A person whose blood pressure is usually normal has an appointment at a clinic or medical center. There is a bit of anxiety about the visit. Anxiety elevates blood pressure, and having it checked is a routine procedure.

Blood pressure is taken by a physician or other provider who often wears a white coat that symbolizes medical professionalism. The reading is higher than it normally would be when not in a clinical setting. The presumed result: white coat syndrome.

Until recently, white coat syndrome had been considered a temporary spike—no harm, no foul. But not anymore.

Real—Dangerous for Some

White coat syndrome/hypertension was first described more than 40 years ago. Since then, multiple studies have confirmed that it’s a real thing. The original scenario is the same—anxiety can elevate blood pressure in a clinical setting. But current research suggests that white coat syndrome may also be a symptom of something more concerning.

In February 2022, a review of studies in the journal Hypertension became the first to provide evidence that white coat syndrome in patients (with no previous organ damage) had an increased risk of mortality, new hypertension, and new organ damage. This study and others have resulted in a decidedly different approach to white coat syndrome diagnosis and treatment. (https://www.ahajournals.org/doi/full/10.1161/HYPERTENSIONAHA.121.18792)

Blood Pressure—How High is Too High?

To be clear, white coat hypertension for most people is still a one-time event that needs attention only in combination with other cardiovascular conditions. According to Cleveland Clinic and other medical centers, the syndrome affects 15-30 percent of people who already have high blood pressure. Patients who don’t normally have high blood pressure can also have the syndrome. (https://my.clevelandclinic.org/health/diseases/23989-white-coat-syndrome)

The definition of high blood pressure has been a moving target and remains a number that your physician determines is right for you. The American Heart Association defines “normal” as less than 120 for the upper (systolic) number; less than 80 for the bottom (diastolic) number. “Elevated” is 120-129 over 79 or less. For numbers defining three advanced stages of hypertension, go to https://www.heart.org/en/health-topics/high-blood-pressure.

The definition of normal can change, depending on a person’s age and health conditions. The AHA’s guideline for those 65 and older is lower than 130/80.  Normal for patients over the age of 80 may be higher.

Diagnosis— Multiple Readings

Diagnosis of white coat syndrome requires at least three separate blood pressure readings at a clinic, as well as elevated numbers when checked at home. Home blood pressure kits and regular checks are a good idea, regardless of the white coat issue.

When you take your blood pressure (BP) at home, follow these CDC guidelines: 1) nothing to eat or drink 30 minutes before taking BP; 2) empty bladder; 3) feet flat on the floor, legs uncrossed; 4) arm resting on a surface, chest high; 5) cuff snugly against bare skin, not over clothing; 6) no talking; 7) same time every day; 8) at least two readings, 1-2 minutes apart. (https://universityhealthnews.com/daily/heart-health/how-to-get-an-accurate-blood-pressure-reading/)

Treatment—Lifestyle Changes, Medications

If blood pressure is found to be slightly elevated—your doctor makes that call—you may be asked to consider lifestyle changes. You’ve heard them; all easier said than done. Here’s a review:

• Lose weight.
• Sit less, exercise more.
• Eat more fruits and vegetables, less red meat and processed foods.
• Limit daily salt intake to 2300 mg.
• Don’t smoke.
• Work on managing stress. (https://universityhealthnews.com/daily/stress-anxiety/how-to-deal-with-stress/)

If your blood pressure is more than slightly elevated, your doctor may prescribe medications to lower it. Examples are diuretics, alpha- and beta-blockers, ACE inhibitors, and calcium blockers. The Hypertension study mentioned earlier also found that patients with white coat syndrome who take medications to control blood pressure don’t have elevated risks of cardiovascular disease.

Antihypertensive drugs carry risks, mostly mild, for some patients. Ask your doctor about medications that might lower your blood pressure too much. Hypotension, as it’s called, could cause dizziness, lightheadedness, passing out, weakness, nausea, and other symptoms.

How low is too low? The National Library of Medicine says that while there is no universally-accepted standard, blood pressure readings under 90/60 indicate hypotension.

White Coat Syndrome—Answers and Actions

It’s real—well documented. It can be dangerous for some, leading to a variety of conditions that require medical intervention. High blood pressure, whether conventional or white coat, is treatable. It starts with lifestyle changes, and for more serious cases, advances to effective and safe antihypertensive medications.

Don’t dismiss white coat hypertension if it shows up at your next doctor’s appointment. Have it checked or regularly check it yourself.

Other Helpful Links from University Health News

https://universityhealthnews.com/daily/heart-health/uhn-blog-whats-the-right-blood-pressure-for-you-it-depends/

https://universityhealthnews.com/daily/heart-health/is-the-blood-pressure-reading-from-your-doctors-visit-accurate/

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There’s cholesterol, total cholesterol, lipoprotein, high-density lipoprotein (HDL), non-HDL, low-density lipoprotein (LDL), Very-low-density lipoprotein (VLDL). Triglycerides. And now, cholesterol ratio.

