Aging well in a pandemic: Older adults share what it takes

Published May 19, 2022 | Originally published on MedicalXpress Breaking News-and-Events

Despite the pandemic’s terrible toll on older adults, a new national poll shows that most people over 50 still say their health is as good as it was before March 2020, or even better.

But a sizable minority—20% of those in their 50s and early 60s, and 14% of those over 65—say their health has declined in that time, according to the new findings from the National Poll on Healthy Aging. A smaller percentage said their health has improved.

The percentage saying their health has declined during the pandemic was much higher—40%—among those who call their current physical or mental health status fair or poor. The poll’s other findings also suggest that this group of older adults may need extra support to help them age well.

The poll team asked older adults in April about how their health today compares with what they expected when they were younger, and what aspects of their life are helping them age well.

“This is a great reminder that this pandemic has not affected everyone equally, and that we have a long-term challenge of understanding and address the needs of older adults whose health has declined over the past two years, or who already had major physical or mental health challenges even before the pandemic,” says Preeti Malani, MD, the poll director and a Michigan Medicine infectious disease physician also trained in geriatrics. “At the same time, our findings underscore the resilience of many older adults, and the importance of everything from social connections to hobbies and getting outdoors in helping them age well.”

The poll is based at the U-M Institute for Healthcare Policy and Innovation and supported by AARP and Michigan Medicine, the University of Michigan’s academic medical center.

The new findings come as the poll celebrates its fifth anniversary with a special webinar on May 19, called “Optimizing Health and Well-Being as We Age” and co-presented by IHPI and AARP.

Key findings about overall health:

• Nearly one-third of older adults of all ages say their health is a higher priority for them now than it was before the pandemic, with women, Black and Hispanic older adults more likely to say so than male or White respondents.
• 20% of adults aged 50 to 64 say their health has declined since the start of the pandemic, compared with 14% of those over 65. By contrast, nearly 14% of those aged 50 to 64 say their health has improved, compared with just under 7% of those over 65. The rest said their health was about the same.
• Blacks and Hispanics were more likely to say their health had improved during the pandemic years.
• Those who are retired are less likely to say their health had improved than those who are working (5% vs 14%).
• 40% of those who say they are in fair or poor physical or mental health said their health had declined in the pandemic, compared with 11% of those who say they’re in excellent, very good or good physical health and 15% who say the same about their mental health.
• Looking back on what they might have expected when they were younger, 26% of people age 50 to 64 say their health is better than they expected, compared with 43% of those over 65. But among those who say their current physical or mental health is fair or poor, 54% say their health now is worse than what they had once expected.

Key findings about factors that older adults say help them age well:

• Two-thirds said their home environment helps a lot. Percentages were significantly higher for those with more education or higher incomes, and those who are married.
• People over 65 were much more likely to say that their relationships and friendships help them a lot as they age, at 71% compared with 58% for people age 50 to 64. Hispanic older adults were most likely to cite relationships and friendships as helping them a lot in aging well.
• Around 55% said their outlook for the future helps them a lot in aging well, though women were much more likely than men to say so (61% vs 47%) and the percentages were lower among those who say they’re in fair or poor physical or mental health (37% and 44%)
• 55% said access to outdoor spaces helps them a lot, but the percentage was only 32% among those who said their physical health is fair or poor.
• 43% said that hobbies help them a lot as they try to age well, though the percentage was 29% among those in fair or poor physical health.
• One-third of those in their 50s and early 60s said continued learning and education helps them a lot as they seek to age well; 22% of those over 65 said this.
• Only 1 in 4 older adults said that their sense of connection to their community helped them a lot as they age.

Malani notes that the vast majority of adults aged 50 to 80 agreed that they know what steps they should take to be healthy as they age, but the poll shows gaps between what people “know” they should do and what they do.

“Over the past five years, we’ve often used our polls to examine the gap between knowledge and action on health and well-being, to better understand why gaps exist and how older adults and their families, their health care providers, and policymakers can or should be doing more,” said Malani.

The National Poll on Healthy Aging results are based on responses from a nationally representative sample of 1,037 adults aged over 50 from the Foresight 50+ Omnibus panel, which draws from the Foresight 50+ Panel by AARP and NORC at the University of Chicago who answered a wide range of questions online and by phone in April 2022. Questions were written, and data interpreted and compiled, by the IHPI team.

Dr Kemi Adu, an experienced GP, has shown an interest in joining Dr Anne Nixon and myself in treating patients with hormonal problems, using body identical natural hormones. I have been mentoring Kemi in my methods over the last few months. Dr Kemi is now available for consultations here at the Superclinic. Ring reception for appointments. I will continue supervising and assisting Dr Kemi as she becomes completely familiar with the methods Dr Nixon and I use.

In case you are wondering, I have no intention of retiring any time soon, as I enjoy what I do and intend to keep doing so. I regret having to turn away so many who need my help, as I have had to restrict my hours of work to ensure quality of life. Having Dr Nixon here has helped, and now Dr Kemi will help even more.

Personal Health & Wellness > Mental Health

Nature Rx: Should you prescribe the forest to patients?

