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I have a stuffy nose, how can I tell if it’s hay fever, COVID or something else?

<a href="https://theconversation.com/profiles/deryn-thompson-1449312">Deryn Thompson</a>, <a href="https://theconversation.com/institutions/university-of-south-australia-1180">University of South Australia</a> Hay fever (also called allergic rhinitis) affects <a href="https://www.abs.gov.au/statistics/health/health-conditions-and-risks/national-health-survey-state-and-territory-findings/latest-release">24%</a> of Australians. <a href="https://www.allergy.org.au/patients/allergic-rhinitis-hay-fever-and-sinusitis/allergic-rhinitis-or-hay-fever">Symptoms</a> include sneezing, a runny nose (which may feel blocked or stuffy) and itchy eyes. People can also experience an itchy nose, throat or ears. But COVID is still <a href="https://theconversation.com/xec-is-now-in-australia-heres-what-we-know-about-this-hybrid-covid-variant-239292">spreading</a>, and <a href="https://theconversation.com/i-feel-sick-how-do-i-know-if-i-have-the-flu-covid-rsv-or-something-else-234266">other viruses</a> can cause cold-like symptoms. So how do you know which one you’ve got? <h2>Remind me, how does hay fever cause symptoms?</h2> <a href="https://www.allergy.org.au/hp/papers/allergic-rhinitis-clinical-update">Hay fever</a> happens when a person has become “sensitised” to an allergen trigger. This means a person’s body is always primed to react to this trigger. Triggers can include allergens in the air (such as pollen from trees, grasses and flowers), mould spores, animals or house dust mites which mostly live in people’s mattresses and bedding, and feed on shed skin. When the body is exposed to the trigger, it produces IgE (immunoglobulin E) antibodies. These cause the release of many of the body’s own chemicals, including histamine, which result in hay fever symptoms. People who have asthma may find their asthma symptoms (cough, wheeze, tight chest or trouble breathing) worsen when exposed to airborne allergens. Spring and sometimes into summer can be the worst time for people with grass, tree or flower allergies. However, animal and house dust mite symptoms usually happen year-round. <h2>What else might be causing my symptoms?</h2> Hay fever does not cause a fever, sore throat, muscle aches and pains, weakness, loss of taste or smell, nor does it cause you to cough up mucus. These symptoms are likely to be caused by a virus, such as COVID, influenza, respiratory syncytial virus (RSV) or a “cold” (often caused by rhinoviruses). These conditions can occur all year round, with some overlap of symptoms: <figure class="align-center zoomable"><a href="https://images.theconversation.com/files/624085/original/file-20241007-16-xf6euv.png?ixlib=rb-4.1.0&q=45&auto=format&w=1000&fit=clip"><img src="https://images.theconversation.com/files/624085/original/file-20241007-16-xf6euv.png?ixlib=rb-4.1.0&q=45&auto=format&w=754&fit=clip" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px" srcset="https://images.theconversation.com/files/624085/original/file-20241007-16-xf6euv.png?ixlib=rb-4.1.0&q=45&auto=format&w=600&h=582&fit=crop&dpr=1 600w, https://images.theconversation.com/files/624085/original/file-20241007-16-xf6euv.png?ixlib=rb-4.1.0&q=30&auto=format&w=600&h=582&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/624085/original/file-20241007-16-xf6euv.png?ixlib=rb-4.1.0&q=15&auto=format&w=600&h=582&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/624085/original/file-20241007-16-xf6euv.png?ixlib=rb-4.1.0&q=45&auto=format&w=754&h=731&fit=crop&dpr=1 754w, https://images.theconversation.com/files/624085/original/file-20241007-16-xf6euv.png?ixlib=rb-4.1.0&q=30&auto=format&w=754&h=731&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/624085/original/file-20241007-16-xf6euv.png?ixlib=rb-4.1.0&q=15&auto=format&w=754&h=731&fit=crop&dpr=3 2262w" alt="" /></a><figcaption><a class="source" href="https://theconversation.com/i-feel-sick-how-do-i-know-if-i-have-the-flu-covid-rsv-or-something-else-234266">Natasha Yates/The Conversation</a></figcaption></figure> COVID still <a href="https://theconversation.com/xec-is-now-in-australia-heres-what-we-know-about-this-hybrid-covid-variant-239292">surrounds</a> us. <a href="https://www.sahealth.sa.gov.au/wps/wcm/connect/public+content/sa+health+internet/about+us/health+statistics/surveillance+of+notifiable+conditions/respiratory+infections+dashboard">RSV and influenza</a> rates appear higher than before the COVID pandemic, but it may be <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10888990/#:%7E:text=Increases%20in%20RSV%20patient%20volume,with%20an%20RSV%20diagnosis%20occurred">due to more testing</a>. So if you have a fever, sore throat, muscle aches/pains, weakness, fatigue, or are coughing up mucus, stay home and avoid mixing with others to limit transmission. People with COVID symptoms can take a rapid antigen test (<a href="https://www.health.gov.au/sites/default/files/2024-04/coronavirus-covid-19-rapid-antigen-tests.pdf">RAT</a>), ideally when <a href="https://www.cochrane.org/CD013705/INFECTN_how-accurate-are-rapid-antigen-tests-diagnosing-covid-19">symptoms start</a>, then isolate until symptoms disappear. <a href="https://www.mja.com.au/journal/2023/219/11/covid-19-rapid-antigen-tests-approved-self-testing-australia-published">One negative RAT alone</a> can’t rule out COVID if symptoms are still present, so test again 24–48 hours after your initial test if symptoms persist. You can now test yourself for COVID, RSV and influenza in a <a href="https://www.tga.gov.au/sites/default/files/2024-02/covid-19-rapid-antigen-self-tests-are-approved-australia-ifu-406813.PDF">combined RAT</a>. But again, a negative test doesn’t rule out the virus. If your symptoms continue, <a href="https://www.tga.gov.au/sites/default/files/2024-02/covid-19-rapid-antigen-self-tests-are-approved-australia-ifu-406813.PDF">test again</a> 24–48 hours after the previous test. <h2>If it’s hay fever, how do I treat it?</h2> Treatment involves blocking the body’s histamine release, by taking antihistamine medication which helps reduce the symptoms. Doctors, nurse practitioners and pharmacists can develop a <a href="https://www.allergy.org.au/images/pc/ASCIA_Allergic_Rhinitis_Treatment_Plan_2024.pdf">hay fever care plan</a>. This may include using a nasal spray containing a topical corticosteroid to help reduce the swelling inside the nose, which causes stuffiness or blockage. Nasal sprays need to delivered <a href="https://allergyfacts.org.au/are-you-using-your-nasal-spray-correctly/">using correct technique</a> and used over several weeks to work properly. Often these sprays can also help lessen the itchy eyes of hay fever. Drying bed linen and pyjamas inside during spring can <a href="https://www.allergy.org.au/patients/allergy-treatments/allergen-minimisation">lessen symptoms</a>, as can putting a <a href="https://www.nps.org.au/consumers/managing-hay-fever">smear of Vaseline</a> in the nostrils when going outside. Pollen sticks to the Vaseline, and gently blowing your nose later removes it. People with asthma should also have an <a href="https://asthma.org.au/manage-asthma/asthma-action-plan/">asthma plan</a>, created by their doctor or nurse practitioner, explaining how to adjust their asthma reliever and preventer medications in hay fever seasons or on allergen exposure. People with asthma also need to be <a href="https://www.nationalasthma.org.au/living-with-asthma/resources/patients-carers/factsheets/thunderstorm-asthma">alert for thunderstorms</a>, where pollens can burst into tinier particles, be inhaled deeper in the lungs and cause a severe asthma attack, and even death. <h2>What if it’s COVID, RSV or the flu?</h2> Australians aged 70 and over and others with underlying health conditions who test positive for COVID are <a href="https://www.healthdirect.gov.au/covid-19/medications#at-home">eligible for antivirals</a> to reduce their chance of severe illness. Most other people with COVID, RSV and influenza will recover at home with rest, fluids and paracetamol to relieve symptoms. However some groups are at greater risk of serious illness and may require additional treatment or hospitalisation. For <a href="https://www.health.nsw.gov.au/Infectious/factsheets/Pages/respiratory-syncytial-virus.aspx">RSV</a>, this includes premature infants, babies 12 months and younger, children under two who have other medical conditions, adults over 75, people with heart and lung conditions, or health conditions that lessens the immune system response. For influenza, people at <a href="https://www.health.nsw.gov.au/Infectious/Influenza/Pages/at-risk.aspx">higher risk</a> of severe illness are pregnant women, Aboriginal people, people under five or over 65 years, or people with long-term medical conditions, such as kidney, heart, lung or liver disease, diabetes and decreased immunity. If you’re concerned about severe symptoms of COVID, RSV or influenza, consult your doctor or call 000 in an emergency. If your symptoms are mild but persist, and you’re not sure what’s causing them, book an appointment with your doctor or nurse practitioner. Although hay fever season is here, we need to avoid spreading other serious infectious. For more information, you can call the healthdirect helpline on 1800 022 222 (known as NURSE-ON-CALL in Victoria); use the <a href="https://www.healthdirect.gov.au/symptom-checker">online Symptom Checker</a>; or visit <a href="http://healthdirect.gov.au/">healthdirect.gov.au</a> or the <a href="https://www.allergy.org.au/patients/allergy-treatments/allergen-minimisation">Australian Society of Clinical Immunology and Allergy</a>.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/240453/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/deryn-thompson-1449312">Deryn Thompson</a>, Eczema and Allergy Nurse; Lecturer, <a href="https://theconversation.com/institutions/university-of-south-australia-1180">University of South Australia</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/i-have-a-stuffy-nose-how-can-i-tell-if-its-hay-fever-covid-or-something-else-240453">original article</a>.

Body

New study finds epilepsy drug could reduce sleep apnoea symptoms

New research has found that a drug used for epilepsy could be used to reduce the symptoms of sleep apnoea. Obstructive sleep apnoea, which affects about one in 20 people, according to the National Institute for Health and Care Excellence in England, includes symptoms like snoring and it causes a person's breathing to start and stop during the night, with many requiring an aid to help keep their airways open. An international study has identified that taking sulthiame, a drug sold under the brand name Ospolot in Europe, may help prevent patients' breathing from temporarily stopping. This provides an additional option for those unable to use mechanical breathing aids like the Cpap machines. “The standard treatment for obstructive sleep apnoea is sleeping with a machine that blows air through a face mask to keep the airways open. Unfortunately, many people find these machines hard to use over the long term, so there is a need to find alternative treatments,” Prof Jan Hedner from Sahlgrenska university hospital and the University of Gothenburg in Sweden said. Researchers conducted a randomised controlled trial of almost 300 obstructive sleep apnoea patients across Europe, who did not use Cpap machines. They were divided into four groups and given either a placebo or different strengths of sulthiame. The study measured patients’ breathing, oxygen levels, heart rhythm, eye movements, as well as brain and muscle activity while asleep. It found after 12 weeks, those taking sulthiame had up to 50% fewer occasions where their breathing stopped, and higher levels of oxygen in their blood. However, a bigger study needs to be done to confirm the beneficial effects on a larger group. The findings, were presented at the European Respiratory Society Congress in Vienna, Austria. Erika Radford, the head of health advice at Asthma + Lung UK said the findings were a positive step forward in moving away from having to rely on mechanical breathing equipment. “This potential alternative to the current main treatment would make it easier for people to manage their condition,” she said. Image: Shutterstock

Body

Ovarian cancer is hard to detect. Focusing on these 4 symptoms can help with diagnosis

