The Adam’s apple is the bump you see on the front of the neck near the throat, known medically as a “laryngeal prominence.”e60dc2a1-f33c-4a05-9b50-8e3e8e5976298807fedc-3a18-4622-aeb6-37227b8db43d The colloquial term “Adam’s apple” likely comes from the biblical story of Adam and Eve, in which Adam ate the forbidden fruit from the Tree of Knowledge and a chunk got stuck in his throat. While everyone has an Adam’s apple, it’s generally more visible in males than females. Even if yours isn’t prominent, it’s important to watch for and treat any health issues that may affect it or the body parts near it.
What Is the Adam’s Apple? What It Is The Adam’s apple is a protrusion on the neck. It’s made of cartilage, a soft, flexible connective tissue present throughout the body that provides support and protection.e60dc2a1-f33c-4a05-9b50-8e3e8e5976291386d94b-2a69-4d0e-a1b7-d8083beecb9a The cartilage that makes up the Adam’s apple surrounds the thyroid gland and the larynx (voice box) and the vocal cords inside it, explains Daniel Kim, DO , a family physician with Medical Offices of Manhattan. An Adam’s apple is part of the thyroid cartilage, Dr. Kim says. The Adam’s apple is visible because the thyroid cartilage, which is shaped like a shield or open book, predominates anteriorly — meaning it projects outward rather than lying flush against the body.e60dc2a1-f33c-4a05-9b50-8e3e8e59762996ad9793-46f1-4919-a34b-1dcff514f138
What Does the Adam’s Apple Do? What It Does The role of the Adam’s apple is to protect the voice box and the vocal cords inside. No other known function has been found, though some researchers believe there may be a correlation between the size of the Adam’s apple and how deep the voice is.e60dc2a1-f33c-4a05-9b50-8e3e8e59762996c133a9-e880-4a8e-9723-37d89fc9e1e9
Is the Adam’s Apple Different in Men and Women? Sex Differences Males are likely to have larger, thicker Adam’s apples than females.e60dc2a1-f33c-4a05-9b50-8e3e8e5976298d9695e2-700b-4f3c-a209-b06d49b02fef “During puberty, the thyroid cartilage grows and becomes more prominent in males,” Kim explains. The larynx also grows during puberty, he adds, and the Adam’s apple may grow in tandem to protect the larynx. A larger Adam’s apple is considered a secondary sex characteristic in males.e60dc2a1-f33c-4a05-9b50-8e3e8e597629d18b2ad0-0c5b-45d3-b168-c28c1109e529
Adam’s Apple Complications and Disorders Complications and Disorders Several health issues can impact thyroid tissue, including the Adam’s apple. “Thyroid disorders, such as goiter , thyroiditis , thyroid nodules, or thyroid cancers , can affect the Adam’s apple,” Kim says. Thyroid cancer can cause swelling of the neck, voice changes, and difficulty swallowing.e60dc2a1-f33c-4a05-9b50-8e3e8e597629ff1bd290-216c-471a-b1e1-80a93d77d32d Issues affecting the larynx, such as laryngitis or laryngeal cancer, may also involve the Adam’s apple. Some of these issues can cause swelling of the larynx, which can make the Adam’s apple appear enlarged.e60dc2a1-f33c-4a05-9b50-8e3e8e597629593a8e64-6c52-48db-954c-d7bf9d3cf6ad Pain or discomfort in the Adam’s apple area could have a number of possible causes, ranging from a simple cold and sore throat to issues related to the thyroid or esophagus.e60dc2a1-f33c-4a05-9b50-8e3e8e597629593a8e64-6c52-48db-954c-d7bf9d3cf6ad
Treatments and Interventions for the Adam’s Apple Treatments In some cases, symptoms affecting the area near the Adam’s apple have to do with surrounding organs and tissues, such as the thyroid, larynx, and esophagus, Kim says. It’s important to see a healthcare provider to get to the underlying cause and determine a treatment plan, he adds. Some people who are concerned about the size or shape of their Adam’s apple — including transgender individuals wanting a more feminized or masculinized appearance — may opt for elective surgical interventions. Chondrolaryngoplasty This plastic surgery, also known as a tracheal shave, can make the Adam’s apple smaller.e60dc2a1-f33c-4a05-9b50-8e3e8e597629adedd9c5-6c67-47e6-80d3-52babb694260 Adam’s Apple Augmentation Using rib cartilage, this procedure makes the Adam’s apple more prominent.e60dc2a1-f33c-4a05-9b50-8e3e8e597629c6d8a6fe-f097-4b30-a90c-1ae6b75405c9
