COVID Recovery: When Ascending the Steps Seems Like Climbing Mt Everest

The date on the calendar read April 10th, Good Friday. For me, it was Great Friday. After 20 days of battling COVID-19, I was being discharged from Penn Presbyterian Medical Center. I had been unconscious and on a ventilator for 13 of those days, suspended somewhere between life and whatever comes next.

Almost 35% of patients with COVID-19 who need ventilators don’t make it off them. But, 6 days after I was admitted and intubated, things were looking so good that my care team considered taking me off the ventilator. Then, it all came crashing down. After being fever-free for 48 hours, I suddenly spiked a 103.5-degree temperature. My heart rate was elevated and I was struggling to breathe.

I had developed ventilator-associated pneumonia, something that affects between 9% to 27% of people on ventilators, and I received intravenous antibiotics to treat it. Doctors told my daughter Lindsey, who is a nurse practitioner, that they didn’t know how much more my body could handle. Yet, thanks to my medical team, I pulled through. I was going home. So, yeah, it was Great Friday for me. What I didn’t realize was that being discharged was just the end of the beginning of my COVID-19 journey.

The April air was bracing as the hospital’s sliding glass doors opened. The sky, which I hadn’t seen in almost three weeks, was a brilliant blue. And there waiting by her car was my fiancée Monica, waiting to take me home. I felt alive.

I was toting a brand new, silver walker along with my personal belongings. Two weeks before COVID, I’d been goal-tending in a men’s ice hockey league, a decades-long routine that kept me in good overall shape. Now here I was, in a wheelchair, holding in front of me a folded walker like a car grill. And, as if that weren’t humbling enough, a sunshine yellow band wrapped around my left wrist declared that I was a FALL RISK, in black letters big and bold enough that a nearsighted person could see them from a block away. And I was indeed a fall risk. I had surrendered 27 pounds to COVID, reducing my goal-tender-toned legs to spindly twigs that Monica called “chicken legs.”

Getting into our house was the first challenge I faced. The six steps I usually bound up suddenly seemed as daunting as summiting Mount Everest. Walker, my new friend, was useless. I grabbed the railing, steadied myself and made the assault with Monica right behind me. I reached the sofa, my head swimming and my heart racing so fast it felt like my chest was vibrating.

I slept a lot at first. The slightest change in posture elevated my heart rate. Talking left me exhausted. Bigger tasks, like showering, required detailed planning and preparation—positioning the shower chair for a smooth transition to Walker, regulating the water temperature (warm but not so steamy as to affect my breathing), then moving from the chair back to Walker. A few days after being discharged, we received a package from Penn’s COVID-19 home-healthcare team. It contained a digital thermometer, a blood pressure cuff, an oximeter (to measure my blood oxygen levels) and a computer tablet.

Every morning and afternoon, Monica loaded my vital signs onto the tablet, in preparation for my twice daily rendezvous with a nurse. The tablet was also used for weekly appointments with a physical therapist and an occupational therapist. Working in concert, Sarah (PT) and Marissa (OT) were vital to my recovery.

My first steps to recovery lasted 30 seconds with Walker. I marched in place (holding on to Walker), practiced sitting down and standing up, did seated toe raises, and balanced on one leg with my hands on a counter. Because I could perform basic self-care and wanted to get back to writing and playing guitar, Marissa focused on range of motion, coordination and hand strengthening exercises with light bands.

My endurance and strength grew. Before long I could, in short spurts, maneuver around the keyboard and play guitar. On nice days Monica and I walked to our neighbor’s house and—eventually—down the street, sans Walker. I graduated from bands to 5-pound weights, which quickly went to 10 pounds, and doing step-ups balancing on one leg.

My heart still raced and I was occasionally short of breath and thoroughly spent after my activities. But I kept going. Five weeks after being discharged from the hospital, I was discharged again, this time from homecare by my nurse and therapists.

I consider myself among the lucky COVID-19 survivors. My heart rate is back to a normal resting range and my breathing has greatly improved. The only lingering issue is my voice. I am told that could take six months to resolve. Otherwise, I am pretty much the person I was before COVID. There are a lot of people to thank for that, especially the doctors and nurses at Penn Presbyterian Medical Center. They saved my life. Then, Monica and my telemedicine team helped me to reclaim my life.

Editor’s note: Following Bob’s illness, he and his friends wrote and recorded a song honoring healthcare workers who work so hard all the time, but particularly during the pandemic to help their patients: Fierce Captains at the Helm.


Daily Aspirin May Cause More Harm Than Good in Healthy Adults

Low-dose aspirin therapy became popular for several years as older adults with low- to moderate-risk of heart disease were often advised to take baby aspirin to help prevent a first heart attack or stroke. But recent studies have found that people in this group who take baby aspirin (81 mg) daily could be at risk for internal bleeding risks without any protection against heart disease.
According to a study published in the Annals of Internal Medicine, around 29 million people in the United States, aged 40 and older, regularly take aspirin. Among them, 6.6 million (24%) do so without their doctor’s recommendation. The researchers cited three randomized controlled trials that examined the supposed benefits of aspirin therapy in older adults. However, all three showed that while daily aspirin provided minimal benefit to users, it did lead to bleeding risks.

