singertrainers

If you suffer from the throbbing, intense pain set off by migraine headaches, you may well wonder which medicines are most likely to offer relief. A recent study suggests a class of drugs called triptans are the most helpful option, with one particular drug rising to the top.

The study drew on real-world data gleaned from more than three million entries on My Migraine Buddy, a free smartphone app. The app lets users track their migraine attacks and rate the helpfulness of any medications they take.

Dr. Elizabeth Loder, professor of neurology at Harvard Medical School and chief of the Division of Headache at Brigham and Women’s Hospital, helped break down what the researchers looked at and learned that could benefit anyone with migraines.

What did the migraine study look at?

Published in the journal Neurology, the study included self-reported data from about 278,000 people (mostly women) over a six-year period that ended in July 2020. Using the app, participants rated migraine treatments they used as “helpful,” “somewhat helpful,” or “unhelpful.”

The researchers looked at 25 medications from seven drug classes to see which were most helpful for easing migraines. After triptans, the next most helpful drug classes were ergots such as dihydroergotamine (Migranal, Trudhesa) and anti-emetics such as promethazine (Phenergan). The latter help ease nausea, another common migraine symptom.

“I’m always happy to see studies conducted in a real-world setting, and this one is very clever,” says Dr. Loder. The results validate current guideline recommendations for treating migraines, which rank triptans as a first-line choice. “If you had asked me to sit down and make a list of the most helpful migraine medications, it would be very similar to what this study found,” she says.

What else did the study show about migraine pain relievers?

Ibuprofen, an over-the-counter pain reliever sold as Advil and Motrin, was the most frequently used medication in the study. But participants rated it “helpful” only 42% of the time. Only acetaminophen (Tylenol) was less helpful, helping just 37% of the time. A common combination medication containing aspirin, acetaminophen, and caffeine (sold under the brand name Excedrin) worked only slightly better than ibuprofen, or about half the time.

When researchers compared helpfulness of other drugs to ibuprofen, they found:

• Triptans scored five to six times more helpful than ibuprofen. The highest ranked drug, eletriptan, helped 78% of the time. Other triptans, including zolmitriptan (Zomig) and sumatriptan (Imitrex), were helpful 74% and 72% of the time, respectively. In practice, notes Dr. Loder, eletriptan seems to be just a tad better than the other triptans.
• Ergots were rated as three times more helpful than ibuprofen.
• Anti-emetics were 2.5 times as helpful as ibuprofen.

Do people take more than one medicine to ease migraine symptoms?

In this study, two-thirds of migraine attacks were treated with just one drug. About a quarter of the study participants used two drugs, and a smaller number used three or more drugs.

However, researchers weren’t able to tease out the sequence of when people took the drugs. And with anti-nausea drugs, it’s not clear if people were rating their helpfulness on nausea rather than headache, Dr. Loder points out. But it’s a good reminder that for many people who have migraines, nausea and vomiting are a big problem. When that’s the case, different drug formulations can help.

Are pills the only option for migraine relief?

No. For the headache, people can use a nasal spray or injectable version of a triptan rather than pills. Pre-filled syringes, which are injected into the thigh, stomach, or upper arm, are underused among people who have very rapid-onset migraines, says Dr. Loder. “For these people, injectable triptans are a game changer because pills don’t work as fast and might not stay down,” she says.

For nausea, the anti-emetic ondansetron (Zofran) is very effective, but one of the side effects is headache. You’re better off using promethazine or prochlorperazine (Compazine), both of which treat nausea but also help ease headache pain, says Dr. Loder.

Additionally, many anti-nausea drugs are available as rectal suppositories. This is especially helpful for people who have “crash” migraines, which often cause people to wake up vomiting with a migraine, she adds.

What are the limitations of this migraine study?

The data didn’t include information about the timing, sequence, formulation, or dosage of the medications. It also omitted two classes of newer migraine medications — known as gepants and ditans — because there was only limited data on them at the time of the study. These options include

• atogepant (Qulipta) and rimegepant (Nurtec)
• lasmiditan (Reyvow).

“But based on my clinical experience, I don’t think that any of these drugs would do a lot better than the triptans,” says Dr. Loder.

Another shortcoming is the study population: a selected group of people who are able and motivated to use a migraine smartphone app. That suggests their headaches are probably worse than the average person, but that’s exactly the population for whom this information is needed, says Dr. Loder.

“Migraines are most common in young, healthy people who are trying to work and raise children,” she says. It’s good to know that people using this app rate triptans highly, because from a medical point of view, these drugs are well tolerated and have few side effects, she adds.

Are there other helpful takeaways?

Yes. In the study, nearly half the participants said their pain wasn’t adequately treated. A third reported using more than one medicine to manage their migraines.

If you experience these problems, consult a health care provider who can help you find a more effective therapy. “If you’re using over-the-counter drugs, consider trying a prescription triptan,” Dr. Loder says. If nausea and vomiting are a problem for you, be sure to have an anti-nausea drug on hand.

She also recommends using the Migraine Buddy app or the Canadian Migraine Tracker app (both are free), which many of her patients find helpful for tracking their headaches and triggers.

About the Author

Julie Corliss, Executive Editor, Harvard Heart Letter

Julie Corliss is the executive editor of the Harvard Heart Letter. Before working at Harvard, she was a medical writer and editor at HealthNews, a consumer newsletter affiliated with The New England Journal of Medicine. She … See Full Bio View all posts by Julie Corliss

About the Reviewer

Howard E. LeWine, MD, Chief Medical Editor, Harvard Health Publishing

Dr. Howard LeWine is a practicing internist at Brigham and Women’s Hospital in Boston, Chief Medical Editor at Harvard Health Publishing, and editor in chief of Harvard Men’s Health Watch. See Full Bio View all posts by Howard E. LeWine, MD

I was in line at a pharmacy recently as the customer ahead of me was picking up her prescription. The pharmacist matter-of-factly said: “that’ll be $850.” All she could say was “really?” She left without her prescription, telling the pharmacist she’d have to call her doctor about a less costly alternative.

