Category: BEAUTY

By now, you’ve probably heard that there is a monkeypox outbreak traveling around the globe. Cases have spread far and wide, including in the US, Canada, Europe, and Australia. It’s the largest outbreak ever recorded outside of western and central Africa, where monkeypox is common.

But controlling this outbreak demands preventive measures, such as avoiding close contact with people who have the illness and vaccination. One method of vaccination, called ring vaccination, has worked well in the past to contain smallpox and Ebola outbreaks. It may be effective for monkeypox as well.

How can monkeypox be contained?

According to the Centers for Disease Control and Prevention (CDC) and the World Health Organization, monkeypox is unlikely to become a pandemic. At this time, the threat to the general public is not high. The focus is on identifying possible cases and containing the outbreak as soon as possible.

Three important steps can help stop this outbreak:

1. Recognize early symptoms

• Usually, early symptoms are flulike, including fever, fatigue, headache, and enlarged lymph nodes.
• A rash appears a few days later, changing over a week or two from small flat spots to tiny blisters similar to chickenpox, then to larger, pus-filled blisters.
• The rash often starts on the face and then appears on the palms, arms, legs, and other parts of the body. If monkeypox is spread by sexual contact, the rash may show up first on or near the genitals.

2. Take steps to stop the spread

• Monkeypox spreads through respiratory droplets or by contact with fluid from skin sores.
•  Anyone who has been diagnosed with monkeypox, or who suspects they might have it, should avoid close contact with others. Once the sores scab over, the infected person is no longer contagious.
• Health care workers and other caregivers should wear standard infection control gear, including gloves and a mask.
• In the current outbreak, many cases began with sores in the genital and rectal areas among men who have sex with men, so doctors suspect sexual contact spread the infection. As a result, experts are encouraging abstinence when monkeypox is suspected or confirmed.

3. Use vaccination to help break the chain

• Monkeypox is closely related to smallpox. People who received a smallpox vaccine in the past may have some protection from monkeypox. (The US smallpox vaccination program was discontinued in 1972, and smallpox was declared eradicated worldwide in 1980.)
• Stockpiled smallpox vaccinations and newer vaccines that can be used for monkeypox or smallpox are also available.

Ring vaccination

Monkeypox differs from the virus that causes COVID-19. People with monkeypox usually have symptoms when they’re contagious, and the number of infected persons is usually limited.

This means it’s possible to vaccinate a “ring” of people around them rather than vaccinating an entire population. This selective approach is called ring vaccination.

Ring vaccination has been used successfully to contain smallpox and Ebola outbreaks. It may come in handy for monkeypox as well. Here’s how it works:

• As soon as a case of monkeypox is suspected or confirmed, the patient and their close contacts are interviewed to identify possible exposures.
• Vaccination is offered to all close contacts.
• Vaccination is also offered to those who had close contact with the infected person’s contacts.

Ideally, people should be vaccinated within four days of exposure.

This approach requires widespread awareness of monkeypox, rapid isolation of suspected cases, and an efficient contact tracing system. And of course, vaccines must be available whenever and wherever new cases arise.

Are the vaccines used for monkeypox effective?

According to the CDC, the smallpox vaccine is 85% effective against monkeypox.

While a newer vaccine (JYNNEOS) directed against monkeypox and smallpox has only been tested for effectiveness in animals, it is also expected to be highly effective in humans.

Of course, vaccinations can only work if people are willing to receive them. We’ll learn more about this as more people are offered the option for vaccination.

Are the vaccines used for monkeypox safe?

As with most vaccines, the most common side effects include

• sore or itchy arm at the site of the injection
• mild allergic reactions
• mild fever or fatigue.

Fortunately, more severe side effects, such as significant allergic reactions, are rare.

The bottom line

In light of the current monkeypox outbreak, you may soon be hearing more about ring vaccination. Then again, if appropriate measures are taken to prevent its spread, this outbreak may soon be over. Either way, this won’t be the last time an unusual virus shows up seemingly out of the blue in unexpected places. Climate change, shrinking animal habitats, rising global animal trade, and increasing international travel mean that it’s only a matter of time before this happens again.

About the Author

Robert H. Shmerling, MD, Senior Faculty Editor, Harvard Health Publishing

Dr. Robert H. Shmerling is the former clinical chief of the division of rheumatology at Beth Israel Deaconess Medical Center (BIDMC), and is a current member of the corresponding faculty in medicine at Harvard Medical School. … See Full Bio View all posts by Robert H. Shmerling, MD

Like many autoimmune disorders, lupus (systemic lupus erythematosus, or SLE) disproportionately affects women during child-bearing years. Lupus is one of more than 80 autoimmune illnesses that affect an estimated 23 million people in the US — and nearly 350 million people worldwide. If you have lupus or another autoimmune illness and you’re planning to have kids, it’s safest to think ahead.

Years ago, people with lupus or other autoimmune disorders were advised to avoid pregnancy. The thinking was that it was simply too risky for mother and fetus. That’s no longer true: in most cases, following expert guidelines now available can make a successful pregnancy possible. These guidelines explain good practices for a range of family planning issues. Below, we answer several common questions about fertility, pregnancy, birth, and breastfeeding.

How might lupus or its treatment affect my fertility?

About 90% of people with lupus are biologically female, and the disease tends to begin between the ages of 15 and 35. So, family planning is a crucial part of lupus care.

Doctors once believed that active lupus interfered with fertility so much that pregnancy was unlikely. While this myth was debunked long ago, people with lupus may take longer than expected to become pregnant. This is more likely if you have active disease requiring aggressive treatment, or if you have certain antibodies (called antiphospholipid antibodies) in your blood.

Your prenatal provider or rheumatologist may recommend that you see a maternal fetal medicine specialist experienced in taking care of pregnant people with fertility issues to fully review your situation.