New Low-Dose Aspirin Guidelines
The American Heart Association issued a set of guidelines in March 2019 that advised against regular daily use of low-dose aspirin among healthy people who do not have any history of heart disease or stroke. The American College of Cardiology also contributed to the guidelines. Regular low-dose aspirin use in this group could cause more harm than good, the guidelines said. However, “ The new recommendation doesn’t apply to people who already have had a stroke or heart attack, or who have undergone bypass surgery or a procedure to insert a stent in their coronary arteries,” the guidelines state.

Internal Bleeding Is a Known Side Effect of Aspirin

Aspirin has long been known to cause internal bleeding in some people. Harvard Health Publishing reported in their November 2019 Harvard Health Letter that aspirin could cause problems in some patients. “It’s a big shake-up, based on three large studies,” Christopher Cannon, MD, stated in the press. Dr. Cannon is the director of education in Cardiovascular Medicine Innovation at Harvard-affiliated Brigham and Women’s Hospital, and a professor at Harvard Medical School in Boston. “Two of the three [studies] showed there was no benefit to taking daily aspirin to prevent a first heart attack or stroke, and aspirin was associated with an increased risk for bleeding severe enough to require transfusions or hospitalization,”
“The other study showed that in people with diabetes but no cardiovascular disease, there was benefit, but also risk: a 1% reduction in heart attack risk, and a 1% increase in bleeding risk,” he added.

The Take-Away

The biggest take-away from these findings is that there is still a place for aspirin therapy among older adults who have had a heart attack or stroke, but not for everyone. The studies and updated guidelines only discourage daily aspirin among those who are healthy and who don’t have any heart conditions.  
This article is an update of  Daily Aspirin Could Harm Healthy Older Adults, Offers No Benefit, published by Sadhana Bharanidharan​, September 17, 2018.


CBD Oil for Anxiety: A Better Option for Panic Attacks?

Mental health is an ever growing concern in the United States. According to the National Alliance on Mental Illness, one in five American adults experiences mental illness every year. That is roughly 47 million people.

Most generalized mental health conditions like panic disorder, depression, anxiety order, and post-traumatic stress disorder are treated with SSRIs (serotonin reuptake inhibitors) that should increase levels of serotonin in the brain. These medications are useful for some, but can also carry a load of side effects and varying results. Many people are seeking an alternative approach when it comes to mental health, something more holistic and natural.

What is CBD?

CBD, also known as cannabidiol, is one of the many compounds found in hemp and sativa cannabis plants. CBD products have been in use for years in the health and wellness worlds, but are gaining more recent traction for mental health.  CBD is the sometimes less known cousin of THC, the psychoactive portion of cannabis plants. Though the two are derived similarly, they are in-fact vastly different. CBD can be extracted and isolated from hemp and cannabis plants, which allows for a pure product without the chance for a “high.”

Though research is still emerging, this natural compound is thought to aid human and animal wellness in a variety of ways from anxiety to pain management. CBD interacts directly with the endocannabinoid system, or ECS, which manages the receptors transmitting to the brain. Because of this, CBD has been gaining exponential popularity for aiding in mental health.

CBD for Panic Attacks

A panic attack can be an intense episode of anxiety or fear, often accompanied by various physical symptoms ranging from increased heart rate to shortness of breath and much worse. There is research  that identifies pathways to the brain that control these emotions and responses, which CBD can influence. There is some evidence supporting the use of CBD for panic attacks and anxiety, though more studies are necessary.

Current common treatments for panic attacks and panic disorders are prescribed medications, which can be moderately effective. There is a need for new treatments as not even half of people suffering from panic disorder solve their attacks with these prescribed SSRIs.

CBD has emerged as a popular choice for Americans looking for a better or more natural approach to chronic pain, sleep issues and anxiety. Because managing stress is an integral part of any mental health issue, CBD can be used to help. The interaction between cannabidiol and the ECS points to positive impacts on serotonin receptors in the brain. More specifically, the CB1 and CB2 receptors in the ECS are found to be help control our emotions, pain management, inflammation, mood and behaviors. Some research shows that when CBD stimulates these receptors, it can lower someone’s level of anxiety and fear.


If you or someone you know is suffering from mental health issues, there is always an option for finding help. Consult your doctor or therapist. If you are seeking a natural alternative and option to help manage anxiety or panic attacks, CBD could be beneficial to you. It’s important to always turn to reliable sources when it comes to purchasing CBD. To compare reliable and lab-backed CBD products, check out the latest tested products from Real Tested CBD. Because the use of CBD for anxiety and panic disorders is optimistic, there are a number of companies on the market nowadays. Always look double check for label claims, purity, potency and third-party test results.

NOTE: This article is a contribution from our advertiser and does not necessarily represent the views of Medical Daily


CBD For Pain Relief: How Effective Is It Really?

It seems that more people are using cannabidiol (CBD) for medical purposes and if you have chronic pain, you might be wondering if you should add it to your own pain management routine. Research is still emerging and CBD hasn’t yet been approved by the Federal Food and Drug Administration (FDA) as a pain reliever, but many people say that CBD helps reduce their inflammation and pain.

