Fact or Fiction?Nutrients: Histamine Intolerance: Symptoms, Diagnosis, and BeyondMedlinePlus: Histamine: The Stuff Allergies Are Made Of

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Mental Health and Weight Loss: The Surprising Connection

In matters of weight loss, food and exercise are regular parts of the conversation. A new survey from Everyday Health suggests that another topic should be considered in that conversation: mental health.

The survey found that 40 percent of respondents listed mental health improvement as a leading reason to lose weight. Indeed, mental health and its connection to body weight and weight loss came up again and again.

For example, stress was listed as a leading obstacle to weight loss, and only 12 percent of respondents said they never ate when feeling stressed, nervous, or anxious. Meanwhile, people in the survey who tried but failed to lose weight were more likely to report mental health struggles, and more likely to report guilt or shame about eating, than those who lost weight.

The survey involved more than 3,000 American adults who had tried to lose weight in the preceding six months. In addition to attitudes around the new medications, go-to weight loss tactics, and common hurdles to weight loss, respondents answered questions about their emotions and mental health state as it related to their weight.

The key takeaways exemplify what researchers have long known: that these two factors are closely related.

“Research shows a bidirectional relationship between mental well-being and weight,” says Allison Young, MD, a psychiatrist in New York City, a member of the American College of Lifestyle Medicine, and Everyday Health’s Health Expert Network. “We don’t fully understand this relationship yet, but there appears to be biological as well as psychological factors responsible for it.”

For instance, one study found that, over a period of 12 months, people whose mental health improved during that time lost significantly more weight than people whose mental health status remained the same or deteriorated.

 Studies have also found that when people lose weight, their psychological health tends to get better.

Obesity is more common among people with psychiatric disorders, research suggests, and that these disorders are more resistant to treatment among people with obesity.

 Some researchers have even argued that metabolic conditions such as obesity, and mental health disorders such as depression, are connected at a cellular level.

“It is not a coincidence that as rates of obesity and diabetes are skyrocketing, the rates of mental disorders are also skyrocketing,” says Christopher Palmer, MD, an assistant professor of psychiatry at Harvard Medical School in Boston. “They are interrelated because they are both disorders of mitochondrial dysfunction.”

Here are some of the key takeaways from the survey, along with expert insights that can help you apply these lessons to your own life.

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To Choose a Diabetes Medication, Factor in Age

Type 2 diabetes medications known as SGLT2 inhibitors, a category that includes Jardiance (empagliflozin), are more effective in reducing the risk for heart attack and stroke in older adults compared with younger ones, according to a new meta-analysis that included over 600 studies.

However, these drugs were less effective at lowering blood sugar levels in older adults than newer drugs called GLP-1s, a category that includes Ozempic (semaglutide) — a finding that surprised researchers, says lead author Peter Hanlon, PhD, clinical senior research fellow at the School of Health and Wellbeing at the University of Glasgow in Scotland. For younger adults, SGLT2 inhibitors were more effective at lowering blood sugar levels compared with GLP-1s.

Although previous large studies didn’t find major differences in how all these medications work based on age, this meta-analysis suggests there may be some variation, says Neda Rasouli, MD, professor of medicine and pharmacy and director of the CU Diabetes and Endocrinology Clinical Trial Program at the University of Colorado School of Medicine in Anschutz. Dr. Rasouli was not involved in this meta-analysis.

“Younger people seemed to respond better to SGLT2 inhibitors for lowering blood sugar compared with older adults, while GLP-1s appeared to lower A1C [a measure of blood sugar levels] more effectively in older individuals,” Rasouli says.

“When it comes to heart protection, SGLT2 inhibitors reduced major adverse cardiovascular events more in older adults, whereas GLP-1s showed a bigger impact in younger people.”

Meta-Analysis Included Data from Over 600 Studies

For the analysis, researchers aimed to find out whether age or sex made a difference in the effectiveness of different type 2 diabetes medications. Scientists analyzed data from 601 randomized clinical trials that included over 395,000 people with diabetes.

There were three types of diabetes medications included:

SGLT2 Inhibitors Sodium-glucose cotransporter-2 inhibitors work by increasing the excretion of sugar in the urine. These drugs are often used for people with heart failure or chronic kidney disease because they have been shown to have heart and kidney benefits and reduce the chances of death from any cause.

Available SGLT2 inhibitors include:

  • Brenzavvy (bexaglifozin)
  • Invokana (canagliflozin)
  • Farxiga (dapagliflozin)
  • Jardiance (empagliflozin)
  • Steglartro (ertugliflozin)
GLP-1 Receptor Agonists Glucagon-like peptide-1 receptor agonists mimic the effects of a natural hormone that stimulates insulin production. This can slow digestion, reduce blood sugar, and help with weight loss.

Available GLP-1 medications include:

  • Ozempic, Rybelsus (semaglutide)
  • Victoza (liraglutide)
  • Mounjaro (Tirzepatide)
  • Trulicity (dulaglutide)
  • Byetta (exenatide)
DPP4 Inhibitors Dipeptidyl peptidase-4 drugs help regulate blood sugar by preventing the breakdown of incretin hormones, which in turn increases insulin production in response to meals.

DPP4 inhibitors include:

  • Januvia (sitagliptin)
  • Zituvio (sitagliptin)
  • Onglyza (saxagliptin)
  • Tradjenta (linagliptin)
  • Nesina (alogliptin)

The meta-analysis revealed a few key findings, says Susan Spratt, MD, professor of medicine and endocrinologist at Duke Health in Durham, North Carolina, who was not involved in the research:

  • The findings confirmed that SGLT2 inhibitors and GLP-1s lower blood sugar and reduce the risk for major adverse cardiac events. DPP4 medications have no impact on heart disease risk.
  • DPP4 medications are less effective in lowering A1C levels compared with the other two drug classes.
  • There was no difference between the drugs’ effect on blood sugar levels between men and women.
  • GLP-1s were more effective in reducing heart attack and stroke risk in younger adults.
  • There was no increased risk of side effects in older people.

“The findings suggest that age should not be a barrier to treatment with SGLT2 inhibitors. [Older adults] are likely to benefit from reduced cardiovascular risk,” says Dr. Hanlon.

It also suggests that for SGLT2 inhibitors and GLP-1s, reduction of blood sugar levels may not be the best way to judge how effectively these medications are preventing heart attack and stroke, he says.

GLP-1 Drugs: The Growing Attention Is ‘Well Deserved’

“The GLP-1 agonist medications are popular because they have a lot of benefits, including weight loss, very strong A1C lowering potential, and reductions in major cardiac events such as heart attack and stroke,” says Dr. Spratt.