By Naveed Saleh, MD, MS | Fact-checked by Barbara Bekiesz

| Published May 18, 2022

Key Takeaways

• Nature prescriptions are becoming increasingly popular. They use the forest and green spaces, which are freely available to all.
• Nature prescription is associated with various health benefits including improvements in diabetes, hypertension, heart disease, and mental illness—although more research is required.
• Before prescribing nature, have a conversation with your patient that explores their interests, commitment, and goals.

When most physicians think of the word “prescription,” drugs come to mind. Not all prescriptions, however, require a trip to the pharmacy. Lifestyle interventions can also be prescribed. Take, for instance, the burgeoning interest in nature prescription.

Nature prescription programs target the staggering rates of chronic disease and sedentary lifestyle in the US.

An emerging body of evidence is focusing on nature prescription, providing guidance on how to prescribe this way.

What is a ‘nature prescription’?

Nature has been a resource to man from our beginning, and the notion of prescribing nature is old. The 16th-century Swiss physician Paracelsus contended that healing comes from nature—not physicians. In Japan, shinrin-yoku (forest bathing) is promoted as a public-health measure.^[1]

No standard definition exists for nature prescription, according to the authors of a review published in the International Journal of Environmental Research and Public Health.^[2] Instead, the practice usually involves a physician or other healthcare professional offering the patient a written recommendation to spend time outside.

There currently are between 75 and 100 nature prescription programs in the US.

They represent a growing trend. The Association of American Physicians cited connecting children and families with nature as a top priority in 2019.

Furthermore, the US National Physical Activity Plan advised the use of park prescriptions. Such prescriptions are compelling because they use existing resources and draw on recent research.

Rooted in medicine

Results from a systematic review and meta-analysis published in Environmental Research demonstrated that greenspace exposure led to numerous health benefits including decreases in hypertension, heart rate, and salivary cortisol levels, as well as in the incidence of diabetes and all-cause and cardiovascular mortality.^[3]

There were, however, issues with the study’s quality and design heterogeneity, which could limit its results. Still, its authors recommended nature prescriptions and street greenery to improve health outcomes.

“Our findings should encourage practitioners and policymakers to give due regard to how they can create, maintain, and improve existing accessible greenspaces in deprived areas,” the authors wrote.

Publishing in medRXiv, Australian researchers found that, compared with controls, nature prescriptions yielded numerous health benefits. In their meta-analysis, they found that prescription nature programs decreased systolic blood pressure by an average of 4.9 mmHg and diastolic blood pressure by an average of 3.6 mmHg.^[4] They also found that these programs reduced depression and anxiety scores, and increased daily step counts.

“Nature prescription programmes may provide cardiometabolic and mental health benefits and increase physical activity,” they wrote. “Effective nature prescription programmes can select from a range of natural settings [and] activities and might be implemented via social and community channels, besides health providers.”

How to write a nature prescription

If you’re on board with writing nature prescriptions, a good resource is Park Rx America. This physician-led organization touts the importance of nature-rich areas and the need to incorporate them into daily life. It counts spending time in nature as the most important first step in human and planetary health.

The organization’s website offers guidance on how to go about constructing the nature prescription. The process begins with asking open-ended questions to find out where the patient feels safe and comfortable outside, and what they like to do outside. Identifying the frequency and duration of the planned activity establishes the “contract” with the patient for the  prescription.^[5]

“Be patient with yourself and with your patient,” the site recommends. “This short but intense conversation about what your patient likes to do outside, where, with whom, for how many minutes/hours, and how many times per week, is one that will change at every visit, similar to adjusting medication doses for maximum benefit. It is rare that any two prescriptions are identical. One size does not fit all, and that’s true within the same patient experience over multiple visits. Like any new intervention you adopt as a provider, there is a learning curve.”

One intriguing activity highlighted is the nature therapy walk.

This 2.5-hour promenade can be done in any natural setting such as a forest, and can involve a guide. The guide invites participants to engage their senses. The participants then form a circle to share their experiences in a non-judgmental manner. Nature serves as the therapist, and the guide provides structure and safety.^[6]

What this means for you

Nature prescription can promote patient health and well-being. Such prescriptions depend on the individual and should be explored with your patients. Nature prescriptions can change over time as the patient experience evolves.

Related: 7 clinically proven natural remedies

Health and Wellness

6 things this immunologist does every night to sleep better and boost her immune system: ‘Exercising isn’t enough’

Published Sat, May 21 202211:00 AM EDT

Dr. Heather Moday, Contributor

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Tara Moore | Getty

More than two years after the emergence of a pandemic, we’re still struggling with outbreaks of Covid-19 — and that means building and maintaining a strong immune system should be a top priority.

As an immunologist and functional medicine doctor, I always remind my patients that while genetics, diet and exercise all play a role in our immune response, sleep is one of the most effective ways to prepare your body to fight infection.

Without adequate sleep, your stress hormones can experience dysregulation, affecting your weight, gut health and immune defense.

Sleep: Power down your body, power up your immune system

Exercising isn’t enough to get high-quality sleep. I see patients who go to the gym every day and have made sacrifices like eliminating alcohol or sugar but still can’t get great sleep.

In fact, a whopping 50 million Americans suffer from some type of sleep disorder, and one in three adults in the U.S. get less than the minimum recommended seven hours of sleep.

This, sadly, is affecting our health in so many ways. Sleep deprivation doesn’t just make us feel tired the next day, it also creates inflammation and increases our risk for disease. It has been linked to increased rates of hypertension, heart disease, obesity, diabetes, depression and cancer.

