I’ve been given opioids after surgery to take at home. What do I need to know?
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Opioids are commonly prescribed when you’re discharged from hospital after surgery to help manage pain at home.
These strong painkillers may have unwanted side effects or harms, such as constipation, drowsiness or the risk of dependence.
However, there are steps you can take to minimise those harms and use opioids more safely as you recover from surgery.
Which types of opioids are most common?
The most commonly prescribed opioids after surgery in Australia are oxycodone (brand names include Endone, OxyNorm) and tapentadol (Palexia).
In fact, about half of new oxycodone prescriptions in Australia occur after a recent hospital visit.
Most commonly, people will be given immediate-release opioids for their pain. These are quick-acting and are used to manage short-term pain.
Because they work quickly, their dose can be easily adjusted to manage current pain levels. Your doctor will provide instructions on how to adjust the dosage based on your pain levels.
Then there are slow-release opioids, which are specially formulated to slowly release the dose over about half to a full day. These may have “sustained-release”, “controlled-release” or “extended-release” on the box.
Slow-release formulations are primarily used for chronic or long-term pain. The slow-release form means the medicine does not have to be taken as often. However, it takes longer to have an effect compared with immediate-release, so it is not commonly used after surgery.
Controlling your pain after surgery is important. This allows you get up and start moving sooner, and recover faster. Moving around sooner after surgery prevents muscle wasting and harms associated with immobility, such as bed sores and blood clots.
Everyone’s pain levels and needs for pain medicines are different. Pain levels also decrease as your surgical wound heals, so you may need to take less of your medicine as you recover.
But there are also risks
As mentioned above, side effects of opioids include constipation and feeling drowsy or nauseous. The drowsiness can also make you more likely to fall over.
Opioids prescribed to manage pain at home after surgery are usually prescribed for short-term use.
But up to one in ten Australians still take them up to four months after surgery. One study found people didn’t know how to safely stop taking opioids.
Such long-term opioid use may lead to dependence and overdose. It can also reduce the medicine’s effectiveness. That’s because your body becomes used to the opioid and needs more of it to have the same effect.
Dependency and side effects are also more common with slow-release opioids than immediate-release opioids. This is because people are usually on slow-release opioids for longer.
Then there are concerns about “leftover” opioids. One study found 40% of participants were prescribed more than twice the amount they needed.
This results in unused opioids at home, which can be dangerous to the person and their family. Storing leftover opioids at home increases the risk of taking too much, sharing with others inappropriately, and using without doctor supervision.
How to mimimise the risks
Before using opioids, speak to your doctor or pharmacist about using over-the-counter pain medicines such as paracetamol or anti-inflammatories such as ibuprofen (for example, Nurofen, Brufen) or diclofenac (for example, Voltaren, Fenac).
These can be quite effective at controlling pain and will lessen your need for opioids. They can often be used instead of opioids, but in some cases a combination of both is needed.
Other techniques to manage pain include physiotherapy, exercise, heat packs or ice packs. Speak to your doctor or pharmacist to discuss which techniques would benefit you the most.
However, if you do need opioids, there are some ways to make sure you use them safely and effectively:
- ask for immediate-release rather than slow-release opioids to lower your risk of side effects
- do not drink alcohol or take sleeping tablets while on opioids. This can increase any drowsiness, and lead to reduced alertness and slower breathing
- as you may be at higher risk of falls, remove trip hazards from your home and make sure you can safely get up off the sofa or bed and to the bathroom or kitchen
- before starting opioids, have a plan in place with your doctor or pharmacist about how and when to stop taking them. Opioids after surgery are ideally taken at the lowest possible dose for the shortest length of time.
If you’re concerned about side effects
If you are concerned about side effects while taking opioids, speak to your pharmacist or doctor. Side effects include:
- constipation – your pharmacist will be able to give you lifestyle advice and recommend laxatives
- drowsiness – do not drive or operate heavy machinery. If you’re trying to stay awake during the day, but keep falling asleep, your dose may be too high and you should contact your doctor
- weakness and slowed breathing – this may be a sign of a more serious side effect such as respiratory depression which requires medical attention. Contact your doctor immediately.
