
Bone on Bone – by Dr. Meredith Warner
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What this is not: a book about one specific condition, injury, or surgery.
What this is: a guide to dealing with the common factors of many musculoskeletal conditions, inflammatory diseases, and their consequences.
Dr. Warner takes the opportunity to address the whole patient—presumably: the reader, though it could equally be a reader’s loved one, or even a reader’s patient, insofar as this book will probably be read by doctors also.
She takes an “inside-out and outside-in” approach; that is to say, addressing the problem from as many vectors as reasonably possible—including supplements, diet, dietary habits (things like intermittent fasting etc), exercise, and even sleep. And yes, she knows how difficult those latter items can be, and addresses them not merely with a “but it’s important” but also with practical advice.
As an orthopedic surgeon, she’s not a fan of surgery, and counsels the reader to avoid that if reasonably possible. She also talks about how many people in the US are encouraged to have MRI scans for financial reasons (as in, they can be profitable for the doctor/institution), and then any abnormality is used as justification for surgery, to backwards-justify the use of the MRI, even if the abnormality is not actually the cause of the pain.
Noteworthily, humans in general are a typically a pile of abnormalities in a trenchcoat. Our propensity to mutation has made us one of the most adaptable species on the planet, yet many would have us pretend that the insides of people look like they do in textbooks, or else are wrong. The reality is not so, and Dr. Warner rightly shows this for what it is.
Bottom line: if you or a loved one are suffering from, or at risk of, musculoskeletal and/or inflammatory conditions, this is a top-tier book for having a much easier time of it.
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5 dental TikTok trends you probably shouldn’t try at home
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TikTok is full of videos that demonstrate DIY hacks, from up-cycling tricks to cooking tips. Meanwhile, a growing number of TikTok videos offer tips to help you save money and time at the dentist. But do they deliver?
Here are five popular dental TikTok trends and why you might treat them with caution.
1. Home-made whitening solutions
Many TikTok videos provide tips to whiten teeth. These include tutorials on making your own whitening toothpaste using ingredients such as hydrogen peroxide, a common household bleaching agent, and baking soda (sodium bicarbonate).
In this video, the influencer says:
And then you’re going to pour in your hydrogen peroxide. There’s really no measurement to this.
But hydrogen peroxide in high doses is poisonous if swallowed, and can burn your gums, mouth and throat, and corrode your teeth.
High doses of hydrogen peroxide may infiltrate holes or microscopic cracks in your teeth to inflame or damage the nerves and blood vessels in the teeth, which can cause pain and even nerve death. This is why dental practitioners are bound by rules when we offer whitening treatments.
Sodium bicarbonate and hydrogen peroxide are among the components in commercially available whitening toothpastes. While these commercial products may be effective at removing surface stains, their compositions are carefully curated to keep your smile safe.
2. Oil pulling
Oil pulling involves swishing one tablespoon of sesame or coconut oil in your mouth for up to 20 minutes at a time. It has roots in Ayurvedic medicine, a traditional medicine practice that originates from the Indian subcontinent.
While oil pulling should be followed by brushing and flossing, I’ve had patients who believe oil pulling is a replacement for these practices.
There has been some research on the potential of oil pulling to treat gum disease or other diseases in the mouth. But overall, evidence that supports the effectiveness of oil pulling is of low certainty.
For example, studies that test the effectiveness of oil pulling have been conducted on school-aged children and people with no dental problems, and often measure dental plaque growth over a few days to a couple of weeks.
Chlorhexidine is an ingredient found in some commercially available mouthwashes.
In one study, people who rinsed with chlorhexidine mouthwash (30 seconds twice daily) developed less plaque on their teeth compared to those who undertook oil pulling for eight to 10 minutes.Ultimately, it’s unlikely you will experience measurable gain to your oral health by adding oil pulling to your daily routine. If you’re time-poor, you’re better off focusing on brushing your teeth and gums well alongside flossing.
3. Using rubber bands to fix gaps
This TikTok influencer shows his followers he closed the gaps between his front teeth in a week using cheap clear rubber bands.
But this person may be one of the lucky few to successfully use bands to close a gap in his teeth without any mishaps. Front teeth are slippery and taper near the gums into cone-shaped roots. This can cause bands to slide and disappear into the gums to surround the tooth roots, which can cause infections and pain.