<a href="https://theconversation.com/profiles/jenny-doust-12412">Jenny Doust</a>, <a href="https://theconversation.com/institutions/the-university-of-queensland-805">The University of Queensland</a> Ovarian cancers are often found when they are already advanced and hard to treat. Researchers <a href="https://ascopubs.org/doi/10.1200/JCO.2010.32.2164">have long believed</a> this was because women first experienced symptoms when ovarian cancer was already well-established. Symptoms can also be <a href="https://cancer.org.au/cancer-information/causes-and-prevention/early-detection-and-screening/early-detection-of-ovarian-cancer">hard to identify</a> as they’re vague and similar to other conditions. But <a href="https://ijgc.bmj.com/content/early/2024/07/24/ijgc-2024-005371">a new study</a> shows promising signs ovarian cancer can be detected in its early stages. The study targeted women with four specific symptoms – bloating, abdominal pain, needing to pee frequently, and feeling full quickly – and put them on a fast track to see a specialist. As a result, even the most aggressive forms of ovarian cancer could be detected in their early stages. So what did the study find? And what could it mean for detecting – and treating – ovarian cancer more quickly? <h2>Why is ovarian cancer hard to detect early?</h2> Ovarian cancer <a href="https://pubmed.ncbi.nlm.nih.gov/24979449/">cannot be detected</a> via cervical cancer screening (which used to be called a pap smear) and pelvic exams <a href="https://pubmed.ncbi.nlm.nih.gov/24979449/">aren’t useful</a> as a screening test. Current <a href="https://www.canceraustralia.gov.au/cancer-types/gynaecological-cancers/clinicians-hub/ovarian-cancer-guidelines">Australian guidelines</a> recommend women get tested for ovarian cancer if they have symptoms for <a href="https://www.canceraustralia.gov.au/sites/default/files/publications/assessment-symptoms-may-be-ovarian-cancer-guide-gps/pdf/ocg_assessment_of_symptoms_gp_card_0.pdf">more than a month</a>. But many of the <a href="https://cancer.org.au/cancer-information/types-of-cancer/ovarian-cancer">symptoms</a> – such as tiredness, constipation and changes in menstruation – are vague and overlap with other common illnesses. This makes early detection a challenge. But it is crucial – a woman’s <a href="https://seer.cancer.gov/statfacts/html/ovary.html">chances of surviving ovarian cancer</a> are associated with how advanced the cancer is when she is diagnosed. If the cancer is still confined to the original site with no spread, the five-year survival rate is 92%. But over half of women diagnosed with ovarian cancer first present when the cancer has <a href="https://seer.cancer.gov/statfacts/html/ovary.html">already metastatised</a>, meaning it has spread to other parts of the body. If the cancer has spread to nearby lymph nodes, the survival rate is reduced to 72%. If the cancer has already metastasised and spread to distant sites at the time of diagnosis, the rate is only 31%. There are mixed findings on whether detecting ovarian cancer earlier leads to better survival rates. For example, a trial in the UK that screened more than 200,000 women <a href="https://pubmed.ncbi.nlm.nih.gov/37183782/">failed to reduce deaths</a>. That study screened the general public, rather than relying on self-reported symptoms. The new study suggests asking women to look for specific symptoms can lead to earlier diagnosis, meaning treatment can start more quickly. <h2>What did the new study look at?</h2> Between June 2015 and July 2022, the researchers recruited 2,596 women aged between 16 and 90 from 24 hospitals across the UK. They were asked to monitor for these four symptoms: <ul> <li>persistent abdominal distension (women often refer to this as bloating)</li> <li>feeling full shortly after starting to eat and/or loss of appetite</li> <li>pelvic or abdominal pain (which can feel like indigestion)</li> <li>needing to urinate urgently or more often.</li> </ul> Women who reported at least one of four symptoms persistently or frequently were put on a <a href="https://pubmed.ncbi.nlm.nih.gov/22479719/">fast-track pathway</a>. That means they were sent to see a gynaecologist within two weeks. The fast track pathway has been used in the UK since 2011, but is not specifically part of Australia’s guidelines. Some 1,741 participants were put on this fast track. First, they did a blood test that measured the cancer antigen 125 (CA125). If a woman’s CA125 level was abnormal, she was sent to do a internal vaginal ultrasound. <h2>What did they find?</h2> The study indicates this process is better at detecting ovarian cancer than general screening of people who don’t have symptoms. Some 12% of women on the fast-track pathway were diagnosed with some kind of ovarian cancer. A total of 6.8% of fast-tracked patients were diagnosed with high-grade serous ovarian cancer. It is the most aggressive form of cancer and responsible for 90% of ovarian cancer deaths. Out of those women with the most aggressive form, one in four were diagnosed when the cancer was still in its early stages. That is important because it allowed treatment of the most lethal cancer before it had spread significantly through the body. There were some promising signs in treating those with this aggressive form. The majority (95%) had surgery and three quarters (77%) had chemotherapy. Complete cytoreduction – meaning all of the cancer appears to have been removed – was achieved in six women out of ten (61%). It’s a promising sign that there may be ways to “catch” and target ovarian cancer before it is well-established in the body. <h2>What does this mean for detection?</h2> The study’s findings suggest this method of early testing and referral for the symptoms leads to earlier detection of ovarian cancer. This may also improve outcomes, although the study did not track survival rates. It also points to the importance of public awareness about symptoms. Clinicians should be able to recognise all of the ways ovarian cancer can present, including vague symptoms like general fatigue. But empowering members of the general public to recognise a narrower set of four symptoms can help trigger testing, detection and treatment of ovarian cancer earlier than we thought. This could also save GPs advising every woman who has general tiredness or constipation to undergo an ovarian cancer test, making testing and treatment more targeted and efficient. Many women remain <a href="https://www.google.com/url?q=https://pubmed.ncbi.nlm.nih.gov/24612526/&sa=D&source=docs&ust=1723610085733806&usg=AOvVaw3J5o5DwRFiDzFaQcD7VTQn">unaware of the symptoms</a> of ovarian cancer. This study shows recognising them may help early detection and treatment.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/236775/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/jenny-doust-12412">Jenny Doust</a>, Clinical Professorial Research Fellow, Australian Women and Girls' Health Research Centre, <a href="https://theconversation.com/institutions/the-university-of-queensland-805">The University of Queensland</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/ovarian-cancer-is-hard-to-detect-focusing-on-these-4-symptoms-can-help-with-diagnosis-236775">original article</a>.

Body

Is it really possible to have Alzheimer’s yet no symptoms?

<a href="https://theconversation.com/profiles/michael-hornberger-1507154">Michael Hornberger</a>, <a href="https://theconversation.com/institutions/university-of-east-anglia-1268">University of East Anglia</a> Some people seem to be more <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11003087/#:%7E:text=Some%20individuals%20are%20able%20to,into%20a%20widely%20debated%20concept.">resilient</a> to developing Alzheimer’s diseases, despite having the biological hallmarks of the devastating disease. For obvious reasons, scientists are very interested in studying this special group of people. Alzheimer’s disease, the most common form of dementia, is thought to start because of a build-up of two proteins in the brain: amyloid and tau. Once these proteins accumulate, for yet-to-be-determined reasons, they become toxic to brain cells (neurons) and these cells start dying. As a result, people develop symptoms such as memory loss because the brain can’t function properly with all these dead neurons. This cascade of events has been known for many years and is how the disease progresses in most people with Alzheimer’s. Most people, except a special group who are more resilient. But why are they resilient? A recent study in the journal <a href="https://actaneurocomms.biomedcentral.com/articles/10.1186/s40478-024-01760-9">Acta Neuropathologica Communications</a> investigated whether our genes might influence how resilient we are against Alzheimer’s disease symptoms when there are high levels of amyloid in our brain. The scientists conducted a study on the brains of three groups of people. The first group comprised people who had died with Alzheimer’s disease. The second were healthy people who died of natural causes. And the third comprised people who had high levels of Alzheimer’s proteins in the brain but never developed symptoms of the disease during their lifetime – or at least never had a diagnosis of Alzheimer’s disease. The last group, they considered as being resilient to Alzheimer’s disease since they had the proteins in their brains but did not have the symptoms or a diagnosis of Alzheimer’s disease during their lifetime. The scientists found that genes related to the activity of the immune system seem to have been more active in the Alzheimer’s resilient group. This would make sense as it is well established that the immune system helps clear the excess proteins from the brain, so genes that help this process might make us more resilient to developing symptoms of the disease. <h2>How to become resilient – even if you don’t have the genes</h2> This is great if you have inherited these genes from your parents, but what does it mean for the rest of us who do not have those genes? Is there a way we can make ourselves more resilient to developing Alzheimer’s disease regardless of our genes? “Yes” is the short answer. There is now good scientific evidence that <a href="https://theconversation.com/can-alzheimers-really-be-reversed-as-a-new-documentary-claims-230705">lifestyle changes</a> and drugs allow us to reduce our risk of developing Alzheimer’s disease in the future. In particular, physical activity has been shown to reduce our risk of developing Alzheimer’s, probably because it has a well-known beneficial effect on our immune system and hence helps clear those rogue proteins accumulating in our brains. This means that being more physically active might have the same effect on our Alzheimer’s resilience as those lucky people who have the “right” genes. Interestingly, we do not know how physically active the resilient people in the study were and how this might have influenced their resilience to Alzheimer’s disease. As so often in science, it is not clear whether nature (genes) or nurture (lifestyle) contributed to their resilience. The other interesting aspect is that the resilient people in the study died of another cause than Alzheimer’s disease, but they might have developed Alzheimer’s disease eventually if they had lived longer.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/230334/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/michael-hornberger-1507154">Michael Hornberger</a>, Professor of Applied Dementia Research, <a href="https://theconversation.com/institutions/university-of-east-anglia-1268">University of East Anglia</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/is-it-really-possible-to-have-alzheimers-yet-no-symptoms-230334">original article</a>.

Mind

How tracking menopause symptoms can give women more control over their health

<a href="https://theconversation.com/profiles/deborah-lancastle-1452267">Deborah Lancastle</a>, <a href="https://theconversation.com/institutions/university-of-south-wales-1586">University of South Wales</a> Menopause can cause more symptoms than hot flushes alone. And some of your symptoms and reactions might be due to the menopause, even if you are still having periods. Research shows that keeping track of those symptoms can help to alleviate them. People sometimes talk about the menopause as though it were a single event that happens when you are in your early 50s, which is <a href="https://www.mayoclinic.org/diseases-conditions/menopause/symptoms-causes/syc-20353397#:%7E:text=Menopause%20is%20the%20time%20that,is%20a%20natural%20biological%20process.">the average time</a> to have your last period. But the menopause generally stretches between the ages of 45 and 55. And some women will experience an earlier “medical” menopause because of surgery to remove the womb or ovaries. The menopause often happens at one of the busiest times of life. You might have teenagers at home or be supporting grown-up children, have elderly parents, be employed and have a great social life. If you feel exhausted, hot and bothered, irritable and can’t sleep well, you might be tempted to think that it is because you never get a minute’s peace. But that is why monitoring symptoms is important. <a href="https://journals.lww.com/menopausejournal/Abstract/2023/03000/Symptom_monitoring_improves_physical_and_emotional.7.aspx">My team recently tested</a> the effects of tracking symptoms and emotions during the menopause. We asked women to rate 30 physical and 20 emotional symptoms of the menopause. The physical and psychological symptoms included poor concentration, problems with digesting food, stress and itchy skin, as well as the obvious symptoms like hot flushes and night sweats. Women tracked positive emotions like happiness and contentment, and negative emotions like feeling sad, isolated and angry. There were two groups of women in this study. One group recorded their symptoms and emotions every day for two weeks. The other group recorded their symptoms and emotions once at the beginning of the fortnight and once at the end. The results showed that the women who monitored their symptoms and emotions every day reported much lower negative emotions, physical symptoms and loneliness at the end of two weeks than at the beginning, compared to the other group. As well as this, although the loneliness scores of the group who monitored every day were lower than the other group, women in both groups said that being in the study and thinking about symptoms helped them feel less lonely. Simply knowing that other women were having similar experiences seemed to help. One participant said: “I feel more normal that other women are doing the same survey and are probably experiencing similar issues, especially the emotional and mental ones.” <h2>Why does monitoring symptoms help?</h2> One reason why tracking might help is that rating symptoms can help you notice changes and patterns in how you feel. This could encourage you to seek help. Another reason is that noticing changes in symptoms might help you link the change to what you have been doing. For example, looking at whether symptoms spike after eating certain foods or are better after exercise. This could mean that you change your behaviour in ways that improve your symptoms. Many menopause symptoms are known as “non-specific” symptoms. This is because they can also be symptoms of mental health, thyroid or heart problems. It is important not to think your symptoms are “just” the menopause. You should always speak to your doctor if you are worried about your health. Another good thing about monitoring symptoms is that you can take information about how often you experience symptoms and how bad they are to your GP appointment. This can help the doctor decide what might be the problem. Websites such as <a href="https://healthandher.com">Health and Her</a> and <a href="https://www.balance-menopause.com">Balance</a> offer symptom monitoring tools that can help you track what is happening to your physical and emotional health. There are several apps you can use on your phone, too. Or you might prefer to note symptoms and how bad they are in a notebook every day.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/209004/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/deborah-lancastle-1452267">Deborah Lancastle</a>, Associate Professor of Psychology, <a href="https://theconversation.com/institutions/university-of-south-wales-1586">University of South Wales</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/how-tracking-menopause-symptoms-can-give-women-more-control-over-their-health-209004">original article</a>.

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Silent cancers: here’s what you need to know when there are no obvious symptoms

