How to Flush Out Kidney Stones

Have you ever heard that passing a kidney stone is more painful than giving birth? Each year, more than 1 million people in the U.S. rush to the emergency room with pain caused by a kidney stone. Kidney stones are hard, pebble-like pieces of material that form in one or both kidneys. They’re caused by high levels of certain minerals in your urine. Stones vary in size from tiny crystals that can only be seen with a microscope to stones over an inch wide. Tiny stones may pass out of your body without your even noticing. With larger stones, you won’t be so lucky. Stones that are larger than a pencil eraser can get stuck in the urinary tract—and that can really hurt.

Everyone is at some risk for developing kidney stones. “It is a very common condition,” says Dr. Ziya Kirkali, a urologist at NIH. “One out of 11 individuals in the U.S. is affected by this disease.” Kidney stones can form at any age, but they usually appear during middle age (40s to 60s). Of those who develop one stone, half will develop at least one more in the future.

“Probably one of the most important reasons why people form stones is dehydration,” Kirkali says. When urine is too concentrated, minerals can build up and form stones. “I can’t over-emphasize the importance of drinking plenty of water, because that’s the most effective way of preventing kidney stone disease.”

During the warmest months of the year, you’re at greatest risk of becoming dehydrated. “So it is really important to drink more than you usually drink during the cooler days or months,” Kirkali says.

To detect kidney stones, your doctor may order lab or imaging tests. Lab tests look in urine for blood, signs of infection, minerals (like calcium), and stones. Blood tests can also detect high levels of certain minerals. “About 80% of all stones are made of calcium oxalate,” Kirkali says. Knowing what the stones are made of can help guide treatment.

Treatment also depends on the stone’s size and location. CT scans or plain X-ray imaging can help your doctor pinpoint the location and estimate the size of a kidney stone. Depending on what your doctor finds, you may be prescribed medicine and advised to drink a lot of fluids. Or, you might need a procedure to break up or remove the kidney stone.

There are different procedures for breaking up or removing kidney stones. One method delivers shock waves to the stone from outside of the body. Other strategies involve inserting a tool into the body, either through the urinary tract or directly into the kidney through surgery. After the stone is located, it can be broken up into smaller pieces.

Once you’ve had a kidney stone, you have an increased chance for having another. NIH-supported scientists are studying ways to prevent kidney stones from returning. “We always tell our patients to drink more, but it’s not so easy to really increase your fluid intake,” Kirkali says. A new study is testing a method to encourage people to drink more fluids each day. Other NIH-funded studies are trying to unravel why some people seem more at risk of developing kidney stones. Still others are looking into how to better detect stones and treat them.

Don’t let the pain of kidney stones send you to the emergency room. Keep hydrated! But if you develop any of the symptoms shown in the “Wise Choices” box, see your doctor right away.

Written by: NIH Office of Communications and Public Liaison
Editor: Harrison Wein, Ph.D.
Managing Editor: Tianna Hicklin, Ph.D.

What’s the Difference Between Bronchitis and Pneumonia?

Coughs help your body clear your airways of irritants and prevent infection. But a deep cough from your chest may signal bronchitis or pneumonia. Although they may have different underlying causes, their symptoms can be similar—and both can be serious enough to send you to the doctor.

Bronchitis and pneumonia both involve Inflammation in the chest. Both can cause coughs that bring up a slimy substance called phlegm to help clear out germs and pus. And both can cause shortness of breath and wheezing.
Bronchitis is a condition in which the bronchial tubes that lead to the lungs become inflamed. Viruses, bacteria, and even toxins like tobacco smoke can inflame the bronchial tubes. Most of the time, though, bronchitis is caused by an infection with one of several types of viruses. If you develop bronchitis during flu season, a likely culprit may be the flu virus. Cold viruses are also common causes at this and other times of year.

Pneumonia is caused by an infection of the lungs. “About 1/3 of cases are caused by viruses, but most of them are bacterial related,” says Dr. Kenneth Olivier, a lung infection expert at NIH. “They’re from bacteria that are quite common, like Streptococcus pneumoniae, which is the leading cause of bacterial pneumonias in all ages in the U.S.”
If you get a fever with bronchitis, it is usually mild (below 101 degrees Fahrenheit). In more serious cases, you may have chest pain, feel short of breath, or wheeze when you breathe in.

“Pneumonia, on the other hand, typically is associated with fever, sometimes very high, spiking fever,” Olivier says. Breathing problems, chest pain, and other symptoms also tend to be more severe with pneumonia. If you have a fever and chills, trouble breathing, or a cough that is bringing up thick phlegm, especially if it’s yellow or green, go see your doctor.

Your doctor can listen to your lungs by placing a stethoscope on your chest. “Frequently, the physician can hear areas where the breath sounds are altered,” Olivier says. If you have pneumonia, your doctor may hear bubbling, crackling, or rumbling sounds from the lungs.

You may be sent for a chest X-ray, which can show whether the lungs contain fluid or pus from an infection. An X-ray is the best way to diagnose pneumonia and rule out bronchitis. Whichever illness you have, resting and drinking plenty of fluids are important ways to care for yourself.

