HEALTH CARE ALASKA
SPRING 2025
07. HEART HEALTH: Lifestyle changes to reduce heart attack and stroke risk
MENTAL HEALTH:
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When sticky thoughts interfere with life Want a calmer brain? Try this
TABLE OF CONTENTS
HEART HEALTH 5 surprising heart-healthy foods you should be eating...................................................... 2 What time is best for blood pressure medication?..................................................... 4 Lifestyle changes to reduce heart attack and stroke risk...................................................... 7
SEASONAL HEALTH CARE: Publisher: Ryan Binkley Editor: Nina Wladkowski Special Projects Director: Brandi Nelson Sales: Joleesa Stepetin Ryan Estrada Victoria Hansen Advertising Operations: Lisa McGuire Graphic Designer: Jian Bautista This special publication was produced by the advertising department of Anchorage Daily News. The ADN newsroom was not involved in its production.
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Spring 2025 | Health care
Avoid risk of strains, sprains and tears of the upper arms while working out............................. 9 Sunscreen needs for any complexion...................................... 11 Is it allergies or a sinus infection?............................................. 13
MENTAL HEALTH: When sticky thoughts interfere with life..................................14 Summertime blues: An uncommon seasonal affective disorder...................................................... 15 Want a calmer brain? Try this..................................................16 PTSD: How is treatment changing? ........................................18
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SURPRISING HEART-HEALTHY FOODS YOU SHOULD BE EATING Chris Mohr, Ph.D., R.D., EatingWell.com, Premium Health News Service
Sadly, heart disease is the No. 1 killer of women and men in America. According to the CDC, someone dies of heart disease every 36 seconds in the United States. Fortunately, there is so much that can be done to help keep us as healthy as possible — things like what and how much we eat, proper exercise, how much sleep we get — even our relationships and stress levels all impact our heart health. Since the foods we choose most of the time play a big role in supporting a healthy heart, and body, let’s examine some of those that maybe don't quite get as much love as the more usual suspects. Fiber, fiber, fiber Fiber’s role in preventing heart disease seems to stem from its ability to lower both blood pressure and cholesterol. In addition, research supports fiber’s ability to help fill you up, meaning the potential for reducing body fat, which can also improve heart health.
1. LENTILS It’s hard to talk about heart health without giving lentils some love, particularly when it comes to the magic of fiber. From a cost-tobenefit perspective, lentils top the list. Adding a simple 1/2 cup of lentils, any color, to your day provides approximately 8 grams of fiber. Here’s a simple way to incorporate them into your daily routine: Add 1/2 cup of cooked lentils on top of a daily salad or a bowl of your favorite soup. For a unique snack, consider sprinkling some feta cheese on 1/2 cup of lentils, drizzling with about 1 teaspoon of olive oil and you’re all set.
2. FIGS You may not picture figs when you think of heart-healthy foods but don’t count out this humble fruit. Figs don't have any fat, sodium or cholesterol and have no added sugar since they’re naturally sweet on their own. Just a few — three to five — dried or fresh figs provide 5 grams of dietary fiber.
Health care | Spring 2025
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Chop up a few dried figs and top your oats or Greek yogurt, or pair them with a handful of almonds for a quick snack.
3. EGGS Gone are the days of avoiding those yolks for the dietary cholesterol content. Based on a continually growing body of research, the 2020 Dietary Guidelines as well as the American Heart Association support that eggs belong in healthy eating patterns. Eggs are a naturally nutrient-rich choice that pairs well with whole grains and produce. They are also a quick-cooking and affordable protein source, making them a star in the kitchen for any meal or snack. Try hard-boiled eggs as a quick protein-rich breakfast or snack, on top of a salad or mixed up as egg salad.
4. PEARS Apples tend to get more love when it comes to heart health — and keeping the doctor away — but pears, with 5 grams of fiber per serving, deserve some too. Enjoy pears as an easy snack, sliced in a green salad, or as a sweet oatmeal topper.
5. OLIVE OIL A study presented at the 2020 American Heart Association Meeting, found that higher olive oil — greater than 1/2 tablespoon per day — intake was associated with a 21% lower risk of coronary heart disease and 15% lower total cardiovascular disease in both men and women. We love olive oil as a cooking oil, in salad dressings, in sauces and even in baking recipes. EatingWell is a magazine and website devoted to healthy eating as a way of life. Online at www.eatingwell.com.