For people with lupus who experience infertility, in vitro fertilization may be a good option. Because certain medicines, such as cyclophosphamide, may reduce fertility, your doctor may recommend adjusting these.

Egg freezing is another option. It can be done before starting medicine that reduces fertility, or to save younger, healthier eggs for the future in case pregnancy must be delayed for a while.

Will I need to change my treatment before pregnancy?

This depends on which medicines you take and how well controlled your illness is. Good control for at least three to six months before getting pregnant is ideal. An unplanned pregnancy can put both you and the pregnancy at risk.

If your lupus has been poorly controlled, or if it affects major organs such as the heart, lungs, or kidneys, you may be counseled to avoid pregnancy, at least for a while, or to change medicines to better control your disease.

Some medicines taken for lupus are unsafe for a developing baby, and are generally avoided during pregnancy. Examples include methotrexate, mycophenolate, and cyclophosphamide. But the health and well-being of the mother must also be considered, since changing medications could put the mother’s health at risk. With advance planning and coordination among your doctors, you can make changes to improve treatment safety.

What else should I do before trying to get pregnant?

It’s a good idea to take a prenatal vitamin and/or a folic acid supplement. Check with your doctors for specific recommendations.

If you smoke, make every effort to quit. Nicotine products have many health risks, such as an increased risk of cancer, heart attack, stroke, and lung disease. And the combination of lupus, pregnancy, and smoking can markedly increase your risk of having abnormal blood clotting. If you’ve found it difficult to quit, talk to your health care team for help. Your doctor may recommend medicines or nicotine replacement therapy to help you quit.

How might pregnancy affect my illness?

Many people with lupus don’t notice a major difference in their disease during pregnancy. However, studies suggest that flare-ups of lupus tend to be more frequent during pregnancy. High blood pressure, preterm delivery, miscarriage, and impaired fetal growth are among the most common complications of lupus pregnancies.

Your doctor will likely recommend continuing treatments for lupus that are considered safe for the developing fetus, such as hydroxychloroquine, and also taking aspirin to help prevent complications. Closely monitoring you during pregnancy is warranted, to detect and treat lupus flare-ups or any of these complications.

Will my prenatal visits be any different because of lupus?

Because people with lupus have higher than average risks for pregnancy complications, a maternal fetal medicine doctor is often recruited to be part of your medical team. The schedule of routine tests to monitor pregnancy may be modified, too. For example, the risk of diabetes during pregnancy may be higher for people with lupus, possibly due to steroid treatment. So screening for diabetes may be recommended earlier than at the usual 24 to 28 weeks of pregnancy.

If you have certain antibodies in your blood (especially ones called anti-Ro and anti-La), your doctors may recommend more frequent fetal monitoring, with particular attention paid to the developing heart.

Even if everything is progressing normally, it’s important not to skip regularly scheduled prenatal care.

Do people with lupus have more pain during pregnancy?

With or without lupus, pregnancy can be uncomfortable! Many women with lupus have arthritis pain, fibromyalgia, or other pain disorders. Daily activity can help. Yoga, walking, and swimming are all great forms of exercise before, during, and after pregnancy.

What about birth?

Fortunately, most women with lupus have a normal birth experience. If you were on blood thinners to prevent abnormal clotting during your pregnancy, your health care team may be more cautious about your risk of bleeding after birth, and will prepare for this by having medicines and blood transfusions ready. Epidural anesthesia, cesarean sections, and other options are generally available as needed for women with lupus.

What else is helpful to know?

In the weeks following a birth, some women do experience a lupus flare. Your health team will monitor you closely for this possibility.

If you hope to breastfeed, ask your care team about the medicines you take. Several medicines, including hydroxychloroquine, are safe to use during breastfeeding.

The bottom line

Most women with lupus can safely and successfully pursue pregnancy if they wish. When it comes to family planning for people with any autoimmune illness, it’s essential to choose reliable sources of information, plan ahead, communicate regularly with your health care team, and — importantly — ask lots of questions.

About the Authors

Alison Shmerling, MD, MPH, Guest Contributor

Alison Shmerling, MD, MPH, is a family physician practicing full-scope family medicine, including low-risk obstetrics. She completed her medical degree and master of public health at Tufts University School of Medicine. She is now affiliated with … See Full Bio View all posts by Alison Shmerling, MD, MPH

Robert H. Shmerling, MD, Senior Faculty Editor, Harvard Health Publishing

Dr. Robert H. Shmerling is the former clinical chief of the division of rheumatology at Beth Israel Deaconess Medical Center (BIDMC), and is a current member of the corresponding faculty in medicine at Harvard Medical School. … See Full Bio View all posts by Robert H. Shmerling, MD

Chronic kidney disease (CKD) affects an estimated 37 million people in the United States. Often, it begins and progresses silently, causing no obvious symptoms until kidney function is severely impaired. During early stages, up to nine in 10 people aren’t aware that they have it.

If kidney disease is caught early and treated properly, serious problems may be avoided. Once kidneys fail, ongoing dialysis or kidney transplant is necessary. But barriers to care are highest for Black and Hispanic people with advanced kidney disease, and also for younger adults ages 22 to 44, according to a recent study.

How does kidney disease affect the body?

As a doctor who focuses on patients with kidney disease, I’ve found that it helps to explain a few basics. Our kidneys have several jobs. Their most important task is to regularly remove toxins from the bloodstream and excess water from the body by making urine.

If you have CKD, your kidneys are not removing toxins from your blood as well as they should. At its most severe, this can progress to end-stage kidney disease (ESKD), which is when the filtering capacity of your kidneys is reduced enough to make you feel ill.

If this occurs, two main forms of treatment can replace your kidney function: dialysis or a kidney transplant. Dialysis can be performed at a treatment center, or at home after appropriate training. Transplant surgery and post-surgical care occur at specialized centers.

What causes kidney disease?