The weight loss often comes with additional benefits including reductions in sleep apnea and musculoskeletal pain, she adds.

“However, we do need to remember that the SGLT2 inhibitors reduce heart failure risk, improve kidney outcomes, slow progression to dialysis and renal decline, and also lower the risk for major adverse cardiac events like heart attack and stroke,” says Spratt.

The main difference between GLP-1s and SGLT2 inhibitors is their effects on weight loss, says Rasouli.

“SGLT2 inhibitors lead to modest weight loss of around 5 percent, whereas GLP-1s typically result in more significant weight loss, often exceeding 10 percent. Additionally, GLP-1s are generally more effective at lowering A1C compared to SGLT2 inhibitors,” she says.

“The growing attention around GLP-1s is well deserved, as they represent a breakthrough in achieving effective weight loss with a relatively good safety profile. Their added benefits of heart and kidney protection make them even more valuable,” says Rasouli.

Work With Your Doctor to Find the Right Diabetes Medication for You

People should work with their healthcare provider to choose the type 2 diabetes medication that’s right for them, says Spratt.

“Choosing a medication will depend on whether the patient may benefit more by reducing blood sugar levels versus reducing heart disease risk,” she says.

Rasouli agrees that the findings may help guide the selection of the right medication for different age groups. “Precision medicine, or the individualization of care, is the future of healthcare,” she says.

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5 Types to Eat and 5 Types to Avoid

The ketogenic diet, or the keto diet for short, is a high-fat (70 to upwards of 80 percent), moderate-protein, and low-carb diet. A common goal on the plan is to change your body’s biochemistry and, in turn, lose weight.

“Following a ketogenic diet changes your fuel source from one that primarily burns carbohydrates to one that burns fat,” says Olivia Wagner, RDN, a functional dietitian and founder of Liv Nourished in Chicago. In metabolic terms, this process is called ketosis.

One of the perks of a keto diet, followers say, is that cheese is not off-limits. In fact, cheese is basically the perfect keto food: high-fat, moderate-protein, and low-carb. “Cheese can add flavor, variety, and new textures into your meals,” says Wagner, adding that the best varieties for the keto diet are high-quality, grass-fed, and full-fat. (Just remember: Cheese isn’t “unlimited” in a keto diet, as it still contains calories and carbs; it’s also high in saturated fat, which is a less heart-healthy option than unsaturated fats, per the American Heart Association.)

Cheese might not be the first food you think of when it comes to weight loss, and yet some research suggests the food may be beneficial for this purpose. For example, in a study on more than 2,500 men who self-reported their intake of dairy products, a higher consumption of cheese specifically was associated with a lower BMI after a five-year follow-up.

 (That said, cheese is high in calories, and so while it can fit into a weight loss or maintenance diet, it’s best enjoyed in moderation.)
Some studies have also suggested that cheese may benefit certain health outcomes, too. Cheese may be linked to better cognition with age, concluded one observational study.

If you find that your results are plateauing while on keto, you may want to take it easy on the cheese, says April Kelly, RDN, founder of Orange County Nutrition Coaching in Newport Beach, California. “Sometimes people lose weight much quicker and feel better when they take out dairy,” she says. If you find you tolerate it okay, there’s no reason to omit it; but if you’re struggling with gastrointestinal side effects or water retention — or if you find that you’re not losing weight despite being in ketosis — it may be time to discuss the role of dairy in your diet with your healthcare team.

If you’ve decided to include cheese on your keto diet menu, you should be aware that not all cheeses are created equal. Here’s what you need to know about which cheeses to eat, which to limit, and which to skip altogether on this low-carb plan.

The 5 Best Types of Cheese to Eat on the Keto Diet

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Dyspareunia (Painful Intercourse)