Cholesterol Simplified

With the help of CDC’s Medline Plus, let’s start with cholesterol. It’s a waxy substance made by the liver and present in blood. We need it, but only in the right amounts. Too much or the wrong kind increases the risk of heart disease. (https://medlineplus.gov/cholesterol.html)

Total Cholesterol

Total cholesterol is the amount of cholesterol in your blood, including low-density lipoprotein (LDL)—the bad kind of cholesterol—and high-density lipoprotein (HDL), the (so-called) good kind. The recommended total cholesterol value is 200 mg/dL or less. Borderline high is 200-239. Everything greater is high.

Low Density Lipoprotein

Low-density lipoprotein moves cholesterol through the arteries to various tissues in the body. It can accumulate on arterial walls. High levels increase the risk of heart disease and stroke. The CDC’s recommended LDL is “about” 100 mg/dL. “About” is a CDC term.

HDL Cholesterol

HDL absorbs cholesterol and moves it back to the liver before it is flushed out of the body. Normal HDL should be at least 40 mg/dL in men; 50 in women. Higher is better, but those numbers have been questioned.

A November 2022 study (20,000 subjects) in the Journal of the American College of Cardiology suggested that low HDL cholesterol was associated with increased cardiovascular risk in white but not Black adults. The high HDL did not appear to be protective in either group. (https://www.jacc.org/doi/10.1016/j.jacc.2022.09.027)

In spite of the findings, major medical institution websites generally recommend higher HDL levels for heart health. Mayo Clinic—60 for women and men; Cleveland Clinic—60+ for men and women; Harvard—60 for women, 45 for men; Johns Hopkins—55+ for women, 45+ for men.

Non-HDL Cholesterol

A non-HDL level is determined by subtracting HDL from total cholesterol. It includes other types of cholesterol (like VLDL). Good (normal) is less than 130 mg/dL for people without risk factors such as high blood pressure, diabetes, obesity, and vascular disease.

Triglycerides

Triglycerides are the most common type of fat found in blood. Think oils, butter, carbs, alcohol. The National Institutes of Health report that between 25 and 30 percent of Americans have abnormally high levels. Below 150 mg/dL is recommended.

Why is Cholesterol Ratio Important?

Instead of relying solely on the numbers just described to determine risk, there has been a shift toward taking cholesterol ratio into consideration. It’s a measurement of both good (HDL) and bad (LDL) cholesterol. To calculate it, divide your total cholesterol by your HDL. Here’s an example of a cholesterol ratio reading:

(Total cholesterol) 150 ÷ (HDL) 60 = cholesterol ratio of 2.5

According to the American Heart Association, the target number is 3.5; lower is better. Anything higher than 3.5 increases the risk of cardiovascular disease.

Treat the Patient, Not the Numbers

Each patient is different, and treatment for cholesterol-related issues should be individualized. Men may have different recommended values than women. One person could have a total cholesterol reading within a normal range but HDL and LDL values out of range. Having other medical issues increases the risk in spite of good cholesterol numbers. Even a patient with normal numbers but a family history of heart disease may be at higher risk and in need of medical intervention.

How to Improve Cholesterol Ratio

The list of ways to lower your cholesterol ratio applies to many other health issues. Below are six suggestions.

• Maintain a healthy weight.
• Choose foods lower in saturated fats.
• Avoid foods with trans fats.
• Exercise regularly.
• Don’t smoke.
• Limit alcohol intake.

Other Helpful Links from University Health News

https://universityhealthnews.com/daily/heart-health/cholesterol-ratio-more-important-than-total-cholesterol-or-ldl-cholesterol/

https://universityhealthnews.com/daily/heart-health/hdl-vs-ldl-more-important-cholesterol-num/

The post Cholesterol Ratio – What is a Normal Reading? appeared first on University Health News.

Cervical Cancer

The recommendation for cervical cancer screening for women ages 30 to 65 is for a Pap test every three years, or a Pap test combined with human papillomavirus (HPV) testing every five years.

“Once a woman reaches age 65, as long as she has had prior regular screenings that have all been negative, she can stop screening. If the Pap test is abnormal or an HPV infection is present, the woman should undergo further evaluation, which may include cervical biopsies and/ or a colposcopy. A woman with an abnormal Pap test or a positive HPV test will likely need screening more frequently than every five years and may not be able to safely stop screening at age 65,” explains Melissa Frey, MD, a gynecologic oncologist at Weill Cornell Medicine.

Early cervical cancer is often asymptomatic; however, as the disease progresses, symptoms can include heavy vaginal bleeding, irregular vaginal bleeding, or bleeding after intercourse. More advanced cervical cancer may produce pain in the pelvis or back, changes in bowel or urinary habits, or blood in the urine or stool. If you experience any of these symptoms, especially if they are persistent, see your gynecologist as soon as possible. If you don’t have a gynecologist, see your primary care physician or another health-care provider.