High blood pressure, diabetes, and high cholesterol are three common risk factors for developing chronic kidney disease. Smoking, obesity, and frequent use of over-the-counter anti-inflammatory medicines, such as ibuprofen or naproxen, worsen kidney function over time.

Severe cases of COVID-19 requiring hospitalization have emerged as a separate risk factor for CKD. And genetic factors may predispose a person to kidney disease as well.

Gaps in kidney care are contributing to health disparities

Statistics show that people who are non-Hispanic Black, Hispanic, and Native American bear a disproportionate burden of kidney disease. For example:

• For every white person who develops ESKD, three Black people develop it.
• While non-Hispanic Black patients make up only 13% of the US population, they represent 35% of people currently on dialysis.
• Among patients initially on a wait list for a kidney transplant in 2014, median wait times were approximately 64 months for Black patients, 57 months for Hispanic patients, and 37 months for white patients.

Most likely, disparities in CKD reflect a combination of the social determinants of health, genetics, and a higher burden of other diseases that contribute to kidney disease, such as high blood pressure and diabetes. Barriers to getting proper treatment — particularly early treatment — play a role, too.

A recent retrospective study in the American Journal of Kidney Medicine suggests age is also a factor. The researchers reviewed data from more than 800,000 patients who received dialysis at home, dialysis at a treatment center, or a kidney transplant between 2011 and 2018. They found

• white people in the study were more likely than people of color to use at-home dialysis or receive a kidney transplant within 90 days.
• the care gap was greatest among adults ages 22 to 44. Black patients in this age group were 79% less likely, and Hispanic patients were 53% less likely, than white patients to receive a kidney transplant within 90 days.

These disparities may be driven partly by the fact that Black and Hispanic patients are less likely to receive appropriate early-stage kidney care, and by differences in insurance. They may also be less likely to have access to a living kidney donor. An important limitation of this study is that these findings cannot be applied to other minority groups.

The bottom line

The good news is that most people can prevent kidney disease by following healthy lifestyle habits, such as eating a low sodium diet, getting moderate exercise, not smoking, and minimizing alcohol intake. If you have high blood pressure, diabetes, high cholesterol, or heart disease, you should be tested for kidney disease once a year. High blood pressure and diabetes — which occur more often among Black Americans and people of color in the US than among white Americans — harm kidneys. Studies such as the one described above increase our understanding of health disparities in kidney disease, with the hope of one day coming up with an equitable solution for everyone, no matter their background or age.

About the Author

Christopher Estiverne, MD, Contributor

Originally from New Jersey, Dr. Christopher Estiverne is currently a staff nephrologist at Brigham and Women’s Hospital in Boston, where he specializes in care of patients with chronic kidney disease. He completed his medical degree and … See Full Bio View all posts by Christopher Estiverne, MD

A new study shows something we’ve always figured was true: our health and habits as children and teens affect our health as adults. And not just our health, but how long we live.

What did the study measure and find?

The International Childhood Cardiovascular Cohorts Consortium Outcomes Study has been collecting data on almost 40,000 people from the United States, Finland, and Australia. They started enrolling them as children in the 1970s through the 1990s, and have been following them ever since.

The researchers have been looking at the effects of five risk factors:

• body mass index, or BMI, a calculation that shows if a person is within a healthy weight range
• systolic blood pressure, which is the top number in a blood pressure reading and is a measure of how much pressure is exerted on the arteries when the heart beats
• total cholesterol value, a measure of how much of the waxy substance is in your blood. While cholesterol is important for doing things like building cells and hormones, having too much of it can lead to heart disease and stroke.
• triglyceride level, a measure of how much of this fatty substance is in the blood. As with cholesterol, too much of it increases the risk of heart disease and stroke.
• smoking in youth.

From 2015 to 2019, the researchers followed up on all of these people, who were 46 on average, which is not very old. They found that almost 800 of them had had cardiovascular events (like a heart attack or stroke), of which more than 300 were fatal.

When the researchers matched outcomes to values for the five factors, they found that they were indeed risk factors:

• People who had higher than normal values for all of the risk factors had almost triple the risk of cardiovascular disease.
• Smoking was the biggest risk factor, followed by BMI, systolic blood pressure, triglycerides, and cholesterol.
• You didn’t need to have all five factors to be at risk; for example, people who were obese as children were more than three times more likely to have cardiovascular disease — and those whose blood pressure was either high or close to high had double the risk.

None of this is a surprise, but seeing it so clearly should be a wake-up call, especially to parents.

What can parents do to help steer a course toward healthy adulthood?

Parents can take these four important steps:

1. Know if your child is at risk. Understandably, many parents don’t pay close attention to the numbers at their child’s checkup, or the results of blood tests. But those numbers are important.

• Make sure you know your child’s BMI — and if it is healthy or not. In adults, we say that a BMI of 19 to 25 is healthy. In children and teens, it’s a bit more complicated; we look at the BMI percentile based on age and gender. If the percentile is between 85 and 95, the child is overweight; if it’s over 95, the child is obese. The Centers for Disease Control and Prevention has a calculator you can use to get the BMI and percentile.
• Know your child’s blood pressure — and whether it is healthy or not. Again, this depends on age, gender, and height. Sadly, many pediatricians miss abnormal blood pressures because numbers that seem normal can be unhealthy for some children, so it’s important to ask your doctor to be sure. Your child’s blood pressure should be measured at every checkup starting at age 3.
• Ask about checking your child’s cholesterol and triglyceride levels. This is generally done in adolescence, but may be done earlier if a child is overweight, or if there is a family history of elevated levels. If you or a close family member has high cholesterol or triglycerides, make sure your child’s pediatrician is aware.
• Ask your child about smoking (and other substance use). Don’t assume you know.

2. Take what you learn — and this study — seriously. An “it’s just baby fat” or “they have plenty of time to get healthy” approach can be dangerous.