Pain impacts everyone at some point in their life, so the use of a natural remedy is enticing. And as CBD research is ongoing, the thought of using CBD now as a natural pain killer may be promising, given the dangers that accompany some other available pain relievers.

How CBD Might Help Manage Pain

Cannabinoids already exist in the human body and are part of the endocannabinoid system. This system has an effect on appetite, pain sensation, memory, and more. Cannabinoids are also the active ingredient in CBD. They bind with neuroreceptors in the body to block signals from sending pain signals to the brain. It also may be that CBD keeps the body from absorbing a compound called anandamide, which helps limit the amount of pain a person feels.

CBD is believed to also have anti-inflammatory properties that can block or slow the inflammatory response in your body that can cause pain. As researchers look more into CBD properties, it would be helpful to have a product that that can provide this effect without the harsh side effects of some pain medications. Since pain is often related to inflammation, CBD might an option. Despite the lack of hard scientific evidence, CBD does appear to relieve both pain and inflammation in some people. Patients who are interested in trying it should discuss this with their doctor – about how much they can take and whether the CBD may interact with any other medications they take.

CBD For Joint Pain,  Arthritis, and Back Pain

CBD may be helpful for people who live with joint pain related to arthritis or other conditions that impact the immune system, again because of the possible anti-inflammatory properties. It may also help suppress the immune system that can help fight against certain diseases. Although CBD products are available in liquids or capsules, to be taken by mouth or added to food, they are also available in topical applications – creams and ointments. Topical CBD may be a better choice for targeting specific areas, like achy joints.

Some people with chronic back pain also use CBD products for relief. Historically, many people with back pain were given opioids, but these can be addictive. CBD may be a viable option for chronic back pain, again because of its possible anti-inflammatory actions. Additionally, some people find CBD helps manage anxiety that can be the result of prolonged back pain. As with arthritis, topicals that are high in CBD may ease back pain. And, CBD oil may not reach the bloodstream like oral CBD does. However, just as you should speak to your doctor about taking oral CBD, consult with him or her if you want to use topical CBD, just to be sure.

CBD For Muscle Pain

Some athletes report using CBD for muscle pain and recovery from extensive exercise. This could be the result of the muscle relaxant properties related to CBD, relieving the tension that leads to pain. Additionally, CBD may help speed up the body’s natural healing process, improving the effects of a work out. And, if CBD supports better sleep cycles, as some claim, it may accelerate recovery so your next workout is as intense as the one before.

Some athletes have claimed that taking CBD before a workout is beneficial for pushing your body to its limit. CBD oil has been gaining popularity among athletes in recent years and it has been credited with enhancing focus while delivering more substantial results. CBD topicals may also be used as a sort of “spot-treatment” when applied over the tissue that is hurting most. When taken orally, CBD oil may reduce tension and spasms, from overusing muscles.

Is CBD A Safe Pain Reliever?

With the limited amount of data and research available, many people are still concerned with the risks associated with taking CBD. The FDA has approved some products with CBD for children who have severe forms of epilepsy, but not for overall pain relief. If you want to try CBD to relieve pain, speak with your doctor for your unique situation. As with any drug, different people experience different effects, so working with an expert is important .

For people who are concerned about addiction, as may happen with opioids, CBD alone is not likely to be addictive, but it may be if it is combined with THC, the substance that gives you the “high.” This may make CBD preferable over potentially addictive medications like opioids. Keep in mind, however, that the information in this article is based on anecdotal evidence rather than scientific findings.

In conclusion, the brand, type, and method of CBD you use is your choice, according to your lifestyle and preferences. There are many brands to sift through, so you should do your research to see what works best when it comes to the pain you have. With little to no government regulation, some companies do not use the most potent CBD available in their products, which can limit how much pain relief you may feel. We would like to believe that CBD is a natural alternative to pain killers and would love to hear your thoughts on this topic. To compare CBD products with lab-test results, click here.

NOTE: This article is a contribution from our advertiser and does not necessarily represent the views of Medical Daily


Back-to-School in 2020: Making the Right Choice

In any other year, August is often a month of pool parties and back-to-school shopping. This August however, parents are instead grappling with whether or not there should be any back-to-school at all. With COVID-19 cases rising in some states, many school districts have elected to start the 2020 school year entirely online. Others are giving parents options to choose a hybrid model of some in-person and some online classes. How are families to decide what to do and what are the risks?

Brooke Hurley, aged 39,  laughed as she described her daughter’s preparations for school. “She told me the other day that when she gets to kindergarten it’s going to be like preschool. She’ll put her backpack in her cubby and hang her coat up and then they’ll have play time.” Her daughter turned five this summer and was excited to start kindergarten, or at least, what a five-year-old thinks kindergarten will be like.

Brooke and her husband Dave Hurley, aged 45, live in South Williamsport, Penn. They decided to keep their daughter home this year, delaying her entry to kindergarten until she’s six. “If she has a bad experience in kindergarten, I don’t want her to look at school like a prison,” Brooke said. This doesn’t mean no education at all though. “We do work with her every day. We try to read to her, we get her to try to read. She writes a little bit every day, does a little bit of math.” 