<a href="https://theconversation.com/profiles/justin-stebbing-1405462">Justin Stebbing</a>, <a href="https://theconversation.com/institutions/anglia-ruskin-university-1887">Anglia Ruskin University</a> The recent revelations about the Princess of Wales’s <a href="https://www.bbc.com/news/uk-68640917">cancer diagnosis</a> highlight a crucial aspect of cancer detection – the disease’s sometimes silent nature. Silent cancers are those without noticeable symptoms. They pose a unique challenge in early detection and treatment. Contrary to common perception, cancer does not always announce its presence through overt symptoms or obvious signs. Many people receive a <a href="https://academic.oup.com/clinchem/article-abstract/70/1/179/7283928">cancer diagnosis incidentally</a>, when it’s found during routine medical examinations or investigations for unrelated health concerns – as seems to be the case for both <a href="https://www.wsj.com/health/kate-middleton-catherine-cancer-what-is-preventative-chemotherapy-9625370d">the princess</a> and <a href="https://www.bbc.co.uk/news/health-68171163">King Charles III</a>. While even silent cancers can sometimes be <a href="https://pubmed.ncbi.nlm.nih.gov/22584215/">aggressive and advance rapidly</a>, they can also remain <a href="https://pubmed.ncbi.nlm.nih.gov/20363069/">dormant</a> for years or <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8819710/">even decades</a>. Some <a href="https://ascopubs.org/doi/10.14694/EdBook_AM.2012.32.98">prostate</a>, <a href="https://ascopubs.org/doi/10.14694/EdBook_AM.2012.32.301">breast</a> and <a href="https://www.frontiersin.org/journals/endocrinology/articles/10.3389/fendo.2020.571421/full">thyroid</a> cancers, for example, <a href="https://www.tmlep.com/clinical-learning/2023-01-23-when-did-this-tumour-start-the-need-for-a-gompertzian-understanding-of-tumour-growth-kinetics">often evolve slowly</a> without obvious symptoms or spreading beyond the original area. Research suggests that some of these cancers are <a href="https://www.frontiersin.org/journals/endocrinology/articles/10.3389/fendo.2020.571421/full">overtreated</a>. Sometimes patients are best left alone or treated much more gently, perhaps even without medical intervention, using a <a href="https://www.nejm.org/doi/full/10.1056/nejmoa1311593">“watch and wait”</a> strategy. This approach may be taken with prostate cancer in the elderly, for example. <h2>The importance of early diagnosis</h2> Whatever the cancer, it’s always important to get an early diagnosis though – and for silent cancers, this is obviously a challenge. Some cancer symptoms <a href="https://pubmed.ncbi.nlm.nih.gov/36702593/">can be vague</a> and easily mistaken for benign ailments. Fatigue, unexplained weight loss and persistent pain are among the nonspecific symptoms that may signal an underlying malignancy. But such symptoms can be misinterpreted or easily dismissed, which contributes to delayed diagnosis and treatment. <figure><iframe src="https://www.youtube.com/embed/MGMy6BzBvp0?wmode=transparent&start=0" width="440" height="260" frameborder="0" allowfullscreen="allowfullscreen"></iframe></figure> Fortunately, in many countries including the UK, we have <a href="https://www.england.nhs.uk/cancer/early-diagnosis/screening-and-earlier-diagnosis/">screening</a> tests for diseases like breast or colon cancer, to increase early diagnoses. Early diagnosis is a <a href="https://acsjournals.onlinelibrary.wiley.com/doi/full/10.1002/cncr.32887">key factor</a> for successful cancer treatment. Detecting cancer in its silent phase offers a window of opportunity for early intervention and improved outcomes. The discovery of asymptomatic cancers through diagnostic imaging or screening tests underscores the importance of these proactive healthcare measures. Identifying cancer at an early stage means the disease is confined to its site of origin, smaller and potentially easier to cure. Diagnosing a smaller cancer often means that if an operation is needed, it may be a less invasive surgery. There may also be a <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6825992/">lower chance</a> of needing post-operative preventative chemotherapy, to mop up any residual cells. Colorectal cancer (CRC) is a good example to show the critical importance of screening. Studies show that patients who participate in CRC <a href="https://www.nice.org.uk/guidance/dg56/chapter/1-Recommendations">screening</a>, such as colonoscopies or tests that look for blood in the stool, are more likely to be diagnosed while asymptomatic and have more positive prognoses after treatment. Those diagnosed with CRC after showing symptoms, such as rectal bleeding or changes in bowel habits, tend to have more <a href="https://bmjopengastro.bmj.com/content/4/1/e000146%20">advanced tumors and poorer outcomes</a>. <figure><iframe src="https://www.youtube.com/embed/nA9_Io3LDpA?wmode=transparent&start=0" width="440" height="260" frameborder="0" allowfullscreen="allowfullscreen"></iframe></figure> Public health initiatives aimed at raising awareness about the importance of both cancer screening and symptom recognition play a pivotal role in reducing diagnostic delays. Empowering people to engage in <a href="https://healthcaredelivery.cancer.gov/prevention/#:%7E:text=Cancer%20can%20be%20prevented%20through,they%20are%20more%20easily%20treated.">preventive healthcare measures</a> such as HPV vaccinations and lifestyle changes that decrease risk can facilitate early detection and intervention, potentially altering the trajectory of the disease. <h2>Biomarker discovery</h2> The latest advances in diagnostic technologies, often known as <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8012218/#:%7E:text=During%20biomarker%20discovery%2C%20evaluation%20of,design%20of%20future%20validation%20studies.">“biomarker discovery”</a>, hold promise for improving early detection rates and refining treatment strategies for silent cancers. From <a href="https://www.cancer.gov/publications/dictionaries/cancer-terms/def/molecular-profiling">molecular profiling</a> to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9922467/">liquid biopsy techniques</a> (blood tests to diagnose cancer), innovative approaches are reshaping the landscape of cancer diagnosis, offering new avenues for personalised and precision medicine. For example, I worked with a team using blood tests to identify cancers in more than <a href="https://www.nature.com/articles/s41388-023-02591-z">1,000 women recalled after screening for mammography</a>. We looked at the DNA that tumour cells release – so-called <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10496721/">cell-free DNA</a> – and also metabolomics (rare markers related to metabolism in the blood). From this information, we found healthy patients, benign disease, pre-cancer and breast cancer. Although there’s increasing awareness and use of this <a href="https://www.sciencedirect.com/science/article/abs/pii/S1769721218307110">approach in Europe</a>, it isn’t standard in the UK. Asymptomatic cancers represent a formidable challenge for patient care. But, by encouraging patients to adopt preventive lifestyles and engage with screenings and tests, asymptomatic cancers don’t have to be a hidden threat to health.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/226536/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/justin-stebbing-1405462">Justin Stebbing</a>, Professor of Biomedical Sciences, <a href="https://theconversation.com/institutions/anglia-ruskin-university-1887">Anglia Ruskin University</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/silent-cancers-heres-what-you-need-to-know-when-there-are-no-obvious-symptoms-226536">original article</a>.

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What are the most common symptoms of menopause? And which can hormone therapy treat?

<a href="https://theconversation.com/profiles/susan-davis-10376">Susan Davis</a>, <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a> Despite decades of research, navigating menopause seems to have become harder – with conflicting information on the internet, in the media, and from health care providers and researchers. Adding to the uncertainty, a recent <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)00462-8/fulltext">series in the Lancet</a> medical journal challenged some beliefs about the symptoms of menopause and which ones menopausal hormone therapy (also known as hormone replacement therapy) can realistically alleviate. So what symptoms reliably indicate the start of perimenopause or menopause? And which symptoms can menopause hormone therapy help with? Here’s what the evidence says. <h2>Remind me, what exactly is menopause?</h2> Menopause, simply put, is complete loss of female fertility. Menopause is traditionally defined as the final menstrual period of a woman (or person female at birth) who previously menstruated. Menopause is diagnosed after 12 months of no further bleeding (unless you’ve had your ovaries removed, which is surgically induced menopause). Perimenopause starts when menstrual cycles first vary in length by seven or more days, and ends when there has been no bleeding for 12 months. Both perimenopause and menopause are hard to identify if a person has had a hysterectomy but their ovaries remain, or if natural menstruation is suppressed by a treatment (such as hormonal contraception) or a health condition (such as an eating disorder). <h2>What are the most common symptoms of menopause?</h2> <a href="https://srh.bmj.com/content/early/2024/02/21/bmjsrh-2023-202099.long">Our study</a> of the highest quality menopause-care guidelines found the internationally recognised symptoms of the perimenopause and menopause are: <ul> <li>hot flushes and night sweats (known as vasomotor symptoms)</li> <li>disturbed sleep</li> <li>musculoskeletal pain</li> <li>decreased sexual function or desire</li> <li>vaginal dryness and irritation</li> <li>mood disturbance (low mood, mood changes or depressive symptoms) but not clinical depression.</li> </ul> However, none of these symptoms are menopause-specific, meaning they could have other causes. In <a href="https://journals.lww.com/menopausejournal/abstract/2015/07000/moderate_to_severe_vasomotor_and_sexual_symptoms.6.aspx">our study of Australian women</a>, 38% of pre-menopausal women, 67% of perimenopausal women and 74% of post-menopausal women aged under 55 experienced hot flushes and/or night sweats. But the severity of these symptoms <a href="https://journals.lww.com/menopausejournal/abstract/2015/07000/moderate_to_severe_vasomotor_and_sexual_symptoms.6.aspx">varies greatly</a>. Only 2.8% of pre-menopausal women reported moderate to severely bothersome hot flushes and night sweats symptoms, compared with 17.1% of perimenopausal women and 28.5% of post-menopausal women aged under 55. So bothersome hot flushes and night sweats appear a reliable indicator of perimenopause and menopause – but they’re not the only symptoms. Nor are hot flushes and night sweats a western society phenomenon, as has been suggested. Women in Asian countries are <a href="https://journals.lww.com/menopausejournal/fulltext/2022/05000/prevalence,_severity,_and_associated_factors_in.9.aspx">similarly affected</a>. Depressive symptoms and anxiety are also often linked to menopause but they’re less menopause-specific than hot flushes and night sweats, as they’re common across the entire adult life span. The <a href="https://srh.bmj.com/content/early/2024/02/21/bmjsrh-2023-202099.long">most robust guidelines</a> do not stipulate women must have hot flushes or night sweats to be considered as having perimenopausal or post-menopausal symptoms. They acknowledge that new mood disturbances may be a primary manifestation of <a href="https://www.cell.com/cell/abstract/S0092-8674(23)00905-4?_returnURL=https%3A%2F%2Flinkinghub.elsevier.com%2Fretrieve%2Fpii%2FS0092867423009054%3Fshowall%3Dtrue">menopausal hormonal changes</a>. The extent to which menopausal hormone changes impact memory, concentration and problem solving (frequently talked about as “brain fog”) is uncertain. <a href="https://www.tandfonline.com/doi/full/10.1080/13697137.2022.2122792">Some studies</a> suggest perimenopause may impair verbal memory and resolve as women transition through menopause. But strategic thinking and planning (executive brain function) <a href="https://www.tandfonline.com/doi/full/10.1080/13697137.2022.2122792">have not been shown to change</a>. <h2>Who might benefit from hormone therapy?</h2> The Lancet papers <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)00462-8/fulltext">suggest</a> menopause hormone therapy <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(23)02799-X/fulltext">alleviates</a> hot flushes and night sweats, but the likelihood of it improving sleep, mood or “brain fog” is limited to those bothered by vasomotor symptoms (hot flushes and night sweats). In contrast, the highest quality <a href="https://srh.bmj.com/content/early/2024/02/21/bmjsrh-2023-202099.long">clinical guidelines</a> consistently identify both vasomotor symptoms and mood disturbances associated with menopause as reasons for menopause hormone therapy. In other words, you don’t need to have hot flushes or night sweats to be prescribed menopause hormone therapy. Often, menopause hormone therapy is prescribed alongside a topical vaginal oestrogen to treat vaginal symptoms (dryness, irritation or urinary frequency). However, none of these guidelines recommend menopause hormone therapy for cognitive symptoms often talked about as “brain fog”. Despite musculoskeletal pain being the most common menopausal symptom in <a href="https://journals.lww.com/menopausejournal/abstract/2016/07000/prevalence_and_severity_of_vasomotor_symptoms_and.6.aspx">some populations</a>, the effectiveness of menopause hormone therapy for this specific symptoms still needs to be studied. Some guidelines, such as an <a href="https://www.tandfonline.com/doi/full/10.1080/13697137.2023.2258783">Australian endorsed guideline</a>, support menopause hormone therapy for the prevention of osteoporosis and fracture, but not for the prevention of any other disease. <h2>What are the risks?</h2> The greatest concerns about menopause hormone therapy have been about breast cancer and an increased risk of a deep vein clot which might cause a lung clot. Oestrogen-only menopause hormone therapy is <a href="https://www.nice.org.uk/guidance/ng23">consistently considered</a> to cause little or no change in breast cancer risk. Oestrogen taken with a progestogen, which is required for women who have not had a hysterectomy, <a href="https://www.moh.gov.my/moh/resources/Penerbitan/CPG/Women%20Health/CPG_Management_of_Menopause_2022_e-version-1.pdf">has been associated with a small increase</a> in the risk of breast cancer, although any <a href="https://www.bmj.com/content/bmj/371/bmj.m3873.full.pdf">risk appears to vary</a> according to the type of therapy used, the dose and duration of use. Oestrogen taken orally has also been associated with an increased risk of a deep vein clot, although the risk varies according to the formulation used. This risk is avoided by using estrogen patches or gels <a href="https://www.bmj.com/content/bmj/364/bmj.k4810.full.pdf">prescribed at standard doses</a> <h2>What if I don’t want hormone therapy?</h2> If you can’t or don’t want to take menopause hormone therapy, there are also effective non-hormonal prescription therapies available for troublesome hot flushes and night sweats. In Australia, most of these options are “off-label”, although the new medication <a href="https://australianprescriber.tg.org.au/articles/management-of-menopause.html">fezolinetant</a> has just been <a href="https://www.tga.gov.au/resources/artg/401401">approved</a> in Australia for postmenopausal hot flushes and night sweats, and is expected to be available by mid-year. Fezolinetant, taken as a tablet, acts in the brain to stop the chemical neurokinin 3 triggering an inappropriate body heat response (flush and/or sweat). Unfortunately, most over-the-counter treatments promoted for menopause are either <a href="https://srh.bmj.com/content/early/2024/02/21/bmjsrh-2023-202099.long">ineffective or unproven</a>. However, cognitive behaviour therapy and hypnosis <a href="https://journals.lww.com/menopausejournal/abstract/2023/06000/the_2023_nonhormone_therapy_position_statement_of.4.aspx">may provide symptom relief</a>. The Australasian Menopause Society has useful <a href="https://www.menopause.org.au/health-info/fact-sheets">menopause fact sheets</a> and a <a href="https://www.menopause.org.au/health-info/find-an-ams-doctor">find-a-doctor</a> page. The <a href="https://www.tandfonline.com/doi/full/10.1080/13697137.2023.2258783">Practitioner Toolkit for Managing Menopause</a> is also freely available.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/225174/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/susan-davis-10376">Susan Davis</a>, Chair of Women's Health, <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/what-are-the-most-common-symptoms-of-menopause-and-which-can-hormone-therapy-treat-225174">original article</a>.

