Physical Therapy for Psoriatic Arthritis Relief

Living with psoriatic arthritis can mean chronic joint pain and swelling, constant fatigue, and a limited range of motion that makes daily activities a challenge. But working with a physical therapist can help alleviate some of these symptoms.

Regular exercise helps keep joints functioning properly, but it’s important to exercise safely and use correct form. That’s where physical therapy (PT) comes in, according to Maura Iversen, DPT, dean of the college of health and wellness at Johnson & Wales University in Providence, Rhode Island.

The goal of PT is to restore or improve joint mobility, strengthen joints, maintain muscular and aerobic fitness, and make it easier to do everyday tasks. A physical therapist may:

  • Develop an individualized fitness plan that includes strengthening, stretching, and aerobic exercises, and show you how to execute them properly.
  • Demonstrate proper posture and body mechanics for day-to-day activities to help relieve pain and improve function.
  • Recommend options such as braces or splints, shoe inserts, and heat or cold therapy to support joints and ease pain and stiffness.
  • Teach you how to use assistive devices that can improve your mobility and help you perform daily tasks.
  • Suggest modifications to your physical environment (ergonomic recommendations) and lifestyle to help you conserve energy and improve function while protecting your joints.

In this Q&A, Iversen talks about how physical therapy can benefit people with psoriatic arthritis and what you need to know about finding the right physical therapist for you.

1. When Should Someone With Psoriatic Arthritis Consider PT, and What Can They Expect?

Iversen: Joint pain and swelling from psoriatic arthritis, coupled with tendon inflammation (enthesitis), are usually what lead people and their physicians to consider physical therapy as a treatment option. You may also be experiencing severe fatigue due to the systemic inflammatory nature of the disease. Whether you have active or stable disease, a referral to a physical therapist can help you understand how exercise and lifestyle changes can help you manage. If your doctor has not yet suggested PT, consider asking for a referral at your next visit.

A physical therapist would begin the initial clinic session with:

  • Your complete health history, including sleep habits, hygiene, and more
  • A discussion about your physical environment at home and work
  • A vital sign assessment, including blood pressure and heart rate at rest and with exercise
  • A full-body exam, including joint range of motion
  • A joint alignment exam to determine if malalignment is placing stress on the joint during movement (if so, it indicates a need to practice caution when exercising that joint)
  • Strength testing
  • Aerobic performance test to assess endurance

A physical therapist may also ask about your goals for treatment and function, discuss potential barriers, and talk about how to implement a comprehensive PT program.

2. What Can a Physical Therapist Do to Help You?

Iversen: A physical therapist can help you manage psoriatic arthritis symptoms in a variety of ways. The PT program can enhance endurance through regular aerobic exercise, such as bicycling, speed walking, and swimming. Low-impact exercises, such as tai chi and yoga, are recommended during flares. High-impact exercise can be implemented when the disease is stable, when there is no joint malalignment, and based on your preferences. Strength and joint motion can be improved with a tailored strengthening program and stretching regimen. Losing weight through lifestyle changes and exercise can also be effective in reducing psoriatic arthritis symptoms. Additionally, passive treatments, such as massage or TENS (transcutaneous electrical nerve stimulation), can be used in conjunction with exercise to help you manage symptoms.

If you’re having trouble functioning at work, a physical therapist can conduct an ergonomic evaluation. They can help you modify your workspace or even speak to your company to create a better work schedule to accommodate you. This could include part-time or fully remote work.

3. What Are Some Common Obstacles to Trying PT, and How Can People With Psoriatic Arthritis Overcome Them?

Iversen: Fear of movement and of engaging in exercise is a common concern for people with psoriatic arthritis. You may worry that movement may cause more joint destruction.

Chronic, inflammatory diseases such as psoriatic arthritis have symptoms that come and go. With psoriatic arthritis, one week you may look and feel fine, and then the next week your symptoms may flare. This fluctuation in symptoms makes it difficult to understand whether the pain you’re experiencing is typical discomfort from exercising after a period of inactivity or from an increase in disease activity.

The benefits of exercise may seem counterproductive, because you’re stressing the joints during exercise. But the goal is to exercise within your pain tolerance and slowly build up strength, endurance, and range of motion. A gradual increase in intensity and frequency of exercise allows you and your physical therapist to determine how your body responds to exercise.

Remember: You are the expert on your body. You know what you can and can’t do. You need to pay attention to your body’s reaction to exercise. If 30 minutes of exercise is too much, you can split the routine into smaller intervals — for example, 10 minutes of exercise, three times a day. If 30 minutes is the threshold for building aerobic capacity, you and your therapist can find ways to complete 30 minutes of exercise while reducing joint pain and stiffness.

4. Is PT Different for People Who Are Athletic?

Iversen: Athletes tend to be self-motivated and good at goal setting and achieving goals. They often are very aware of their body’s capabilities and listen to their body’s response when exercising. If an athlete can only do five reps instead of 10, it’s not a big deal to them.

Nonathletes often need external motivation and tend to benefit from the support of exercising in a group or with a physical therapist or fitness instructor. Someone who is not athletic may wish they could do more but might be unclear on how to self-motivate. The group setting is very helpful for nonathletes to feel more comfortable with exercise.

The Arthritis Foundation has some wonderful collaborative programs. I keep a list of what’s available for people, and I connect them with the types of resources they’re more likely to use.

5. How Do You Know if You Have the Right Physical Therapist?

Iversen: Exercise is a form of medicine. Just as a rheumatologist will adjust your medication to identify which drug works best, you need a physical therapist who will help you determine the best exercise regimen, use of assistive devices, and adjunct therapy (such as massage) for the different phases of disease activity and based on your current physical condition. When you’re in a flare, the regimen needs to be adjusted according to the active symptoms. When the flare subsides, a greater emphasis on higher intensity, frequency, and duration of exercise can be used.

Physical therapists can specialize in various practice areas, such as geriatrics or pediatrics. Identifying a physical therapist who specializes in rheumatic diseases is important. The American College of Rheumatology maintains a database of providers specializing in rheumatic conditions. You can also search for a physical therapist who specializes in orthopedics through the American Physical Therapy Association.

6. Will Insurance Cover PT for Psoriatic Arthritis?

Iversen: Each insurance company has different fee structures and visit allowances. If you are referred by your rheumatologist or primary care specialist, sessions should be covered. Your therapist’s office should know what the insurance company allows. This can help the physical therapist determine the best way to care for you.

The Takeaway

  • Engaging in physical therapy for psoriatic arthritis can greatly improve joint mobility, strength, and daily functioning while helping you stay active safely.
  • A physical therapist can also help you overcome barriers such as fatigue or fear of worsening symptoms, guide you through an individualized exercise plan, and help you modify your exercise program as needed during a flare.
  • Seeking out a physical therapist with expertise in rheumatic diseases, such as psoriatic arthritis, can help you get specialized care.