Although both work, the Hurleys say they’re lucky. “We have a pretty good support network around us with my parents and Brooke’s parents,” explained Dave. “Brooke’s mom was a teacher so we have people to help kind of guide her.” 

Is There a Right or Wrong?

But what is the right call? Should we all be staying home or is in-person school a good idea? Like most COVID-19 conundrums, there isn’t a clear yes or no answer. Susan Coffin, MD, a physician at the Children’s Hospital of Philadelphia (CHOP), said she wants to see transmission going down and a low rate of virus before kids go back. Speaking in a webinar for the media, hosted by CHOP, Dr. Coffin said the idea of wanting low rates of transmission before schools start again is universal. “I really would want to know that the schools my children are going to go to are adequately resourced,” Dr. Coffin said, “Do they have a good and workable plan to keep children and staff safe while in school?” 

But going to school and staying safe won’t be easy. “Children are naturally social critters, I always think that they’re sometimes drawn to each other as if they’re magnets,” Dr. Coffin joked. But there are some workable solutions. She mentioned circles on the floor to encourage distancing, classes held outdoor or in a gym, or the popular hybrid model where some students stay home while others attend in person. 

But what happens if someone at school does get sick, despite the precautions? What then? Dr. Coffin said to expect your schools to be in close contact with public health officials. “We don’t want to break people’s privacy, so we will have to be respectful and not allow the rumor mill to get too far ahead of us,” Dr. Coffin said. 

Going to School

If you’ve made the decision to send your children to school, Dr. Coffin suggested sending them out the door with their own mask, a back-up mask, and some hand sanitizer. Jason Lewis, PhD, a psychologist at CHOP who also participated in the webinar, advised that parents talk to their children early and often about the need for wearing masks in order to prepare them. “Practice having them use [a mask] around the house in a familiar situation. Start off with little doses at a time.” 

“You can think about using positive reinforcement strategies, certainly lots of praise, labeled praise, lots positive attention,” Dr. Lewis suggested. Even a little bit of bribery might be okay. “If they wear the mask for a certain amount of time they can earn some type of reward, whether it be extra time on TV, they get to choose dessert, or special playtime with mom or dad,” he offered.

Children Are Smarter Than We Give Them Credit For

Kids do seem to grasp the situation. The Hurley’s daughter has taken some of the safety advice to heart. “If anybody tries to blow her a kiss she goes, “Do not blow me a kiss, you know that’s not good.”” Brooke said. Although the Hurleys seem confident in their decision to delay kindergarten a year, thinking about the social aspect is hard. “She has had very little social interaction with other little kids,” Dave said. About a month ago the family had a socially distanced playdate to catch fireflies, and it was their daughter who enforced good social distancing rules. “She’s like, “There’s bugs over there. You’re getting too close.”” Brooke said.

Although Brooke and Dave seem very much on the same page, it hasn’t been easy. The school’s plans have changed a lot. Dave likened it to being stuck in a boat in the middle of the river, “having all these people yelling things at you, “Do this, do this, do this. You don’t know who to listen to, is kind of how I feel with it. Where’s good information coming from? Where’s the bad information coming from? And then it comes down to, okay, well, the officials who are they listening to. Are they listening to the good information, the wrong information, and how can they tell the difference if I can’t?”

If you’re worried about making the school decision, Dr. Coffin suggested some specific questions you can ask your school administrators: “Can you tell me what my child’s classroom is going to look like…tell me what’s going to look different,” or “I’m struggling to get my daughter to wear her mask, tell me what you’re going to do if she’s not able to wear her mask consistently.” She said this will be a good way to see how well your school has planned for some common problems. 

As for what in-person school might look like, Dr. Coffin said to expect more of the same. “The principles that various institutions are using to keep kids safe when they come to school should look a lot like what you’re getting used to seeing in your community,” she explained. “They’re going to be based on the exact same principles, principles of distancing, wearing masks and removing yourself or your child from a group of people if they have any symptoms or have been exposed to coronavirus.” 

Uncertainty Is OK

Feeling confused or conflicted about what to do is perfectly reasonable. “One of the first things that I would say is [parents] have to do their research,” Misty Hook, PhD, a licensed psychologist in Allen, Texas, told Medical Daily. Dr. Hook also added that these need to be reliable facts, from a trustworthy source like the CDC. Once you have your facts, then you can talk about the situation. Dr. Coffin recommended looking at your county health department for infection rates. Other sources are your state’s health department or the Johns Hopkins tracker, which counts cases by county. 

When Parents Don’t Agree

If you’re in a situation where you and your partner (or ex-partner) don’t agree about sending your child back, Dr. Hook suggested sitting down, in person if possible, and discussing the situation. But if that doesn’t work, the next step is looking for compromises. If both parents worry about socialization, but one fears in-person school, then maybe socially distant playdates and at-home schooling can be a good compromise. If compromise isn’t an option, Dr. Hook suggested asking, “Who has the biggest stake?” Dr. Hook has asthma, for example, which could put her at higher risk of contracting the virus, but this is broadly applicable. “Other people have their grandparents living with them, or they are caretakers for their elderly parents or something like that. So who has the biggest stake?” She suggested that parents who don’t agree ask each other what happens if the other is right? Sort of, what’s the worst case scenario if my fears are true. 

