What is tinnitus?

Tinnitus is a generic term used to describe a ringing or noise in the ears that occurs in the absence of external sound. This is a very common condition that is thought to occur in up to 15% of people. It can occur in one or both ears, and often people will describe the sound as “coming from their head.” There are a variety of descriptions that people use for their tinnitus such as whooshing, ringing, pulsing, and/or buzzing, and the quality of the sound varies by individual.

Symptoms of tinnitus can cause great distress

While tinnitus can be caused by conditions that require medical attention, it is often a condition that is not medically serious. However, the distress and anxiety it produces can often disrupt people’s lives. Because of the negative impact tinnitus can have on people, it may be helpful to learn more information on what symptoms are common and benign (not serious), and those that require medical attention and interventions.

What causes tinnitus?

Tinnitus can be broken down into two major types: pulsatile and non-pulsatile.

Pulsatile tinnitus is a noise in the ear that sounds like a heartbeat. Often people will describe a perception of a pulsing in their head and the ability to hear their heartbeat. Tinnitus that sounds like someone’s heartbeat can be caused by normal or abnormal blood flow in the vessels near the ear. This type of tinnitus should be brought to the attention of your physician, because there are various rare conditions that cause it that may require medical intervention.

Non-pulsatile tinnitus is more common, but it can be more difficult to identify a cause. Most often tinnitus is associated with a hearing loss. However, people can have tinnitus with normal hearing. While people with tinnitus often believe the problem is with their ears, there is some evidence in tinnitus research that suggests the noise originates in the brain, even though it is perceived through the ears.

There are some specific conditions of the ear or brain that are associated with tinnitus. It is common for many of these conditions to have other symptoms associated with them, such as hearing loss or imbalance.

Despite the list of possible causes of tinnitus, often times there may be no identifiable causes, and doctors generically say that a patient has tinnitus. Even if a source of the tinnitus is identified, most tinnitus is due to benign, or non-threatening, conditions.

Note: This list is not intended to be comprehensive, but to provide representative examples of things that may cause tinnitus.

Should I be concerned about tinnitus?

Even though tinnitus is often benign, there are some specific symptoms that should alert people to seek medical evaluation:

• pulsatile tinnitus of any kind
• tinnitus in one ear only
• bothersome tinnitus that cannot be ignored
• tinnitus associated with room-spinning sensations (or vertigo)
• tinnitus associated with sudden changes or fluctuations in hearing status.

If you experience tinnitus with any of the symptoms above, it is important to discuss them with your doctor or an otolaryngologist, who is a specialist in diagnosing, managing, and treating medical conditions of the head and neck, including the ears.

What can I do about it?

The most important thing you can do about your tinnitus is discuss it with your physician. Often you will be sent for a hearing test, because most tinnitus is associated with some degree of hearing loss. The hearing test will often provide additional information to the physician about whether further tests are necessary.

If it is determined that tinnitus is caused by any of the conditions previously noted, treatment aimed at those conditions may offer relief. If there is hearing loss, hearing aids may help both hearing and tinnitus. Distraction techniques such as a white-noise machine or background noise may also help, particularly during sleep.

One of the challenges in treating non-pulsatile, benign tinnitus is that there are few medications that reliably resolve symptoms. It is also difficult to find medical therapies for tinnitus, because we are still working to identify a specific location where tinnitus originates. Despite this challenge, there is new research showing effective non-medication approaches to tinnitus, One example of this is neural stimulation techniques, which have shown promise in appropriate patients.

The most effective treatment for non-pulsatile, benign tinnitus is cognitive behavioral therapy. Specific behavioral therapy, called tinnitus retraining therapy, has consistently been shown to reduce tinnitus compared to other treatment modalities. This can also aid in addressing any underlying stress or anxiety about the condition.

Ultimately, tinnitus is a very challenging condition for both patients and physicians. Being informed is important in helping you manage this condition. If you feel that tinnitus is interfering with your life or causing you significant stress, ask your physician about your options.

If you were to sum up the overall health of a nation in one single number, what would that be? At the top of the list, you would likely find average life expectancy — the total number of years, on average, that a person in a country can expect to live. Wars, famine, and economic crises are expected to lower life expectancy. Breakthroughs in science, strong economies, and behaviors like eating a healthy diet, exercising, and avoiding tobacco typically raise average life expectancy.

An amazing rise, a surprising fall

Between 1959 and 2014, the United States experienced an unprecedented increase in life expectancy, which rose from 69.9 years to 78.9 years. The simple thought of adding almost 10 years, on average, to the lifespan of each individual in the country in that short amount of time is amazing and astounding, a true testament to our rapidly increasing understanding of health, medicine, and the environment.