How to Keep Your Adam’s Apple Healthy Health Tips Your Adam’s apple doesn’t significantly impact your health.e60dc2a1-f33c-4a05-9b50-8e3e8e597629467e82a3-f0e0-4f4d-b836-798a34360c3d But it’s still wise to take precautions and practice a healthy lifestyle to keep the body parts associated with the Adam’s apple (such as the thyroid, larynx, vocal cords, and esophagus) in good shape. To maintain a healthy throat and voice, Kim recommends the following: Stay hydrated Avoid straining your voice Rest your voice when you’re sick Avoid smoking See your doctor regularly for thyroid and throat checkups You’ll also want to eat right. A diet that supports vocal health is one that limits spicy foods and is rich in whole grains, fruits, and vegetables.e60dc2a1-f33c-4a05-9b50-8e3e8e597629fea732b7-4308-4adc-8baa-1be71c9bbff6
The Takeaway “Adam’s apple” is a colloquial term referring to the bump near the front of the throat; the medical term is “laryngeal prominence.” An Adam’s apple is part of the thyroid cartilage, which protects the larynx (voice box) and vocal cords from injury. Men are more likely than women to have prominent Adam’s apples due to increased growth of that cartilage during puberty. Although the Adam’s apple doesn’t significantly affect health, it’s a good idea to see a doctor if you experience new or persistent pain in the area.
Resources We Trust Cleveland Clinic: Adam’s Apple Nemours KidsHealth: What’s an Adam’s Apple? StatPearls: Anatomy, Head and Neck: Adam’s Apple National Institute on Deafness and Other Communication Disorders: Taking Care of Your Voice StatPearls: Anatomy, Head and Neck: Larynx
Author: user
Wet Cough: Causes and Treatment
A wet cough is one that produces mucus or phlegm. It’s also sometimes called a productive or chesty cough. An occasional cough is usually nothing to be worried about — it’s a normal reflex that helps rid the body of irritants. Producing a small amount of mucus can even be useful for lubricating the airways.e60dc2a1-f33c-4a05-9b50-8e3e8e5976297f5a7296-e8a5-43dc-b985-927b659ec62a But a wet cough can sometimes be cause for concern. It may be a sign of infection, or it could indicate an underlying health condition. Generally, if you have a wet cough that won’t go away , you should consult a healthcare provider for diagnosis and treatment.e60dc2a1-f33c-4a05-9b50-8e3e8e5976292914ebdb-b58e-44e1-b656-edc7fb630815
What Is a Wet Cough? What It Is “A wet cough is usually what we call a productive cough, where one produces [a buildup of] mucus or phlegm because of the body’s inability to clear it,” says Barbara Bawer, MD , a family medicine physician at the Ohio State University Wexner Medical Center in Westerville. Mucus comes from the mucous membranes, such as those lining the nose, throat, and lungs. Although people may find it unpleasant, mucus has several important roles . It moisturizes structures of the body and acts like a shield to protect the body from germs and harmful particles. When you’re healthy, mucus is typically thin and clear, but mucus can be a different consistency and color when there is underlying illness. If it’s white, yellow, or green, mucus could be a sign of infection.e60dc2a1-f33c-4a05-9b50-8e3e8e5976290ba5a264-09cf-484d-9372-3226f7a481ff Phlegm, or sputum, is a thicker type of mucus and may signal that your body is trying to fight off infection. When you cough up phlegm, it comes from the lower respiratory tract.e60dc2a1-f33c-4a05-9b50-8e3e8e5976290ba5a264-09cf-484d-9372-3226f7a481ff A wet cough may feel as if you have something stuck in your throat you need to expel, and it may be worse at night , since mucus can collect in your throat when you’re lying down. A wet cough can be caused by mucus in the lower respiratory tract (lungs or bronchi) needing to be expectorated (coughed up), or it can be due to mucus from the nose or sinuses that drips down into the throat. In this discussion, we focus on wet coughs that stem from infection in the lower respiratory tract. People often compare a wet cough to a dry cough, which is a cough that doesn’t produce any mucus or phlegm. When you’re sick, you may have a dry cough that later becomes a wet cough. Neither is inherently worse than the other, but they can have different causes and therefore treatments.