If you’re diagnosed with bronchitis, your doctor probably won’t give you antibiotics. Because viruses are the usual cause of bronchitis, antibiotics are seldom helpful. If you’re wheezing, however, you may be given medicine to open your airways. Your cough may last 10 to 20 days.

Because bacteria are often the cause of pneumonia, your doctor may prescribe antibiotics. It can take 1 to 4 weeks to recover from pneumonia. Some people require treatment in the hospital.

Germs that cause colds, the flu, and lower airway infections are contagious. The best way to prevent getting bronchitis or pneumonia is to avoid getting these infections. And when you’re sick, take care not to spread your germs to others (see “Wise Choices” box for tips).

Guard Against Airway Infections
-Wash your hands often with soap and water.
-Use alcohol-based hand gel if you’re unable to wash them.
-Cough into a tissue, your elbow, or your sleeve.
-Ask your doctor about vaccines for you and your children. Certain vaccines can prevent airway infections caused by harmful viruses and bacteria.
-Avoid people who are coughing or showing signs of infection.
-Avoid tobacco smoke.

Written by NIH Office of Communications and Public Liaison
Editor: Harrison Wein, Ph.D.
Managing Editor: Tianna Hicklin, Ph.D.

Preventing and Treating Drug Abuse

Drug abuse can be a painful experience—for the person who has the problem, and for family and friends who may feel helpless in the face of the disease. But there are things you can do if you know or suspect that someone close to you has a drug problem.

Certain drugs can change the structure and inner workings of the brain. With repeated use, they affect a person’s self-control and interfere with the ability to resist the urge to take the drug. Not being able to stop taking a drug even though you know it’s harmful is the hallmark of addiction.

A drug doesn’t have to be illegal to cause this effect. People can become addicted to alcohol, nicotine, or even prescription drugs when they use them in ways other than prescribed or use someone else’s prescription.
People are particularly vulnerable to using drugs when going through major life transitions. For adults, this might mean during a divorce or after losing a job. For children and teens, this can mean changing schools or other major upheavals in their lives.

But kids may experiment with drug use for many different reasons. “It could be a greater availability of drugs in a school with older students, or it could be that social activities are changing, or that they are trying to deal with stress,” says Dr. Bethany Deeds, an NIH expert on drug abuse prevention. Parents may need to pay more attention to their children during these periods.

The teenage years are a critical time to prevent drug use. Trying drugs as a teenager increases your chance of developing substance use disorders. The earlier the age of first use, the higher the risk of later addiction. But addiction also happens to adults. Adults are at increased risk of addiction when they encounter prescription pain-relieving drugs after a surgery or because of a chronic pain problem. People with a history of addiction should be particularly careful with opioid pain relievers and make sure to tell their doctors about past drug use.

There are many signs that may indicate a loved one is having a problem with drugs. They might lose interest in things that they used to enjoy or start to isolate themselves. Teens’ grades may drop. They may start skipping classes.

“They may violate curfew or appear irritable, sedated, or disheveled,” says child psychiatrist Dr. Geetha Subramaniam, an NIH expert on substance use. Parents may also come across drug paraphernalia, such as water pipes or needles, or notice a strange smell.

“Once drug use progresses, it becomes less of a social thing and more of a compulsive thing—which means the person spends a lot of time using drugs,” Subramaniam says.

If a loved one is using drugs, encourage them to talk to their primary care doctor. It can be easier to have this conversation with a doctor than a family member. Not all drug treatment requires long stays in residential treatment centers. For someone in the early stages of a substance use problem, a conversation with a doctor or another professional may be enough to get them the help they need. Doctors can help the person think about their drug use, understand the risk for addiction, and come up with a plan for change.

Substance use disorder can often be treated on an outpatient basis. But that doesn’t mean it’s easy to treat. Substance use disorder is a complicated disease. Drugs can cause changes in the brain that make it extremely difficult to quit without medical help.

For certain substances, it can be dangerous to stop the drug without medical intervention. Some people may need to be in a hospital for a short time for detoxification, when the drug leaves their body. This can help keep them as safe and comfortable as possible. Patients should talk with their doctors about medications that treat addiction to alcohol or opioids, such as heroin and prescription pain relievers.

Recovering from a substance use disorder requires retraining the brain. A person who’s been addicted to drugs will have to relearn all sorts of things, from what to do when they’re bored to who to hang out with. NIH has developed a customizable wallet card to help people identify and learn to avoid their triggers, the things that make them feel like using drugs. You can order the card for free at drugpubs.drugabuse.gov/publications/drugs-brain-wallet-card.

“You have to learn ways to deal with triggers, learn about negative peers, learn about relapse, [and] learn coping skills,” Subramaniam says.

NIH-funded scientists are studying ways to stop addiction long before it starts—in childhood. Dr. Daniel Shaw at the University of Pittsburgh is looking at whether teaching healthy caregiving strategies to parents can help promote self-regulation skills in children and prevent substance abuse later on.

Starting when children are two years old, Shaw’s study enrolls families at risk of substance use problems in a program called the Family Check-Up. It’s one of several parenting programs that have been studied by NIH-funded researchers.

