Get Well, Stay Well – by Dr. Gemma Newman
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Dr. Gemma Newman is a GP (British equivalent of what in America is called a “family doctor”) who realized she was functioning great as a diagnostic flowchart interpreter and pill dispensary, but not actually doing much of what she got into the job to do: helping people.
Her patients were getting plenty of treatments, but not getting better. Often, they were getting worse. And she knew why: they come in for treatment for one medical problem, when they have six and a half medical problems probably a stack of non-medical problems that contributed to them,
So, this book sets out to do what she tries to do in her office, but often doesn’t have the time: treat the whole person.
In it, she details what areas of life to look at, what things are most likely to contribute to wellness/unwellness (be those things completely in your power or not), and how to—bit by bit—make all the parts better, and keep them that way.
The writing style is conversational, and while it’s heavily informed by her professional competence, there’s no arcane science here; it’s more about the system of bringing everything together harmoniously.
Bottom line: if you think there’s more to wellness than can be represented on an annual physicals chart, then this is the book to help you get/keep on top of things.
Click here to check out Get Well, Stay Well, and do just that!
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Study links microplastics with human health problems – but there’s still a lot we don’t know
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Mark Patrick Taylor, Macquarie University and Scott P. Wilson, Macquarie University
A recent study published in the prestigious New England Journal of Medicine has linked microplastics with risk to human health.
The study involved patients in Italy who had a condition called carotid artery plaque, where plaque builds up in arteries, potentially blocking blood flow. The researchers analysed plaque specimens from these patients.
They found those with carotid artery plaque who had microplastics and nanoplastics in their plaque had a higher risk of heart attack, stroke, or death (compared with carotid artery plaque patients who didn’t have any micro- or nanoplastics detected in their plaque specimens).
Importantly, the researchers didn’t find the micro- and nanoplastics caused the higher risk, only that it was correlated with it.
So, what are we to make of the new findings? And how does it fit with the broader evidence about microplastics in our environment and our bodies?
What are microplastics?
Microplastics are plastic particles less than five millimetres across. Nanoplastics are less than one micron in size (1,000 microns is equal to one millimetre). The precise size classifications are still a matter of debate.
Microplastics and nanoplastics are created when everyday products – including clothes, food and beverage packaging, home furnishings, plastic bags, toys and toiletries – degrade. Many personal care products contain microsplastics in the form of microbeads.
Plastic is also used widely in agriculture, and can degrade over time into microplastics and nanoplastics.
These particles are made up of common polymers such as polyethylene, polypropylene, polystyrene and polyvinyl chloride. The constituent chemical of polyvinyl chloride, vinyl chloride, is considered carcinogenic by the US Environmental Protection Agency.
Of course, the actual risk of harm depends on your level of exposure. As toxicologists are fond of saying, it’s the dose that makes the poison, so we need to be careful to not over-interpret emerging research.
A closer look at the study
This new study in the New England Journal of Medicine was a small cohort, initially comprising 304 patients. But only 257 completed the follow-up part of the study 34 months later.
The study had a number of limitations. The first is the findings related only to asymptomatic patients undergoing carotid endarterectomy (a procedure to remove carotid artery plaque). This means the findings might not be applicable to the wider population.
The authors also point out that while exposure to microplastics and nanoplastics has been likely increasing in recent decades, heart disease rates have been falling.
That said, the fact so many people in the study had detectable levels of microplastics in their body is notable. The researchers found detectable levels of polyethylene and polyvinyl chloride (two types of plastic) in excised carotid plaque from 58% and 12% of patients, respectively.
These patients were more likely to be younger men with diabetes or heart disease and a history of smoking. There was no substantive difference in where the patients lived.
Inflammation markers in plaque samples were more elevated in patients with detectable levels of microplastics and nanoplastics versus those without.
Microplastics are created when everyday products degrade. JS14/Shutterstock And, then there’s the headline finding: patients with microplastics and nanoplastics in their plaque had a higher risk of having what doctors call “a primary end point event” (non-fatal heart attack, non-fatal stroke, or death from any cause) than those who did not present with microplastics and nanoplastics in their plaque.
The authors of the study note their results “do not prove causality”.