If you’re having trouble stopping opioids
Talk to your doctor or pharmacist if you’re having trouble stopping opioids. They can give you alternatives to manage the pain and provide advice on gradually lowering your dose.
You may experience withdrawal effects, such as agitation, anxiety and insomnia, but your doctor and pharmacist can help you manage these.
How about leftover opioids?
After you have finished using opioids, take any leftovers to your local pharmacy to dispose of them safely, free of charge.
Do not share opioids with others and keep them away from others in the house who do not need them, as opioids can cause unintended harms if not used under the supervision of a medical professional. This could include accidental ingestion by children.
For more information, speak to your pharmacist or doctor. Choosing Wisely Australia also has free online information about managing pain and opioid medicines.
Katelyn Jauregui, PhD Candidate and Clinical Pharmacist, School of Pharmacy, Faculty of Medicine and Health, University of Sydney; Asad Patanwala, Professor, Sydney School of Pharmacy, University of Sydney; Jonathan Penm, Senior lecturer, School of Pharmacy, University of Sydney, and Shania Liu, Postdoctoral Research Fellow, Faculty of Medicine and Dentistry, University of Alberta
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Overcoming Tendonitis – by Dr. Steven Low & Dr. Frank Skretch
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If you assumed tendonitis to be an inflammatory condition, you’re not alone. However, it’s not; the “-itis” nomenclature is a misnomer, and while one can rarely go wrong with reducing chronic/systemic inflammation, it’s not the cure for tendonitis.
What, then, is tendonitis and what does cure it? It’s a non-inflammatory proliferation disorder, meaning, something is growing (or in this case, simply being replaced) in a way it shouldn’t. As to fixing it, that’s more complex.
This book does cover 20 interventions (sorted into “major” and “minor”), ranging from exercise therapies to surgery, with many things between. It also examines popular myths that do not help, such as rest, ice, heat, and analgesics.
The style of this book is hard science, but don’t worry, it explains everything along the way. It does however mean that if you’re not very accustomed to wading through scientific material, you can’t just dip into the middle of the book and be guaranteed to understand what’s going on. Indeed, before even getting to discussing tendonitis/tendinopathy, the first chapter is very reassuringly dedicated to “understanding the levels and classification of evidence in studies”, along with the assorted scales and guidelines of the Center for Evidence-Based Medicine.
The rest, however, is about the etiology, diagnosis, and treatment of tendonitis and tendinopathy more generally. One interesting thing is that, according to the abundant high-quality evidence presented in this book, what works for one body part’s tendonitis does not necessarily work for another body part, so we get quite a part-by-part rundown.
Bottom line: this book has a wealth of useful, applicable information about management of tendonitis, making it indispensable if you or a loved one suffer from such—but settle in, because it’s not a light read.
Click here to check out Overcoming Tendonitis, and overcome tendonitis!
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Hate salad or veggies? Just keep eating them. Here’s how our tastebuds adapt to what we eat
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Do you hate salad? It’s OK if you do, there are plenty of foods in the world, and lots of different ways to prepare them.
But given almost all of us don’t eat enough vegetables, even though most of us (81%) know eating more vegetables is a simple way to improve our health, you might want to try.
If this idea makes you miserable, fear not, with time and a little effort you can make friends with salad.
Why don’t I like salads?
It’s an unfortunate quirk of evolution that vegetables are so good for us but they aren’t all immediately tasty to all of us. We have evolved to enjoy the sweet or umami (savoury) taste of higher energy foods, because starvation is a more immediate risk than long-term health.
Vegetables aren’t particularly high energy but they are jam-packed with dietary fibre, vitamins and minerals, and health-promoting compounds called bioactives.
Those bioactives are part of the reason vegetables taste bitter. Plant bioactives, also called phytonutrients, are made by plants to protect themselves against environmental stress and predators. The very things that make plant foods bitter, are the things that make them good for us.
Unfortunately, bitter taste evolved to protect us from poisons, and possibly from over-eating one single plant food. So in a way, plant foods can taste like poison.
For some of us, this bitter sensing is particularly acute, and for others it isn’t so bad. This is partly due to our genes. Humans have at least 25 different receptors that detect bitterness, and we each have our own genetic combinations. So some people really, really taste some bitter compounds while others can barely detect them.