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Early indicators of dementia: 5 behaviour changes to look for after age 50

<a href="https://theconversation.com/profiles/daniella-vellone-1425451">Daniella Vellone</a>, <a href="https://theconversation.com/institutions/university-of-calgary-1318">University of Calgary</a> Dementia is often thought of as a memory problem, like when an elderly person asks the same questions or misplaces things. In reality, individuals with dementia will not only experience issues in other areas of cognition like learning, thinking, comprehension and judgement, but they may also experience <a href="https://www.alzint.org/u/World-Alzheimer-Report-2021.pdf">changes in behaviour</a>. It’s important to understand what dementia is and how it manifests. I didn’t imagine my grandmother’s strange behaviours were an early warning sign of a far more serious condition. She would become easily agitated if she wasn’t successful at completing tasks such as cooking or baking. She would claim to see a woman around the house even though no woman was really there. She also became distrustful of others and hid things in odd places. These behaviours persisted for some time before she eventually received a dementia diagnosis. <h2>Cognitive and behavioural impairment</h2> When cognitive and behavioural changes interfere with an individual’s functional independence, that person is considered to have dementia. However, when cognitive and behavioural changes don’t interfere with an individual’s independence, yet still negatively affect relationships and workplace performance, they are referred to as <a href="https://alzheimer.ca/sites/default/files/documents/other-dementias_mild-cognitive-impairment.pdf">mild cognitive impairment (MCI)</a> and <a href="https://doi.org/10.1186/s13195-021-00949-7">mild behavioural impairment (MBI)</a>, respectively. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9169943/">MCI and MBI can occur together</a>, but in one-third of people who develop Alzheimer’s dementia, the behavioural symptoms come <a href="http://dx.doi.org/10.1016/j.jagp.2019.01.215">before cognitive decline</a>. Spotting these behavioural changes, which emerge in later life (ages 50 and over) and represent a persistent change from longstanding patterns, can be helpful for implementing preventive treatments before more severe symptoms arise. As a medical science PhD candidate, my research focuses on problem behaviours that arise later in life and indicate increased risk for dementia. <h2>Five behavioural signs to look for</h2> <figure class="align-center zoomable"><a href="https://images.theconversation.com/files/551071/original/file-20230928-17-jmy46j.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img src="https://images.theconversation.com/files/551071/original/file-20230928-17-jmy46j.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px" srcset="https://images.theconversation.com/files/551071/original/file-20230928-17-jmy46j.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=525&fit=crop&dpr=1 600w, https://images.theconversation.com/files/551071/original/file-20230928-17-jmy46j.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=525&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/551071/original/file-20230928-17-jmy46j.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=525&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/551071/original/file-20230928-17-jmy46j.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=659&fit=crop&dpr=1 754w, https://images.theconversation.com/files/551071/original/file-20230928-17-jmy46j.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=659&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/551071/original/file-20230928-17-jmy46j.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=659&fit=crop&dpr=3 2262w" alt="Illustration of five behaviour changes that may indicate risk of dementia" /></a><figcaption>Spotting behavioural changes can be helpful for implementing preventive treatments before more severe symptoms arise. (Daniella Vellone)</figcaption></figure> There are <a href="https://doi.org/10.3233%2FJAD-160979">five primary behaviours</a> we can look for in friends and family who are over the age of 50 that <a href="https://doi.org/10.1186/s13024-023-00631-6">might warrant further attention</a>. <h2>1. Apathy</h2> <a href="https://doi.org/10.1002%2Ftrc2.12370">Apathy</a> is a decline in interest, motivation and drive. An apathetic person might lose interest in friends, family or activities. They may lack curiosity in topics that normally would have interested them, lose the motivation to act on their obligations or become less spontaneous and active. They may also appear to lack emotions compared to their usual selves and seem like they no longer care about anything. <h2>2. Affective dysregulation</h2> <a href="https://doi.org/10.1016/j.jad.2023.03.074">Affective dysregulation</a> includes mood or anxiety symptoms. Someone who shows affective dysregulation may develop sadness or mood instability or become more anxious or worried about routine things such as events or visits. <h2>3. Lack of impulse control</h2> <a href="https://doi.org/10.1002%2Ftrc2.12016">Impulse dyscontrol</a> is the inability to delay gratification and control behaviour or impulses. Someone who has impulse dyscontrol may become agitated, aggressive, irritable, temperamental, argumentative or easily frustrated. They may become more stubborn or rigid such that they are unwilling to see other views and are insistent on having their way. Sometimes they may develop sexually disinhibited or intrusive behaviours, exhibit repetitive behaviours or compulsions, start gambling or shoplifting, or experience difficulties regulating their consumption of substances like tobacco or alcohol. <h2>4. Social inappropriateness</h2> <a href="http://dx.doi.org/10.1017/S1041610217001260">Social inappropriateness</a> includes difficulties adhering to societal norms in interactions with others. Someone who is socially inappropriate may lose the social judgement they previously had about what to say or how to behave. They may become less concerned about how their words or actions affect others, discuss private matters openly, talk to strangers as if familiar, say rude things or lack empathy in interactions with others. <h2>5. Abnormal perceptions or thoughts</h2> <a href="https://doi.org/10.1038/s44220-023-00043-x">Abnormal perception or thought content</a> refers to strongly held beliefs and sensory experiences. Someone with abnormal perceptions or thoughts may become suspicious of other people’s intentions or think that others are planning to harm them or steal their belongings. They may also describe hearing voices or talk to imaginary people and/or act like they are seeing things that aren’t there. Before considering any of these behaviours as a sign of a more serious problem, it’s important to rule out other potential causes of behavioural change such as drugs or medications, other medical conditions or infections, interpersonal conflict or stress, or a recurrence of psychiatric symptoms associated with a previous psychiatric diagnosis. If in doubt, it may be time for a doctor’s visit. <h2>The impact of dementia</h2> Many of us know someone who has either experienced dementia or cared for someone with dementia. This isn’t surprising, given that dementia is predicted to affect <a href="https://www.ctvnews.ca/health/nearly-one-million-canadians-will-live-with-dementia-by-2030-alzheimer-society-predicts-1.6056849#:">one million Canadians by 2030</a>. While people between the ages of 20 and 40 may think that they have decades before dementia affects them, it’s important to realize that dementia isn’t an individual journey. In 2020, care partners — including family members, friends or neighbours — spent <a href="https://alzheimer.ca/sites/default/files/documents/Landmark-Study-1-Path-Forward-Alzheimer-Society-of-Canada-2022-wb.pdf">26 hours per week</a> assisting older Canadians living with dementia. This is equivalent to 235,000 full-time jobs or $7.3 billion annually. These numbers are expected to triple by 2050, so it’s important to look for ways to offset these predicted trajectories by preventing or delaying the progression of dementia. <h2>Identifying those at risk</h2> While there is currently no cure for dementia, there has been progress towards <a href="https://alzheimer.ca/en/about-dementia/dementia-treatment-options-developments">developing effective treatments</a>, which <a href="https://alzheimer.ca/en/about-dementia/do-i-have-dementia/how-get-tested-dementia-tips-individuals-families-friends/10">may work better earlier in the disease course</a>. More research is needed to understand dementia symptoms over time; for example, the online <a href="https://www.can-protect.ca/">CAN-PROTECT study</a> assesses many contributors to brain aging. Identifying those at risk for dementia by recognizing later-life changes in cognition, function as well as behaviour is a step towards not only preventing consequences of those changes, but also potentially preventing the disease or its progression.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/213954/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/daniella-vellone-1425451">Daniella Vellone</a>, Medical Science and Imaging PhD Candidate, <a href="https://theconversation.com/institutions/university-of-calgary-1318">University of Calgary</a> This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/early-indicators-of-dementia-5-behaviour-changes-to-look-for-after-age-50-213954">original article</a>.

Mind

10 signs of an ulcer you should never ignore

What is a stomach ulcer? Peptic ulcers are painful sores that line the stomach – and they affect about millions people per year. Normally the stomach has a protective layer that keeps the acidic juices in the stomach from getting to sensitive tissue and causing an ulcer. However, some people are at risk of developing stomach ulcers, most often due to long-term use of NSAIDs, the class of pain reliever that includes ibuprofen or aspirin, or an infection with a type of bacteria called H. pylori. The good news is that treatment can help many ulcers to heal. Here are the signs of an ulcer you shouldn’t ignore. You have pain specifically in your upper abdomen One of the most common ulcer symptoms is severe pain in the upper abdomen, according to gastroenterology specialist Dr Neil Sengupta. Ulcers can develop anywhere in the upper digestive tract, he says but we often think about those occurring in the stomach or small intestine, where we feel pain. This ulcer pain usually occurs when your stomach is empty and can come and go for as long as several months, according to the National Institute of Diabetes and Digestive and Kidney Diseases. You feel nauseous One of the other tell-tale ulcer symptoms is feeling nauseous, says Dr Sengupta. Many patients report that having a little food in your stomach can help ulcer symptoms subside. You've had unexplained vomiting From time to time, nausea brought on by ulcers may become so intense that it could actually cause you to vomit. If that happens, stay away from medications like ibuprofen and aspirin. According to Dr Sengupta, these over-the-counter pain medications actually put you at a higher risk of developing ulcers – or make your current ulcers worse. You bleed when you use the toilet Blood coming from the gastrointestinal tract can signal a variety of underlying health issues. Still, Dr Sengupta says when this bleeding is combined with upper abdominal pain, he’s “highly suspicious” that it’s one of the signs of an ulcer. Many patients notice this blood either when vomiting, or when using the bathroom, as their stools may appear black. If you notice this blood, along with nausea and pain in the stomach or chest, Dr Sengupta says doctors will often perform a blood test and an upper endoscopy – where they use a camera to look into the stomach itself – to check if an ulcer is the culprit. Blood in your stool can also be caused by haemorrhoids, or be a symptom of bowel cancer, so it’s a good idea to get checked out by your doctor. You have chest pain Some patients with ulcers describe chest pain, a term called ‘non-cardiac chest pain’, which refers to pain in the area that’s not caused by a heart attack or heart disease, according to the American College of Gastroenterology. The discomfort is commonly caused by a gastrointestinal problem, though it can also stem from stress or anxiety. You're more bloated than usual If you notice your stomach feeling particularly bloated, it may be more serious than a little bit of gas – it could be one of the signs of an ulcer. Of course, bloating can also be caused simply by eating something your body doesn’t agree with, but when combined with these other symptoms, it’s worth checking out. Your appetite went MIA (missing in action) Another less common, but possible, ulcer symptom is weight loss. You may notice your appetite is off, and stomach discomfort makes it hard to eat. This drop in food intake, combined with occasional vomiting, may lead to unexpected weight loss. You're feeling weirdly hungry You’d think that an ulcer would kill your appetite, but some people feel this burning or gnawing sensation in their stomach weirdly as hunger. The pain may briefly stop after you’ve had something to eat. You've had back pain You might associate ulcers with the stomach and small intestine, but believe it or not, some people report that the pain travels into their upper or mid-back. If that happens, it can make your symptoms all the more confusing. You keep burping Belching is a less common symptom of an ulcer, but your doctor might be suspicious if it’s accompanied by the other symptoms on this list. Talk to your doctor if you’ve been burping more than usual; ulcer or not, it can be a disruptive symptom and your doctor will want to figure out the cause. Image credits: Getty Images This article originally appeared on <a href="https://www.readersdigest.co.nz/healthsmart/10-signs-of-an-ulcer-you-should-never-ignore?pages=1" target="_blank" rel="noopener">Reader's Digest</a>.

Body

How do stimulants actually work to reduce ADHD symptoms?