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What time is best for blood pressure medication? DEAR MAYO CLINIC: I was recently prescribed high blood pressure medication. My routine was to take the pills before bed, but I’m finding when I do, I’m up all night using the bathroom. Does it really matter when I take the medication? Also, will I likely have to take this medication for life? ANSWER: The most important thing about blood pressure medications is to take them every day simultaneously and not miss doses. Taking blood pressure medication before bed is usually unnecessary unless your doctor has specifically instructed you to. One of the most common blood pressure medications is a diuretic or water pill. Diuretics are very effective at lowering blood pressure and are often the first therapy prescribed as a blood pressure-lowering agent. Examples of diuretic medication include hydrochlorothiazide or furosemide. These medicines are meant to remove excess fluid from the body through urination, so taking them at night will keep you up and interfere with sleep. Diuretics should normally be taken in the morning, or, if taken twice daily, at least six hours before bedtime. In the past, many doctors recommended taking blood pressure medication at night because heart attacks happen most often in the early morning hours. However, since blood pressure typically drops at night in people with normal and high levels, it is unnecessary to drop it further. In addition, modern blood pressure medications are cleared from the body more slowly, so timing is less important. As long as the medication is taken regularly, preferably at the same time daily, it doesn’t matter what the clock reads. Discussing an alternative medication with your healthcare team may be valuable if you still struggle with excessive urination overnight. As far as whether you will take medication for life, it really depends on your situation. Lifestyle adjustments can help lower or eliminate the need for medicine over time. Consider these recommendations to help reduce hypertension: Make dietary changes Michael Schuh, Pharm.D., Mayo Foundation for Medical Education and Research, Premium Health News Service
What you eat can have a direct effect on your blood pressure. The most Health care | Spring 2025
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valuable tip is to limit sodium. Reducing the amount of salt, saturated and total fat in your diet, adding in whole grains, low-fat dairy and increasing the number of fruits and vegetables daily can help maintain normal blood pressure. Overall, the more processed the food, the less healthy it is because more salt, sugar and saturated fats are added to make it more appealing. Exercise regularly Research shows that regular physical activity can aid blood pressure management. In overweight people, blood pressure can be reduced simply by losing even five pounds. The American Heart Association advises adults to aim for at least 150 minutes of moderateintensity or 75 minutes of vigorous-intensity aerobic exercise each week and muscle-strengthening activity at least two days each week. Limit alcohol and tobacco Many people do not realize that alcohol increases blood pressure. It is best to refrain from alcohol; otherwise, women should limit alcoholic drinks to one a day; men limit themselves to two alcoholic drinks per day. In people older than 65, alcohol has a better chance of interacting with medications, particularly if more than one drink is consumed. Quitting all forms of tobacco also can help improve overall health and reduce your risk of heart attack and stroke. Reduce stress Stress alone may not cause high blood pressure, but daily stress is more likely to elevate blood pressure, even if a person is already taking blood pressure medication. Stress can be managed in various, nonmedication ways, such as cognitive behavioral therapy, biofeedback and adoption of other habits, such as yoga, meditation and mindfulness.
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Regularly check your blood pressure and stay in touch with your healthcare team as you make lifestyle adjustments. Never alter or stop taking medications prescribed for you without talking with your physician first, even if the side effects are challenging. But, hopefully, with diet changes, exercise and less stress, you can begin to see your blood pressure number change for the better. — Michael Schuh, Pharm.D., and Sheena Crosby, Pharm.D., Department of Pharmacy, Mayo Clinic, Jacksonville, Florida. Mayo Clinic Q & A is an educational resource and doesn’t replace regular medical care. This Mayo Clinic Q&A represents inquiries this healthcare expert has received from patients. For more information, visit www.mayoclinic.org.
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The key to good vision is being seen early HOW VISITING AN OPTOMETRIST CAN HELP PREVENT DIABETIC RETINOPATHY
When Dr. Ladd Nolin, an optometrist with Alaska EyeCare Centers, performs routine eye exams, he looks for more about his patients’ eyes than whether or not they can read letters on a chart. He checks the coordination of the patient’s eye muscles by asking them to follow an object with their eyes. He shines a light into their eyes to see how their pupils respond. And he checks for various diseases, ranging from glaucoma, macular degeneration and cataracts, to dry eye disease, hypertensive retinopathy and ocular infection. However, for patients with diabetes, one of the most vital tests determines whether diabetic retinopathy—a severe but preventable eye disease that has the best outcomes when caught early— is developing. “Early detection and treatment is so important,” Dr. Nolin said. Diabetic retinopathy is a common complication and one of the leading causes of blindness for people with diabetes. As Dr. Nolin explained, because diabetes is a microvascular disease, it can limit appropriate blood flow to the body’s extremities, including the eyes. This can cause leakage of blood and fluid from the retinal blood vessels into the surrounding light-sensitive retinal tissue, resulting in vision loss. It’s a medical issue that is most pronounced when blood sugar levels are high for long periods of time. “It can potentially affect any diabetic over time whose blood sugar is not under optimal control with their primary care physician,” Dr. Nolin said. “Early detection and treatment is important because over time the leakage of blood and fluid into the retinal tissue can cause more advanced hemorrhaging and edema—swelling—leading to permanent retinal damage, retinal detachments and loss of vision.” According to the National Eye Institute, an agency part of the United States Department of Health and Human Services, “the early stages of diabetic retinopathy usually don’t have symptoms. Some people may notice changes in their vision, like trouble reading or seeing faraway objects. These changes may come and go.” In the later stages of the disease, when blood vessels have started to bleed into the gel-like fluid that fills the eyes, patients might see dark, floating spots or cobweb-like streaks. While these visual impairments occasionally go away on their own, it’s important to get treatment as soon as possible. Without treatment, scars can form in the eye, and the bleeding can come back.
Because retinopathy can take years to develop, depending on the stability and level of blood sugar, it’s particularly important for diabetics to have an eye doctor monitor their vision and eye health over time so it never gets to the point of permanent eye damage, or leads to other serious eye conditions, like diabetic macular edema—when blood vessels in the retina leak fluid, which causes blurred vision; or neovascular glaucoma—when abnormal blood vessels grow and block fluid from draining out of the eye, which can also cause vision loss. Eye doctors check for diabetic retinopathy as part of a dilated eye exam, during which the optometrist administers eye drops to widen the pupil. Then, an optometrist or ophthalmologist looks into the eye, checking for subtle changes in the retina using advanced imaging technologies like fundus photography or optical coherence tomography. A retina specialist will perform different treatments depending on the level of retinopathy, said Dr. Nolin. Those treatment options may include injections, laser treatment or eye surgery, all of which are most effective when started early. While diabetic retinopathy is serious and anyone with diabetes— including type 1, type 2 and gestational diabetes— can get it, it is preventable. “Any population that has a family history of diabetes, those with unregulated diets filled with processed foods and sugars and those who do not exercise on a regular basis are at higher risk for developing diabetes and diabetic retinopathy,” Dr. Nolin explained. “But maintaining stable blood sugar, blood pressure and cholesterol levels can prevent damage to their retinas and vision.” He also added that keeping a balanced diet, getting regular exercise, not smoking and carefully following doctor’s instructions for insulin or other diabetes medicines can greatly help support a patient’s eye health. Similarly, consuming supplements with lutein—a naturally occurring antioxidant found in foods like egg yolks, leafy green vegetables and oranges that can help prevent or slow down eye degeneration—and omega 3—a type of healthy fat that can help to improve symptoms of dry eye disease by limiting inflammation—can also help with retina function. Additionally, sunglasses can help limit UV exposure, which can lead to increased ocular inflammation as well as cataracts. But, above all, Dr. Nolin said, “In order to protect their eye health, patients can first and foremost get annual eye wellness and vision exams, as well as maintain their systemic health with their primary care provider.”
