If other treatments haven’t provided enough relief, surgery may be recommended. Each surgical approach is different. Your healthcare provider will make recommendations based on how the contracture affects your daily activities.
Generally, less involved procedures may mean a quicker recovery, but your symptoms might return sooner, says Claude Jarrett, MD, an orthopedic surgeon based in Wilmington, North Carolina, who specializes in upper extremity surgery. More complex surgeries often need more recovery time, but the results may last longer, he adds.
Needle Aponeurotomy
One of the least invasive surgical options is needle aponeurotomy (or needle fasciotomy), which can be done in a medical office. After numbing the area with a local anesthetic, a healthcare provider uses the tip of a needle to poke tiny holes in the tight cord beneath the skin.
This weakens the cord enough that your finger can be gently stretched back to a straighter position. This procedure can help improve finger movement, even in severe cases, with few side effects.
Fasciotomy
A fasciotomy is a minor surgery that involves making an incision in the palm to break up the tight cords. You’ll typically receive a local anesthetic to numb your hand. While the cord isn’t removed in a fasciotomy, breaking it up helps decrease the contracture and improve finger movement.
This procedure works well for many people, though some may eventually need additional treatment.
Partial Palmar Fasciectomy
If contractures are severe, a partial palmar fasciectomy (removal of the fascia) may be recommended. This surgery involves removing portions of the cord through multiple incisions in the palm and affected finger or fingers.
Depending on the extent of the surgery, a skin graft, in which healthy skin from another part of your body is used to cover the wound, may be necessary to heal the wound.
Compared with00 a needle fasciotomy (aponeurotomy), this surgery requires more healing time, but it often provides longer-lasting results, with about 20 percent of people experiencing a return of their contracture.
Dermofasciectomy
If you have a more severe case of Dupuytren’s contracture or if the contractures return after previous treatments, you may need a dermofasciectomy (removal of fascia and skin). In this procedure, the surgeon removes both the cord and the overlying skin from your palm and uses a skin graft to cover the area.
A dermofasciectomy can reduce the chance of the contracture coming back. Some of the risks of this procedure include the skin graft not working well, scarring, and a higher chance of complications, including infection and chronic pain syndrome.
Like any medical treatment, chiropractic care can have side effects. Most people feel temporary soreness, stiffness, or mild discomfort after a chiropractic adjustment. Some may experience headaches or fatigue, but these effects are usually temporary. Though rare, more serious complications can occur, such as herniated discs, pinched nerves, or stroke.
For people with AS, the risks of chiropractic care are more serious. As AS progresses, the vertebrae (the bones that make up the spine) can begin to grow together and fuse, making the spine stiff and less flexible. These bones can develop osteoporosis, a condition that makes them weak and brittle, explains Biggee. The bones can become so fragile that they break without any obvious cause.
Even heavy massage for someone with advanced AS can cause the bones to break or slip out of place, potentially leading to nerve damage, says Biggee.
“If chiropractors are not familiar with the anatomy that goes along with the chronic changes of AS, any manipulation that’s not done carefully or even done without knowledge could really be harmful,” says Aly Cohen, MD, a rheumatologist and integrative medicine practitioner based in New Jersey, and the author of Detoxify: The Everyday Toxins Harming Your Immune System and How to Defend Against Them.
Indeed, guidelines from the American College of Rheumatology, the Spondylitis Association of America, and the Spondylitis Research and Treatment Network advise against spinal manipulation in people with spinal fusion or osteoporosis due to the risk of serious injury.
Research on chiropractic care for ankylosing spondylitis is limited. For example, a review study found that there wasn’t enough research to show whether chiropractic care is helpful for people with AS. Because of these increased risks and the lack of clear evidence that chiropractic care is beneficial for AS, healthcare providers typically don’t recommend it, says Biggee.
If you have AS and are considering chiropractic treatment, talk with your rheumatologist first. They can make recommendations based on your condition.
Unless you completely avoid social media, there’s a good chance you’ve seen influencer posts promoting direct-to-consumer medical tests like full-body MRI scans or “egg timer” fertility assessments.
A new study suggests you should scroll on by.
Researchers examined about 1,000 posts from social media influencers with a combined total of more than 194 million followers that touted the benefits of these five types of medical tests you can get without seeing your doctor first:
Overall, 85 percent of these posts on Instagram and TikTok touted benefits without mentioning any risks, according to study findings published in JAMA Network Open.
“These tests are controversial, as they all lack evidence of net benefit for healthy people and can lead to harms including overdiagnosis and overuse of the medical system,” says the lead study author, Brooke Nickel, PhD, a master of international public health and a senior research fellow in public health at the University of Sydney in Australia. “If information about medical tests on social media sounds too good to be true, it probably is.”
Influencers May Benefit Financially From Promoting Medical Tests
In the study, 68 percent of the influencers had financial interests in promoting medical tests such as partnerships, sponsorships, or a share of proceeds from sales, the study found.