Many of us routinely experience sticker shock over drug costs. And ever more dramatic examples suggest there’s no limit. So, let’s talk about ways to minimize what we spend on prescription drugs; how we got to this juncture where some medicines cost more than a million dollars per dose; and what changes are needed in our pricey medication-industrial-complex.

7 ways to minimize your spending on prescription drugs

Consider these seven strategies to pare drug costs. Savings will vary depending on insurance, donut holes, deductibles, and cost-sharing.

• Ask your healthcare provider three questions: Is every medicine you take truly necessary? Is it safe to reduce the dose of any medicines you take? Could a lower-cost or generic drug be substituted?
• If you have health insurance, check the list of preferred medications (the formulary), which tend to cost less than other similar medicines.
• Split pills: In some cases, a prescription will cost less if each pill contains more than your needed dose and can be divided. For example, if you usually take a 25-mg pill, taking half of a 50-mg pill may help you save on drug costs and copays. Ask your pharmacist if the math works for you.
• Ask if a 90-day supply rather than a 30-day supply would reduce copays.
• Look for prescription drug discount programs that offer savings. Restrictions apply and availability varies by location. Also, paying through a discount program might not count toward your insurance deductible or maximum out-of-pocket costs, so it isn’t always less expensive to use these programs.
• Compare prices at different pharmacies and review your options with a pharmacist. Sometimes the price is lower if you don’t use your insurance.
• Consider using an online mail-order service (such as Blink Health or Cost Plus Drug Company). However, spending through these sites may not count toward your insurance deductible. And the prices are not always lower online.

These measures will help some people more than others and can take up a lot of time. The sad truth is that even if you did everything you could, the impact on your wallet might be small.

Why are medicine costs so high in the US?

My top five contenders are:

Drug makers’ profit motive. Pharmaceutical companies routinely reject this idea. They say it’s expensive to develop new drugs and run the required clinical trials to prove safety and effectiveness. Many promising drugs fail, and the FDA drug approval process is difficult and costly.

Yet one recent study published in JAMA Network Open found no connection between how much a drug company spends on research and development (R&D) for a drug and the drug’s price. Even after accounting for R&D spending, most of the top 30 pharmaceutical companies make billions of dollars in profit. And in Europe, where drug prices are negotiated, the very same drugs made by the same companies for the same health problems typically cost far less than in the US.

Pharmacy benefit managers (PBMs) handle drug benefits for large employers, Medicare, and health insurance companies. PBMs negotiate prices with health insurers and pharmacies. They help decide which drugs to cover and how much patients pay. Their fees and incentives — often a share of total spending on medicines, which might encourage approval of higher-priced drugs — contribute to the costs health consumers wind up paying. A flurry of state and federal legislation is intended to limit what PBMs can do and the transparency of their operations.

Cost-sharing. In recent years, insurers have increasingly shifted costs to patients through higher copays, deductibles, and premiums. Sometimes this is justified by the notion that this incentivizes patients to seek care only when truly necessary; of course, it could also discourage people from seeking care even when warranted.

Legal maneuvers. Many drug makers file numerous patents and sue potential competitors to extend their time holding a monopoly on a particular drug (see example). Or they create “me too” drugs by slightly tweaking an existing drug so they can patent it as a brand-new drug. Some pharmaceutical companies acquire patents for older drugs and then jack up the price. Others have bought or merged with another drugmaker to avoid price competition.

Direct-to-consumer advertising. Drug companies spend billions on ads (nearly $8.1 billion in 2022). Marketing costs raise the price of drugs while boosting demand for newer, heavily promoted drugs. Advertised drugs tend to be far more expensive (and not always better) than older drugs. Perhaps this is why such advertising is banned in most other countries.

What might slow rising drug costs?

Although prescription drug prices are likely to remain high for the foreseeable future, three developments could help slow rising drug prices in the coming years:

• The Inflation Reduction Act of 2022 allows the US government to negotiate drug prices for Medicare, which is expected to lower drug costs. The first 10 price-protected drugs — including the blood thinner apixaban (Eliquis) and the diabetes medicine sitagliptin (Januvia) — take effect in 2026. More drugs will be added to this list each year. If you’re on one of these drugs, the impact could be large. But with more than 20,000 approved drugs on the market, it’s not a solution that will help everyone.
• Recent FDA action allowing Florida to import drugs from Canada, and other proposed federal and state legislation aiming to protect people from high prescription drug prices.
• Organizations advocating for lower prescription drug prices, including AARP, Consumers Union, and Patients for Affordable Drugs, appear to have the attention of lawmakers as never before.

The bottom line

Let’s face it: our complex, broken healthcare system incentivizes those who develop and distribute drugs to set the prices well above what many can afford. And the amount you can chip away on your own is limited. What we really need is an overhaul to remove middlemen who contribute to added cost without always adding value.

Until we get there, do what you can, even if the impact is small. Trying your best to stay healthy could be the most important step you take. After all, the best way to limit how much you spend on prescription drugs is to have no reason to take them.

About the Author

Robert H. Shmerling, MD, Senior Faculty Editor, Harvard Health Publishing; Editorial Advisory Board Member, Harvard Health Publishing

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

Now that it’s 2024, perhaps you’ve thought about taking up a new exercise program, eating better, or some other ways to improve your health. That’s great! Or, as my grandfather would say, “there’s nothing wrong with that” — his highest possible praise.