During the program, a parenting consultant visits the home to observe the parents’ relationship with their child. Parents complete several questionnaires about their own and their family’s well-being. This includes any behavior problems they are experiencing with their child. Parents learn which of their children’s problem behaviors might lead to more serious issues, such as substance abuse, down the road. The consultant also talks with the parents about possible ways to change how they interact with their child. Many parents then meet with the consultants for follow-up sessions about how to improve their parenting skills.

Children whose parents are in the program have fewer behavioral problems and do better when they get to school. Shaw and his colleagues are now following these children through their teenage years to see how the program affects their chances of developing a substance abuse problem. You can find video clips explaining different ways parents can respond to their teens on the NIH Family Checkup website at www.drugabuse.gov/family-checkup.

Even if their teen has already started using drugs, parents can still step in. They can keep closer tabs on who their children’s friends are and what they’re doing. Parents can also help by finding new activities that will introduce their children to new friends and fill up the after-school hours—prime time for getting into trouble. “They don’t like it at first,” Shaw says. But finding other teens with similar interests can help teens form new habits and put them on a healthier path.

A substance use problem is a chronic disease that requires lifestyle adjustments and long-term treatment, like diabetes or high blood pressure. Even relapse can be a normal part of the process—not a sign of failure, but a sign that the treatment needs to be adjusted. With good care, people who have substance use disorders can live healthy, productive lives. 

Written by: NIH Office of Communications and Public Liaison
Editor: Harrison Wein, Ph.D.
Managing Editor: Tianna Hicklin, Ph.D.

Knowing the Symptoms of Brain Tumors

A tumor in the brain isn’t like tumors in other parts of your body. It has limited room for growth because of the skull. This means that a growing tumor can squeeze vital parts of the brain and lead to serious health problems. Learning about the possible symptoms of brain tumors can help you know when to tell a doctor about them.

A tumor is an abnormal mass of cells. When most normal cells grow old or get damaged, they die, and new cells take their place. Sometimes, this process goes wrong. New cells form when the body doesn’t need them, and old or damaged cells don’t die as they should. The extra cells can form a tumor.

A tumor that starts in the brain is called a primary brain tumor. People of all ages can develop this type of tumor, even children. And there are many different ways they can form.

“There are over 130 different types of primary brain tumors,” says Dr. Mark R. Gilbert, an NIH brain tumor expert. About 80,000 people in the U.S. are diagnosed with a primary brain tumor each year.

Cancer that has spread to the brain from another part of the body is called a metastatic brain tumor. Metastatic brain tumors are far more common than primary tumors.

Both primary and metastatic brain tumors can cause similar symptoms. Symptoms depend mainly on where the tumor is in the brain.

“The symptoms of brain tumors can be either dramatic or subtle,” Gilbert says. A seizure is an example of a dramatic symptom. About 3 of every 10 patients with a brain tumor are diagnosed after having a seizure, he explains.
Other symptoms are less obvious. For example, you might notice memory problems or weakness on one side of your body. Until symptoms develop, you may not know you have a brain tumor.

If you have symptoms that suggest a brain tumor, tell your doctor. Your doctor will give you a physical exam and ask about your personal and family health history. You may need to have additional tests. Tumors can be detected by imaging methods such as MRI or CT scans.

“Brain imaging technology has really changed the way we are able to visualize abnormalities,” Gilbert explains. It allows brain surgeons to learn as much as possible about the tumor and remove it more safely. NIH researchers are continuing to look for ways to better detect and treat brain tumors. Treatments differ depending on the type and location of the tumor. Treatment can involve surgery, radiation (beams of high energy rays aimed at the tumor), or drugs that kill or block the growth of cancer cells.

Usually, brain tumor treatment requires a team of health care professionals. This may include surgeons, cancer specialists, nutritionists, nurses, and mental health providers. The team does more than treat the tumor. They also try to minimize its impact on a patient’s quality of life.

“There is a definite advantage to being cared for by people who do this on a routine basis,” Gilbert says. A person who has been diagnosed with a brain tumor may want to seek treatment at a nearby cancer center, if possible. To look for a cancer center near you, visit www.cancer.gov/research/nci-role/cancer-centers.
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Possible Symptoms of a Brain Tumor
The symptoms of a brain tumor depend on its size, type, and location. The most common ones are listed below. These do not mean you have a brain tumor. But talk with your doctor if you experience any of the following:
-Severe headaches 
-Muscle jerking or twitching (seizures or convulsions)
-Nausea and vomiting
-Changes in speech, vision, or hearing
-Problems balancing or walking
-Changes in your mood, personality, or ability to concentrate
-Problems with memory
-Numbness, tingling, or weakness in the arms or legs

Written by NIH Office of Communications and Public Liaison

Keeping Your Gut in Check

Your digestive system is busy. When you eat something, your food takes a twisty trip that starts with being chewed up and ends with you going to the bathroom. A lot happens in between. The health of your gut plays a key role in your overall health and well-being. You can make choices to help your body stay on tract.

Your digestive, or gastrointestinal (GI), tract is a long, muscular tube that runs from your mouth to your anus. It’s about 30 feet long and works with other parts of your digestive system to break food and drink down into smaller molecules of nutrients. The blood absorbs these and carries them throughout the body for cells to use for energy, growth, and repair.