Ovarian Cancer

There is currently no recommendation for ovarian cancer screening, and the U.S. Preventive Services Task Force (USPSTF) recommends against screening in asymptomatic women. However, the task force does advise that women who have family members with breast, ovarian, fallopian tube, or peritoneal cancer be evaluated to see if they have increased risk of a mutation in the BRCA1 or BRCA2 gene in their family history. If they do, then genetic testing may be advised.

“For women with an elevated lifetime risk of ovarian cancer, either due to a family history of ovarian cancer or a mutation in the BRCA1 or BRCA2 gene, a gynecologist can consider screening with pelvic ultrasound and a blood test for a tumor marker called CA125. However, the woman and her gynecologist must discuss the limitations of such ‘screening,’ as we currently have no evidence that sonograms or blood tests can reliably detect ovarian cancer in its early stages,” explains Dr. Frey. “Women with a BRCA1 or BRCA2 mutation should discuss the option of removal of the fallopian tubes and ovaries as a possible way to avoid ovarian cancer.”

In the early stages, ovarian cancer is often asymptomatic. Symptoms of advanced ovarian cancer include pain in the pelvis, abdomen, or back, bloating, changes in bowel or urinary habits (especially urinary urgency and frequency), and feeling full quickly when eating.

“If a gynecologist suspects a pelvic mass on exam or if a woman has any symptoms of ovarian cancer, she should undergo further evaluation,” says Dr. Frey.

Endometrial Cancer

Endometrial cancer, which is cancer of the innermost layer that lines the uterus, is the most common of the gynecologic cancers in the U.S.

“There is no recommendation for routine screening for endometrial cancer unless a woman has a strong family history of endometrial cancer or a known genetic mutation such as Lynch syndrome. Women at increased risk of endometrial cancer can consider sonograms of the uterus and endometrial biopsies. For all other women, screening is only recommended if there is a suspicion for endometrial cancer,” explains Dr. Frey.

The most common symptom of endometrial cancer is abnormal uterine bleeding. This can include bleeding after menopause or heavy or irregular bleeding in women who are still menstruating.

“Other symptoms of endometrial cancer can include a palpable uterine mass and abdominal pain or bloating,” notes Dr. Frey. (A palpable mass is a lump that can be felt when someone presses on it.)

If you experience any of the symptoms mentioned for a period of two or more weeks, and they are a departure from how you normally feel, see your gynecologist or other health-care provider and have it checked out. If you do have cancer, the sooner you find out, the sooner you can proceed with a treatment plan that may save your life.

The post Early Detection of Gynecological Cancers Means Better Outcomes appeared first on University Health News.

Seasonal allergy can start when trees start to pollinate. Tree pollen allergies can start as early as  February. Grass pollen starts next in early spring. If you live in a tropical climate, grass pollens may be around most of the year. A rainy April or May can cause mold pollens to last into the fall. Weed pollens, especially ragweed, kick in from August through November.

What Causes Allergy Fatigue?

According to the American College of Allergy, Asthma & Immunology (ACAAI), although you might not think about fatigue or sleepiness as allergy symptoms, untreated allergies often lead to these symptoms. One reason is that an allergic reaction can release chemicals in your body that directly cause fatigue.

A more obvious cause is lack of sleep. When you can’t breathe well through your nose or you are coughing and sneezing all night, it’s hard to get a good night’s sleep. Finally, if you are not careful choosing the right over-the-counter (OTC) allergy medications (that aren’t non-drowsy allergy medicines), they may cause drowsiness or disrupt your sleep.

Do Antihistamines Make You Sleepy?

It depends on the type. Allergy symptoms are caused by your body’s defense system, called the immune system. If you have allergies, your immune system identifies otherwise harmless substances like mold spores or tree pollen as foreign invaders, and launches an attack against them. One of the main chemicals released is histamine. It causes allergic rhinitis and itchy, watery eyes. To treat your seasonal allergy symptoms, you may opt for over the counter medication found in the allergy section of your pharmacy. These are OTC antihistamines and are effective for some seasonal allergy sufferers because they block the effects of histamine.

There are two types of OTC antihistamines. Older antihistamines, called first-generation antihistamines cause drowsiness along with dry eyes and constipation. Common brand names are Benadryl and Chlor Trimeton. Both the FDA and ACAAI suggest avoiding these antihistamines.

The best bet is to ask your doctor to recommend an OTC allergy medication or to choose a newer non-sedating OTC antihistamine. Non-sedating means it won’t make you sleepy. There are several OTC non-drowsy antihistamine brands, such as Zyrtec, Claritin, and Allegra. Look for non-sedating on the label or ask your pharmacist.