In fact, few medical treatments rival the massive health benefits of regular exercise. But how do you decide which type of exercise is best for you? Well, you could get advice from your doctor or a personal trainer. You might read books on fitness or sample exercise classes. It turns out, though, that many people are simply scrolling through tons of engaging “fitspirational” posts on social media. If you do that regularly — more often, say, than taking a brisk walk — a new study suggests you should rethink that strategy.

What exactly is fitspiration?

Fitspiration describes social media posts intended to inspire physical fitness and promote health. You can find fitspirational posts on TikTok, Instagram, Facebook, and other popular social media sites. Typically, they feature glossy photos and videos packaged with exercise and diet recommendations, accompanied by encouraging messages and quotes.

On Instagram alone, a search for #fitspiration (or related hashtags such as #fitspo) currently lists nearly 100 million posts. Most of them display images of attractive, lean, and fit women as they exercise and talk about fitness and optimizing health.

What’s the problem with fitspiration?

The potential benefits of a pro-fitness message reaching millions of people are obvious. But the message has to be credible and valid. And, importantly, posts should not convey inaccurate, unhelpful, or even harmful information. That’s where the problems start.

Clearly, social media posts about fitness can have positive effects, according to some research, especially when focused on realistic exercise goals rather than appearance. However, fitspirational posts may have downsides for viewers, including

• increased body dissatisfaction
• negative mood
• decreased perception of attractiveness
• embracing thinness as the ideal
• a limited range of diverse body shapes and types, suggesting that beauty is defined by being ultra-fit and thin
• a focus on appearance rather than function and capability.

A study of #fitspiration: Do these social media posts actually inspire fitness?

A recent study assesses the quality of content with fitspiration hashtags posted by Instagram influencers. The results were disappointing, though not surprising.

The authors identified 100 Instagram accounts of the most popular fitspiration influencers. Each of these accounts’ last 15 posts was analyzed. Posts were not considered credible if they

• displayed nudity or revealing clothing, such as wearing a bikini at the gym
• sexualized the person exercising, such as focusing on a woman’s breasts
• included images of extreme body types, such as people who are severely underweight or extremely muscular
• conveyed messages encouraging thinness or other negative messages rather than emphasizing health
• contained fitness information in three or fewer posts out of 15.

Here’s what the researchers found:

• 26% portrayed sexualized images
• 22% posted nudity or images of people exercising in revealing clothing not appropriate for exercise
• 15% featured people with extreme body types
• 41% posted fitness-related content in three or fewer posts.

A quarter of these accounts failed the credibility test on more than one of these criteria. Even among the accounts considered credible, only half were posted by people with credentials related to fitness or health, such as certification as a physical therapist or personal trainer.

While this study did not examine whether the posts had an actual impact on fitness outcomes, the findings raise questions about the quality of fitspiration content.

What does this mean for you?

If you’re looking for fitness-related health content, seek out the best information you can. Be skeptical of any sources lacking credentials related to fitness. Be especially wary of posts selling a product or service.

The authors of this study established certain criteria for fitness-related content they reviewed. You could apply this to posts you see online.

The bottom line

It should be no surprise to find that when it comes to health information, social media may not always be the best place to start.

While taking steps to improve your health is commendable — truly, there’s nothing wrong with that! — getting motivated to be more physically active is just a start. Information you rely on to improve your physical fitness shouldn’t just look appealing. It should be well-vetted for safety and backed by solid evidence that it can actually improve your health.

Here’s to better fitness in the New Year!

About the Author

Robert H. Shmerling, MD, Senior Faculty Editor, Harvard Health Publishing; Editorial Advisory Board Member, Harvard Health Publishing

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

Need another jolt of motivation to shore up a resolution to shed weight, sleep more soundly, boost nutrition or exercise levels, or cut back on alcohol? Then you'll be pleased to learn that any (and all) of these efforts can also add up to better brain health.

An international study led by researchers at the McCance Center for Brain Health at Massachusetts General Hospital devised and validated a Brain Care Score (BCS) card that makes it easy to total up what you're doing well and where you might do better. The prize is a healthier brain — specifically a lower risk for dementia and strokes.

Designed to predict how current habits might impact future brain health, the user-friendly scorecard is apparently the first of its kind, says Dr. Andrew Budson, a lecturer in neurology at Harvard Medical School.

"It's a real service that the researchers have developed a scale like this and completed the first study to determine if scoring worse on this scale raises your risk for dementia and stroke," says Dr. Budson, who wasn't involved in the analysis. "On one hand, no one's done something quite like this before. On the other, however, it's really wrapping together health factors everyone has known for a number of years in new packaging."

What's included on the scorecard?

Called the McCance Brain Care Score, the card tallies points from 12 physical, lifestyle, and social-emotional domains.

Physical components relate to

• blood pressure
• blood sugar
• cholesterol
• body mass index (BMI).

Lifestyle components include

• nutrition
• alcohol intake
• smoking
• aerobic activities
• sleep.

Social-emotional factors inquire about

• stress management
• social relationships
• meaning in life.

Each response is given a score of 0, 1, or 2, with the highest possible score totaling 21. Higher scores suggest better brain care.

"All these physical and lifestyle factors can contribute to the risk of dementia to some extent through strokes," Dr. Budson says. "Those that aren't a risk through strokes are usually related to the fact that a healthy brain is a brain that's using all of its parts. Engaging in healthy relationships and meaningful activities helps us maintain good brain structure and function."

What did the analysis involve?

The study was published online in Frontiers of Neurology in December 2023. It involved nearly 399,000 adults ages 40 through 69 (average age 57; 54% women) who contributed personal health information to the UK Biobank.

During an average follow-up period of 12.5 years, participants recorded 5,354 new cases of dementia and 7,259 strokes. Researchers found that participants with higher Brain Care Scores at the study's start had lower risks of developing dementia or strokes over time.