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LIFESTYLE CHANGES TO REDUCE HEART ATTACK AND STROKE RISK. Tina Ardon, M.D., Mayo Foundation for Medical Education and Research, Premium Health News Service
DEAR MAYO CLINIC: I am 35 and in good health. I am diligent about getting an annual physical. At my last one, the doctor said that while my numbers look good, since high blood pressure and high cholesterol run in my family, I should consider medications to lessen my risk of a heart attack or stroke. I am not inclined to take medication if I do not need it yet. Is there anything else I can consider in terms of lifestyle modifications? ANSWER: Congratulations on being aware of your family history and being proactive about your overall health. While genetics does play a role in heart disease, it is important to remember that family history does not mean you automatically will have cardiac problems or suffer a stroke. Heart disease remains the No. 1 cause of death in the U.S., with over 655,000 people dying annually, according to the American Heart Association. Heart disease actually leads to more deaths in women annually than breast cancer. Likewise, strokes affect more than 795,000 people annually in the U.S. and are the leading cause of disability in the country. Strokes can occur at any age. While medication can be an option for some patients, I recommend that you consider the following recommendations to keep your heart, brain and body in shape.
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KNOW YOUR NUMBERS
FEED YOUR HEART AND CUT THE SALT
Aiming to maintain a healthy weight is important, but it also is important to be aware of other numbers, especially your blood pressure and cholesterol.
Research shows that consuming food high in sugar, salt and saturated fat can increase the risk of heart disease. While it can be difficult to change your eating habits, I encourage my patients to eat at least five servings of fruits and vegetables per day. Besides being low in calories and rich in dietary fiber, fruits and vegetables are full of important vitamins and minerals. Eat at least one serving of fish per week. Consider using olive oil when you cook or in salads instead of mayonnaise or other rich condiments. Also, be aware of salt. As good as it tastes, too much sodium can cause high blood pressure. Avoid processed foods, and stock up on a variety of herbs and spices to use in your cooking. Try to avoid anything that comes in a box or a package.
The biggest challenge is that there generally are no symptoms associated with high blood pressure, also known as hypertension, which is why it’s often called the silent killer. Having high blood pressure long term, however, can cause many serious health problems, such as heart disease and stroke, as well as kidney disease, so it’s vital to keep blood pressure numbers down. High blood pressure is determined by the amount of blood your heart pumps and the amount of resistance to blood flow in your arteries. The more blood your heart pumps and the narrower your arteries, the higher your blood pressure. Ideally, a normal blood pressure is below 120/80 mmHg. You are said to have prehypertension if your top number ranges from 120 to 139 mmHg or your lower number ranges from 80 to 89 mmHg. Prehypertension tends to worsen over time. And anything over 140/90 mmHg is considered hypertensive. You should check your blood pressure two to three times a week because you don’t know if it’s high or if it’s at goal unless you check it. If you already have had a baseline cholesterol check at your last physical, talk with your clinician about how often you might need to repeat the test, given your family history. Cholesterol is a waxy substance that's found in the fats in your blood. When you have too much cholesterol, you can develop fatty deposits in your blood vessels that can make it difficult for blood to flow through your arteries. An estimated MILLION ADULTS IN THE U.S. HAVE HIGH CHOLESTEROL.
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Make sure you also are having your blood glucose checked regularly because diabetes also can contribute to vascular issues.
MOVE MORE It’s important to keep your heart healthy by getting active. American Heart Association guidelines recommend 150 minutes a week of moderateintensity aerobic activity or 75 minutes per week of vigorous activity. Ideally, the goal would be five times a week, but it’s important to find something — anything — you love to do that gets you moving, even if it’s in small increments. For instance, park farther away at the grocery store or take the stairs instead of the elevator. Any movement can count toward your fitness goals. LESSEN STRESS Stress can be a trigger for many people, which can increase your blood pressure and lead to other unhealthy habits, such as smoking, overeating and difficulty sleeping. I recommend making mindfulness a part of your daily routine, as well as activities to help reduce stress and anxiety. Consider massage, yoga or meditation. Make a cup of tea and curl up with a good book. You can get your exercise by going for a walk. Whatever you choose, your heart will benefit. Be open with your health care team about your desire to delay medication as long as possible and discuss your goals for living a healthier lifestyle. Together, you can come up with the best follow-up schedule that suits you. Just remember that change takes time. Focus on one thing you can do today, and then add in another change the next week. — Tina Ardon, M.D., Family Medicine, Mayo Clinic, Jacksonville, Florida Mayo Clinic Q & A is an educational resource and doesn’t replace regular medical care. This Mayo Clinic Q&A represents inquiries this healthcare expert has received from patients. For more information, visit www.mayoclinic.org.