Talking to Your Child

Once you come to a decision, telling your child should be done in person, with an explanation of why you made your decision. If your child doesn’t agree, Dr. Hook suggested trying to change the narrative, “Emphasize compassion for others, the need to sacrifice for the good of society…or they can say this is a way that we show others that we care for them. So reframe the decision in a way that they probably get on board and think more positively than negatively.” Both Dr. Lewis and Dr. Hook emphasized the importance of acknowledging and validating a child’s feelings.

They also agreed it’s important to validate your own feelings and make time for self-care. “Let’s face it, this is an anxiety provoking time for us as adults as well, there’s a lot of uncertainty, and that affects us.” Dr. Lewis said. 


Don’t Depend on Coconut Oil for Heart Health; It Increases LDL Cholesterol

Coconut oil has become an increasingly popular ingredient as consumers look for healthier plant-based foods that are low in unsaturated fats. But maybe that container of coconut oil should remain in your pantry for now, given the results of a study review that looked at how healthy coconut oil really is. The researchers found that consuming coconut oil may actually increase your “bad” cholesterol, much more than other non-tropical vegetable oils.

“Good” vs “Bad” Cholesterol

Not all cholesterol is bad. Our body needs some in order to produce vital hormones, vitamin D, and other substances. The “bad” cholesterol we hear so much about is called low-density lipoprotein or LDL. The “good” cholesterol is high-density lipoprotein or HDL. The LDL can cause a plaque build-up in your arteries, making it difficult for blood to flow freely. Plaque can also break off and travel to your heart or brain, causing a heart attack or stroke. HDL, on the other hand, cleans your blood by removing some of the LDL. Many factors can increase LDL, such as diabetes, obesity, unhealthy diets, sedentary lifestyles, drinking alcohol, and smoking. 

What the Study Looked At

The study, published in the American Heart Association (AHA)’s journal Circulation, was led by researchers from the Saw Swee Hock School of Public Health, National University of Singapore. They evaluated 16 studies from online medical databases that compared coconut oil’s effects against heart-healthy oils. These oils, such as olive oil, canola oil and almond oil, among others, have less saturated fat and contain monounsaturated and polyunsaturated fats that are good for your heart, according to the AHA.

In the review’s conclusion, the researchers found that coconut oil consumption increased LDL cholesterol levels 10.47 mg/dL more than non-tropical vegetable oils did. Although, the coconut oil did positively impact good cholesterol (and increase of 4.00 mg/dL), the negative effect was far worse.

Just being overweight or obese is a major risk for heart disease, which kills 647,000 Americans every year, according to the CDC. And since coconut oil is high in saturated fat, the researchers also wanted to know the impact coconut oil may have on weight gain. Obesity, inflammation and fasting glucose (blood glucose levels after you have fasted for several hours) were not affected by the coconut oil. Only the LDL was visibly increased.

All Oils Must Be Used With Caution

The Mayo Clinic calls the notion of coconut oil being heart-healthy a myth because there is no evidence on the supposed benefits. Other vegetable oils such as canola or olive oil have been studied across long-term studies, leading researchers to believe they are safe to consume. However, the right oils must be used for the right purposes. Some oils should not be used at higher temperatures.

Choosing the appropriate cooking oil should be determined by the maximum temperature at which it can burn, called the smoke point. This is when the oil turns toxic at a high boiling point. For instance, almond, avocado and hazelnut oils have a high smoke point. If you need an oil that has a higher smoke point, you should choose one in this group. Corn, hemp and pumpkin seed oils have medium smoke points, explains Cleveland Clinic.

Additionally, the AHA tells us to avoid partially hydrogenated oils or those made with unsaturated fat called trans-fat, which is known to increase LDL. For every tablespoon, the oils should have less than 4 grams of saturated fat, the AHA states. So, the next time you’re out grocery shopping, you know what not to get. 


One Area COVID-19 Doesn’t Seem to Affect: Increasing Risk of Blood Clot During Pregnancy

Pregnant women have enough to worry about. But research shows that blood clots from COVID-19 may not be one of them.

Blood clots that seal a cut or wound are welcome and necessary; clots inside your body are not. To keep your organs and body tissues healthy, fresh blood must pump through the blood vessels and “used” blood must return to the lungs to be refreshed with oxygen. Blood clots cause two serious problems: they either block or restrict the blood flow, which is dangerous, or break off and travel to other parts of the body, which can kill you. In the first event, body tissue can die from lack of nutrients because the blood can’t flow freely, leading to gangrene. In the second event, the broken off pieces can lead to vital organs like the heart, the lungs and the brain, heart attacks, pulmonary emboli, or strokes.

Pregnancy Affects Clotting

Pregnant women have a higher risk of these clots than women who aren’t pregnant. But COVID-19 seems to have given them a pass — one of the few, if only, groups shown such compassion. 