Other Non-Drowsy Allergy Medicines

In addition to non-sedating antihistamines, there are other OTC options to treat your allergies. These include:

• Intranasal corticosteroids. These are nasal sprays that block immune system swelling and irritation (inflammation). These nasal sprays block persistent nasal allergy symptoms. Several are available OTC, and others by prescription.
• Decongestant nasal sprays. These sprays give immediate results for nasal congestion by shrinking your nasal tissues. The problem is that they have a rebound effect, your nasal tissues may swell up even worse when the medication wears of. These sprays should only be used for a few days at most to relieve nasal congestion.
• Pseudoephedrine (Sudafed). This medication is an oral decongestant that opens up your nasal passages, but it has significant side effects including loss of appetite, palpitations, and insomnia. Although it is a stimulant – it is the main ingredient of methamphetamine – it can cause sleepiness indirectly by interfering with your sleep schedule. Because of these side effects, you need to ask a pharmacist for pseudoephedrine. It is kept off the pharmacy shelves.

How to Tell the Difference Between COVID and Seasonal Allergies?

COVID 19 and seasonal allergies have different causes, but share a lot of the same symptoms. It is important to know the difference. You can try to treat your seasonal allergies with OTC meds, but with COVID 19 symptoms you will need a call to your doctor. _[5]

• Symptoms that can occur in both COVID 19 and seasonal allergy are cough, fatigue, sneezing, sore throat, runny nose, red eyes, and loss of smell or taste.
• Symptoms of seasonal allergy that are not seen in COVID 19 are itchy nose or eyes.
• Symptoms of COVID 19 that are not seen in seasonal allergy are fever, muscle aches, nausea, vomiting, or diarrhea.
• COVID 19 can cause difficulty breathing. Seasonal allergies do not cause difficulty breathing or shortness of breath unless you also have asthma, and your allergies trigger an asthma attack.

Final Tips for Managing Seasonal Allergy Fatigue and Other Symptoms

If you are struggling to control allergy symptoms on your own, see your health care provider. You may want to see an allergy specialist. You can be tested to find out which allergies you have, which can help you avoid them. Avoidance is often the best treatment. Your doctor may prescribe effective allergy medications that are not available OTC, including an antihistamine nasal spray or allergy shots, called immunotherapy. Other management tips include: _[2,3]

• Check weather reports for pollen levels. Avoid outdoor activities on high pollen days.
• Keep your house and car windows shut and turn on air conditioning during allergy season.
• Take a shower and change your clothes after coming home during allergy season.
• Wear a mask when outdoors, especially when mowing the lawn or raking the leaves.
• Remember that spring and summer pollen levels are highest in the evening and fall pollen levels are highest in the morning. All pollens are higher on dry and windy days.

The post Can Allergies Make You Tired? appeared first on University Health News.

Why Do Our Bodies Need Water?

How much of the human body is water? It might surprise you to learn that water makes up about 60 percent of our body weight.

And what does water do for the body? The benefits of drinking water are many: It’s vital for almost every function in the body. Water acts as a building block, a solvent for chemical reactions, and a transport material for nutrients and waste.

Water also helps maintain blood volume and allows proper circulation, helps regulate our body temperature, and acts as a shock absorber for our joints and our brain. There are still more health benefits of water: It helps lubricate the linings of our inner organs and maintains healthy kidney function._[1,2]

6 Health Benefits of Drinking Water

Drinking plenty of water can help keep your body healthy and functioning at its highest capacity. Staying hydrated will help you to:

1. Improve physical performance.

During physical activity, our bodies use up a lot of water. So stay hydrated before, during, and after exercise helps to protect your body from harm, and to help you to perform better. Proper hydration can reduce fatigue, improve endurance, lower your maximum heart rate, and more. Drinking water can also help you to be less sore after exercise. _[1,3,4]

2. Help you to lose weight.

Are you having trouble with your weight loss efforts? Increasing your water intake may help you achieve better results. Studies show that people who are on diets lose more weight when they also increase their water intake._[5,6] In one study, people on weight loss diets who drank 500 ml of water before each of their three daily meals for 12 weeks lost 4.6 more pounds on average than people who did not drink the additional water._[5]

3. Boost your mood.

People who drink more water also tend to have better moods. One study found that when people who regularly drank less than 1.2 liters of water per day increased their intake to 2.5 liters per day, the participants experienced significantly less confusion, bewilderment, fatigue, and sleepiness. On the other hand, for people who regularly drank two to four liters of water per day who were then restricted to one liter per day, the reduced water intake led negative effects on mood, including decreased contentedness, calmness, and positive emotions._[7]

4. Boost your brainpower.

When you consume more water, you may improve your cognitive performance, too. Several studies have shown that people drinking water during cognitive tasks performed much better than those people who did not drink water during the tasks. These results have been found in both adults and children._[8-10] Studies suggest that even mild dehydration can impair cognitive function in the short-term._[8] So next time you need to focus, take a test, or use all of your brainpower, keep a glass of water next to you and keep sipping.

5. Prevent headaches.

Drinking plenty of water every day has been proven to reduce the risk of gout attacks.

