Chiropractors have been banned again from manipulating babies’ spines. Here’s what the evidence actually says
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Chiropractors in Australia will not be able to perform spinal manipulation on children under the age of two once more, following health concerns from doctors and politicians.
But what is the spinal treatment at the centre of the controversy? Does it work? Is there evidence of harm?
We’re a team of researchers who specialise in evidence-based musculoskeletal health. I (Matt) am a registered chiropractor, Joshua is a registered physiotherapist and Giovanni trained as a physiotherapist.
Here’s what the evidence says.
Remind me, how did this all come about?
A Melbourne-based chiropractor posted a video on social media in 2018 using a spring-loaded device (known as the Activator) to manipulate the spine of a two-week-old baby suspended upside down by the ankles.
The video sparked widespread concerns among the public, medical associations and politicians. It prompted a ban on the procedure in young children. The Victorian health minister commissioned Safer Care Victoria to conduct an independent review of spinal manipulation techniques on children.
Recently, the Chiropractic Board of Australia reinstated chiropractors’ authorisation to perform spinal manipulation on babies under two years old. But this week, it backflipped, following heavy criticism from medical associations and politicians.
What is spinal manipulation?
Spinal manipulation is a treatment used by chiropractors and other health professionals such as doctors, osteopaths and physiotherapists.
It is an umbrella term that includes popular “back cracking” techniques.
It also includes more gentle forms of treatment, such as massage or joint mobilisations. These involve applying pressure to joints without generating a “cracking” sound.
Does spinal manipulation in babies work?
Several international guidelines for health-care professionals recommend spinal manipulation to treat adults with conditions such as back pain and headache as there is an abundance of evidence on the topic. For example, spinal manipulation for back pain is supported by data from nearly 10,000 adults.
For children, it’s a different story. Safer Care Victoria’s 2019 review of spinal manipulation found very few studies testing whether this treatment was safe and effective in children.
Studies were generally small and were of poor quality. Some of those small, poor-quality studies, suggest spinal manipulation provides a very small benefit for back pain, colic and potentially bedwetting – some common reasons for parents to take their child to see a chiropractor. But overall, the review found the overall body of evidence was very poor.
However, for most other children’s conditions chiropractors treat – such as headache, asthma, otitis media (a type of ear infection), cerebral palsy, hyperactivity and torticollis (“twisted neck”) – there did not appear to be a benefit.
The number of studies investigating the effectiveness of spinal manipulation on babies under two years of age was even smaller.
There was one high-quality study and two small, poor quality studies. These did not show an appreciable benefit of spinal manipulation on colic, otitis media with effusion (known as glue ear) or twisted neck in babies.
Is spinal manipulation on babies safe?
In terms of safety, most studies in the review found serious complications were extremely rare. The review noted one baby or child dying (a report from Germany in 2001 after spinal manipulation by a physiotherapist). The most common complications were mild in nature such as increased crying and soreness.
However, because studies were very small, they cannot tell us anything about the safety of spinal manipulation in a reliable way. Studies that are designed to properly investigate if a treatment is safe typically include thousands of patients. And these studies have not yet been done.
Why do people see chiropractors?
Safer Care Victoria also conducted surveys with more than 20,000 people living in Australia who had taken their children under 12 years old to a chiropractor in the past ten years.
Nearly three-quarters said that was for treatment of a child aged two years or younger.
Nearly all people surveyed reported a positive experience when they took their child to a chiropractor and reported that their child’s condition improved with chiropractic care. Only a small number of people (0.3%) reported a negative experience, and this was mostly related to cost of treatment, lack of improvement in their child’s condition, excessive use of x-rays, and perceived pressure to avoid medications.
Many of the respondents had also consulted their GP or maternity/child health nurse.
What now for spinal manipulation in children?
At the request of state and federal ministers, the Chiropractic Board of Australia confirmed that spinal manipulation on babies under two years old will continue to be banned until it discusses the issue further with health ministers.
Many chiropractors believe this is unfair, especially considering the strong consumer support for chiropractic care outlined in the Safer Care Victoria report, and the rarity of serious reported harms in children.
Others believe that in the absence of evidence of benefit and uncertainty around whether spinal manipulation is safe in children and babies, the precautionary principle should apply and children and babies should not receive spinal manipulation.