• If your child has an elevated BMI, blood pressure, cholesterol level, or triglyceride level, talk with your doctor about what you can do — and do it. 
• No matter what your child’s numbers are, make sure they have a healthy diet, rich in fruits, vegetables, whole grains, healthy fats, and lean protein. Limit added sugar (especially in beverages), processed foods, and unhealthy fats.
• Same goes for exercise: children should be exercising for an hour a day. That doesn’t have to be a team sport, if your child is not a team sports kind of person (or your life doesn’t lend itself to team sports); active play, going for walks, doing exercise videos, or even just dancing in the living room is fine.

3. Talk to your kids about not smoking. Start early — well before adolescence, when peer pressure becomes powerful. Make sure they know the facts, and help them learn and practice ways to say no.
4. See your doctor regularly. Children should see their doctor at least yearly, and if your child has one of the five risk factors, they will need more frequent visits. Make these visits a priority — your child’s life might literally depend on it.

Follow me on Twitter @drClaire

About the Author

Claire McCarthy, MD, Senior Faculty Editor, Harvard Health Publishing

Claire McCarthy, MD, is a primary care pediatrician at Boston Children’s Hospital, and an assistant professor of pediatrics at Harvard Medical School. In addition to being a senior faculty editor for Harvard Health Publishing, Dr. McCarthy … See Full Bio View all posts by Claire McCarthy, MD

“The horse has left the barn.”

Those six words, said by my husband’s oncologist, changed our lives forever, although the sense of impending loss had begun weeks earlier with a blood test. There would be more tests, exams, and visits to specialists. As George and I waited for a definitive diagnosis, we bargained with ourselves and with the universe. When we finally met with the cancer treatment team to review all the tests, George’s 6-foot 2-inch frame struggled to fit into the space at the small table, where we strained to follow the conversation. Hearing the word metastatic — meaning cancer had spread throughout his body — was like fingernails on a blackboard.

But there’s no real way to prepare for grief, an inescapable feature of the human condition. Its stress following the death of a loved one can lead to physical illness: cardiovascular diseases, broken-heart-syndrome (takotsubo cardiomyopathy), cancers, and ulcers. Emotional distress often sparks physical distress known as somatic symptoms. How each person navigates grieving varies. Comfort takes different forms for different people. While my journey is individual, my story touches on universal themes, particularly for those grieving in the time of COVID-19.

Anticipatory grief strikes first

George’s diagnosis was advanced metastatic prostate cancer, spread to lymph nodes and bone. There would be no surgery. No radiation. No chemotherapy. Only palliative care.

Some days George wanted to talk only with me. Other days he wanted to talk with those who were “in the same boat.” He saw himself as washed up on the shores of a new, unknown continent. I felt washed up with him. The National Cancer Institute describes these feelings as anticipatory grief, a reaction that anticipates impending loss.

In time, we returned to everyday routines. Sometimes we laughed and didn’t think about his illness. George even conceived of and hosted an annual party for his best friends — men who would be his pallbearers — and their partners. The “pallbearer party,” as it came to be known, was a wonderfully raucous event. Grown men laughed until they cried. Each year, by the end of the night, I knew the tears were for anticipated loss.

George lived another 11 years, more than twice what was expected. But anticipating his loss did not cushion my broken heart.

Acute grief following a death

George died in May 2020, at the beginning of the COVID-19 lockdown. Despite the pallbearers’ dress rehearsals, there was no funeral, no gathering of loved ones. Nothing to soothe my overwhelming pain.

In those first few weeks, time seemed stretched thin, moments repeating themselves like musical notes on a scratched record. I felt untethered, unmoored, adrift. My sides ached from crying; my knees were unsteady. I don’t recall eating.

At the funeral home, when I saw George in a casket, the large room seemed bright from lights hitting the shiny wood floor. Later, I realized the room was much smaller and dimmer than I remembered, its floor not shiny but covered by oriental rugs. Burgundy drapes kept out the sun. As I took in the scene, so different from my recollection, my chest heaved and spasmed.

Such physical reactions and perceptions are common in acute grief. The death of a loved one is accompanied by waves of physical distress that can include muscle aches, shortness of breath, queasy stomach, and trouble sleeping. Food may have no taste, and some experience visual hallucinations. The grief-stricken may not believe their loved one is dead.

Grief in the time of COVID-19

Restrictions to help prevent the spread of COVID-19 disrupted social rituals that connect us during grief. In The Atlantic, Ed Yong describes this absence of much-needed support as the “final pandemic betrayal.”

Although my husband died of cancer, not COVID, I experienced the loss of comforting rituals and the sense that my grief was never truly acknowledged. Experts call this disenfranchised grief. Some predict that prolonged grief disorder driven by this pandemic may reach rates seen only in survivors of natural disasters and wars.

Grief is proof of love

Losing loved ones is not easily incorporated into our life story, though it becomes part of it. The finality and acceptance of a monumental loss takes time. In The Year of Magical Thinking, Joan Didion captures the sudden tragic death of her husband: “John was talking and then he wasn’t.” Life changes in an instant. Yet it takes time to untangle and embrace all that it means.

My life must now be reconfigured and re-envisioned without George. Letting go of grief happens haltingly. Gradually, I noticed that more of my memories of George were happy ones, slowly crowding out the all-consuming early intensity of grief. With time I began to re-engage with the world.

Just as George had, I found I wanted to talk with others in the same boat. A bereavement group helped. I began to exercise more. That helped too. When our dogs died, I got a new puppy. Above all, I learned to be kind to myself.

If you, too, are struggling with loss, experts advise some basics: try to eat, sleep, and exercise regularly; consider a bereavement group or seek out others experiencing grief; stay open to new possibilities — new hobbies, people, and opportunities. Talk to a professional if, after months, you are preoccupied with thoughts of your loved one or find no meaning in life without them. These may be signs that your grief is stalled or prolonged. Effective treatment can help.