With such a long GI highway, it’s common to run into bumps in the road. About 60 to 70 million Americans are affected by digestive diseases, like gastroesophageal reflux disease (GERD) or irritable bowel syndrome (IBS). GERD happens when your stomach acid and/or contents come back up into your esophagus (swallowing tube) or throat. This causes uncomfortable symptoms like heartburn and indigestion. IBS is a group of symptoms that includes pain in the abdomen and changes in bowel habits. People with IBS may have constipation, diarrhea, or both. Many more people have other digestive problems, like bloating and stomach pain.

“There are many factors that can impact gut health,” says Dr. Lin Chang, a GI expert at the University of California, Los Angeles. How your body’s built, your family and genetic history, how you manage stress, and what you eat can all affect your gut.

“I see a lot of lifestyle-related GI issues, and there are often no quick fixes for that,” she says. “In general, people do well when they create a more routine schedule, eat a healthy diet and smaller more frequent meals, add in some exercise, and get a good amount of sleep.”

Chang studies the connection between stress and IBS. Her research group has found that people who have early life stress are more likely to develop IBS. “However, this increased risk for IBS went down when people confided in someone they trust about the stress they experienced,” she explains. “Finding healthy ways to manage stress is important for GI health, and your health overall.”

What you eat can help or hurt your digestive system, and influence how you feel. “Increasing fiber is really important for constipation,” says Chang. “Most Americans do not eat a lot of fiber so you have to gradually increase the fiber in your diet. Otherwise you might get gas and more bloating, and won’t stick with [the changes].”
Chang says you should eat at least 20–30 grams of fiber a day for constipation. You can spread out your fiber in small amounts throughout the day. Start with small servings and gradually increase them to avoid gas, bloating, and discomfort.

Try to eat fruits and vegetables at every meal. A variety of fruits, vegetables, whole grains, and nuts can provide a healthy mix of different fibers and nutrients to your diet. An added benefit is that the more fiber and whole foods you eat, the less room you’ll have for less healthy options.

But some fiber-rich foods, called high FODMAP foods, can be hard to digest. Examples include certain fruits and vegetables, dairy products, and wheat and rye products. If you have IBS, your doctor may recommend a diet low in FODMAPS.

Researchers are coming to understand the complex community of bacteria and other microbes that live in the human GI tract. Called gut flora or microbiota, these microbes help with our digestion. But evidence has been growing that gut microbes may influence our health in other ways too. Studies suggest that they may play roles in obesity, type 2 diabetes, IBS, and colon cancer. They might also affect how the immune system functions. This can affect how your body fights illness and disease. Recent studies have found that microbes’ effects on the immune system may impact the development of conditions such as allergy, asthma, and rheumatoid arthritis.

You might have heard that probiotics—live microbes that are similar to those found in the human gut—can improve your gut health. These are also called “friendly bacteria” or “good bacteria.” Probiotics are available in dietary supplements and in certain foods, such as yogurt.

There is some evidence that probiotics may be helpful in preventing diarrhea associated with antibiotics and improving symptoms of IBS, but more needs to be learned. Researchers still don’t know which probiotics are helpful and which aren’t. They also don’t know how much of the probiotics people would have to take or who would most likely benefit from them.

Certain food additives called emulsifiers are something else that may affect your gut health. Emulsifiers are added to many processed foods to improve texture and extend shelf life. But studies show they can affect our gut flora.
“Our work and other research indicate that emulsifiers and other food additives can negatively impact the microbiota and promote inflammatory diseases,” says Georgia State University’s Dr. Andrew Gewirtz. His group has been studying the relationships between food additives, gut bacteria, and disease in mice. The team also plans to examine how different food additives may affect people.

Based on what his team and others have found, Gewirtz advises, “The take home message: Eat a balanced diet and less processed foods.”

“The GI system is complicated and such an important part of our health,” Chang says. “It takes a real partnership between patient and doctor to get to the root of issues. Everyone has to find a healthy routine that works for them.”

She encourages you to take an active role in finding a doctor who makes you feel comfortable. The right doctor will listen carefully to your health history and symptoms. You can help keep your gut in check by talking with your doctor and—together—making the right choices for you.

Wise Choices for Better Gut Health
-Eat slower. Chew your food well before swallowing. It may help you swallow less air and better sense when you’re full.
-Enjoy smaller meals. Eat in moderation to avoid overfilling your stomach and encourage digestion. A packed stomach may also cause reflux, or your food to come back up.
-Set a bedtime for your gut. Try to limit how much you eat after dark. Your GI tract is most active in the morning and daytime.
-Manage stress. Learn healthy ways to reduce stress like relaxation breathing, mindfulness, and exercise. Stress makes it harder to digest your food well.
-Create a routine. Try to eat around the same times each day. Your GI system may do best on a schedule.
-Consider probiotics. Talk with your doctor about taking probiotics (supplemental healthful bacteria). They may ease constipation and IBS symptoms.

Written by NIH Office of Communications and Public Liaison
Editor: Harrison Wein, Ph.D.
Managing Editor: Tianna Hicklin, Ph.D.

FSCJ Offers Free Oral Cancer Screening

Florida State College at Jacksonville (FSCJ) welcomes the public for a free event on the importance of oral cancer screenings as part of its Quarterly Health Series.