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Douglas Bartels, M.D., Mayo Foundation for Medical Education and Research, Premium Health News Service
Q: A:
I AM TRYING TO GET INTO SHAPE FOR SUMMER, AND ONE AREA THAT HAS ALWAYS BEEN CHALLENGING HAS BEEN MY UPPER ARMS. RECENTLY, THOUGH, I BEGAN A WORKOUT ROUTINE, BUT A FRIEND WARNED ME ABOUT THE RISK OF INJURIES. DO YOU HAVE ANY ADVICE TO AVOID PROBLEMS?
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Having well-defined, muscular upper arms often is the goal of anyone seeking a fit and toned appearance. But there’s more to these hardworking muscles than good looks. The primary arm muscles include the biceps, the muscle in front of your arm, and the triceps, the one at the back. They do the heavy lifting when flexing or extending your arm and making twisting motions. Despite their strength, these muscles can be damaged through overuse or forceful injury, such as lifting a heavy object from a truck bed or incorrectly using weights at the gym. Overuse can irritate the tendons, which connect muscles to bones, causing pain and inflammation. A forceful injury can tear or rupture the bicep or tricep tendons. Injuries to the upper arm muscles and tendons are most common in men 30-50, but women also may experience them. While bruising and swelling are obvious signs of an injury, many people may simply experience severe arm pain as well as shoulder and arm weakness.
Depending upon the situation, there also may be a bulge. Tendon ruptures are most common Among the most common injuries is a tendon rupture. If you have a ruptured tendon, you likely may feel a tearing sensation and actually hear a pop. This typically occurs around the elbow but sometimes at the shoulder. The muscle tends to ball up, forming a “Popeye” bulge that doesn’t improve. It usually is accompanied by swelling, bruising, cramping and extreme pain, as well as loss of function. The sooner a rupture is treated, the better the recovery, since scar tissue can form and the arm muscles can begin to weaken or atrophy. Consult with an orthopedic surgeon to learn about both nonsurgical and surgical options. Treating upper arm injuries Some patients choose to forego surgery. However, pain, arm function and appearance won’t improve over time.
If a tendon ruptures, the first line of treatment is to reattach it to the bone using sutures and anchors. This surgery is typically an outpatient procedure, with patients going home the same day. Recovery may take three months or more. After surgery, the arm is immobilized by a splint with a 90-degree bend at the elbow and a sling for several weeks, giving the repair time to heal. Passive therapy, where someone moves your arm for you, is designed to help you regain range of motion and prevent the elbow from stiffening. You may want to continue using the sling for protection and comfort. At four to five weeks after surgery, active motion helps you regain strength. At that point, you’ll be able to do light activities, such as getting dressed, personal care and working at a computer. By three months, you’ll be gradually rebuilding strength through increased activity. Preventing injury To prevent injury to your upper arm muscles and tendons, maintain overall strength, avoid overloading your arm muscles and be sure you're using proper technique when working with weights at home or the gym. If you are not sure what proper technique means, consider reaching out to a sports medicine specialist or a physical medicine expert. If you are concerned about an injury, don’t delay in seeking out care. It’s important to speak to a medical professional as soon as you have concerns so that your healing and recovery can begin. — Douglas Bartels, M.D., Orthopedic Surgery, Mayo Clinic Health System, Eau Claire, Wisconsin Mayo Clinic Q & A is an educational resource and doesn’t replace regular medical care. This Mayo Clinic Q&A represents inquiries this healthcare expert has received from patients. For more information, visit www.mayoclinic.org.
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SUNSCREEN NEEDS FOR ANY COMPLEXION Naiara Sbroggio Barbosa, M.D., Mayo Foundation for Medical Education and Research, Premium Health News Service
Q:
I spent many a summer at the beach growing up. My mother always slathered me with sunscreen. Now, as a 30-yearold woman, sunscreen remains a part of my routine, regardless of the weather. Recently, I was surprised to learn that one of my friends — a young Black woman — never wears sunscreen. She said her darker complexion means she’s protected from sun damage and, thus, not at risk for skin cancer. Is this true? I thought all people were susceptible to skin cancer.
A:
You are correct. Regardless of skin tone, anyone can get skin cancer. Although people with darker skin produce more melanin, which does have some additional sun defense, that does not mean darkerskinned people are fully protected from developing skin cancer. People who have lighter or fair skin color are at increased risk of sunburn and skin cancer, but any person can experience sun damage and develop skin cancer. Sunscreen is important for all skin types and tones — and not just on sunny days. Statistics indicate that people with darker skin have a lower rate of skin cancers, but studies have shown that they tend to be diagnosed later and at a worse stage, which is more challenging to treat. HOW COMMON IS SKIN CANCER? Skin cancer is the most common cancer in the U.S. The American Academy of Dermatology estimates that 1 in 5 people will develop skin cancer annually. In general, exposure to ultraviolet (UV) light from the sun or tanning equipment increases the risk of developing skin cancer. Primary types of skin cancer: basal cell carcinoma, squamous cell carcinoma and melanoma
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Basal cell and squamous cell carcinoma are the most common and are estimated to affect more than 5 million people in the U.S. annually. Melanoma accounts for most deaths due to skin cancer. Research has found that melanoma prognosis and survival are worse for certain minority groups, especially Black and Hispanic people when compared to white people. MYTHS AND FACTS There are many misconceptions when it comes to skin cancer risk and how to protect oneself from the sun. Two common misconceptions I hear are: A suntan is safer than a sunburn. Similar to your friend’s belief that her darker pigment offers protection, one common misconception is that skin that tans is protective, and, therefore, will not suffer from damage from the sun. Both sunburn and suntanning are processes that damage the skin and can lead to all forms of skin cancer. When our body is exposed to significant UV radiation — which can come from the sun, tanning beds and sunlamps — the skin increases production of a pigment called melanin in an attempt to protect our