Dyspareunia (pronounced: dis-pahr-OON-eeuh) is the medical term for painful sexual intercourse. This pain can happen before, during, or after sex, depending on its cause. You can treat dyspareunia with the help of a healthcare provider, who can prescribe medications and other treatments to decrease your pain.
Overview Overview What Is Dyspareunia? Dyspareunia describes genital, vaginal, or pelvic pain right before, during, or after sexual intercourse.e60dc2a1-f33c-4a05-9b50-8e3e8e597629061b5c80-733b-4294-849a-229eef7072ede60dc2a1-f33c-4a05-9b50-8e3e8e597629f9d43855-368a-4e2d-8fbf-784edc0ba269 This pain can feel sharp, throbbing, cramping, or burning. Dyspareunia happens most often in women, and about 3 out of 4 people with vaginas experience this type of pain at least once in their lives.e60dc2a1-f33c-4a05-9b50-8e3e8e5976292ace4830-a4f3-48f8-a31d-82495753099b The group at highest risk for dyspareunia is women who have passed menopause (around age 50).
But painful sex can happen because of anything from your feelings about sex to medical conditions.e60dc2a1-f33c-4a05-9b50-8e3e8e597629161bc67a-f7ea-40a0-9881-72759c479228e60dc2a1-f33c-4a05-9b50-8e3e8e5976292212e95c-82af-46dd-ae0b-1dfd0c216e16 If you feel pain during sex, you may find it hard to share that with your partner. In fact, one study of almost 400 women found that about half didn’t tell sexual partners about their dyspareunia.e60dc2a1-f33c-4a05-9b50-8e3e8e597629c2486ac6-ddd6-4755-b9f2-3e2aac1663e6 But even if you don’t loop your partner in right away, it’s important to share your symptoms so you can get some relief.
Signs and Symptoms of Dyspareunia Symptoms Dyspareunia symptoms can vary based on its type. These types fall under two categories: where and when you feel pain.e60dc2a1-f33c-4a05-9b50-8e3e8e5976296500dd03-4dfb-4120-a862-ea336202cd51 Sexual intercourse can cause pain in a few different places:e60dc2a1-f33c-4a05-9b50-8e3e8e597629839d3268-6412-42e5-83a1-e1ae8d5c09dee60dc2a1-f33c-4a05-9b50-8e3e8e597629164fadff-dec5-483e-aa1f-49a3a6c28adce60dc2a1-f33c-4a05-9b50-8e3e8e5976296500dd03-4dfb-4120-a862-ea336202cd51 Entry pain : Felt at the vagina’s opening when penetration first happens Positional pain : Felt in some sexual positions, but not others Deep pain : Felt during deep penetration, and can be worse in some sexual positions Providers may also label dyspareunia based on the history and timing of your pain:e60dc2a1-f33c-4a05-9b50-8e3e8e597629164fadff-dec5-483e-aa1f-49a3a6c28adce60dc2a1-f33c-4a05-9b50-8e3e8e5976296500dd03-4dfb-4120-a862-ea336202cd51 Primary pain : You have felt pain during sex since you became sexually active Secondary pain : You begin to feel sexual pain after a period of pain-free sex Complete pain : You feel pain every time you have intercourse Situational pain : Sexual pain only happens in certain times and situations Sexual pain can come with a wide range of physical sensations, and dyspareunia symptoms can include the following:e60dc2a1-f33c-4a05-9b50-8e3e8e597629164fadff-dec5-483e-aa1f-49a3a6c28adce60dc2a1-f33c-4a05-9b50-8e3e8e597629c4972e08-b43f-4501-b2ef-9b24899da8df Sharp or deep pain during thrusting Throbbing and aching to the pelvic region or genitals hours after intercourse Cramping in your pelvic area Pelvic floor muscle tightness or spasms Pain in the bladder Burning or piercing pain during penetration Pain when inserting a tampon Dyspareunia can affect any area in the pelvis, including the pelvic floor muscles, uterus, vagina , vulva, bladder, lower back or abdomen, and tissues surrounding your pelvic organs.e60dc2a1-f33c-4a05-9b50-8e3e8e597629164fadff-dec5-483e-aa1f-49a3a6c28adce60dc2a1-f33c-4a05-9b50-8e3e8e5976298ad233a5-458e-4284-930a-a974520d623a
Causes and Risk Factors of Dyspareunia Causes Dyspareunia can have many causes, including medical conditions, trauma or injury to the pelvic area, or psychological factors surrounding sex.e60dc2a1-f33c-4a05-9b50-8e3e8e597629127601a2-200f-4a99-a5ea-074013c34dfbe60dc2a1-f33c-4a05-9b50-8e3e8e597629225a841c-b557-4cba-94b5-20fc1914acf8e60dc2a1-f33c-4a05-9b50-8e3e8e59762929423e67-c407-4e86-9c52-bc3676045542 Medical Conditions Pain during sexual intercourse can be a symptom of these medical conditions:e60dc2a1-f33c-4a05-9b50-8e3e8e59762929423e67-c407-4e86-9c52-bc3676045542e60dc2a1-f33c-4a05-9b50-8e3e8e597629225a841c-b557-4cba-94b5-20fc1914acf8e60dc2a1-f33c-4a05-9b50-8e3e8e597629205a4b77-16b6-43c6-a72e-a0a9b3f5fc26 Skin disorders : Such as contact dermatitis Vulvodynia : A pain disorder that affects the vulva Cysts : Fluid-filled growths in the pelvic area Endometriosis : Tissues similar to the uterus lining appearing in other places (like the abdomen) Pelvic inflammatory disease : Infection of the vagina, uterus, fallopian tubes, or ovaries Genitourinary syndrome of menopause (GSM) : Thinning, inflammation, and dryness of the vaginal lining Hormonal changes : Perimenopause and menopause -related estrogen drops and hormonal changes from breastfeeding Nerve problems : Pinched or inflamed nerves in the back or pelvic area Vaginitis : Inflammation of the vagina caused by bacterial, viral, or yeast infection Vaginismus : Vagina muscle tightening Vaginal dryness : Lack of lubrication leading to irritation. Sometimes extending foreplay can help.e60dc2a1-f33c-4a05-9b50-8e3e8e5976292b19b53d-fcc8-461b-88dc-4ff9cd7e4a86 Pelvic floor dysfunction : Tight ligaments and muscles in the pelvic floor (around the vagina) Bowel conditions : Like irritable bowel syndrome Bladder conditions : Like urinary tract infections Several medical conditions can cause vaginal dryness, which can lead to painful sex. These include having your ovaries