“Influencers are incentivized to overstate benefits and minimize harms, and many do not have the training needed to vet the science behind products,” says Lauren Westafer, DO, MPH, an assistant professor of emergency medicine at UMass Chan Medical School Baystate in Springfield, Massachusetts.
“Given that most influencers have a sponsorship or generate revenue through link clicks and similar mechanisms, I immediately hear alarm bells ring with each of these types of posts,” says Dr. Westafer, who wasn’t involved in the new study.
Potential Risks of Direct-to-Consumer Medical Tests
At the same time, just 6 percent of the posts mentioned two of the main potential risks of direct-to-consumer medical tests: overdiagnosis and overtreatment.
People swayed by influencers to try these tests can experience needless pain, anxiety, and suffering, especially if results suggest serious health issues that lead them to do even more testing and checkups, says Alex Sheng, MD, an associate professor and the residency program director at the Warren Alpert Medical School of Brown University in Providence, Rhode Island.
“A false positive test can lead to a lot of worries and further downstream tests that can be invasive, painful, or even cause permanent harm,” says Dr. Sheng, who wasn’t involved in the new study. And “a false negative test can falsely reassure someone.”
Listen to Your Gut — ‘SIFT’ Through the Noise
To avoid getting deceived by influencer posts, Sheng recommends using the same method used for spotting fake news. It’s called the “SIFT” method.
Stop. Consider your emotional response before sharing posts and be wary of content that’s designed to get clicks.
Investigate the source. Try to look up the author or creator of the post and see if they have any financial incentives to promote something or credentials to suggest they have expertise.
Find better coverage. Look for trusted sources of information that use fact-checkers and can back their claims with scientific evidence. Websites that can help vet information include FactCheck.org and Snopes.com.
Trace claims to their original source. If you can’t find a credible source for claims in a post, that’s a red flag that it’s misinformation.
At the end of the day, however, social media posts often have few facts to check, and are based more on hyperbolic ideas and emotional appeals, says Westafer. The best way to sort fact from fiction is often to speak to the doctor who knows you and your medical history best, Westafer adds.
“There is a lot of misinformation online, particularly on social media sources, and anything can seem glamorous in edited reels and curated stories,” Westafer says. “As a result, the most credible sources are doctors who aren’t necessarily pushing these tests — often this is someone’s primary care physician.”
Staging cancers helps doctors understand how advanced a cancer is, come up with the best treatment plan, and predict the path of the disease, including the chance of recovery. A colon cancer diagnosis or a rectal cancer diagnosis typically involves a biopsy — studying suspicious tissue from the colon or rectum under a microscope. If doctors discover cancer they will run imaging tests to see how advanced the disease is and whether it has spread to other areas of the body. The tests you might encounter include: Computed tomography (CT or CAT) scan In this test, cross-sectional images of the body created with X-rays are examined for signs that colorectal cancer has spread to other organs like the liver. Ultrasound This device can spot tumors by creating sound waves and transforming echoes into images on a screen. Magnetic resonance imaging (MRI) scan Radio waves and strong magnets produce detailed images that can help doctors see cancerous growths. Chest X-ray Doctors may use this test to see if cancer cells have spread to the lungs. Positron emission tomography (PET) scan Doctors inject a small amount of a radioactive sugar substance into the blood, then look to see how much it is absorbed by cells in different areas of the body. Cancer cells tend to absorb more of these sugars than normal cells because they require more energy to fuel their rapid growth. ( 1 )
How It’s Staged Staging Colon Cancer and Rectal Cancer Each cancer has its own staging criteria. In the case of colon and rectal cancer, the system used is one that goes by the acronym TNM, which stands for tumor, node, and metastasis. The TNM system is organized around the answers to a series of questions. Tumor (T) Has the tumor grown beyond the inside lining of the colon or rectum and into the wall? If so, how many layers deep is it? Node (N) Has the tumor spread to the lymph nodes? If so, where and how many? Metastasis (M) Has the cancer spread beyond the lymph nodes to other parts of the body? If so, where and how much? Once doctors make all these assessments, they combine this information to stage the cancer. ( 2 )