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5 Ways to Manage Psoriatic Arthritis-Related Brain Fog

Most people associate psoriatic arthritis with joint pain. But if you’ve ever been unable to concentrate and put tasks off as a result — and then gotten frustrated about why you just can’t get it done — it could be brain fog, another symptom of psoriatic arthritis.

Brain fog is a term that’s used to describe an episode of mental confusion, which often results in lack of focus, poor memory, and reduced mental clarity. In one study nearly half of the participants with psoriatic arthritis experienced mild cognitive impairment.

There are a number of possible reasons people with psoriatic arthritis may have brain fog. Psoriatic arthritis symptoms such as fatigue and pain can make it difficult to think clearly. Inflammation related to the condition may also affect brain function.

 And people with psoriatic arthritis have a greater risk of depression, which can affect cognitive function, concentration, and memory.

Another potential cause of brain fog: “If you have an autoimmune disease such as psoriatic arthritis, you’re more likely to have fibromyalgia,” says Anca Askanase, MD, a professor of medicine and the director of rheumatology clinical trials at Columbia University Irving Medical Center in New York City. “Fibromyalgia is associated with sleep disturbance, sleep fatigue, and brain fog.”

The good news? There are steps you can take to manage brain fog if you have psoriatic arthritis. Here are five strategies to try.

1. Stay Active

Regular physical activity can help you not only manage symptoms such as joint pain but also improve cognitive function. Research shows that exercise combined with cognitive training can improve global cognition — including attention, memory, and word recognition — and orientation in adults with mild cognitive impairment.

So get moving. The Centers for Disease Control and Prevention recommends 30 minutes of aerobic activity at least five days a week, plus strength-training exercises two days a week.

 Walking, swimming, and biking are good aerobic options for people who have psoriatic arthritis.

2. Eat a Balanced Diet

Although there’s no one diet for managing psoriatic arthritis, what you eat can affect your overall health and your cognitive health.

Research shows that eating plans with an overall dietary approach (rather than keying in on a specific nutrient or health fad) are linked to a low risk of cognitive decline. Examples include the DASH, Mediterranean, MIND, and Nordic diets.

3. Get More (and Better) Sleep

“Having appropriate sleep hygiene is very important for people with psoriatic arthritis, as well as for people with fibromyalgia,” says Manika Zeri, MD, a rheumatologist at Atrium Health Rheumatology in Charlotte, North Carolina. Why? Sleep deprivation disrupts your brain’s ability to function properly, which can lead to impaired judgment, lowered cognitive flexibility, and a poor attention span.

“It’s important to zero in on why you can’t fall asleep or stay asleep,” says Dr. Zeri. “Things such as limiting caffeine intake, exercising, not having a TV in your bedroom, and turning off electronics close to bedtime can all reduce the chance of a sleepless night.”

4. Meditate

Mindfulness can play a significant role in stress relief, but it can also help with mental clarity, something people with brain fog often lack. In fact, one study found that meditation may increase all-important gray matter, which includes areas of the brain responsible for decision-making, memory, and more.

There are many types of meditation you can try. If you’re new to meditating, you can begin by sitting or lying in a quiet room, closing your eyes, and focusing on your breathing for a few minutes a day.

5. Play Brain Games

Like your heart and lungs, your brain needs exercise to stay sharp and clear. And research has found that taking up a hobby, such as dancing, knitting, or painting, could help provide cognitive stimulation.

The benefits of a hobby can be twofold: It helps with mental clarity and increases the likelihood of social interaction. The latter is important for people with psoriatic arthritis, who may feel isolated or alone because of the condition.

The Takeaway

  • Brain fog is a common yet challenging symptom of psoriatic arthritis, characterized by impaired memory, a lack of focus, and mental confusion.
  • Implementing habits such as eating a balanced diet, exercising regularly, prioritizing sleep, meditating, and engaging in hobbies can help boost cognitive function and alleviate brain fog.
  • You should also talk to your doctor to determine if related health issues, such as depression or fibromyalgia, may be contributing to brain fog.

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Psoriatic Arthritis Exercise Mistakes to Avoid

Although it may be the last thing you feel like doing, staying active is an essential part of managing psoriatic arthritis. Exercising regularly not only helps improve symptoms such as pain and fatigue, but also helps keep your joints flexible and your muscles strong. It can even enhance your overall quality of life.

While the right kinds of exercise can have a strong beneficial effect, exercising the wrong way can actually make psoriatic arthritis worse. So be sure to avoid these common exercise mistakes.

1. You Don’t Work on Muscle Strength

“One of the things to realize, which a lot of people don’t, is the importance of strengthening,” says Chris Kolba, PhD, a physical therapist at The Ohio State University Wexner Medical Center in Columbus.

“Basically, the stronger your muscles are, the better they can absorb shock and control motion,” he explains, “which ultimately minimizes stress on the actual joint.” Some research has found that people with psoriatic arthritis who work strength training into their exercise routine twice a week improve their quality of life and functional fitness, compared with those who don’t do strength training.

It’s important not to start out with too much weight or resistance, Dr. Kolba notes. Instead, begin at an intensity that doesn’t feel too difficult, and do more repetitions of the exercise than you would be able to at a higher weight.

2. You Don’t Get Enough Aerobic Activity

As important as strength training is, it’s equally essential to do aerobic exercise.

If you’ve experienced discomfort in your joints while doing moderate-impact aerobic exercises, such as jogging, you may be tempted to skip cardio altogether, Kolba says. But lower-impact options, such as elliptical machines, stationary bikes, rowing machines, and pool exercises, can boost your health without overstressing your joints.

As an alternative, you can use lighter weights for strength training and do them in a circuit — taking only short, timed pauses between activities — to achieve cardiovascular benefits, he notes.

3. You Focus on High-Impact Exercises

Running and jumping may not be good options if you have psoriatic arthritis, Kolba says, because they can strain your joints and accelerate the inflammatory process.

He notes that the stress you put on your joints equals about double your body weight when walking but five to eight times your body weight when jogging.

“That’s a lot of stress for a joint that’s irritated or inflamed,” Kolba says. “There’s a tremendous amount of force coming up through the legs and into the spine.”

Any type of jumping or rapid form of resistance activity could be even worse for your joints. “Those activities just aren’t going to be tolerable in most people with joint issues,” he says.

But some research has found that high-intensity interval training (HIIT) can be both safe and beneficial for people who have psoriatic arthritis.

So if HIIT is something you’re interested in, consider talking to your doctor or physical therapist about safe ways to incorporate it in your exercise routine.

4. You Don’t Work on Balance

Lack of balance, Kolba says, “is typically what leads to falls, and a lack of strength is typically what prevents you from catching yourself.”

It’s common to lose strength and balance as you age or as an inflammatory condition such as psoriatic arthritis progresses, he notes. But you can take steps to work on improving your strength and balance. This means, to some extent, that you can “minimize the progression of whatever arthritic changes you have,” Kolba says.

Make sure you include balance exercises in your overall workout plan.