removed, some tumors, diabetes, and treatment for cancer.e60dc2a1-f33c-4a05-9b50-8e3e8e597629225a841c-b557-4cba-94b5-20fc1914acf8 Medications can also lower lubrication, including some for depression, high blood pressure, allergies, and birth control.e60dc2a1-f33c-4a05-9b50-8e3e8e597629ede8b2fd-f104-4e51-be33-dee0b1204f5f Trauma or Injury Any injury or trauma to the pelvic area can cause painful sex, including the following:e60dc2a1-f33c-4a05-9b50-8e3e8e5976292b19b53d-fcc8-461b-88dc-4ff9cd7e4a86e60dc2a1-f33c-4a05-9b50-8e3e8e597629127601a2-200f-4a99-a5ea-074013c34dfbe60dc2a1-f33c-4a05-9b50-8e3e8e597629225a841c-b557-4cba-94b5-20fc1914acf8 Pelvic surgery : Like hysterectomy or ovary removal Childbirth : From unhealed tearing or stretching while giving birth Accidents : Any injury to the vulva, vagina, or pelvis Female genital mutilation : Also known as female circumcision or cutting, in which the clitoris and labia are removed or altered for cultural or religious reasons Psychological Factors Sometimes, psychological factors can lead to dyspareunia. These can include a lack of desire or arousal because of several issues, including:e60dc2a1-f33c-4a05-9b50-8e3e8e59762929423e67-c407-4e86-9c52-bc3676045542e60dc2a1-f33c-4a05-9b50-8e3e8e597629ede8b2fd-f104-4e51-be33-dee0b1204f5f Anxiety Depression Stress Concerns over appearance Fear of intimacy Relationship problems History of sexual abuse Your mental and emotional state can play a big part in your ability to become aroused, and can lead to painful sex. Emotional and Psychological Impact Dyspareunia can cause more than physical pain. Discomfort during sex often leads to lower desire and less sex, which can put a strain on your quality of life and relationship.e60dc2a1-f33c-4a05-9b50-8e3e8e597629225a841c-b557-4cba-94b5-20fc1914acf8e60dc2a1-f33c-4a05-9b50-8e3e8e597629127601a2-200f-4a99-a5ea-074013c34dfb Sexual issues can also prompt lower self-confidence, self-image, and self-esteem.e60dc2a1-f33c-4a05-9b50-8e3e8e5976295b4fd815-798e-49d5-beeb-93c64fa7e96b Sometimes these issues can even turn into depression and anxiety.e60dc2a1-f33c-4a05-9b50-8e3e8e597629127601a2-200f-4a99-a5ea-074013c34dfb But once you address the cause of these issues with a healthcare provider, you may soon have less painful and more fulfilling sex.
How Is Dyspareunia Diagnosed? Diagnosis A healthcare provider can diagnose the cause of dyspareunia through several methods.e60dc2a1-f33c-4a05-9b50-8e3e8e597629929f6bfc-3033-44db-94fa-c9ad790eb8d2e60dc2a1-f33c-4a05-9b50-8e3e8e597629180fea96-c4b7-439b-8801-e1e87f8d573d Medical History First, your provider may ask when and where you feel pain. They may want to know if sexual pain happens with some partners and positions but not others. If these questions make you feel uncomfortable, remember their answers will help your provider solve this puzzle and start you on the path to recovery. Pelvic Exam To rule out some medical causes of dyspareunia, your provider may do a pelvic exam. During this exam, your provider may observe your genitals and may also look inside your vagina. They may try to find the painful areas by pushing gently and asking for feedback. Pelvic Ultrasound If your provider thinks your pain may come from something inside your pelvis, like endometriosis or a cyst, they may want to do an ultrasound to see that area. This ultrasound can be done through the skin of your lower abdomen, or through a wand inserted in the vagina. Laparoscopy Rarely, your provider may not see the cause through an ultrasound but still suspects the pain is coming from an internal problem. In that case, they might recommend a minimally invasive surgery to investigate. It can feel difficult to bring up sexual pain with a healthcare provider, but whatever you tell them will help. Remember: They have heard it all. And the more they know, the better they can direct your care.
Treatment and Medication Options for Dyspareunia Treatment Depending on its cause, you can treat dyspareunia with medications, natural remedies, mental health therapy, or surgery.e60dc2a1-f33c-4a05-9b50-8e3e8e597629a76144a0-0db7-4bb7-9a10-c0df444a7990 The best treatment will address all aspects of your pain: physical, emotional, and behavioral.e60dc2a1-f33c-4a05-9b50-8e3e8e597629e22b67fa-8389-4571-81a6-66d6adbc825b Medication Options The cause of your sexual pain will direct whether medications may help you. Some common medication options for dyspareunia include:e60dc2a1-f33c-4a05-9b50-8e3e8e597629e22b67fa-8389-4571-81a6-66d6adbc825be60dc2a1-f33c-4a05-9b50-8e3e8e597629792d7f51-4ff4-4191-bb7d-51f391c15495e60dc2a1-f33c-4a05-9b50-8e3e8e597629778bfc0f-0d3c-4a6e-a033-18bcb8626ff3 Tricyclic antidepressants : Block some pain signals to and from your braine60dc2a1-f33c-4a05-9b50-8e3e8e5976290ec44060-427e-4cd2-84bb-ea6897d09f05 Oral or topical hormone replacement : Increase estrogen and natural lubrication NSAIDS : Over-the-counter pain relievers like acetaminophen (Tylenol) and ibuprofen (Advil) Botox injections : Stabilize pelvic floor muscles Ospemifene (Osphena) : Nonhormonal oral medication that behaves like estrogen and decreases vaginal dryness Prasterone (Intrarosa) : Works similarly to ospemifene, but is inserted in the vagina Therapies Various therapies can help rewrite the script on your sexual pain and the emotions that cause or come with the experience. Physical Therapy A physical therapist uses pelvic floor therapy to help you learn to relax your pelvic muscles.e60dc2a1-f33c-4a05-9b50-8e3e8e597629792d7f51-4ff4-4191-bb7d-51f391c15495 These exercises can also retrain how your brain responds to sensations in that area, leading to less