Eva Grayzel, a nationally-recognized Master Storyteller and performance artist, was diagnosed with stage IV oral cancer at age 33 and was only given a 15 percent chance of survival. Drawing on her own experience and success story, Ms. Grayzel now applies her stage skills to communicating the importance of regular screenings in a unique and powerful way.

For over a decade, she has captivated dental professionals worldwide using her story as a catalyst for change. The riveting details of her delayed diagnosis stimulate thinking about enhanced patient care and education. A champion for early detection, Eva founded the Six-Step Screening(tm) oral cancer awareness campaign.

Immediately following the presentation, attendees are invited to the FSCJ Dental Hygiene Clinic for complimentary oral cancer screenings with our students under the supervision of clinic dentists.

Tuesday, October 24, 2017, at 5-6 p.m.
Zeke Bryant Auditorium – FSCJ North Campus, 4501 Capper Road, Jacksonville, FL 32218

Dealing with Hurt Feelings and Self Injury

People deal with difficult feelings in all sorts of ways. They may talk with friends, go work out, or listen to music. But some people may feel an urge to hurt themselves when distressed. Harming or thinking about harming yourself doesn’t mean you have a mental disorder. But it is an unhealthy way to cope with strong feelings. Finding new ways to cope can help you get through difficult times.

Some unhealthy ways people may try to relieve emotional pain include cutting, burning, or hitting themselves. These behaviors can be difficult to detect. People usually keep them a secret. Wounds can often be treated at home and covered with clothing or jewelry.

“The largest percentage of people who engage in non-suicidal self-injuring behaviors are teenagers,” says Dr. Jennifer Muehlenkamp, an NIH-funded psychologist at the University of Wisconsin-Eau Claire. Around 2 out of 10 teens and college-aged students report trying this behavior at least once.

Those are the key ages because youths are changing environments, Muehlenkamp explains. “Transitioning into college or from junior high into high school creates a lot of potential change. You lose the familiarity of your social group, and your social support might shift. There’s a lot of new stress and pressures.”

People who are anxious, are depressed, or have an eating disorder are also more likely to turn to self-injuring behaviors. So are those in sexual minority groups who experience discrimination and bullying, such as those who identify as gay, lesbian, bisexual, or transsexual.

“Self-injury is a sign that someone is struggling,” says Muehlenkamp. “Many youths transition out of it. But those who engage in it more repetitively and chronically may benefit from a direct clinical intervention.”

If you’re a parent or caregiver who’s concerned, look for frequent unexplained injuries and clues like bandages in trash cans. Watch to see if the person wears appropriate clothing for the weather. Someone who is self-harming may wear long pants or sleeves to cover their injuries, even when it’s hot.

“The way most people find out is the person who is self-injuring will disclose it,” Muehlenkamp says. They often tell a friend or a sibling first.

If someone confides in you, “your first reaction is essential to whether or not they will seek help,” Muehlenkamp explains. “Be as nonreactive and nonjudgmental as possible.”

Not everyone who self-injures is suicidal. But the only way to know is to ask. If they express any suicidal thinking, get them connected with a mental health provider. You can also call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255) for advice.

Parents can open conversations with their kids by asking them if they’ve heard of self-harming behaviors or if they know friends who do it. If a friend has confided in them, they can offer to go talk to a trusted adult with their friend to get them help.

There are no medications for treating self-injuring behaviors. But some medications can help treat mental disorders that the person may be dealing with, like depression or anxiety. Mental health counseling or therapy can also help you learn new ways to cope with emotion. See the Wise Choices box for tips on handling strong emotion.

Written by NIH Office of Communications and Public Liaison
Editor: Harrison Wein, Ph.D.
Managing Editor: Tianna Hicklin, Ph.D.

Coping With Grief – Life After Loss

Losing someone you love can change your world. You miss the person who has died and want them back. You may feel sad, alone, or even angry. You might have trouble concentrating or sleeping. If you were a busy caregiver, you might feel lost when you’re suddenly faced with lots of unscheduled time. These feelings are normal. There’s no right or wrong way to mourn. Scientists have been studying how we process grief and are learning more about healthy ways to cope with loss.

The death of a loved one can affect how you feel, how you act, and what you think. Together, these reactions are called grief. It’s a natural response to loss. Grieving doesn’t mean that you have to feel certain emotions. People can grieve in very different ways.

Cultural beliefs and traditions can influence how someone expresses grief and mourns. For example, in some cultures, grief is expressed quietly and privately. In others, it can be loud and out in the open. Culture also shapes how long family members are expected to grieve.

“People often believe they should feel a certain way,” says Dr. Wendy Lichtenthal, a psychologist at Memorial Sloan-Kettering Cancer Center. “But such ‘shoulds’ can lead to feeling badly about feeling badly. It’s hugely important to give yourself permission to grieve and allow yourself to feel whatever you are feeling. People can be quite hard on themselves and critical of what they are feeling. Be compassionate and kind to yourself.”

Adapting to Loss 
Experts say you should let yourself grieve in your own way and time. People have unique ways of expressing emotions. For example, some might express their feelings by doing things rather than talking about them. They may feel better going on a walk or swimming, or by doing something creative like writing or painting. For others, it may be more helpful to talk with family and friends about the person who’s gone, or with a counselor.