Causes of Wet Cough Causes Causes of wet cough range from relatively mild viral infections to chronic health conditions and environmental irritants. Infection Viruses and bacteria are common causes of wet cough, causing infections such as:e60dc2a1-f33c-4a05-9b50-8e3e8e597629a641b0ac-800e-435c-b39d-37720c0d2327 Colds Acute (short-term) bronchitis Flu Tuberculosis Pneumonia Chronic Respiratory Diseases The following long-term illnesses may cause a wet cough: Asthma Bronchiectasis (an uncommon condition in which the airways widen and develop pouches) Chronic obstructive pulmonary disease (COPD) , especially if complicated by chronic bronchitis Cystic fibrosis Other Underlying Health Conditions Wet cough could be an indication or symptom of a chronic condition, such as: Congestive heart failure Gastroesophageal reflux disease (GERD) Lung cancer Pulmonary edema Environmental Issues The following external factors may trigger a wet cough: Allergens and symptoms of allergies , such as postnasal drip (an example of productive cough coming from the upper respiratory tract) Exposure to pollutants Smoking Secondhand smoke
Treatments for Wet Cough Treatment A healthcare professional can diagnose a wet cough and prescribe the recommended treatment. If your wet cough is mild and improving, you may not need to seek medical care — you can try home remedies and over-the-counter (OTC) medications. For a persistent wet cough, you may need to see a doctor for prescription medication. Home Remedies It’s always a good idea to drink plenty of fluids when you’re sick. In the case of a wet cough, fluids can thin out the mucus in the back of your throat, making it easier to cough up.e60dc2a1-f33c-4a05-9b50-8e3e8e59762941998439-458e-41b6-b1fb-52f413016290 You can also try the following to alleviate an acute wet cough: Avoid allergens. Drink herbal teas. Mix honey into tea or water (except for babies younger than 1 year old). Turn on a humidifier. Keep your head elevated. Take steamy showers. OTC Medications When home remedies aren’t enough, you may need to head to the drugstore for OTC treatments, such as cough syrup for wet cough. These are appropriate for a temporary cough. Medications called expectorants work by alleviating mucus buildup and making mucus easier to cough up.e60dc2a1-f33c-4a05-9b50-8e3e8e597629e3859d8e-a505-4702-866f-9bf5e83150e7 Guaifenesin, a member of this class of medications, is an example of an expectorant that breaks up mucus.e60dc2a1-f33c-4a05-9b50-8e3e8e59762941998439-458e-41b6-b1fb-52f413016290 Unlike expectorants, cough suppressants aim to stop you from coughing. But healthcare professionals generally don’t recommend cough suppressants for a wet cough because expelling mucus is your body’s way of clearing germs.e60dc2a1-f33c-4a05-9b50-8e3e8e597629e3859d8e-a505-4702-866f-9bf5e83150e7 OTC medications for wet cough are usually formulated for adults. For wet cough in infants and children, talk to your pediatrician.e60dc2a1-f33c-4a05-9b50-8e3e8e59762941998439-458e-41b6-b1fb-52f413016290 Prescription Treatments For a severe wet cough or one caused by an underlying condition, you may need prescription medication. Antibiotics generally aren’t needed to treat a wet cough, especially if it’s caused by a viral infection. Your healthcare provider may prescribe them if a bacterial infection is causing your symptoms. You may also need prescription medication for chronic conditions causing a wet cough, such as asthma or GERD (acid reflux). Asthma treatments typically include inhalers, while proton pump inhibitors may be useful for treating GERD.
How to Prevent Wet Cough Prevention One way to prevent wet cough is to avoid getting sick with a contagious illness or, if you have a chronic condition, prevent flare-ups. Ways to avoid contagious illnesses, Dr. Bawer notes, include: Vaccination (for contagious respiratory infections such as flu and pneumonia) Handwashing Wearing masks Avoiding exposure to people who are sick Take steps to keep your immune system strong to avoid or reduce the impact of respiratory infections, Bawer notes, such as: Staying hydrated. Eating a balanced diet. Getting enough sleep. Exercising regularly. Managing stress. If a wet cough is due to an underlying chronic condition, you may be able to prevent it by avoiding flare-ups. For example, if you have an allergy that leads to wet cough, avoid known allergens (triggers) and use allergy treatments like antihistamines, Bawer says. Or, if asthma or COPD flare-ups lead to wet cough, avoid triggers like smoking, she adds.