pain.e60dc2a1-f33c-4a05-9b50-8e3e8e597629e22b67fa-8389-4571-81a6-66d6adbc825b Vaginal Dilators Your therapist may also recommend vaginal dilators to gently stretch your vaginal tissue. These dilators start small (about 12 millimeters wide) and progressively get bigger as you’re able to insert them.e60dc2a1-f33c-4a05-9b50-8e3e8e59762992f59628-f0c4-4c81-a0d4-63fe4762927d Sex Therapy If your sexual pain comes from an emotional response, a sex therapist can help you unravel those feelings. They can also help you work through any relationship issues with your partner and help you get back to sexual intimacy.e60dc2a1-f33c-4a05-9b50-8e3e8e597629778bfc0f-0d3c-4a6e-a033-18bcb8626ff3 Cognitive Behavioral Therapy In cognitive behavioral therapy (CBT), a mental health professional helps you change negative thought and behavior patterns around sex. This therapy can also lessen fear and anxiety surrounding sex and sexual pain.e60dc2a1-f33c-4a05-9b50-8e3e8e597629e22b67fa-8389-4571-81a6-66d6adbc825b e60dc2a1-f33c-4a05-9b50-8e3e8e597629778bfc0f-0d3c-4a6e-a033-18bcb8626ff3 Surgery Surgery provides another option if your pain is caused by scar tissue from an injury or previous surgery.e60dc2a1-f33c-4a05-9b50-8e3e8e597629e22b67fa-8389-4571-81a6-66d6adbc825b You can also have your vagina surgically widened if your pain comes from vaginal tightness. But surgical options are more rare, and often only considered after you’ve tried other therapies.e60dc2a1-f33c-4a05-9b50-8e3e8e597629a3dcfcfd-72a4-464f-adf5-6426d2b3ad90
Lifestyle Changes for Dysparuenia Lifestyle Changes For less painful sex, you can adjust some habits around the act:e60dc2a1-f33c-4a05-9b50-8e3e8e5976293334984c-5aa6-4936-9b79-68de2448c34de60dc2a1-f33c-4a05-9b50-8e3e8e5976297aaf1b38-790b-49f9-9766-a8f2cc420e69 Use lubricants : Lubricants with a water or silicone base can keep your vulva and vagina from becoming too dry during sex. Avoid irritants : Use lubricants, soaps, and sanitary pads with no added perfumes. Practice relaxation techniques : Take some time before sex to relax and calm your body. You can try activities like meditation , massage, or deep breathing exercises to help. Take it slow : Longer foreplay can help your body prepare for penetration with less pain. Try different positions : Avoid positions that hurt more than others. Communicate : Throughout a sexual encounter, talk to your partner about what feels good and what’s hurting — never hesitate to ask for a break or change. Use ice after sex : If soreness in your vulva lingers after intercourse, a wrapped ice pack to the area can help lessen inflammation and pain. If you’re working through some therapies and don’t feel ready for intercourse yet, you can still experience sexual pleasure as well as intimacy with your partner. Oral sex, mutual masturbation , and other nonpenetrative sex options can fulfill you and keep you close to your partner while avoiding pain.e60dc2a1-f33c-4a05-9b50-8e3e8e5976297ed31b8c-69a9-4ee0-ae94-0059f9787fa3
Prevention of Dyspareunia Prevention Dyspareunia can’t always be prevented, but you can do a few things to make sex less painful and more pleasurable. Visit a healthcare provider on the schedule they recommend to stay up-to-date on wellness exams and important tests like pap smears.e60dc2a1-f33c-4a05-9b50-8e3e8e5976290b1d04d7-3066-46b6-8dfd-92b5022e850c Use condoms during sex to protect against sexually transmitted infections and keep your genital area clean.e60dc2a1-f33c-4a05-9b50-8e3e8e5976290b1d04d7-3066-46b6-8dfd-92b5022e850c Use plenty of lubrication during sexual encounters to prevent friction and irritation.e60dc2a1-f33c-4a05-9b50-8e3e8e597629db4ac9ee-4543-4509-bb62-58a2d7fb2a9e You can also use stress management techniques like regular exercise, mindfulness, and journaling to prevent muscle tightness.e60dc2a1-f33c-4a05-9b50-8e3e8e5976293a98f038-b6bc-4c89-8858-70cff2a30192
How Long Does Dyspareunia Last? Prognosis and Outlook Dyspareunia can resolve quickly or may persist for years, depending on its cause and how quickly you can get treatment. For example, your prognosis will be short if sexual pain comes from vaginal dryness, and you can resolve it by using lubrication the next time you have sex.e60dc2a1-f33c-4a05-9b50-8e3e8e597629a13156ad-9a59-4e06-962b-86276d9b363f But if painful sex comes from a medical condition or psychological issues, it may take longer to address. Whatever the cause, it’s important to let a healthcare provider know what’s going on. This is especially true if you experience any of these symptoms:e60dc2a1-f33c-4a05-9b50-8e3e8e597629a13156ad-9a59-4e06-962b-86276d9b363f New pain during sex Sexual pain has gotten worse Bleeding during or after intercourse Unusual vaginal discharge Sores on your genitals Irregular periods The Takeaway Dyspareunia is pain in the vaginal or pelvic region that happens right before, during, or after sexual intercourse. Medical and psychological conditions, including hormonal changes, injury, anxiety, or stress, can cause dyspareunia. You can treat dyspareunia with medications, physical therapy, counseling, and through some lifestyle modifications. It can feel awkward to speak to a healthcare provider about sex, but it’s important to share your symptoms so your provider can help you make a plan for pain relief.
Resources We Trust Mayo Clinic: Painful Intercourse (Dyspareunia)Cleveland Clinic: Dyspareunia (Painful Intercourse)American Family Physician: Dyspareunia in WomenAmerican College of Obstetricians and Gynecologists: When Sex Is PainfulSexual Medicine Society of North America: Why Does Sex Hurt?: A Guide for Figuring Out What Might Be Causing Painful Sex