These threats to health and independence take a stunning — and growing — toll on people in the US. Dementia affects one in seven Americans, a rate expected to triple by 2050. Meanwhile, more than 795,000 people in the United States suffer a stroke each year, according to the CDC.

What did the study find?

Each five-point step higher in the BCS rating assigned when the study began was linked to significantly lower risks of dementia and stroke, with those odds varying by age group:

• Participants younger than 50 at the study's start were 59% less likely to develop dementia and 48% less likely to have a stroke with each five-point higher score on BCS.
• Participants 50 through 59 at the study's start were 32% less likely to develop dementia and 52% less likely to have a stroke with each five-point higher score on BCS.

But those brain disease benefits appeared to diminish for those older than 59 at the study's start. This group experienced only 8% lower odds of dementia and a 33% lower risk of stroke with each five-point higher score on BCS. Study authors theorized that some of these participants may have already been experiencing early dementia, which is difficult to detect until it progresses.

"I feel very comfortable that the study's conclusions are entirely correct, because all the factors that go into its BCS are well-known things people can do to reduce their risk of stroke and dementia," Dr. Budson says.

What are the study's limitations?

However, Dr. Budson notes that the study did have a couple of limitations,. The UK Biobank fell just short of collecting all the components of the BCS in its dataset, lacking meaning-of-life questions. So its scores ranged from 0 to 19, not up to 21. "It's a practical limitation, but it should be acknowledged that so far, there have been no studies to validate the actual 21-point scale they're recommending we use," he says.

The analysis also evaluated participants' scores at just one point in time instead of several, Dr. Budson says. Future research should determine whether people can lower their stroke and dementia risk by improving their BCS over time with behavior and lifestyle changes.

How can you play this game at home?

While better brain health may be the clear prize of a higher score, it's far from the only benefit. That's because improving any health component of the BCS also benefits our overall well-being.

"By improving these factors, not only will people help their brain, but they'll also help their heart and reduce their risk of cancer," Dr. Budson adds. "These factors will absolutely also improve your psychological health, which is certainly an important part of brain health."

The scale's simple breakdown of health factors also makes it easy to focus on tweaking one or two without getting overwhelmed.

"Let's say someone's nutrition isn't perfect — and they know it — but they're not willing to change their diet. Fine. They can then decide to do more aerobic exercise, for example, or to stop drinking, or to get the sleep their body needs," he says.

What one change could put you on a path to better brain health?

If he had to choose just one factor to improve brain health, Dr. Budson would focus on meaning of life, "which means you generally feel your life has meaning or purpose," he says. To do that, he suggests giving deep, quiet thought to what you wish your life's purpose to be, whether you expect to live a long time or just a few years.

"Once you have a purpose, then you have a reason to follow through with assessing all the other items on the BCS scale and seeing what you can do so you'll be around longer, and be competent and capable longer, to help fulfill the meaning and purpose of your life," he says.

About the Author

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

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

About the Reviewer

Howard E. LeWine, MD, Chief Medical Editor, Harvard Health Publishing

Dr. Howard LeWine is a practicing internist at Brigham and Women’s Hospital in Boston, Chief Medical Editor at Harvard Health Publishing, and editor in chief of Harvard Men’s Health Watch. See Full Bio View all posts by Howard E. LeWine, MD

The tongue is secured to the front of the mouth partly by a band of tissue called the lingual frenulum. If the frenulum is short, it can restrict the movement of the tongue. This is commonly called a tongue-tie.

Children with a tongue-tie can’t stick their tongue out past their lower lip, or touch their tongue to the top of their upper teeth when their mouth is open. When they stick out their tongue, it looks notched or heart-shaped. Since babies don’t routinely stick out their tongues, a baby’s tongue may be tied if you can’t get a finger underneath the tongue.

How common are tongue-ties?

Tongue-ties are common. It’s hard to say exactly how common, as people define this condition differently. About 8% of babies under age one may have at least a mild tongue-tie.

Is it a problem if the tongue is tied?

This is really important: tongue-ties are not necessarily a problem. Many babies, children, and adults have tongue-ties that cause them no difficulties whatsoever.

There are two main ways that tongue-ties can cause problems:

• They can cause problems with breastfeeding by making it hard for some babies to latch on well to the mother’s nipple. This causes difficulty with feeding for the baby and sore nipples for the mother. It doesn’t happen to all babies with a tongue-tie; many of them can breastfeed successfully. Tongue-ties are not to blame for gassiness or fussiness in a breastfed baby who is gaining weight well. Babies with tongue-ties do not have problems with bottle-feeding.
• They can cause problems with speech. Some children with tongue-ties may have difficulty pronouncing certain sounds, such as t, d, z, s, th, n, and l. Tongue-ties do not cause speech delay.

What should you do if think your baby or child has a tongue-tie?

If you think that your newborn is not latching well because of a tongue-tie, talk to your doctor. There are many, many reasons why a baby might not latch onto the breast well. Your doctor should take a careful history of what has been going on, and do a careful examination of your baby to better understand the situation.

You should also have a visit with a lactation specialist to get help with breastfeeding — both because there are lots of reasons why babies have trouble with latching on, and also because many babies with a tongue-tie can nurse successfully with the right techniques and support.

Talk to your doctor if you think that a tongue-tie could be causing problems with how your child pronounces words. Many children just take some time to learn to pronounce certain sounds. It is also a good idea to have an evaluation by a speech therapist before concluding that a tongue-tie is the problem.

What can be done about a tongue-tie?

When necessary, a doctor can release a tongue-tie using a procedure called a frenotomy. A frenotomy can be done by simply snipping the frenulum, or it can be done with a laser.