“Though people don’t often associate them with grief, laughing and smiling are also healthy responses to loss and can be protective,” explains Dr. George Bonanno, who studies how people cope with loss and trauma at Columbia University. He has found that people who express flexibility in their emotions often cope well with loss and are healthier over time.

“It’s not about whether you should express or suppress emotion, but that you can do this when the situation calls for it,” he says. For instance, a person with emotional flexibility can show positive feelings, like joy, when sharing a happy memory of the person they lost and then switch to expressing sadness or anger when recalling more negative memories, like an argument with that person.

Grief is a process of letting go and learning to accept and live with loss. The amount of time it takes to do this varies with each person. “Usually people experience a strong acute grief reaction when someone dies and at the same time they begin the gradual process of adapting to the loss,” explains psychiatrist Dr. M. Katherine Shear at Columbia University. “To adapt to a loss, a person needs to accept its finality and understand what it means to them. They also have to find a way to re-envision their life with possibilities for happiness and for honoring their enduring connection to the person who died.”

Researchers like Lichtenthal have found that finding meaning in life after loss can help you adapt. Connecting to those things that are most important, including the relationship with the person who died, can help you co-exist with the pain of grief.

Types of Grief 
About 10% of bereaved people experience complicated grief, a condition that makes it harder for some people to adapt to the loss of a loved one. People with this prolonged, intense grief tend to get caught up in certain kinds of thinking, says Shear, who studies complicated grief. They may think the death did not have to happen or happen in the way that it did. They also might judge their grief—questioning if it’s too little or too much—and focus on avoiding reminders of the loss.

“It can be very discouraging to experience complicated grief, but it’s important not to be judgmental about your grief and not to let other people judge you,” Shear explains.

Shear and her research team created and tested a specialized therapy for complicated grief in three NIH-funded studies. The therapy aimed to help people identify the thoughts, feelings, and actions that can get in the way of adapting to loss. They also focused on strengthening one’s natural process of adapting to loss. The studies showed that 70% of people taking part in the therapy reported improved symptoms. In comparison, only 30% of people who received the standard treatment for depression had improved symptoms.

You may begin to feel the loss of your loved one even before their death. This is called anticipatory grief. It’s common among people who are long-term caregivers. You might feel sad about the changes you are going through and the losses you are going to have. Some studies have found that when patients, doctors, and family members directly address the prospect of death before the loss happens, it helps survivors cope after the death.

Life Beyond Loss 
NIH-funded scientists continue to study different aspects of the grieving process. They hope their findings will suggest new ways to help people cope with the loss of a loved one. Although the death of a loved one can feel overwhelming, many people make it through the grieving process with the support of family and friends. Take care of yourself, accept offers of help from those around you, and be sure to get counseling if you need it.

“We believe grief is a form of love and it needs to find a place in your life after you lose someone close,” Shear says. “If you are having trouble moving forward in your own life, you may need professional help. Please don’t lose hope. We have some good ways to help you.”

Wise Choices – Coping With Loss
-Take care of yourself. Try to exercise regularly, eat healthy food, and get enough sleep. Avoid habits that can put your health at risk, like drinking too much alcohol or smoking.
-Talk with caring friends. Let others know if you need to talk.
-Try not to make any major changes right away. It’s a good idea to wait for a while before making big decisions, like moving or changing jobs.
-Join a grief support group in person or online. It might help to talk with others who are also grieving. Check with your local hospice, hospitals, religious communities, and government agencies to find a group in your area.
-Consider professional support. Sometimes talking to a counselor about your grief can help.
-Talk to your doctor. Be sure to let your healthcare provider know if you’re having trouble with everyday activities, like getting dressed, sleeping, or fixing meals.
-Be patient with yourself. Mourning takes time. It’s common to feel a mix of emotions for a while.

Written by NIH Office of Communications and Public Liaison
Editor: Harrison Wein, Ph.D.
Managing Editor: Tianna Hicklin, Ph.D.

Friends of the Library Offers FREE Presentation on Community Hospice

Friends of the Library is offering a FREE presentation led by Maureen Paschke, a specialist in social gerontology, who will inform participants about Community Hospice and its services for patient care and family needs.

Ms. Paschke is an expert in the non-medical aspects of aging and has led bereavement support groups for those who find themselves alone. Participants will also learn about palliative care and what that means for patients and their loved ones.

This FREE program is brought to the community by the Education Committee of the Friends of the Fernandina Beach Library. It will be held in the Fernandina Beach Library’s Meeting Room at 24 North 4th Street, on Tuesday, January 17 at 10:30 a.m. Registration is not required.

For further information regarding this event, on joining Friends of the Library or to donate, please visit the Friends of the Library website at www.fernandinaFOL.org.

Tai Chi and Your Health

You may have seen the flowing postures and gentle movements of tai chi and wondered what it’s all about. Tai chi is an ancient mind and body practice. While more research is needed, studies suggest that it may have many health benefits.

Tai chi is sometimes referred to as “moving meditation.” There are many types of tai chi. They typically combine slow movements with breathing patterns and mental focus and relaxation. Movements may be done while walking, standing, or sitting.