How to get better sleep

The good news is that as soon as you start prioritizing sleep, your immune system can rebound quickly.

Here are six things I do every night to ensure a good night’s rest:

1. Cut down on digital devices

You might be shocked by how much time you spend surfing the web, watching TV and mindlessly scrolling on your phone. Once you’ve gotten honest about what you do with your time, think about how you can cut down on those nonessential activities and reassign time for sleep instead.

I also suggest putting your phone and computer in a drawer at the same time every evening. Experts in human behavior have found that being successful at making healthy lifestyle choices is less about innate willpower and more about creating a lifestyle that makes these decisions easier.

2. Create an optimal sleep environment

Your bedroom should be your sleep sanctuary. You don’t need expensive linens, a weighted blanket or a cooling pad. A comfortable mattress, high-quality pillow and soft bedding will do just fine.

If you have indicator lights on electronics in your bedroom, cover them with black electrical tape. If you have bright streetlights outside your window, use blackout curtains. If you can hear traffic noise, use a white noise machine to drown it out.

Finally, make sure your bedroom is nice and cool (the optimal temperature for sleeping is around 65 degrees Fahrenheit or 18.3 degrees Celsius).

3. Calm the mind before bedtime

Insomnia is often caused by ruminating about things that haven’t happened — or may never happen.

One way to calm your mind and body is to journal before bedtime. Processing your worries by writing them down has been found to help clear the mind of stressful thoughts so they won’t keep you up at night.

Breathing exercises can help, too. If I’m in an anxious or worried state, or just a little amped up, I use the 4-5-7 breath technique:

1. Sitting calmly, place the tip of your tongue on the roof of your mouth near the back of your upper front teeth and breath out with a “whoosh” sound.
2. Inhale through your nose to a silent count of four seconds, hold your breath for a count of seven, and breath out through your nose for a count of eight.
3. Repeat this cycle three more times, for a total of four rounds.

4. Experiment with magnesium

Magnesium is often referred to as the “relaxation” mineral, thanks to its demonstrated ability to combat insomnia.

You can always take a magnesium supplement, but one of my favorite ways to use it for sleep is by taking a warm Epsom salt bath. Magnesium sulfate is the main component of Epsom salt, and by penetrating your skin and muscles, it can have a relaxing effect.

Even just soaking in a warm bath helps you fall asleep faster.

5. Wear blue light-blocking glasses

Blue light messes with your body’s ability to prepare for sleep because it blocks a hormone called melatonin that makes you sleepy.

And given the excessive amounts of blue light in our homes (i.e., from smartphones, tablets, computers), blue light-blocking glasses are an essential for me. Wearing these glasses has been shown to significantly improve sleep quality and decrease insomnia.

The best glasses usually have yellow or orange lenses and block higher percentages, some up to 90%, of blue-spectrum light. My favorites are Swanswick glasses, but there are several good manufacturers and prescription options as well.

6. Do some easy stretching

Implementing stretching or restorative yoga before bedtime can help with pain, elevated blood pressure, restless leg syndrome and anxiety. Just a few poses can engage your parasympathetic nervous system and help you sleep better.

I love doing legs-up-the-wall poses. And the best part is that you really only need five or so minutes to make a big difference.

Dr. Heather Moday is a board-certified allergist, immunologist and functional medicine physician. She is also the author of ”The Immunotype Breakthrough: Your Personalized Plan to Balance Your Immune System, Optimize Health, and Build Lifelong Resilience.” Follow her on Instagram @theimmunityMD and Facebook.

Daily Covid Briefing

Over 75 Percent of Long Covid Patients Were Not Hospitalized for Initial Illness, Study Finds

Researchers analyzed the largest database of private insurance claims in the United States in the first four months after a diagnostic code for long Covid was created.

By Pam Belluck

• May 18, 2022Updated 4:09 p.m. ET

More than three-quarters of Americans diagnosed with long Covid were not sick enough to be hospitalized for their initial infection, a new analysis of tens of thousands of private insurance claims reported on Wednesday.

The researchers analyzed data from the first few months after doctors began using a special diagnostic code for the condition that was created last year. The results paint a sobering picture of long Covid’s serious and ongoing impact on people’s health and the American health care system.

Long Covid, a complex constellation of lingering or new post-infection symptoms that can last for months or longer, has become one of the most daunting legacies of the pandemic. Estimates of how many people may ultimately be affected have ranged from 10 percent to 30 percent of infected adults; a recent report from the U.S. Government Accountability Office said that between 7.7 million and 23 million people in the United States could have developed long Covid. But much remains unclear about the prevalence, causes, treatment and consequences of the condition.

The new study adds to a growing body of evidence that, while patients who have been hospitalized are at greater risk for long Covid, people with mild or moderate initial coronavirus infections — who make up the vast majority of coronavirus patients — can still experience debilitating post-Covid symptoms including breathing problems, extreme fatigue and cognitive and memory issues.

“It’s generating a pandemic of people who were not hospitalized, but who ended up with this increased disability,” said Dr. Paddy Ssentongo, an assistant professor of infectious disease epidemiology at Penn State, who was not involved in the new study.