However, it would be remiss not to be cautious. The history of environmental health is replete with examples of what were initially considered suspect chemicals that avoided proper regulation because of what the US National Research Council refers to as the “untested-chemical assumption”. This assumption arises where there is an absence of research demonstrating adverse effects, which obviates the requirement for regulatory action.
In general, more research is required to find out whether or not microplastics cause harm to human health. Until this evidence exists, we should adopt the precautionary principle; absence of evidence should not be taken as evidence of absence.
Global and local action
Exposure to microplastics in our home, work and outdoor environments is inevitable. Governments across the globe have started to acknowledge we must intervene.
The Global Plastics Treaty will be enacted by 175 nations from 2025. The treaty is designed, among other things, to limit microplastic exposure globally. Burdens are greatest especially in children and especially those in low-middle income nations.
In Australia, legislation ending single use plastics will help. So too will the increased rollout of container deposit schemes that include plastic bottles.
Microplastics pollution is an area that requires a collaborative approach between researchers, civil societies, industry and government. We believe the formation of a “microplastics national council” would help formulate and co-ordinate strategies to tackle this issue.
Little things matter. Small actions by individuals can also translate to significant overall environmental and human health benefits.
Choosing natural materials, fabrics, and utensils not made of plastic and disposing of waste thoughtfully and appropriately – including recycling wherever possible – is helpful.
Mark Patrick Taylor, Chief Environmental Scientist, EPA Victoria; Honorary Professor, School of Natural Sciences, Macquarie University and Scott P. Wilson, Research Director, Australian Microplastic Assessment Project (AUSMAP); Honorary Senior Research Fellow, School of Natural Sciences, Macquarie University
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Finding Geriatric Doctors for Seniors
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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
❝[Can you write about] the availability of geriatric doctors Sometimes I feel my primary isn’t really up on my 70 year old health issues. I would love to find a doctor that understands my issues and is able to explain them to me. Ie; my worsening arthritis in regards to food I eat; in regards to meds vs homeopathic solutions.! Thanks!❞
That’s a great topic, worthy of a main feature! Because in many cases, it’s not just about specialization of skills, but also about empathy, and the gap between studying a condition and living with a condition.
About arthritis, we’re going to do a main feature specifically on that quite soon, but meanwhile, you might like our previous article:
Keep Inflammation At Bay (arthritis being an inflammatory condition)
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Why a common asthma drug will now carry extra safety warnings about depression
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Australia’s Therapeutic Goods Administration (TGA) recently issued a safety alert requiring extra warnings to be included with the asthma and hay fever drug montelukast.
The warnings are for users and their families to look for signs of serious behaviour and mood-related changes, such as suicidal thoughts and depression. The new warnings need to be printed at the start of information leaflets given to both patients and health-care providers (sometimes called a “boxed” warning).
So why did the TGA issue this warning? And is there cause for concern if you or a family member uses montelukast? Here’s what you need to know.
First, what is montelukast?
Montelukast is a prescription drug also known by its brand names which include Asthakast, Lukafast, Montelair and Singulair. It’s used to manage the symptoms of mild-to-moderate asthma and seasonal hay fever in children and adults.
Asthma occurs when the airways tighten and produce extra mucus, which makes it difficult to get air into the lungs. Likewise, the runny nose characteristic of hay fever occurs due to the overproduction of mucus.
Leukotrienes are an important family of chemicals found throughout the airways and involved in both mucus production and airway constriction. Montelukast is a cysteinyl leukotriene receptor antagonist, meaning it blocks the site in the airways where the leukotrienes work.
Montelukast can’t be used to treat acute asthma (an asthma attack), as it takes time for the tablet to be broken down in the stomach and for it to be absorbed into the body. Rather, it’s taken daily to help prevent asthma symptoms or seasonal hay fever.
It can be used alongside asthma puffers that contain corticosteriods and drugs like salbutamol (Ventolin) in the event of acute attacks.
What is the link to depression and suicide?
The possibility that this drug may cause behavioural changes is not new information. Manufacturers knew this as early as 2007 and issued warnings for possible side-effects including depression, suicidality and anxiousness.
The United Kingdom’s Medicines and Healthcare products Regulatory Agency has required a warning since 2008 but mandated a more detailed warning in 2019. The United States’ Food and Drug Administration has required boxed warnings for the drug since 2020.