However, nothing should be done about a tongue-tie that isn’t causing problems. While a frenotomy is a relatively minor procedure, complications such as bleeding, infection, or feeding difficulty sometimes occur. So it’s never a good idea to do it just to prevent problems in the future. The procedure should only be considered if the tongue-tie is clearly causing trouble.

It’s also important to know that clipping a tongue-tie doesn’t always solve the problem, especially with breastfeeding. Studies do not show a clear benefit for all babies or mothers. That’s why it’s important to work with a lactation expert before even considering a frenotomy.

If a newborn with a tongue-tie isn’t latching well despite strong support from a lactation expert, then a frenotomy should be considered, especially if the baby is not gaining weight. If it is done, it should be done early on and by someone with training and experience in the procedure.

What else should parents know about tongue-tie procedures?

Despite the fact that the evidence for the benefits of frenotomy is murky, many providers are quick to recommend them. If one is being recommended for your child, ask questions:

• Make sure you know exactly why it is being recommended.
• Ask whether there are any other options, including waiting.
• Talk to other health care providers on your child’s care team, or get a second opinion.

About the Author

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

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

By midwinter, our urge to hibernate can start to feel constricting instead of cozy. What better antidote to being cooped up indoors than a bracing hike in the crisp air outdoors?

Winter backdrops are stark, serene, and often stunning. With fewer people on the trail, you may spot more creatures out and about. And it’s a prime opportunity to engage with the seasons and our living planet around us, says Dr. Stuart Harris, chief of the Division of Wilderness Medicine at Massachusetts General Hospital. But a multi-mile trek through rough, frosty terrain is far different than warm-weather hiking, requiring consideration of health and safety, he notes. Here’s what to know before you go.

Winter hiking: Safety first

“The challenge of hiking when environmental conditions are a little more demanding requires a very different approach on a winter’s day as opposed to a summer’s day,” Dr. Harris says. “But it gives us a chance to be immersed in the living world around us. It’s our ancient heritage.”

A safety-first attitude is especially important if you’re hiking with others of different ages and abilities — say, with older relatives or small children. It’s crucial to have both the right gear and the right mindset to make it enjoyable and safe for all involved.

Planning and preparation for winter hikes

Prepare well beforehand, especially if you’re mixing participants with vastly different fitness levels. Plan your route carefully, rather than just winging it.

People at the extremes of age — the very old or very young — are most vulnerable to frigid temperatures, and cold-weather hiking can be more taxing on the body. “Winter conditions can be more demanding on the heart than a perfectly-temperatured day,” Harris says. “Be mindful of the physical capabilities of everyone in your group, letting this define where you go. It’s supposed to be fun, not a punishing activity.”

Before setting out:

• Know how far, high, and remote you’re going to go, Dr. Harris advises, and check the forecast for the area where you’ll be hiking, taking wind chill and speed into account. Particularly at higher altitudes, weather can change from hour to hour, so keep abreast of expectations for temperature levels and any precipitation.
• Know if you’ll have access to emergency cell coverage if anything goes wrong.
• Always share plans with someone not on your hike, including expected route and time you’ll return. Fill out trailhead registers so park rangers will also know you’re on the trail in case of emergency.

What to wear for winter hikes

Prepare for extremes of cold, wind, snow, and even rain to avoid frostbite or hypothermia, when body temperature drops dangerously low.

• Dress in layers. Several thin layers of clothing are better than one thick one. Peel off a layer when you’re feeling warm in high sun and add it back when in shadow. Ideally, wear a base layer made from wicking fabric that can draw sweat away from the skin, followed by layers that insulate and protect from wind and moisture. “As they say, there’s no bad weather, just inappropriate clothing,” Dr. Harris says. “Take a day pack or rucksack and throw a couple of extra thermal layers in. I never head out for any hike without some ability to change as the weather changes.”
• Protect head, hands, and feet. Wear a wool hat, a thick pair of gloves or mittens, and two pairs of socks. Bring dry spares. Your boots should be waterproof and have a rugged, grippy sole.
• Wear sunscreen. You can still get a sunburn in winter, especially in places where the sun’s glare reflects off the snow.

Carry essentials to help ensure safety

• Extra food and water. Hiking in the cold takes serious energy, burning many more calories than the same activity done in summer temperatures. Pack nutrient-dense snacks such as trail mix and granola bars, which often combine nuts, dried fruit, and oats to provide needed protein, fat, and calories. It’s also key to stay hydrated to keep your core temperature normal. Bonus points for bringing a warm drink in a thermos to warm your core if you’re chilled.
• First aid kit. Bandages for slips or scrapes on the trail and heat-reflecting blankets to cover someone showing signs of hypothermia are wise. Even in above-freezing temperatures, hypothermia is possible. Watch for signs such as shivering, confusion, exhaustion, or slurring words, and seek immediate help.
• Light source. Time your hike so you’re not on the trail in darkness. But bring a light source in case you get stuck. “A flashlight or headlamp is pretty darn useful if you’re hiking anywhere near the edges of daylight,” Harris says.
• Phone, map, compass, or GPS device plus extra batteries. Don’t rely on your phone for GPS tracking, but fully charge it in case you need to reach someone quickly. “Make sure that you have the technology and skill set to be able to navigate on- or off-trail,” Harris says, “and that you have a means of outside communication, especially if you’re in a large, mixed group.”

About the Author

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

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

Animals renowned for their outstanding night vision include owls, cats, tarsiers (a tiny primate in Southeast Asia) — and even the dung beetle.

But humans? Not so much.

Over time, many people suffer from night blindness, also known as nyctalopia. This condition makes seeing in dim or dark settings difficult because your eyes cannot adjust to changes in brightness or detect light.