Ultimately, high quality research is urgently needed to better understand whether spinal manipulation is beneficial for the range of conditions chiropractors provide it for, and whether the benefit outweighs the extremely small chance of a serious complication.
This will help parents make an informed choice about health care for their child.
Matt Fernandez, Senior lecturer and researcher in chiropractic, CQUniversity Australia; Giovanni E. Ferreira, NHMRC Emerging Leader Research Fellow, Institute of Musculoskeletal Health, University of Sydney, and Joshua Zadro, NHMRC Emerging Leader Research Fellow, Sydney Musculoskeletal Health, University of Sydney
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Syringe Exchange Fears Hobble Fight Against West Virginia HIV Outbreak
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CHARLESTON, http://w.va/. — More than three years have passed since federal health officials arrived in central Appalachia to assess an alarming outbreak of HIV spread mostly between people who inject opioids or methamphetamine.
Infectious disease experts from the Centers for Disease Control and Prevention made a list of recommendations following their visit, including one to launch syringe service programs to stop the spread at its source. But those who’ve spent years striving to protect people who use drugs from overdose and illness say the situation likely hasn’t improved, in part because of politicians who contend that such programs encourage illegal drug use.
Joe Solomon is a Charleston City Council member and co-director of SOAR WV, a group that works to address the health needs of people who use drugs. He’s proud of how his close-knit community has risen to this challenge but frustrated with the restraints on its efforts.
“You see a city and a county willing to get to work at a scale that’s bigger than ever before,” Solomon said, “but we still have one hand tied behind our back.”
The hand he references is easier access to clean syringes.
In April 2021, the CDC came to Charleston — the seat of Kanawha County and the state capital, tucked into the confluence of the Kanawha and Elk rivers — to investigate dozens of newly detected HIV infections. The CDC’s HIV intervention chief called it “the most concerning HIV outbreak in the United States” and warned that the number of reported diagnoses could be just “the tip of the iceberg.”
Now, despite attention and resources directed toward the outbreak, researchers and health workers say HIV continues to spread. In large part, they say, the outbreak lingers because of restrictions state and local policymakers have placed on syringe exchange efforts.
Research indicates that syringe service programs are associated with an estimated 50% reduction in HIV and hepatitis C, and the CDC issued recommendations to steer a response to the outbreak that emphasized the need for improved access to those services.
That advice has thus far gone unheeded by local officials.
In late 2015, the Kanawha-Charleston Health Department launched a syringe service program but shuttered it in 2018 under pressure, with then-Mayor Danny Jones calling it a “mini-mall for junkies and drug dealers.”
SOAR stepped in, hosting health fairs at which it distributed naloxone, an opioid overdose reversal drug; offered treatment and referrals; provided HIV testing; and exchanged clean syringes for used ones.
But in April 2021, the state legislature passed a bill limiting the number of syringes people could exchange and made it mandatory to present a West Virginia ID. The Charleston City Council subsequently added guidelines of its own, including requiring individual labeling of syringes.
As a result of these restrictions, SOAR ceased exchanging syringes. West Virginia Health Right now operates an exchange program in the city under the restrictions.
Robin Pollini is a West Virginia University epidemiologist who conducts community-based research on injection drug use. “Anyone I’ve talked to who’s used that program only used it once,” she said. “And the numbers they report to the state bear that out.”
A syringe exchange run by the health department in nearby Cabell County — home to Huntington, the state’s largest city after Charleston — isn’t so constrained. As Solomon notes, that program exchanges more than 200 syringes for every one exchanged in Kanawha.
A common complaint about syringe programs is that they result in discarded syringes in public spaces. Jan Rader, director of Huntington’s Mayor’s Office of Public Health and Drug Control Policy, is regularly out on the streets and said she seldom encounters discarded syringes, pointing out that it’s necessary to exchange a used syringe for a new one.
In August 2023, the Charleston City Council voted down a proposal from the Women’s Health Center of West Virginia to operate a syringe exchange in the city’s West Side community, with opponents expressing fears of an increase in drug use and crime.
Pollini said it’s difficult to estimate the number of people in West Virginia with HIV because there’s no coordinated strategy for testing; all efforts are localized.
“You would think that in a state that had the worst HIV outbreak in the country,” she said, “by this time we would have a statewide testing strategy.”