Unfortunately, that’s where the good news ends. Between 2010 and 2014, life expectancy in the US plateaued. And then in 2014, something worse happened: life expectancy began decreasing. The US experienced three years in a row of declining life expectancy. As an article in the Washington Post observes, this is the first time the US has seen such prolonged declines since 1915 to 1918, when Americans experienced both World War I and a flu pandemic. The US is also the only developed country in the world whose average life expectancy stopped increasing after 2010. We now rank 35th in the world. The average American can expect to live 3.5 years less than the average Canadian. So now, in this decade, without large-scale war causalities or a severe pandemic, without economic crisis or famine, why is US life expectancy decreasing?

Diving into details on life expectancy

A recent report in JAMA provides a comprehensive, detailed look at this phenomenon. The authors focused attention on midlife, defined as adults ages 25 to 64. Midlife is the time when adults are typically the most productive, raising families and making up the majority of the workforce. Tragically, mortality rates in this age group are bringing down the national average. Key findings below help explain why.

(First, a quick note about percentages: A 100% increase in deaths from an illness means the death rate doubled since the last time it was measured. A 400% increase means deaths are five times as high as they were previously.)

Certain health problems are driving higher death rates. Since 1999, the US has seen drastic decreases in deaths due to heart disease, cancer, HIV, and motor vehicle injuries. But since 1999, drug overdose deaths in midlife increased almost 400%, while deaths from alcoholic liver disease and suicide increased by about 40% each. Likewise, deaths caused by illnesses related to high blood pressure increased by nearly 80%, while those from obesity-related illness rose 114%.

Gender matters. Overall, men have lower life expectancy than women. Likewise, during midlife men were more likely than women to die from most causes, with some important exceptions. For example, overdose deaths nearly quadrupled overall, but among women the increase was 1.4 times higher than among men. And deaths related to alcoholic liver disease were 3.4 times higher among women than men.

Race and ethnicity matter. Since 1999, nearly all racial and ethnic groups have experienced an initial improvement in life expectancy followed by a decline. Only non-Hispanic American Indians and Alaska Natives did not experience a decline. Death rates of non-Hispanic black individuals in midlife have remained substantially higher compared with non-Hispanic white people over the past decades. But for certain conditions the disparities are even greater, including a relative increase of over 170% in fatal drug overdoses between 2010 and 2017.

Where you live matters. One of the most fascinating parts of the report is the state-by-state mortality comparison. The difference in mortality between the highest and lowest life expectancy states is seven years! Furthermore, there has been a shift over the past decades. For example, in 1959, Kansas had the highest life expectancy, but in 2016 it ranked 29th. There were also differences between neighboring states: Alabama and Georgia had a negligible (0.1 year) difference in 1990, but by 2016, Georgia’s life expectancy was 2.3 years greater. And finally, states who have been hit hardest with the opioid overdose epidemic have also seen decreases in life expectancy, particularly those in New England and the Ohio Valley. In fact, the authors of the report calculated that there were over 33,000 excess deaths from 2010 to 2017. About a third of these deaths occurred in just four Ohio River Valley states: West Virginia, Ohio, Indiana, and Kentucky.

Life expectancy is much more than just a number

In unpacking this important report, so many unanswered questions rise to the surface. I think of the potential every child has, and the years of people’s lives that are lost unnecessarily and prematurely, especially during midlife years when they could be most productive. There is, fortunately, a glimmer of a silver lining: a new report shows that, in 2018, life expectancy increased in the U.S. by 0.1 years—so, just over five weeks.

Still, what would our country’s average life expectancy be if we could eliminate stigma around addiction, increase treatment resources, and end overdose-related deaths? What would the number be if every American was guaranteed access to inexpensive medicines for chronic conditions such as high blood pressure? If we recognized that mental illness is a chronic disease and people had access to appropriate behavioral health services? If our society addressed the social determinants of health, focusing on vast disparities between racial and ethnic groups, as well as rural and city inhabitants? I can’t tell you the answers. But as a nation, we must address these tough questions if we wish to resume our once remarkable progress extending people’s lives.

Recently there has been much discussion and many questions about vegan diets. Are vegan diets — which exclude meat, poultry, seafood, eggs, and dairy — healthful? Do they provide complete nutrition? Should I try one? Will it help me lose weight?

Many people around the world eat plant-based diets for a variety of reasons, some because meat is not readily available or affordable, others because of religious convictions or concerns about animal welfare. Health has become another reason people are moving to plant-based diets. And research supports the idea that plant-based diets, including vegan diets, provide health benefits.

What does the science say?

A recent meta-analysis, published in JAMA Internal Medicine, looked at nine observational studies totaling over 300,000 participants to see how plant-based diets (both vegan and vegetarian) relate to type 2 diabetes risk. The study found that those most closely following plant-based diets (emphasizing foods like whole grains, legumes, nuts, vegetables, and fruits, while de-emphasizing or eliminating animal foods such as meat, dairy, and eggs) had a 23% lower risk of developing type 2 diabetes.