First, an explanation on why pregnant women are at risk for blood clots. When a woman gets pregnant, her body begins to prepare for delivery in several ways; two increase the blood clotting risk.

First, the blood “thickens” a bit during pregnancy to lessen the amount of blood lost during delivery. Otherwise, it would be hard to stop the bleeding that occurs when the placenta separates from the uterus. Second, carrying the baby can also contribute to clots. As the baby grows, it may press down on the blood vessels in the mother’s pelvis, restricting how much blood can flow back and forth from her legs. Finally, after pregnancy, women are still at risk for a few months, particularly if they had a Caesarian section or have to remain on bedrest.

Pregnant women can also fit into other high risk groups along with, such as those who:

  • Are on prolonged bed rest or are immobile
  • Have a blood clotting disorder
  • Smoke
  • Are overweight or obese

Women Who Take Estrogen Are Also at Risk

The researchers also looked at women who use oral contraceptives to prevent pregnancy or hormone replacement therapy (HRT). The Centers for Disease Control and Prevention says that 12.9% of women in the U.S. who use contraception use the birth control pill. In addition, thousands of women take HRT after menopause, as do transgender women. They, too, are at higher risk of developing blood clots, because of the estrogen in the medications. Their risk can climb if they belong to any of the risk groups listed above, in addition to being over 60 years old. “Estrogen, a key ingredient in most birth control pills, increases a woman’s risk for developing a blood clot by increasing the plasma concentration of clotting factors,” Susan Todd Peeler, MD, a board certified gynecologist with The Institute for Gynecologic Care at Annapolis, told Medical Daily. “This shifts the balance towards [clot] formation and prevention of clot breakdown.” She added that the clotting effects from the birth control medications depend on the amount of estrogen as well as the type of progesterone the pill contains.

Now to COVID-19

Physicians and researchers are learning more about COVID-19 as they treat more patients. One important and potentially fatal complication associated with the infection is blood clots. According to an article published by The Ohio State University Wexner Medical Center, physicians found clots in the brain, heart, lungs, and legs in many of their COVID-19 patients. Notably, Broadway star Nick Cordero, who died from COVID-19, developed blood clots earlier in his fight, which forced his physicians to amputate one leg. Given that these pregnant women and those taking estrogen are already at higher risk, researchers wondered if that risk was amplified if they became infected with COVID-19. And if so, what would be the best way to treat them?

“During this pandemic, we need additional research to determine if women who become infected with the coronavirus during pregnancy should receive anticoagulation therapy or if women taking birth control pills or hormone replacement therapy should discontinue them,” said one of the study’s authors, Daniel I. Spratt, MD, in a press release issued by the Endocrine Society. Spratt is from the Maine Medical Center in Portland, and Tufts University School of Medicine in Boston. “Research that helps us understand how the coronavirus causes blood clots may also provide us with new knowledge regarding how blood clots form in other settings and how to prevent them.”

The authors wrote that there are many uncertainties but so far, there has not been an increase in pregnant women getting blood clots if they also had COVID-19, but researchers have detected some abnormalities in the placenta.

What Does This Mean in Real Life?

Peeler was not surprised to hear that there was a concern that pregnant women or those using hormones may be at increased risk of clots. However, she doesn’t recommend anticoagulants (blood thinners) be started or oral contraceptives/HRT be stopped as a matter of course. “There is incomplete evidence to support discontinuation of estrogen therapy (HRT or OCP) in these patients,” she said. “However, the patient should discuss all medications with their treating physician at the time of COVID-19 diagnosis for personalized advice.” Adults who are hospitalized with COVID-19 should be watched and treated for blood clots as would any other hospitalized adult, she added. “Any medication that potentially increases the risk for a blood clot would be discontinued in these patient’s upon admission. For pregnant patients admitted to the hospital with COVID-19, recommendations for [clot prevention] are the same as those for hospitalized nonpregnant patients.”

If you are pregnant, or you take birth control pills or HRT, speak with your doctor about what you should do if you are exposed to COVID-19 or if you have symptoms. Because this illness is so new, there are still many unknowns and speaking directly with a healthcare professional who knows your situation is the best step.


The News You’ve Longed to Hear: Eating Chocolate 3x a Week Could Help the Heart

It appears that having a sweet tooth may be helpful after all. In fact, eating chocolate in moderation a few times a week could benefit you. According to a study published recently in the European Journal of Preventive Cardiology, consuming chocolate between one to three times per week reduced risk of coronary artery disease by 8 percent. 

To draw this conclusion, researchers across the U.S. looked at six studies over five decades from 1966 to January 2020. Comprising 336,289 individuals, the study subjects were from three continents. This included 266,264 people from the United States, 68,809 from Sweden and 1,216 from Australia. 

Individuals were followed for nearly nine years in the chosen studies to be able to make comparisons between people who did not eat chocolate and the progression of the diseases they suffered from. As many as 21,777 diseases were reported by the participants during the follow-up period. Of which, 14,043 cases were of coronary artery disease, 4,667 heart attacks, 2,735 strokes and 332 heart failures. This gave the study’s authors the opportunity to investigate the impact of chocolate on disease risk, particularly if it affected the heart’s functioning.  