When to See a Doctor About Wet Cough When to Seek Medical Care If a wet cough persists for several weeks, you should see a doctor. You also consult a healthcare professional if your wet cough involves the following symptoms: Thick, greenish-yellow phlegm Wheezing Fever Fainting Shortness of breath Ankle swelling Weight losse60dc2a1-f33c-4a05-9b50-8e3e8e5976292168833b-50cf-4440-8773-e6d98c558e01 If your cough is accompanied by the following symptoms, seek emergency care: Difficulty breathing or swallowing Choking or vomiting Chest pain Coughing up pink or bloody phlegme60dc2a1-f33c-4a05-9b50-8e3e8e5976292168833b-50cf-4440-8773-e6d98c558e01 You may also consider seeing a doctor if your wet cough worsens over the course of a few days, as this could mean your condition is more concerning, Bawer adds.
The Takeaway A wet cough is any cough that produces mucus or phlegm, and it can come from either the upper or lower respiratory tract. A wet cough is your body’s way of getting rid of irritants or harmful particles, and may be a sign of infection. A wet cough is usually treatable with home remedies and over-the-counter drugs, but a severe wet cough or one caused by an underlying condition may require prescription medications. Seek out medical care if your wet cough persists for several weeks or head to the emergency room if you cough up bloody phlegm or have difficulty breathing or swallowing.
Resources We Trust Cleveland Clinic: 9 Ways to Stop Coughing at NightMayo Clinic: BronchitisMedlinePlus: CoughAmerican Lung Association: Learn About CoughNational Jewish Health: COPD: How to Cough Up Mucus and Phlegm From Chest Congestion
Cabot Creamery Butter Recalled for Possible Fecal Contamination
Agri-Mark, the parent company of Cabot Creamery, has voluntarily recalled about 1,700 lb of butter due to contamination with coliform bacteria, according to an enforcement report from the U.S. Food and Drug Administration (FDA). Elevated levels of coliform bacteria can suggest sanitation failures during production.
Agri-Mark recalled 189 cases of “Cabot Creamery 8 oz Extra Creamy Premium Butter, Sea Salted.” The packaging included two 4-ounce (oz) sticks of butter, with the UPC code 0 78354 62038 0 and the lot number 090925-055. The recalled butter has a best-by date of 09/09/25.
The enforcement report lists the recall as a class 3 event, which means eating the recalled butter is not likely to cause negative health consequences. No illnesses have been reported to date related to this recall.
The recalled butter was sold in seven states: Arkansas, Connecticut, Maine, New Hampshire, New York, Pennsylvania, and Vermont.
What Is Coliform Bacteria?
For over a century, the presence of coliform bacteria has been considered an indicator of unsanitary conditions. Most coliform bacteria don’t cause foodborne illness, but many of the strains that do are types of E. coli.
E. coli can cause several different types of illness depending on the strain, but it’s often connected to watery or bloody diarrhea.
Other symptoms of E. coli infection include stomach cramps, vomiting, and fever.
Some groups are more vulnerable to E. coli infection, including:
- Children younger than 5
- Adults 65 and older
- People with weakened immune systems
- International travelers
Neither the FDA nor Agri-Mark have said that the recalled butter is contaminated with E. coli, but it may be safer to return or throw away the butter.
The Link Between Epstein-Barr Virus and Multiple Sclerosis
While the cause of multiple sclerosis (MS) is still unknown, it is generally believed that genetic susceptibility and environmental factors both play a role. Among of the environmental factors that have been studied at some length are certain kinds of infection, particularly infection by the Epstein-Barr virus (EBV), which is part of the human herpesvirus family of infectious diseases. Indeed, multiple studies suggest that EBV, the most common cause of mononucleosis, or “ mono ” (often called “the kissing disease” because it’s transmitted via saliva or mucus ), may play a role in the development of MS . Now, a study published in October 2021 by JAMA Network Open , which included nearly 2.5 million people, found that those diagnosed with infectious mononucleosis, an acute illness most commonly caused by EBV (though it’s linked with other viruses as well), during childhood were nearly twice as likely to develop MS. And for people diagnosed with infectious mononucleosis during adolescence, the risk of MS was three times higher, according to the researchers.