Water deprivation is a very common cause of headache. In most cases, rehydrating can provide relief from a headache. For some people, dehydration can also trigger a migraine, so be sure to keep your water intake regular if you are prone to getting migraines or headaches._[1]

6. Protect against disease.

One of the most important answers to the question “Why is water important?” is its role in disease prevention. Proper hydration may be a useful tool in preventing a variety of health conditions and diseases. Staying hydrated may protect against kidney stones, constipation, asthma, urinary tract infections, coronary heart disease, and even possibly some cancers._[1,11]

How Much Water Should You Drink a Day?

The amount of water you need to drink will depend on several factors, including your age, gender, activity level, and more. However, here’s a good general guideline when it comes to recommended daily water intake: Women should drink at least 2.21 liters per day and men should drink three liters per day._[2] (See also our post Confused About How Much Water to Drink? A Myth-vs.-Reality Check.)

Increase your daily water intake as you increase your activity level. Be sure to always drink filtered water to avoid toxins found in tap water. For tips on choosing the best water filter, read more here.

As you age, you will likely feel less thirsty and thus be prone to drinking less fluid._[1] However, hydration is as important as ever in old age, so be sure to keep water on hand and drink regularly throughout the day, even if you don’t feel thirsty.

Need help drinking more water? Keep track of your water intake by measuring your progress with a cup or water bottle placed in a spot you will see it throughout the day. Set goals for yourself at time points throughout the day to make sure you are drinking enough.

RECOMMENDED FOR YOU

• The Dangers of Dehydration: Swollen Eyes and a Shrunken Brain
• Confused About How Much Water to Drink? A Myth-vs.-Reality Check
• The Fastest Water Filter Comparison Available

Originally published in 2015, this post is regularly updated by the editors of University Health News.

SOURCES

[1] Nutr Rev. 2010 Aug;68(8):439-58.
[2] Eur J Clin Nutr. 2010 Feb;64(2):115-23.
[3] Nutrition. 2004 Jul-Aug;20(7-8):651-6.
[4] Athl Train. 2006 Jan-Mar;41(1):36-45.
[5] Obesity (Silver Spring). 2010 Feb;18(2):300-7.
[6] Obesity (Silver Spring). 2008 Nov;16(11):2481-8.
[7] PLoS One. 2014 Apr 11;9(4):e94754.
[8] ACSMs Health Fit J. 2013 Nov;17(6):21-28.
[9] Appetite. 2009 Jun;52(3):776-9.
[10] Appetite. 2013 Jan;60(1):148-53.
[11] Nutr Rev. 2005 Jun;63(6 Pt 2):S2-5.
[12] Water and Healthier Drinks | Healthy Weight, Nutrition, and Physical Activity | CDC

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Watching or reading the news can be a little stressful even in the calmest of times. But when the daily headlines bring on a cascade of alarming health news about the current coronavirus pandemic, it’s only natural to feel overwhelmed and anxious.

“Excessive anxiety is a common response to situations like this, and we need to manage our own anxiety as best as we can,” says Maurizio Fava, MD, Psychiatrist-in-Chief at Massachusetts General Hospital and director of the Division of Clinical Research at the Mass General Research Institute.

These days, it can seem harder than ever to keep your stress levels under control, but it is especially important because of the health risks associated with stress. Apart from triggering feelings of anxiety or depression that can interfere with our daily functioning and long-term mental health, stress can also affect our ability to stay healthy and defend against illnesses ranging from COVID-19 to a common cold. Stress, immunity and disease progression are all interrelated.

Stress triggers an immune response and creates inflammation throughout the body. Inflammation is associated with mental health challenges and most serious health concerns.

 “At a time when we eAxperience COVID-19, a threat to our health and the health of our friends, families, and community, our stress levels tend to increase significantly, and this can have negative effects on both our physical and mental health,” Dr. Fava explains. “Stress-reduction strategies are therefore critical for all of us to deal with the current situation. The stress response is natural, but needs to be contained so that we are not overwhelmed by it.”

At-Home Strategies

If you’re spending most or all of your time at home, you may need to make some lifestyle changes to keep stress from getting the better of you. The big three components include exercise, diet, and sleep.

“Regular exercise can both reduce stress and improve mood,” Dr. Fava says. “Getting adequate sleep through good sleep hygiene is also critical. Avoiding cigarettes, alcohol, and other drugs can also help. And, of course, try to eat a healthy, balanced diet, reducing caffeine and excessive carbohydrates. Establishing a new routine can be very helpful as well.”

Rather than focusing on matters out of your hands, he suggests exploring positive, helpful information. “Go online and search for helpful tips to manage stress from home. Consider yoga or relaxation exercises,” he says.

One simple relaxation technique is simply deep breathing:

• Sit comfortably with your back straight.
• Inhale through your nose.
• Exhale through your mouth, while contracting your abdominal muscles.
• Repeat while focusing your attention only on your breathing.