skin cells from DNA mutations. This process is what creates a tan. Unfortunately, no UV-induced tan is safe. I recommend a spray tan if you are looking for color. Only the sun can cause skin cancer. While spending time outdoors is a great way to reduce stress and get vitamin D, which is important to our health, UV radiation may be present on cloudy days (reflecting off water, snow, buildings) and it still exists in the environment. Protection from UV rays is important any time of year, not just on sunny days. Though it is well known that UV radiation is one of the major culprits leading to skin cancer in people with light skin, it is likely not the major factor leading to skin cancer in people with darker skin. Additional research is still needed, but, interestingly, people with darker skin have a higher risk of developing skin cancer in areas that are not sun-exposed, such as the palms of the hands and soles of the feet, inside of the mouth, and under the nails. As such, it is important to check all those areas when checking your skin for concerning spots. PROTECTING YOUR SKIN
Chemical sunscreen tends to be easier to spread and blend on the skin compared to mineral/ barrier sunscreen, which is usually zinc-based and, therefore, thicker and whiter in color. While zinc sunscreen is less irritating for sensitive skin, it may be more cumbersome for people with darker skin tones. Recently, many brands have created sunscreens that blend more easily with a variety of skin tones. Find one that you like and you feel comfortable applying — and reapplying — to your skin. The key to getting the full amount of SPF protection from sunscreen is applying it generously and frequently. Most people simply do not apply enough. For example, about 2 tablespoons of sunscreen, or about enough to fill a shot glass, is only enough for your face, your neck and the back of your hands. Apply sunscreen generously to the rest of your exposed skin as well. Reapply sunscreen at least every two hours, or more often if you’ve been sweating or swimming. Sunscreen may be waterresistant, but no sunscreen is waterproof. — Naiara Sbroggio Barbosa, M.D., Dermatology, Mayo Clinic, Jacksonville, Florida Mayo Clinic Q & A is an educational resource and doesn’t replace regular medical care. This Mayo Clinic Q&A represents inquiries this healthcare expert has received from patients. For more information, visit www.mayoclinic.org.
Practicing good sun safety and taking precautions to reduce UV ray exposure is important for everyone, regardless of skin color. Avoid being in the sun during peak hours (10 a.m.–3 p.m.), or when the UV index is at a level 3 or higher. Seek shade when possible; wear sunscreen every day, even if you work indoors; and wear sun protective gear outdoors, including a hat, sunglasses and long-sleeved shirts or pants. With respect to sunscreens, look for a broadspectrum product with sun protection factor (SPF) 30 or higher. Recent research has shown that a higher SPF provides better protection. You also want to find a sunscreen that is labeled as broadspectrum or full-spectrum sunscreen. There are many different types of sunscreen. Both chemical and physical sunscreens offer effective sun protection when applied correctly. Chemical sunscreens work by absorbing the UV light and causing it to undergo a chemical reaction that prevents it from damaging your skin. Physical sunscreen literally blocks UV light from reaching your skin by either reflecting the light or absorbing it. These products contain zinc oxide or titanium dioxide.
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IS IT
ALLERGIES OR A SINUS INFECTION?
Q:
I have had allergies since childhood, suffering during both the spring and fall seasons. This past month, however, I am experiencing more congestion and mucus, and I even have some facial pain. I’m beginning to wonder if my symptoms are really from allergies or if they may be caused by a sinus infection instead. How can I tell the difference?
A:
Allergies and sinus infections often are mistaken for one another. But they are two separate conditions. By paying close attention to the specific symptoms you have, you can usually identify which one is more likely to be causing the problem. When someone has allergies, it means their body is negatively reacting to allergens, such as pollen, dust mites or pet dander. This reaction happens when the immune system releases certain substances, such as histamine, into the bloodstream. This leads to allergy symptoms, which may include itching, sneezing, sinus pressure, nasal congestion and discharge. Although allergies can produce many of the same symptoms as a sinus infection, the condition is different.
A sinus infection, also called sinusitis, affects the cavities around your nasal passages. The infection causes your sinuses to become inflamed and swollen. The swelling makes it hard for your sinuses to drain, and mucus builds up. You become congested and have trouble breathing through your nose. Sinusitis often causes thick nasal discharge. In addition, you may experience headaches as well as pressure around your eyes, cheeks, nose or forehead. Though more uncommon, cough and a sore throat can accompany sinusitis, too. One of the telltale signs to discern if you have allergic rhinitis or a sinus infection is if you have itchy, watery eyes along with other symptoms. Itchiness is rarely a symptom of a sinus infection. Contrary to popular belief, the color of your mucus does not help tell the difference between allergies or sinus infections. Given that you have noted seasonal allergies, pay
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Jacqueline Squire, M.D., Mayo Foundation for Medical Education and Research, Premium Health News Service
attention to the timing of your symptoms. This also may help decide if they likely are caused by allergies. For example, tree pollen is most common in the spring. Grass pollen is common in late spring and early summer, while ragweed pollen is prevalent in the fall. Mold and fungi spores are usually more plentiful in warm-weather months. Of course, the seasons may be different, depending on the region of the country where you live. Finally, medication response also can help you determine if you need additional medical care. For allergies, overthe-counter medications, such as antihistamines, can be quite effective in relieving allergy symptoms, particularly itching and a runny nose. You also may try adding an over-the-counter nasal corticosteroid daily to help with allergy symptoms. These nasal sprays help prevent and treat nasal inflammation and congestion, especially if you have seasonal allergies and use them just as the allergy symptoms begin. If you suspect your nasal congestion and other symptoms are the results of sinus problems rather than allergies, you just may need to be patient. In most cases, viruses cause sinusitis. These viral infections usually go away on their own within a week to 10 days. Self-care measures, such as extra rest and fluids, saline sinus rinses, and overthe-counter pain relievers and decongestants, can help. But if symptoms are persistent or severe, antibiotics may be needed to treat the infection. If your symptoms are increasing, do not improve with current therapy or last for more than two weeks, you could benefit from a visit with your primary care clinician or an allergist. There are other options to help alleviate symptoms and address ongoing allergies or recurrent sinusitis. — Jacqueline Squire, M.D., Allergy and Immunology, Mayo Clinic, Jacksonville, Florida Mayo Clinic Q & A is an educational resource and doesn’t replace regular medical care. This Mayo Clinic Q&A represents inquiries this healthcare expert has received from patients. For more information, visit www.mayoclinic.org.