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Hip Replacement

Hip replacement surgery, also known as hip arthroplasty, is a surgical procedure that involves removing damaged or worn-out parts of the hip joint and replacing them with parts made of metal, ceramic, and very hard plastic. This surgery aims to relieve pain, improve mobility, restore function, and help people carry out daily activities and do the things they enjoy.
Who Typically Needs a Hip Replacement? Why It’s Done Hip replacement is generally recommended for people experiencing significant pain and loss of mobility because of hip arthritis, hip fractures, or other severe joint disorders that do not respond to more conservative treatments. In the United States, there are an estimated 450,000 total hip replacement surgeries performed each year, a number that is expected to grow as the population ages. The hip is one of the body’s largest joints, and it’s a ball-and-socket joint. The socket is formed by the acetabulum, a part of the pelvis. The ball is the femoral head, which is the upper end of the femur, or thigh bone. Cartilage cushions the ends of the bones and allows them to move easily, and thin tissue called the synovial membrane surrounds the hip joint. In a healthy hip, the membrane makes fluid that lubricates the cartilage and allows easy and friction free movement.e60dc2a1-f33c-4a05-9b50-8e3e8e597629eb9c183e-2464-4509-9008-6968a54cdc00 The most common reasons people undergo hip replacement surgery include: Osteoarthritis This age-related “wear and tear” type of arthritis usually occurs in people age 50 and older. The cartilage that cushions the bones of the hip wears away, causing the bones to rub against each other. Rheumatoid Arthritis This autoimmune condition causes inflammation in the joints that can damage cartilage. Posttraumatic Arthritis A serious hip injury or fracture can cause damage to the cartilage. Osteonecrosis (Also Called Avascular Necrosis) An injury to the hip may disrupt the blood supply to the femoral head, leading to bone death and joint collapse. Childhood Hip Disease Some people are born with hip problems or have them as children. Even if the issue is successfully treated at the time, it may still cause arthritis later in life, because the hip may not grow normally, affecting the joint.e60dc2a1-f33c-4a05-9b50-8e3e8e597629eb9c183e-2464-4509-9008-6968a54cdc00 There are several factors that go into the medical decision on whether a person needs a hip replacement, says Nathan Mesko, MD , the section head of orthopedic oncology and trauma at Cleveland Clinic in Ohio. Symptoms The most common symptoms leading to hip replacement include groin pain or pain in the front of the thigh that can radiate to the knee. Imaging Changes X-rays , CT scans , or MRIs that show clear arthritic changes factor into the decision to do the surgery. Lifestyle and Quality of Life A person’s lifestyle, including what they are giving up because of their symptoms and what they would like to get back to, influence the decision about whether to have a hip replacement, says Dr. Mesko. Previous Treatments Nonsurgical treatments such as anti-inflammatory drugs, physical therapy, activity modifications, and injections are usually tried before surgery is considered. “Every case is unique, and sometimes it may make sense to move into a more surgically based discussion immediately based on severity and intensity of symptoms, advanced imaging changes, and minimal hope that nonsurgical measures will provide meaningful relief,” Mesko says.
How Is Hip Replacement Performed? How It’s Performed During hip replacement surgery, the damaged bone and cartilage is removed and replaced with a prosthetic implant. There are two main types of hip replacement surgery: Total Hip Replacement In total hip replacement, the whole hip — both the femoral head (the ball) and the acetabulum (the socket) — are replaced. Almost all hip replacements are total hip replacements. Partial Hip Replacement Very rarely, only part of the hip needs to be replaced. This is usually recommended for specific types of hip fractures or to remove certain types of tumors.e60dc2a1-f33c-4a05-9b50-8e3e8e597629bfffc4a5-0504-435d-aed2-07cb66915082 To access the joint, the surgeon will begin by making an incision, either in the front, the back, or the side of the hip. These approaches are called anterior, posterior, and lateral, respectively. “The outcome of the surgery is generally the same regardless of the approach used. What matters most is the surgeon’s experience and expertise. You want a surgeon who performs hip replacements regularly and has mastered their technique,” says Mesko.
Both Hips Replaced at the Same Time: Simultaneous Bilateral Hip Replacement In simultaneous bilateral total hip replacement, both hip joints are replaced during a single surgery. This is used for people with pain or loss of function in both hips because of arthritis, childhood hip disorders, or other hip-related bone diseases. There are benefits to the surgery if a person needs both hips replaced, including having one surgery rather than two, less expense (compared with two surgeries), and one round of rehab instead of two. But having both hips replaced at once is associated with a longer exposure to anesthesia, more blood loss, and a higher risk of complications such as blood clots . Because of those risks, the surgery is usually only recommended for younger people in better overall health.e60dc2a1-f33c-4a05-9b50-8e3e8e597629dc6a8778-22a4-4f68-8029-69e0cb400e5d
How to Prepare for Hip Replacement How to Prepare Take steps to prepare yourself and your environment before surgery to ensure a smooth procedure and recovery. Mesko recommends “doing your homework,” and if you have any concerns or questions, make sure to have a discussion with your provider. He also offers the following tips to set yourself up for a successful hip replacement: Stop smoking. Smoking can hinder wound healing and increase the risk of complications. Work on your core strength. Ask your provider for recommendations on how to safely improve your core strength through exercises such as modified planks or bridges. Control any chronic conditions. If you have diabetes or other chronic conditions, make sure they are well managed before undergoing surgery. A target A1C of less than 8.0 is typically recommended for people with diabetes before surgery. Working to achieve a healthy weight before surgery can also make recovery easier. Visit the dentist. Take care of all outstanding dental work before surgery. Make sure any existing wounds are healed. If you have any open wounds, cuts, or sores, these should all be healed prior to an elective total joint replacement. Prepare your home for the recovery period. Preparing your home for recovery is essential. Ensure that there are no tripping hazards. If possible, rearrange your home so you can stay on a single level (no climbing or descending stairs) for one to two weeks after surgery to give yourself a chance to recover and adapt.
What Should I Expect During and After Hip Replacement Surgery? What to Expect Hip replacement procedures are typically performed in a hospital or specialized surgery center. To make sure you don’t feel any pain, you’ll get a spinal block, which numbs you from the waist down, or general anesthetic, which induces a sleeplike state. The surgery is usually completed within two hours. The steps of a hip replacement are as follows: An incision is made over the hip. Diseased and damaged bone and cartilage are removed, and any healthy bone is left intact. The replacement socket is implanted into the pelvic bone. A metal stem is inserted into the top of the thigh bone, which is then topped with a replacement ball. The new ball is inserted into the new socket. The surgeon closes the incisions with stitches or clips and covers them with a bandage. After the surgery, you’ll be taken to the recovery area to rest and allow the anesthesia to wear off. Your doctor will decide how long you need to stay in the hospital; most people can go home the same day or the day after.e60dc2a1-f33c-4a05-9b50-8e3e8e5976294b9753b7-c220-495e-974f-ba35a0f6692a