Montelukast can help children and adults with asthma. adriaticfoto/Shutterstock Montelukast is known to potentially induce a number of behaviour and mood changes, including agitation, anxiety, depression, irritability, obsessive-compulsive symptoms, and suicidal thoughts and actions.
Initially a 2009 study that analysed data from 157 clinical trials involving more than 20,000 patients concluded there were no completed suicides due to taking the drug, and only a rare risk of suicide thoughts or attempts.
The most recent study, published in November 2024, examined data from more than 100,000 children aged 3–17 with asthma or hay fever who either took montelukast or used only inhaled corticosteroids.
It found montelukast use was associated with a 32% higher incidence of behavioural changes. The behaviour change with the strongest association was sleep disturbance, but montelukast use was also linked to increases in anxiety and mood disorders.
In the past ten years, around 200 incidences of behavioural side-effects have been reported to the TGA in connection with montelukast. This includes 57 cases of depression, 60 cases of suicidal thoughts and 17 suicide attempts or incidents of intentional self-injury. There were seven cases where patients taking the drug did complete a suicide.
This is of course tragic. But these numbers need to be seen in the context of the number of people taking the drug. Over the same time period, more than 200,000 scripts for montelukast have been filled under the Pharmaceutical Benefits Scheme.
Overall, we don’t know conclusively that montelukast causes depression and suicide, just that it seems to increase the risk for some people.
We’re still not sure how the drug can act on the brain to lead to behaviour changes. Elif Bayraktar/Shutterstock And if it does change behaviour, we don’t fully understand how this happens. One hypothesis is that the drug and its breakdown products (or metabolites) affect brain chemistry.
Specifically, it might interfere with how the brain detoxifies the antioxidant glutathione or alter the regulation of other brain chemicals, such as neurotransmitters.
Why is the TGA making this change now?
The new risk warning requirement comes from a meeting of the Australian Advisory Committee on Medicines where they were asked to provide advice on ways to minimise the risk for the drug given current international recommendations.
Even though the 2024 review didn’t highlight any new risks, to align with international recommendations, and help address consumer concerns, the advisory committee recommended a boxed warning be added to drug information sheets.
If you have asthma and take montelukast (or your child does), you should not just stop taking the drug, because this could put you at risk of an attack that could be life threatening. If you’re concerned, speak to your doctor who can discuss the risks and benefits of the medication for you, and, if appropriate, prescribe a different medication.
If this article has raised issues for you, or if you’re concerned about someone you know, call Lifeline on 13 11 14.
Nial Wheate, Professor of Pharmaceutical Chemistry, Macquarie University
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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America’s Health System Isn’t Ready for the Surge of Seniors With Disabilities
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The number of older adults with disabilities — difficulty with walking, seeing, hearing, memory, cognition, or performing daily tasks such as bathing or using the bathroom — will soar in the decades ahead, as baby boomers enter their 70s, 80s, and 90s.
But the health care system isn’t ready to address their needs.
That became painfully obvious during the covid-19 pandemic, when older adults with disabilities had trouble getting treatments and hundreds of thousands died. Now, the Department of Health and Human Services and the National Institutes of Health are targeting some failures that led to those problems.
One initiative strengthens access to medical treatments, equipment, and web-based programs for people with disabilities. The other recognizes that people with disabilities, including older adults, are a separate population with special health concerns that need more research and attention.
Lisa Iezzoni, 69, a professor at Harvard Medical School who has lived with multiple sclerosis since her early 20s and is widely considered the godmother of research on disability, called the developments “an important attempt to make health care more equitable for people with disabilities.”
“For too long, medical providers have failed to address change in society, changes in technology, and changes in the kind of assistance that people need,” she said.
Among Iezzoni’s notable findings published in recent years:
Most doctors are biased. In survey results published in 2021, 82% of physicians admitted they believed people with significant disabilities have a worse quality of life than those without impairments. Only 57% said they welcomed disabled patients.
“It’s shocking that so many physicians say they don’t want to care for these patients,” said Eric Campbell, a co-author of the study and professor of medicine at the University of Colorado.
While the findings apply to disabled people of all ages, a larger proportion of older adults live with disabilities than younger age groups. About one-third of people 65 and older — nearly 19 million seniors — have a disability, according to the Institute on Disability at the University of New Hampshire.