Every “first” without George — the first birthday, first wedding anniversary, first anniversary of his death — awakened the early days of intense grief. Still, the experience of living through each made me realize I could survive. I think George would be pleased.

Additional resources

Grief and Loss, CDC

NIH News in Health: Coping with Grief, National Institutes of Health

The Center for Prolonged Grief, Columbia University

About the Author

Martha E. Shenton, PhD, Contributor

Dr. Martha Shenton is professor of psychiatry and radiology at Harvard Medical School, and director of the Psychiatry Neuroimaging Laboratory at Brigham and Women’s Hospital in Boston. She and her team have pioneered in developing neuroimaging … See Full Bio View all posts by Martha E. Shenton, PhD

It’s an old line: everyone complains about the weather but no one is doing anything about it.

But if you’re a person with bad allergies or asthma, stormy weather can be more than an annoyance; it can be a serious threat to your health. “Thunderstorm asthma” was first reported in the 1980s in England and Australia, and cases continue to crop up. Just after severe thunderstorms passed through Melbourne, Australia in 2016, more than 9,000 people sought urgent medical care for asthma during one notable event. Medical facilities were overwhelmed and at least eight people died. That’s unusual, but if you do have asthma — or seasonal allergies, as it turns out — understanding this trigger can help you stay well.

What is thunderstorm asthma?

The term describes an attack of asthma that starts or worsens after a thunderstorm. It can occur in anyone with asthma, but it most often affects people with seasonal allergic rhinitis, which many people know as hay fever or allergies. Heralded by a runny nose, sneezing, and itchy eyes, seasonal allergies are often worst in the spring, summer, or early fall.

Rain tends to lower pollen counts by cleansing the air, and many people find that rainy weather tends to reduce asthma symptoms triggered by allergies. But thunderstorms can make asthma worse because of a unique sequence of events:

• Cold downdrafts concentrate air particles, such as pollen and mold
• These air particles are swept up into clouds where humidity is high
• In the clouds, wind, humidity, and lightning break up the particles to a size that can readily enter the nose, sinuses, and lungs
• Wind gusts concentrate these small particles so large amounts can be inhaled.

What raises risk for experiencing thunderstorm asthma?

According to a new study in the Journal of Allergy and Clinical Immunology, a whopping 144 out of 228 people with seasonal allergies reported experiencing thunderstorm asthma — that’s 65%! And many of the asthma attacks set off by thunderstorms weren’t mild. Nearly half of people who had an attack sought emergency hospital treatment.

Among people with seasonal allergies, risk factors for experiencing thunderstorm asthma include having

• poorly controlled asthma symptoms (assessed by a standard asthma questionnaire)
• a low score on a rapid exhalation test (a common breathing test for asthma)
• higher levels of a certain antibody (ryegrass pollen-specific IgE)
• higher numbers of certain blood cells (eosinophils, which tend to increase when people have allergic conditions)
• higher levels of exhaled nitric oxide (one measure of lung inflammation among people with asthma).

Not everyone with these risk factors will develop thunderstorm asthma. And even among those who do, asthma attacks won’t necessarily occur with every storm. But it may be useful to know if you’re among those at risk, especially if you live in an area where thunderstorms are common.

The bottom line

Thunderstorm asthma may seem like more of a curiosity than a serious threat to public health. But when it affects a large population area, emergency rooms can become overwhelmed, as happened during the 2016 Melbourne event. A better understanding of when these events are expected could lead to advanced warning systems, enhanced emergency room preparedness, and even preventive treatment.

In the US, 25 million people have asthma and more than 20 million have seasonal allergies. Odds are good that millions have both, which puts large numbers of people at risk for developing thunderstorm asthma.

If you’re among them, the weather forecast may be much more than just a guide on what to wear or whether to bring an umbrella. Knowing thunderstorms are headed your way may serve as an advance warning to double check that you are taking your asthma medicines properly, have a supply of rescue medicine handy, or simply plan to stay indoors until the storm has passed.

About the Author

Robert H. Shmerling, MD, Senior Faculty Editor, Harvard Health Publishing

Dr. Robert H. Shmerling is the former clinical chief of the division of rheumatology at Beth Israel Deaconess Medical Center (BIDMC), and is a current member of the corresponding faculty in medicine at Harvard Medical School. … See Full Bio View all posts by Robert H. Shmerling, MD

As of June 2022, 37 US states have passed medical cannabis laws and 19 states have legalized recreational cannabis. Cannabis has proven beneficial for a range of conditions such as childhood seizure disorders, nausea, vomiting, and loss of appetite in people with HIV/AIDs.

In the meantime, a new generation of cannabis products has exploded onto the scene, driven by marketing that fuels a multibillion-dollar industry. The average content of THC (tetra-9-tetrahydrocannabinol, the psychoactive and potentially addictive chemical in cannabis) in smoked whole-plant products has risen from 1% to 4% in the 1970s to 15% to 30% from today’s cannabis dispensaries. Edibles and vapes may contain even higher concentrations of THC.

While public perception that cannabis is a harmless substance is growing, the long-term benefits and risks of cannabis use remain unclear. However, one consistent pattern of research has emerged: heavy long-term cannabis use can impact midlife cognition.

New research on cannabis use and cognition in midlife

Recent research published in The American Journal of Psychiatry closely followed nearly 1,000 individuals in New Zealand from age 3 to age 45 to understand the impact of cannabis use on brain function. The research team discovered that individuals who used cannabis long-term (for several years or more) and heavily (at least weekly, though a majority in their study used more than four times a week) exhibited impairments across several domains of cognition.

Long-term cannabis users’ IQs declined by 5.5 points on average from childhood, and there were deficits in learning and processing speed compared to people that did not use cannabis. The more frequently an individual used cannabis, the greater the resulting cognitive impairment, suggesting a potential causative link.