In a 2016 study published in the American Journal of Clinical Nutrition, researchers analyzed the diets of over 26,000 men for nearly eight years. They found that vegan diets were linked with a 35% lower risk of prostate cancer compared to non-vegetarian diets.

And an extensive review of the literature published in The Lancet in February 2019 showed that a mostly plant-based diet could prevent approximately 11 million deaths per year globally, and could sustainably produce enough food for the planet’s growing population without further damage to the environment.

Finally, a position paper from the Academy of Nutrition and Dietetics noted that appropriately planned vegetarian (including vegan) diets are healthful, nutritionally adequate, and may provide health benefits for the prevention and treatment of certain diseases. It went on to say that these diets are appropriate for all life stages including pregnancy, lactation, infancy, childhood, adolescence, and older adulthood.

Careful planning is important for a vegan diet

While vegan diets can be healthy, you may have to do a little planning to balance a vegan plate and ensure you get enough protein, calcium, iron, and vitamin B₁₂. Here are some foods and nutrients to pay special attention to.

Protein. A variety of vegan foods are rich in protein. They include soybean products (tofu, edamame, tempeh), seitan, lentils, beans or peas, nutritional yeast, spirulina, soy milk, cashew milk, nuts and seeds, nut and seed butters, veggie burgers, and meat alternatives.

Healthy fats. Healthy, vegan sources of fats include various oils (olive, canola, sunflower, safflower, soybean, and corn), nuts and seeds, avocado, flaxseeds, and chia seeds. It is important for vegans to eat foods containing alpha-linolenic acid, a type of fat that can be converted into essential omega-3 fats (DHA and EPA) in your body. The richest sources of alpha-linolenic acid are flaxseeds and flax oil, chia seeds, hempseed oil, walnuts or walnut oil, canola oil, and soybean oil. If you do not consume these items daily, consider consuming a flaxseed oil supplement.

Calcium. Without dairy, an unbalanced vegan diet can lack calcium. Aim for one to two cups per day of well-absorbed sources of calcium such as tofu, calcium-enriched fruit juice, cooked Chinese cabbage, turnip greens, mustard greens, collard greens, or fortified plant milks (soy, almond, cashew). If you fall short of the daily goal, you may need a calcium supplement.

Vitamin B₁₂. There are only two reliable sources of vitamin B₁₂ for vegans; fortified foods and supplements. Examples of B₁₂-fortified foods include: fortified plant milks (soy, almond, cashew), meat alternatives, fortified cereals, and nutritional yeast. If you are not consuming about six micrograms per day, talk to your doctor about taking a vitamin B₁₂ supplement.

Iodine. Vegans who do not consume key vegan sources of iodine, such as iodized salt or sea vegetables, may be at risk for iodine deficiency. Sea salt, kosher salt, and salty seasoning such as tamari are generally not iodized.

Round out your meals with a variety of vegetables, fruits, and whole grains.

Ideas for balanced vegan meals

Breakfast:

• Quinoa porridge made with almond milk, almonds, and blueberries
• Veggie “omelet” made with shredded tofu, soy cheese, chopped vegetables; 1 slice of whole grain toast
• Refried pinto beans in a small whole-grain tortilla with tomatoes, onions, and fresh salsa

Lunch:

• Vegan pizza made with whole-wheat crust, tomato slices, soy cheese, mushrooms, broccoli, peppers, and onions
• Mediterranean barley salad: cooked barley with celery, red onion, red and orange bell pepper, cannellini beans, with olive oil and vinegar dressing on a bed of fresh baby spinach
• Lentil stew

Dinner:

• Vegetarian chili made with red, black, and kidney beans, canned tomatoes, celery, onions, carrots, and spices
• Stir-fried tofu with broccoli, cauliflower, asparagus, and yellow peppers topped with peanuts over brown rice
• Whole-wheat pasta with garbanzo beans and peas topped with a pesto sauce; kale salad with artichoke hearts, asparagus, and balsamic vinaigrette

Snacks:

• Nuts, hummus and carrots, bean dip with whole-grain chips, apple with peanut butter, sunflower or pumpkin seeds, baba ghanoush with whole wheat pita bread

As a parent, you can’t help but worry about the safety of your children. So it’s natural that as stories about the novel coronavirus that started in China flood the news, parents worry about whether their children could be at risk.

We are still learning about this new virus; there is much we do not know yet about how it spreads, how serious it can be, or how to treat it. The fact that so much is unknown is a big part of what makes it frightening. But there are things we do know — about this virus and other similar viruses — that can help us keep our children safe and well.

All of the advice below assumes that you and your family have not recently traveled to an area where there are known cases of coronavirus, or had some other possible exposure. If that is the case, you should call your doctor immediately for advice.

