Tourette’s Syndrome Treatment Options
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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
❝Is there anything special that might help someone with Tourette’s syndrome?❞
There are of course a lot of different manifestations of Tourette’s syndrome, and some people’s tics may be far more problematic to themselves and/or others, while some may be quite mild and just something to work around.
It’s an interesting topic for sure, so we’ll perhaps do a main feature (probably also covering the related-and-sometimes-overlapping OCD umbrella rather than making it hyperspecific to Tourette’s), but meanwhile, you might consider some of these options:
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Cardiac Failure Explained – by Dr. Warrick Bishop
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The cover of this book makes it look like it’ll be a flashy semi-celebrity doctor keen to sell his personalized protocol, along with eleventy-three other books, but actually, what’s inside this one is very different:
We (hopefully) all know the basics of heart health, but this book takes it a lot further. Starting with the basics, then the things that it’s easy to feel like you should know but actually most people don’t, then into much more depth.
The format is much more like a university textbook than most pop-science books, and everything about the way it’s written is geared for maximum learning. The one thing it does keep in common with pop-science books as a genre is heavy use of anecdotes to illustrate points—but he’s just as likely to use tables, diagrams, callout boxes, emboldening of key points, recap sections, and so forth. And for the most part, this book is very information-dense.
Dr. Bishop also doesn’t just stick to what’s average, and talks a lot about aberrations from the norm, what they mean and what they do and yes, what to do about them.
On the one hand, it’s more information dense than the average reader can reasonably expect to need… On the other hand, isn’t it great to finish reading a book feeling like you just did a semester at medical school? No longer will you be baffled by what is going on in your (or perhaps a loved one’s) cardiac health.
Bottom line: if you’d like to know cardiac health inside out, this book is an excellent place to start.
Click here to check out Cardiac Failure Explained, and get to the heart of things!
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Brain Maker – by Dr. David Perlmutter
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Regular 10almonds readers probably know about the gut-brain connection already, so what’s new here?
Dr. David Perlmutter takes us on a tour of gut and brain health, specifically, the neuroprotective effect of healthy gut microbiota.
This seems unlikely! After all, vagus nerve or no, the gut microbiota are confined to the gut, and the brain is kept behind the blood-brain barrier. So how does one thing protect the other?
Dr. Perlmutter presents the relevant science, and the honest answer is, we’re not 100% sure how this happens! We do know part of it: that bad gut microbiota can result in a “leaky gut”, and that may in turn lead to such a thing as a “leaky brain”, where the blood-brain barrier has been compromised and some bad things can get in with the blood.
When it comes to gut-brain health…
Not only is the correlation very strong, but also, in tests where someone’s gut microbiota underwent a radical change, e.g. due to…
- antibiotics (bad)
- fasting (good)
- or a change in diet (either way)
…their brain health changed accordingly—something we can’t easily check outside of a lab, but was pretty clear in those tests.
We’re also treated to an exposé on the links between gut health, brain health, inflammation, and dementia… Which links are extensive.
In closing, we’ll mention that throughout this book we’re also given many tips and advices to improve our gut/brain health, reverse damage done already, and set ourselves up well for the future.
Click here to check out “Brain Maker” on Amazon and take care of this important part of your health!
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52 Weeks to Better Mental Health – by Dr. Tina Tessina
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We’ve written before about the health benefits of journaling, but how to get started, and how to make it a habit, and what even to write about?
Dr. Tessina presents a year’s worth of journaling prompts with explanations and exercises, and no, they’re not your standard CBT flowchart things, either. Rather, they not only prompt genuine introspection, but also are crafted to be consistently uplifting—yes, even if you are usually the most disinclined to such positivity, and approach such exercises with cynicism.
There’s an element of guidance beyond that, too, and as such, this book is as much a therapist-in-a-book as you might find. Of course, no book can ever replace a competent and compatible therapist, but then, competent and compatible therapists are often harder to find and can’t usually be ordered for a few dollars with next-day shipping.
Bottom line: if undertaken with seriousness, this book will be an excellent investment in your mental health and general wellbeing.