 Try doing yoga or tai chi along with stretching exercises before a harder workout or on a low-key exercise day.

5. You Skip Warm-Ups

You should never jump right into a tough workout. Instead, get your muscles moving in a more relaxed way for five to 10 minutes, such as by stretching or walking, before you increase the intensity.

Kolba says many of his clients find that warming up and stretching helps eliminate stiffness and soreness. This not only gets your muscles ready for a workout, but also gives you the energy and motivation to exercise in a way that feels satisfying.

6. You Push Through Motion Limitations

When you have joint inflammation, you may not be able to move all of your limbs through the full range of motion.

 This is an important consideration when deciding which exercises to do.

Particularly when strength training, finding a range of motion that’s pain free should be your goal, Kolba says. Once you’ve been doing the activity successfully for a while, “You can eventually slowly start to increase the range of motion that you’re able to move the weight through.”

7. You Overexert Yourself

While it may be tempting to give yourself the most rigorous workout possible, this isn’t a good idea if you have an inflammatory condition such as psoriatic arthritis.

“The key is to listen to your joints during exercise,” says Kolba. “And more importantly, how does it feel later?”

While some level of discomfort after a workout is normal, you should never be above a four on a pain scale of zero to 10, he says, “where 10 is going to the hospital and zero is no pain at all.” If you’re experiencing anything above a four, Kolba notes, you risk aggravating inflammation.

8. You Don’t Use Proper Form

Depending on which joints have the most stiffness and pain, you may instinctively change the way your body is positioned during exercises — particularly with strength training. This is especially true for people with shoulder or knee issues, Kolba says.

Using a “faulty movement pattern” can lead to even more muscle and joint issues, he says, so if you have significant joint pain or restricted motion, it’s important to work with a trainer or physical therapist to make sure your form is correct.

If you have trouble using proper form for certain exercises, “We would stay away from those, based on how you felt and what we saw,” Kolba notes.

9. You Don’t Consider Hand Limitations

If you have pain or stiffness in your fingers, it may be more difficult to do any number of strength-training exercises, particularly if it involves free weights.

To use free weights safely, “You have to grip and hold onto them,” Kolba says. If you have hand problems, you may need to stick to very light weights, he notes.

Many exercise machines offer a better alternative, he adds, since the handles can’t be dropped and sometimes require only pushing with the inside of your hand instead of gripping with your fingers. Even machines that involve pulling may not require a full-force grip.

Another good alternative, Kolba says, is using resistance bands, which can be looped around your wrists or hands. This can help you gradually build your grip without straining the joints in your hands.

In any case, he says, you should work on your grip if it’s impaired. “If you ignore it, it eventually gets worse.”

10. You Skip Rest Days

If you’re sore from a workout you did the previous day, you should take it easy, Kolba says. This doesn’t necessarily mean being sedentary. Just don’t push yourself.

“You could definitely take the day off and bring [your pain] down to a two or zero,” he says, adding that just warming up and doing some stretches can also do wonders to help reduce stiffness and soreness.

You may even want to plan a workout routine that alternates between heavier and lighter workouts, Kolba says. For example, do stretching and balancing exercises the day after an aerobic or strength-training routine. Light biking can also be a good way to keep moving on off days, he notes.

Applying heat or ice to sore muscles can help your body recover while you rest. Ice is good immediately following exercise if you’re having joint pain. But heat is better for loosening tight joints and easing sore muscles after a workout.

11. You Don’t Stay Hydrated

“Lots of water” is the way to go, Kolba says, not only when exercising or sweating a lot, but also on rest days.

Aside from replenishing fluids lost during a workout, staying hydrated helps flush toxins from your body, which helps fight inflammation. What’s more, drinking enough water can help keep your joints lubricated.

While you shouldn’t be drinking water in quantities that feel uncomfortable, it’s generally a good idea to drink water frequently throughout the day. When you feel thirsty or notice your mouth is dry, he says, that’s a sign you’re already dehydrated.

Water is key, but the Arthritis Foundation also recommends tea (keep caffeine content in mind though), smoothies, milk, and other beverages to stay hydrated.

12. You Forget the Role Diet Plays

A healthy, balanced diet is good for managing psoriatic arthritis in general, Kolba notes. But when you’re working out, your muscles also need a variety of nutrients to move effectively and grow stronger.

“Cutting out sugar and processed foods and eating high-quality food in general — fruits and vegetables, lean meats — are simple strategies that can help minimize inflammation,” he says.

Maintaining a healthy weight is also important for people with psoriatic arthritis, because a lower body weight puts less pressure on joints. In addition, having obesity can affect how well treatment works, particularly if you’re taking a biologic medication.

If you’re unsure how you should be eating to support your exercise routine and overall health, ask your doctor for a referral to a dietitian or nutritionist.

The Takeaway

  • When you’re experiencing joint pain and fatigue, exercise may feel like the last thing you want to do. But staying active can actually help keep joints flexible, strengthen muscles, and improve psoriatic arthritis symptoms.
  • Incorporating a mix of aerobics, strength training, and balance exercises is important for a well-rounded psoriatic arthritis–friendly exercise program. Working with a physical therapist can help you exercise with proper technique and form.
  • It’s equally important to listen to your body, know your limitations, and rest as needed to avoid aggravating psoriatic arthritis symptoms. And don’t forget to stay hydrated and well-nourished!

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How Time of Day Affects Mood and Productivity

A study of nearly 50,000 adults in the United Kingdom has found that, in general, things really do seem better in the morning. Participants reported less depression and anxiety and more happiness, life satisfaction, and sense of purpose in the early hours of the day.

The findings match what Susan Albers, PsyD, a psychologist at Cleveland Clinic in Ohio, sees in her practice.

“My patients report that in the morning they often feel their best, and in the evening, they struggle a lot with anxiety, difficulty sleeping, and turning off their brain,” says Dr. Albers, who wasn’t involved in the study.

Happiness and Mood Measured Over 2 Years and 1 Million Survey Responses

For this study, investigators aimed to explore whether time of day was associated with variations in mental health, including feelings of depression, anxiety, and loneliness, as well as happiness, life satisfaction, and a sense that life was worthwhile. They also looked at the day of the week, season, and year.

The researchers surveyed 49,218 adults in the United Kingdom between 2020 and 2022. By the end of the period, researchers had collected nearly a million responses.

About 3 out 4 participants were women, 68 percent had a college degree, and 94 percent were white. To compensate, researchers weighed the responses to reflect population proportions.

Happiness and Mental Health Were Best in the Morning and Lowest by Midnight

Mental health and well-being were measured via online questionnaires using validated assessment tools or through single direct questions such as:

  • In the past week, how happy did you feel?
  • How satisfied have you been with your life?
  • To what extent have you felt the things you are doing in your life are worthwhile?

Time stamps on completion of each survey provided information on time of day (people could respond from 6 am to midnight), day of the week, season, and year.