Doctors don’t understand their responsibilities. In 2022, Iezzoni, Campbell, and colleagues reported that 36% of physicians had little to no knowledge of their responsibilities under the 1990 Americans With Disabilities Act, indicating a concerning lack of training. The ADA requires medical practices to provide equal access to people with disabilities and accommodate disability-related needs.
Among the practical consequences: Few clinics have height-adjustable tables or mechanical lifts that enable people who are frail or use wheelchairs to receive thorough medical examinations. Only a small number have scales to weigh patients in wheelchairs. And most diagnostic imaging equipment can’t be used by people with serious mobility limitations.
Iezzoni has experienced these issues directly. She relies on a wheelchair and can’t transfer to a fixed-height exam table. She told me she hasn’t been weighed in years.
Among the medical consequences: People with disabilities receive less preventive care and suffer from poorer health than other people, as well as more coexisting medical conditions. Physicians too often rely on incomplete information in making recommendations. There are more barriers to treatment and patients are less satisfied with the care they do get.
Egregiously, during the pandemic, when crisis standards of care were developed, people with disabilities and older adults were deemed low priorities. These standards were meant to ration care, when necessary, given shortages of respirators and other potentially lifesaving interventions.
There’s no starker example of the deleterious confluence of bias against seniors and people with disabilities. Unfortunately, older adults with disabilities routinely encounter these twinned types of discrimination when seeking medical care.
Such discrimination would be explicitly banned under a rule proposed by HHS in September. For the first time in 50 years, it would update Section 504 of the Rehabilitation Act of 1973, a landmark statute that helped establish civil rights for people with disabilities.
The new rule sets specific, enforceable standards for accessible equipment, including exam tables, scales, and diagnostic equipment. And it requires that electronic medical records, medical apps, and websites be made usable for people with various impairments and prohibits treatment policies based on stereotypes about people with disabilities, such as covid-era crisis standards of care.
“This will make a really big difference to disabled people of all ages, especially older adults,” said Alison Barkoff, who heads the HHS Administration for Community Living. She expects the rule to be finalized this year, with provisions related to medical equipment going into effect in 2026. Medical providers will bear extra costs associated with compliance.
Also in September, NIH designated people with disabilities as a population with health disparities that deserves further attention. This makes a new funding stream available and “should spur data collection that allows us to look with greater precision at the barriers and structural issues that have held people with disabilities back,” said Bonnielin Swenor, director of the Johns Hopkins University Disability Health Research Center.
One important barrier for older adults: Unlike younger adults with disabilities, many seniors with impairments don’t identify themselves as disabled.
“Before my mom died in October 2019, she became blind from macular degeneration and deaf from hereditary hearing loss. But she would never say she was disabled,” Iezzoni said.
Similarly, older adults who can’t walk after a stroke or because of severe osteoarthritis generally think of themselves as having a medical condition, not a disability.
Meanwhile, seniors haven’t been well integrated into the disability rights movement, which has been led by young and middle-aged adults. They typically don’t join disability-oriented communities that offer support from people with similar experiences. And they don’t ask for accommodations they might be entitled to under the ADA or the 1973 Rehabilitation Act.
Many seniors don’t even realize they have rights under these laws, Swenor said. “We need to think more inclusively about people with disabilities and ensure that older adults are fully included at this really important moment of change.”
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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Women Living Deliciously – by Florence Given
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“Wouldst thou like to live deliciously?” as the line goes, and this book answers that, and how.
While roundly aimed at women, as per the title, this book will be of benefit to anyone who finds that society has wanted to keep you small and contained, and that perhaps you were meant for better.
The book is divided into three sections:
- Excavating
- Planting
- Blooming
…which broadly describes the process the author takes us through, of:
- Digging up what is wrong
- Putting better things in place
- Enjoying life
This is important, because otherwise a lot of people will understandably exhort us to step 3 (enjoying life), without really thinking about steps 1 and 2.
Her wording of it is important too, it wasn’t just being flowery for floweriness’ sake—rather, it highlights the nature of the process: while “enjoy life” seems like a thing-in-itself (as Kant might say), in reality, there’s another necessary thing (or series of things) behind it. In contrast, the gardening metaphor renders it clear: how will your flowers bloom if you do not plant them? And what good will planting them do if the soil is not right for them?