<a href="https://theconversation.com/profiles/mary-bushell-919262">Mary Bushell</a>, <a href="https://theconversation.com/institutions/university-of-canberra-865">University of Canberra</a> Stimulants are <a href="https://adhdguideline.aadpa.com.au/">first-line drugs</a> for children and adults diagnosed with attention-deficit hyperactivity disorder (ADHD). But how do they actually work? <h2>First, let’s look at the brain</h2> ADHD is a neurodevelopmental condition, which means it affects how the brain functions. Medical imaging indicates people with ADHD may have slight differences in their brain’s <a href="https://jamanetwork.com/journals/jama/article-abstract/195386">structure</a>, the way their brain regions work together to perform tasks, and how their brain’s chemical messengers, called neurotransmitters, pass on information. These brain differences are associated with the symptoms of ADHD, including inattention, impulse control and problems with memory. <h2>What stimulants are prescribed in Australia?</h2> The three main stimulants prescribed for ADHD in Australia are dexamfetamine, methylphenidate (sold under the brand names Ritalin and Concerta) and lisdexamfetamine (sold as Vyvanse). Dexamfetamine and methylphenidate have been around <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3666194/">since</a> the 1930s and 1940s respectively. Lisdexamfetamine is a newer stimulant that has been around <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2873712/">since</a> the late 2000s. Dexamfetamine and lisdexamfetamine are amphetamines. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2873712/">Lisdexamfetamine</a> is inactive when it’s taken and actually changes into active dexamfetamine in the red blood cells. This is what’s known as a “prodrug”. <h2>So how do they work for ADHD?</h2> Stimulant drugs are thought to alter the activity of key neuotransmitters, dopamine and noradrenaline, in the brain. These neurotransmitters help with attention and focus, among other things. Stimulants increase the amount of dopamine and noradrenaline in the tiny gaps between neurons, known as synapses. They do this by predominantly blocking a transporter that then prevents their re-uptake back into the neuron that released them. This means more dopamine and noradrenaline can bind to their respective receptors. This <a href="https://www.tga.gov.au/sites/default/files/auspar-lisdexamfetamine-dimesilate-180515-pi.pdf">helps</a> connected neurons in the brain talk to one another. Amphetamines also increase the amount of dopamine the neuron releases into the synapse (the tiny gaps between neurons). And it stops the enzymes that break down dopamine. This results in an increase of dopamine in the synapse. <h2>What effect do they have on ADHD symptoms?</h2> We still don’t fully understand the underlying brain mechanisms that change behaviour in people with ADHD. But <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6109107/">research shows</a> stimulants that modulate noradrenaline and dopamine can improve brain processes such as: <ul> <li>attention</li> <li>memory</li> <li>decision-making</li> <li>task completion</li> <li>hyperactivity.</li> </ul> They can also improve general behaviour, such as self-control, not talking over the top of others, and concentration. These behaviours are important for social interactions. Stimulants <a href="https://pubmed.ncbi.nlm.nih.gov/15737659/">reduce ADHD symptoms</a> in about 70% to 80% of children and adults who take them. Some people will notice their symptoms improve right away. Other times, these improvements will be more noticeable to parents, carers, teachers, colleagues and partners. <h2>Not everyone gets the same dose</h2> The optimal stimulant dose varies between individuals, with multiple dosage options available. This enables a “start low, go slow” approach, where the stimulant can be gradually increased to the most effective dose for the individual. There are also different delivery options. Dexamfetamine and methylphenidate are available in immediate-release preparations. As these have short half-lives (meaning they act quickly and wear off rapidly), they are often taken multiple times a day – usually in the morning, lunch and afternoon. Methylphenidate is also <a href="https://www.ebs.tga.gov.au/ebs/picmi/picmirepository.nsf/pdf?OpenAgent&id=CP-2010-PI-03175-3&d=20231023172310101">available</a> in long-acting tablets (Concerta) and capsules (Ritalin LA). They are released into the body over the day. Lisdexamfetamine is a long-acting drug and is not available in a short-acting formulation. The long-acting stimulants are generally taken once in the morning. This avoids the need to take tablets during school or work hours (and the need to store a “controlled drug”, which has the potential for abuse, outside the home). <h2>What are the side effects?</h2> The most common side effects are sleep problems and decreased appetite. A <a href="https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD012069.pub2/full">recent study</a> showed children and young people taking methylphenidate for ADHD were around 2.6 times more likely to have sleep problems and 15 times more likely to have a decreased appetite than those not taking methylphenidate. Headache and abdominal pain are also relatively common. <h2>Can someone without ADHD take a stimulant to improve productivity?</h2> Stimulants are tightly controlled because of their potential for abuse. In Australia, only paediatricians, psychiatrists or neurologists (and GPs in special circumstances) can prescribe them. This follows a long assessment process. As stimulants increase dopamine, they can cause euphoria and a heightened sense of wellbeing. They can also cause <a href="https://www.ncbi.nlm.nih.gov/books/NBK576548/#:%7E:text=The%20immediate%20psychological%20effects%20of,and%20may%20result%20in%20insomnia.">weight loss</a>. A common myth about stimulant medicines is they can improve the concentration and productivity of people without ADHD. A <a href="https://www.science.org/doi/full/10.1126/sciadv.add4165">recent study shows</a> the opposite is true. This study gave a group of 40 people online arithmetic tasks to complete across four sessions. At each of the sessions, participants were given either a placebo or a stimulant before completing the task. The results showed that while stimulants did not impact getting the correct answer, it increased the number of moves and time to solve the problems compared to a placebo. This indicates a reduction in productivity. However, the myth that stimulants improve study prevails. It’s likely that users feel different – after all, they are taking a medicine that speeds up messages between the brain and body. It may make them “feel” more alert and productive, even if they’re not.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/215801/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/mary-bushell-919262">Mary Bushell</a>, Clinical Assistant Professor in Pharmacy, <a href="https://theconversation.com/institutions/university-of-canberra-865">University of Canberra</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/how-do-stimulants-actually-work-to-reduce-adhd-symptoms-215801">original article</a>.

Mind

Lots of women try herbs like black cohosh for menopausal symptoms like hot flushes – but does it work?

<a href="https://theconversation.com/profiles/sasha-taylor-1461085">Sasha Taylor</a>, <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a> and <a href="https://theconversation.com/profiles/susan-davis-10376">Susan Davis</a>, <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a> Menopause is the stage of life where the ovaries stop releasing eggs and menstrual periods cease. Most Australian women go through menopause between <a href="https://www.nature.com/articles/nrdp20154">45 and 55</a> years of age, with the average age being 51 years, although some women may be younger. Hot flushes and night sweats are <a href="https://www.nature.com/articles/nrendo.2017.180">typical symptoms</a> of menopause, with vaginal dryness, muscle and joint pains, mood changes and sleep disturbance also commonly reported. Up to <a href="https://pubmed.ncbi.nlm.nih.gov/25706184/">75% of women</a> experience menopausal symptoms, with nearly 30% severely affected. These symptoms can negatively impact day-to-day life and wellbeing. The main therapies available include menopausal hormone therapy (MHT) and non-hormonal prescription therapy. Some women will elect to try complementary and alternative medicines, such as herbal medicines and nutritional supplements. Black cohosh is one of them. <h2>What causes hot flushes</h2> The cause of hormonal hot flushes (also called hot flashes) still isn’t completely understood, but the decline in oestrogen at menopause appears to play a role in a process that involves the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3833827/">area of the brain that regulates temperature</a> (the hypothalamus). Factors linked to a greater likelihood of hot flushes include <a href="https://pubmed.ncbi.nlm.nih.gov/19675142/">being overweight or having obesity</a> and <a href="https://pubmed.ncbi.nlm.nih.gov/25706184/">smoking</a>. MHT, previously known as hormone replacement therapy (HRT), usually includes oestrogen and is the <a href="https://pubmed.ncbi.nlm.nih.gov/26444994/">most effective treatment</a> for menopausal symptoms, such as hot flushes. But women may choose complementary and alternative medicines instead – either because they shouldn’t take hormone therapy, for example because they have breast cancer, or because of personal preference. Close <a href="https://pubmed.ncbi.nlm.nih.gov/26224187/">to 40%</a> of Australian women report using complementary and alternative medicines for menopausal symptoms, and up to 20% using them specifically to treat hot flushes and sweats. <h2>A long history</h2> Complementary and alternative medicines have a long history of use in many cultures. Today, their potential benefits for menopausal symptoms are promoted by the companies that make and sell them. The <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6419242/">complementary and alternative medicines</a> women often try for menopausal symptoms include phytoestrogens, wild yam, dong quai, ginseng and black cohosh. Black cohosh (plant name Cimicifuga racemosa) was <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6599854/">traditionally</a> used by Native Americans to treat a variety of health concerns such as sore throat, kidney trouble, musculoskeletal pain and menstrual problems. It is now a popular herbal choice for hot flushes and night sweats, as well as vaginal dryness and mood changes. There are <a href="https://pubmed.ncbi.nlm.nih.gov/37252752/">many theories</a> for how the active ingredients in black cohosh might work in the body, such as acting like oestrogen, or affecting chemical pathways in the brain. But despite extensive research, the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6599854/">evidence to support these theories remains inconclusive</a>. It is also not clear whether black cohosh is effective for hot flushes. Results from individual studies are mixed, with <a href="https://pubmed.ncbi.nlm.nih.gov/17565936/">some</a> finding black cohosh improves hot flushes, while <a href="https://pubmed.ncbi.nlm.nih.gov/18257142/">others</a> have found it doesn’t. A 2012 <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6599854/">review</a> combined all the results from studies of menopausal women using black cohosh to that date and found overall there was no proof black cohosh reduces hot flushes more effectively than an inactive treatment (placebo). <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6599854/">This review</a> also revealed that many studies did not use rigorous research methods, so the findings are hard to interpret. A more recent <a href="https://pubmed.ncbi.nlm.nih.gov/33021111/">review</a> of clinical trials claimed black cohosh may ease menopausal symptoms, but the included studies were mostly small, less than six months long, and included women with mild symptoms. There is also no meaningful evidence black cohosh helps other symptoms of menopause, such as vaginal symptoms, sexual problems, or poor general wellbeing, or that it protects against bone loss. Evidence for how black cohosh is absorbed and metabolised by the body is also lacking, and it is not known what dose or formulation is best to use. More good quality studies are needed to decide whether black cohosh works for hot flushes and other menopausal symptoms. <h2>Is it safe to try?</h2> A <a href="https://pubmed.ncbi.nlm.nih.gov/33021111/">review of studies</a> suggests black cohosh is safe to use, although many of the studies have not reported possible adverse reactions in detail. Side effects such as gastrointestinal upset and rashes may occur. While there have been <a href="https://www.mja.com.au/journal/2008/188/7/liver-failure-associated-use-black-cohosh-menopausal-symptoms#0_i1091948">rare reports of liver damage</a>, there is <a href="https://pubmed.ncbi.nlm.nih.gov/21228727/">no clear evidence</a> black cohosh was the cause. Even so, in Australia, black cohosh manufacturers and suppliers are required to put a warning label for the potential of harm to the liver on their products. It is recommended black cohosh is not used by women with menopausal symptoms <a href="https://www.canceraustralia.gov.au/cancer-types/breast-cancer/impacted-by-breast-cancer/physical-changes/menopause/treatments-menopausal-symptoms">after breast cancer</a>, as its safety after breast cancer is uncertain. All women should consult with their doctor before using black cohosh if they are taking other medications in case of possible drug interactions. Many women like to try herbal therapies for hot flushes and other menopausal symptoms. While black cohosh is generally considered safe and some women may find it helps them, at the moment there is not enough scientific evidence to show its effects are any better than placebo. Women experiencing troublesome menopausal symptoms, such as hot flushes, should talk to their doctor about the best treatment options for them.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/211272/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/sasha-taylor-1461085">Sasha Taylor</a>, Research fellow, Chronic Disease & Ageing, <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a> and <a href="https://theconversation.com/profiles/susan-davis-10376">Susan Davis</a>, Chair of Women's Health, <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/lots-of-women-try-herbs-like-black-cohosh-for-menopausal-symptoms-like-hot-flushes-but-does-it-work-211272">original article</a>.

Body

How do hay fever treatments actually work? And what’s best for my symptoms?

<a href="https://theconversation.com/profiles/mary-bushell-919262">Mary Bushell</a>, <a href="https://theconversation.com/institutions/university-of-canberra-865">University of Canberra</a> Spring has sprung and many people are welcoming longer days and more time outdoors. But for <a href="https://www.aihw.gov.au/reports/chronic-respiratory-conditions/allergic-rhinitis-hay-fever/contents/allergic-rhinitis">almost one in five Australians</a>, spring also brings the misery of watery, itchy red eyes, a runny, congested nose, and sneezing. Hay fever (also known as allergic rhinitis) is caused when an allergen enters the nose or eyes. Allergens are harmless airborne substances the body has incorrectly identified as harmful. This triggers an immune response, which leads to the release of inflammatory chemicals (mediators) – one of which is histamine. Allergens that trigger hay fever differ from person to person. Common seasonal allergens include tree, grass and weed pollens (year-round allergens include dust mites, mould and pet dander). It’s now <a href="https://www.sciencedirect.com/science/article/pii/S132602002302191X">pollen season</a> in many parts of Australia, with pollen counts at their highest and hay fever cases surging. So what medicines can prevent or reduce hay fever symptoms, and how do they work? <h2>Antihistamines</h2> Knowing the release of histamine is a cause of hay fever symptoms, it’s unsurprising that anti-histamines are one of the most frequently recommended medicines to treat hay fever. Antihistamines block histamine from binding to histamine receptors in the body and having an effect, reducing symptoms. In Australia, we broadly have two types. The older sedating (introduced in the <a href="https://www.tga.gov.au/news/safety-alerts/first-generation-antihistamines-winter-warning">1940s</a>) and newer, less-sedating (introduced in the 1980s) antihistamines. Less-sedating antihistamines used to treat allergic rhinitis include bilastine (Allertine), cetirizine (Zyrtec), loratadine (Claratyne) and fexofenadine (Telfast). Bilastine, which came onto the Australian market only last year, is only available from a pharmacy, on recommendation from a pharmacist. The others have been around longer and are available at supermarkets and in larger quantities from pharmacies. Cetirizine is the <a href="https://www.tga.gov.au/resources/publication/scheduling-decisions-interim/scheduling-delegates-interim-decisions-and-invitation-further-comment-accsacms-november-2016/35-cetirizine-hydrochloride#:%7E:text=Risks%20of%20cetirizine%20hydrochloride%20use,significant%20at%20the%20proposed%20doses.">most likely</a> (of the less-sedating antihistamines) to cause sedation. The older sedating antihistamines (such as promethazine) cross the blood-brain barrier, causing drowsiness and even brain fog the next day. They have lots of side effects and potential drug interactions, and as such have little place in the management of hay fever. The newer less-sedating antihistamines are <a href="https://australianprescriber.tg.org.au/articles/antihistamines-and-allergy.html#:%7E:text=Less%20sedating%20antihistamines%20are%20equally,an%20ongoing%20good%20safety%20profile">equally effective</a> as the older sedating ones. Antihistamines are usually taken orally (as a tablet or solution) but there are also topical preparations such as nasal sprays (azelastine) and eye drops. Antihistamine nasal sprays have <a href="https://www.sciencedirect.com/science/article/abs/pii/S108112061000743X">equal to or better efficacy</a> than oral antihistamines. The individual response to antihistamines varies widely. For this reason, you may need to trial several different types of antihistamines to see which one works best for you. Increasing the dose of an antihistamine, or combining an oral and topical antihistamine, does not provide any additional benefit. Paying extra for a brand name doesn’t offer any more or less effect than the generic (both have the same active ingredient and are <a href="https://www.tga.gov.au/news/news/generic-prescription-medicines-fact-sheet">bioequivalent</a>, which means they have the same outcomes for patients). <h2>Steroid nasal sprays</h2> If your symptoms don’t improve from antihistamines alone, a nasal spray containing a corticosteroid is often recommended. Corticosteroids prevent the release of several key chemicals that cause inflammation. How they work is complex: in part, corticosteroids “turn off” the production of late phase inflammatory mediators (cytokines and chemokines). This reduces the future release of more inflammatory mediators, which reduces inflammation. Corticosteroids and antihistamines have different mechanisms of action. Research shows corticosteroid nasal sprays are <a href="https://journals.sagepub.com/doi/full/10.2500/ajra.2016.30.4397">more effective</a> than antihistamines in controlling an itchy, runny, congested nose. But when instilled into the nose, corticosteroids <a href="https://aao-hnsfjournals.onlinelibrary.wiley.com/doi/10.1016/j.otohns.2007.10.027">also reduce</a> the eye symptoms of hay fever. There are also nasal sprays that contain both an antihistamine and corticosteroid. While there are a range of corticosteroid nasal sprays containing different active ingredients, a large study published this year shows they are all <a href="https://www.frontiersin.org/articles/10.3389/fphar.2023.1184552/full">about as effective as each other</a>, and work best when they have been taken for several days. <h2>Sodium cromoglycate</h2> Another medicine used to treat hay fever symptoms is sodium cromoglycate, which is available as an eye drop and over-the-counter in pharmacies. This medicine is known as a mast cell stabiliser. As the name suggests, it stabilises or prevents mast cells from breaking down. When mast cells break down, they release histamine and other chemicals that cause inflammation. This eye drop is both a preventative and treatment medicine, usually used before allergies strike. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9375451/">Evidence shows</a> it is effective at reducing the symptoms of allergic conjunctivitis (eye inflammation from allergies). <h2>Decongestants</h2> Decongestants constrict blood vessels. They can be taken orally, administered as a nasal spray, or instilled into the eyes. When administered into the eyes it will reduce redness, and when administered into the nose, it will stop it from running. However, decongestants should be used for a short duration only and are not for long term use. In fact, if a nasal spray decongestant is used for more than five days, you can experience something called “rebound congestion”: a severe stuffy nose. <h2>Saline</h2> Saline (saltwater) nasal sprays or irrigation products are also available to flush out the allergens and provide hay fever relief. While there are not many studies in the area, there is evidence that saline irrigation <a href="https://www.cochrane.org/CD012597/ENT_nasal-saline-allergic-rhinitis#:%7E:text=Saline%20irrigation%20may%20reduce%20patient,any%20outcomes%20beyond%20three%20months">may reduce hay fever symptoms</a>. Saline is safe and is not associated with adverse effects. If you’re suffering from hay fever symptoms and unsure what to try, talk to your prescriber or pharmacist, who can guide you through the options and identify the best one for your symptoms, medical conditions and medicines. Allergen immunotherapy (or allergen shots) is another option hay fever sufferers <a href="https://www.allergy.org.au/patients/allergy-treatments/allergen-immunotherapy-faqs">may discuss</a> with their doctors. However it’s not a quick fix, with therapy taking three to five years.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/213071/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/mary-bushell-919262">Mary Bushell</a>, Clinical Assistant Professor in Pharmacy, <a href="https://theconversation.com/institutions/university-of-canberra-865">University of Canberra</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/how-do-hay-fever-treatments-actually-work-and-whats-best-for-my-symptoms-213071">original article</a>.