The analysis, based on what the report calls the largest database of private health insurance claims in the United States, found 78,252 patients who were diagnosed with the new code from the International Classification of Diseases — diagnostic code U09.9 for “Post COVID-19 condition, unspecified” — between Oct. 1, 2021, and Jan. 31, 2022.

Dr. Claire Steves, a clinical academic and physician at King’s College London, who was not involved in the new research, said the overall number of people who received the diagnosis was “huge,” given that the study covered only the first four months after the diagnostic code was introduced and did not include people covered by government health programs like Medicaid or Medicare (though it did include people in private Medicare Advantage plans). “That’s probably a drop in the ocean compared to what the real number is,” Dr. Steves said.

The study, conducted by FAIR Health, a nonprofit organization that focuses on health care costs and insurance issues, found that 76 percent of the long Covid patients did not require hospitalization for their initial coronavirus infection.

Another striking finding was that while two-thirds of the patients had pre-existing health conditions in their medical records, nearly a third did not, a much larger percentage than Dr. Ssentongo said he would have expected. “These are people who have been healthy and they’re like, ‘Guys, something is not right with me,’” he said.

The researchers plan to continue to track the patients to see how long their symptoms last, but Robin Gelburd, the president of FAIR Health, said that the organization decided to publish data from the first four months now, “given the urgency” of the issue.

She said researchers were working to try to answer some of the questions that are not addressed in the report, including providing detail on some patients’ previous health conditions to try to identify whether certain medical problems put people at higher risk of long Covid.

The organization also plans to analyze how many patients in the study were vaccinated and when, Ms. Gelburd said. More than three-quarters of the patients in the study were infected in 2021, most of those in the last half of the year. On average, patients were still experiencing long Covid symptoms that qualified for the diagnosis four and a half months after their infection.

The findings suggest a potentially staggering impact of long Covid on people in the prime of their lives, and on society at large. Nearly 35 percent of the patients were between the ages of 36 to 50, while nearly one-third were ages 51 to 64, and 17 percent were ages 23 to 35. Children were also diagnosed with post-Covid conditions: Nearly 4 percent of the patients were 12 or younger, while nearly 7 percent were between ages 13 and 22.

Six percent of the patients were 65 and older, a proportion that most likely reflects the fact that patients covered by the regular Medicare program weren’t included in the study. They were much more likely than the younger groups with long Covid to have had pre-existing chronic medical conditions.

The insurance data analyzed did not include information about the race or ethnicity of patients, researchers said.

The analysis, which Ms. Gelburd said was evaluated by an independent academic reviewer but not formally peer-reviewed, also calculated a risk score for the patients, a way of estimating how likely people are to use health care resources. Comparing all the insurance claims the patients had up until 90 days before they contracted Covid with their claims 30 days or more after they were infected, the study found that average risk scores went up for patients in every age group.

Ms. Gelburd and other experts said the scores suggested that the repercussions of long Covid are not simply confined to increased medical spending. They signal “how many people are leaving their jobs, how many are being given disability status, how much absenteeism is there in school,” Ms. Gelburd said. “It’s like a pebble thrown into the lake, and these ripples circling that pebble are concentric circles of impact.”

Because the study captured only a privately insured population, Dr. Ssentongo said, it almost certainly understates the scope and burden of long Covid, especially since low-income communities have been disproportionately affected by the virus and often have less access to health care. “I think it may even be worse if we added in the Medicaid population and all these other people that would have been missed” in the study’s data, he said.

Sixty percent of the patients with the post-Covid diagnosis were female, the study reported, compared with 54 percent of Covid patients overall in the FAIR Health database. In the oldest and youngest age groups, however, there were roughly as many males as females.

“I think there is a female preponderance in terms of this condition,” Dr. Steves said, adding that the reasons could include differences in biological factors that make women more prone to autoimmune conditions.

The insurance claims showed that nearly one-quarter of the post-Covid patients had respiratory symptoms, nearly one-fifth had coughs and 17 percent had been diagnosed with malaise and fatigue, a far-reaching category that could include issues like brain fog and exhaustion that gets worse after physical or mental activity. Other common issues included abnormal heartbeats and sleep disorders.

Generalized anxiety disorder was more common for 23- to 35-year-olds than for other age groups, the study reported, while hypertension was more common in the oldest patients.

I have just had a patient complain of her breasts enlarging dramatically over the last 3 months, Her Bra size has gone up 2 sizes, and she feels very uncomfortable as a result. She wondered whether her hormones treatment could have been responsible. She is very good with lifestyle, diet, and stress, so there is no other reason to explain this breast size increase. Her hormones are normal. I suspected the vaccine may have been responsible, Looking on-line, I note many other women have reported the same thing post Covid Jab. Some of the comments:

‘Almost two cup sizes’

“Been an A cup my full life,” she said in her video.

“Getting the Pfizer vaccine making my boobs grow almost two cup sizes.”

Another TikTok user claimed she’d received a “free boob job” after receiving the Pfizer jab.

But while many social media users are excited by their increased bust sizes, scientists have warned that the side effect is temporary.

In Australia, the Department of Health has listed swollen lymph nodes as a “less common” side effect of the Pfizer vaccine.

However in the US, doctors have said some women had booked in for mammograms after confusing the swelling for signs of cancer.