What are the dangers for those experiencing night blindness?

Night blindness is especially problematic and dangerous when driving. Your eyes cannot adjust between darkness and the headlights of oncoming vehicles, other cars may appear out of focus, and your depth perception becomes impaired, which makes it difficult to judge distances.

Night blindness also may affect your sight at home by making it hard for your vision to quickly adjust to a dark room after turning off the lights. “This can cause people to bump into furniture or trip and suffer an injury,” says Dr. Isabel Deakins, an optometrist with Harvard-affiliated Massachusetts Eye and Ear.

What happens in the eye to create night blindness?

The ability to see in low-light conditions involves two structures in the eye: the retina and the iris.

The retina, located in the back of the eye, contains two types of light-detecting cells called cones and rods. The cones handle color vision and fine details while the rods manage vision in dim light.

The iris is the colored part of your eye. It contains muscles that widen or narrow the opening of your pupil to adjust how much light can enter your eyes.

If your irises don’t properly react, the pupils can dilate and let in too much light, which causes light sensitivity and makes it hard to see in bright light. Or your pupils may remain too small and not allow in enough light, making it tough to see in low light.

What causes night blindness?

Night blindness is not a disease but a symptom of other conditions. “It’s like having a bruise on your body. Something else causes it,” says Dr. Deakins.

Several conditions can cause night blindness. For instance, medications, such as antidepressants, antihistamines, and antipsychotics, can affect pupil size and how much light enters the eye.

Eye conditions that can cause night blindness include:

• glaucoma, a disease that damages the eye’s optic nerves and blood vessels
• cataracts, cloudy areas in the lens that distort or block the passage of light through the lens
• dry eye syndrome.

However, one issue that raises the risk of night blindness that you can’t control is age. “Our eyes react more slowly to light changes as we age, and vision naturally declines over time,” says Dr. Deakins.  “The number of rods in our eyes diminish, pupils get smaller, and the muscles of the irises weaken.”

What helps if you have night blindness?

If you notice any signs of night blindness, avoid driving and get checked by an eye care specialist like an optometrist or ophthalmologist. An eye exam can determine if your eyeglass prescription needs to be updated.

“Often, a prescription change is enough to reduce glare when driving at night," says Dr. Deakins. “You may even need separate glasses with a stronger eye prescription that you wear only when driving at night.”

Adding an anti-reflective coating to your lens may help to cut down on the glare of the headlights of an oncoming car. However, skip the over-the-counter polarized driving glasses sold at many drug stores. "These may help cut down on glare, but they don't address the causes of night blindness," says Dr. Deakins.

An eye exam also will identify glaucoma or cataracts, which can be treated. Glaucoma treatments include eyedrops, laser treatment, or surgery. Cataracts are corrected with surgery to replace the clouded lens with an artificial one. Your eye care specialist can also help identify dry eye and recommend treatment.

Ask your primary care clinician or a pharmacist if any medications that you take may cause night blindness. If so, it may be possible to adjust the dose or switch to another drug.

Three more ways to make night driving safer

You also can take steps to make night driving safer. For example:

• Wash the lenses of your glasses regularly. And take them to an optician to buff out minor scratches.
• Keep both sides of your front and rear car windshields clean so that you can see as clearly as possible.
• Dim your dashboard lights, which cause glare, and use the night setting on your rearview mirror.

About the Author

Matthew Solan, Executive Editor, Harvard Men's Health Watch

Matthew Solan is the executive editor of Harvard Men’s Health Watch. He previously served as executive editor for UCLA Health’s Healthy Years and as a contributor to Duke Medicine’s Health News and Weill Cornell Medical College’s … See Full Bio View all posts by Matthew Solan

About the Reviewer

Howard E. LeWine, MD, Chief Medical Editor, Harvard Health Publishing

Dr. Howard LeWine is a practicing internist at Brigham and Women’s Hospital in Boston, Chief Medical Editor at Harvard Health Publishing, and editor in chief of Harvard Men’s Health Watch. See Full Bio View all posts by Howard E. LeWine, MD

When we think about radiation therapy, we typically picture treatments directed at tumors by a machine located outside the body. Now imagine a different scenario — one in which radioactive particles injected into the bloodstream find and destroy individual cancer cells, while leaving healthy cells unscathed.

The drug

One such “radioligand” is already available for certain patients with prostate cancer. Called Lu-PSMA-617 (trade name Pluvicto), it carries a lethal payload of radioactive atoms. The drug binds with a cell protein known as prostate-specific membrane antigen (PSMA), which is abundant on most prostate cancer cells but absent on most normal cells. After sticking to that protein, Lu-PSMA-617 delivers its radioactive cargo, and then the targeted cell dies.

As it currently stands, Lu-PSMA-617 is approved only for very a specific circumstance: eligible patients must have been treated already with chemotherapy for metastatic castration-resistant prostate cancer (mCRPC). During this advanced stage of the disease, prostate-specific antigen (PSA) levels rise despite treatments that block testosterone, a hormone that fuels prostate cancer growth (rising PSA indicates the cancer is progressing).

Doctors will often respond by switching to second-line hormonal treatments that block testosterone in other ways. If those drugs don’t work or become ineffective, then chemotherapy is typically the next option.

But could men with mCRPC bypass chemotherapy — along with its challenging side effects — and start on Lu-PSMA-617 right away? Investigators evaluated that potential strategy during a newly-completed clinical trial.

The study

The PSMAfore phase 3 trial enrolled 468 men with mCRPC. All the men had PSMA-positive tumors, and each of them had been treated already with a second-line testosterone blocker. For most men, that drug was abiraterone; the rest had been treated with a drug called enzalutamide. None of the men had yet been given chemotherapy.