Body

Woman dies after being accused by doctors of faking symptoms

A woman from New Zealand has passed away from a debilitating illness after being told by a doctor that her illness was “all in her head”. Stephanie Aston, 33, died after a long and public battle with Ehlers-Danlos Syndrome (EDS), a rare genetic disorder affecting the body’s connective tissue, on September 1st. EDS, of which there are 13 different variants, is often referred to as an "invisible illness", as sufferers can often appear healthy despite experiencing excruciating symptoms, such as severe migraines, dislocating joints, easy bruising, abdominal pain, iron deficiency, fainting and an abnormally fast heart-rate. Aston said she was dismissed by a doctor in 2016, who dismissed her symptoms and told her that she was faking her disease. Despite being diagnosed with EDS by three different specialists, one doctor in Auckland, who Aston referred to as 'Doctor A', suggested she was not seriously unwell and indicated she was causing her illnesses, <a href="https://www.nzherald.co.nz/nz/stephanie-aston-death-eds-sufferers-call-for-change-after-doctors-accused-woman-of-faking-illness/VX4Q6CAWRVH25I6OCKGQ4KTW4M/">The NZ Herald</a> reports. Ehlers-Danlos Syndromes New Zealand founder Kelly McQuinlan said Stephanie's death has shocked the community, and said more needs to be done for those suffering with the debilitating condition. “A lot of people are feeling very lost,” she said. “I think most people in these rare positions or invisible illnesses, definitely experience setbacks and disbelieving because things can’t be seen but really the clinical symptoms are there that are being ignored.” Ms McQuinlan described Ms Aston as a “beacon” for those with the illness in a tribute to her on Facebook. “Most people in our community have experienced some form of sort of doctors not believing them or questioning their diagnosis which is extremely hard,” she wrote. “When they see someone in their community pass away, the first thing they think is ‘What if my care is not looked after? What’s going to happen to me?’.” “At the end of the day, if symptoms aren’t managed correctly, anyone can get sick enough that they will pass away.” Image credits: Facebook

Caring

10 things your feet can reveal about your health

You notice: Dry, flaky feet It could be: Thyroid problems, especially if moisturiser doesn’t help. When the thyroid gland (the butterfly-shaped gland at the base of your neck) isn’t working properly, it doesn’t produce thyroid hormones, which control metabolic rate, blood pressure, tissue growth and skeletal and nervous system development. “Thyroid problems cause severe dryness of the skin,” says foot specialist Marlene Reid. “When we see cracking on the feet, or if moisturiser doesn’t improve dryness over a few days, we usually refer patients to their primary doctor to make sure their thyroids are okay.” Brittle toenails can also signal thyroid complications. You notice: Bald toes It could be: Arterial disease. If the fuzz on your toes suddenly disappears, it could signal poor blood circulation caused by peripheral arterial disease (PAD) which builds up plaque in the leg arteries. “Signs of PAD can include decreased hair growth on the feet and ankles, purplish toes and thin or shiny skin,” says podiatric surgeon Suzanne Fuchs. Symptoms are subtle, but doctors can check for a healthy pulse in the foot. In severe cases, they may spot PAD on an X-ray. “If I take an X-ray of a broken foot, and I see a hardening of the arteries, 99 per cent of the time the same thing is happening in the heart blood vessels,” says podiatric surgeon Gary A. Pichney. You notice: Ulcers that don't heal It could be: Diabetes. Uncontrolled glucose levels can damage nerves and cause poor circulation, so blood doesn’t reach all areas of the body, including the feet. When blood doesn’t get to a wound caused by, say, irritating shoes, the skin doesn’t heal properly, and that’s how diabetic blisters and ulcers can develop. “Many, many people with diabetes are diagnosed first because of foot problems,” says Reid. Other signs of diabetes may include persistent tingling or numbness of the feet. If you suffer from these foot problems, ask your doctor about getting your blood sugar levels tested. You notice: An enlarged, painful big toe It could be: Gout. Gorged on wine and steak? The painful aftermath could be gout, a type of arthritis that often affects the joint of the big toe. Foods high in purine, a chemical compound found in red meats, fish and certain alcohol, can trigger an attack by raising levels of uric acid in the body. Uric acid is normally excreted through urine, but is overproduced or under-excreted in some people. “You’ll see the deposition of the uric acid in the joint, most commonly the big toe or the ankle,” says podiatric foot and ankle specialist Bob Baravarian. “The patient will wake up with a hard, red, swollen joint. It’s extremely painful.” A doctor may prescribe anti-inflammatory drugs for short-term relief and medicines to reduce uric acid production. You may also need to follow a low-purine diet for long-term prevention. You notice: Small, red lines under the toenail It could be: A heart infection. Red streaks underneath the toenails or fingernails could be broken blood vessels known as splinter haemorrhages. While problems like psoriasis, fungal infection, or even just experiencing trauma to the nail can cause splinter haemorrhages, it can also be a sign of endocarditis, or an infection of the heart’s inner lining, according to the American Academy of Family Physicians. (Keep in mind this is a rare condition.) People who have an existing heart condition are at higher risk of developing endocarditis. The infection can result in heart failure if left untreated. If you notice splinter haemorrhages on your toenails or fingernails, and haven’t experienced any recent trauma to the nail, see your doctor to check your heart and blood circulation. You notice: Clubbing It could be: Lung cancer or heart disease. Another symptom that appears in both toes and fingers, clubbing is often associated with lung cancer, chronic lung infection, or heart conditions caused by birth defects or infection of the lining of heart valves and chambers. Clubbing often occurs in these conditions because of the lower amount of oxygen in the blood. The tissue swells and results in the ‘clubbed’ appearance – rounder, wider fingers and toes. Though patients are typically aware they have a disease that is causing the clubbing, it’s best to get checked if you see any abnormalities. You notice: Pitted toenails It could be: Psoriasis. If you find tiny holes, grooves or ridges in your toenails, you may have nail psoriasis. Though most people who experience nail psoriasis also have skin psoriasis (an autoimmune disease that makes skin patchy and irritated), five per cent of people with nail psoriasis aren’t affected elsewhere. “If you’ve never been diagnosed with psoriasis, but your toenails have little pits in them, you should get them checked out,” says Pichney. Other symptoms include white patches and horizontal lines across the nails. To treat psoriasis, your doctor may prescribe topical creams or steroids injected under the nail. You notice: Spooned nails It could be: Anaemia or lupus. Do you have a depression in the toenail deep enough to hold a water droplet? Also known as koilonychias, spoon-shaped toenails or fingernails are most commonly associated with an iron deficiency, research shows, but it can also come from malnutrition, thyroid disorders or injury. Spooned nails occasionally appear in infants, but normalise in the first few years of life. If you notice spooning, contact your physician, who will obtain a blood test to identify the exact cause. You notice: A straight line under your toenails It could be: Skin cancer. A dark, vertical line underneath a toenail could be acral lentiginous melanoma, or hidden melanoma – a form of the skin cancer that appears on obscure body parts. (Other hidden melanomas include eye melanoma and mouth melanoma.) “It will be a black line from the base of your nail to the end of the nail,” says Pichney. “It should be seen by a podiatrist or dermatologist. You want to make sure it’s not cancer, but it may be a fungus, which is usually yellow-brown and sporadic throughout the whole nail.” You notice: A suddenly high arch It could be: Nerve damage. “Most high-arched feet are associated with some form of underlying neuromuscular condition,” says Pichney. “If someone experiences thinning of the arch muscles in the foot, it could be an indication of a neurological condition called Charcot-Marie-Tooth (CMT).” An inherited disorder that damages the peripheral nerves (those outside the brain and spinal cord), CMT can also cause changes in gait, numbness in the feet, difficulty balancing, loss of muscles in the lower legs, and later on, similar symptoms in the arms and hands. See your doctor if you notice abnormalities. “For anything that’s different or changes when it comes to the foot, see your podiatrist right away,” says Reid. Image credits: Getty Images This article originally appeared on <a href="https://www.readersdigest.com.au/healthsmart/10-subtle-signs-of-disease-your-feet-can-reveal" target="_blank" rel="noopener">Reader's Digest</a>.

Body

Got no COVID-19 symptoms? A gene mutation might be the reason

<div class="copy"> A global study has unearthed a possible genetic reason why some people infected with the virus that causes COVID-19 show no symptoms. Human leukocyte antigens – or HLAs – are important genes that support immune function in the human body, particularly in identifying viral pathogens. And a particular variation in the HLA-B complex has been found to at least double the likelihood that a person infected with SARS-CoV-2 will be asymptomatic. For people who inherit a copy of the HLA-B15 variant from one parent, there was a 2.4 times greater chance of avoiding symptoms. Homozygous carriers — born with copies of the variant from each parent — were 8.5 times more likely to avoid symptoms. It’s a somewhat common variant among certain ethnicities – about 1 in 10 people with European ancestry are potential carriers – but having the gene is not a guaranteed protector against coronavirus symptoms. The findings, <a href="https://doi.org/10.1038/s41586-023-06331-x" target="_blank" rel="noreferrer noopener" data-type="URL" data-id="https://doi.org/10.1038/s41586-023-06331-x">published</a> in Nature, have emerged from a joint study between researchers at the University of California San Fransisco and Australian institutions including Latrobe University, Monash University and the QIMR Berghofer Centre. The research came about almost by accident. <div class="in-content-area content-third content-right"> </div> Co-lead authors Professor Stephanie Gras from Latrobe and Jill Hollenbach from UCSF first met at a research conference in May 2022 and pooled their resources to track the association of possible gene variations with COVID-19 symptoms. Their teams narrowed a group of 30,000 people with high-quality HLA data to a cohort of about 1,500 unvaccinated people who tested positive for the virus. They then focussed on five locations of interest in the HLA genes while monitoring the emergence of symptoms to determine which variants, if any, might have a greater linkage to being COVID asymptomatic. “The [SARS-CoV-2] virus gets inside cells and ‘presents’ some small part of the virus on the surface via the HLA molecule,” Gras explains. “Those act as a red flag for T cells. The cell sends the signal to the T cell that it has been infected with the virus, and the T cells get activated and kill that [infected] cell. “HLA-B15 can actually present a small part of the spike protein that is very similar between SARS-CoV-2 and seasonal coronaviruses… [that] circulate every year in the population and give us the common cold during winter most of the time. They share some similarities.” The understanding provides a possible application for future treatments. Now an association between the variant and asymptomatic cases has been identified, the Gras and Hollenbach teams have begun to study the interaction between HLA-B15 and the SARS-CoV-2 spike protein at the atomic level. That research is already underway, including at the Australian Synchrotron at the Australian Nuclear Science and Technology Organisation. “We’re doing atomic-level models of proteins to understand the interaction,” Gras says. “We want to compare the T cells within people who are asymptomatic with HLA-B15 and people who are not asymptomatic with HLA-B15. Actually, HLA-B15 is not a magic bullet, you can have it and still have severe COVID.” Image credits: Getty Images </div> <div id="contributors"> <a href="https://cosmosmagazine.com/health/covid/got-no-covid-19-symptoms-a-gene-mutation-might-be-the-reason/">This article</a> was originally published on <a href="https://cosmosmagazine.com">Cosmos Magazine</a> and was written by <a href="https://cosmosmagazine.com/contributor/matthew-agius">Matthew Ward Agius</a>. </div>