If this happens, you may require surgery that involves cutting your gums to remove the bands. If the bands have caused an infection, you may lose the affected teeth. So it’s best to leave this sort of work to a dental professional trained in orthodontics.
4. Filing or cutting teeth to shape them
My teeth hurt just watching this video.
Cutting or filing teeth unnecessarily can expose the second, more sensitive tooth layer, called dentine, or potentially, the nerve and blood vessels inside the tooth. People undergoing this sort of procedure could experience anything from sensitive teeth through to a severe toothache that requires root canal treatment or tooth removal.
You may notice dentist drills spray water when cutting to protect your teeth from extreme heat damage. The drill in this video is dry with no water used to cool the heat produced during cutting.
It may also not be sterile. We like to have everything clean and sterile to prevent contaminated instruments used on one patient from potentially spreading an infection to another person.
Importantly, once you cut or file your teeth away, it’s gone forever. Unlike bone, hair or nails, our teeth don’t have the capacity to regrow.
5. DIY fillings
Many people on TikTok demonstrate filling cavities (holes) or replacing gaps between teeth with a material made from heated moulded plastic beads. DIY fillings can cause a lot of issues – I’ve seen this in my clinic first hand.
While we may make it look simple in dental surgeries, the science behind filling materials and how we make them stick to teeth to fill cavities is sophisticated.
Filling a cavity with the kind of material made from these beads will be as effective as using sticky tape on sand. Not to mention the cavity will continue to grow bigger underneath the untreated “filled” teeth.
I know it’s easy to say “see a dentist about that cavity” or “go to an orthodontist to fix that gap in your teeth you don’t like”, but it can be expensive to actually do these things. However if you end up requiring treatment to fix the issues caused at home, it may end up costing you much more.
So what’s the take-home message? Stick with the funny cat and dog videos on TikTok – they’re safer for your smile.
Arosha Weerakoon, Senior Lecturer and General Dentist, School of Dentistry, The University of Queensland
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Building Psychological Resilience (Without Undue Hardship)
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What’s The Worst That Could Happen?
When we talk about the five lifestyle factors that make the biggest difference to health, stress management would be a worthy addition as number six. We haven’t focused explicitly on that for a while, so let’s get ready to start the New Year on a good footing…
You’re not going to have a stress-free 2024
What a tender world that would be! Hopefully your stressors will be small and manageable, but rest assured, things will stress you.
And that’s key: “rest assured”. Know it now, prepare for it, and build resilience.
Sounds grim, doesn’t it? It doesn’t have to be, though.
When the forecast weather is cold and wet, you’re not afraid of it when you have a warm dry house. When the heating bill comes for that warm dry house, you’re not afraid of it when you have money to pay it. If you didn’t have the money and the warm dry house, the cold wet weather could be devastating to you.
The lesson here is: we can generally handle what we’re prepared for.
Negative visualization and the PNS
This is the opposite of what a lot of “think and grow rich”-style gurus would advise. And indeed, it’s not helpful to slide into anxious worrying.
If you do find yourself spiralling, here’s a tool for getting out of that spiral:
RAIN: an intervention for dealing with difficult emotions
For now, however, we’re going to practice Radical Acceptance.
First, some biology: you may be aware that your Central Nervous System (CNS) branches into the Sympathetic Nervous System (SNS) and the Parasympathetic Nervous System (PNS).
The PNS is the part that cues our body to relax, and suppresses our fight/flight response. We’re going to activate it.
Activating the PNS is easy for most people in comfortable circumstances (e.g., you are not currently exposed to stressful stimuli). It may well be activated already, and if it’s not, a few deep breaths is usually all it takes.
If you’d like a quick and easy Mindfulness-Based Stress Reduction (MBSR) technique, here you go:
No-Frills, Evidence-Based Mindfulness
Activating the PNS is hard for most people in difficult circumstances (e.g., you either are currently exposed to stressful stimuli, or you are in one of the emotional spirals we discussed earlier).
However, we can trick our bodies and brains by—when we are safe and unstressed—practicing imagining those stressful stimuli. Taking a moment to not just imagine it experientially, but immersively. This, in CBT and DBT, is the modern equivalent to the old samurai who simply accepted, before battle, that they were already dead—and thus went into battle with zero fear of death.