The investigators randomized all the enrolled men into two groups. Men in the treatment group were given infusions of Lu-PSMA-617, while men in the control group were switched to a second testosterone-blocker that they hadn’t yet received.

The findings

After nearly a year and a half of follow-up, Lu-PSMA-617 treatment generated promising results. Crucially, the treated men avoided further cancer progression for a year on average, which was six months longer than progression was avoided in the control group.

Lu-PSMA-617 also produced significant drops in PSA: in 58% of the Lu-PSMA-617-treated men, PSA levels declined by half or more. Just 20% of men in the control group experienced comparable PSA declines. Lu-PSMA-617 was also well tolerated. The most common side effects were dry mouth and minor gastrointestinal symptoms, and treated men also reported less pain and better quality of life.

Commentary

Researchers still need to show that using Lu-PSMA-617 before chemotherapy actually lengthens survival before the FDA will approve this new indication. The enrolled subjects are still being followed, and “hopefully with further follow up, this sequence of treatments may become more widely available,” says Dr. Marc B. Garnick, the Gorman Brothers Professor of Medicine at Harvard Medical School and Beth Israel Deaconess Medical Center.

Added Dr. Garnick, “This study marks another advance in our emerging treatment options for men with advanced prostate cancer, and underscores the methodical progression of pharmaceutical development. When new therapies are introduced, they are studied in patients in whom the treatment options are limited. Fortunately, Lu-PSMA-617 showed excellent results in this population, and the study outlined here suggests that it may be able to move this therapy to even earlier forms of advanced prostate cancer. We anxiously await longer-term follow-up of this important research.”

About the Author

Charlie Schmidt, Editor, Harvard Medical School Annual Report on Prostate Diseases

Charlie Schmidt is an award-winning freelance science writer based in Portland, Maine. In addition to writing for Harvard Health Publishing, Charlie has written for Science magazine, the Journal of the National Cancer Institute, Environmental Health Perspectives, … See Full Bio View all posts by Charlie Schmidt

About the Reviewer

Marc B. Garnick, MD, Editor in Chief, Harvard Medical School Annual Report on Prostate Diseases; Editorial Advisory Board Member, Harvard Health Publishing

Dr. Marc B. Garnick is an internationally renowned expert in medical oncology and urologic cancer. A clinical professor of medicine at Harvard Medical School, he also maintains an active clinical practice at Beth Israel Deaconess Medical … See Full Bio View all posts by Marc B. Garnick, MD

As a kid, I spent many Saturdays romping around my Florida neighborhood imitating Colonel Steve Austin, better known as The Six Million Dollar Man to avid TV watchers in the 1970s.

The popular show featured a bionic man — half human and half machine — who could jump from three-story buildings, leap over six-foot-high walls, and bolt into a full 60-mile-per-hour sprint. Naturally, these actions occurred in slow motion with an iconic vibrating electronic sound effect.

My own bionic moves involved jumping to pluck oranges from tree branches, hopping over anthills, and leaping across narrow ditches while humming that distinctive sound. I didn’t realize it, but this imitation game taught me the foundations of plyometrics — the popular training routine now used by top athletes to boost strength, power, and agility.

What are plyometrics?

Plyometric training involves short, intense bursts of activity that target fast-twitch muscle fibers in the lower body. These fibers help generate explosive power that increases speed and jumping height.

“Plyometrics are used by competitive athletes who rely on quick, powerful movements, like those in basketball, volleyball, baseball, tennis, and track and field,” says Thomas Newman, lead performance specialist with Harvard-affiliated Mass General Brigham Center for Sports Performance and Research. Plyometrics also can help improve coordination, agility, and flexibility, and offer an excellent heart-pumping workout.

Who can safely try plyometrics?

There are many kinds of plyometric exercises. Most people are familiar with gym plyometrics where people jump onto the top of boxes or over hurdles.

But these are advanced moves and should only be attempted with the assistance of a trainer once you have developed some skills and muscle strength.

Keep in mind that even the beginner plyometrics described in this post can be challenging. If you have had any joint issues, especially in your knees, back, or hips, or any trouble with balance, check with your doctor before doing any plyometric training.

How to maximize effort while minimizing risk of injury

• Choose a surface with some give. A thick, firm mat (not a thin yoga mat); well-padded, carpeted wood floor; or grass or dirt outside are good choices that absorb some of the impact as you land. Do not jump on tile, concrete, or asphalt surfaces.
• Aim for just a few inches off the floor to start. The higher you jump, the greater your impact on landing.
• Bend your legs when you land. Don’t lock your knees.
• Land softly, and avoid landing only on your heels or the balls of your feet.

Three simple plyometric exercises

Here are three beginner-level exercises to jump-start your plyometric training. (Humming the bionic man sound is optional.)

Side jumps

Stand tall with your feet together. Shift your weight onto your right foot and leap as far as possible to your left, landing with your left foot followed by your right one. Repeat, hopping to your right. That’s one rep.

• You can hold your arms in front of you or let them swing naturally.
• Try not to hunch or round your shoulders forward as you jump.
• To make this exercise easier, hop a shorter distance to the side and stay closer to the floor.

Do five to 15 reps to complete one set. Do one to three sets, resting between each set.

Jump rope

Jumping rope is an effective plyometric exercise because it emphasizes short, quick ground contact time. It also measures coordination and repeated jump height as you clear the rope.

• Begin with two minutes of jumping rope, then increase the time or add extra sets.
• Break it up into 10- to 30-second segments if two minutes is too difficult.
• If your feet get tangled, pause until you regain your balance and then continue.

An easier option is to go through the motions of jumping rope but without the rope.

Forward hops

Stand tall with your feet together. Bend your knees and jump forward one to two feet. Turn your body around and jump back to the starting position to complete one rep.