“At its root, tai chi is about treating the whole person and enhancing the balance and crosstalk between the body’s systems,” says Dr. Peter Wayne, a longtime tai chi researcher at Harvard Medical School. “It’s a promising intervention for preserving and improving many areas of health, especially in older adults.”

Several studies have found evidence that tai chi can increase balance and stability in older people and reduce the risk and fear of falls. Each year, more than 1 in 4 older adults falls, and 1 out of 5 of these falls causes a serious injury such as broken bones or a head injury.

“Trying to be careful can make you more prone to falls,” Wayne says. “Tai chi may help you move more confidently and safely again.” Some NIH-funded research suggests that tai chi may also improve balance and prevent falls in people with mild-to-moderate Parkinson’s disease.

Research suggests that practicing tai chi might help improve posture and confidence, how you think and manage emotions, and your quality of life. Studies have found that it may help people with fibromyalgia sleep better and cope with pain, fatigue, and depression. Regular practice may also improve quality of life and mood in people with chronic heart failure or cancer. Older adults may find that tai chi can help improve sleep quality and protect learning, memory, and other mental functions.

Further study will be needed to fully evaluate and confirm the potential benefits of tai chi. But since the practice involves moving slowly and mindfully, there’s little chance of harm when done correctly.

“Whether you’re interested in trying tai chi to help with a chronic health issue or the stresses of everyday life, tai chi—if taught properly—can be a great complement to other ways of healthy living and rehabilitation,” Wayne says. “I think we’re all looking for tools to help us live productive, long lives with a little more grace and ease.”

There are different styles and ways to practice tai chi, Wayne says. If you’re interested in trying it, you can start simply. For instance, try standing behind and holding onto a sturdy chair for support, then mindfully rock back and forth to build awareness of all the parts of your body and their connections. Eventually, you might move on to practice more complex movements or sequences.

Want to learn more? Read the Wise Choices box to consider whether tai chi might be right for you. And watch NIH’s online tai chi videos at nccih.nih.gov/video/taichidvd-full.

This article is brought to you by NIH Office of Communications and Public Liaison
Editor: Harrison Wein, Ph.D., Managing Editor: Vicki Contie, Contributors: Vicki Contie, Alan Defibaugh (illustrations), Tianna Hicklin, Anita Ramanathan, and Bonnie Tabasko.

The Benefits of Daily Cleaning Between Teeth

You may have seen or heard news stories suggesting that you can forget about flossing, since scientists lack solid evidence that you’ll benefit from cleaning between your teeth with a sturdy string. But many dentists may beg to differ. They’ve seen the teeth and gums of people who floss regularly and those who haven’t. The differences can be striking.

“Every dentist in the country can look in someone’s mouth and tell whether or not they floss,” says Dr. Tim Iafolla, a dental health expert at NIH. Red or swollen gums that bleed easily can be a clear sign that flossing and better dental habits are needed. “Cleaning all sides of your teeth, including between your teeth where the toothbrush can’t reach, is a good thing,” Iafolla says.

If dentists, and maybe even your personal experience, suggest that regular flossing keeps your mouth healthy, then why the news reports? It’s because long-term, large-scale, carefully controlled studies of flossing have been somewhat limited.

Researchers have found modest benefits from flossing in small clinical studies. For instance, an analysis of 12 well-controlled studies found that flossing plus toothbrushing reduced mild gum disease, or gingivitis, significantly better than toothbrushing alone. These same studies reported that flossing plus brushing might reduce plaque after 1 or 3 months better than just brushing.

But there’s no solid evidence that flossing can prevent periodontitis, a severe form of gum disease that’s the leading cause of tooth loss in adults. Periodontitis can arise if mild gum disease is left untreated. Plaque may then spread below the gum line, leading to breakdown of bone and other tissues that support your teeth. Periodontitis develops slowly over months or years. Most flossing studies to date, however, have examined only relatively short time periods.

Another research challenge is that large, real-world studies of flossing must rely on people accurately reporting their dental cleaning habits. And people tend to report what they think is the “right” answer when it comes to their health behaviors, whether flossing, exercising, smoking, or eating. That’s why well-controlled studies (where researchers closely monitor flossing or perform the flossing) tend to show that flossing is effective. But real-world studies result in weaker evidence.

“The fact that there hasn’t been a huge population-based study of flossing doesn’t mean that flossing’s not effective,” Iafolla says. “It simply suggests that large studies are difficult and expensive to conduct when you’re monitoring health behaviors of any kind.”

While the scientific evidence for flossing benefits may be somewhat lacking, there’’s little evidence for any harm or side effects from flossing, and it’s low cost. So why not consider making it part of your daily routine?

Talk to your dentist if you have any questions or concerns about your teeth or gums. If flossing is difficult, the dentist may recommend other ways to remove plaque between teeth, such as with a water flosser or interdental cleaners. “If you need help learning how to floss, or if you don’t think you’re doing it right, your dentist or hygienist will be happy to show you how,” Iafolla says. “It helps to know the proper technique.”

Article by NIH Office of Communications and Public Liaison
Editor: Harrison Wein, Ph.D.
Managing Editor: Vicki Contie
Contributors: Erin Calhoun, Vicki Contie, Alan Defibaugh (illustrations), Bonnie Tabasko, and Carol Torgan.