“I’m sure hundreds of thousands of women will be affected by this for sure,” Dr. Esserman, Director of University of California San Francisco’s Breast Care Center, told ABC7 Chicago.

The Radiological Society of North America has also published a study on the topic, advising that doctors and patients should be aware of the side effect to rule out any potential false cancer diagnoses.

Some women who received the Pfizer or Moderna COVID-19 vaccines have reported side effects that resemble breast cancer symptoms. In addition to experiencing disproportionately severe side effects compared to men, along with abnormal menstrual cycles, doctors have also seen female patients develop swollen lymph nodes after receiving the vaccine. This has some people speculating that the COVID vaccine can make your breasts larger, dubbing it the “Pfizer boob job.”

Swollen lymph nodes can be an early sign of cancer—particularly when the swelling occurs in the armpit on one side of the body—but there are other reasons behind the condition, such as when the body is fighting off a cold or an infection. 

Instances of swollen lymph nodes following a COVID-19 vaccination have a relatively straightforward explanation, one which thankfully doesn’t involve cancer.

The mRNA vaccines deliver a small amount of genetic code to instruct cells how to replicate the virus’ surface protein “spike,” which in turn activates the immune system. Lymph nodes contain B-cells that use this information to generate antibodies in response to a foreign entity. The buildup of antibodies in the lymph nodes may result in them becoming enlarged. This can lead to breasts feeling larger for a short time following a COVID vaccine, but it is not cause for undue concern.

The Centers for Disease Control and Prevention documented 11% of patients with swollen lymph nodes after their first shot of the Moderna vaccine. Sixteen percent of patients experienced swollen nodes following their second shot. The swelling typically occurs two to four days after injection and can last between four and 12 weeks. 

Some doctors have expressed concern that women who experience swollen breasts as a side effect of the COVID vaccine may undergo unnecessary diagnostic tests to check for breast cancer.

“It is important to recognize that lymph nodes may become enlarged for a number of reasons having nothing to do with malignant disease, including in patients known to have cancer,” Dr. Maurie Markman, president of Medicine and Science at Cancer Treatment Centers of America, wrote in a blog post. “If someone is concerned, it is always reasonable to check with a physician.”

But in at least one case, the swollen lymph node side effect caused by the vaccine reminded a woman to check the rest of her body. She discovered she actually did have breast cancer.

The American Cancer Society and the Society of Breast Imaging are among several public health agencies that recommend women planning to get a mammogram do so before receiving the vaccine. If they must get screened after a vaccine, experts advise waiting between four and 12 weeks.

Even in patients not experiencing swelling or tenderness, it’s still possible for enlarged lymph nodes to show up on a mammogram—potentially triggering a false positive.

“If it’s within four weeks after your vaccination, then you have a higher chance of having enlarged lymph nodes on the side where you have the vaccine,” Dr. Hannah Milch, a radiologist and assistant clinical professor at the UCLA David Geffen School of Medicine, told ABC 30 News. “If you have it in your left arm, the lymph nodes in your left armpit may be bigger than normal. This is a body’s normal response. It’s doing what it should do, and it will go back to back down in size.”

Milch said she’s been seeing patients with swollen lymph nodes at least once or twice per week. The condition isn’t unique to the COVID-19 vaccines, according to Milch. She sometimes sees it in people after getting their annual flu shot, though she says that during “flu vaccine season, I probably see it like twice total.”

Milch stressed that people shouldn’t intentionally delay mammogram screening appointments or vaccinations without consulting with their doctor.

“You can tell the technologist that you just had the COVID vaccination, and which arm you had it in and when. So they can document that,” Milch said. “If somebody gets a screening mammogram and we see enlarged lymph nodes, we ask them to come back for an ultrasound usually, and we take another look.”

Milch also said breast cancer survivors should request their shot be administered on the opposite side of the body from where the cancer was diagnosed. 

“If somebody comes in, and they have enlarged lymph nodes, let’s say, on a side where they had cancer in the past. That might send off more alarm bells [than] if they had no history of cancer,” Milch said. “So we take that very seriously. Having said that, it’s perfectly possible if they get a vaccination in the same arm as the side where their breast cancer was that they will have the same reaction as somebody who did not have a history of breast cancer.”

Serious Adverse Effects of Covid Vaccines 40 Times Higher Than Recorded by Government, German Scientist Says

The number of serious adverse effects from Covid vaccination is 40 times higher than currently recorded by the German Government, a scientist leading a study into the vaccines has said. German news outlet MDR has the story (translated via Google).

The study “Safety Profile of COVID-19 Vaccines” (“ImpfSurv” for short), which focuses on the effects and side effects of the various vaccines, has been running for a year. Around 40,000 vaccinated people are interviewed at regular intervals throughout Germany. Participation in the study is voluntary and independent of how the vaccines work in the subjects.

One result: eight out of 1,000 vaccinated people struggle with serious side effects. “The number is not surprising,” explains Prof. Dr. Harald Matthes, head of the study: “It corresponds to what is known from other countries such as Sweden, Israel or Canada. Incidentally, even the manufacturers of the vaccines had already determined similar values ​​in their studies.” With conventional vaccines, such as against polio or measles, the number of serious side effects is significantly lower.