Key findings included:

  • While happiness, life satisfaction, and worthwhile ratings were high in the morning, they were lowest around midnight. Likewise, depression and anxiety were low in the morning and highest late at night.
  • Happiness, life satisfaction, and worthwhile ratings were all slightly higher on Mondays and Fridays than on Sundays. Happiness was also higher on Tuesdays.
  • Loneliness levels stayed constant across days of the week. There was more variation in mental health and well-being during weekends than weekdays.
  • There was clear evidence of a seasonal influence on mood. Compared with winter, people tended to have lower levels of depression, anxiety, and loneliness, and higher levels of happiness, life satisfaction, and feeling that life was worthwhile in other seasons. Mental health was best in the summer across all outcomes.
  • Mental health and well-being also steadily improved from 2020, the first year of the COVID-19 pandemic, to 2022.

How Sunlight and Sleep Affect Mood

The findings fit with what we know about biology and mood, says Albers.

“The hormone cortisol peaks in the morning, which helps with alertness and energy,” she says.

Cortisol is the “stress hormone” that our bodies release in fight or flight situations. But it has important functions in regulating the body even when we aren’t stressed, such as limiting inflammation, regulating our metabolism, and regulating blood sugar. People whose bodies aren’t producing enough cortisol may have symptoms such as fatigue, unintentional weight loss, poor appetite, and low blood pressure.

“The circadian rhythms of our sleep-wake cycle could be a factor, because exposure to sunlight, particularly in the morning, makes us feel good,” says Albers.

Especially if we get a good night’s sleep, it serves as a reset button for our emotional state, and we look at the next day as a new start, she says.

The findings that mood dips and anxiety rises at night resonated with what Albers sees with her patients.

“Late at night is when we experience decision fatigue. First thing in the morning, we haven’t made many decisions yet, but by the end of the day, we’ve made hundreds of big and little choices. At that point, we’re just really mentally and emotionally exhausted,” she says.

How to Be Your Happiest and Most Productive Self

To leverage your ups and minimize your downs, Albers suggests “conducting an observational study of yourself.”

“Track your moods throughout the day to see what is optimal for you. If your experience matches the findings of this study, try to plan important or challenging tasks for first thing in the morning, when you’re going to be the most focused and have the best concentration, energy, and mood,” she says.

Exercising in the evening also can be a good way to naturally boost mood, says Albers.

“It’s a good practice to have a nighttime ‘wind-down’ ritual. Doing some mindfulness exercises, relaxation, and stress management at night can help to turn off your brain so that you’re not awake at night and ruminating and stressing about everything that’s happened throughout the day,” she says.

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Flu Levels Are High or Very High Across Much of the U.S.

Flu is currently sweeping through the United States, making many Americans miserable with sneezing, congestion, cough, body aches, and fever.

The latest available data from the Centers for Disease Control and Prevention (CDC) shows that 44 states are experiencing high or very high levels of influenza.

The federal health agency estimates that, so far this season, there have been at least 20 million illnesses, 250,000 hospitalizations, and 11,000 deaths from flu.
The virus is becoming notably widespread among children, leading to temporary school closures in many states, including Georgia, Iowa, Missouri, Ohio, Oklahoma, Tennessee, Texas, and Virginia.

“Flu cases are traditionally expected to rise after children return to school from the holidays in January, which may explain the current spike in cases,” says Asif Noor, MD, a specialist in pediatric infectious disease at NYU Langone Health in New York City.

Is the Flu Actually Worse This Year?

While the virus may be hitting people hard right now, and the flu season is far from over, indications suggest that this year should not be any worse than the last, when the CDC recorded about 40 million illnesses for the 2023–24 season.

“The flu activity we’re having now seems to be on par with what we had during flu seasons prior to the COVID-19 pandemic, which kind of erased people’s memory of what flu seasons are like,” says Amesh Adalja, MD, an infectious disease physician and senior scholar at the Johns Hopkins Center for Health Security in Baltimore.

Lower Vaccination Rates May Be a Factor

Dr. Adalja says that a lower vaccination rate may be a contributing factor in driving up respiratory infections and serious illness.

“Influenza vaccine rates have slipped since COVID-19, as vaccine hesitancy spilled from COVID into other vaccines, including influenza,” says Adalja, who is also a spokesperson for the Infectious Diseases Society of America.

About 44 percent of American adults ages 18 and older have received a flu vaccine this season, according to the CDC. For the flu season last year, about 45 percent of adults got the shot.

For the 2020-21 season, however, the rate was above 50 percent.
Low vaccination uptake among children may explain the widespread flu activity in schools. According to the latest available numbers from January 25, coverage among children ages 6 months to less than 18 years is at 44.5 percent — that’s down from 49.1 percent at the same time last year, and a significant drop from 58.3 percent at the end of January 2020.

What’s the Difference Between Influenza A and Influenza B?

Seasonal influenza vaccines are formulated each year to protect against the main groups of type A and type B flu viruses, based on surveillance data from the World Health Organization.

The A and B viruses are very similar, but they have slight differences in their protein structure. Influenza A usually accounts for more flu cases and causes more severe illness than type B flu. Dr. Noor estimates that currently 98 percent of flu illnesses are due to the A strain and 2 percent are due to the B strain.

Predicting which strains and subtypes will actually be circulating can be challenging, and minor mutations can occur within the flu A and flu B strains that can make a vaccine less effective.

How Effective Is the Flu Vaccine This Year?

While the vaccine for this season will prevent severe infection, it wasn’t the best match for the currently circulating strains, says Saahir Khan, MD, PhD, an infectious disease specialist with Keck Medicine of USC in Los Angeles.

“The typical range of flu vaccine effectiveness is about 40 to 60 percent,” says Dr. Khan. “This year’s flu shot is on the lower end of that range — so probably closer to 40 percent.”

Because flu season can extend into May or even June in some cases, there’s still plenty of time to get a flu shot, and it’s still well worthwhile.

“It’s not too late to get vaccinated. We are seeing a lot of influenza nationally, so there’s definitely still time,” says Luis Ostrosky, MD, chief of infectious diseases at UTHealth in Houston. “Even if this season’s vaccine is slightly less effective than in other years, it will still lower the severity of illness, lower hospitalizations and death, and avoid other possible effects from the flu, such as stroke and heart attack.”

Know the Symptoms of Flu, and Treat Them Early On

If you can identify signs of flu, you can start care early on and potentially reduce the duration and severity of the illness. Common symptoms are:

  • Aching muscles, especially in your back, arms, and legs
  • Fever of 100.4 degrees F or higher
  • Chills and sweats
  • Headache
  • Cough
  • Runny or stuffy nose
  • Sore throat
  • Fatigue and weakness

Khan adds that anecdotally he’s hearing of more patients this season reporting stomach symptoms as part of their influenza.

The problem with many respiratory illnesses, however, is that they share similar symptoms, so they are hard to tell apart. “The common cold is usually mild with just a runny nose, but anything that is coupled with fever and cough might be COVID, RSV, or the flu,” says Dr. Ostrosky.