Make Smart Choices as You Celebrate the Season

Mashed potatoes and gravy, Grandma’s apple pie, and other holiday favorites can be a joyous part of any celebration. But to feel your best, you know you need to eat in moderation and stay active. How can you avoid temptation when delicious foods and calories abound?

“From Halloween through New Year’s, there’s always a decision to make about food,” says Dr. Marci Gluck, an NIH psychologist who studies obesity and eating behaviors. Tasty treats tend to appear more often at work and festive gatherings, and to come as gifts. They may also tempt you when grocery shopping. “As the holidays approach, it’s important to think ahead and make a plan,” Gluck says.

Consider your health goals for the holiday season, whether it’s avoiding overeating, staying active, connecting with others, reducing stress, or preventing weight gain. You can plan to make time for buying healthy groceries, cooking at home, scheduling regular physical activity, and setting aside a little quiet time for yourself.

Gluck suggests you start by adopting a flexible mindset. “Many people have an attitude of all or nothing: either I’m on a diet or I’m not on a diet,” she says. This “either-or” thinking can lead to negative self-talk, or being hard on yourself for small indulgences, overeating, or weight gain.

“Most people just throw their plan out the window when they think they’ve slipped up, and they ‘fall off the wagon,'” Gluck says. “Celebrations don’t have to derail your lifestyle. You’ll have plenty of opportunities to follow your plan and eat healthy.”

Look for opportunities to make healthy choices and feel good about them. “Small choices really can make big changes,” Gluck says. “Each moment that you put something in your mouth or choose to exercise adds up over time. That can be true for weight loss or weight gain.”

Around the holidays, we often find ourselves with too many food options, for too many days in a row. It can be challenging to decide what to eat and when to say no.

“Eat what you love—in moderation,” suggests Jody Engel, a nutritionist and registered dietitian at NIH. Consider choosing items that are unique to the season, instead of eating foods you can have any time of the year.

When you feel the urge to splurge in unhealthy ways, Engel recommends trying something else first, like drinking a glass of water, eating a piece of fruit, or climbing a few flights of stairs. You might even consider walking around your house or office for 5 minutes or more. Such diversions might be enough to help you resist unhealthy temptations.

You could also try eating mindfully, Engel suggests. Slow down to really taste and enjoy your food. Eating more slowly also allows your body time to signal your brain when you’re full, which takes about 20 minutes. If you eat too much too quickly, it’s easy to gobble up as much as twice what your body needs before your brain even gets the message.

Dr. Susanne Votruba, an NIH obesity and nutrition researcher, says it’s a good idea to identify and avoid any “trigger foods”—foods that may spur you to binge or eat more than usual. Overeating can bring feelings of bloating, reflux, indigestion, and nausea.

“Some people can eat less healthy foods in moderation and be fine, or have ‘cheat days’ where they allow themselves to eat whatever they want for a day and stay on track for the rest of the week,” Votruba says. “Others may have to avoid certain ‘trigger foods’ completely, or they’ll spiral into unhealthy eating patterns for the rest of the week or abandon their plan altogether. Everyone is different.”

Because of these differences, Votruba says, it’s important not to force food on other people. “Even if you don’t have an issue with food, be aware of other people around you, and respect their choices,” she says.

What if you do fall to temptation? “Every day is a new day when it comes to eating,” Votruba says. “If you overeat one day, work to get back on track the next meal or next day.”

While food is a big part of the holidays, remember that there are other paths to staying healthy. “Don’t make the holidays be just about food,” Votruba suggests. “The key is not only what you eat, but how much you’re moving. Even little bits of extra exercise can be very helpful for everyone over the holidays.”

Plan ahead for how you’ll add physical activity to days that might otherwise involve a lot of sitting. Get the whole family involved, Engel suggests. “You have to make an effort to incorporate exercise into days of big eating,” she says. “Otherwise the day will come and go.”

Sign up to walk or run a community race. Enjoy catching up with family or friends on a walk or jog instead of on the couch. In between meals, take a family hike at a nearby park, stroll around your neighborhood, or play a game of flag football.

The emotions of winter celebrations come into this picture, too. “Joy, sadness, and stress are associated with overeating during the holidays,” Gluck says. “People who are emotional eaters may be particularly vulnerable to temptations around the holidays.”

If holiday stress causes you to derail your healthy plans, consider ways to reduce stress and manage emotions. These might include talking to a trusted friend, meditation, physical activity, or just getting outside.

“If you know you have a difficult time during holidays, plan outings once or twice a week with people who make you feel happy,” says Gluck. “If it’s in your best interest, also feel okay about declining invitations without feeling guilty.”

Support your family and friends, too. Encourage them to eat healthy during celebrations and throughout the year. If you’re serving dinner, consider baking, broiling, or grilling food instead of frying. Replace sour cream with Greek yogurt, and mashed potatoes with mashed cauliflower. Make take-home containers available ahead of time, so guests don’t feel they have to eat everything in one sitting.

Article by NIH Office of Communications and Public Liaison
Editor: Harrison Wein, Ph.D.
Managing Editor: Vicki Contie
Contributors: Erin Calhoun, Vicki Contie, Alan Defibaugh (illustrations), Bonnie Tabasko, and Carol Torgan

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