Serious side effects are symptoms that last for weeks or months and require medical attention. These include muscle and joint pain, heart muscle inflammation, excessive reactions of the immune system and neurological disorders, i.e., impairments of the nervous system. “Most side effects, including severe ones, subside after three to six months, 80% heal. But unfortunately there are also some that last much longer,” reports Professor Matthes. …

“In view of around half a million cases with serious side effects after Covid vaccinations in Germany, we doctors have to take action,” emphasises Prof. Matthes, who, in addition to his work at the Berlin Charité, is on the board of several medical societies and has been systematically examining the effects of drugs for years. “We have to come to therapy offers, discuss them openly at congresses and in public without being considered anti-vaccination.”

Ovarian cancer is not a silent killer – recognizing its symptoms could help reduce misdiagnosis and late detection

Published: April 25, 2022 10.13pm AEST

Author

1. Barbara Goff Professor of Obstetrics and Gynecology, University of Washington

Disclosure statement

Barbara Goff receives funding from National Institutes of Health, TEAL foundation. Ovarian Cancer Research Foundation and Marsha Rivkin Foundation

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Republish our articles for free, online or in print, under Creative Commons licence.

Ovarian cancer is the most deadly of gynecologic tumors. Fewer than 40% of those diagnosed with ovarian cancer are cured, and approximately 12,810 people in the U.S. die from the disease every year.

For the past 25 years, scientists have tried to identify a screening test to detect ovarian cancer in its earliest stages, when the chance of cure is high. Unfortunately, multiple clinical trials with hundreds of thousands of participants have failed to identify an effective way to screen for ovarian cancer. In fact, the U.S. Preventive Services Task Force gave ovarian cancer screening a grade of D in 2018, meaning it recommends against periodic screening because it doesn’t improve survival and can prove harmful to patients.

Because no effective screening test currently exists, 70% of people with ovarian cancer are diagnosed at advanced stages, when chances of cure are poor. Around 60% to 90% of people with stage one or two cancer that stays around the ovaries and pelvis are disease-free five years after diagnosis, compared with only 10% to 40% of those with stage three or four cancer that has spread through the abdomen and beyond.

But even those with advanced disease have a higher chance of being cured if complete surgical removal is still possible. This makes early diagnosis all the more important for overall survival.

Without screening tests, many physicians wrongly assume that early diagnosis for ovarian cancer isn’t possible. As a gynecologic oncologist who treats hundreds of ovarian cancer patients each year, I was frustrated by these late diagnoses, and wondered if better recognition of its symptoms could help clinicians and patients identify ovarian cancer earlier. Ovarian cancer is often misdiagnosed.

Detectable symptoms

Ovarian cancer has historically been called a “silent killer,” because clinicians thought its symptoms were undetectable. Patients were often diagnosed so late that doctors thought nothing could be done.

But there have been many studies over the past 20 years demonstrating that ovarian cancer does have early warning signs. My colleagues and I conducted one of the earliest studies in 2000. Our survey of 1,700 people with ovarian cancer found that 95% of patients reported noticeable symptoms three to 12 months before diagnosis. The most common symptoms were pain in their pelvis and abdomen, increased frequency and urge to urinate, difficulty eating or feeling full quickly, and bloating or abdominal distension.

Importantly, people with both advanced- and early-stage disease reported similar types of symptoms. Subsequent studies from multiple researchers further confirm that patients with even early-stage ovarian cancer experience frequent symptoms.

We also found that providers often misdiagnosed ovarian cancer as another condition. When we asked patients what their doctors told them was the cause of their symptoms, 15% had their symptoms attributed to irritable bowel disease, 12% to stress, 9% to gastritis, 6% to constipation, 6% to depression and 4% to some other cause. Thirty percent were given treatment for a different condition. And 13% were told there was nothing wrong.

One major issue has been distinguishing ovarian cancer symptoms from those of common gastrointestinal and urinary conditions. In another study, my team and I found that patients with ovarian cancer have symptoms with a recent onset and occur more than 50% of the month.

To facilitate early detection of ovarian cancer, my team and I compared the symptoms ovarian cancer patients experienced with those of patients without ovarian cancer. We developed an index that identified six important symptoms of ovarian cancer: bloating, increased abdominal size, feeling full quickly, difficulty eating, pelvic pain and abdominal pain. Symptoms needed to occur more than 12 times a month but to have lasted for less than a year.

Based on these criteria, our index was able to detect ovarian cancer in 60% to 85% of the patients in our study, a range similar to that achieved through diagnostic blood tests for ovarian cancer.

Preventing ovarian cancer

While early detection is important, there are also prevention strategies that can help reduce the risk of developing ovarian cancer.

If you have a family history of ovarian cancer, inform your doctor, who may recommend genetic testing to fully determine your risk, or prophylactic surgery to prevent the development of cancer.

Oral contraceptives, tubal ligation (or surgery to close the fallopian tubes), pregnancy and breastfeeding all reduce the risk of ovarian cancer.

Finally, up to 70% of ovarian cancers may arise from the fallopian tubes. Removing the fallopian tubes at the time of another surgery may be another option to help reduce the risk of ovarian cancer. This should be done only if you do not plan on becoming pregnant in the future.

Can taking vitamins and supplements help you recover from COVID?