The study also found that people who knew these long-term cannabis users well observed that they had developed memory and attention problems. The above findings persisted even when the study authors controlled for factors such as dependence on other drugs, childhood socioeconomic status, or baseline childhood intelligence.

The impact of cannabis on cognitive impairment was greater than that of alcohol or tobacco use. Long-term cannabis users also had smaller hippocampi (the region of the brain responsible for learning and memory). Interestingly, individuals who used cannabis less than once a week with no history of developing dependence did not have cannabis-related cognitive deficits. This suggests there is a range of recreational use that may not lead to long-term cognitive issues.

More studies are needed on cannabis use and brain health

The new research is just one of several studies suggesting there is a link between long-term heavy cannabis use and cognition. Still, future studies are needed to establish causation and explore how long-term cannabis use might impact the risk of developing dementia, since midlife cognitive impairment is associated with higher rates of dementia.

What should you do if you experience cognitive effects of cannabis?

Some people who consume cannabis long-term may develop brain fog, lowered motivation, difficulty with learning, or difficulty with attention. Symptoms are typically reversible, though using products with higher THC content may increase risk of developing cognitive symptoms.

Consider the following if you are experiencing cannabis-related cognitive symptoms:

• Try a slow taper. Gradually decrease the potency (THC content) of cannabis you use or how frequently you use it over several weeks, especially if you have a history of cannabis withdrawal.
• Work with your doctor. Be open with your doctor about your cognitive symptoms, as other medical or psychiatric factors may be at play. Your doctor can also help you navigate a cannabis taper safely, and potentially more comfortably, using other supportive means. Unfortunately, most patients are not comfortable talking with their doctors about cannabis use.
• Give it time. It may take up to a month before you experience improvements after reducing your dose, as cannabis can remain in the body for two to four weeks.
• Try objective cognitive tracking. Using an app or objective test such as the mini-mental status exam to track your brain function may be more accurate than self-observation. Your mental health provider may be able to assist with administering intermittent cognitive assessments.
• Consider alternative strategies. Brain function is not static, like eye color or the number of toes on our feet. Aerobic exercise and engaging in mindfulness, meditation, and psychotherapy may improve long-term cognition.

Cannabis is an exciting yet controversial topic that has drawn both hype and skepticism. It is important for individuals and healthcare professionals to place emphasis on research studies and not on speculation or personal stories. Emerging studies suggesting the connection between long-term heavy use of cannabis and neurocognition should raise concern for policymakers, providers, and patients.

About the Authors

Kevin Hill, MD, MHS, Contributor

Dr. Kevin Hill is director of addiction psychiatry at Beth Israel Deaconess Medical Center, and an associate professor of psychiatry at Harvard Medical School. He earned a master’s in health science at the Robert Wood Johnson … See Full Bio View all posts by Kevin Hill, MD, MHS

Michael Hsu, MD, Guest Contributor

Dr. Michael Hsu is a resident psychiatrist and is currently the chief resident of outpatient psychiatry at Brigham and Women's Hospital, a teaching hospital of Harvard Medical School. After graduating from the University of Pennsylvania with … See Full Bio View all posts by Michael Hsu, MD

Let’s not kid ourselves: the pandemic is still with us, despite how it may sometimes seem.

Increasingly, people are going back to work in person. Schools reopened this spring. And mask mandates are history in most parts of the US. In many places, case rates are falling and deaths due to COVID-19 have become uncommon. For many, life now closely resembles pre-pandemic normalcy. So, what do you need to know about where we are now?

Not so fast: COVID remains a big problem

The virus is still very much with us, not behind us. According to the CDC, in the US there are nearly 100,000 new cases (likely an underestimate) and around 300 deaths each day due to COVID as of this writing. Despite this, more and more people are paying less and less attention.

That could be a big mistake. With summer travel season here and some dire warnings about fall and winter, it’s worth stepping back, taking a deep breath, and reassessing the situation.

Here are responses to five questions I’ve been hearing lately.

1. I haven’t gotten COVID by now. So, do I still need a vaccine?

Yes, indeed! Vaccination and boosters are the best way to avoid a severe case of COVID-19 infection.

Maybe you’ve been spared infection so far because you’ve been vigilant about physical distancing, masking, and other preventive measures. Or perhaps you’ve inherited genes that make your immune system particularly good at evading the COVID-19 virus. Or maybe you’ve just been lucky.

Regardless of the reason, it’s best not to let your guard down. The SARS-CoV-2 virus that causes COVID is highly contagious, especially the most recent variants. And while some people are at higher risk than others, anyone can be infected and anyone can become seriously ill from this virus. Even if you get a mild or moderate case of COVID-19, remember that some people experience symptoms of long COVID, such as fatigue and brain fog.

2. More and more vaccinated people are getting sick with COVID. And I’ve heard that more COVID-related deaths have occurred since vaccines rolled out than before they were available. So, how much of a difference do vaccines and booster shots really make?

They make a huge difference.

It’s estimated that COVID-19 vaccinations have saved more than two million lives in the US. If vaccination rates had been higher, estimates suggest more than 300,000 additional lives could have been saved.

We know that rates of infection, hospital admission, and death dropped dramatically among vaccinated people soon after vaccines became available. We also know that most severe cases of COVID-19 among the vaccinated occur among people who haven’t had a booster shot. Overall, severe cases and deaths remain much lower among people who are vaccinated and boosted than among people who are not vaccinated.