RELATED: Can You Prevent Multiple Sclerosis? EBV Stays for Life Researchers at the University of British Columbia in Vancouver (UBC), led by Marc Horwitz, PhD , have been studying the relationship between MS and EBV closely to see if it can offer clues as to how to diagnose MS earlier and, ultimately, treat it more effectively. Dr. Horwitz is the Sauder Chair of Pediatric Virology and a co-leader of the Infection, Inflammation, and Immunity Research Group at UBC. More than 90 percent of people worldwide will be infected with EBV by age 35, according to the American Academy of Family Physicians (AAFP) . In children, EBV usually looks like a mild, brief illness. But in up to 50 percent of teenagers and young adults, it can show up as infectious mononucleosis and cause extreme fatigue and other flu-like symptoms that can last for weeks, the AAFP says. “Most of us in North America and Europe get mononucleosis as a result of exposure to EBV, typically in our teens or early twenties,” says Horwitz. “But what a lot of people don’t know is that EBV stays in our bodies for the rest of our lives. And though it may be dormant and not causing new infection or illness, our body’s response to it may be affecting other aspects of our health,” he says. It’s possible that those who get an EBV infection that’s initially more active — including those who experienced infectious mononucleosis in childhood or adolescence — have an increased risk of MS later in life, Horwitz adds. Links Between EBV and MS While epidemiological studies suggest that some 95 percent of people in the general population have evidence of exposure to EBV in their blood, that percentage is closer to 100 percent among those who have MS. “Anecdotally, we also know that people with MS typically had more severe cases of mononucleosis than those without MS,” Horwitz says. And the relationship may not end there. A study by Horwitz and his team, published in November 2020 in Frontiers in Immunology , observed that mice infected with a herpesvirus similar to EBV (mice can’t get EBV) had high levels of the virus in their B cells — white blood cells that produce antibodies to fight infection. Mice with high levels of the virus in their B cells experienced more severe symptoms of experimental autoimmune encephalomyelitis, essentially a form of MS in mice. The researchers found that those mice developed a disease reminiscent of MS, with MS-like brain lesions and loss of balance. “There’s no evidence that EBV is more active in people with MS,” Horwitz says. “However, if you test people without MS for EBV, even with extremely accurate tests, it would be undetectable. In people with MS, it’s detectable.” This finding builds on an earlier analysis published by Horwitz’s UBC colleagues that identified several studies that observed links between EBV and the risk of developing relapsing-remitting MS (RRMS) . The association with primary progressive MS ( PPMS ) was less clear. Immune System Overreaction Horwitz and his team, among others, believe these findings may indicate that the immune systems of those with MS have a history of “overreacting” to their initial EBV infection, with their B cells producing higher levels of anti-EBV antibodies, compared with those who don’t have MS. This can have benefits in terms of fighting infections, but it may also be detrimental in terms of susceptibility to autoimmune diseases such as MS. Specifically, EBV seems to have a profound effect on a type of B cells called ABCs, or age-associated B cells. As the name indicates, ABCs accumulate as people age. However, people with MS have higher levels of ABCs at a younger age, perhaps driven by EBV, Horwitz explains. Additional studies from other researchers have also found that people with RRMS have higher levels of the human herpesvirus antibody immunoglobulin M, and that people with a history of another herpesvirus, varicella zoster (more commonly known as chickenpox ), may have an increased risk of RRMS. Horwitz and his team are now looking at ways in which the presence of these ABCs can potentially be used to identify people at risk of certain forms of MS. There appears to be a similar relationship between ABCs and other autoimmune disorders, including rheumatoid arthritis (RA) and lupus , he says. The team’s findings on RA and EBV were published in June 2021 in the online scientific journal eLife . Hope for Treatment and Prevention For all of these autoimmune diseases, understanding the role of EBV in their development could help shape research into new treatments, according to Horwitz. More important, as research reveals the role EBV may play in these diseases, as well as certain forms of cancer , it could push efforts to develop a vaccine against the virus, he says. “What we’re trying to do is understand the changes that are happening to the cells in the bodies of people with MS that are holding EBV,” Horwitz explains. “If we can identify those cells, we have a potential way to determine a person’s risk for developing MS. If we can identify and get rid of those cells, we may have a cure for MS.” “But you still have to be genetically susceptible to MS to get it,” he adds. “You’re not going to get MS simply because you had EBV when you were younger. Otherwise, more of us would have MS. However, what we think is that EBV may provide a key to a better understanding of MS and how it develops, and that can only help people with MS.”
The Leading Cause of Cervical Cancer
A persistent infection with some types of HPV can lead to various types of cancer in women.
Nearly all cases of cervical cancer are caused by HPV, and most of these cases are tied specifically to HPV types 16 and 18.
HPV causes approximately 10,800 cases of cervical cancer each year in the United States.
Early stages of vaginal and cervical cancers may not cause any symptoms, making regular screening important. More advanced-stage cancer can lead to abnormal vaginal bleeding or discharge and pain during intercourse.