The only way to know for sure if you have the flu is through testing, and now home tests can tell you within minutes if you have the virus. New combination COVID-flu tests may be even more helpful, as they can quickly differentiate between influenza A, influenza B, and COVID-19 — all from a single nasal swab.

Most people who get the flu will recover with plenty of rest and hydration, within a few days to less than two weeks. Some over-the-counter medications such as ibuprofen or acetaminophen can temporarily relieve symptoms.

Prescription antiviral medications can actually fight the virus and block it from replicating and infecting more cells. These drugs can shorten the duration and severity of illness if treatment is started when symptoms are just beginning. The four available prescription drugs for flu are:

  • oseltamivir phosphate (Tamiflu)
  • zanamivir (Relenza)
  • peramivir (Rapivab)
  • baloxavir marboxil (Xofluza)

“You can discuss these options with your doctor, but these medications are probably more of a priority for people who are more vulnerable,” says Khan.

Avoiding Flu and Preventing Spread

Although some regions in the United States are experiencing higher flu rates than others, no one area is really safe from getting the illness. Adalja notes that a number of factors may account for the amount of flu activity in a state, including the level of social activity, the amount of travel in a geographic area, the density of a region, and colder weather that may force people to cluster indoors.

To prevent the spread of flu and protect yourself, Noor advises following basic precautionary measures. “Masking and hand-washing are the two most effective methods of preventing and spreading infection,” he says, in addition to staying home when sick and steering clear of people with symptoms.

“Although people have moved away from using masks, masks protect people from getting sick, particularly in crowded places, and they prevent the spread of infection to other people.”

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Why Does My Belly Button Smell? Causes, Treatment, and Prevention

Belly button odor is more common than some realize, and it can result from basic hygiene issues as well as more serious infections.

1. Poor Hygiene

Washing with soap and water helps remove dirt, oils, and sweat from your skin. But without regular cleansing, these substances can build up in the navel, potentially leading to a musty odor.

This is especially true if you have a deeper-set belly button because the extra folds of skin can make thorough cleaning more challenging, explains Barbara Bawer, MD, a family medicine physician at Ohio State University Wexner Medical Center in Columbus, Ohio. “A deeper-set belly button creates a darker, more humid environment where bacteria can thrive,” she says.

2. Accumulation of Dirt, Sweat, Lint, or Debris

Even if you shower or bathe regularly, your belly button might not get the attention it needs. This often-overlooked area also acts as a catchall for dead skin cells and lint from clothing. And between trapped moisture and accumulated debris, it’s an ideal environment for odor to develop.

This combination also creates the perfect condition for a navel stone to form. This is a small, painless mass made from clumps of debris that can have an unpleasant odor, too.

3. Bacterial Infections

While it’s normal to have some bacteria on the skin, problems can occur when bacteria gets inside the belly button and multiplies. Bacterial infections that may affect the belly button include impetigo (which often starts as sores or blisters on the mouth and nose) and cellulitis (which often causes swelling and pain), and these typically occur when skin bacteria enters the skin through a cut and multiplies, according to Dr. Bawer.

If you don’t completely dry the navel after bathing or sweating, moisture can encourage the growth of bacteria that cause impetigo and cellulitis. Signs of an infection in your belly button include swelling, redness, pain, pus, and a foul smell coming from the affected area.

These infections are more likely in individuals with a weakened immune system (often caused by chronic diseases like diabetes, cancer, and HIV/AIDS), poor circulation, skin folds due to overweight and obesity, and lack of mobility due to illness or injury. These factors can impair healing, which creates an environment for bacteria to thrive.

Bacterial skin infections are usually mild and treatable with antibiotics. However, if left untreated they can lead to complications like abscesses (pockets of pus that may require drainage) or sepsis (a life-threatening infection that spreads to the bloodstream).

4. Yeast Infections

Yeast infections — which can cause a sour, bread-like odor — can also occur in the navel. A common culprit is Candida, says Bawer. This fungus thrives in dark, warm, and moist environments, making the belly button an ideal spot, she explains.

Sweating heavily, such as during workouts or in hot, humid climates, can increase moisture in the belly button. Additionally, wearing tight clothing or fabrics that don’t breathe well can trap heat and moisture, creating a breeding ground for fungi.

Individuals who take antibiotics, wear dentures, are getting cancer treatment, or have health conditions that affect the immune system (like HIV or diabetes) are also at greater risk of yeast infections.

Belly button yeast infections often improve within a couple of weeks of starting treatment with a topical antifungal cream, ointment, or powder. However, infections can return if the area isn’t kept dry.

5. Cysts

A buildup of dead skin cells and oils in the belly button can also cause small, nonpainful bumps beneath the skin called epidermoid cysts. While these cysts are typically harmless, they can become infected or inflamed. When this happens, you might notice a grayish-white discharge and a cheesy odor.

If left untreated, a cyst can become infected, leading to the development of an abscess that may require drainage.

6. Piercings

Another worrisome cause of belly button odor is an infection, either in the belly button itself or spreading through the body, often caused by not cleaning a belly button piercing regularly with warm soap and water, says Benedict Ifedi, MD, a family medicine physician with Memorial Hermann in Houston, Texas.

If a belly button piercing is not properly cleaned, dead skin cells, oils, and bacteria build up, leading to infection. Common symptoms of infection include pain, redness, and smelly pus that can be yellow, gray, green, brown, white, or blood-red.

Similar to other infections, if a belly button infection from a piercing is left untreated, the bacteria can multiply and spread beyond the piercing site, potentially entering the bloodstream. This can lead to sepsis.

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Period Cramps? 10 Ways to Treat Menstrual Pain at Home

Can You Heal Menstrual Cramps With Home Remedies?

Most of the time, menstrual cramps can be treated at home. For extremely painful cramps, you should consult your physician.

Medical interventions you may need for your anti-cramping arsenal include prescription pain relievers, which have a higher potency than you can buy in the store; birth control in the form of pills, patches, vaginal rings, implants, or injections; or hormonal intrauterine devices, Tang says.

Home Remedies Often Do the Trick

To reduce period pain, here are 10 safe and effective home remedies for menstrual cramp relief.

1. Boost Feel-Good Endorphins With Exercise

When researchers in Australia examined nearly two dozen studies about home remedies for menstrual pain, exercise proved to be number one. Moving the body was even (moderately) more effective than taking a pain-relieving medication, they wrote in BMC Complementary and Alternative Medicine in 2019.

Tang says many of her patients are helped by exercise, including cardio and strength training. This is likely because exercise increases hormones like progesterone and dopamine that diminish pain.

2. Try Yoga Poses to Ease Menstrual Pain

Whether it’s the stretching of your muscles or the relaxing effect of the poses, a regular yoga practice can indeed help your cramps.

Yoga exercises were found to be especially helpful in several of the studies the Australian authors examined.

In one study published in 2021, 30 women who did yoga once a week for three months had less pain than the 30 other women who didn’t.