In addition to the testing SOAR conducted in 2021 at its health fairs, there was extensive testing during the CDC’s investigation. Since then, the reported number of HIV cases in Kanawha County has dropped, Pollini said, but it’s difficult to know if that’s the result of getting the problem under control or the result of limited testing in high-risk groups.
“My inclination is the latter,” she said, “because never in history has there been an outbreak of injection-related HIV among people who use drugs that was solved without expanding syringe services programs.”
“If you go out and look for infections,” Pollini said, “you will find them.”
Solomon and Pollini praised the ongoing outreach efforts — through riverside encampments, in abandoned houses, down county roads — of the Ryan White HIV/AIDS Program to test those at highest risk: people known to be injecting drugs.
“It’s miracle-level work,” Solomon said.
But Christine Teague, Ryan White Program director at the Charleston Area Medical Center, acknowledged it hasn’t been enough. In addition to HIV, her concerns include the high incidence of hepatitis C and endocarditis, a life-threatening inflammation of the lining of the heart’s chambers and valves, and the cost of hospital resources needed to address them.
“We’ve presented that data to the legislature,” she said, “that it’s not just HIV, it’s all these other lengthy hospital admissions that, essentially, Medicaid is paying for. And nothing seems to penetrate.”
Frank Annie is a researcher at CAMC specializing in cardiovascular diseases, a member of the Charleston City Council, and a proponent of syringe service programs. Research he co-authored found 462 cases of endocarditis in southern West Virginia associated with injection drug use, at a cost to federal, state, and private insurers of more than $17 million, of which less than $4 million was recovered.
Teague is further concerned for West Virginia’s rural counties, most of which don’t have a syringe service program.
Tasha Withrow, a harm reduction advocate in bordering rural Putnam County, said her sense is that HIV numbers aren’t alarmingly high there but said that, with little testing and heightened stigma in a rural community, it’s difficult to know.
In a January 2022 follow-up report, the CDC recommended increasing access to harm reduction services such as syringe service programs through expansion of mobile services, street outreach, and telehealth, using “patient-trusted” individuals, to improve the delivery of essential services to people who use drugs.
Teague would like every rural county to have a mobile unit, like the one operated by her organization, offering harm reduction supplies, medication, behavioral health care, counseling, referrals, and more. That’s an expensive undertaking. She suggested opioid settlement money through the West Virginia First Foundation could pay for it.
Pollini said she hopes state and local officials allow the experts to do their jobs.
“I would like to see them allow us to follow the science and operate these programs the way they’re supposed to be run, and in a broader geography,” she said. “Which means that it shouldn’t be a political decision; it should be a public health decision.”
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.
This article first appeared on KFF Health News and is republished here under a Creative Commons license.
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Is TikTok right? Are there health benefits to eating sea moss?
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Sea moss is the latest “superfood” wellness influencers are swearing by. They claim sea moss products – usually in gel form – have multiple health benefits. These include supporting brain and immune function, or protecting against viruses and other microbes.
But do these health claims stack up? Let’s take a look.
Plataresca/Shutterstock What is sea moss?
Sea moss is produced using a kind of seaweed – particularly red algae – that grow in various locations all around the world. Three main species are used in sea moss products:
- Chondrus crispus (known as Irish moss or carrageenan moss)
- Eucheuma cottonii (sea moss or seabird’s nest)
- Gracilaria (Irish moss or ogonori).
Some products also contain the brown algae Fucus vesiculosus (commonly known as bladderwrack, black tang, rockweed, sea grapes, bladder fucus, sea oak, cut weed, dyers fucus, red fucus or rock wrack).
Most sea moss products are sold as a gel that can be added to recipes, used in smoothies, frozen into ice cubes or eaten on its own. The products also come in capsule form or can be purchased “raw” and used to make your own gels at home.
Several kinds of red algae are used in commercially-available sea moss products. Nancy Ann Bowe/Shutterstock What’s the evidence?
Sea moss products claim a host of potential health benefits, from supporting immunity, to promoting skin health and enhancing mood and focus, among many others.
But is there any evidence supporting these claims?
Recent studies have reviewed the biological properties of the main sea moss species (Chondrus crispus, Eucheuma cottonii, Gracilaria and Fucus vesiculosus).
They suggest these species may have anti-inflammatory, antioxidant, anticancer, antidiabetic and probiotic properties.