The Pap test, or Pap smear, is one of two screening tests, and was invented by the doctor and scientist George Papanicolaou.
This has long been the standard for detecting abnormal cells — called cervical dysplasia — in the cervix. The Pap test involves scraping some cells from the surface of the cervix and examining them under a microscope.
Cervical dysplasia is not cancer, but in some cases it develops into cancer.
Follow-up care for cervical dysplasia depends on its severity. For mild dysplasia, the doctor may recommend a repeat test for a year later to see whether the dysplasia has worsened or has disappeared on its own. For severe dysplasia, a procedure to remove the abnormal cells may be called for.
A newer test, called the HPV test, checks for the virus itself in cervical cells, not for changes in the appearance of the cells. The U.S. Food and Drug Administration (FDA) has approved several different HPV tests, some of which are approved as a primary HPV test — meaning that no Pap test is needed.
Currently, it’s recommended that women ages 25 to 65 get a primary HPV test every five years.
If a primary HPV test is not available, then a Pap test along with an HPV test can be performed every five years, or a Pap test alone can be performed every three years.
If you don’t identify as a woman but do have a cervix, you should still be screened regularly for cervical HPV or dysplasia in order to detect and treat early evidence of cervical cancer.
Paying for Cervical Cancer Screening
Most health insurance plans cover recommended cervical cancer screenings, often at no cost to the individual beyond the cost of an office visit. This fee may also be waived if the tests are done as part of an annual physical exam.
Insurance plans purchased through the HealthCare.gov Marketplace must cover Pap tests and HPV tests without charging a copayment or coinsurance, as long as the screening tests are done by a healthcare provider in your plan’s network.
If you have no health insurance, your insurance does not cover screening exams, or your yearly income is at or below 250 percent of the federal poverty level, you may be eligible for free screening through the CDC’s National Breast and Cervical Cancer Early Detection Program (NBCCEDP).
The NBCCEDP offers both Pap tests and HPV tests, as well as diagnostic testing and referrals to treatment if results are abnormal.
To see if you’re eligible for free screenings, contact a local program in your area.
Alcohol’s Impact on Your Health
Beth Biggee, MD, is medical director and an integrative rheumatologist at Rheumission, a virtual integrative rheumatology practice for people residing in California and Pennsylvania. This first-of-its-kind company offers whole person autoimmune care by a team of integrative rheumatologists, lifestyle medicine practitioners, autoimmune dietitians, psychologists, and care coordinators.
Dr. Biggee also works as a healthcare wellness consultant for Synergy Wellness Center in Hudson, Massachusetts. Teamed with Synergy, she provides in-person lifestyle medicine and holistic consults, and contributes to employee workplace wellness programs. She has over 20 years of experience in rheumatology and holds board certifications in rheumatology and integrative and lifestyle medicine. Dr. Biggee brings a human-centered approach to wellness rather than focusing solely on diseases.
Dr. Biggee graduated cum laude with a bachelor’s degree from Canisius College, and graduated magna cum laude and as valedictorian from SUNY Health Science Center at Syracuse Medical School. She completed her internship and residency in internal medicine at Yale New Haven Hospital, completed her fellowship in rheumatology at Tufts–New England Medical Center, and completed training in integrative rheumatology at the University of Arizona Andrew Weil Center for Integrative Medicine. Following her training, she attained board certification in rheumatology and internal medicine through the American Board of Internal Medicine, attained board certification in integrative medicine through the American Board of Physician Specialties, and attained accreditation as a certified lifestyle medicine physician through the American College of Lifestyle Medicine. She is certified in Helms auricular acupuncture and is currently completing coursework for the Aloha Ayurveda integrative medicine course for physicians.
In prior roles, Dr. Biggee taught as an assistant clinical professor of medicine at Mary Imogene Bassett Hospital (an affiliate of Columbia University). She was also clinical associate of medicine at Tufts University School of Medicine and instructed “introduction to clinical medicine” for medical students at Tufts. She was preceptor for the Lawrence General Hospital Family Medicine Residency.
Dr. Biggee has published in Annals of Rheumatic Diseases, Arthritis in Rheumatism, Current Opinions in Rheumatology, Journal for Musculoskeletal Medicine, Medicine and Health Rhode Island, and Field Guide to Internal Medicine.
What to Know About the ‘Suicide Tree’ From ‘The White Lotus’
In the Season 3 premiere of The White Lotus, the jovial hotel employee Pam warns the Ratliff family not to eat the fruit of the “mighty pong pong tree,” because its seeds are toxic — so toxic, in fact, they could kill you.