Body

Silent signs of acid reflux you might be ignoring

Sore throat or hoarseness A sore throat that doesn’t go away and isn’t accompanied by typical cold symptoms (like a runny nose) may in fact be a symptom of acid reflux. “Your throat feels sore because a little bit of acid is coming up from the oesophagus and irritating the throat,” says gastroenterologist Dr Gina Sam. Unexplained hoarseness may be caused by stomach acid moving up to your larynx, or voice box, and tends to be more noticeable in the mornings when it’s had all night to travel while you were lying down. Persistent cough or wheezing “Wheezing or a cough that mimics asthma or bronchitis can be caused by acid reflux moving from the stomach to the lungs,” says Dr Evan Dellon, from the Center for Esophageal Diseases and Swallowing. On the other hand, wheezers and coughers can sometimes make themselves more prone to reflux because these actions put pressure on the belly and push stomach acid upwards. You're having dental problems If you’re a dedicated brusher and flosser but your dentist is still filling cavities and tells you your tooth enamel is eroding or notices discolouration, acid reflux may be to blame. “Even a small amount of acid reflux making its way up from the oesophagus to your throat or mouth while lying down can impact tooth enamel,” says Dr Dellon. Ringing in your ears If your ears always ring (a condition known as tinnitus), especially after a meal, it may be caused by reflux getting into the sinuses and even the interior of the ear, says Dr Sam. “A lot of patients see their ENT to get consults about sinus pain and ear ringing, but it’s often acid reflux,” she says. You have trouble swallowing Food getting stuck when you swallow, liquid that just won’t go down, or the sensation that something is stuck in your throat could all be signs of acid reflux, says Dr Sam. Chronic reflux can irritate the throat, and scar tissue can develop in the oesophagus and narrow it. See your doctor if you have difficulty swallowing, as this can also be a symptom of other more serious conditions. Nasal congestion Nasal congestion that comes and goes may be caused by acid reflux. “If you’ve tried cutting down on reflux-producing foods and eating late at night and the symptom doesn’t go away, it’s probably just congestion,” says Dr Sam. “But if it goes away and comes back, and then goes away again, it’s probably acid reflux.” Image credits: Getty Images This article originally appeared on <a href="https://www.readersdigest.co.nz/healthsmart/silent-signs-of-acid-reflux-you-might-be-ignoring" target="_blank" rel="noopener">Reader's Digest</a>.

Body

Wacky pet laws that will make you laugh

There are laws to protect people from harm, animals from cruelty and to keep the animal-human relationship harmonious. But then there are those wacky laws that will make you scratch your head and wonder how they became laws in the first place. 1. In some areas of Oklahoma dogs must have a permit signed by the mayor in order to congregate in groups of three or more on private property. 2. In Chicago, you cannot bring your French poodle to the opera. 3. In Berea, Ohio, any pet that goes out after dark must wear a tail light. 4. In Creskill, New York, all outside cats must wear three bells to warn birds of their approach. 5. In Madison, Wisconsin dogs are forbidden from harassing squirrels in the public park next to the capital. 6. In Denver Colorado an animal control officer must notify dogs of any impending impounds three days before it’s due to happen. They do this by posting notices on trees in the public parks and along the road running next to the park. 7. In Memphis, Tennessee, if a frog's croaking keeps you awake at night, you can have that frog arrested. 8. In Turin, Italy owners can be fined up to $650 for not walking their dog at least three times a day. 9. In Reed City, Michigan, you cannot own a pet cat and bird simultaneously. 10. In French Lick Springs, Indiana, all black cats must wear bells on Friday the 13th. 11. In certain areas of Oklahoma it is against the law to make “ugly” or “mean” faces at a dog. 12. In Honolulu, Hawaii, it’s unlawful to annoy birds at any public park. Image credit: Shutterstock

Legal

Hot flushes, night sweats, brain fog? Here’s what we know about phytoestrogens for menopausal symptoms

<a href="https://theconversation.com/profiles/caroline-gurvich-473295">Caroline Gurvich</a>, <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a>; <a href="https://theconversation.com/profiles/jane-varney-963066">Jane Varney</a>, <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a>, and <a href="https://theconversation.com/profiles/jayashri-kulkarni-185">Jayashri Kulkarni</a>, <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a> While some women glide through menopause, <a href="https://pubmed.ncbi.nlm.nih.gov/26271251/">more than 85%</a> experience one or more unpleasant symptoms, which can impact their physical and mental health, daily activities and quality of life. Hot flushes and night sweats are the most common of these, affecting <a href="https://pubmed.ncbi.nlm.nih.gov/29393299/">75% of women</a> and the symptom for which most women seek treatment. Others include changes in weight and body composition, skin changes, poor sleep, headaches, joint pain, vaginal dryness, depression and brain fog. While menopause hormone therapy is the most effective treatment for menopausal symptoms, it is sometimes not recommended (such as following breast cancer, as there is conflicting evidence about the safety of menopause hormone therapy following breast cancer) or avoided by people, who may seek non-hormonal therapies to manage symptoms. In Australia it is estimated <a href="https://pubmed.ncbi.nlm.nih.gov/26224187/">more than one-third</a> of women seek complementary or alternative medicines to manage menopausal symptoms. But do they work? Or are they a waste of time and considerable amounts of money? <h2>What’s on the market?</h2> The <a href="https://pubmed.ncbi.nlm.nih.gov/30868921/">complementary or alternative interventions</a> for menopausal symptoms are almost as varied as the symptoms themselves. They include everything from mind-body practices (hypnosis, cognitive behavioural therapy and meditation) to alternative medicine approaches (traditional Chinese medicine and acupuncture) and natural products (herbal and dietary supplements). There is some evidence to support the use of <a href="https://pubmed.ncbi.nlm.nih.gov/23435026/">hypnosis</a> and <a href="https://pubmed.ncbi.nlm.nih.gov/22336748/">cognitive behaviour therapy</a> for the treatment of hot flushes. Indeed these therapies are recommended in <a href="https://www1.racgp.org.au/getattachment/bfaa5918-ddc4-4bcb-93cc-d3d956c1bbfd/Making-choices-at-menopause.aspx">clinical treatment guidelines</a>. But there is less certainty around the benefit of other commonly used complementary and alternative medicines, particularly nutritional supplements. The most popular <a href="https://pubmed.ncbi.nlm.nih.gov/26224187/">nutritional supplements</a> for hot flushes are phytoestrogens (or plant estrogens). This trend has been driven in part by <a href="https://www.dailymail.co.uk/femail/article-11915645/HRT-not-supplement-created-experts-women-RAVING-effects.html">supplement companies</a> that promote such agents as a safer or more natural alternative to hormone therapy. <h2>What are phytoestrogens?</h2> Phytoestrogens are plant-derived substances that can show oestrogen-like activity when ingested. There are numerous types including isoflavones, coumestans and lignans. These can be consumed in the form of food (from whole soybeans, soy-based foods such as tofu and soy milk, legumes, wholegrains, flaxseeds, fruits and vegetables) and in commercially produced supplements. In the latter category, extracts from soy and red clover yield isoflavones and flaxseed gives us lignans. Because declining oestrogen levels drive menopausal symptoms, the theory is that consuming a “natural”, plant-based substance that acts like oestrogen will provide relief. <figure class="align-center zoomable"><a href="https://images.theconversation.com/files/528788/original/file-20230529-17-mh3zlk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img src="https://images.theconversation.com/files/528788/original/file-20230529-17-mh3zlk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px" srcset="https://images.theconversation.com/files/528788/original/file-20230529-17-mh3zlk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/528788/original/file-20230529-17-mh3zlk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/528788/original/file-20230529-17-mh3zlk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/528788/original/file-20230529-17-mh3zlk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/528788/original/file-20230529-17-mh3zlk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/528788/original/file-20230529-17-mh3zlk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" alt="Soy-rich foods on a table: edamame, soy milk, soy sauce" /></a><figcaption>Phytoestrogens can be consumed in foods like tofu or soy milk. <a class="source" href="https://www.shutterstock.com/image-photo/soy-bean-tofu-other-products-187030769">Shutterstock</a></figcaption></figure> <h2>What does the evidence say?</h2> In the case of isoflavones, initial support came from <a href="https://pubmed.ncbi.nlm.nih.gov/23562010/">epidemiological data</a> showing <a href="https://pubmed.ncbi.nlm.nih.gov/15919681/">women in Asian countries</a>, consuming a traditional, phytoestrogen-rich diet (that is, one including tofu, miso and fermented or boiled soybeans), experienced fewer menopausal symptoms than women in Western countries. However, several factors may influence the effect of dietary phytoestrogens on menopausal symptoms. This includes gut microbiota, with research showing only around <a href="https://pubmed.ncbi.nlm.nih.gov/15919681/">30% of women</a> from Western populations possess the gut microbiota needed to convert isoflavones to their active form, known as equol, compared to an estimated 50–60% of menopausal women from Japanese populations. Circulating oestrogen levels (which drop considerably during menopause) and the <a href="https://academic.oup.com/humupd/article/11/5/495/605995">duration of soy intake</a> (longer-term intake being more favourable) may also influence the effect of dietary phytoestrogens on menopausal symptoms. Overall, evidence regarding the benefit of phytoestrogens for hot flushes is fairly mixed. A <a href="https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD001395.pub4/full">Cochrane review</a> synthesised study results and failed to find conclusive evidence phytoestrogens, in food or supplement form, reduced the frequency or severity of hot flushes or night sweats in perimenopausal or postmenopausal women. The review did note genistein extracts (an isoflavone found in soy and fava beans) may reduce the number of hot flushes experienced by symptomatic, postmenopausal women, though to a lesser extent than hormone therapy. Another <a href="https://pubmed.ncbi.nlm.nih.gov/36253903/">recent study</a> showed marked reductions in hot flushes in women following a low fat, vegan diet supplemented with daily soybeans. However, it was questioned whether concurrent weight loss contributed to this benefit. In Australia, <a href="https://ranzcog.edu.au/wp-content/uploads/2022/05/Managing-menopausal-symptoms.pdf">clinical guidelines</a> do not endorse the routine use of phytoestrogens. <a href="https://www.nice.org.uk/guidance/ng23/chapter/Recommendations#managing-short-term-menopausal-symptoms">Guidelines for the United Kingdom</a> note some support for the benefit of isoflavones, but highlight multiple preparations are available, their safety is uncertain and interactions with other medicines have been reported. <h2>Can phytoestrogens help the psychological symptoms of menopause?</h2> Less research has explored whether phytoestrogens improve psychological symptoms of menopause, such as depression, anxiety and <a href="https://theconversation.com/brain-fog-during-menopause-is-real-it-can-disrupt-womens-work-and-spark-dementia-fears-173150">brain fog</a>. A recent systematic review and <a href="https://pubmed.ncbi.nlm.nih.gov/33987926/">meta-analysis</a> found phytoestrogens reduce depression in post- but not perimenopausal women. Whereas a more <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9022873/">recent clinical trial</a> failed to find an improvement. Some research suggests phytoestrogens may reduce the <a href="https://www.sciencedirect.com/science/article/pii/S0960076015301254?via=ihub">risk of dementia</a>, but there are no conclusive findings regarding their effect on menopausal brain fog. <h2>The bottom line</h2> At present there is uncertainty about the benefit of phytoestrogens for menopause symptoms. If you do wish to see if they might work for you, start by including more phytoestrogen-rich foods in your diet. Examples include tempeh, soybeans, tofu, miso, soy milk (from whole soybeans), oats, barley, quinoa, flaxseeds, sesame seeds, sunflower seeds, almonds, chickpeas, lentils, red kidney beans and alfalfa. Try including one to two serves per day for around three months and monitor symptoms. These are nutritious and good for overall health, irrespective of the effects on menopausal symptoms. Before you trial any supplements, discuss them first with your doctor (especially if you have a history of breast cancer), monitor your symptoms for around three months, and if there’s no improvement, stop taking them.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/204801/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/caroline-gurvich-473295">Caroline Gurvich</a>, Associate Professor and Clinical Neuropsychologist, <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a>; <a href="https://theconversation.com/profiles/jane-varney-963066">Jane Varney</a>, Senior Research Dietitian in the Department of Gastroenterology, <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a>, and <a href="https://theconversation.com/profiles/jayashri-kulkarni-185">Jayashri Kulkarni</a>, Professor of Psychiatry, <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a> This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/hot-flushes-night-sweats-brain-fog-heres-what-we-know-about-phytoestrogens-for-menopausal-symptoms-204801">original article</a>. Images: Getty