Stages Colon and Rectal Cancer Stages There are five stages of colon cancer, ranging from 0 to 4. Doctors may also follow the stage number with a letter that offers more information. Generally, the higher the number and letter, the more advanced the cancer. Stage 0 The cancer is in its earliest stage, called carcinoma in situ or intramucosal carcinoma. It has not grown beyond the inner layer (mucosa) of the colon or rectum (Tis, N0, M0). Stage 1 The cancer has grown into the submucosa, and possibly into the thick muscle layer beneath it (muscularis propria). It has not spread to nearby lymph nodes or distant sites (T1 or T2, N0, M0). Stage 2A The cancer has grown into the colon wall or rectum but not through it. It has not reached nearby organs or lymph nodes or spread to distant sites (T3, N0, M0). Stage 2B The cancer has grown through the wall of the colon or rectum but not into nearby tissue or organs. It has not spread to nearby lymph nodes or distant sites (T4a, N0, M0). Stage 2C The cancer has grown through the wall of the colon or rectum and is attached to or has grown into other nearby tissues or organs. It has not spread to nearby lymph nodes or distant sites (T4b, N0, M0). Stage 3A The cancer has grown into the submucosa and possibly the muscularis propria; it has spread to 1 to 3 nearby lymph nodes or into areas of fat near the lymph nodes, but not to distant sites (T1 or T2, N1/N1c, M0). — or — The cancer has grown into the submucosa and spread to 4 to 6 nearby lymph nodes but not to distant sites (T1, N2a, M0). Stage 3B The cancer has grown into the wall of the colon or rectum or through the visceral peritoneum (the inner lining of the abdominal cavity) but has not reached nearby organs. It has spread to 1 to 3 nearby lymph nodes or into areas of fat near the lymph nodes but not to distant sites (T3 or T4a, N1/N1c, M0). — or — The cancer has grown into the muscularis propria or into the wall of the colon or rectum and has spread to 4 to 6 nearby lymph nodes but not to distant sites (T2 or T3, N2a, M0). — or — The cancer has grown into the submucosa and possibly the muscularis propria. It has spread to 7 or more nearby lymph nodes but not to distant sites (T1 or T2, N2b, M0). Stage 3C The cancer has grown through the wall of the colon or rectum, including the tissues lining it (the visceral peritoneum), but has not reached nearby organs. It has spread to 4 to 6 nearby lymph nodes but not to distant sites (T4a, N2a, M0). — or — The cancer has grown into the wall of the colon or rectum, including the visceral peritoneum, but has not reached nearby organs. It has spread to 7 or more nearby lymph nodes but not to distant sites (T3 or T4a, N2b, M0). — or — The cancer has grown through the wall of the colon or rectum and is attached to or has grown into nearby tissues or organs. It has spread to at least one nearby lymph node or areas of fat close to it but not to distant sites (T4b, N1 or N2, M0). Stage 4A The cancer has spread to one distant organ, such as the liver or lungs, or distant set of lymph nodes, but not to distant parts of the lining of the abdominal cavity, the peritoneum (any T, any N, M1a). Stage 4B The cancer has spread to more than one distant organ or distant set of lymph nodes, but not to distant parts of the peritoneum (any T, any N, M1b). Stage 4C The cancer has spread to distant parts of the peritoneum (any T, any N, M1c). ( 3 )
Survival Rates Colon & Rectal Cancer Survival Rates The National Cancer Institute has collected data (most recently for the years 2004 through 2010) to create relative five-year survival rates for different kinds of cancer — the estimated percent of people at each stage who are expected to be alive five years after diagnosis. For colorectal cancers, available statistics are based on a previous version of the TNM cancer staging system that differs from the one used today; it does not have a stage 2C, for instance. Generally speaking, the higher the cancer’s stage, the poorer the prognosis. The fact that stage 3A colon cancer has a higher survival rate than stage 2A and 2B cancers seems odd, but it may reflect more aggressive treatment, among other factors, because patients with stage 3 colon cancer always get chemotherapy, while chemo’s ability to improve survival in stage 2 disease is controversial and related to microscopic examination of the tumor. Keep in mind that each cancer case is unique, and many factors apart from stage influence the outcome, such as a person’s age, overall health, and responsiveness to cancer treatment. Stage 1: colon cancer, 92 percent; rectal cancer, 88 percent Stage 2A: colon cancer, 87 percent; rectal cancer, 81 percent Stage 2B: colon cancer, 65 percent; rectal cancer, 50 percent Stage 3A: colon cancer, 90 percent; rectal cancer, 83 percent Stage 3B: colon cancer and rectal cancer, 72 percent Stage 3C: colon cancer, 53 percent; rectal cancer, 58 percent Stage 4: colon cancer, 12 percent; rectal, 13 percent ( 4 )
Fatty fish have previously been linked with lower levels of multiple sclerosis (MS) disability, and a recent study adds further support to the benefits of fish consumption when it comes to living with MS, a disease that attacks the central nervous system.
“We were encouraged to see that patients who increased their fish intake after diagnosis still benefited, indicating that dietary changes may have a meaningful impact on MS progression, even later in the disease course,” says study author Anna Hedström, MD, PhD, a senior research specialist with the department of clinical neuroscience at the Karolinska Institute in Stockholm.
“While more research is needed, fish consumption as part of a balanced, anti-inflammatory diet could be a simple and practical strategy for MS management,” Dr. Hedström says.
People With MS Saw Benefits From Both Oily and Lean Fish
Drawing on dietary and health data from more than 2,700 adults newly diagnosed with MS, researchers observed that eating more fish was associated with slowing of disability progression. Participants were 38 years old on average, and were followed for up to 15 years after diagnosis.
One of the most interesting findings, Hedström says, was that both lean and oily fish were tied to a lower risk of disability progression.
She and her collaborators expected to see positive effects from oily fish, such as salmon, mackerel, sardines, and herring, as these are rich in vitamin D and omega-3 fatty acids, nutrients known for their anti-inflammatory and neuroprotective properties.