Published: May 10, 2022 6.00am AEST

Author

1. Treasure McGuire Assistant Director of Pharmacy, Mater Health SEQ in conjoint appointment as Associate Professor of Pharmacology, Bond University and Associate Professor (Clinical), The University of Queensland

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Treasure McGuire does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.

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Australia’s surge in COVID cases this year has seen many people looking for ways to protect themselves or boost their immunity and recovery. An upswing in sales of dietary supplements has followed.

In Australia, the Therapeutic Goods Administration includes vitamins, minerals, amino acids, enzymes, plant extracts and microbiome supplements under the term “complementary medicine”.

The supplement industry’s global estimated worth  was about US $170 billion (A$239 billion) in 2020. Australian complementary medicines revenue was estimated at A$5.69 billion in 2021 – doubling in size over the past decade. The latest data shows 73% of Australians bought complementary medicines in the previous year, with vitamins featuring in more than half of purchases.

But how likely are these purchases to be effective in preventing COVID or treating it?

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Fear, avoidance and laboratory studies

Historically, the public has purchased supplements from sources that also provide health-care advice. Lockdowns and blanket health messages about social distancing and personal hygiene have created a new normal. So people are doing more shopping online for supplements and turning to the internet, friends or social media for vitamin recommendations. For some, this has led to an unhealthy fear of COVID (coronaphobia) and negative impacts on daily life.

As with any medicine, consumers should seek information from reliable sources (doctors, pharmacists or evidence-based peer-reviewed articles) about the potential benefits and harms of supplements before purchase. Strong evidence supports vaccination as effective against the acute respiratory symptoms of COVID. Researchers have also looked at whether supplements may prevent or reduce the duration and severity of this viral infection by boosting the immune response.

Deficiencies in essential nutrients that support immune function (vitamin C, vitamin D, zinc and selenium) have been shown to increase susceptibility to infection, including COVID. But there is little evidence supplementation in a healthy person prevents respiratory infections such as COVID. An evidence gap exists between a supplement’s action in laboratory or animal studies and findings from well designed and conducted clinical trials.

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A pandemic ‘infodemic’

Ready access to supplements without a prescription from a myriad of online and shopfront sources and the uncontrolled spread of claims that supplements can prevent or treat COVID symptoms, has created an “infodemic”.

These claims are fuelled by supplement manufacturers being able to “list” their products on the Australian Register of Therapeutic Goods, with limited evidence of safety or effectiveness. This appearance of official approval tallies with the common misperception that “natural” means “safe”.

Supplements can cause harm in the form of adverse effects, drug interactions and expense. They also add to a patient’s medication burden, may delay more effective therapy, or give false hope to the vulnerable.

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Vitamins A to zinc

The recent COVID A to Z Study illustrates some of the challenges involved.

It was designed to test the effectiveness of high-dose zinc, vitamin C, and a combination of both, to shorten the duration of COVID-related symptoms compared with usual care in adult outpatients with confirmed infection.

These nutrients were chosen because:

• vitamin C studies in mice showed this antioxidant to be essential for antiviral immune responses against the influenza A virus, especially in the early stages of the infection
• deficiency of zinc, an essential trace element, has been associated with increased susceptibility to viral infections.

The authors planned to include 520 patients but the safety monitoring committee recommended the study be stopped early, due to low likelihood of detecting significant outcome differences between the groups. There were also more adverse effects (nausea, diarrhoea, and stomach cramps) reported in the supplement groups than those receiving usual care.

Little evidence of benefits

Despite the large variety of complementary medicines marketed, most clinical trials to date have studied the impact of vitamin D, vitamin C or zinc to reduce the risk of contracting COVID, improve rates of hospitalisation or death.

Even with high treatment doses, results have been generally disappointing. Vitamin D, zinc and some probiotics may be beneficial to prevent viral infections. Vitamins D, C, A, zinc, calcium and some probiotics may be beneficial to treat viral infections. But other supplements studied (including copper, magnesium, selenium and echinacea) are unlikely to be beneficial or are not supported by sufficient data.

However, supplements may be beneficial when individuals are unable to achieve a balanced and varied diet.

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Potentially harmful

High doses or chronic use of COVID supplements have also been linked with adverse effects: vitamin D with muscle pain and loss of bone mass; vitamin A with elevated liver function tests and blurred vision; vitamin E with bleeding risk; plant extracts, magnesium with gastrointestinal effects; and selenium with hair loss and brittle nails.

So, the evidence is not convincing that taking vitamins and supplements will prevent you catching COVID or help you recover from the infection, unless you have a known nutrient deficiency or a poor diet

Can Covid Lead to Impotence?

Some studies find higher rates of erectile dysfunction among men recovering from the illness. But other factors related to the pandemic, like heightened anxiety, may also be to blame.

By Roni Caryn Rabin

• May 5, 2022

For a respiratory disease, Covid-19 causes some peculiar symptoms. It can diminish the senses of smell and taste, leave patients with discolored “Covid toes,” or even cause a swollen, bumpy “Covid tongue.”

Now scientists are examining a possible link to an altogether unexpected consequence of Covid: erectile dysfunction. A connection has been reported in hundreds of papers by scientists in Europe and North America, as well as in Egypt, Turkey, Iran and Thailand.