Breathing from the abdomen stimulates the vagus nerve, which extends from the head down through your chest and into the colon. Deep breathing in this way activates the relaxation response, slowing your heart rate and lowering your stress levels.

Another helpful stress-management strategy is mindfulness. It’s the ability to be fully aware of your current environment and what you’re doing in the moment. You’re taking in all the sights and sounds around you and you’re focused on what you’re doing in that moment, not worried about things out of your control. Of course, accepting that there are circumstances you can’t manage or affect is a challenge for most of us. But the more you can let those concerns go, the greater the feeling of control you’ll have. And that can go a long way toward reducing your stress.

Finding Help

To help you develop your mindfulness skills, there are many computer and smartphone apps to get you started or keep you going if you’re already a mindfulness practitioner. Apps such as Headspace, Smiling Mind, and Stop, Breathe and Think are especially helpful because you can use them on your own schedule or if you’re unable to get out to a mindfulness meditation class.

But mindfulness also means acknowledging your thoughts and feelings without judgment. It’s about experiencing the world with gentleness and forgiveness. “By practicing mindfulness or relaxation exercise we may help ourselves,” Dr. Fava says. “Personally, I love to take a walk around the neighborhood with my wife. It is a wonderful routine that allows us to talk with each other and relax at the same time.”

Dr. Fava also recommends reaching out to friends and relatives more often, especially if they are people who bring positivity and joy to your life. “The social distance that we need to practice to keep ourselves safe has led, in some cases, to greater opportunities to connect virtually with friends and family,” he says. “Let’s take advantage of that.”

If you are looking for suggestions on what to do help with your stress and anxiety, Drs. Smoller and Choi from the Department of Psychiatry at MGH put together the MGH Guide to Mental Health Resources for COVID-19.

Visit www.massgeneral.org/psychiatry/guide-to-mental-health-resources.

The post Manage Your Stress During Times of Crisis appeared first on University Health News.

An Inside View

When the heart pumps, pressure is created to expel blood by way of arteries and capillaries to nourish the entire body. Veins bring the blood back to the heart. In the first phase, called systolic pressure, blood is forced out of the heart and pressure is at its peak. In the second (diastolic) phase, the heart fills and pressure is at its lowest. These two pressures are represented in numbers— such as 130 over 80 (130/80). Systolic is the top number; diastolic, the lower figure.

Elevated blood pressure can create tiny tears in arteries. This enables substances in the blood, such as fat and cholesterol, to stick more easily to arterial walls. The substances cause arteriosclerosis, which forces the heart to work harder to circulate blood.

High blood pressure is common as we get older because blood vessels naturally thicken and stiffen over time. This age-related trend might lead some people to believe that it’s okay to skip medications and to stop taking regular readings.

Some of those with ele­vated blood pressure may feel perfectly fine. But high blood HTN is a silent predator that can strike without notice and result in serious, life-altering consequences.

New Guidelines. Based on American Col­lege of Cardiology (ACC) and American Heart Association (AHA) guidelines, high blood pressure should be treated ear­lier with lifestyle changes and in some patients, with medication, at 130/80 rather than 140/90. Newer guidelines—the first since 2003—lower the definition of high blood pressure to account for complications that can occur at lower numbers and to allow for earlier intervention. The new definition has resulted in nearly half of the U.S. adult population having high blood pressure.   In a person who has high blood pres­sure, there is more resistance to the flow of blood through the arteries, so the heart has to work harder to push blood through the body. It’s like adding weight to a barbell—adding more weight makes the barbell harder to lift.

About 75 percent of people with heart failure have a history of hypertension, and the lifetime risk of developing heart failure with a blood pressure higher than 160/90 is double that of blood pressure lower than 140/90 millimeter of mer­cury (mmHg).

Although up to 90 percent of people ages 80 and older have some degree of hypertension, it is not normal, and it greatly increases the risk of heart attack or stroke. Using medications to bring blood pressure down below 120/80 mmHg can reduce the risk of heart fail­ure, even in the very elderly.

Controlling High Blood Pressure. Lifestyle modifications can lower blood pressure, in some cases as much as 20 points. Lifestyle changes should be the first course of action. Here are five specific suggestions:

• Lose weight if you are overweight.
• Stop smoking.
• Follow the DASH diet (Dietary Approaches to Stop Hypertension).
• Limit salt intake to 2,300 milli­grams (mg) per day.
• Break a sweat with exercise at least 30 minutes a day most days of the week.

The next course of action is medications, which should be started if blood pressure readings are in the 140s. Work with your doctor in evaluating your tolerance to a new medication and reporting blood pressure changes, if any. Take your blood pressure daily, in the morning, and keep a written log.

In addition, HTN should be regularly monitored and managed by a physician. The length of time between follow-up appointments will be based on your current health and other medical conditions.

A primary care physician can initiate and manage therapy. However, if your blood pressure is difficult to treat or if other conditions complicate medication choices, you may be referred to a cardiologist.

For more information on other conditions that are linked to heart failure, purchase Managing Heart Failure from University Health News.