As of this writing, there are relatively few cases in the United States, and many measures are being taken to limit the spread of the virus. It’s important to stay informed and listen to the advice of public health officials in your area — and not panic if your child or someone else in your family or community gets a cough and fever. It’s far more likely to be a cold, or influenza (flu), than coronavirus.

In fact, influenza infects millions of people every year and kills thousands. Every year, doctors and public health officials talk about ways you can keep you and your loved ones from catching the flu. Those precautions can also help keep you safe from coronavirus, as it seems that the two illnesses spread in similar ways.

• Make sure everyone washes their hands! Using soap and water and washing for 20 seconds (about as long as it takes you to sing the alphabet song) does the trick. If you don’t have a sink handy, hand sanitizer will do — make sure you spread it well, getting it all over the hands including between the fingers. Wash before meals and snacks, after being in public places, and after being around anyone who is or might be sick.
• Encourage healthy habits, like eating a healthy diet, exercising, and getting enough sleep. This helps keep your child’s immune system strong.
• Make sure your child has received the flu vaccine. The flu is far more common — and can be very dangerous too.
• Teach children not to touch their mouths, eyes, or noses with their hands unless they have just washed them. This is easier said than done, I admit. Make a game out of it — have them itch with their knees instead. Carry tissues for wiping mouths and noses, and throw out used tissues promptly.
• Teach children to be careful about the surfaces they touch when you are out in public. Little hands seem to instinctively reach for everything around them, so you’ll need to be creative. Bring things for them to hold instead, or hold hands with them. Have them wear gloves (in cool climates in the winter you’d likely do that anyway — have extras so you can wash the worn ones when you get home). It’s not a bad idea to carry some wipes with you to wipe down seats, tables, and other such things in public areas before you use them.

Does avoiding sick people mean staying home?

In addition to the steps above:

• Stay away from sick people to the extent that this is possible. Unless there is a specific public health advisory in your area or an area you are traveling to, this does not mean holing up in your house, skipping school or daycare, and declining every birthday party invitation. Ultimately, it’s impossible to stay away from anyone who has any germs that might be spread; as is true of many viruses, it appears that people with coronavirus may be contagious before they have clear symptoms. Just be aware of symptoms of people around you, such as coughing or sneezing. Keep space between you and others in public spaces (again, to the extent possible).
• If you are hosting people at your house, you have the right (responsibility, actually) to ask people not to come if they are sick. Keep hand sanitizer by the door of your house and ask guests to use it when they arrive.
• If anyone in your family gets a fever and cough, they should stay home. Chances are it’s not coronavirus, but whatever it is, it’s likely contagious. Not only is staying home and resting the best way to get better, but also you don’t want to panic others by having your child cough in their child’s face.

Advice if your child has a fever and cough

If your child gets a fever and cough, this is what you should do:

• Call your doctor’s office for advice specific to your child and your community.
• If your doctor does not think your child needs to be checked, you can help them feel better by
  • being sure they stay hydrated. Make sure they are drinking regularly. Popsicles are a good way to get fluids in, and can soothe a sore throat.
  • using acetaminophen or ibuprofen for fever. Check with your doctor’s office about the right dose for your child.
  • using a humidifier to help with congestion.
  • limiting the use of over-the-counter cold medicines in children under the age of 6. They don’t help much (even with kids over 6), and can have side effects. In children over a year, honey can soothe a cough. Use salt water drops for stuffy noses.
  • making sure they rest. Being glued to a TV or device all day is not a good idea.

Watch for warning signs of problems, and seek medical attention if they occur:

• any trouble breathing (rapid or heavy breathing, sucking in around the neck or ribs, looking pale or bluish)
• severe cough that won’t stop
• high fever that won’t come down with acetaminophen or ibuprofen
• unusual sleepiness
• irritability or pain that you cannot soothe
• refusal to take fluids, or any signs of dehydration (dry mouth, no tears when crying, not urinating at least every six hours).

You should also check in with your doctor if your child has an unusual rash, is having a lot of vomiting or diarrhea — or if there is something else that concerns you. I have learned over the years that parents have a very good “spidey-sense” when something is wrong.

Again: try not to panic. There’s a lot of misinformation floating around. Check reliable sources for updates, follow these tips, and call your doctor if you have any questions.

Follow me on Twitter @drClaire

Most anyone who has struggled with secondary infertility knows that it is an incredibly lonely experience. You may be blessed with one or two children — possibly more — but struggling to expand or complete your family. Surrounded by families with young children, you find yourself alone and in pain.

If you are a veteran of primary infertility, you may remember strategies you developed for shielding yourself from the pregnancies of others. Not so this second time around: pregnant women and moms with babies and toddlers surround you at preschool.

If you had your first child with ease and are new to infertility, you may feel even less equipped to deal with seemingly limitless fecundity. Primary infertility prepared your fellow travelers for the envy, anger, sadness, isolation, and awkwardness it brings. For you these feelings are new, and along with them comes the guilt of secondary infertility: “Why can’t I be happy with the child I have?” Today we’ll focus on ways you can cope with secondary infertility.