The study authors, however, were somewhat surprised to also find positive health outcomes associated with lean fish such as cod, haddock, and pollock. Hedström and her team speculate that specific bioactive compounds in these types of fish, such as taurine and selenium, may play a role, as their antioxidant effects and positive influence on the body’s immune response may help protect nerve cells.
“While there are no specific MS guidelines, our findings suggest that consuming fish at least once a week — and ideally a mix of both lean and oily fish — may be associated with better long-term outcomes in MS,” says Hedström.
She warns, however, that excessive intake of certain fish can lead to exposure to mercury and other environmental contaminants. Large predatory fish, in particular — such as shark, swordfish, and king mackerel — may have higher mercury levels and should be eaten in moderation, advises Hedström.
In comparison, smaller, oily fish (such as sardines, salmon, anchovies) tend to have lower mercury levels and may be a safer choice for frequent consumption.
How Eating Fish Affects MS Disability Progression
For the study, 2,719 MS patients provided information regarding their consumption of lean and oily fish, with frequency categorized as: never or seldom, one to three times a month, and weekly.
Disease progression was measured using the Expanded Disability Status Scale (EDSS). MS causes problems with vision and walking, among other issues, and the EDSS measures the progression of symptoms. In the study, confirmed disability worsening was defined as an increase in the EDSS score of at least 1 point from baseline, sustained between two further checkups, at least six months apart.
The results showed that eating fish weekly at the time of diagnosis was associated with a 34 percent lower risk of confirmed disability worsening, compared with monthly or never.
Trends analysis found that the more lean and oily fish consumed, the lower was the risk of confirmed disability worsening and progression to higher scores of 3 and 4 on the EDSS scale.
A subset of about 1,700 participants completed an online follow-up questionnaire that assessed changes in their fish intake over time.
In this group, those who increased their fish consumption within five years post diagnosis had a significantly lower risk of confirmed disability worsening — as much as 59 percent lower — compared with those who maintained a low intake of fish.
The researchers further noted that the results held true even after accounting for potentially influential factors of physical activity, body mass index (BMI), smoking, alcohol intake, and sun exposure.
The Role of Diet in Easing MS Symptoms
For Kalina Sanders, MD, a neurologist and director of the Comprehensive MS Clinic at Baptist Health in Jacksonville Beach, Florida, the study reinforces how important dietary habits are for MS management.
“Having a balanced diet that is rich in polyunsaturated fatty acids found in fish is a way to minimize inflammation and enhance neuroprotection,” says Dr. Sanders. “This may ultimately impact how some patient’s disease activity and disability changes over time.”
She stresses that the research has limitations, in that fish consumption details were self reported, so there may be inaccuracies with recall. The study also lacked information on fish preparation methods, which could influence the nutritional content and health effects.
Additionally, she emphasizes that this is an observational study, so it cannot establish a causal relationship between fish consumption and reduced MS disability progression.
Blood thinners are medications that stop or slow the formation of blood clots, keep clots from getting bigger, or prevent clots that have already formed from traveling to other parts of the body. Blood thinners are lifesaving medications, notes the National Blood Clot Alliance (NBCA), helping to prevent strokes, heart attacks, and pulmonary embolisms.
You may be taking a blood thinner if you have:
Certain heart or blood vessel diseases
Atrial fibrillation (abnormal heart rhythm)
A heart valve replacement
A risk of blood clots after surgery
Congenital heart defects
Blood thinners come in pill form or as an injection. And there are two different types.
Anticoagulants make it harder for blood clots to form and include heparin, warfarin, dabigitran, apixaban, rivoroxaban, and edoxaban.
Antiplatelets prevent blood cells called platelets from clumping together and forming a clot. Antiplatelets include aspirin and clopidogrel and are mainly taken by people who have had a heart attack or stroke.
There are certain risks that come with taking blood thinners. Side effects can include bleeding and bruising, as well as upset stomach, nausea, and diarrhea. Different blood thinners can have different side effects and contraindications; warfarin, for example, should not be taken during pregnancy.
There’s a lot you need to know when taking blood-thinning medications. Here are 16 dos and don’ts for staying safe and fully protected.
1. Do Watch Out for New or Increased Bleeding
“The main side effect of a blood thinner, not surprisingly, is bleeding,” says Christopher B. Granger, MD, a cardiologist at Duke Health in Durham, North Carolina.
The reason is that blood thinners are preventing your body’s natural ability to clot blood, which it does to stop bleeding and heal minor wounds.
So when taking a blood thinner, you might notice increased bleeding from cuts or scrapes, more frequent or more intense nosebleeds, or heavier-than-normal periods.
If minor bleeding bothers you, don’t stop taking the medication, says Mary Cushman, MD, the director of the University of Vermont Medical Center’s thrombosis and hemostasis program, in Burlington. Ask your doctor or pharmacist to recommend special wound dressings and other over-the-counter products that can help.
But if you notice blood in your urine, begin coughing up blood, vomit material that looks like coffee grounds (an indication of bleeding in the stomach), or have black bowel movements (a possible sign of bleeding in the digestive tract), call your doctor immediately, Dr. Cushman says.