The post High Blood Pressure: One Heart Failure Risk Factor appeared first on University Health News.

People with COPD signs and symptoms tend to decrease their physical activity as shortness of breath makes exertion more and more difficult. If your COPD prognosis is poor, you also may think you need to cut down on physical activity. However, decreased activity can start a vicious cycle of progressive deconditioning. This leads to a worsening of COPD symptoms and more breathlessness. COPD rehabilitation is aimed at breaking that cycle.

COPD Rehabilitation: Program Basics

COPD rehabilitation is more than an exercise program, although exercise is the most important component. According to the American Association of Cardiovascular and Pulmonary Rehabilitation (AACPR), pulmonary rehabilitation is tailored to the needs of individual patients, and is designed to optimize physical and social performance and autonomy.

A portable spirometer, called an “incentive” spirometer, challenges and recruits reluctant alveolae.

The AACPR lists the following core components for a COPD rehabilitation program:

• Exercise training and other therapeutic exercise (aerobic, strength, and flexibility training)
• Education and skills training (such as breathing retraining)
• Secretion clearance techniques
• Prevention and management of COPD exacerbations
• Control of irritants and allergens
• Instruction in proper use and safety of oxygen systems
• Nutritional assessment and intervention if necessary (Find out how a COPD diet might help you in our article on COPD home remedies.)
• Psychosocial assessment, support, panic control, and professional intervention, if necessary
• Help with smoking cessation if currently smoking
• Education about medication use
• Implementation of a home treatment program follow-up

COPD patients at all stages can benefit from a COPD rehabilitation program—in fact, one study found that patients in the earlier stages of COPD derived greater benefits than those in the later stages.

Although those with less advanced COPD had better results, those with severe COPD signs and symptoms also had improved ability to exercise, and less shortness of breath. This research suggests that when it comes to COPD rehabilitation, the earlier the better. However, all of the patients were helped by the program. Other studies have found that rehabilitation benefits are generally sustained for up to 18 months after the program ends, especially if the exercise training is maintained.

There are many COPD rehabilitation programs around the country. Your doctor can most likely refer you to one—alternately, the American Association for Cardiovascular and Pulmonary Rehabilitation (www.aacvpr.org) has a searchable online directory of rehabilitation programs. Health insurance may or may not cover COPD rehabilitation—you’ll need to check with your insurance carrier.

Medicare coverage of COPD rehabilitation can vary from state to state, so check with your doctor or provider to obtain the guidelines in your state.

See also these University Health News posts:

• “Lung Diseases and COPD Facts: Understanding the Breathing Process“
• “Lifestyle Changes Among the Keys to COPD Treatment“
• “Is There Such a Thing as a COPD Diet?“

Originally published in May 2016 and updated.

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Low COPD oxygen levels may also cause fatigue, memory loss, headaches in the morning, depression, and confusion. Over time, chronically low oxygen levels also can cause heart failure and impact COPD life expectancy. This makes COPD oxygen therapy a major treatment approach for stage 4 COPD.

Do You Need COPD Oxygen Therapy?

To determine whether a person with COPD has hypoxemia, a physician will perform either an arterial blood gas test or pulse oximetry, both of which measure the amount of oxygen in the blood.

With oxygen therapy, COPD hypoxemia levels may not be as poor, but oxygen therapy usually is given only to patients with very severe (stage 4) COPD. In Stage 4 COPD, airflow is severely limited and the amount of air that can be blown out in one second (called the FEV1 ratio) is less than 30 percent of what would be expected for someone without lung disease. For these people, long-term use of supplemental oxygen for more than 15 hours each day can extend COPD life expectancy and improve the quality of life.

COPD oxygen therapy also may reduce shortness of breath during exertion, which makes it easier to perform activities of daily living. Oxygen therapy also may improve mental functioning, reduce depression, and aid the heart.

Using COPD Oxygen Therapy for Hypoxemia

Supplemental oxygen may be used continuously (24 hours) or periodically, such as only during exercise or overnight. The primary goal of using supplemental oxygen is to ensure adequate delivery of oxygen to preserve the function of vital organs.

Normal atmospheric air is about 21 percent oxygen, but the amount of oxygen you breathe into your lungs can be increased with additional pure oxygen that you inhale with each breath. Your doctor will prescribe a specific amount of supplemental oxygen, and provide instructions on when and how long it should be used, as well as which delivery method will be used. There are three methods for delivering oxygen—with each system, the oxygen is breathed in through a mask or a nasal tube (cannula).