The first few steps to coping with secondary infertility

Seek good medical care. If you went through primary infertility, you know the ropes of the world of reproductive medicine. However, if this is all new to you, do not delay in seeking expert help. There is a lot to learn in reproductive medicine. Beginning to understand it may help you feel that you have some control of your situation. Don’t be reluctant to seek a second and even a third opinion — you will learn from each consult, and talking with a few physicians can help land you in the right place.

Try to avoid self-blame. It is tempting to blame yourself. You are a likely target if you feel you waited too long to have a second child, or perhaps blame yourself for not having your first child sooner. If you have two or more children and are struggling to complete your family, you may accuse yourself of greed. Another form of self-blame comes when parents feel they are being punished for not fully appreciating or enjoying the child they have, or worse still, being “bad” parents.

Take charge of the message. Although many people choose to have one child and feel confident with “one and done,” there is often the assumption that a family means two or more children. As a parent of one child, you are likely to frequently encounter the following questions: “Is she your only child?” or “Are you going to have more?”

It helps to figure out a short, direct, and containable message to give anyone who asks about family size. Something like, “We’re hoping to have a larger family, but it’s not been easy for us.” Or “___ is our first child, but we are hoping he/she will have a sibling before too long.”

Additional ways to cope with secondary infertility

Try not to focus on age. Many parents think a lot about the spacing of their children. Secondary infertility derails plans for ideal spacing — whatever that may mean to you. My advice to people is blunt: let it go. I remind clients that close or distant relationships with siblings are not defined by spacing. All of us know adults who cherish their sister or brother 10 or 15 years their junior, but argue constantly with the sibling who is within two years of their age.

Parents in their 40s worry also about their advancing age. Many will say, “I need to have a second child by the time I am X or it will be too late.” Here I remind people that they already have a child. Their future child will have an older sibling (or more than one) to share the challenges that may come from having older parents. One can’t turn back the clock.  If you are worried about age, all you can do is avoid unnecessary delays.

Explore other paths to parenthood. More people are becoming parents in their late 30s or early 40s. Many will face age-related infertility for a second child. Egg donation, and sometimes embryo donation or adoption, are options for expanding their families. It never hurts to look ahead to familiarize yourself with other paths to parenthood. Learning about them doesn’t mean you will end up pursuing them, but it enables you to be proactive and to feel some control over your situation.

Enjoy your child. At the risk of sounding preachy, I think it is important for you to take time to enjoy your child. Chances are that he or she will have a sibling at some point. And when that child arrives you will be busy with an infant. While another child (or more) may be your ultimate goal, certain pleasures come from having one child. Seize the sweetness of being with your little person without the distractions that are inevitable with a larger family.

Secondary infertility doesn’t just impact parents with young children; it also challenges people in second or third marriages or relationships, who had children earlier and now want to have a child with a new partner. And it affects those who had one or two children several years ago and decide, as adolescence — or even a departure for college — looms on the horizon, that they want to expand their family. As you make your way, best you can, to a larger family, remember that you have many fellow travelers. It may just be hard to recognize them.

Cutaneous melanoma, also called malignant melanoma, is the type of skin cancer that is most likely to spread to other parts of the body. Though melanoma accounts for only about 1% of skin cancers, it is responsible for more than 90% of skin cancer-related deaths.

But thanks to developments in skin cancer treatment (mostly in the last decade), patients with melanoma have much better chances of living longer.

What is a melanoma?

Melanoma involves the uncontrolled growth of a type of cell known as a melanocyte. One of the most important functions of a normal melanocyte is to protect your skin from the sun’s damaging ultraviolet (UV) rays. It does this by producing melanin pigment. (Though we usually refer to melanoma of the skin, melanomas can also develop from melanocytes in other parts of the body, such as the retina or gastrointestinal tract.)

There are many factors that may result in the development of melanomas. These include environmental factors such as sun damage or use of tanning beds; immune suppression; genetic causes, such as inheritance of a gene that makes you more susceptible to melanomas; and spontaneous gene mutations.

Treatment options: The old and the new

Until several years ago, treatment options for people with advanced metastatic disease (melanoma that has spread to other parts of the body) were quite limited. Surgical removal of the cancer, chemotherapy, and less targeted immunotherapy and interferon therapy (to reduce tumor proliferation) were possible treatment options. But only about one in 10 patients with advanced metastatic disease survived for five years, and median survival was less than one year.

Thanks to significant developments in genetic research, including findings from the Human Genome Project, patients with widespread disease now have a much better chance of survival. For example, research showing that some melanomas have mutations that abnormally activate certain signaling pathways, which contribute to uncontrolled tumor growth, has led to advances in targeted immunotherapy.