So, she gives us a “ground upwards” therapeutic approach.
The style throughout is casual but sincere and heartfelt, and while this is a book of personal change rather than social change, it does reference feminism throughout so if that’s not for you, then neither is this book.
Bottom line: this is a lot more than just a pep talk or a book of platitudes; it’s a lot of concrete, applicable stuff to markedly live life better.
Click here to check out Women Living Deliciously, and live deliciously!
PS: we notice a one-star review on Amazon expressed disappointment upon discovering that this is not a recipe book. So please be aware, the only recipe in this book is the recipe for a fulfilling and vibrant life 😎
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PTSD, But, Well…. Complex.
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PTSD is typically associated with military veterans, for example, or sexual assault survivors. There was a clear, indisputable, Bad Thing™ that was experienced, and it left a psychological scar. When something happens to remind us of that—say, there are fireworks, or somebody touches us a certain way—it’ll trigger an immediate strong response of some kind.
These days the word “triggered” has been popularly misappropriated to mean any adverse emotional reaction, often to something trivial.
But, not all trauma is so clear. If PTSD refers to the result of that one time you were smashed with a sledgehammer, C-PTSD (Complex PTSD) refers to the result of having been hit with a rolled-up newspaper every few days for fifteen years, say.
This might have been…
- childhood emotional neglect
- a parent with a hair-trigger temper
- bullying at school
- extended financial hardship as a young adult
- “just” being told or shown all too often that your best was never good enough
- the persistent threat (real or imagined) of doom of some kind
- the often-reinforced idea that you might lose everything at any moment
If you’re reading this list and thinking “that’s just life though”, you might be in the estimated 1 in 5 people with (often undiagnosed) C-PTSD.
How About You? Take The (5mins) Test Here
Now, we at 10almonds are not doctors or therapists and even if we were, we certainly wouldn’t try to diagnose from afar. But, even if there’s only a partial match, sometimes the same advice can help.
So what are the symptoms of C-PTSD?
- A feeling that nothing is safe; we might suddenly lose what we have gained
- The body keeps the score… And it shows. We may have trouble relaxing, an aversion to exercise for reasons that don’t really add up, or an aversion to being touched.
- Trouble sleeping, born of nagging sense that to sleep is to be vulnerable to attack, and/or lazy, and/or negligent of our duties
- Poor self-image, about our body and/or about ourself as a person.
- We’re often drawn to highly unavailable people—or we are the highly unavailable person to which our complementary C-PTSD sufferers are attracted.
- We are prone to feelings of rage. Whether we keep a calm lid on it or lose our temper, we know it’s there. We’re angry at the world and at ourselves.
- We are not quick to trust—we may go through the motions of showing trust, but we’re already half-expecting that trust to have been misplaced.
- “Hell is other people” has become such a rule of life that we may tend to cloister ourselves away from company.
- We may try to order our environment around us as a matter of safety, and be easily perturbed by sudden changes being imposed on us, even if ostensibly quite minor or harmless.
- In a bid to try to find safety, we may throw ourselves into work—whatever that is for us. It could be literally our job, or passion projects, or our family, or community, and in and of itself that’s great! But the motivation is more of an attempt to distract ourselves from The Horrors™.
“Alright, I scored more of those than I care to admit. What now?”
A lot of the answer lies in first acknowledging to yourself what happened, to make you feel the way you do now. If you, for example, have an abject hatred of Christmas, what were your childhood Christmases like? If you fear losing money that you’ve accumulated, what underpins that fear? It could be something that directly happened to you, but it also could just be repeated messages you received from your parents, for example.
It could even be that you had superficially an idyllic perfect childhood. Health, wealth, security, a loving family… and simply a chemical imbalance in your brain made it a special kind of Hell for you that nobody understood, and perhaps you didn’t either.
Unfortunately, a difficult task now lies ahead: giving love, understanding, compassion, and reassurance to the person for whom you may have the most contempt in the world: yourself.
If you’d like some help with that, here are some resources:
ComplexTrauma.org (a lot of very good free resources, with no need for interaction)
CPTSD Foundation (mostly paid courses and the like)
Some final words about healing…
- You are in fact amazing,
- You can do it, and
- You deserve it.
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