However, the vast majority of research relating to Chondrus crispus, Gracilaria and Fucus vesiculosus – and all of the research on Eucheuma cottonii – comes from studies done in test tubes or using cell and animal models. We should not assume the health effects seen would be the same in humans.
In cell and animal studies, researchers usually administer algae in a laboratory and use specific extracts rich in bioactive compounds rather than commercially available sea moss products.
They also use very different – often relatively larger – amounts compared to what someone would typically consume when they eat sea moss products.
This means the existing studies can’t tell us about the human body’s processes when eating and digesting sea moss.
Sea moss may have similar effects in humans. But so far there is very little evidence people who consume sea moss will experience any of the claimed health benefits.
Nutritional value
Eating sea moss does not replace the need for a balanced diet, including a variety of fruits and vegetables.
Chondrus crispus, Eucheuma cottonii and Gracilaria, like many seaweeds, are rich sources of nutrients such as fatty acids, amino acids, vitamin C and minerals. These nutrients are also likely to be present in sea moss, although some may be lost during the preparation of the product (for example, soaking may reduce vitamin C content), and those that remain could be present in relatively low quantities.
There are claims that sea moss may be harmful for people with thyroid problems. This relates to the relationship between thyroid function and iodine. The algae used to make sea moss are notable sources of iodine and excess iodine intake can contribute to thyroid problems, particularly for people with pre-existing conditions. That is why these products often carry disclaimers related to iodine sensitivity or thyroid health.
Is it worth it?
So you may be wondering if it’s worth trying sea moss. Here are a few things to consider before you decide whether to start scooping sea moss into your smoothies.
A 375mL jar costs around $A25–$30 and lasts about seven to ten days, if you follow the recommended serving suggestion of two tablespoons per day. This makes it a relatively expensive source of nutrients.
Sea moss is commonly sold as a gel that can be eaten on a kitchen bench. April Sims/Shutterstock Sea moss is often hyped for containing 92 different minerals. While there may be 92 minerals present, the amount of minerals in the algae will vary depending on growing location and conditions.
The efficiency with which minerals from algae can be absorbed and used by the body also varies for different minerals. For example, sodium is absorbed well, while only about 50% of iodine is absorbed.
But sea moss has also been shown to contain lead, mercury and other heavy metals – as well as radioactive elements (such as radon) that can be harmful to humans. Seaweeds are known for their ability to accumulate minerals from their environment, regardless of whether these are beneficial or harmful for human nutrition. Remember, more doesn’t always mean better.
What else am I eating?
While you won’t get a full nutritional breakdown on the jar, it is always wise to check what other ingredients you may be eating. Sea moss products can contain a range of other ingredients, such as lime, monk fruit powder, spirulina and ginger, among many others.
These ingredients differ between brands and products, so be aware of your needs and always check.
Despite their health claims, most sea moss products also carry disclaimers indicating that the products are not intended to diagnose, treat, cure or prevent any disease.
If you have concerns about your health, always speak to a health professional for accurate and personalised medical advice.
Margaret Murray, Senior Lecturer, Nutrition, Swinburne University of Technology
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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What is PNF stretching, and will it improve my flexibility?
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Whether improving your flexibility was one of your new year’s resolutions, or you’ve been inspired watching certain tennis stars warming up at the Australian Open, maybe 2025 has you keen to focus on regular stretching.
However, a quick Google search might leave you overwhelmed by all the different stretching techniques. There’s static stretching and dynamic stretching, which can be regarded as the main types of stretching.
But there are also some other potentially lesser known types of stretching, such as PNF stretching. So if you’ve come across PNF stretching and it piques your interest, what do you need to know?
Undrey/Shutterstock What is PNF stretching?
PNF stretching stands for proprioceptive neuromuscular facilitation. It was developed in the 1940s in the United States by neurologist Herman Kabat and physical therapists Margaret Knott and Dorothy Voss.
PNF stretching was initially designed to help patients with neurological conditions that affect the movement of muscles, such as polio and multiple sclerosis.
By the 1970s, its popularity had seen PNF stretching expand beyond the clinic and into the sporting arena where it was used by athletes and fitness enthusiasts during their warm-up and to improve their flexibility.
Although the specifics have evolved over time, PNF essentially combines static stretching (where a muscle is held in a lengthened position for a short period of time) with isometric muscle contractions (where the muscle produces force without changing length).