2. Do Have Your Blood Checked as Often as Your Doctor Recommends
“Warfarin requires regular blood work to ensure you have the right dose, so your blood doesn’t become too thin or not thin enough,” says Cushman. “At the beginning, it can be two or three times per week. Once you’re stabilized, it’s usually every four weeks or so.”
Some of the newer drugs, which work on more closely targeted aspects of the clotting process, don’t require as much testing because they cause less bleeding, says Granger.
“This is one of the reasons why we’re particularly enthusiastic about some of the newer blood thinners called DOACs,” notes Granger about direct-acting oral anticoagulants (DOACs) like apixaban and rivaroxaban. “Compared to warfarin, the old-fashioned blood thinner, DOACs caused less bleeding into the brain, which is the most devastating type of bleeding.”
3. Do Tell Your Healthcare Provider About Any Other Medications You Take
Let your doctor, nurse, or pharmacist know about any prescription or over-the counter drugs, vitamins, and herbal supplements you’re taking.
Granger warns against taking aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs) like naproxen and ibuprofen that can increase your risk of bleeding.
Different blood thinners react with different drugs.
Warfarin, in particular, can interact with a host of other medications:
Aspirin
Acetaminophen (Tylenol)
Antacids or laxatives
Nirmatrelvir/ritonavir (Paxlovid)
Certain antibiotics
Antifungal drugs such as fluconazole (Diflucan)
Ibuprofen (Advil) or naproxen sodium (Aleve)
Atrial fibrillation medications such as amiodarone (Pacerone, Nexterone)
The following herbal supplements can also interact with warfarin:
DOACs like dabigatran, rivaroxaban, apixaban, and edoxaban have fewer contraindications than warfarin but can still interact with antiarrhythmic drugs, aspirin and antiplatelet drugs, NSAIDs, antifungal drugs, anti-epileptic drugs, HIV medications, and St. John’s wort.
4. Do Tell Your Doctor if You Plan to Stop Any Medication
Just as taking prescription and over-the-counter drugs can affect your blood-thinning medication, so can stopping them. It’s important to keep your doctor informed of any medication changes you’re considering.
5. Do Talk to Your Doctor About Different Dosages
Granger says that typically warfarin blood thinners are started on a lower dose and increased as necessary, as higher doses also increase the chance of excessive bleeding.
Very elderly people or those who have decreased renal or kidney function may be on a lower dose, says Granger. “Being on the correct dose is important.”
Even with the newer DOACs, dosage may need to be changed depending on other medication you’re taking.
If you have concerns about your dose, talk to your doctor about adjusting your medication.
6. Do Consider Wearing a Medical Alert Bracelet
In case of an emergency — such as a car accident — it’s important that healthcare providers know you’re taking a blood thinner, which can raise your bleeding risk and potentially change your recommended treatment.
Wear a medical alert bracelet, available in some pharmacies and online, or carry a card in your wallet that states the name of your blood thinner.
Devices like the Apple Watch and Fitbit have apps that can check your heartbeat and rhythm for atrial fibrillation (a possible complication of atrial fibrillation is blood clotting). If a device identifies possible irregular heartbeats, schedule an appointment with your physician.
7. Do Plan Ahead for Travel
If you plan on taking a trip, get your doctor’s okay for traveling, advises Michael Zimring, MD, a specialist in travel medicine at Mercy Medical Center in Baltimore. Then research your destination: Learn where the nearest hospital or clinic is in case you run into a situation that causes excess bleeding or you’re in need of emergency blood work.
8. Don’t Sit Too Long
Sitting for long periods of time, whether it’s in a car or on a plane trip, or even sitting at your desk at work without getting up for hours, can raise your blood clot risk.
A blood thinner makes it less likely that you’ll get a clot, but “it’s still smart to get up and move around every hour or two,” Dr. Zimring says.
What if you’re stuck in your seat for a while?
“Lift your legs up and down, pump your calves, point and flex your toes — do anything you can to get the blood flowing,” he says.
9. Do Be Consistent With Vitamin K Intake
Warfarin works by reducing the clotting effects of vitamin K, which is found in many green vegetables, including kale, broccoli, Brussels sprouts, and collard and mustard greens. So if that’s the medication you’re taking, eating too many of these foods at once could reduce its effectiveness, Cushman notes.
But if you eat moderate amounts of green vegetables every day, your doctor can take that into account when determining the dosage you need, she adds. It’s not about avoiding these foods so much as staying consistent with how much you consume, because your dose of blood thinner is calibrated accordingly.
“If you binge on a big spinach salad one day, you might have problems,” Cushman says. “But if you eat salad every day and don’t vary it, you’ll be stable. You don’t have to totally block [these foods] out.”
Vitamin K is also found in meal replacement drinks. If you’re taking warfarin, it’s important to check nutrition labels for the amount of vitamin K you may be consuming.
10. Do Drink Plenty of Water
Dehydration causes blood vessels to narrow and blood to thicken, raising the risk for blood clots. Staying well-hydrated improves circulation, according to the American Heart Association.