Click here to check out 52 Weeks to Better Mental Health, and get on the best path for you!
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Black Bean Burgers With Guacamole
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Once again proving that burgers do not have to be unhealthy, this one’s a nutritional powerhouse full of protein, fiber, vitamins, and minerals, as well as healthy fats and extra health-giving spices.
You will need
- 1 can black beans, drained and rinsed (or 1 cup same, cooked, drained, and rinsed)
- 3 oz walnuts (if allergic, substitute with pumpkin seeds)
- 1 tbsp chia seeds
- 1 tbsp flax seeds
- ½ red onion, finely chopped
- 1 small eggplant, diced small (e.g. ½” cubes or smaller)
- 1 small carrot, grated
- 3 tbsp finely chopped cilantro (or if you have the “this tastes like soap” gene, then substitute with parsley)
- 1 tbsp lemon juice
- 1 jalapeño pepper, finely chopped (adjust per heat preferences)
- ¼ bulb garlic, crushed
- 2 tsp black pepper
- 1 tsp smoked paprika
- 1 tsp cayenne pepper (adjust per heat preferences)
- ½ tsp MSG or 1 tsp low-sodium salt
- Burger buns (you can use our Delicious Quinoa Avocado Bread recipe if you like)
For the guacamole:
- 1 large ripe avocado, pitted, skinned, and chopped
- 1 tbsp lime juice
- 1 tomato, finely chopped
- ¼ red onion, finely chopped
- ¼ bulb garlic, crushed
- 1 tsp red chili pepper flakes (adjust per heat preferences)
Method
(we suggest you read everything at least once before doing anything)
1) Process the walnuts, chia seeds, and flax seeds in a food processor/blender, until they become a coarse mixture. Set aside.
2) Heat a little oil in a skillet, and fry the red onion, aubergine, and carrot for 5 minutes stirring frequently, then add the garlic and jalapeño and stir for a further 1 minute. Set aside.
3) Combine both mixtures you set aside with the rest of the ingredients from the burger section of the recipe, except the buns, and process them in the food processor on a low setting if possible, until you have a coarse mixture—you still want some texture, not a paste.
4) Shape into patties; this recipe gives for 4 large patties or 8 small ones. When you’ve done this, put them in the fridge for at least 30 minutes, to firm up.
5) While you wait, make the guacamole by mashing the avocado with the lime juice, and then stirring into the onion, tomato, garlic, and pepper.
6) Cook the patties; you can do this on the grill, in a skillet, or in the oven, per your preference. Grilling or frying should take about 5 minutes on each side, give or take the size and shape of the patties. Baking in the oven should take 20–30 minutes at 400℉ / 200℃ turning over halfway through, but keep an eye on them, because again, the size and shape of the patties will affect this. You may be wondering: aren’t they all going to be patty-shaped? And yes, but for example a wide flat patty will cook more quickly than the same volume of burger mixture in a taller less wide patty.
7) Assemble! We recommend the order: bottom bun, guacamole, burger patty, any additional toppings you want to add (e.g. more salad, pickles, etc), top bun:
Enjoy!
Want to learn more?
For those interested in some of the science of what we have going on today:
- Level-Up Your Fiber Intake! (Without Difficulty Or Discomfort)
- Chickpeas vs Black Beans – Which is Healthier?
- Kidney Beans or Black Beans – Which is Healthier?
- Coconut vs Avocado – Which is Healthier?
- Our Top 5 Spices: How Much Is Enough For Benefits?
Take care!
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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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What happens to your vagina as you age?
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The vagina is an internal organ with a complex ecosystem, influenced by circulating hormone levels which change during the menstrual cycle, pregnancy, breastfeeding and menopause.
Around and after menopause, there are normal changes in the growth and function of vaginal cells, as well as the vagina’s microbiome (groups of bacteria living in the vagina). Many women won’t notice these changes. They don’t usually cause symptoms or concern, but if they do, symptoms can usually be managed.
Here’s what happens to your vagina as you age, whether you notice or not.