A less drastic example is the zen master who had a favorite teacup, and feared it would get broken. So he would tell himself “the cup is already broken”. One day, it actually broke, and he simply smiled ruefully and said “Of course”.
How this ties together: practice the mindfulness-based stress reduction we linked above, while imagining the things that do/would stress you the most.
Since it’s just imagination, this is a little easier than when the thing is actually happening. Practicing this way means that when and if the thing actually happens (an unfortunate diagnosis, a financial reversal, whatever it may be), our CNS is already well-trained to respond to stress with a dose of PNS-induced calm.
You can also leverage hormesis, a beneficial aspect of (in this case, optional and chosen by you) acute stress:
Dr. Elissa Epel | The Stress Prescription
Psychological resilience training
This (learned!) ability to respond to stress in an adaptive fashion (without maladaptive coping strategies such as unhelpful behavioral reactivity and/or substance use) is a key part of what in psychology is called resilience:
And yes, the CBT/DBT/MBSR methods we’ve been giving you are the evidence-based gold standard.
Only the best for 10almonds subscribers! 😎
❝That was helpful, but not cheery; can we finish the year on a cheerier note?❞
We can indeed:
How To Get Your Brain On A More Positive Track (Without Toxic Positivity)
Take care!
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Natural Alternatives for Depression Treatment
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Questions and Answers at 10almonds
Have a question or a request? You can always hit “reply” to any of our emails, or use the feedback widget at the bottom!
This newsletter has been growing a lot lately, and so have the questions/requests, and we love that! In cases where we’ve already covered something, we might link to what we wrote before, but will always be happy to revisit any of our topics again in the future too—there’s always more to say!
As ever: if the question/request can be answered briefly, we’ll do it here in our Q&A Thursday edition. If not, we’ll make a main feature of it shortly afterwards!
So, no question/request too big or small
Natural alternatives to medication for depression?
Great question! We did a mean feature a while back, but we definitely have much more to say! We’ll do another main feature soon, but in the meantime, here’s what we previously wrote:
See: The Mental Health First-Aid That You’ll Hopefully Never Need
^This covers not just the obvious, but also why the most common advice is not helpful, and practical tips to actually make manageable steps back to wellness, on days when “literally just survive the day” is one’s default goal.
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Forget Ringing the Button for the Nurse. Patients Now Stay Connected by Wearing One.
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HOUSTON — Patients admitted to Houston Methodist Hospital get a monitoring device about the size of a half-dollar affixed to their chest — and an unwitting role in the expanding use of artificial intelligence in health care.
The slender, battery-powered gadget, called a BioButton, records vital signs including heart and breathing rates, then wirelessly sends the readings to nurses sitting in a 24-hour control room elsewhere in the hospital or in their homes. The device’s software uses AI to analyze the voluminous data and detect signs a patient’s condition is deteriorating.
Hospital officials say the BioButton has improved care and reduced the workload of bedside nurses since its rollout last year.
“Because we catch things earlier, patients are doing better, as we don’t have to wait for the bedside team to notice if something is going wrong,” said Sarah Pletcher, system vice president at Houston Methodist.
But some nurses fear the technology could wind up replacing them rather than supporting them — and harming patients. Houston Methodist, one of dozens of U.S. hospitals to employ the device, is the first to use the BioButton to monitor all patients except those in intensive care, Pletcher said.
“The hype around a lot of these devices is they provide care at scale for less labor costs,” said Michelle Mahon, a registered nurse and an assistant director of National Nurses United, the profession’s largest U.S. union. “This is a trend that we find disturbing,” she said.
The rollout of BioButton is among the latest examples of hospitals deploying technology to improve efficiency and address a decades-old nursing shortage. But that transition has raised its own concerns, including about the device’s use of AI; polls show the public is wary of health providers relying on it for patient care.
In December 2022 the FDA cleared the BioButton for use in adult patients who are not in critical care. It is one of many AI tools now used by hospitals for tasks like reading diagnostic imaging results.
In 2023, President Joe Biden directed the Department of Health and Human Services to develop a plan to regulate AI in hospitals, including by collecting reports of patients harmed by its use.
The leader of BioIntelliSense, which developed the BioButton, said its device is a huge advance compared with nurses walking into a room every few hours to measure vital signs. “With AI, you now move from ‘I wonder why this patient crashed’ to ‘I can see this crash coming before it happens and intervene appropriately,’” said James Mault, CEO of the Golden, Colorado-based company.