PNF stretching is typically performed with the help of a partner.
There are 2 main types
The two most common types of PNF stretching are the “contract-relax” and “contract-relax-agonist-contract” methods.
The contract-relax method involves putting a muscle into a stretched position, followed immediately by an isometric contraction of the same muscle. When the person stops contracting, the muscle is then moved into a deeper stretch before the process is repeated.
For example, to improve your hamstring flexibility, you could lie down and get a partner to lift your leg up just to the point where you begin to feel a stretch in the back of your thigh.
Once this sensation eases, attempt to push your leg back towards the ground as your partner resists the movement. After this, your partner should now be able to lift your leg up slightly higher than before until you feel the same stretching sensation.
This technique was based on the premise that the contracted muscle would fall “electrically silent” following the isometric contraction and therefore not offer its usual level of resistance to further stretching (called “autogenic inhibition”). The contract-relax method attempts to exploit this brief window to create a deeper stretch than would otherwise be possible without the prior muscle contraction.
The contract-relax-agonist-contract method is similar. But after the isometric contraction of the stretched muscle, you perform an additional contraction of the muscle group opposing the muscle being stretched (referred to as the “agonist” muscle), before the muscle is moved into a static stretch once more.
Again, if you’re trying to improve hamstring flexibility, immediately after trying to push your leg towards the ground you would attempt to lift it back towards the ceiling (this bit without partner resistance). You would do this by contracting the muscles on the front of the thigh (the quadriceps, the agonist muscle in this case).
Likewise, after this, your partner should be able to lift your leg up slightly higher than before.
The contract-relax-agonist-contract method is said to take advantage of a phenomenon known as “reciprocal inhibition.” This is where contracting the muscle group opposite that of the muscle being stretched leads to a short period of reduced activation of the stretched muscle, allowing the muscle to stretch further than normal.
What does the evidence say?
Research has shown PNF stretching is associated with improved flexibility.
While it has been suggested that both PNF methods improve flexibility via changes in nervous system function, research suggests they may simply improve our ability to tolerate stretching.
It’s worth noting most of the research on PNF stretching and flexibility has focused on healthy populations. This makes it difficult to provide evidence-based recommendations for people with clinical conditions.
And it may not be the most effective method if you’re looking to improve your flexibility in the long term. A 2018 review found static stretching was better for improving flexibility compared to PNF stretching. But other research has found it could offer greater immediate benefits for flexibility than static stretching.
At present, similar to other types of stretching, research linking PNF stretching to injury prevention and improved athletic performance is relatively inconclusive.
PNF stretching may actually lead to small temporary deficits in performance of strength, power, and speed-based activities if performed immediately beforehand. So it’s probably best done after exercise or as a part of a standalone flexibility session.
Static stretching may be a more effective way to improve flexibility over the long-term. GaudiLab/Shutterstock How much should you do?
It appears that a single contract-relax or contract-relax-agonist-contract repetition per muscle, performed twice per week, is enough to improve flexibility.
The contraction itself doesn’t need to be hard and forceful – only about 20% of your maximal effort should suffice. The contraction should be held for at least three seconds, while the static stretching component should be maintained until the stretching sensation eases.
So PNF stretching is potentially a more time-efficient way to improve flexibility, compared to, for example, static stretching. In a recent study we found four minutes of static stretching per muscle during a single session is optimal for an immediate improvement in flexibility.
Is PNF stretching the right choice for me?
Providing you have a partner who can help you, PNF stretching could be a good option. It might also provide a faster way to become more flexible for those who are time poor.
However, if you’re about to perform any activities that require strength, power, or speed, it may be wise to limit PNF stretching to afterwards to avoid any potential deficits in performance.
Lewis Ingram, Lecturer in Physiotherapy, University of South Australia and Hunter Bennett, Lecturer in Exercise Science, University of South Australia
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Red Lentils vs Oats – Which is Healthier?
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Our Verdict
When comparing red lentils to oats, we picked the oats.
Why?
In terms of macros, oats have more protein, carbs, fiber, and even a little fat—mostly healthy mono- and polyunsaturated fats, thus making them the more nutritionally dense. That said, red lentils have the lower glycemic index, (low GI compared to oats’ medium GI) which offsets that, so we’ll call this category a tie.