What’s more, a full bladder will prompt you to get up regularly to use the restroom, helping prevent long periods of sitting, Zimring adds.
11. Do Seek Care Immediately if You Fall or Hit Your Head
Call your doctor or go straight to the emergency room, advises the Agency for Healthcare Research and Quality (AHRQ), even if you’re not bleeding.
Even if you aren’t visibly injured, you could be bleeding internally, especially if you hit your head, the AHRQ notes. And a bruise is a sign that you’re bleeding beneath the skin.
12. Don’t Worry Too Much About Shaving
People on blood thinners are often fearful of cutting themselves while shaving, but “you won’t bleed to death from a nick,” Cushman says.
If shaving any part of your body stresses you out, switch to an electric razor or a different hair-removal method.
13. Don’t Drink Excessive Amounts of Alcohol
Sobriety or alcohol only in moderation is advised for all adults, according to the Dietary Guidelines for Americans, whether they’re on blood thinners or not. Moderation means two drinks or less a day for men and one drink or less a day for women. But if you take warfarin, you should be particularly careful when it comes to drinking, notes the American Heart Association, as alcohol can affect how the drug is metabolized. Talk with your doctor about how much, if any, alcohol you can safely consume while taking a blood thinner.
Drinking to the point of intoxication also increases your chances of falling or having an accident, adds Cushman.
14. Don’t Necessarily Stop Your Blood Thinner Before a Dental Procedure
Dental treatments can cause bleeding, which may last longer if you’re taking a blood thinner, the American Dental Association (ADA) notes.
Talk to your doctor about whether or not to stop taking your blood thinner for dental procedures. And let your dentist know what drug you’re taking and what your doctor has advised.
The risks of stopping your blood thinner “far outweigh the consequences of prolonged bleeding, which can be controlled,” the ADA says.
15. Don’t Double Up on Missed Doses
You should try to take your blood thinner at the same time each day, in accordance with your doctor or pharmacist’s instructions. But if you forget a dose, resist the urge to make up for it with a double dose next time.
If you miss a dose of warfarin and remember within eight hours of the time you were supposed to take it, go ahead and take it. If more than eight hours have passed, wait until the next day and take only the prescribed dose for that day, advises Cleveland Clinic.
If you’ve forgotten a dose of a DOAC, and it is less than half the time to your next scheduled dose, take the medicine and continue as normal. If not, take the next dose at the scheduled time, advises the British Heart Foundation. Don’t take a double dose, as that could increase the risk of bleeding.
16. Don’t Be Afraid to Stay Active
Staying physically active is healthy, so don’t stop your favorite exercise routines because you’re using blood thinners.
“Not only can you, but you should stay active,” says Granger. “Now, I wouldn’t do anything crazy like jump out of airplanes or get into a boxing ring, but most things are okay.”
But do take the proper precautions, the NBCA notes. Always wear a helmet when cycling or skiing, gloves when gardening, and shoes to avoid cuts on your feet. Also wear your medical alert bracelet or carry your blood thinner card in case of an injury.
Low-impact activities such as walking, biking, yoga, Pilates, and strength training should be fine. But if you enjoy higher-intensity sports that pose a greater risk of injury, ask your doctor if they’re safe for you.
The Takeaway
Blood thinners play a critical role in preventing serious events such as strokes and heart attacks by managing the formation and expansion of blood clots.
Regular blood work to monitor the effects of blood thinners is essential, especially if you’re taking medications like warfarin, which require precise dosing to avoid risks like excessive bleeding.
Be sure to let your healthcare provider know about all medications, supplements, and vitamins you’re taking, as they can interact dangerously with blood thinners.
If you experience severe bleeding signs such as blood in the urine or vomit, seek immediate medical attention to address potential side effects related to blood thinner use.
For many people, HCM is a benign condition and it will not lead to dangerous cardiovascular disease, says Ningxin Wan, MD, a cardiologist at NewYork-Presbyterian Queens and an assistant professor at Weill Cornell Medicine. But that does not mean people who do not have symptoms should ignore follow-up appointments meant to monitor the condition, she says. Regular evaluation and preventive treatment is key to making sure that HCM doesn’t lead to a bad outcome.
“People who have HCM can live a normal lifestyle, unlike other heart diseases that really affect longevity, given that it is recognized and treated early on,” Wan says.
It’s also important to pay attention even to mild symptoms, and how they change over time.
“If I can get one message out to these patients it’s that we have treatments to help with symptoms and if you do not have symptoms, please do not forget that this is a condition that could get worse, and you need to monitor it,” Wan says.
Even people who do not experience symptoms should see a cardiologist regularly, as untreated HCM can increase the likelihood and severity of other cardiovascular issues, such as heart failure and arrhythmia (abnormal heartbeat).
Sudden Cardiac Death
The most severe complication of HCM is sudden cardiac arrest, in which the heart suddenly stops beating. Without emergency treatment, sudden cardiac arrest will result in death.
Although sudden cardiac death is the most well-known effect of HCM, it is rare, affecting about 1 in 3,000 people per year. Most such deaths occur in people who were unaware that they had the condition. This phenomenon is often associated with college-age athletes, though it doesn’t necessarily occur during exercise, and it can occur at any age.