The BioButton stays on the skin with an adhesive, is waterproof, and has up to a 30-day battery life. The company says the device — which allows providers to quickly notice deteriorating health by recording more than 1,000 measurements a day per patient — has been used on more than 80,000 hospital patients nationwide in the past year.
Hospitals pay BioIntelliSense an annual subscription fee for the devices and software.
Houston Methodist officials would not reveal how much the hospital pays for the technology, though Pletcher said it equates to less than a cup of coffee a day per patient.
For a hospital system that treats thousands of patients at a time — Houston Methodist has 2,653 non-ICU beds at its eight Houston-area hospitals — such an investment could still translate to millions of dollars a year.
Hospital officials say they have not made any changes in nurse staffing and have no plans to because of implementing the BioButton.
Inside the hospital’s control center for virtual monitoring on a recent morning, about 15 nurses and technicians dressed in scrubs sat in front of large monitors showing the health status of hundreds of patients they were assigned to monitor.
A red checkmark next to a patient’s name signaled the AI software had found readings trending outside normal. Staff members could click into a patient’s medical record, showing patients’ vital signs over time and other medical history. These virtual nurses, if you will, could contact nurses on the floor by phone or email, or even dial directly into the patient’s room via video call.
Nutanben Gandhi, a technician who was watching 446 patients on her monitor that morning, said that when she gets an alert, she looks at the patient’s health record to see if the anomaly can be easily explained by something in the patient’s condition or if she needs to contact nurses on the patient’s floor.
Oftentimes an alert can be easily dismissed. But identifying signs of deteriorating health can be tough, said Steve Klahn, Houston Methodist’s clinical director of virtual medicine.
“We are looking for a needle in a haystack,” he said.
Donald Eustes, 65, was admitted to Houston Methodist in March for prostate cancer treatment and has since been treated for a stroke. He is happy to wear the BioButton.
“You never know what can happen here, and having an extra set of eyes looking at you is a good thing,” he said from his hospital bed. After being told the device uses AI, the Montgomery, Texas, man said he has no problem with its helping his clinical team. “This sounds like a good use of artificial intelligence.”
Patients and nurses alike benefit from remote monitoring like the BioButton, said Pletcher of Houston Methodist.
The hospital has placed small cameras and microphones inside all patient rooms enabling nurses outside to communicate with patients and perform tasks such as helping with patient admissions and discharge instructions. Patients can include family members on the remote calls with nurses or a doctor, she said.
Virtual technology frees up on-duty nurses to provide more hands-on help, such as starting an intravenous line, Pletcher said. With the BioButton, nurses can wait to take routine vital signs every eight hours instead of every four, she said.
Pletcher said the device reduces nurses’ stress in monitoring patients and allows some to work more flexible hours because virtual care can be done from home rather than coming to the hospital. Ultimately it helps retain nurses, not drive them away, she said.
Sheeba Roy, a nurse manager at Houston Methodist, said some members of the nursing staff were nervous about relying on the device and not checking patients’ vital signs as often themselves. But testing has shown the device provides accurate information.
“After we implemented it, the staff loves it,” Roy said.
Serena Bumpus, chief executive officer of the Texas Nurses Association, said her concern with any technology is that it can be more burdensome on nurses and take away time with patients.
“We have to be hypervigilant in ensuring that we are not leaning on this to replace the ability of nurses to critically think and assess patients and validate what this device is telling us is true,” Bumpus said.
Houston Methodist this year plans to send the BioButton home with patients so the hospital can better track their progress in the weeks after discharge, measuring the quality of their sleep and checking their gait.
“We are not going to need less nurses in health care, but we have limited resources and we have to use those as thoughtfully as we can,” Pletcher said. “Looking at projected demand and seeing the supply we have coming, we will not have enough to meet demand, so anything we can do to give time back to nurses is a good thing.”
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.
Subscribe to KFF Health News’ free Morning Briefing.
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Potatoes & Anxiety
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It’s Q&A Day at 10almonds!
Have a question or a request? You can always hit “reply” to any of our emails, or use the feedback widget at the bottom!