WHEN STICKY THOUGHTS INTERFERE WITH LIFE Howard LeWine, M.D., Harvard Health Publishing, The Medicine Cabinet
Q:
I tend to hold on to thoughts and can’t seem to stop dwelling on them. Nothing dangerous, but when a thought takes hold, it affects my concentration and mood. Is this common? How can I break the cycle?
A:
It’s normal for people to have sticky thoughts occasionally. If it happens a lot, it could be due to stress or an underlying condition, such as the following: • Generalized anxiety disorder. People with generalized anxiety disorder, a condition marked by excessive worry, can have sticky thoughts about many things, such as an upcoming event, finances or a future bus or plane ride. • Depression. When you’re depressed, which involves having feelings of extreme sadness or hopelessness, you tend to feel bad about yourself. You might have sticky thoughts that you’ve failed at something or that no one likes or cares about you. • Obsessive-compulsive disorder (OCD). OCD is characterized by obsessions, intrusive, disturbing thoughts; or compulsions, feelings of pressure to carry out repetitive behaviors, such as hand washing. A classic OCD sticky thought is about germs, and whether you touched something contaminated and need to wash your hands. • Post-traumatic stress disorder (PTSD). PTSD is a cluster of symptoms that can occur after witnessing or experiencing a traumatic event, such as violence or loss of life. One PTSD symptom is a sticky thought that replays the traumatic scene.
• Examine the evidence. How much of the thought is true? Write out the evidence for it and then write down anything that contradicts it. If your brain says you’re a failure, think of ways you’ve succeeded. • Distract yourself. It’s hard to focus on a sticky thought when you’re in the middle of an activity. To break away from the thought, change the scenery and go for a walk, or jump into an activity that engages you. • Schedule more activities. If you have too much free time in the day, your brain will have more time to focus on sticky thoughts. Stay busy. • Talk to a family member or friend. Sharing your thoughts helps give you perspective and helps fight isolation and loneliness. It’s hard to navigate sticky thoughts alone, especially if you have an underlying mental health condition and you’re unaware of it. Don’t carry the burden by yourself. If you’ve been experiencing sticky thoughts for a few weeks, talk to your primary care doctor or make an appointment with a therapist for an evaluation. Howard LeWine, M.D., is an internist at Brigham and Women’s Hospital in Boston and assistant professor at Harvard Medical School. For additional consumer health information, please visit www.health.harvard.edu.
Sticky thoughts can have negative effects. They make it hard to concentrate, they can promote fear and they can damage your self-esteem. After devoting so much time to one of them, you might start to believe it. When you try to push a sticky thought away, it seems to stick even more. That’s because you wind up devoting additional attention to it. Instead, try one of the following tactics.
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SUMMERTIME BLUES:
AN UNCOMMON SEASONAL AFFECTIVE DISORDER Howard LeWine, M.D., Harvard Health Publishing, The Medicine Cabinet
Q:
I am one of those people that get depressed when days get longer. Why do some people get the summertime blues?
A:
“Summertime blues” is an uncommon version of seasonal affective disorder known as summertime SAD: SAD is marked by depressive symptoms at a specific time of year. Classic SAD occurs in late fall or winter when sunlight levels plummet and gloomy days dominate. For a sliver of the 2% of people who develop SAD over their lifetime, however, these symptoms clash with the arrival of beautiful weather, fun outdoor activities, fragrant greenery and vacation escapes.
As with depression in general, however, both versions of SAD affect women more often than men. The season-led shift from cold to warm can also sink the mood in ways more concerning than a mere case of summertime blues. These summer SAD symptoms resemble overall depression signs, including not enjoying activities that usually bring pleasure, irritability, low energy and trouble concentrating. Importantly, though, reverse SAD sometimes differs from winter-driven depression with opposite symptom patterns related to eating and sleeping. Many people with non-seasonal depression sleep too little, eat less and lose weight. But those with summertime SAD may actually sleep more than one-half the day and put on extra pounds.
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A harbinger of winter SAD is a steady drop in natural light, which is thought to disrupt the body’s built-in 24-hour clock, along with the brain’s ability to process serotonin, a chemical influencing mood. But in summer, people are exposed to many hours of daylight, so the working assumption is that light isn’t the problem. Theories abound, but ultimately, scientists aren’t completely certain why SAD can strike in summer. The key is to understand what’s unique to you. Use these measures to help combat summertime SAD: LEAN IN ON TREATMENT. People who take antidepressants shouldn’t pick spring or summer to decrease their dosage, and extra therapy appointments might be in order. REVISE ROUTINES. Tame overwhelming amounts of “together time” with kids or other family members by lining up more child care and sharing carpooling duties. Fall back on tried-andtrue ways to regain control over your days, such as setting reminder alarms and keeping a family schedule. DOUBLE DOWN ON EXERCISE. Milder days can be ideal for swimming, brisk walks, and bike rides, but don’t become a couch potato if heat and humidity drive you inside. Burn off stress in indoor gyms or pools, or with home-based exercise equipment. Howard LeWine, M.D., is an internist at Brigham and Women’s Hospital in Boston and assistant professor at Harvard Medical School. For additional consumer health information, please visit www.health.harvard.edu. .