Most yoga instructors say you can practice during your periods or between them, but some advise against doing inverted poses (like a shoulder stand) in the midst of menstruation, so as not to interfere with your natural flow.

3. Curl Up With a Heating Pad to Ease Period Cramps

“The uterus is a muscle, so anything that helps relax muscles, like applying heat, can be beneficial, Thielen says.

Indeed, a trial published in 2019 found that heat application reduced the pain intensity of period cramps after 20 minutes, 110 minutes, and 24 hours. Heat application was also shown to increase pain thresholds in the abdomen when used alone or with electrical stimulation.

The most recent study comparing heat with over-the-counter pain relievers found that women who applied a heat patch on their lower abdomen reported more pain reduction, even after eight hours, than those who self-medicated with over-the-counter pain relievers.

Similarly, another study found that heat was just as effective as ibuprofen for period cramps. Over the two study days, the women used heat alone, heat plus ibuprofen, ibuprofen alone, or a placebo. The best results were in the heat plus ibuprofen group; adding heat led to faster improvements.

4. Pop a Safe Painkiller to Cut the Inflammation

Moderate use of nonsteroidal anti-inflammatory (NSAID) medication like ibuprofen (Advil, Motrin) or naproxen (Aleve) is one of the best ways to curb period pain, Thielen recommends. This is because NSAIDs reduce the amount of prostaglandins in the body. For this reason, taking a pill just before you get your period can keep the level of pain-causing prostaglandins from rising, she says.

As with any medicine, you should first check with your doctor to be sure NSAIDs are a good choice for you, especially if you have a history of bleeding or stomach or kidney issues.

5. Acupuncture May Relax the Nervous System

According to a meta-analysis published in 2019, acupuncture — in particular electroacupuncture, which utilizes electrical current — was more effective than NSAIDs in reducing menstrual pain.

Another study published in 2024 found that buccal acupuncture, a micro-needle technique, was safe and effective, providing short-term menstrual pain relief. Researchers also noted that buccal acupuncture showed long-term efficacy in reducing the severity and frequency of cramps. This benefit may be a result of acupuncture’s anti-inflammatory effects.

If you do see an acupuncturist, Tang suggests asking them about adding moxibustion, a type of Chinese therapy where mugwort herbs are burned close to the skin. The herbs and the heat seem to combine to relieve the cramping, she says. According to a trial published in 2020, moxibustion is most effective when used before period onset.

6. Or Try Acupressure Pressure Points You Can Do Yourself

Acupuncture must be performed by a trained professional, but acupressure, which involves finger pressure instead of tiny needles, can be done yourself at home. This was another method found to be effective in the BMC Complementary and Alternative Medicine review.

In a study published in 2023, researchers found that acupressure was just as effective as pharmacological treatment in reducing pain.

One pressure point you can try pressing on is called the Sanyinjiao point (SP-6), which was found to be an effective way to reduce pain in a review published in 2024. This point is located on the inside of the leg, a four-finger height above the ankle.

7. Some Herbs Can Calm Menstrual Cramping

Cinnamon and ginger have been shown to be effective when it comes to menstrual cramps, researchers reported in July 2023. Both inhibit pathways that lead to blood vessel constriction and cramping.

Chamomile is another herb that may help with cramps. According to a trial published in 2022, chamomile and honey tea reduced menstrual pain to about the same degree as an NSAID.

Chamomile tea, as well as peppermint tea, have been used by menstruating people in numerous cultures for centuries because they are calming to the body.

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21 Healthy High-Protein Snacks to Help You Power Through the Day

3. Nuts

Whether you’re a fan of peanuts, almonds, cashews, walnuts, or pistachios, whole nuts are a healthy, high-protein snack choice. Plus, nuts are high in fiber, which also keeps you feeling full longer. High-fiber foods tend to take longer to eat and fill you up with fewer calories than low-fiber foods.

While nuts are chock-full of heart-healthy fats, it’s still important to measure out portions, as they’re a calorie-dense food.

 Stick to 1 oz — about a handful. Peanuts have the highest protein count, at 7 g per oz and 161 calories, research shows, but most nuts have at least 6 g.

 Eat them on their own, or pair them with some fresh or dried fruit, Woodson says.

4. Cottage Cheese

Low-fat cottage cheese has long been a staple on the grocery lists of health-conscious shoppers, and for good reason: It’s an excellent source of protein. A half cup serving contains 14 g of protein and has less than 100 calories.

 Paired with diced fruit or veggies for dipping, or on its own, it makes a terrific snack to hold you over between meals.

5. Bean Dip

Between their fiber and protein content, beans are an easy go-to at mealtimes. Mashed or blended, they also make a snack-worthy dip. Black beans are a tasty option with almost 8 g of protein per ½ cup and about 114 calories.

 Or opt for cannellini beans with nearly 9 g per ½ cup.

Woodson recommends turning beans into a dip for easy snacking. Simply combine a cup of drained and rinsed beans, chopped onion, minced garlic, chopped cilantro, lime juice, and your favorite seasonings in a blender or food processor. When the munchies hit, enjoy half the recipe with veggie stick dippers for a filling snack.

6. Celery and Nut Butter

This savory veggie-nut combo is also a fiber and protein win. While peanut butter is a tried-and-true favorite (add raisins for the classic ants-on-a-log), a slew of other nut and seed butters are available, including almond and sunflower butters.

Nut butters are high-protein foods, with 2 tbsp providing about 7 g of protein and 191 calories (for peanut butter).

 And though nut butter does contain fat, it’s mostly the good-for-you unsaturated kind (like whole nuts), which may lower blood pressure and reduce your risk of heart disease.

Nut butters made with only nuts and salt are a great option because they don’t have added sugars or oils, but Woodson points out that not everyone can find or afford these and says that any nut butter works as part of a high-protein snack. Enjoy the spreads on celery (or carrots or other veggies).

7. Edamame

Half a cup of cooked edamame, or fresh soybeans, contains 9 g of protein (plus high-quality fiber), making for a satisfying 112 calorie snack.

 Try them in the pod sprinkled with a touch of sea salt. Pinch the beans from the pods as you go.

8. Chia Seed Pudding

Like many seeds, chia seeds are nutritionally dense, with nearly 10 g of fiber per ounce and plenty of calcium.

 What makes them unique is that they are also a rich source of omega-3 fatty acids, an important nutrient that reduces inflammation and also reduces the risk of cardiovascular diseases.

And they are super absorbent: When soaked in liquid, chia seeds produce a gel-like substance that has a consistency similar to pudding.

For a nutritious snack that’s fun to eat, try Wirtz’s recipe: Mix 2 tbsp (equal to 1 oz) of chia seeds with 4 oz of nonfat milk or a high-protein milk alternative. Stir in 1 teaspoon (tsp) of pure maple syrup or honey, and refrigerate for 1 to 2 hours. Between the milk and the chia seeds, you’ll get 9 g of protein in the 198 calorie snack. To serve, top with fresh or frozen berries or 1 teaspoon (tsp) of unsweetened cocoa powder for a little extra flavor and fiber.