Newer therapies targeting these pathways, and immune checkpoint inhibitors that block specific targets in tumor production pathways, are now available to treat advanced melanoma. These include kinase inhibitors such as dabrafenib (Tafinlar) and vemurafenib (Zelboraf), and immune checkpoint inhibitors such as nivolumab (Opdivo), pembrolizumab (Keytruda), and ipilimumab (Yervoy).

A study examining one of these newer therapies showed that at three years after treatment, the survival rate for people who were treated with the checkpoint inhibitor ipilimumab along with the older chemotherapy drug dacarbazine was 21%, compared to 12% for those who were treated with only dacarbazine.

Another potential therapy receiving more attention now includes cancer vaccines. In addition, some companies have introduced enhanced testing of biopsy samples, which may allow for more accurate assessment of a person’s risk of the cancer spreading and recurring, which in turn can influence treatment decisions. Many more possibilities are also on the horizon.

Prevention still worth more than the cure

Although there are now more effective therapies available to treat melanoma, advanced melanoma still carries a poor prognosis. And even the newer therapies come with significant side effects, including the risk of developing other types of skin cancers such as squamous cell carcinoma and basal cell carcinoma. Therefore, it is paramount to protect ourselves from getting melanoma in the first place.

Simple healthy behaviors can help. These include routinely wearing (and re-applying) sunscreen, avoiding the sun during hours of peak sunlight (around 10 am to 2 pm), and making sure your doctor conducts routine skin checks.

It’s also important to know your own skin. Examine your own skin every month or so, and have a partner examine the areas of skin you can’t see. Look out for the “ugly duckling” (a mole that looks different from the others). The so-called ABCDEs of melanoma have their limitations (they don’t catch all melanomas), but can also help when conducting skin checks on yourself or a loved one. That means being on the lookout for

A: Asymmetry (one side looks different from another)
B: irregular Borders
C: Color differences
D: Diameter (often greater than 6 millimeters)
E: Evolution (a mole that appears to be changing over time).

If you notice anything unusual, seek advice from your doctor. In general, the earlier you catch a skin cancer, the better your prognosis.

News about a deadly virus that appeared in Wuhan, China in December (now called 2019 novel coronavirus, or 2019-nCoV) is everywhere lately. And as the number of cases rises, it’s understandable if you’re wondering how likely it is that you or a loved one will become ill. And quite likely, you’re also wondering how to prevent this.

So, where should you turn for the latest information on a rapidly changing situation? It’s hard to beat the convenience of the internet, and we know there’s a lot of useful and reliable information online. But there’s also a lot of misinformation. The trick is to figure out which is which.

Why you need to know about this new virus

The concern regarding this new virus is well-deserved. As of January 31, there have been

• Nearly 10,000 confirmed cases and 213 confirmed deaths attributed to 2019-nCoV, according to the World Health Organization (WHO). 99% of the cases and all of the deaths have been in China.
• 26 countries reporting cases, according to the Centers for Disease Control and Prevention (CDC). Nearly all of those with confirmed cases either live in China or had traveled from China to other countries.
• six cases in the US in four states (Arizona, California, Illinois, and Washington). Another 160 people in 36 states are being evaluated for suspected infection.

All of these numbers are likely to rise in the coming days and weeks, because each infected person could potentially spread the infection to many others. And it’s possible that a person can spread the infection before he or she knows they’re sick; this has not been proven for this particular virus, but if true, quickly containing its spread may be impossible. That’s why it’s particularly important to get reliable information about what is happening and what you can do to protect yourself.

Beware: Misinformation is rampant

Just as the number of people and countries affected by this new virus have spread, so have conspiracy theories and unfounded claims about it. Already social media sites, including Facebook, Twitter, YouTube, and TikTok, have seen a number of false and misleading posts about 2019-nCoV, such as:

• “Oregano Oil Proves Effective Against Coronavirus,” an unfounded claim
• a hoax stating that the US government had created and patented a vaccine for coronavirus years ago, shared with nearly 5,000 Facebook users
• a false claim that “coronavirus is a human-made virus in the laboratory”
• sales of unproven “nonmedical immune boosters” to help people ward off 2019-nCoV
• unfounded recommendations to prevent infection by taking vitamin C and avoiding spicy foods
• a video with useless advice about preventing 2019-nCoV by modifying your diet (for example, by avoiding cold drinks, milkshakes, or ice cream). This video, which demonstrates the removal of a parasitic worm from a person’s lip, is many years old and has nothing to do with 2019-nCoV.

Facebook is trying to fact-check postings, label those that are clearly false, and reduce their ranking so they are less prominently displayed. Twitter,YouTube and TikTok have also taken steps to limit or label misinformation. But it’s nearly impossible to catch them all, especially since some are in private social media groups and are harder to find.