Is it true that the share of severe COVID cases and deaths occurring among the vaccinated has risen? Yes, but possible explanations for this trend actually show that vaccines continue to protect people from serious illness:

• When rates of infection fall, overall rates of hospital admission and death fall for everyone, vaccinated or not. So, the gap between rates of infection and death between vaccinated and unvaccinated people gets smaller.
• Available vaccines aren’t as effective against new variants of the virus. True, but these vaccines still effectively reduce the risk of severe disease.
• Immunity wanes over time. That’s true for even the best vaccines, which is why boosters are needed. Yet only about a third of the US population has received a COVID booster. That makes it easier for the virus to continue to spread and mutate.
• We’ve now logged more time with vaccines than without them since the pandemic began. Because no vaccine is 100% effective, the numbers of cases and deaths will continue adding up, eventually outnumbering pre-vaccine cases and deaths.

3. First, vaccines were going to solve this. Then we needed one booster shot. Now we need two. What’s happening, and why should I even consider this?

Good questions. The protection provided by most vaccines tends to wane over time. That’s why tetanus shots are recommended every 10 years. We’ve learned that protection against COVID-19 may wane a few months after the initial vaccine doses. A first booster is recommended for everyone who is vaccinated, five months after completing the two-dose Moderna or Pfizer vaccine series or four months after the single-dose J&J vaccine.

Because immunity from the first booster may wane sooner in older adults and people with certain health conditions, another Pfizer or Moderna vaccine dose is now available to those over age 50 and others at particularly high risk.

4. Now that mask mandates are in the rearview mirror and everyone is tired of COVID restrictions, what else helps?

It’s not yet clear that mask mandates should have been lifted as soon as they were, especially when rates of infection were starting to rise again. We’ll only know in retrospect if that was a good idea.

As for other measures, physical distancing, masking up, and other steps still make sense in certain situations. For example, if you’re using public transportation or traveling by air, a well-fitted mask can provide a measure of protection. If you’re regularly exposed to a lot of people and know you will soon be in close contact with someone who is at high risk, mask up and get tested in advance.

5. What’s the bottom line here?

Get vaccinated! If you’re eligible for a booster, get one. It makes no sense to get the initial vaccine and forego boosters. If you’re one of very few people who had a significant reaction to one type of vaccine, ask about getting a different type of vaccine as a booster.

When the pandemic began, few were expecting that more than two years later it would still be causing so much suffering and death. But we shouldn’t pretend it’s over; don’t throw out your masks just yet and do follow public health recommendations. If you’ve decided not to get vaccinated or boosted, think again (and again)!

Yes, we’ve all had it with the pandemic. But I think of it this way: when it looks like rain, throwing out your umbrella and pretending it’s sunny are decisions you’ll probably regret.

About the Author

Robert H. Shmerling, MD, Senior Faculty Editor, Harvard Health Publishing

Dr. Robert H. Shmerling is the former clinical chief of the division of rheumatology at Beth Israel Deaconess Medical Center (BIDMC), and is a current member of the corresponding faculty in medicine at Harvard Medical School. … See Full Bio View all posts by Robert H. Shmerling, MD

When the trademark throbbing from a migraine finally lifts, the relief is profound. But for many people regularly stricken with these potentially debilitating headaches, their distress isn’t over just because the pain ends. Instead, a distinct phase of migraine called the postdrome leaves them feeling achy, weary, dazed, and confused — symptoms eerily similar to another affliction altogether.

Dubbed the “migraine hangover,” this constellation of post-headache symptoms is remarkably common, following up to 80% of migraine attacks, according to research published in Neurology. Scientists are increasingly turning their focus to this previously underrecognized component of migraine, according to Dr. Paul Rizzoli, clinical director of the Graham Headache Center at Brigham and Women’s Faulkner Hospital.

“Not knowing it’s an accepted part of migraine, patients come up with some creative ways to tell us about their postdrome symptoms — they feel washed out, their head feels hollow, or they feel like they have a hangover but weren’t even drinking,” Dr. Rizzoli explains. “Until recent years, science hadn’t paid attention to this facet of the syndrome, but it’s a natural progression from focusing on the problem as a whole.”

The four phases of migraine

The typical migraine can be a wretched experience, with stabbing head pain joined by nausea, brain fog, and extreme sensitivity to light and sound, among other symptoms. Nearly 16% of Americans are affected by migraines, which strike women at nearly twice the rate as men. Severe headaches are also one of the top reasons for emergency room visits.

Spanning hours to days, migraine headaches can include four clear phases, each with its own set of symptoms. The pre-pain prodrome and aura phases may include various visual changes, extremes of irritability, difficulty speaking, or numbness and tingling, while the headache itself can feel like a drill is working its way through the skull.

Lingering migraine symptoms: The hangover

After that ordeal, one to two days of postdrome symptoms may sound tame by comparison, Dr. Rizzoli says. But the lingering fogginess, exhaustion, and stiff neck can feel just as disabling as the headache that came before. Since migraine is believed to act as a sort of electrical storm activating neurons in the brain, it’s possible that migraine hangover results from “some circuits being electrically or neurochemically exhausted,” Dr. Rizzoli says. “It just takes time for the brain to return to normal function, or even replace some chemicals that have been depleted in the process.”

But much is still unknown about migraine postdrome, he adds, and research has found no consistent association between factors such as the type of migraine medication taken and duration of any subsequent hangover.

Tips to ease a migraine hangover

Following these steps regularly may help you ward off lingering symptoms after a migraine:

• Drink plenty of water.
• Practice good headache hygiene by maintaining regular eating and sleeping patterns and easing stress.
• If possible, try to lighten your load for next 24 hours after the headache pain ends.
• Stop taking pain medicine once the headache is gone.

For migraine hangover sufferers so distracted by their inability to return to normal activities even after migraine pain lifts, physicians sometimes prescribe medications typically meant for conditions such as memory loss, depression, or seizures. While they may differ from the usual drugs used to treat migraine, some of these medicines have been observed to help postdrome syndrome or act as a preventive for headache.

“Think of the headache you just had like you’ve run a marathon or done some other stressing activity,” Dr. Rizzoli says. “Your body needs to recover, which is not the same as staying in bed with the lights off. Ease up, but stay functional.”