In the category of vitamins, red lentils have more of vitamins B6, B9, and choline, while oats have more of vitamins B1, B2, and B5. Another tie!
When it comes to minerals, however, we have a tiebreaker category: red lentils have more selenium, while oats have more calcium, copper, iron, magnesium, manganese, phosphorus, potassium, and zinc. An easy win for oats this time!
So, thanks to the minerals, oats are the clear winner in total. But by all means, enjoy either or both; diversity is good!
Want to learn more?
You might like to read:
The Best Kind Of Fiber For Overall Health? ← it’s β-glucan, the kind find in oats!
Enjoy!
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The Insider’s Guide To Making Hospital As Comfortable As Possible
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Nobody Likes Surgery, But Here’s How To Make It Much Less Bad
This is Dr. Chris Bonney. He’s an anesthesiologist. If you have a surgery, he wants you to go in feeling calm, and make a quick recovery afterwards, with minimal suffering in between.
Being a patient in a hospital is a bit like being a passenger in an airplane:
- Almost nobody enjoys the thing itself, but we very much want to get to the other side of the experience.
- We have limited freedoms and comforts, and small things can make a big difference between misery and tolerability.
- There are professionals present to look after us, but they are busy and have a lot of other people to tend to too.
So why is it that there are so many resources available full of “tips for travelers” and so few “tips for hospital patients”?
Especially given the relative risks of each, and likelihood, or even near-certainty of coming to at least some harm… One would think “tips for patients” would be more in demand!
Tips for surgery patients, from an insider expert
First, he advises us: empower yourself.
Empowering yourself in this context means:
- Relax—doctors really want you to feel better, quickly. They’re on your side.
- Research—knowledge is power, so research the procedure (and its risks!). Dr. Bonney, himself an anesthesiologist, particularly recommends you learn what specific anesthetic will be used (there are many, and they’re all a bit different!), and what effects (and/or after-effects) that may have.
- Reframe—you’re not just a patient; you’re a customer/client. Many people suffer from MDeity syndrome, and view doctors as authority figures, rather than what they are: service providers.
- Request—if something would make you feel better, ask for it. If it’s information, they will be not only obliged, but also enthusiastic, to give it. If it’s something else, they’ll oblige if they can, and the worst case scenario is something won’t be possible, but you won’t know if you don’t ask.
Next up, help them to help you
There are various ways you can be a useful member of your own care team:
- Go into surgery as healthy as you can. If there’s ever a time to get a little fitter, eat a little healthier, prioritize good quality sleep more, the time approaching your surgery is the time to do this.
- This will help to minimize complications and maximize recovery.
- Take with you any meds you’re taking, or at least have an up-to-date list of what you’re taking. Dr. Bonney has very many times had patients tell him such things as “Well, let me see. I have two little pink ones and a little white one…” and when asked what they’re for they tell him “I have no idea, you’d need to ask my doctor”.
- Help them to help you; have your meds with you, or at least a comprehensive list (including: medication name, dosage, frequency, any special instructions)
- Don’t stop taking your meds unless told to do so. Many people have heard that one should stop taking meds before a surgery, and sometimes that’s true, but often it isn’t. Keep taking them, unless told otherwise.
- If unsure, ask your surgical team in advance (not your own doctor, who will not be as familiar with what will or won’t interfere with a surgery).
Do any preparatory organization well in advance
Consider the following:
- What do you need to take with you? Medications, clothes, toiletries, phone charger, entertainment, headphones, paperwork, cash for the vending machine?
- Will the surgeons need to shave anywhere, and if so, might you prefer doing some other form of depilation (e.g. waxing etc) yourself in advance?
- Is your list of medications ready?
- Who will take you to the hospital and who will bring you back?
- Who will stay with you for the first 24 hours after you’re sent home?
- Is someone available to look after your kids/pets/plants etc?
Be aware of how you do (and don’t) need to fast before surgery
The American Society of Anesthesiologists gives the following fasting guidelines:
- Non-food liquids: fast for at least 2 hours before surgery
- Food liquids or light snacks: fast for at least 6 hours before surgery
- Fried foods, fatty foods, meat: fast for at least 8 hours before surgery
(see the above link for more details)
Dr. Bonney notes that many times he’s had patients who’ve had the worst thirst, or caffeine headache, because of abstaining unnecessarily for the day of the surgery.