In the US, the flu is a much bigger threat

While news of a novel and deadly virus spreading across the globe may be terrifying, it’s important to recognize that the most threatening virus in this country right now isn’t 2019-nCoV — it’s the flu. According to the CDC, there have already been up to 26 million cases of the flu this season, leading to hundreds of thousands of hospital admissions and up to 25,000 deaths. And this flu season has not been particularly severe.

Getting a flu shot is a great first step if you’re worrying about avoiding illness. Other measures to protect yourself from the flu (such as staying away from others who are sick and taking care to not infect others if you’re sick) are basic strategies that can also help you avoid 2019-nCoV.

Reliable online sources on 2019-nCoV

While no one source of information is perfect, some are undeniably better than others! It’s best to look for sites that

• rely on experts who use well-accepted scientific analyses and publish their results in reputable medical journals
• have a mission to inform and protect the public, such as the CDC and the WHO, which recently added a myth busters page to its information on 2019-nCoV
• are not promoting or selling a product related to the information provided.

Other good online sources of information on the virus include

• Medline Plus, from the US National Library of Medicine
• the UK’s National Health Service
• the US Food and Drug Administration
• major news outlets with deep expertise in health reporting, such as The New York Times, The Washington Post, and The Boston Globe’s STAT News.

While gathering information online may be your easiest initial option, contact your doctor if you have symptoms of an infection, such as fever, cough, or shortness of breath. If necessary, your doctor may recommend that you see a specialist at an academic medical center (such as a hospital affiliated with a major medical school) who is likely to have the most recent information about a previously unknown infectious illness like this one.

The bottom line

When considering a new infectious disease about which so much is still unknown, it’s important to seek out reliable information and act on it. Be skeptical of implausible conspiracy theories or claims of “fake news” that dismiss recommendations from public health officials. Addressing the concerns surrounding 2019-nCoV requires accessible, reliable, and frequently updated information; the best we can do is to look to the experts whose mission it is to protect public health.

Chances are that you or someone you know has experienced unpleasant symptoms after a meal or snack. Maybe you experienced some degree of sneezing, wheezing, rashes, brain fog, joint pain, nausea, bloating, diarrhea, or another symptom. This may have led you to believe you have a food allergy — and maybe you do. But it’s also possible that you have a food intolerance, celiac disease, or a food sensitivity. This is important, because some of the reactions can range from just annoying to life-threatening.

Food intolerances

Food intolerance refers mostly to the inability to process or digest certain foods. The most common food reaction appears to be lactose intolerance. As we get older, our ability to digest dairy decreases. That’s because, with age, our intestines make less of the enzyme (lactase) that processes lactose, a type of sugar present in milk and dairy products. As a result, we have more lactose sitting in the digestive tract, which can cause stomach bloating, inflammation, and diarrhea. Research has found that only about 35% of people worldwide can digest lactose beyond the age of about seven or eight.

Lactose intolerance is not a serious disease, but it can be quite uncomfortable. Avoiding dairy products is a surefire way to avoid symptoms; some, like milk, tend to produce more severe symptoms than others, like yogurt and cheese. Over-the-counter lactase enzyme supplements can also help.

Food allergies

A more severe problem happens when someone develops a true allergic reaction, an overblown response by the body’s immune system against a seemingly harmless substance — in this case, a food. The classic example is the potentially life-threatening difficulty breathing and low blood pressure following exposure to peanuts or seafood. Food allergies can show up at any time in our lives, even during older adulthood.

If you think you may have a food allergy, consider allergy testing and treatment, especially if your symptoms are severe (significant rashes, feeling of passing out, facial swelling, and problems breathing). Scrupulously reading ingredient labels is wise. And carrying epinephrine shots in case of accidental ingestion or contact with the food in question is essential and can be lifesaving.

Celiac disease

Celiac disease affects about 1% of the Western population. In this autoimmune condition, the ingestion of gluten initiates a complex inflammatory reaction that can make people with celiac disease very sick. Celiac disease is not a true allergy; eating gluten once does not cause an immediate life-threatening problem. However, prolonged and continuous ingestion can cause diarrhea, weight loss, and malnutrition.

Avoiding gluten is the only solution to this problem. Gluten is found in a variety of grains, including wheat, rye, barley, semolina, bulgur, and farina. Many processed foods also contain gluten. People with celiac disease must also be careful about cross-contamination, when a gluten-free food comes into contact with a gluten-containing food.

Food sensitivities

After eating certain foods, a large part of the population experiences symptoms that are not related to food intolerances, food allergies, or celiac disease. These are referred to as food sensitivities. Though there is controversy around what exactly happens in the body of someone with a food sensitivity, it appears that exposure to specific foods may create an immune reaction that generates a multitude of symptoms. The symptoms are not life-threatening, but they can be quite disruptive and include joint pain, stomach pain, fatigue, rashes, and brain fog. Gluten is probably the best-known trigger of food sensitivities.