“Our study suggests that chocolate helps keep the heart’s blood vessels healthy. In the past, clinical studies have shown that chocolate is beneficial for both blood pressure and the lining of blood vessels. I wanted to see if it affects the blood vessels supplying the heart (the coronary arteries) or not. And if it does, is it beneficial or harmful?,” study author Dr. Chayakrit Krittanawong of Baylor College of Medicine, Houston, Texas said in the news release.

This systematic analysis of previous studies took the quantity of chocolate into account. Each serving was limited to 30 grams of chocolate. Researchers could not determine the optimal amount required to promote good health as chocolate products are made with milk, sugar and fat in varying amounts. For this reason, Dr. Krittanawong advises against overindulging: “Moderate amounts of chocolate seem to protect the coronary arteries but it’s likely that large quantities do not.The calories, sugar, milk, and fat in commercially available products need to be considered, particularly in diabetics and obese people.”

chocolate Dark chocolate is among the top sources of antioxidants that could help improve health and reduce risk of diseases. Pixabay

When it came to understanding protective effects of chocolate on diabetes alone, the researchers found that eating two servings of chocolate helped prevent diabetes. However, when the consumption was increased to about six servings per week, no positive effect was noted on diabetes control. With congenital heart defect (CHD) and strokes, disease risk was brought down by less than three servings a week. “In conclusion, chocolate intake is associated with decreased risks of CHD, stroke, and diabetes. Consuming chocolate in moderation [≤6 servings/week] may be optimal for preventing these disorders,” the authors wrote.

While it may be confusing to people that doctors generally do not recommend food with sugar content, dark chocolate in moderation is recommended for people with diabetes and heart disease. Cocoa, the main ingredient in chocolate, contains flavonols, an antioxidant that can reduce risk of heart disease and diabetes, according to the Mayo Clinic.“Chocolate contains heart healthy nutrients such as flavonoids, methylxanthines, polyphenols and stearic acid which may reduce inflammation and increase good cholesterol [high-density lipoprotein or HDL cholesterol],’’ Dr. Krittanawong explained. 

Nevertheless, the new study did not examine the different types of chocolates available, hence the paper did not mention dark chocolate specifically. The study has many such limits. Researchers could not determine the physiological process of chocolate consumption and reduced risk of heart disease either. Therefore, long-term, double-blind, randomized controlled trials are required to understand this further, they said. One such study due to be completed by 2021 is COSMOS (for COcoa Supplement and Multivitamin Outcome Study) led by Harvard and Brigham and Women’s Hospital.

This four-year long study with 18,000 people is examining whether cocoa extract supplement containing 600 mg/d flavanols and a multivitamin could protect cardiovascular health and cancer risk. Furthermore, Harvard researchers maintained that their intention is not to make a clinical recommendation, but to provide more information on the benefits of cocoa flavanols. 


Making Smart Lifestyle Changes Now Could Alter AD’s Risk Later

Dementia is not an inevitable part of aging, although we couldn’t be faulted for thinking so given the high number of Americans who live with the condition. Alzheimer’s disease (AD) is the most common cause of dementia, affecting more than 5.5 million adults in the United States alone. The World Health Organization (WHO) estimates there are about 50 million people worldwide with AD, and the number is increasing by 10 million every year. These numbers are going to continue climbing as the world’s population ages. We need to act now to help combat this rise – but what can we do?

What Is Alzheimer’s Disease?
Medically and scientifically, AD is an irreversible, progressive brain disorder that slowly destroys memory and thinking skills. Eventually, according to the NIH, the patient can’t carry out the simplest tasks. Realistically, it’s a disease that takes our loved ones away from us, leaving behind a shell. It can tear a family apart emotionally and financially as they watch loved ones deteriorate over time.

There is no cure yet for AD. Some medications, like galantamine and memantine were approved by the Food and Drug Administration (FDA) to help manage AD symptoms in the early stages, but they don’t slow down the disease progression and they don’t cure it. People with AD can live for an average of three to 10 years after their official diagnosis, but their ability to function drops to the point that the cannot do the most basic tasks, like toileting or eating.

Since there is no cure, researchers are also working to find ways to either prevent the disease onset or delay it as much as possible. A study, published last month in the Journal of Neurology, Neurosurgery & Psychiatry, may give us a better look into what changes the average person can make to help minimize their AD risk. The researchers evaluated hundreds of studies that looked at modifiable factors, those can be changed, and interventions, what we can actually do. They looked at 134 risk factors and found 43 that could have a strong connection with AD. They narrowed them down to these top 10 risk factors:

  • Lower education level
  • Fewer current cognitive (mental) challenges and activity
  • High body mass index later in life
  • Hyperhomocysteinaemia, a condition that affects how amino acids are broken down in the body
  • Depression
  • High stress levels
  • Diabetes
  • Head trauma
  • High blood pressure (hypertension) in middle age
  • Orthostatic hypotension, blood pressure that drops just after you get up from a sitting or lying position

Other factors weren’t as strong, but could still play a role in AD development. They included smoking, lack of physical exercise, not getting enough sleep, having heart disease, and more.