The family patriarch Tim later asks Pam again about the tree, and she explains that the Thai locals call it “the suicide tree.”
No spoilers! Suffice it to say that pong pong poisoning is real and provides a major plot twist in the season finale.
What Is a Pong Pong Tree?
The pong pong tree (Cerbera odollam) is a toxic plant belonging to the dogbane family, which are flowering plants famous for producing poisons. It grows in Southeast Asia, the Pacific Islands, and northern Australia, but it can also be found in other countries around the world as an ornamental tree.
The poison in the plant, cerberin, is most concentrated in the two seeds (or kernels) found in each fruit, which are roughly the size of peach pits.
Historically, humans have used the poisonous fruit in a variety of ways: for murder, suicide, and even, in the case of the Madagascar witch trials of the 1800s, for proof of guilt or innocence.
What Would Happen if You Ate Pong Pong Seeds IRL?
Cerberin is dangerous because it affects how the heart works, explains Hilary Hamnett, DPhil, an associate professor in forensic science at the University of Lincoln in the UK and the author of Poisonous Tales: A Forensic Examination of Poisons in Fiction.
“It interferes with signals to the heart by causing an electrolyte imbalance. Without treatment, the heart gradually slows down until it stops,” says Dr. Hamnett.
Early symptoms of pong pong poisoning include nausea, vomiting, and diarrhea as the body tries to expel the poison, she says.
“But as it begins to affect the heart, a person may experience confusion, agitation, chest pains, and palpitations. Heart rates can drop to 30–40 beats per minute [the norm for adults is between 60 and 100] as well as lowered blood pressure, leading to dizziness,” says Hamnett.
How Common Is Pong Pong Poisoning?
It’s unclear exactly how many people get poisoned by pong pong fruit each year.
“In terms of poisonings that have been reported in the scientific literature, it’s not that common — a handful of cases a year in the U.S.,” says Hamnett.
Owen McDougal, PhD, a professor of chemistry and biochemistry at Boise State University in Idaho, agrees that pong pong poisoning is rare. “Someone has to be pretty deliberate to poison themselves. The pit needs to be ground to a powder and consumed in order to be effective,” he says.
“Where deaths happen outside of its natural habitat, the seeds are usually purchased online,” says Hamnett.
People should beware, she adds — there have been deaths reported from weight loss supplements that contain pong pong seeds.
How Many Seeds Would It Take to Cause Death?
“One seed from the pong pong fruit can be fatal, and half seeds have been shown to make people very sick and cause abnormal heart rhythms. Different people need different amounts, but it’s likely that two seeds or one whole fruit (including seeds) could very likely kill a person,” says Matthew Badgett, MD, an internal medicine doctor at Cleveland Clinic in Ohio.
What’s the Treatment for Pong Pong Poisoning?
There’s no antidote specifically for cerberin, but the symptoms of poisoning can be treated, says Hamnett.
“One of the treatments is atropine, which is another poison [found in deadly nightshade] that affects the heart in a way opposite to cerberin. Additionally, the antidote to a very similar poison, called digoxin, which is found in foxgloves, is often given in hospital for pong pong poisoning and can have some success,” she says.
Healthcare workers can also take measures to stabilize the heart, says Badgett.
In a review of six cases of intentional pong pong seed ingestion reported to U.S. poison control centers, all were treated at a hospital, but only three survived.
Why Doctors Misdiagnose Skin of Color
The company VisualDx, which makes desktop and mobile apps for physicians that help them recognize skin symptom patterns in patients with various skin tones with an assist from artificial intelligence, launched a larger-scale effort in collaboration with Project Impact, the Skin of Color Society, and the New England Journal of Medicine Group. Project Impact aims to raise awareness about misdiagnosis and share resources and strategies that help physicians more accurately diagnose disease in Black and brown skin.
“We’re focused on all kinds of bias — racial and gender bias — and the reasons doctors make mistakes,” says Art Papier, MD, a dermatologist at the University of Rochester in New York and the founder of VisualDx.
The apps rely on VisualDx’s extensive library of images. A University of Connecticut study published in June 2020 in the Journal of the American Academy of Dermatology surveyed more than 15,000 images of skin conditions across six printed textbooks and two online resources, and found that VisualDx’s image library had the highest percentage of dark skin images (28.5 percent) compared with six printed textbooks (roughly 10 percent) and two web sources (about 22 percent).
“The key to good AI is good data,” says Dr. Papier. “We’ve been very purposeful since the inception of our company to collect imagery from people of all skin tones.”