Body

13 signs of cancer men are likely to ignore

<h2>Difficulty urinating</h2> If it’s consistently difficult to urinate, or there’s blood in your urine or semen, or if you experience unexplained erectile dysfunction, see your doctor; these could be symptoms of prostate cancer. “Unfortunately, there aren’t noticeable symptoms of prostate cancer until the aggressive stages,” says gastroenterologist Dr Moshe Shike. Dr Shike says he frequently sees patients who ignore these symptoms for up to six months before they seek help, but the sooner you check out your symptoms, the better. <h2>Testicular changes</h2> Just as women should be familiar with how their breasts look and feel, men should pay attention to their testicles. If you notice changes in size (to one or both), if they feel swollen or extra heavy, or if you feel a lump, these symptoms could indicate testicular cancer, says Dr Maurie Markman, an oncologist. Testicular cancer is most common in young and middle-aged men. <div> </div> <h2>Noticeable skin changes</h2> Men over 50 are more likely to die from skin cancer than women in the same age group; young men have a higher probability of developing deadly melanoma (the most serious skin cancer) than any other cancer, according to the Skin Cancer Foundation. It’s easy to miss the early warning signs of cancer in men, says Dr Richard Wender, a cancer specialist. “Many people think freckles, moles, or a darker age spot is just like the others they’ve had,” he explains. If you notice a mole getting darker, larger, or becoming raised, get it checked. With melanoma, spots are often irregularly shaped (not round), significantly darker in colour, or even two distinctly different colours within one spot, he says. “Melanoma is far less common than other skin cancers, but has the potential to be more deadly,” says Dr Wender. “However, many melanomas have a long period where they’re not invasive and easy to cure, as long as they’re caught early.” <h2>Sores or pain in your mouth</h2> A cold sore that heals is probably nothing to worry about, nor is a toothache that goes away after a trip to the dentist. But if you notice sores that don’t heal, pain that sticks around, white or red patches on the gums or tongue, and any swelling or numbness of the jaw, it could be a sign of some mouth cancers. Men who smoke or use chewing tobacco have an increased risk of developing mouth cancer, says Dr Markman. “More men smoke than women. Smokers and users of chewing tobacco need to be far more concerned with sores in their mouth that do not heal quickly, compared to non-smokers,” he says. <h2>Chronic coughing</h2> A cough that lasts three weeks or more – without other symptoms, such as a cold or allergies – could be an early symptom of lung cancer. Leukaemia can also lead to bronchitis-like symptoms. “If it’s different than your regular cough and if it persists, or you cough up a little blood, that’s significant,” says Dr Markman. Some lung cancer patients report chest pain that extends up into the shoulder or down the arm. <h2>Blood in your stool</h2> It could be haemorrhoids or something benign – but it could also be a symptom of colon cancer. Routine screening typically starts at age 50, but cases are becoming more common in younger adults, which is why it’s important to see a doctor for any suspicious symptoms. “It’s easy to dismiss it as haemorrhoids or constipation, and if the problem comes and goes, people reassure themselves that nothing’s wrong, especially younger people,” says Dr Wender. “But blood in a bowel movement is never normal, so get it checked out.” <h2>Stomach pain or nausea</h2> Everyday digestive distress is rarely cancer – but you should see a doctor if you notice persistent stomach cramps or are starting to feel nauseated all the time. It could be something as simple as an ulcer, but it could also signal leukaemia or oesophageal, liver, pancreatic, or colorectal cancer. <h2>Frequent fevers or infections</h2> If you’re usually healthy but notice yourself getting sick or feverish more frequently, it could be an early sign of leukaemia. This blood cancer triggers the body to produce abnormal white blood cells, which weakens the body’s infection-fighting abilities. Be on the lookout for flu-like symptoms that don’t go away. <h2>Difficulty swallowing</h2> A sore throat that persists for a few weeks and gets worse could be a symptom of throat or stomach cancer, as well as an early sign of lung cancer. <h2>Excessive bruising</h2> A random bruise is probably nothing to worry about. However, if you start to notice bruises popping up all the time, especially in places you wouldn’t normally get them, like your hands or fingers, see a doctor. Unusual bruising can be a symptom of leukaemia, according to Cancer Treatment Centers of America. Over time, leukaemia impairs the blood’s ability to carry oxygen and clot. <h2>Unexplained weight loss</h2> “If you have less appetite when you usually have a good appetite, and there’s no big life event or problems happening to cause that, get it checked out,” says Dr Markman. Losing weight can be a side effect of many different cancers such as oesophageal, pancreatic, liver, and colon, but it’s an especially common symptom of leukaemia or lymphoma, says Dr Wender. <h2>Persistent fatigue</h2> Everyone has low-energy days. However, if you feel tired every day for more than a month, or experience shortness of breath when you didn’t before, see a doctor, says Dr Wender. Leukaemia and lymphoma commonly cause persistent fatigue. “Most of the time it won’t be cancer, but get it checked because you never know,” he says. <h2>Chronic headaches</h2> If you’re not prone to migraines and never get headaches, but suddenly find yourself popping pain meds all the time, it could be a sign of a brain tumour, which causes pain by pressing on nerves. Image credit: Shutterstock This article originally appeared on <a href="https://www.readersdigest.co.nz/healthsmart/13-signs-of-cancer-men-are-likely-to-ignore" target="_blank" rel="noopener">Reader's Digest</a>.

Body

Many people are tired of grappling with long COVID – here are some evidence-based ways to counter it

<a href="https://theconversation.com/profiles/kyle-b-enfield-1409764">Kyle B. Enfield</a>, <a href="https://theconversation.com/institutions/university-of-virginia-752">University of Virginia</a> A patient of mine, once a marathon runner, now gets tired just walking around the block. She developed COVID-19 during the 2020 Christmas holiday and saw me during the summer of 2021. Previously, her primary care doctor had recommended a graded exercise program. But exercise exhausted her. After months of waiting, she finally had an appointment at our post-COVID-19 clinic at the University of Virginia. She is hardly alone in her extended search for answers. Studies suggest that <a href="https://doi.org/10.1016/S0140-6736(22)01214-4">from 10%</a> to <a href="https://doi.org/10.1016/j.eclinm.2022.101762">45% of COVID-19 survivors</a> have at least <a href="https://www.cdc.gov/coronavirus/2019-ncov/long-term-effects/index.html">one of the following symptoms three months after recovery</a>: fatigue, cough, shortness of breath, difficulty sleeping, difficulty with daily activities or mental fogginess, otherwise known as “brain fog.” There are many names for this condition: <a href="https://theconversation.com/long-covid-stemmed-from-mild-cases-of-covid-19-in-most-people-according-to-a-new-multicountry-study-195707">long COVID</a>, long-haul COVID, post-acute COVID-19 syndrome and chronic COVID. Patients report that their symptoms, or the severity of them, <a href="http://dx.doi.org/10.1136/bmjgh-2021-007004">fluctuate over time</a>, which <a href="https://theconversation.com/deciphering-the-symptoms-of-long-covid-19-is-slow-and-painstaking-for-both-sufferers-and-their-physicians-164754">makes diagnosis and treatment difficult</a>. <h2>A response to infection</h2> Researchers and doctors have seen <a href="https://doi.org/10.2340/16501977-2694">similar recovery patterns from other viruses</a>, including <a href="https://www.cdc.gov/vhf/ebola/about.html">Ebola</a> and Middle East Respiratory Syndrome, <a href="https://www.lung.org/lung-health-diseases/lung-disease-lookup/middle-eastern-respiratory-syndrome-mers">or MERS</a>, which is another coronavirus. This suggests that the illness we see following a bout with COVID-19 may be part of a patient’s response to the infection. But doctors and researchers do not yet know why some patients go on to have persistent symptoms. My clinical practice and academic research <a href="https://scholar.google.com/scholar?as_ylo=2022&q=Kyle+Enfield&hl=en&as_sdt=0,47">focus on critically ill patients</a>. Most of my patients now are people who had COVID-19 with various levels of severity. I often tell these patients that we are still learning about this disease, which wasn’t part of our vernacular before 2020. Part of what we do at the clinic is help patients understand what they can do at home to start improving. <figure><iframe src="https://www.youtube.com/embed/ype9O4rD3Gk?wmode=transparent&start=0" width="440" height="260" frameborder="0" allowfullscreen="allowfullscreen"></iframe><figcaption>For millions of Americans, COVID-19 is still a part of their lives.</figcaption></figure> <h2>Dealing with fatigue</h2> <a href="https://doi.org/10.1038/s41598-021-95565-8">Chronic fatigue</a> can greatly affect quality of life. Exercise limitations can have their roots in problems with the lung, heart, brain, muscles or all of the above. Graded exercise therapy works for some but not all patients. Graded exercise is the slow introduction of exercise, starting slowly and gradually increasing in load over time. Many are frustrated because they feel more exhausted after exercising or even doing the routine tasks of daily living. The lack of progress <a href="https://doi.org/10.1016/j.jpsychores.2019.109893">leads to feelings of depression</a>. The condition of feeling more exhausted after exercise <a href="https://www.cdc.gov/me-cfs/healthcare-providers/clinical-care-patients-mecfs/treating-most-disruptive-symptoms.html">is called post-exertional malaise</a>, which is defined as physical and mental exhaustion after an activity, often 24 hours later, that is out of proportion with the activity. For example, you feel good today and decide to go for a walk around the block. Afterward you are fine, but the next day your muscles ache and all you can do is lie on the couch. Some patients don’t even have the energy to answer emails. Rest or sleep do typically relieve the fatigue. There is no one-size-fits-all approach to treatment; the severity and frequency of post-exertional malaise varies from person to person. <h2>Signs and symptoms</h2> Fatigue following any illness is common, as is exercise intolerance. So when should you see a medical professional? Diagnostic testing for post-exertional malaise exists, but it’s not readily available to all patients. These questions may provide clues to whether or not you are experiencing it: <ul> <li>Does it take more than one day to recover to your usual baseline activity?</li> <li>Do you feel unwell, weak, sleep poorly or have pain when recovering from activity?</li> <li>Are you feeling limited in your ability to do your daily tasks after activity?</li> <li>Does exercise activity affect you positively?</li> <li>Do you have soreness and fatigue after nonstrenuous days, or mental fatigue after strenuous or nonstrenuous activities?</li> </ul> All of these can be clues to discuss with your primary care provider, who may want to do additional testing to confirm the diagnosis, such as a <a href="https://me-pedia.org/wiki/Two-day_cardiopulmonary_exercise_test">two-day cardiopulmonary exercise test</a>. Before your appointment, there are a few things you can do at home that may help. <h2>Taking it easy</h2> One of those techniques is pacing, or activity management, an approach that balances activities with rest. The <a href="https://www.rcot.co.uk/">Royal College of Occupational Therapists</a> and the <a href="https://ics.ac.uk/">Intensive Care Society</a>, both in the U.K., developed what they call the <a href="https://www.rcot.co.uk/conserving-energy">3Ps – Pace, Plan and Prioritize</a>. Pacing yourself means breaking down activities into smaller stretches with frequent breaks rather than doing it all at once. An example would be to climb a few steps and then rest for 30 seconds, instead of climbing all the stairs at once. Planning involves looking at the week’s activities to see how they can be spread out. Think about the ones that are particularly strenuous, and give yourself extra time to complete them. This helps with prioritizing – and recognizing those tasks that can be skipped or put off. <h2>Focusing on the breathing</h2> Some patients with long COVID develop abnormal breathing patterns, including shallow rapid breathing, known as hyperventilating, or breath-holding. Either of these patterns can make you feel short of breath. Symptoms of abnormal breathing patterns include frequent yawning, throat-clearing, experiencing pins-and-needles sensations, palpitations and chest pain. Don’t ignore these symptoms, because they can be signs of serious medical problems like <a href="https://www.cdc.gov/heartdisease/heart_attack.htm">heart attacks</a> and <a href="https://www.cdc.gov/heartdisease/atrial_fibrillation.htm">abnormal heart rhythms</a>. Once those are ruled out, it is possible to relearn to breathe properly. You can <a href="https://longcovid.physio/breathing-pattern-disorders">practice these techniques at home</a>. The simple version: Find a comfortable position – either lying down or sitting upright with your back supported. Place one hand on your chest and the other over your belly button. Exhale any stale air out of your lungs. Then breathe in through your nose and into your abdomen, creating a gentle rise in the belly. You should feel the hand resting on your belly button move up and down. Try to avoid short, shallow breaths into the upper chest. Slowly exhale all the air out of your lungs. The goal is to take around eight to 12 breaths per minute. Focus on a longer exhale than inhale. For example, inhale as described for a count of two, then exhale for a count of three, as a starting point. If you take one breath every five seconds, you will be breathing 12 breaths per minute. As you get more comfortable with this, you can increase the time to further reduce your breaths per minute. <figure><iframe src="https://www.youtube.com/embed/tEmt1Znux58?wmode=transparent&start=0" width="440" height="260" frameborder="0" allowfullscreen="allowfullscreen"></iframe><figcaption>Box breathing is easy to learn and you can do it anywhere, anytime.</figcaption></figure> A more advanced tool <a href="https://www.youtube.com/watch?v=a7uQXDkxEtM">is called box breathing</a>: Breathe in for a count of four to five, holding your breath for a count of four to five, breathing out for a count of four to five and hold that for a count of four to five. Long COVID patients who use these techniques show improvement in <a href="https://doi.org/10.1016/S2213-2600(22)00125-4">symptoms of breathlessness and sense of well-being</a>. <h2>The road to recovery</h2> The patient I referred to earlier did all of these things. As we worked with her, we discovered she had multiple reasons for her symptoms. In addition to overbreathing and symptoms of post-exertion malaise, she had a new cardiac problem, possibly related to her COVID-19 illness, that made her <a href="https://doi.org/10.1161/JAHA.121.024207">heart work less well during exercise</a>. Now she is recovering; while not back to marathon running, she is feeling better. Currently there is no cure for long COVID, though we hope research will lead to one. <a href="https://clinicaltrials.gov/ct2/results?cond=long+covid&term=&cntry=&state=&city=&dist=">Clinical trials looking at potential therapies</a> are continuing. In the meantime, people should be cautious about using medications that are not proved to help – and if you’re having symptoms, get evaluated.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/201451/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/kyle-b-enfield-1409764">Kyle B. Enfield</a>, Associate Professor of Medicine, <a href="https://theconversation.com/institutions/university-of-virginia-752">University of Virginia</a> This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/many-people-are-tired-of-grappling-with-long-covid-here-are-some-evidence-based-ways-to-counter-it-201451">original article</a>. Images: Getty

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Many people are tired of grappling with long COVID – here are some evidence-based ways to counter it