In cases where we’ve already covered something, we might link to what we wrote before, but will always be happy to revisit any of our topics again in the future too—there’s always more to say!
As ever: if the question/request can be answered briefly, we’ll do it here in our Q&A Thursday edition. If not, we’ll make a main feature of it shortly afterwards!
So, no question/request too big or small
❝My other half considers potatoes a wonder food, except when fried. I don’t. I find, when I am eating potatoes I put on weight; and, when I’m not eating them, I lose it. Also, although I can’t swear to it, potatoes also make me feel a little anxious (someone once told me it could have something to do with where they are on the “glycemic index”). What does the science say?❞
The glycemic index of potatoes depends on the kind of potato (obviously) and also, less obviously, how it’s prepared. For a given white potato, boiling (which removes a lot of starch) might produce a GI of around 60, while instant mash (basically: potato starch) can be more like 80. For reference, pure glucose is 100. And you probably wouldn’t take that in the same quantity you’d take potato, and expect to feel good!
So: as for anxiety, it could be, since spiked blood sugars can cause mood swings, including anxiety.
Outside of the matter of blood sugars, the only reference we could find for potatoes causing anxiety was fried potatoes specifically:
❝frequent fried food consumption, especially fried potato consumption, is strongly associated with 12% and 7% higher risk of anxiety and depression, respectively❞
…which heavily puts the blame not on the potatoes themselves, but on acrylamide (the orange/brown stuff that is made by the Maillard reaction of cooking starches in the absence of water, e.g. by frying, roasting, etc).
Here’s a very good overview of that, by the way:
A Review on Acrylamide in Food: Occurrence, Toxicity, and Mitigation Strategies
Back on the core topic of potatoes and GI and blood sugar spikes and anxiety, you might benefit from a few tweaks that will allow you to enjoy potatoes without spiking blood sugars:
10 Ways To Balance Blood Sugars
Enjoy!
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How Useful Is Peppermint, Really?
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Peppermint For Digestion & Against Nausea
Peppermint is often enjoyed to aid digestion, and sometimes as a remedy for nausea, but what does the science say about these uses?
Peppermint and digestion
In short: it works! (but beware)
Most studies on peppermint and digestion, that have been conducted with humans, have been with regard to IBS, but its efficacy seems quite broad:
❝Peppermint oil is a natural product which affects physiology throughout the gastrointestinal tract, has been used successfully for several clinical disorders, and appears to have a good safety profile.❞
However, and this is important: if your digestive problem is GERD, then you may want to skip it:
❝The univariate logistic regression analysis showed the following risk factors: eating 1–2 meals per day (OR = 3.50, 95% CI: 1.75–6.98), everyday consumption of peppermint tea (OR = 2.00, 95% CI: 1.14–3.50), and eating one, big meal in the evening instead of dinner and supper (OR = 1.80, 95% CI: 1.05–3.11).
The multivariate analysis confirmed that frequent peppermint tea consumption was a risk factor (OR = 2.00, 95% CI: 1.08–3.70).❞
~ Dr. Jarosz & Dr. Taraszewska
Source: Risk factors for gastroesophageal reflux disease: the role of diet
Peppermint and nausea
Peppermint is also sometimes recommended as a nausea remedy. Does it work?
The answer is: maybe
The thing with nausea is it is a symptom with a lot of possible causes, so effectiveness of remedies may vary. But for example:
- Aromatherapy for treatment of postoperative nausea and vomiting ← no better than placebo
- The Effect of Combined Inhalation Aromatherapy with Lemon and Peppermint on Nausea and Vomiting of Pregnancy: A Double-Blind, Randomized Clinical Trial ← initially no better than placebo, then performed better on subsequent days
- The Effects of Peppermint Oil on Nausea, Vomiting and Retching in Cancer Patients Undergoing Chemotherapy: An Open Label Quasi-Randomized Controlled Pilot Study ← significant benefit immediately
Summary
Peppermint is useful against wide variety of gastrointestinal disorders, including IBS, but very definitely excluding GERD (in the case of GERD, it may make things worse)
Peppermint may help with nausea, depending on the cause.
Where can I get some?
Peppermint tea, and peppermint oil, you can probably find in your local supermarket (as well as fresh mint leaves, perhaps).
For the “heavy guns” that is peppermint essential oil, here’s an example product on Amazon for your convenience
Enjoy!
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