• Compressed oxygen gas: Compressed oxygen gas is contained in tanks or cylinders of varying sizes. Large stationary tanks are used inside the home, while smaller, more portable tanks can be used on brief forays outside the home (they usually have enough oxygen to last a few hours).
• Liquid oxygen: When oxygen gas is cooled, it produces a liquid form of oxygen. When the liquid is warmed, it turns back into a gas that can be inhaled. Like compressed oxygen gas, liquid oxygen systems include a large tank for use in the home. The system also includes a small portable canister for use outside the home (this canister is filled with liquid oxygen from the indoor tank). One disadvantage of liquid oxygen systems is the tendency for the liquid to evaporate over time.
• Oxygen concentrator: An oxygen concentrator is an electric device that takes air from the room and separates the oxygen from other gases. The oxygen is then available to be inhaled through a mask or nasal cannula. This system does not require that tanks of liquid or gaseous oxygen be continuously refilled. The supply of oxygen is unlimited and the device is small enough to be moved from room to room—however, it is not portable enough to be taken outside, and it requires electricity to operate.

Traveling with COPD Oxygen Therapy

If you need to travel by air and you use COPD oxygen therapy, you will need to notify the airline well in advance in order to arrange for use of oxygen during the flight. Also keep in mind that even if you don’t require COPD oxygen therapy at home, you may need supplemental oxygen while flying. This is because the air pressure inside an airplane cabin is lower than it is on the ground, especially when the airplane is taking off and landing.

Low air pressure decreases the amount of oxygen in the air. People without lung disease can adapt to the changes in air pressure, but for a person with severe COPD, even a small change in air pressure may cause an exacerbation of symptoms.

Always discuss air travel plans with your doctor. Lung function tests will likely be needed to determine whether supplemental oxygen is required, and your doctor will also need to provide a letter for the airline. During the flight, the oxygen will be provided by the airline (there will likely be a fee for this service), since passengers are not allowed to bring their own oxygen canisters on board an airplane.

Information about which airlines permit the use of oxygen on flights, along with their policies, is available from the Airline Oxygen Council of America (www.airlineoxygencouncil.org).

For further reading on COPD, see these University Health News posts:

• “Is There a COPD Cure? Here’s the Answer“
• “GOLD COPD Guidelines for Lung Disease Treatment“
• “Is There Such a Thing as a COPD Diet?“
• “How to Prevent Smoking Diseases—and Add Years to Your Life“

Originally published in May 2016 and updated.

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What Causes Insomnia?

Insomnia can be a short-term or long-term issue. Short-term (or transient) insomnia can be caused by illness, stress, travel, or environmental factors. Long-term (or chronic) insomnia is usually caused by an underlying psychological or physical condition, according to the University of Maryland Medical Center.

Illnesses or medical conditions that can cause short-term insomnia include allergies, gastrointestinal problems, arthritis, asthma, chronic pain, and neurological conditions, according to the National Sleep Foundation.

Neurological diseases that may cause insomnia include Parkinson’s or restless leg syndrome (RLS). People who have RLS, for example, typically experience an increase in symptoms during periods of rest or inactivity; this makes sleeping much more difficult. Studies show that people suffering from RLS are more likely to suffer from depression, stress, and anxiety.

Insomnia not only can have an impact on your nights, but on your days as well. A chronic lack of sleep causes daytime sleepiness and an increase in anxiety and irritability, and also puts you at risk for drowsy driving and falls at home.

Some of these conditions can be mistakenly attributed to aging and related medical problems, so if you believe you aren’t getting enough sleep at night, it’s important to see your healthcare provider. Your physician may prescribe medication to treat your insomnia. Non-benzodiazepine sedative hypnotics such as Ambien, Sonata, Lunesta, and Rozerem are the most popular, according to the University of Maryland Medical Center. As with any prescription drug, it’s important to understand any and all possible side effects.

Beyond Sleep Meds

Prescription medications may not be necessary to treat your insomnia. In certain instances, the solution may lie in lifestyle changes. The following six tips can go a long way in making sure you fall asleep easily and stay asleep throughout the night.

1. Set the same bedtime and wake-up time each and every day. This can help your body to get in a routine for when to sleep. It’s also important to avoid naps if suffering from insomnia, as this may disturb your body’s sleep routine.
2. Avoid electronics and screens before bed. These devices may distract you from falling asleep and can keep your body in an alert state.
3. Exercise during the day. The more physical activity your body goes through during the day, the more likely you are to feel tired when it comes time to sleep.
4. Avoid stimulants before bedtime. Set a cutoff time during the day to have that last cup of coffee. A study by the Journal of Clinical Sleep Medicine examined the effects of caffeine on sleep and recommended not using caffeine within 6 hours of bedtime.
5. Avoid alcohol before bedtime. While consuming alcohol before bed may initially help you to fall asleep quickly, you’re more likely to experience disruptions during your sleep and wake up throughout the night.
6. Avoid staring at the clock. If you’re experiencing trouble falling asleep, staring at a clock as time passes by can only magnify the issue and increase your anxiety related to not falling asleep.

Stick with these changes for some time and don’t get discouraged if you find yourself continuing to experience insomnia at first. Your body may have to go through an adjustment period to practice good sleep hygiene.

If an insomnia problem still persists over time, however, seek help from your physician or consider seeing a sleep specialist.

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