The best tool we have to identify food sensitivities is a process of careful observation and experimentation. Removing certain foods believed to cause reactions from the diet for two to four weeks, reintroducing them one by one, and watching for symptoms is the current gold standard to pin down what may be causing symptoms. This so-called “elimination diet” is not high-tech, and it is far from perfect. A physician or nutritionist can provide guidance for undertaking an elimination diet, and can help you understand limitations and avoid possible pitfalls. Removing certain foods can help stave off undesirable symptoms and improve your quality of life.

Food reactions, especially sensitivities, can also fade away with time. Our bodies, immune systems, and the gut microbiome are continually changing, and what may not sit well today may be fine to have later on in life. At some point, you may consider reintroducing small amounts of a food that you have been sensitive to, to see what you may be able to tolerate.

The bottom line

Though food reactions are common, they can be challenging to understand. Identifying the cause can be difficult and time-consuming, but it is worth the time and effort. Once you’ve identified the problem, and the food or foods that trigger it, a nutritionist or a physician can help you develop the most comprehensive diet that is safe for you.

Two lines on a home pregnancy test, a flickering heartbeat on ultrasound, and suddenly your world has changed: you’re pregnant! Regardless of where this new path takes you, you may start to examine your daily decisions in a new way as you discover an intense drive to protect the growing baby inside you. Even your exercise routines may come under scrutiny, particularly if late-night Googling has you second-guessing everything that you believed you knew.

Just how safe is exercise during pregnancy?

The short answer? Exercise during pregnancy is not only safe, it’s encouraged. An overriding principle for pregnancy is: what is good for mom is good for baby. The American College of Obstetricians and Gynecologists (ACOG) and the US Office of Disease Prevention and Health Promotion note that exercising during pregnancy may reduce

• weight gain
• risk for gestational diabetes, particularly in overweight or obese women
• risk for cesarean delivery.

Plus, it helps pregnant women prevent or manage inevitable aches and pains. Regular physical activity during pregnancy may help psychological well-being and possibly even reduce depression and anxiety during the postpartum period. Additionally, women who exercise during pregnancy may recover more quickly after the birth.

How active should you be?

Best-laid plans aside, the ACOG recommends engaging in moderate activity for 20 to 30 minutes on three to seven days per week throughout your pregnancy. It is safest to avoid exercising for longer than 45 minutes in one session to prevent hypoglycemia (low blood sugar).

The best time to boost your activity level is before you conceive. Generally, you can safely continue to exercise at the level of strenuous activity you practiced before your pregnancy. So, if you enjoyed moderate activity, stick with that rather than ramping up during your pregnancy. If you enjoyed vigorous activity, you may be able to continue this, though it’s safest to check with your obstetric team to be sure.

Of course, many women become pregnant without an established exercise routine in place. If this is true for you, start slowly and ramp up gradually. For example, try walking a few more times per week, then add to the amount of time you walk. Finally, you might step up intensity by walking more quickly.

What types of exercise can you do?

The best exercises to engage in are activities you actually enjoy doing. Pregnant women can generally do brisk walking, swimming, stationary cycling, low-impact aerobics, yoga or Pilates, and running. Most of these activities can be modified for your growing belly.

There are some activities you should avoid, including:

• contact sports that could cause injury, such as basketball, hockey, or soccer
• sports that are risky or likely to cause falls, such as skiing, surfing, or gymnastics
• scuba diving
• hot yoga or hot Pilates, because increases in body temperature might harm a fetus.

What if you have a high-risk pregnancy?

What if your pregnancy is not straightforward? High-risk pregnancies come in a variety of forms. Often, they occur when women have complex medical conditions (such as epilepsy or lupus), develop a condition that could affect the pregnancy (such as a short cervix or placenta previa), or if the fetus has a complex condition (such as a heart defect).

Usually, doctors recommend mild activity like walking or stretching, because it isn’t linked to poor outcomes, such as inadequate growth or preterm delivery. Even if you have a high-risk condition where vigorous activity is discouraged, you and your doctor can come up with an individualized plan for light, safe activities.

Although bed rest was advised in the past for certain high-risk conditions, it hasn’t been shown to improve outcomes. And unfortunately, bed rest can put you at a higher risk for blood clots, loss of bone density, and deconditioned muscles, which could further complicate your pregnancy. The mood-boosting benefits of exercise may be even more critical in high-risk pregnancies.

The bottom line

Whether you are new to exercise or a lifelong athlete, physical activity is generally safe and well tolerated in pregnancy. With rare exceptions, mild to moderate exercise offers physical and psychological benefits. If you have a high-risk pregnancy, your obstetrician can help you choose activities that will be safe for you and your baby. Pregnancy is the first step along the journey of parenthood. Let regular physical activity now become part of a lifetime of dedication to good health for your family.