9. Pumpkin Seeds and Fruit

Although nuts get most of the attention when it comes to snacking, seeds are a great option, too. Similar to nuts, seeds are high in healthy unsaturated fats and pack a decent protein punch, Woodson says.

An ounce of roasted pumpkin seeds is super easy to take and eat on the go, and will give you 8.5 g protein. “But, while pumpkin seeds are quite nutritious, they might not be enough for everyone to feel full and satisfied at snacktime.” says Caroline Thomason, RD, CDCES, a dietitian and certified diabetes care and education specialist based in Washington, DC. She recommends pairing them with a piece of fresh fruit, which won’t add any protein but will give you some additional fiber.

10. DIY Protein Balls

Making your own protein balls is an excellent way to include ingredients you want in your diet — and leave out those you don’t. When making the bite-size balls yourself, start with high-protein ingredient choices like rolled oats (nearly 11 g of protein per cup), peanut butter (4 g of protein per tbsp), and chia seeds (0.5 g of protein per ounce).

11. Turkey and Whole-Grain Tortilla Roll-Ups

Turkey is rich in protein. Each ounce of roasted turkey (breast meat) packs more than 8 g protein.

Roll 2 to 3 oz of roast turkey into a small whole-wheat tortilla, then add some extra flavor with your favorite condiments or sliced veggies.

12. Cheese Quesadilla

“Cheese is a great way to get in lots of different nutrients, including calcium and protein,” Woodson says. “But it’s also high in fat and sodium, so it’s best not to go overboard.” There’s no need to nix cheese from your diet, but Woodson recommends sticking to an ounce (which packs 8 g of protein) or less.

Take a step in a high-protein direction by making a cheesy quesadilla for a snack: Sprinkle 1 oz of cheddar or other shredded cheese atop a small whole wheat tortilla, then fold the tortilla in half and zap in the microwave or cook on a griddle until the cheese has melted. Each one has 11 g of protein.

13. Roasted Chickpeas

Roasted chickpeas make a crunchy, tasty, high-protein snack. To make your own, on a baking sheet mix a drizzle of olive oil and pinch of salt with a drained can of cooked chickpeas. Roast in a 425-degree Fahrenheit oven 20 to 30 minutes or until crispy. The result is a crunchy snack with 14.5 g of protein per cup.

 Pack individual servings in zip-top bags for grab-and-go snacking.

14. Trail Mix

Use your favorite nuts, seeds, and dried fruits to make a simple, DIY trail mix. Again, peanuts are the highest-protein nut, but nuts in general are a healthy addition to your diet for their beneficial effects on heart health.

Keep high-protein ingredients like peanuts, walnuts, pumpkin seeds, and sunflower seeds on hand, as well as dried fruits or mini chocolate chips for sweetness. Woodson recommends mixing an ounce of peanuts with a tablespoon of raisins for a quick sweet-salty snack that has 7 g of protein.

15. Protein Shake

Protein powder makes it easy to score a high-protein shake — some powders contain more than 20 g per scoop.

 Pop a scoop of protein powder in the blender with your favorite additions, such as Greek yogurt, milk, frozen fruit, flaxseed meal, or nut butter, and then sip at your leisure.

When it comes to choosing a protein powder, Woodson says that there are all different types out there to meet different needs; some are plant-based while others use milk or egg proteins, and some use added sugar while others use zero-calorie sugar substitutes. Pick whichever one meets your needs, but make sure it has at least 15 g of protein per serving, she says.

16. Tuna on Toast

Canned tuna is a convenient, no-cook protein solution, with 20 g of protein per 3 oz serving.

 For a satisfying snack, mix a 6 oz can with 1 tbsp of mayo and some chopped scallions, celery, or onions. Spread half the mixture atop a slice of whole wheat toast and save the rest for tomorrow. “I love this combo of satiating protein and high-fiber carbs for a snack,” Thomason says. You’ll get a whopping 24 g of protein from this one.

17. Bean Salad

A veggie-based salad is packed with nutrients, but it won’t net you much protein by itself. Instead, try a bean salad as a quick, protein- and fiber-packed snack.

Start with a 15 oz can of pinto beans and add about a cup of diced vegetables (like carrots, celery, onions, or anything else you like), then season with salt, spices, chopped herbs, and some olive oil. A third of the recipe packs 6.5 g of protein from the beans, plus lots of other nutrients from whichever veggies and herbs you choose. “This is a snack with some serious staying power,” Thomason says. “Plus, I love that the longer it marinates in the fridge, the better it tastes!”

18. Easy Smoothie

You don’t need any fancy powders to whip up a smoothie with enough protein for a snack, Woodson says. Simply blend a chopped frozen banana with ½ cup of nonfat milk (plus more if you need extra liquid for your blender blades to whizz up the mixture) and a tablespoon of peanut butter, and you’ll have a milkshake-like snack that packs 8 g protein in addition to a serving of fruit.

If you want to up the protein factor even more, Thomason recommends adding ½ cup of Greek yogurt, which adds an additional 11 g protein.

19. Froyo Bark

There are more ways to enjoy Greek yogurt than the usual parfait or fruit-bottomed cup. Making your own frozen yogurt “bark” is another novel, high-protein snack. Again, you’ll rack up 20 g of protein with each 7 oz container.

Woodson loves how versatile the bark can be, since you can mix up your toppings and add-ins every time. To make the bark: stir together a 7 oz container of plain, low-fat Greek yogurt, 1 tsp of honey, 1 tbsp raisins, and 2 tbsp of almonds (chopped). Spread the mixture in an even layer on a baking sheet covered with parchment paper and place in the freezer until firm. Then, use a sharp knife to cut it into pieces. Store in a sealed container in the freezer.

The bark makes two servings, and each packs 13 g protein, thanks to the yogurt and almonds.

20. Mini Frittatas

If the usual hard-boiled eggs are feeling a bit uninspired, jazz things up (but keep the protein) with mini frittatas. Made in a muffin tin, these egg bites can include additional sources of protein like shredded cheese or diced ham, says Woodson. Or add some veggies.

Here’s how to make them: Whisk together 10 eggs, a ½ cup of milk, a sprinkle of salt and pepper, and any other seasonings or add-ins you’d like. Spoon the mixture into 10 greased muffin tin wells and bake at 375 degrees Fahrenheit for about 20 minutes or until set.

Each mini frittata has 6 g of protein.

21. ‘Nooch’ Popcorn

Though popcorn is technically a whole grain, it doesn’t contain as much protein as some other grain options at 1 g per cup.

 Woodson recommends upgrading the protein in your popcorn while adding a cheesy (but totally plant-based) flavor with nutritional yeast (also known as “nooch”). Two tbsp packs 5 g of protein.