Papier says he was inspired to create VisualDx after witnessing a misdiagnosis early in his career. When he was in training as a dermatology resident more than 20 years ago, he was in the ER when a patient with dark skin came into the intensive care unit with a severe rash caused by a rare condition called Stevens-Johnson syndrome.
The patient said the rash had started two weeks earlier, but other healthcare professionals hadn’t recognized its severity because it looks subtler on brown skin, Papier recalls. “That made me get committed to the idea of getting as many images as we could find in patients of color,” he says.
Psoriasis on Black Skin: What You Should Know
Pinpointing psoriasis on darker or Black skin can be different than spotting it on lighter skin for several reasons.
Color
The appearance of psoriasis can vary based on the level of melanin, or the pigment that colors our skin. For Black patients or those with darker pigmented skin, lesions may be violet, dark brown, or gray, according to Corey L. Hartman, MD, a board-certified dermatologist and the founder of Skin Wellness Dermatology. On lighter skin, psoriasis appears as thick plaques with a silver scale.
“Since psoriasis looks different on Black skin — and there’s not enough education about what this looks like — it’s often misdiagnosed,” Dr. Hartman says.
Location
Psoriasis on lighter skin often appears on the arms, chest, legs, and shoulders, Hartman says. People with darker skin are more likely to find psoriasis lesions on the scalp, elbows, knees, torso, buttocks, and even nails. Affected areas can also vary in size.
If you have scalp psoriasis, work with your dermatologist to create a hair-care regimen that works for your specific type of hair.
Effects
The aftereffects of psoriasis also differ among individuals with heavily pigmented skin. Depending on the severity of the outbreak, Hartman says that lesions from psoriasis can leave spots of discoloration or post-inflammatory dyspigmentation for months after a flare-up resolves. Dermatologists caution Black patients not to confuse this with active psoriasis, and they do not recommend using topical steroid treatments on non-inflamed, hyperpigmented areas.
Severity
Research also suggests that Black people who have psoriasis may have more severe breakouts than people with lighter skin.
Because of this, Hartman tells his patients of color to pay attention to any changes in their skin and to consult with a dermatologist if they notice any symptoms. This way, the condition can be treated before it worsens.
Do People With Diabetes Bruise Easily?
Diabetes can make people more prone to easy or unexpected bruising in several ways:
- High blood sugar can cause blood vessel damage
- Needles and lancets can cause injury at the puncture site
- Peripheral neuropathy can damage nerves, dulling your ability to notice injury
- Diabetes impacts collagen production, which thins the skin
People with diabetes may have chronically high blood sugar, which can then contribute to problems with blood flow and blood vessel damage that can lead to bruises. Those same circulatory problems can also mean those contusions may stick around for longer than they might if diabetes weren’t present.
People with diabetes may be slower to heal from cuts, too. “People with diabetes can experience delayed wound healing for several reasons,” says Joshua J. Neumiller, PharmD, CDCES, the president-elect of healthcare and education for the American Diabetes Association. “If people have hyperglycemia (high blood glucose), high blood pressure, or high cholesterol for a long period of time, this can lead to blood vessel damage and poor circulation (blood flow).”
Bruising may also be related to diabetes treatment or complications rather than diabetes itself. Dr. Farah says she sees a lot of bruising in those with diabetes at the injection site where they’re using a needle for insulin. The lancets that help measure blood sugar, insulin pumps, and continuous glucose monitors (CGMs) can also contribute to bruising.
“In the case of people who bruise due to injection of medications or through glucose monitoring (with fingersticks or CGM), it is important to use new needles and lancets each time and rotate injection and testing sites,” says Dr. Neumiller.
Peripheral neuropathy, nerve damage that can result from prolonged high blood sugar levels, can also increase your risk of bruising, particularly to the feet.
“Neuropathy is nerve damage that leads to changes in the ability to feel one’s body parts,” says Deena Adimoolam, MD, an endocrinologist for Mount Sinai Health System in New York City. “Due to this loss of sensation, people with neuropathy may not realize they have injured their body part, which may lead to unexplained bruising.”
People with diabetic peripheral neuropathy can experience dizziness and be prone to falls, which can then lead to bruising, too.
Diabetes can also contribute to problems with collagen, which plays a role in bruising. A lack of collagen can make skin less elastic, leaving it vulnerable to damage.
“When blood glucose is elevated, it can interact with collagen, leading to skin changes in people with diabetes,” says Neumiller.