HCM treatment, which may include the use of an implantable cardioverter-defibrillator (ICD), can greatly reduce the risk of sudden cardiac arrest.
High morning blood sugar happens when your body secretes a surge of hormones, including growth hormone, epinephrine, and cortisol, typically between 3 a.m. and 8 a.m. These hormones directly cause an increase in blood sugar. This is a normal part of waking up, but in people with diabetes, this temporary rise in blood sugar is more powerful and longer lasting than it should be.
“Those hormones affect insulin sensitivity and can increase blood glucose levels if you don’t adjust your insulin doses,” says Ben Tzeel, RD, CDCES, founder of Your Diabetes Insider. If someone uses insulin to manage their diabetes, Tzeel says, they may need to adjust their dosage in the morning to account for this effect.
Sometimes this blood sugar spike happens almost immediately after you get out of bed and start walking around. Some people with diabetes refer to this as the “‘feet on the floor’ effect,” says Tzeel. “This is directly related to your body saying, ‘Okay, you’re up! Here’s some glucose from your liver to give you fuel and start your day!’”
The main complication of the dawn phenomenon is a rise in A1C levels.
Depending on how elevated your blood sugar is, you may experience the following symptoms:
And when diabetes goes unmanaged, it can lead to complications such as eye, kidney, and nerve damage; heart disease; and poor circulation.
A new report from the Centers for Disease Control and Prevention (CDC) shows a dramatic decline in cervical cancer cases since the introduction of the human papillomavirus (HPV) vaccine.
The study found that from 2008 to 2022, rates of precancerous cervical lesions decreased by about 80 percent in women ages 20 to 24 who were screened for cervical cancer. This is the age group most likely to have received the HPV vaccine, which was first recommended in the United States in 2006 for preteen girls and boys, according to the authors.
The vaccine has been called “dangerous” by Health and Human Services secretary Robert F. Kennedy Jr.
The HPV vaccine has “100 percent” translated into fewer cases of cervical cancer, says Elena Ratner, MD, a professor of obstetrics, gynecology, and reproductive sciences and the co-chief of gynecologic oncology at Yale School of Medicine in New Haven, Connecticut.
“I’ve been practicing medicine for about 25 years, and I can tell you, even in that short period of time, the paradigm of cervical cancer has changed dramatically — we see way less of it. We’re now hitting the benefit of those first generations of adolescents getting vaccinated,” says Dr. Ratner, who wasn’t involved in the study.
Reduction in Cervical Cancer Seen in Vaccinated Preteens and ‘Catch-Up’ Vaccinations
To analyze how the incidence of cervical cancer has changed since the introduction of the HPV vaccine, investigators tracked cervical precancers (CIN2+ and CIN3+) in five U.S. areas from 2008 to 2022 through a program called HPV-IMPACT.
Researchers gathered census data on all women between ages 20 and 64 living in these areas, and monitored the labs where tissue samples are sent to identify confirmed cases of cervical precancers.
To understand how many women were screened for these conditions, they estimated how many women had Pap tests or HPV tests each year, factoring in different types of insurance such as private, public, and uninsured.
While the largest drop happened in younger women, the HPV vaccine also positively affected older women.
Among women ages 25 to 29 years, there was a 37 percent reduction in higher-grade precancers (CIN3+) — also notable because rates of precancer were on the rise in this group until 2015. This age group includes women who were vaccinated as part of catch-up vaccination programs (recommended for young adults who didn’t get the vaccine as kids), the authors said.
The findings in younger and older women support the current guidelines on HPV vaccination, the authors concluded.
Is the HPV Vaccine Safe?
Rigorous scientific research suggests that not only is the HPV vaccine effective, but it is very safe as well. The ingredients in the HPV vaccine occur naturally in the environment, the human body, and foods.
The HPV vaccine does contain aluminum (as do the hepatitis B and Tdap vaccines); this metal improves the immune response to the vaccine. People are exposed to aluminum every day through food, cooking utensils, water, and even breast milk, and vaccines with an aluminum component have been administered to billions of people without adverse effects. Studies with millions of participants from around the world have demonstrated the safety of the HPV vaccine.
“In my experience, and both in my clinical experience and all the evidence-based medicine that I’m aware of, I have not seen any toxicity to the vaccine. I have not seen any long-term side effects or morbidity from the vaccine,” says Ratner.
Who Should Get the HPV Vaccine?
The human papillomavirus (HPV) vaccine protects against genital warts, most cases of cervical cancer, and other cancers caused by HPV, including of the vagina and vulva. Men can also get cancer of the throat, tonsils, back of tongue, penis, and anus from HPV.
HPV is a common sexually transmitted infection (STI) that spreads through skin-to-skin contact, including vaginal, anal, and oral sex.
Here are some of the groups that may benefit from vaccination against HPV.
Boys and Girls Ages 9 to 12
The CDC recommends the HPV vaccine for both boys and girls starting at ages 11 or 12, though it can be given as early as age 9. The vaccine is most effective when given before any exposure to HPV, which typically happens before individuals begin sexual activity.