 To make the nutritional yeast stick, cook popcorn in the microwave or on the stovetop as usual, then sprinkle on nutritional yeast and shake the bag or stir the pot to coat the kernels. For every eight cups of popped popcorn, you’ll need ⅓ cup of nooch.
Four cups of popped popcorn with 2 tbsp nutritional yeast has 9 g of protein.

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Recipe Conversions and MS: Bridging Understanding Through Translation

Around the winter holidays, I pull out recipes that I make only at this time of the year. Usually, unless I’m testing them for a publication, I give recipes a pass. But at this time of year, I want my gingerbread to taste like it did last year, the year before, and that first time I had it as a child.

As I read through those recipes, I come across measurements noted in metric, imperial, and standard (also known as U.S. customary) units.

It brings to mind when I was converting recipes for my two cookery books, Dingle Dinners and Burren Dinners. As both books were sold to an international audience, we had to make sure each recipe used all three methods of measurement.

It was a lot of work, but my history with translating the language of multiple sclerosis made it an important stipulation when I was negotiating with publishers.

As I saw it from the MS-to-cookery perspective, let me explain it from the other side of the lens.

The Terms We Use Affect the Outcome

If you were to come to my house and I cooked you a dish that you particularly liked and you asked me for the recipe, even if I didn’t use one, I would jot it down and email it within a few days. Just like if someone asked me about some aspect of my MS, I’d accommodate by answering the best I could.

But if I sent you that recipe using milliliters and grams and you were used to cups and ounces, you’d have to do a good bit of additional work to make the recipe.

For the person asking for and receiving the information, we often have to convert the message into their terms of understanding.

Even With the Best Intentions, Misunderstandings Occur

Even when we think we understand it, the recipe might not come out correctly. A specific instance of that comes to mind from my memoir, Chef Interrupted, in which I shared a good few recipes.

One particular recipe — Joan Foster’s Wheaten Bread — I transcribed from the cook’s own handwriting. When Joan listed 1 pint of buttermilk, that’s what I put in the manuscript. I didn’t realize that she was writing in imperial measures, in which a “pint” isn’t the 16 fluid ounces (fl oz) I and my U.S. readers would think of as a pint. A pint in imperial measures is nearly 20 fl oz.

You can imagine that there were many loaves of very dry bread coming out of ovens before we corrected it for the second edition.

It’s sort of like when I’ve been explaining multiple sclerosis to someone who is under the impression that I’m talking about muscular dystrophy. Different conversation altogether.

We All Translate When Speaking of Ourselves

Coming from a place that uses standard measurements, now living in a metric land, but just across the Irish Sea from the home of imperial measures, I’ve become quite accustomed to converting recipes for or from others.

Similarly, I think we’ve all likely learned to convert our experiences with MS for those from other disease (or wellness) communities to make ourselves understood.

We also learn to better understand what someone might be trying to say to us about their disease if we recognize that they are coming at us directly, without considering the conversions we’re trying to make in our heads.

It’s just another thing we learn to do when living life with multiple sclerosis.

Wishing you and your family the best of health.

Cheers,

Trevis

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Even Mild Headaches Can Raise Suicide Risk

People diagnosed with headaches may be more likely to attempt or complete suicide, a new study has found.

The association between suicide and headache was robust across four types of headache: migraine, tension-type headache, post-traumatic headache, and trigeminal autonomic cephalalgia (which includes cluster headache), says lead author Holly Elser, MD, PhD, a neurology resident at Penn Medicine in Philadelphia.

Although previous research has linked migraine and suicide risk, researchers in the latest study found that less painful headaches also carried additional suicide risk.

“In particular, we find that patients diagnosed with tension-type headache — which is highly prevalent and typified by mild-to-moderate symptoms — experience elevated risk of attempted and completed suicide as compared with members of the general population without a diagnosis of headache,” says Dr. Elser.

It’s estimated that 70 percent of people have occasional or frequent tension headaches, which feels like pressure on the forehead and temples.

Certain Kinds of Headaches Pose the Greatest Risk

A Danish population study followed over 119,000 people diagnosed with headaches and compared them with a control group of more than 597,000 individuals without headaches. Researchers followed people for 15 years and used diagnostic codes to track attempted suicide and death registries to identify completed suicide.

Investigators adjusted for factors that could influence the outcome, including age, sex, education level, income level, and coexisting health conditions.

Out of every 1,000 people with headache, 7.8 attempted suicide, and 2.1 out of every 1,000 completed suicide.

In the general population, 0.33 percent (3.3 out of 1,000) attempted suicide, and 0.15 percent (1.5 out of 1,000) completed suicide.

The risk for people diagnosed with post-traumatic headaches was the highest, with a 214 percent higher risk for attempted suicide compared with the general population.

Post-traumatic headache is a type of headache that happens after a head injury or trauma, such as whiplash or a concussion. Its main symptom is persistent head pain, and dizziness, nausea, and sensitivity to light may also be present. This type of headache can continue weeks or even months after the initial injury.

Researchers also found that people diagnosed with headaches in emergency settings had a significantly higher risk of suicide attempts and completions. That suggests that the severity and complexity of a headache disorder might be crucial factors in suicide risk, they wrote.

“This study was not limited to only migraine, and the association of suicide with tension-type headache is an important addition to our understanding of the suicide risks of patients with headaches and chronic pain,” says Timothy Collins, MD, chief of the headache and pain division of the neurology department at Duke University School of Medicine in Durham, North Carolina. Dr. Collins was not part of the study.

Why Headaches Might Increase the Risk of Suicide

While the study did not examine why headache may increase suicide risk, there are several theories about the link, says Elser:

  • There may be a complex, bidirectional association between headache and mental health disorders. The headaches may worsen in response to psychiatric symptoms, and worsening of headache can lead to feelings of hopelessness or demoralization, she says.
  • Prior studies consistently demonstrate an association between chronic pain and suicide risk. Previous research has shown that the risk of death from suicide is double in people with chronic pain.

  • There may be common underlying causes of headaches and psychiatric symptoms, including increased inflammation and changes in the release of serotonin, a neurotransmitter that plays a role in mood, sleep, and appetite.

“It is interesting that the use of opioids was higher in all headache groups versus the control group, despite evidence-based guidelines that opioids are not appropriate treatment for headaches, and research showing that chronic opioid therapy is associated with an increased risk of suicide,” says Collins.

Screening People With Headache for Depressive Symptoms and Suicidal Thoughts May Help People at Risk

“Screening and early recognition of depressive symptoms and suicidality may help to identify patients with headache who are at elevated suicide risk. Patients diagnosed with headache with comorbid psychiatric symptoms may benefit in particular from comanagement with behavioral health specialists,” says Elser.

Collins agrees that the most significant risk is the coexistence of depression, and that everyone with newly diagnosed headache disorders should be screened.

People With Headache Should Seek Treatment

People with headaches — newly diagnosed or not — should seek care with a specialist and should have screening for depression as part of their headache treatment, says Collins.

“There are so many headache-specific treatments that can be used to treat headaches. Most of the time, improved headaches with decreased pain significantly improves depressed mood,” he says.

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