Unless told otherwise by your surgical team, you can have black coffee/tea up until two hours before your surgery, and you can and should have water up until two hours before surgery.
Hydration is good for you and you will feel the difference!
Want to know more?
Dr. Bonney has his own website and blog, where he offers lots of advice, including for specific conditions and specific surgeries, with advice for before/during/after your hospital stay.
He also has a book with many more tips like those we shared today:
Calm For Surgery: Supertips For A Smooth Recovery
Take good care of yourself!
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What’s the difference between physical and chemical sunscreens? And which one should you choose?
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Sun exposure can accelerate ageing, cause skin burns, erythema (a skin reaction), skin cancer, melasmas (or sun spots) and other forms of hyperpigmentation – all triggered by solar ultraviolet radiation.
Approximately 80% of skin cancer cases in people engaged in outdoor activities are preventable by decreasing sun exposure. This can be done in lots of ways including wearing protective clothing or sunscreens.
But not all sunscreens work in the same way. You might have heard of “physical” and “chemical” sunscreens. What’s the difference and which one is right for you?
How sunscreens are classified
Sunscreens are grouped by their use of active inorganic and organic ultraviolet (UV) filters. Chemical sunscreens use organic filters such as cinnamates (chemically related to cinnamon oil) and benzophenones. Physical sunscreens (sometimes called mineral sunscreens) use inorganic filters such as titanium and zinc oxide.
These filters prevent the effects of UV radiation on the skin.
Organic UV filters are known as chemical filters because the molecules in them change to stop UV radiation reaching the skin. Inorganic UV filters are known as physical filters, because they work through physical means, such as blocking, scattering and reflection of UV radiation to prevent skin damage.
Nano versus micro
The effectiveness of the filters in physical sunscreen depends on factors including the size of the particle, how it’s mixed into the cream or lotion, the amount used and the refraction index (the speed light travels through a substance) of each filter.
When the particle size in physical sunscreens is large, it causes the light to be scattered and reflected more. That means physical sunscreens can be more obvious on the skin, which can reduce their cosmetic appeal.
Nanoparticulate forms of physical sunscreens (with tiny particles smaller than 100 nanometers) can improve the cosmetic appearance of creams on the skin and UV protection, because the particles in this size range absorb more radiation than they reflect. These are sometimes labelled as “invisible” zinc or mineral formulations and are considered safe.
So how do chemical sunscreens work?
Chemical UV filters work by absorbing high-energy UV rays. This leads to the filter molecules interacting with sunlight and changing chemically.
When molecules return to their ground (or lower energy) state, they release energy as heat, distributed all over the skin. This may lead to uncomfortable reactions for people with skin sensitivity.
Generally, UV filters are meant to stay on the epidermis (the first skin layer) surface to protect it from UV radiation. When they enter into the dermis (the connective tissue layer) and bloodstream, this can lead to skin sensitivity and increase the risk of toxicity. The safety profile of chemical UV filters may depend on whether their small molecular size allows them to penetrate the skin.
Chemical sunscreens, compared to physical ones, cause more adverse reactions in the skin because of chemical changes in their molecules. In addition, some chemical filters, such as dibenzoylmethane tend to break down after UV exposure. These degraded products can no longer protect the skin against UV and, if they penetrate the skin, can cause cell damage.
Due to their stability – that is, how well they retain product integrity and effectiveness when exposed to sunlight – physical sunscreens may be more suitable for children and people with skin allergies.
Although sunscreen filter ingredients can rarely cause true allergic dermatitis, patients with photodermatoses (where the skin reacts to light) and eczema have higher risk and should take care and seek advice.
What to look for
The best way to check if you’ll have a reaction to a physical or chemical sunscreen is to patch test it on a small area of skin.
And the best sunscreen to choose is one that provides broad-spectrum protection, is water and sweat-resistant, has a high sun protection factor (SPF), is easy to apply and has a low allergy risk.
Health authorities recommend sunscreen to prevent sun damage and cancer. Chemical sunscreens have the potential to penetrate the skin and may cause irritation for some people. Physical sunscreens are considered safe and effective and nanoparticulate formulations can increase their appeal and ease of use.
Yousuf Mohammed, Dermatology researcher, The University of Queensland and Khanh Phan, Postdoctoral research associate, Frazer Institute, The University of Queensland
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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