Men
The vaccine has significant benefits for men to prevent oropharyngeal cancer, which is cancer of the throat, tonsils, and back of tongue. That’s especially important because there is no screening for that type of cancer.
It’s almost 100 percent effective in preventing external genital warts.
Certain Young Adults
The vaccine is recommended for young adults who did not receive the vaccine during childhood.
Teens and young adults up through age 26 who haven’t yet received the HPV vaccine or haven’t finished the series should get it. This includes people who may have already been sexually active or have had some exposure to HPV. The vaccine can still provide protection against strains of the virus they haven’t encountered.
People ages 27 to 45 should discuss their risks with their healthcare team to decide if they should get the HPV vaccine.
When Should I Get an HPV Vaccine — and Who Should Avoid Them?
“The best time or the best way for the vaccine to be most efficient is when somebody gets a vaccine before they get exposed to the HPV virus,” says Ratner.
But the vaccine is beneficial even after you’ve been exposed, she explains.
“The vaccine can still help you fight the HPV strains that you don’t yet have. The HPV vaccine is effective against nine different HPV strains,” she says.
That means it could be appropriate for some people in their early forties, she says. “For example, someone gets divorced and now has new partners. It’s recommended for them to get their HPV vaccine because now they’re going to be exposed to new HPV strains,” says Ratner.
There are some people who shouldn’t get the vaccine — for example, pregnant women or people who are allergic to an ingredient in the vaccine. Talk with your doctor to find out if you are eligible.
Bottom Line: The HPV Vaccine Has Been a Game Changer in Preventing Cervical Cancer
“As an oncologist, someone who takes care of women with cervical cancer and who has been taking care of women with cervical cancer for decades, I can tell you that this vaccine changed the face of cervical cancer. This vaccine has saved women from getting cancer and then dying from this cancer,” says Ratner.
Many people who get flu infections experience relatively mild symptoms that can be managed at home. But serious and potentially life-threatening complications are possible, and some doctors are seeing a spike this year in severe neurological symptoms among infected children.
Public health officials in Massachusetts reported that physicians in the state have observed a possible increase in the number of cases of children with influenza who develop neurologic complications compared with prior years.
“Similar possible increases have been observed in other jurisdictions throughout the U.S.,” Massachusetts officials said in the February 14 report. “At this time, it is not clear why increased cases of neurological complications associated with influenza are being observed this season.”
How Flu Can Affect the Brain
The report focused on a small but rising number of children hospitalized for influenza who developed severe neurological complications such as seizures, hallucinations, reduced consciousness, nerve damage, abscesses, and swelling in the brain.
Among the most worrying complications is a condition known as influenza-associated acute necrotizing encephalopathy (ANE), according to the report. ANE is a severe form of influenza-associated encephalopathy or encephalitis (IAE), which involves serious neurological issues that result from inflammation and swelling in the brain.
A report from the Centers for Disease Control and Prevention (CDC) notes that it’s too soon in the current flu season to tell whether neurological complications really are on the rise among kids with the flu. But the CDC did report some preliminary data that is in line with what doctors are seeing in Massachusetts.
From 2010 until February 8, 2025, 1,840 kids died of influenza, including 166 deaths (9 percent of cases) associated with IAE.
Cases are higher than normal this flu season, with 9 out of 68 pediatric influenza deaths (13 percent of cases) involving IAE.
Too Soon to Tell if This Flu Season Will Be Worse for Children
“We don’t know at this time whether the anecdotal reports of influenza neurological complications translates into a higher overall rate of complications, or if it ends up being similar to previous years,” says James Antoon, MD, PhD, an assistant professor of pediatrics at Vanderbilt University Medical Center in Nashville, Tennessee, who wasn’t involved in the IAE reports.
“These complications are uncommon but can be life-threatening,” Dr. Antoon says. “While neurologic complications of influenza are more common in those with underlying neurologic conditions, they can occur in otherwise healthy children as well.”
Low Flu Vaccine Uptake Could Be a Contributing Factor
More than half of the children with IAE across all the flu seasons in the CDC analysis had no underlying medical conditions that would increase their risk, according to the CDC report. However, just 20 percent of these kids received flu vaccinations.
If there really is a surge in severe neurological complications among kids with the flu this year, lower vaccination rates could be one reason for the increase, Antoon says.
It’s also possible that the strain of influenza circulating this year is contributing to more severe infections than strains circulating in previous years, Antoon says. But the vaccine developed this year is a good match for the currently circulating strains of influenza, Antoon adds.
“It’s possible there is something different about the influenza strains this season, or the interaction between the virus and the immune system, that could be contributing to more neurological complications,” Antoon says.
Vaccination Is the Best Way to Prevent Serious Flu Complications
Vaccination is still the best way to prevent getting the flu or experiencing serious complications, says Philip Britton, PhD, a pediatric infectious disease physician and an associate professor at the University of Sydney in Australia, who wasn’t involved in the recent IAE reports.