New Blood Tests May Indicate AD Earlier

Currently, we can’t tell if someone definitely has AD until after death when the brain is evaluated in an autopsy. While still living, an AD diagnosis is based on excluding all other causes but researchers are working on tests that can tell if you have AD or might get AD.

Physicians who attended this year’s virtual Alzheimer’s Association International Conference (AAIC) learned about a new blood test that has had good results. The researchers said they developed a “highly accurate” blood test that measures levels of p-tau217, a protein and marker of AD. More study is needed, but early results are promising. “The p-tau217 levels were increased about seven-fold in Alzheimer’s, and, in individuals with a gene causing Alzheimer’s, the levels started to increase already 20 years before onset of cognitive impairment,” the presenters said. Although the test still must be verified and confirmed, the researchers believe that it will allow people to be diagnosed earlier and, with new clinical trials, new treatments may be discovered.

So, What Does This Mean for the Average Person?

No matter how hard we try to prevent illness or injury, there are no guarantees prevention will happen.   People who wear seatbelts can still be injured in a car accident – but their chances for survival are better with the seatbelt than without. The same holds true for trying to prevent diseases like AD. By living healthier lives and making lifestyle changes earlier in life, we may reduce our risks, especially if we have a family history of AD. But even more telling, the risk factors for AD are also risk factors for other diseases and conditions. People who exercise, manage their stress levels and blood pressure, treat their diabetes, and don’t smoke lower their risks of developing heart disease and strokes, for example.

Speak with your doctor about lifestyle improvements you can make. Starting slowly bit by bit will increase your chances of succeeding with these changes – trying too hard too fast often leads to giving up. Check with your insurance company if you’re covered for sessions with a dietitian to improve your diet, an athletic therapist to get moving, or a counselor to help manage stress and/or stop smoking.


Sideline Kids Longer with Concussion Injuries, Researchers Say

The studies are out there and so is the real-life evidence,  yet their messages of the dangers of concussion are being ignored, say authors of a new study: high school athletes are still sustaining brain injuries and in increasing numbers. These researchers also found that young athletes who get concussions need at least a month to recover. The new was study was published in the journal Orthopedics.

A concussion is a type of traumatic brain injury usually caused by a physical blow to the head, although any hit to the body that rapidly or violently shakes the neck and head can also cause a concussion. Concussions are a common occurrence in several sports, including contact sports like football or individual sports where participants can hit their head from falls, such as skateboarding and downhill skiing. They can also occur off the playing field or surface such as a fall down the stairs, a blow to a head in a car accident. Common symptoms include:

  • Headache
  • Ringing in the ears
  • Nausea
  • Vomiting
  • Fatigue or drowsiness
  • Blurry vision
  • Confusion
  • Loss of consciousness
  • Slurred speech
  • Forgetfulness

For this study, researchers observed 357 high school adolescents (62% males) who were on average 15-and-a-half years old and involved in sports from September 2013 to December 2016. The researchers looked at data related to athletes who sustained concussions during this period and compared these to historical data on concussions among young athletes.

According to the research team, led by Toufic R. Jildeh, MD, administrative chief resident in Orthopaedic Surgery at Henry Ford Hospital in Michigan, 33% of participants had concussions while 14% experienced amnesia. Athletes who had one concussion during the study period needed an average of over 30 days to recover before they resumed their sport. For those who experienced recurrent concussions, the recovery period was longer.

The most common sport resulted in concussions was football, at 27.7% of the study particiants; 33.1% of these athletes had previous concussions. The researchers noted that athletes who had a history of previous concussions recorded slower visual motor speed and reaction time than those who had concussions for the first time. 

Co-author Kelechi Okoroha, MD, a sports medicine surgeon at Henry Ford, highlighted in the press release, the main takeaway of their study: “Depending on the number of concussions, the 30-day mark gives us a baseline for how much time adolescent athletes required before returning to sport,” he said.

Jildeh led a similar study that was published in 2019 the American Journal of Sports Medicine. That study focused on players in the National Football League (NFL), but it also resulted in similar findings: recurrent concussions caused players to be sidelined much longer to ensure optimum recovery.  “Historically, the literature reported a concussion prevalence of 4-5%, however recent studies have found that nearly 20% of adolescents have suffered at least one concussion, there’s a huge disparity in terms of reporting over time,” Jildeh said in a press release issued by the university.

While concussions are generally described by medical professionals as a mild form of brain injury, the Mayo Clinic says the effects of this condition can be serious and long-lasting. The original symptoms can continue, and new ones, such as sensitivity to light, irritablity, anxiety, inability to sleep, difficulty concentrating, and balance issues, can last days, weeks, or even months.

Another important issue to keep in mind is second-impact syndrome. This is rare but potentially fatal. If an athlete returns to play while not yet healed from the original concussion, a second impact or blow to the head can cause rapid swelling that can lead to death.

The take-away? Even though concussions are considered mild traumatic brain injuries, they are serious and should be treated seriously.

Football Concussion Concussion is a mild form of traumatic brain injury (TBI) that occurs due to a traumatic blow to the head. Pixabay