Let’s clear up the terminology
We’re focusing on the vagina, the muscular tube that goes from the external genitalia (the vulva), past the cervix, to the womb (uterus). Sometimes the word “vagina” is used to include the external genitalia. However, these are different organs and play different roles in women’s health.
What happens to the vagina as you age?
Like many other organs in the body, the vagina is sensitive to female sex steroid hormones (hormones) that change around puberty, pregnancy and menopause.
Menopause is associated with a drop in circulating oestrogen concentrations and the hormone progesterone is no longer produced. The changes in hormones affect the vagina and its ecosystem. Effects may include:
- less vaginal secretions, potentially leading to dryness
- less growth of vagina surface cells resulting in a thinned lining
- alteration to the support structure (connective tissue) around the vagina leading to less elasticity and more narrowing
- fewer blood vessels around the vagina, which may explain less blood flow after menopause
- a shift in the type and balance of bacteria, which can change vaginal acidity, from more acidic to more alkaline.
What symptoms can I expect?
Many women do not notice any bothersome vaginal changes as they age. There’s also little evidence many of these changes cause vaginal symptoms. For example, there is no direct evidence these changes cause vaginal infection or bleeding in menopausal women.
Some women notice vaginal dryness after menopause, which may be linked to less vaginal secretions. This may lead to pain and discomfort during sex. But it’s not clear how much of this dryness is due to menopause, as younger women also commonly report it. In one study, 47% of sexually active postmenopausal women reported vaginal dryness, as did around 20% of premenopausal women.
Other organs close to the vagina, such as the bladder and urethra, are also affected by the change in hormone levels after menopause. Some women experience recurrent urinary tract infections, which may cause pain (including pain to the side of the body) and irritation. So their symptoms are in fact not coming from the vagina itself but relate to changes in the urinary tract.
Not everyone has the same experience
Women vary in whether they notice vaginal changes and whether they are bothered by these to the same extent. For example, women with vaginal dryness who are not sexually active may not notice the change in vaginal secretions after menopause. However, some women notice severe dryness that affects their daily function and activities.
In fact, researchers globally are taking more notice of women’s experiences of menopause to inform future research. This includes prioritising symptoms that matter to women the most, such as vaginal dryness, discomfort, irritation and pain during sex.
If symptoms bother you
Symptoms such as dryness, irritation, or pain during sex can usually be effectively managed. Lubricants may reduce pain during sex. Vaginal moisturisers may reduce dryness. Both are available over-the-counter at your local pharmacy.
While there are many small clinical trials of individual products, these studies lack the power to demonstrate if they are really effective in improving vaginal symptoms.
In contrast, there is robust evidence that vaginal oestrogen is effective in treating vaginal dryness and reducing pain during sex. It also reduces your chance of recurrent urinary tract infections. You can talk to your doctor about a prescription.
Vaginal oestrogen is usually inserted using an applicator, two to three times a week. Very little is absorbed into the blood stream, it is generally safe but longer-term trials are required to confirm safety in long-term use beyond a year.
Women with a history of breast cancer should see their oncologist to discuss using oestrogen as it may not be suitable for them.
Are there other treatments?
New treatments for vaginal dryness are under investigation. One avenue relates to our growing understanding of how the vaginal microbiome adapts and modifies around changes in circulating and local concentrations of hormones.
For example, a small number of reports show that combining vaginal probiotics with low-dose vaginal oestrogen can improve vaginal symptoms. But more evidence is needed before this is recommended.
Where to from here?
The normal ageing process, as well as menopause, both affect the vagina as we age.
Most women do not have troublesome vaginal symptoms during and after menopause, but for some, these may cause discomfort or distress.
While hormonal treatments such as vaginal oestrogen are available, there is a pressing need for more non-hormonal treatments.
Dr Sianan Healy, from Women’s Health Victoria, contributed to this article.
Louie Ye, Clinical Fellow, Department of Obstetrics and Gynecology, The University of Melbourne and Martha Hickey, Professor of Obstetrics and Gynaecology, The University of Melbourne
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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