Want a calmer brain? Try this Maureen Salamon, Harvard Health Blog, Premium Health News Service
FOR NEUROSCIENTIST SARA LAZAR, A FORM OF MEDITATION CALLED OPEN AWARENESS IS AS FUNDAMENTAL TO HER DAY AS BREATHING. “I just become aware that I am aware, with no particular thing that I focus on,” explains Lazar, an associate researcher in the psychiatry department at Massachusetts General Hospital and assistant professor of psychology at Harvard Medical School. “This sort of practice helps me become more aware of the subtle thoughts and emotions that briefly flit by, that we usually ignore but are quite useful to tune into.” But meditation doesn’t just change your perspective in the moment. Some studies show certain types of meditation offer an array of benefits, from easing chronic pain and stress and lowering high blood pressure to help relieve anxiety and depression. And, as Lazar’s research has shown, meditation can actually change the structure and connectivity of brain areas that help us cope with fear and anxiety. “It’s become really clear that all of our experiences shape our brain in one way or another,” Lazar says. “A lot of people talk about meditation being a mental exercise. Just as you build your physical muscles, you can build your calm muscles. Meditation is a very effective way of training those muscles.”
WHAT COUNTS AS MEDITATION? More than you might have believed. An intriguing if somewhat perplexing aspect of meditation is that it encompasses a broad range of practices. “It’s clear what is not meditation, but there’s less consensus on what it is,” Lazar says. Open awareness, Lazar’s go-to meditation, joins other forms, including focused awareness, slow deep breathing, guided meditation and mantra meditation, along with many variations. At their core, Lazar says, is an awareness of the moment, noticing what you’re experiencing and nonjudgmentally disengaging from intrusive thoughts that might interfere with your ability to attend to this task. Meditation can also involve sitting with eyes closed and paying attention to your body and any sensations that are present. A regular meditation practice typically involves slowing down, breathing and observing inner experience.
“Meditation can involve flickering candles, breath awareness or mantras — all of these things,” Lazar says. “But there’s definitely an element of focusing and regulating your attention.” A close look at how meditation alters the brain: Small MRI imaging studies have zeroed in meditation’s effects on the amygdala, an almond-shaped structure deep within the brain that processes fear and anxiety as well as other emotions. Lazar and her colleagues have spent many years laying the groundwork to show how practicing mindfulness-based stress reduction (MBSR) alters the amygdala after only about two months. The MBSR practice in this research consisted of weekly group meetings and daily home mindfulness practices, including sitting meditation and yoga.
WHAT HAS THEIR RESEARCH FOUND? One key study involved 26 people with high levels of perceived stress. After an eight-week regimen of MBSR, brain scans showed the density of their amygdalae decreased, and these brain changes correlated to lower reported stress levels. Building on this, Lazar and colleagues designed a study that focused on 26 people diagnosed with generalized anxiety, a disorder marked by excessive, ongoing and often illogical anxiety levels. The researchers randomized participants to either practice MBSR or receive stress management education. These participants were compared to 26 healthy participants. In this first-of-its-kind research, participants were shown a series of images with angry or neutral facial expressions while their brain activity was gauged using functional MRI imaging. At the beginning of the study, anxiety patients showed higher levels of amygdala activation in response to neutral faces than healthy participants. This suggests a stronger fear response to a nonthreatening situation. But after eight weeks of MBSR, MRI imaging showed increased connections between the amygdala and the prefrontal cortex, a brain area crucial to emotional regulation. The amygdalae in participants with generalized anxiety no longer displayed a fear response to neutral faces. These participants also reported their symptoms had improved.
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“It seems meditation helps to down-regulate the amygdala in response to things it perceives to be threatening,” Lazar says.
Meditation. This offers a quick taste of meditation, walking you through three pared-down but distinct steps. “It’s simple, fast and anyone can do it,” she says.
HOW CAN MEDITATION BENEFITS HELP US IN DAILY LIFE?
Simple ways to expand this basic approach are:
Lazar believes training your brain to stop and notice your thoughts in a slightly detached way can calm you amidst the muddle of work deadlines, family friction or distressing news. “That’s one of the biggest translations” of meditation to everyday benefits, she says. “The person or situation that is stressing you out won’t go away, but you can watch your reactivity to the situation in a mindful, detached way, which shifts your relationship to it.” “It’s not indifference,” she adds. “It’s sort of like a bubble bursting — you realize you don’t need to keep going on this loop. Once you see that, it totally shifts your relationship to that reaction bubbling through your brain.”
WANT TO TRY MEDITATION — OR EXPAND YOUR PRACTICE? Haven’t tried meditating? To get started, Lazar recommends the Three-Minute Breathing Space
• • •
Adding minutes, just as you might for exercise Meditating outdoors Pausing to notice how you feel after you meditate
“Or try either doing a longer session or short hits throughout the day, such as a three-minute breathing break four to five times a day,” Lazar suggests. Another way to enhance your practice is to use ordinary, repetitive moments throughout the day — such as reaching for a doorknob — as a cue to pause for five seconds and notice the sensation of your hand on the knob. “As you walk from your office to your car, for instance, instead of thinking of all the things you have to do, you can be mindful while you’re walking,” Lazar says. “Feel the sunshine and the pavement under your feet. There are simple ways to work meditation into each day.” Maureen Salamon is executive editor of Harvard Women’s Health Watch.