This means we don’t all have the same starting point when it comes to interacting with salads and veggies. So be patient with yourself. But the steps toward learning to like salads and veggies are the same regardless of your starting point.
It takes time
We can train our tastes because our genes and our receptors aren’t the end of the story. Repeat exposures to bitter foods can help us adapt over time. Repeat exposures help our brain learn that bitter vegetables aren’t posions.
And as we change what we eat, the enzymes and other proteins in our saliva change too. This changes how different compounds in food are broken down and detected by our taste buds. How exactly this works isn’t clear, but it’s similar to other behavioural cognitive training.
Add masking ingredients
The good news is we can use lots of great strategies to mask the bitterness of vegetables, and this positively reinforces our taste training.
Salt and fat can reduce the perception of bitterness, so adding seasoning and dressing can help make salads taste better instantly. You are probably thinking, “but don’t we need to reduce our salt and fat intake?” – yes, but you will get more nutritional bang-for-buck by reducing those in discretionary foods like cakes, biscuits, chips and desserts, not by trying to avoid them with your vegetables.
Adding heat with chillies or pepper can also help by acting as a decoy to the bitterness. Adding fruits to salads adds sweetness and juiciness, this can help improve the overall flavour and texture balance, increasing enjoyment.
Pairing foods you are learning to like with foods you already like can also help.
The options for salads are almost endless, if you don’t like the standard garden salad you were raised on, that’s OK, keep experimenting.
Experimenting with texture (for example chopping vegetables smaller or chunkier) can also help in finding your salad loves.
Challenge your biases
Challenging your biases can also help the salad situation. A phenomenon called the “unhealthy-tasty intuition” makes us assume tasty foods aren’t good for us, and that healthy foods will taste bad. Shaking that assumption off can help you enjoy your vegetables more.
When researchers labelled vegetables with taste-focused labels, priming subjects for an enjoyable taste, they were more likely to enjoy them compared to when they were told how healthy they were.
The bottom line
Vegetables are good for us, but we need to be patient and kind with ourselves when we start trying to eat more.
Try working with biology and brain, and not against them.
And hold back from judging yourself or other people if they don’t like the salads you do. We are all on a different point of our taste-training journey.
Emma Beckett, Senior Lecturer (Food Science and Human Nutrition), School of Environmental and Life Sciences, University of Newcastle
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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A Tale Of Two Cinnamons
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Cinnamon’s Health Benefits (But Watch Out!)
Cinnamon is enjoyed for its sweet and punchy flavor. It also has important health properties!
Let’s take a look at the science…
A Tale Of Two Cinnamons
In your local supermarket, there is likely “cinnamon” and if you’re lucky, also “sweet cinnamon”. The difference between these is critical to understand before we continue:
“Cinnamon” = Cinnamomum cassia or Cinnamomum aromaticum. This is cheapest and most readily available. It has a relatively high cinnamaldehyde content, and a high coumarin content.
“Sweet cinnamon” Cinnamomum verum or Cinnamomum zeylanicum. It has a lower cinnamaldehyde content, and/but a much lower (almost undetectable) coumarin content.
You may be wondering: what’s with the “or” in both of those cases? Each simply has two botanical names in use. It’s inconvenient and confusing, but that’s how it is.
Great! What’s cinnamaldehyde and what’s coumarin?
Cinnamaldehyde is what gives cinnamon its “spice” aspect; it’s strong and fragrant. It also gives cinnamon most of its health benefits.
As a quick aside: it’s also used as the flavoring element in cinnamon flavored vapes, and in that form, it can cause health problems. So do eat it, but we recommend not to vape it.
Coumarin is toxic in large quantities.
The recommended safe amount is 0.1mg/kg, so you could easily go over this with a couple of teaspoons of cassia cinnamon:
Toxicology and risk assessment of coumarin: focus on human data
…while in Sweet/True/Ceylon cinnamon, those levels are almost undetectable:
Medicinal properties of ‘true’ cinnamon (Cinnamomum zeylanicum): a systematic review
If you have a cinnamon sensitivity, it is likely, but not necessarily, tied to the coumarin content rather than the cinnamaldehyde content.
Summary of this section before moving on:
“Cinnamon”, or cassia cinnamon, has about 50% stronger health benefits than “Sweet Cinnamon”, also called Ceylon cinnamon.