• Let your arms swing naturally during the hop.
• To make this exercise easier, hop a shorter distance and stay closer to the floor.
• If you want more of a challenge, hop farther and higher. As this becomes easier to do, try hopping over small hurdles. Begin with something like a stick and then increase the height, such as with books of various thicknesses.

Do five to 10 hops to complete one set. Do one to three sets, resting between each set.

About the Author

Matthew Solan, Executive Editor, Harvard Men's Health Watch

Matthew Solan is the executive editor of Harvard Men’s Health Watch. He previously served as executive editor for UCLA Health’s Healthy Years and as a contributor to Duke Medicine’s Health News and Weill Cornell Medical College’s … See Full Bio View all posts by Matthew Solan

About the Reviewer

Howard E. LeWine, MD, Chief Medical Editor, Harvard Health Publishing

Dr. Howard LeWine is a practicing internist at Brigham and Women’s Hospital in Boston, Chief Medical Editor at Harvard Health Publishing, and editor in chief of Harvard Men’s Health Watch. See Full Bio View all posts by Howard E. LeWine, MD

If your fingers or toes ever turn pale (or even ghostly white) and go numb when exposed to cold, you might assume you just have poor circulation. That’s what I used to think when I first started noticing this problem with my own hands many years ago.

It usually happened near the end of a long hike on a spring or fall afternoon, when the temperature dropped and I didn’t have any gloves handy. My pinkie, third, and middle fingers would turn white, and the fingernails took on a bluish tinge. As I soon discovered, I have Raynaud’s phenomenon, an exaggeration of normal blood vessel constriction.

Raynaud’s phenomenon: Beyond poor circulation

When you’re exposed to a cold environment, your body reacts by trying to preserve your core temperature. Blood vessels near the surface of your skin constrict, redirecting blood flow deeper into the body. If you have Raynaud’s phenomenon, this process is more extreme.

Is wintry weather the only trigger for Raynaud’s phenomenon?

“Cold weather is the classic trigger for Raynaud’s phenomenon," says rheumatologist Dr. Robert H. Shmerling, senior faculty editor at Harvard Medical School's Harvard Health Publishing.

"But it can occur any time of year — for example, when you come out of a heated pool, walk into an air-conditioned building, or reach into the freezer section at the supermarket. Even slight changes in air temperature can trigger an episode.”

What happens when an episode occurs?

During an episode, the small arteries supplying the fingers and toes contract spasmodically, hampering the flow of oxygen-rich blood to the skin. Some of these vessels even temporarily collapse, and the skin becomes pale and cool, sometimes blanching to a stark white color.

In addition to the hands, Raynaud’s can also affect the feet. Less often, the nose, lips, and ears.

Is Raynaud’s phenomenon a circulation problem?

Technically, Raynaud’s phenomenon is a circulation problem, but it’s very different than what doctors typically mean by poor circulation, says Dr. Shmerling. Limited or poor circulation usually affects older people whose arteries are narrowed with fatty plaque (known as atherosclerosis). This condition is often caused by high cholesterol, high blood pressure, and smoking.

In contrast, Raynaud’s usually affects younger people (mostly women) without those issues. And the circulation glitch is generally temporary and completely reversible, he adds.

How can you prevent episodes?

As I can attest, the best treatment for this condition is to prevent episodes in the first place, mainly by avoiding sudden or unprotected exposure to cold temperatures. I’ve always bundled up in the winter before heading outside, but now I bring extra layers and gloves even when the temperature might dip even slightly, or the weather may turn rainy or windy. Preheating the car in winter before getting in, and wearing gloves in chilly grocery store aisles, can also help.

Generally, it’s best to avoid behavior and medicines that cause blood vessels to constrict. This includes not smoking and not taking certain medications, such as cold and allergy formulas that contain pseudoephedrine and migraine drugs that contain ergotamine. Emotional stress may also provoke an episode of Raynaud’s, so consider tools and techniques that can help you ease stress, such as mindfulness techniques.

If necessary, your doctor may prescribe a medication that relaxes the blood vessels, usually a calcium-channel blocker such as nifedipine (Adalat, Procardia). If that’s not effective, drugs to treat erectile dysfunction such as sildenafil (Viagra) may help somewhat. Other treatment options include losartan (Cozaar), fluoxetine (Prozac), and topical nitroglycerin. You may only need to use these medications during the cold season, when Raynaud’s tends to be worse.

What steps may help during an episode?

Once an episode starts, it’s important to warm up the affected extremities as quickly as possible. For me, placing my hands under warm running water does the trick.

When that’s not possible, you can put them under your armpits or next to another warm part of your body. When the blood vessels finally relax and blood flow resumes, the skin becomes warm and flushed — and very red. The fingers or toes may throb or tingle.

Is Raynaud’s phenomenon linked to other health problems?

Some people with Raynaud’s phenomenon have other health problems, usually connective tissue disorders such as lupus or scleroderma. Your doctor can determine this by reviewing your symptoms, performing a physical exam, and taking a few blood tests. But most of the time, there is no underlying medical problem.

About the Author

Julie Corliss, Executive Editor, Harvard Heart Letter

Julie Corliss is the executive editor of the Harvard Heart Letter. Before working at Harvard, she was a medical writer and editor at HealthNews, a consumer newsletter affiliated with The New England Journal of Medicine. She … See Full Bio View all posts by Julie Corliss

About the Reviewer

Howard E. LeWine, MD, Chief Medical Editor, Harvard Health Publishing

Dr. Howard LeWine is a practicing internist at Brigham and Women’s Hospital in Boston, Chief Medical Editor at Harvard Health Publishing, and editor in chief of Harvard Men’s Health Watch. See Full Bio View all posts by Howard E. LeWine, MD