Estimates of the magnitude of the problem vary wildly. A paper by Dr. Ranjith Ramasamy, director of reproductive urology at the University of Miami’s Desai Sethi Urology Institute, and his colleagues found that the risk of erectile dysfunction increased by 20 percent after a bout with Covid. Other investigators have reported substantially higher increases in that risk.

When patients first started coming to Dr. Ramasamy’s clinic complaining of erection problems, “We dismissed it, thinking it was all psychological or stress induced,” he said.

But over time, he and other physicians began to see a pattern, he said. “Six months after the initial infection, patients had gotten better overall, but they continued to complain of these problems,’’ including both erectile dysfunction and low sperm counts, Dr. Ramasamy, who has written several papers on the topic, said.

At the outset of the pandemic, Dr. Emmanuele Jannini, a professor of endocrinology and medical sexology at the University of Rome Tor Vergata, reported a strong link between erectile dysfunction and Covid. When he compared men who had been ill with Covid with those who had not, he found that those who had been infected were nearly six times as likely to report impotence as those who had avoided the coronavirus.

“Communicating that the disease can affect your sexual life is a tremendously powerful message,” especially for men who still resist vaccination, Dr. Jannini said in an interview. “The evidence is very strong.”

Research from imaging scans and biopsies indicates that the coronavirus can infect tissue within the male genital tract, where it may linger long after the initial infection. Scientists say it is too early to be certain that the link to erectile dysfunction is causal, since so many factors — psychological as well as physiological — play a role in producing and maintaining an erection. The pandemic has led to social isolation and a surge in anxiety and depression, all of which may play a role.

“Men’s erections are more complicated than people think,” Dr. Justin Dubin, who co-wrote a paper about the adverse impact of Covid on men’s health, said.

“You need good blood flow, you need the nerves to be firing, and you need good hormone levels, specifically testosterone,” he said. “But you also need to be in a good state of mind, and you also need to be aroused. If any of these things go wrong, you may have an issue getting an erection.”

In that sense, the pandemic is the perfect confluence of converging factors for causing erectile dysfunction, Dr. Joseph Katz, a professor at Florida College of Dentistry, said. Dr. Katz stumbled on the issue of erectile dysfunction while investigating Covid’s effects on oral health.

Some researchers speculate that erectile dysfunction may be linked to the well-documented loss of the ability to taste and smell experienced by Covid patients, because these senses play an important role in sexual arousal. “It is through smells that the arousal mechanism in the brain is ignited,” three Italian urologists wrote last year in a letter responding to Dr. Jannini’s paper.

At the very least, men need healthy blood vessels and good blood flow in order to develop and sustain erections. The coronavirus may damage blood vessels and the lining of the vessels, called the endothelium, as it binds to the molecular receptors that are plentiful on endothelial cells.

The vessels may not constrict and stretch as needed to allow for blood flow to the penis. Injury to the blood vessels may also contribute to more serious complications of Covid, like heart attacks, strokes and abnormal clotting.

The coronavirus invades cells in the penis and testicles of monkeys, researchers discover.

“Our entire vascular system is connected — it’s not an isolated penis problem,” Dr. T. Mike Hsieh, director of the men’s health center at University of California, San Diego, said.

But vascular problems can manifest in the sexual organs first, because the vessels there are so small. (Dr. Jannini calls erectile dysfunction “the canary in the coal mine” for cardiovascular disease.) Erectile dysfunction and cardiovascular disease share risk factors — such as being severely overweight, having metabolic diseases like diabetes, smoking and older age — which also increase the odds of having severe Covid.

“The artery for the penis is one-tenth the size of a coronary artery, and when you have a narrower vessel, whether it’s a plumbing problem or a vascular problem, it will show up there first, even before you see it in a larger artery,” Dr. Hsieh said.

Erectile dysfunction can precede a heart attack by about five years, he said, and can be an early signal that there are other underlying risk factors.

“When I see a guy for erectile dysfunction, they don’t just get a Viagra or Cialis prescription,” Dr. Hsieh said. “They get a referral to a primary care colleague or a cardiologist to make sure their cholesterol is in check, their diabetes is under control, to discuss weight management, lifestyle or dietary changes.”

Erectile dysfunction may point the way to better diagnosis of long Covid, Dr. Jannini said, or even deteriorating mental health.

“If you have a patient who survived Covid, and you want to know if he has long Covid or not, just ask him how it’s going in bed,” Dr. Jannini said. “If he’s having a normal sex life, the possibility of him having serious long Covid is very, very low.”

Left untreated, erectile dysfunction can lead to further complications. Cases of Peyronie’s disease, a condition that causes curved, painful erections as a result of fibrous scar tissue built up in the penis, and orchitis, the inflammation of one or both of the testicles, have developed in men who have had Covid, according to published research.

Men who don’t have normal erections for several months at a time may develop scar tissue and fibrosis, which makes erectile dysfunction harder to treat and may even lead to shortening of the penis.

Erectile dysfunction can resolve on its own, but Dr. Hsieh encouraged men with symptoms to see their physicians, and sooner rather than later.

“If you’re having these problems, do not wait,” he said. “For the most part, we can get the guys’ sex lives back.”

A version of this article appears in print on May 6, 2022, Section A, Page 18 of the New York edition with the headline: Global Studies Tie Covid To Erectile Dysfunction. Order Reprints | Today’s Paper | Subscribe