“Cinnamon”, or cassia cinnamon, has about 250% stronger health risks than “Sweet Cinnamon”, also called Ceylon cinnamon.
The mathematics here is quite simple; sweet cinnamon is the preferred way to go.
The Health Benefits
We spent a lot of time/space today looking at the differences. We think this was not only worth it, but necessary. However, that leaves us with less time/space for discussing the actual benefits. We’ll summarize, with links to supporting science:
“Those three things that almost always go together”:
Heart and blood benefits:
- Reduces triglyceride levels
- Reduces high blood pressure
- Reduces insulin insensitivity
- Reduces fasting blood sugar levels
Neuroprotective benefits:
The science does need more testing in these latter two, though.
Where to get it?
You may be able to find sweet cinnamon in your local supermarket, or if you prefer capsule form, here’s an example product on Amazon
Enjoy!
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Bath vs Shower – Which is Healthier?
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Our Verdict
When comparing bathing to showering, we picked the shower.
Why?
For the basic task of getting your body clean, the shower is better as it is an entirely one-way process. Clean water hits your body, dirty water leaves it, and no dirt is making its way back.
Baths do not have this advantage, and if you enter a bath dirty, you will then be sitting in dirty water. You will leave it a lot cleaner than you entered it (because a lot of the dirt stayed in the bathwater to be drained away after the bath), but not as clean as if you had showered.
One could argue soap or equivalent will prevent the dirt re-sticking, and that’s true, but it’s true for soap in the shower too, so it doesn’t offset anything.
Additionally, being immersed in water for more than 15 minutes can start to have a (paradoxically) dehydrating effect on the skin; this happens not only because of losing skin oils to the water, but also because of osmosis, the resultant mild edema, the body’s homeostatic response to the mild edema, then getting out the bath and drying, leaving one with the response having now just caused dehydrated skin.
Baths do have some health advantages! And these come primarily from the mental health benefits of relaxation in warm water and/or generally pampering oneself. Additionally, some bath oils or bath salts can be beneficial in a way that couldn’t be administered the same way in the shower.
Best of both worlds?
In some parts of the world (Thailand and Turkey come to mind; doubtlessly there are many others) there are traditions of first taking a shower to get clean, and then taking a bath for the rest of the bathing experience. As a bonus, the bathing experience is then all the more pleasant for the water remaining just as clean as it was to start with.
However, if you do have to pick one (and for the purpose of our “This or That” exercise, we do), then it’s the shower, hands-down.
Want to read more?
You might want to also take into account how it’s still possible to have too much of a good thing:
Enjoy!
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How To Clean Your Brain (Glymphatic Health Primer)
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That’s not a typo! The name “glymphatic system” was coined by the Danish neuroscientist Dr. Maiken Nedergaard, and is a nod to its use of glial cells to do a similar job to that of the peripheral lymphatic system—but this time, in the CNS. Today, we have Dr. Jin Sung to tell us more:
Brainwashing (but not like that)
The glymphatic system may sound like a boring job, but so does “sanitation worker” in a city—yet the city would grind to a messy halt very very quickly without them. Same goes for your brain.
Diseases that are prevalent when this doesn’t happen the way it should include Alzheimer’s (beta-amyloid clearance) and Parkinson’s (alpha-synuclein clearance) amongst others.
Things Dr. Sung recommends for optimal glymphatic function include: sleep (7–9 hours), exercise (30–45 minutes daily), hydration (half your bodyweight in pounds, in ounces, so if your body weighs 150 lbs, that means 75 oz of water), good posture (including the use of good ergonomics, e.g. computer monitor at right height, car seat correct, etc), stress reduction (reduces inflammatory cytokines), getting enough omega-3 (the brain needs certain fats to work properly, and this is the one most likely to see a deficit), vagal stimulation (methods include humming, gargling, and gagging—please note we said vagal stimulation; easy to misread at a glance!), LED light therapy, and fasting (intermittent or prolonged).
For more on each of these, including specific tips, enjoy:
Click Here If The Embedded Video Doesn’t Load Automatically!
Want to learn more?
You might also like to read:
- Ask Not What Your Lymphatic System Can Do For You…
- The Vagus Nerve (And How You Can Make Use Of It)
- Casting Yourself In A Healthier Light
- Intermittent Fasting: How Does It Work?