What Are the Risks and Potential Complications of Hip Replacement? Risks and Complications As with any surgery, there are risks associated with hip replacement. Although complications are rare, these are some of them. Infection Infection can occur at the surgical site or deeper within the joint. It is typically treated with antibiotics, but in some cases, additional surgery may be needed. Blood Clots Deep vein thrombosis (DVT) can develop in the legs after surgery, posing a risk if the clot moves to the lungs ( pulmonary embolism ). Fracture Healthy parts of the hip joint can fracture during surgery. Sometimes the fractures are small and can heal on their own, but larger fractures might need to be stabilized with wires, screws, a metal plate, or bone grafts. Dislocation The new hip joint can occasionally become dislocated, especially in the first few months after surgery. Implant Problems Over time, the implant may wear down or loosen, requiring revision surgery. Changes in Leg Length A new hip sometimes makes one leg longer or shorter than the other. Sometimes this is caused by the shortening or hardening of muscles around the hip and may be helped by special exercises.e60dc2a1-f33c-4a05-9b50-8e3e8e59762966897dd8-ce78-43f0-a845-89005b78f3db “With advancements in surgical techniques and materials, the risk of complications is generally low. However, it’s important to follow all postoperative care instructions and attend regular follow-up appointments to monitor for any issues,” says Mesko.
What Type of Care Is Needed Following Hip Replacement? Follow-Up Care There is pain after surgery, but most people start to feel better quickly. A walker, cane, or crutches may be needed for one or two weeks after the surgery, but recovery is typically fast. Care during your initial recovery period generally includes: Postoperative Monitoring You will be monitored for signs of infection, blood clots, and proper healing. Moving with the help of crutches or a walker is encouraged. Applying pressure to the legs by wearing compression stockings or inflatable air sleeves and taking blood-thinning medications may be recommended to help prevent blood clots. Wound Care The stitches or staples used to close the incision will be removed after about two weeks. The incision takes about six weeks to heal. It’s okay to shower during this time, but swimming and bathing should be avoided until it’s completely healed. Pain Management Your doctor will prescribe pain medications to help you manage discomfort. Nonsteroidal anti-inflammatory drugs (NSAIDs), acetaminophen (Tylenol), or opioids may be used, depending on your needs. A combination of medications may be used for pain relief as well as to minimize the need for opioids — they are narcotics and can be addictive. In some cases, a series of regional blocks using local anesthetics may be used. Icing the leg and the incision site, and keeping the leg elevated above the heart when you lie down can help with pain and swelling. Follow-Up Appointments You will need to see your provider in the days or weeks following surgery to check for proper healing and assess the function of the new hip joint. Physical Therapy Most people will have a physical therapy session before their surgery and will work with a PT right after surgery to review the exercises before they go home. Rehab will be a combination of outpatient (where you go to a healthcare or rehabilitation facility) and at-home exercises, with an initial focus on regular movements like getting out of bed, in and out of a chair, and climbing stairs.e60dc2a1-f33c-4a05-9b50-8e3e8e597629c5601870-c8dd-4911-b32c-60109c0f03b6
What’s Next? For most people, it takes about two to eight weeks to recover from hip replacement. Your activity level and general health before surgery and your age will play a role in how long it takes.e60dc2a1-f33c-4a05-9b50-8e3e8e597629f864ddcf-a1b3-4c8e-8a9d-592b574a401d You may need to use a cane, crutches, or a walker for a week or two after surgery, but recovery is relatively fast. In about three to six weeks, most people can resume the light activities of daily living such as sitting, standing, and climbing stairs. Walking is the best therapy for hip replacement.e60dc2a1-f33c-4a05-9b50-8e3e8e597629f864ddcf-a1b3-4c8e-8a9d-592b574a401d Most people can go back to work within two to six weeks and can safely drive within a month after surgery.e60dc2a1-f33c-4a05-9b50-8e3e8e597629c776b9f6-94b9-4b90-9d2a-9ecc9bd91458 Although hip replacement doesn’t cure arthritis (there is no cure for arthritis), the symptoms of pain, stiffness, and inflammation of the hip should go away after the recovery period.e60dc2a1-f33c-4a05-9b50-8e3e8e59762915617e6a-8a9b-4cd3-885a-a552dd53ef03 In recent years, technological advancements such as robotic-assisted surgery and the use of artificial intelligence during the procedure have enhanced the precision of the surgery, improving both the accuracy of the procedure and the recovery process. “With modern techniques, materials, and advances in implant engineering, we can confidently tell patients that the likelihood of a successful hip replacement is over 90 to 95 percent,” says Mesko.e60dc2a1-f33c-4a05-9b50-8e3e8e59762968765950-6657-44dd-affb-a41833d1d498 While complications like infection, dislocation, or nerve injury can occur, these are typically rare, especially when performed by an experienced surgeon, he says. Many people live with their hip replacement the rest of their lives.e60dc2a1-f33c-4a05-9b50-8e3e8e59762915617e6a-8a9b-4cd3-885a-a552dd53ef03 Research suggests that about 75 percent of hip replacements will last 15 to 20 years, and close to 60 percent will last 25 years.e60dc2a1-f33c-4a05-9b50-8e3e8e597629f98f0b6f-f6d7-4c90-ba9b-0418e3ec9518
What Can You Do Before and After Surgery to Maximize Your Results? To ensure the best possible outcome after hip replacement surgery, Mesko recommends the following. Pre-Surgery Strengthening Focus on improving core strength and hip muscle strength through exercises like bridges and planks. Post-Surgery Physical Therapy Adhere to your prescribed physical therapy regimen to help regain mobility and strength in the hip. Weight Management If you are overweight, losing weight can reduce the stress on the new hip joint and improve your recovery. Support System Arrange for help at home during the recovery period, as you will need assistance with daily tasks in the early weeks. The Takeaway Hip replacement surgery is highly effective for people with severe hip pain and mobility loss due to conditions like arthritis or fractures, with a success rate of over 90 percent. Preparation for surgery is key to a smooth recovery, and includes preoperative testing, physical therapy, managing chronic conditions, and preparing your home for post-surgery care. Most people who engage in physical therapy can expect to regain mobility and return to low-impact activities like walking within a few weeks. Follow postoperative care instructions and attend follow-up appointments to improve outcomes and help prevent complications.