STILL NEED HEALTH INSURANCE? A United Way Healthcare Navigator can help.
Certain life events, like losing health coverage (including Medicaid), getting married or having a baby, may qualify you for Special Enrollment at HealthCare.gov. Connect with a Healthcare Navigator to learn more. The help is FREE, local, confidential and language interpretation is available. This program is supported by the Centers for Medicare and Medicaid Services (CMS) of the U.S. Department of Health and Human Services (HHS) as part of a financial assistance award totaling $2 million with 100% funded by CMS/HHS. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by CMS/HHS, or the U.S. Government.
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PTSD:
How is treatment changing?
Julie Corliss, Harvard Health Blog, Premium Health News Service
Over the course of a lifetime, as many as seven in 10 adults in the United States will directly experience or witness harrowing events. These include gun violence, car accidents, and other personal trauma; natural or human-made disasters, such as Hurricane Katrina and the 9/11 terrorist attacks; and military combat. And some — though not all — will experience posttraumatic stress disorder, or PTSD.
WHO IS MORE LIKELY TO EXPERIENCE PTSD?
New guidelines released in 2024 can help guide effective treatment.
What about people who were not in the military? Within the general population, estimates suggest PTSD occurs in 4% of men and 8% of women — a difference at least partly related to the fact that women are more likely to experience sexual assault.
WHAT IS PTSD? PTSD is a potentially debilitating mental health condition. It’s marked by recurrent, frightening episodes during which a person relives a traumatic event. After a disturbing event, it’s normal to have upsetting memories, feel on edge and have trouble sleeping. For most people, these symptoms fade over time. But when certain symptoms persist for more than a month, a person may be experiencing PTSD. These symptoms include: • • • •
Recurring nightmares or intrusive thoughts about the event Feeling emotionally numb and disconnected Withdrawing from people and certain situations Being jumpy and on guard
The National Center for PTSD offers a brief self-screening test online, which can help you decide whether to seek more information and help.
Not everyone who experiences violence, disasters and other upsetting events goes on to develop PTSD. However, military personnel exposed to combat in a war zone are especially vulnerable. About 11% to 20% of veterans who served in Iraq or Afghanistan have PTSD, according to the National Center for PTSD.
WHAT ARE THE NEW GUIDELINES FOR PTSD TREATMENT? Experts from the U.S. Department of Veterans Affairs and Department of Defense collaborated on new guidelines for treating PTSD. They detailed the evidence both for and against specific therapies for PTSD. Their findings apply to civilian and military personnel alike, says Dr. Sofia Matta, a psychiatrist at Harvardaffiliated Massachusetts General Hospital and senior director of medical services at Home Base, a nonprofit organization that provides care for veterans, service members and their families. The circle of care is widely drawn for good reason. “It’s important to recognize that PTSD doesn’t just affect the person who is suffering but also their families and sometimes, their entire community,” Matta says. The rise in mass shootings in public places and the aftermath of these events are a grim reminder of this reality, she adds. Health care | Spring 2025 18
Both cognitive processing therapy and prolonged exposure therapy were effective. These two therapies teach people how to evaluate and reframe the upsetting thoughts stemming from the traumatic experience. The guidelines also recommend mindfulness-based stress reduction, an eight-week program that includes meditation, body scanning and simple yoga stretches. WHICH MEDICATIONS ARE RECOMMENDED FOR PTSD? Some people with severe symptoms need medication to feel well enough to participate in therapy. “People with PTSD often don’t sleep well due to insomnia and nightmares, and the resulting fatigue makes it hard to pay attention and concentrate,” says Matta. Three medicines commonly prescribed for depression and anxiety — paroxetine (Paxil), sertraline (Zoloft) and venlafaxine (Effexor) — are recommended. Prazosin (Minipress) may help people with nightmares, but the evidence is weak. WHICH MEDICATIONS ARE NOT RECOMMENDED FOR PTSD? The guidelines strongly recommended not taking benzodiazepines (anti-anxiety drugs often taken for sleep). Benzodiazepines such as alprazolam (Xanax) and clonazepam (Klonopin) offer no proven benefits for people with PTSD. They have several potential harms, including negative cognitive changes and decreased effectiveness of PTSD psychotherapies. WHICH TREATMENT APPROACHES ARE MOST EFFECTIVE FOR PTSD?
WHAT ABOUT CANNABIS, PSYCHEDELICS, AND BRAIN STIMULATION THERAPIES?
The new guidelines looked at psychotherapy, medications, nondrug therapies. Psychotherapy, sometimes paired with certain medicines, emerged as the most effective approach.
Right now, evidence doesn’t support the idea that cannabis helps ease PTSD symptoms. And there are possible serious side effects from the drug, such as cannabis hyperemesis syndrome (severe vomiting related to long-term cannabis use).
The experts also recommended not taking certain drugs due to lack of evidence or possible harm. WHICH PSYCHOTHERAPIES ARE RECOMMENDED FOR PTSD? The recommended treatment for PTSD, psychotherapy, is more effective than medication. It also has fewer adverse side effects and people prefer it, according to the guidelines. Which type of psychotherapy can help? Importantly, the most effective therapies for people with PTSD differ from those for people with other mental health issues, says Matta.
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There isn’t enough evidence to recommend for or against psychedelic-assisted therapies such as psilocybin (magic mushrooms) and MDMA (ecstasy). “Because these potential therapies are illegal under federal law, the barriers for conducting research on them are very high,” says Matta. However, recent legislative reforms may make such studies more feasible. Likewise, the evidence is mixed for a wide range of other nondrug therapies, such as brain stimulation therapies like repetitive transcranial magnetic stimulation or transcranial direct current stimulation. Julie Corliss is executive editor of Harvard Heart Letter.
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