Take care!
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What you need to know about menopause
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Menopause describes the time when a person with ovaries has gone one full year without a menstrual period. Reaching this phase is a natural aging process that marks the end of reproductive years.
Read on to learn more about the causes, stages, signs, and management of menopause.
What causes menopause?
As you age, your ovaries begin making less estrogen and progesterone—two of the hormones involved in menstruation—and your fertility declines, causing menopause.
Most people begin perimenopause, the transitional time that ends in menopause, in their late 40s, but it can start earlier. On average, people in the U.S. experience menopause in their early 50s.
Your body may reach early menopause for a variety of reasons, including having an oophorectomy, a surgery that removes the ovaries. In this case, the hormonal changes happen abruptly rather than gradually.
Chemotherapy and radiation therapy for cancer patients may also induce menopause, as these treatments may impact ovary function.
What are the stages of menopause?
There are three stages:
- Perimenopause typically occurs eight to 10 years before menopause happens. During this stage, estrogen production begins to decline and ovaries release eggs less frequently.
- Menopause marks the point when you have gone 12 consecutive months without a menstrual period. This means the ovaries have stopped releasing eggs and producing estrogen.
- Postmenopause describes the time after menopause. Once your body reaches this phase, it remains there for the rest of your life.
How do the stages of menopause affect fertility?
Your ovaries still produce eggs during perimenopause, so it is still possible to get pregnant during that stage. If you do not wish to become pregnant, continue using your preferred form of birth control throughout perimenopause.
Once you’ve reached menopause, you can no longer get pregnant naturally. People who would like to become pregnant after that may pursue in vitro fertilization (IVF) using eggs that were frozen earlier in life or donor eggs.
What are the signs of menopause?
Hormonal shifts result in a number of bodily changes. Signs you are approaching menopause may include:
- Hot flashes (a sudden feeling of warmth).
- Irregular menstrual periods, or unusually heavy or light menstrual periods.
- Night sweats and/or cold flashes.
- Insomnia.
- Slowed metabolism.
- Irritability, mood swings, and depression.
- Vaginal dryness.
- Changes in libido.
- Dry skin, eyes, and/or mouth.
- Worsening of premenstrual syndrome (PMS).
- Urinary urgency (a sudden need to urinate).
- Brain fog.
How can I manage the effects of menopause?
You may not need any treatment to manage the effects of menopause. However, if the effects are disrupting your life, your doctor may prescribe hormone therapy.
If you have had a hysterectomy, your doctor may prescribe estrogen therapy (ET), which may be administered via a pill, patch, cream, spray, or vaginal ring. If you still have a uterus, your doctor may prescribe estrogen progesterone/progestin hormone therapy (EPT), which is sometimes called “combination therapy.”
Both of these therapies work by replacing the hormones your body has stopped making, which can reduce the physical and mental effects of menopause.
Other treatment options may include antidepressants, which can help manage mood swings and hot flashes; prescription creams to alleviate vaginal dryness; or gabapentin, an anti-seizure medication that has been shown to reduce hot flashes.
Lifestyle changes may help alleviate the effects on their own or in combination with prescription medication. Those changes include:
- Incorporating movement into your daily life.
- Limiting caffeine and alcohol.
- Quitting smoking.
- Maintaining a regular sleep schedule.
- Practicing relaxation techniques, such as meditation.
- Consuming foods rich in plant estrogens, such as grains, beans, fruits, vegetables, and seeds.
- Seeking support from a therapist and from loved ones.
What health risks are associated with menopause?
Having lower levels of estrogen may put you at greater risk of certain health complications, including osteoporosis and coronary artery disease.
Osteoporosis occurs when bones lose their density, increasing the risk of fractures. A 2022 study found that the prevalence of osteoporotic fractures in postmenopausal women was 82.2 percent.
Coronary artery disease occurs when the arteries that send blood to your heart become narrow or blocked with fatty plaque.
Estrogen therapy can reduce your risk of osteoporosis and coronary artery disease by preserving bone mass and maintaining cardiovascular function.
For more information, talk to your health care provider.
This article first appeared on Public Good News and is republished here under a Creative Commons license.
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