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Hepatitis C During Pregnancy: Risks, Testing, Treatment

An estimated 1 to 2.5 percent of pregnant women in the United States have hepatitis C , a chronic viral infection that can potentially cause serious liver damage , liver failure, and liver cancer if untreated.e60dc2a1-f33c-4a05-9b50-8e3e8e597629e01222b3-fed2-429a-9492-6707273ae7b9 A person with hepatitis C can transmit the infection to a fetus during pregnancy, which may put the baby at risk for complications . If you are planning to become pregnant and have been diagnosed with hepatitis C, it’s important to be treated as soon as possible. While there are no approved treatments for women with hepatitis C who are already pregnant, receiving prenatal care from an experienced ob-gyn will help ensure the best possible outcome.e60dc2a1-f33c-4a05-9b50-8e3e8e597629585a1dc9-f779-444f-8a42-fdaae5c49afb Here’s what to know about how hepatitis C spreads, how it can affect you and your baby, and how and when to get tested and treated for the virus.
What Is Hepatitis C and How Does It Spread? How Hepatitis C Spreads Hepatitis C is a virus that invades cells in the liver (hepatocytes) and causes it to become inflamed. Over time, this inflammation can lead to liver damage and cirrhosis , a life-threatening condition in which scar tissue replaces healthy liver tissue. Hepatitis C often does not cause any symptoms until it has caused significant damage, which is why it’s important to get tested. In general, men are more likely than women to be infected with hepatitis C and are less likely to clear the virus in the acute phase of infection. Estrogen may have a protective effect in women of childbearing age.e60dc2a1-f33c-4a05-9b50-8e3e8e597629ab0674e6-dfd4-4093-b211-eccf82118d51 There are two types of hepatitis C: Acute Hepatitis People with acute hepatitis may have symptoms that last up to six months. Sometimes the body can fight off the infection, and the virus goes away, but for most people, a short-term infection leads to chronic infection. Chronic Hepatitis Long-term or chronic hepatitis can last a lifetime if it’s not treated. Without proper diagnosis and medication, it can cause serious health problems, including liver damage, cirrhosis, liver cancer, and even death.e60dc2a1-f33c-4a05-9b50-8e3e8e597629cfe95c61-74a0-4163-b0ab-8c2510d6f309 The blood of a person who has hepatitis C can spread the infection. In the United States, most people get the virus by sharing needles, syringes, or other equipment used to inject or snort illegal drugs. While it is uncommon, the virus can be sexually transmitted or spread via personal items (such as razors or toothbrushes) and unsanitary tattoo and piercing instruments. Prior to 1992, when widespread screening of the blood supply was instituted, it was possible to get hepatitis C from a blood transfusion or an organ transplant if the donor was infected with the virus.e60dc2a1-f33c-4a05-9b50-8e3e8e59762944db286a-8335-4c93-b943-0fd89ea1c854 A pregnant woman can pass the hepatitis C virus to a fetus in the uterus through her bloodstream. Around 5 percent of babies whose mothers have hepatitis C contract the infection this way.e60dc2a1-f33c-4a05-9b50-8e3e8e597629a7d8d49f-8029-448e-ad41-116bce534479 Unlike hepatitis A or B, there is no vaccine for hepatitis C, so prevention focuses on avoiding risk factors.e60dc2a1-f33c-4a05-9b50-8e3e8e5976296487030a-9a91-4bc6-8a90-2a127f770eae
How Hepatitis C Affects Pregnant Women Effects on Pregnant Women Pregnant women with hepatitis C may have a higher risk for certain pregnancy complications: Gestational diabetes causes high blood sugar and can affect your pregnancy and your baby’s health. Preeclampsia is a serious pregnancy complication that can cause high blood pressure; high levels of protein in the urine, indicating kidney damage; or other signs of organ damage. If left untreated, preeclampsia can lead to serious or even fatal complications for both the mother and baby.e60dc2a1-f33c-4a05-9b50-8e3e8e5976295fde7c7d-4513-4c73-b189-f960f1bb358e Cesarean section (C-section) is required at higher rates.e60dc2a1-f33c-4a05-9b50-8e3e8e59762930c0ed2a-45f6-4d7b-ad82-450ef8a40aaf
How Hepatitis C Can Affect a Baby Effects on Babies Research indicates that hepatitis C may cause health issues for babies: Preterm birth (babies born before 37 weeks of pregnancy) is the leading cause of infant death and a risk factor for health and developmental problems at birth and later in life. Low birth weight is defined as less than 5.5 pounds. If the mother has another infection, such as hepatitis B or HIV, the chances of the baby developing hepatitis C go from 5 percent to about 10 to 15 percent.e60dc2a1-f33c-4a05-9b50-8e3e8e5976296b34b3e9-39f3-4f36-b5e0-0315d1b27bad
Diagnosing Hepatitis C During Pregnancy Diagnosis The Centers for Disease Control and Prevention recommends that all pregnant women be tested for hepatitis C. Because the infection often comes with no symptoms, testing is required for a diagnosis. A pregnant woman should be tested as early as possible, ideally at the first prenatal visit.e60dc2a1-f33c-4a05-9b50-8e3e8e597629597482fa-0ae2-47dc-9f01-7dcc9c4c92cd Knowing a pregnant woman’s hepatitis C status ensures that she will be carefully monitored as the pregnancy progresses. Testing the mother also identifies at-risk infants, so they can be tested and monitored after birth.e60dc2a1-f33c-4a05-9b50-8e3e8e5976290819af68-d39e-444a-a43e-47975ab0ba64
How to Treat Hepatitis C During Pregnancy Treatment There are no hepatitis C treatments approved for use during pregnancy due to concerns that the treatment may harm the fetus. Once a woman has given birth and stopped breastfeeding, it is safe to begin antiviral treatment.e60dc2a1-f33c-4a05-9b50-8e3e8e597629be745772-9199-4417-b82c-81c0151b6cd7 However, if you test positive for hepatitis C before becoming pregnant, you can start treatment before trying to conceive. Over 90 percent of people with hepatitis C can be cured within 8 to 12 weeks of treatment with oral therapy. New antiviral medicines called direct-acting antivirals (DAAs) are used to clear the virus from the body. DAAs have better outcomes, fewer side effects, and shorter treatment times than previous medications. Treatment with DAAs typically lasts for eight weeks. The goal is for the virus to be undetectable in the blood 12 weeks after the treatment ends.e60dc2a1-f33c-4a05-9b50-8e3e8e597629a22292b7-124d-4c83-afba-e3bf45caea62 Research evaluating the safety of DAAs to treat hepatitis C during pregnancy is ongoing and may lead to approval or guideline changes in the future.e60dc2a1-f33c-4a05-9b50-8e3e8e5976295634b332-4314-4c43-8f10-7e91a1879c07 Monitoring Health During Pregnancy It’s important for pregnant women to go to all their prenatal visits. This is especially true if you have hepatitis C, so your healthcare provider can monitor your health and your baby’s development and growth. It’s also important to make sure that everyone on your healthcare team is aware of your diagnosis. Let your provider know all the medicines you are taking, including over-the-counter medications, as some medicines, such as acetaminophen (Tylenol), can make liver problems worse.e60dc2a1-f33c-4a05-9b50-8e3e8e59762962cfc7a2-2a6b-4052-8737-f56d4a9d3652 Lifestyle and Diet Recommendations Talk with your healthcare team to get personalized recommendations and support for taking care of yourself and your baby during pregnancy. In general, these guidelines are suggested: Stay away from harmful substances, including illegal drugs and tobacco. If you need help quitting, tell your healthcare team so they can help you get treatment. Do not drink alcohol. Alcohol can damage your liver and harm your baby. Follow your healthcare team’s recommendation for a healthy diet during pregnancy. If you haven’t received vaccines for hepatitis A and hepatitis B, get them. These vaccines are safe during pregnancy. Stay away from people who have colds and other infections. Tell the people you live or have sex with that you have hepatitis C. Don’t share personal items like razors, towels, toothbrushes, or nail clippers. Use a condom every time you have sex. Keep any cuts, scrapes, or blisters covered. If you use drugs, don’t share supplies used to snort or inject them, like needles, syringes, or straws.e60dc2a1-f33c-4a05-9b50-8e3e8e5976296dc90618-8616-4275-8ec9-176bc09a27cf
How to Avoid Hepatitis Transmission From Mother to Baby Prevention There is no evidence that any preventive treatments can reduce the risk of passing on the virus to a baby, including having a C-section rather than a vaginal delivery. There is limited evidence that invasive prenatal testing, prolonged rupture of the membranes, and scalp fetal monitoring are associated with a slight increase in the risk for transmission.e60dc2a1-f33c-4a05-9b50-8e3e8e597629e0b10963-f8dd-40c7-b3a4-b76f46ce3765
Newborn Care Newborn Care Testing a baby right after delivery can’t provide a definitive diagnosis of hepatitis C infection. Though the risk is low, it is possible for the mother’s hepatitis C antibodies to appear in the baby’s blood for up to 18 months, even if the baby does not have the virus. Screening guidelines recommend that all babies born to women with hepatitis C get tested for antibodies at 18 months of age; those who have antibodies should get tested after age 3 to confirm or rule out chronic hepatitis C.e60dc2a1-f33c-4a05-9b50-8e3e8e5976298f512bba-2cc0-48b9-a753-1268d9e4a7f9 If a child tests positive for hepatitis C, they need to see a specialist and receive treatment, even if there are no symptoms. Is Breastfeeding Safe? Mothers with hepatitis C can safely breastfeed their infants. There is no evidence that breastfeeding increases the risk of transmitting the infection. However, if there is any bleeding from the nipples or they are cracked, women should not breastfeed until the bleeding has stopped and the nipples have healed.e60dc2a1-f33c-4a05-9b50-8e3e8e59762968072c3e-198e-450d-a442-11b3d0eeed7a The Takeaway Hepatitis C is a viral liver infection that can affect pregnant women and their babies. While the risk of transmitting the virus from mother to baby is generally low, it’s important to understand potential complications, including gestational diabetes, preeclampsia, and preterm birth. Testing for hepatitis C early in pregnancy is recommended to ensure proper monitoring and prenatal care. No antiviral treatments are approved for use during pregnancy, due to potential risks to the fetus, but effective therapies are available after the baby is born.
Resources We Trust Mayo Clinic: Hepatitis CCenters for Disease Control and Prevention: Clinical Care of Hepatitis CColumbia University Irving Medical Center: Hepatitis C in PregnancyOffice on Women’s Health: Viral Hepatitis in Pregnancy MedlinePlus: Hepatitis C

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