About the Author

Maureen Salamon, Executive Editor, Harvard Women's Health Watch

Maureen Salamon is executive editor of Harvard Women’s Health Watch. She began her career as a newspaper reporter and later covered health and medicine for a wide variety of websites, magazines, and hospitals. Her work has … See Full Bio View all posts by Maureen Salamon

Here we are, well into year three of the COVID-19 pandemic, and now we’re having an outbreak of monkeypox? Is this a new virus? How worried should we be? While new information will continue to come in, here are answers to several common questions.

What is monkeypox?

Monkeypox is an infection caused by a virus in the same family as smallpox. It causes a similar (though usually less severe) illness and is most common in central and western Africa. It was first discovered in research monkeys more than half a century ago. Certain squirrels and rats found in Africa are among other animals that harbor this virus.

Currently, an outbreak is spreading fast outside of Africa. The virus has been reported in at least a dozen countries, including the US, Canada, Israel, and in Europe. As of this writing, Reuters reports more than 100 confirmed or suspected cases, making this the largest known outbreak outside of Africa. So far, no deaths have been reported.

Naturally, news about an unfamiliar virus spreading quickly internationally reminds us of the start of the COVID-19 pandemic. But monkeypox is not new — it was first discovered in 1958 — and several features make it likely to be far less dangerous.

What are the symptoms of monkeypox?

The early symptoms of monkeypox are flulike, and include

• fever
• fatigue
• headache
• enlarged lymph nodes.

The rash that appears a few days later is unique. It often starts on the face and then appears on the palms, arms, legs, and other parts of the body. Some recent cases began with a rash on the genitals. Over a week or two, the rash changes from small, flat spots to tiny blisters (vesicles) similar to chickenpox, and then to larger, pus-filled blisters. These can take several weeks to scab over. Once that happens, the person is no longer contagious.

Although the disease is usually mild, complications can include pneumonia, vision loss due to eye infection, and sepsis, a life-threatening infection.

How does a person get monkeypox?

Typically, this illness occurs in people who have had contact with infected animals. It may follow a bite or scratch, or consuming undercooked animal meat.

The virus can spread between people in three ways:

• inhaling respiratory droplets
• directly touching an infected person
• less often, through indirect contact such as handling an infected person’s clothing.

The respiratory route involves large droplets that don’t linger in the air or travel far. As a result, person-to-person spread typically requires prolonged, intimate contact.

Is monkeypox a sexually transmitted illness?

Monkeypox is not considered a sexually transmitted illness (STI) because it can be spread through any physical contact, not just through sexual contact. Some of the recent cases have occurred among men who have sex with men. That pattern hasn’t been reported before.

Can monkeypox be treated?

Yes. Although there are no specific, FDA-approved treatments for monkeypox, several antiviral medicines may be effective. Examples are cidofovir, brincidofovir, and tecovirimat.

Can monkeypox be prevented?

Vaccination can help prevent this illness:

• Smallpox vaccination, which was routine in the US until the 1970s, may be up to 85% effective against monkeypox.. The US government has stockpiled doses of smallpox vaccine that could be used in the event of a widespread outbreak.
• Additionally, the FDA approved a vaccine (called JYNNEOS) in 2019 for people over 18 who are at high risk for smallpox or monkeypox. The makers of this vaccine are ramping up production as this outbreak unfolds.

If you are caring for someone who has monkeypox, taking these steps may help protect you from the virus: wear a mask and gloves; regularly wash your hands; and practice physical distancing when possible. Ideally, a caregiver should be previously vaccinated against smallpox.

How sick are most people who get monkeypox?

Monkeypox is usually a mild illness that gets better on its own over a number of weeks.

Researchers have found that the West African strain of monkeypox is responsible for the current outbreak. That’s good news, because the death rate from this strain is much lower than the Congo Basin strain (about 1% to 3% versus 10%). More severe illness may occur in children, pregnant people, or people with immune suppression.

What else is unusual about this outbreak?

Many of those who are sick have not traveled to or from places where this virus is usually found, and have had no known contact with infected animals. In addition, there seems to be more person-to-person spread than in past outbreaks.

Is there any good news about monkeypox?

Yes. Monkeypox usually is contagious after symptoms begin, which can help limit its spread. One reason COVID-19 spread so rapidly was that people could spread it before they knew they had it.

Outbreaks occur sporadically, and tend to be relatively small because the virus does not spread easily between people. The last US outbreak was in 2003; according to the CDC, nearly 50 people in the Midwest became ill after contact with pet prairie dogs that had been boarded near animals imported from Ghana.

Perhaps the best news is this: unlike SARS-CoV2, the virus that causes COVID-19, monkeypox is unlikely to cause a pandemic. It doesn’t spread as easily, and by the time a person is contagious they usually know they’re sick.

How worried should we be?

The growing numbers of cases in multiple countries suggest community spread is underway. More cases will probably be detected in the coming days and weeks.

It’s still early in the outbreak and there are many unanswered questions, including:

• Has the monkeypox virus mutated to allow easier spread? Early research is reassuring.
• Who is most at risk?
• Will illness be more severe than in past outbreaks?
• Will existing antiviral drugs and vaccines be effective against this virus?
• What measures can we take to contain this outbreak?

So, monkeypox is no joke and researchers are hard at work to answer these questions. Stay tuned as we learn more. And let your doctor know if you have an unexplained rash or other symptoms of monkeypox, especially if you have traveled to places where cases are now being reported.

About the Author

Robert H. Shmerling, MD, Senior Faculty Editor, Harvard Health Publishing

Dr. Robert H. Shmerling is the former clinical chief of the division of rheumatology at Beth Israel Deaconess Medical Center (BIDMC), and is a current member of the corresponding faculty in medicine at Harvard Medical School. … See Full Bio View all posts by Robert H. Shmerling, MD