Embryo donation: One possible path after IVF

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For decades, in vitro fertilization (IVF) has enabled countless people to have children, often after years of disappointment. It’s a complex process, medically and emotionally. Those embarking on an IVF cycle are often laser-focused on the baby they long for. Most hope a cycle will yield several embryos, because it frequently takes more than one embryo transfer to achieve a successful full-term pregnancy.

Any remaining embryos may offer the hope of future pregnancies and additional children. Yet remaining embryos also bring difficult decisions to the fore — if not immediately, then in subsequent years. The decisions one person, or a couple, makes might be divided into five paths. One path — donating embryos to another person or couple hoping for children — carries with it many questions. This path, and those questions, are the subject of this post.

A decision pathway for people who became parents through IVF

If you became a parent through IVF and have remaining embryos, you are not alone. Estimates vary on the number of cryopreserved embryos in the United States, but it’s likely to be in the hundreds of thousands.

You may be among the many people or couples who plan to use their embryos, or among those whose family feels complete. And you may be starting to figure out what to do with your embryos, or you may be putting the decision on hold, paying for annual embryo storage and feeling no urgency to make a decision, since embryos can remain safely frozen for many years. Having “extras” in deep freeze may offer comfort, kind of a psychological insurance policy after years of disappointment and loss.

Sooner or later, though, most people find themselves at a decision point, considering these options:

  • You can discard your remaining embryos. This may feel harder than you anticipated but absolutely doable. You see these embryos as part of the IVF process that enabled you to have your cherished child or children. The word “discard” sounds harsh, but you are not prepared to parent another child and do not see donating them to others as an option.
  • You can decide to have an additional child. A larger family wasn’t what you’d planned on or hoped for, but you see extra embryos as part of IVF, and a new child as meant to be. You look at the family you have and decide it is worth undergoing at least one more embryo transfer before making a final decision to discard.
  • You can decide to donate your embryos to science. Unfortunately, if you begin to explore this, you’ll discover there is no easy route for it. Perhaps you will choose to explore other possible pathways, or decide to focus on one of the other options.
  • You can donate your embryos to another person or couple. For some, this feels natural: you have been given the gift of children and you want to pay it forward to others longing for pregnancy and parenthood. However, for many the decision to donate does not feel easy or natural. Rather, it poses a huge dilemma: you want to honor the embryos and offer them a chance at life, but you have unsettled feelings when you think of your genetic offspring being raised by another family.
  • Not to decide is to decide. In listing options, it is important to acknowledge that some of your fellow IVF parents are deciding not to decide. They are among the many who have “abandoned” their embryos (the term clinics use for families that avoid contact). They stop paying their storage fees; they fail to respond to outreach calls and letters.

What questions arise if you choose to donate embryos to another family?

Writing in TheNew York Times about facing her own decision about unused embryos, author Anna Hecker said, “For me this far surpasses discomfort. I see it as a life-or-death decision, which makes it nearly impossible to make.”Having worked with couples making this decision, I can attest that this sense of the “nearly impossible” passes over time, as people grapple with their choice and come to a place of clarity and peace.

Below are some — though not all — questions you are likely to confront as you think about donating embryos. If you are part of a couple, you can sort through these questions with your partner. (If you are single, the decision is yours to make.)

  • How would we feel about another family raising a child created with our genes?
  • Would it feel okay if we knew the family we donate to, or could that make it harder, seeing what might have been our child growing up with others as parents?
  • Is this fair to the children involved? How will our children feel knowing they have full genetic siblings in another family? What will they make of the fact that it was the random choice of an embryologist who determined which embryo would land in our family and which in another?
  • How will children who come from our donation feel? Will they feel displaced, like they landed in the wrong family? Will they, perhaps, feel a bit like a science-fiction project?
  • How will we feel about possible challenges in the future: our child gets sick, the family we donate to gets divorced, we fervently disagree with the parenting style and values of the other family?
  • If we decide to donate, how should we go about finding a family? Does geography or demographics matter — for example, will it feel good or more complicated to have them nearby? Should we donate to a same-sex couple, an older single woman, or others?
  • Do we want to tell family members and friends of our decision to donate our embryos? If so, how much do we share of this information?
  • If there are several embryos, do we donate all to the same family or divide them? For those who feel strongly about not wanting to discard embryos, it may be important to ensure that none are discarded when the receiving family feels complete.
  • If our embryos were created with the help of donor eggs and/or sperm, should we seek permission or approval from the donor? How do we go about this if we do not have access to the donor?

These questions are complicated, best made over time and with care. While you may want to make the decision soon so that you can feel closure and move on as a family, I have found this is one instance in life when moving slowly, visiting and revisiting a decision, accepting doubt and the need to take pauses, all contribute to you eventually feeling the rightness of your decision.

Recent study shows more complications with alternative prostate biopsy method

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If a screening test for prostate cancer produces an abnormal result, the next step is typically a biopsy. In the United States, this is almost always done by threading a biopsy needle into the prostate through the rectum. By watching on an ultrasound machine, doctors can see where the needle is going. Called a transrectal ultrasound (TRUS) biopsy, this procedure comes with a small but growing risk of infections that are in turn increasingly resistant to current antibiotics.

To minimize infection risk, doctors can also thread the biopsy needle through a patch of skin between the anus and scrotum called the perineum, thus bypassing rectal bacteria. These so-called transperineal (TP) biopsies offer a further advantage in that they provide better access to the tip (or apex) of the prostate, which is where 30% of cancers occur. However, they are also more painful for the patient. Until recently, they were done only in hospital operating rooms under general anesthesia.

Today, technical advances are making it possible for doctors to perform TP biopsies under local anesthesia in their own offices. And with this development, pressure to limit infections by adopting this approach is growing.

During a recent study, Harvard scientists looked at how the two methods compare in terms of cancer detection and complication rates. In all, 260 men were included in the study, each closely matched in terms of age, race, prostate-specific antigen levels, and other diagnostic findings. Half the men got TRUS biopsies and the other half got TP biopsies, and all the procedures were performed at a single medical practice between 2014 and 2020. Per standard clinical protocols, all the men in the TRUS group took prophylactic antibiotics to prepare. By contrast, just 43% of men in the TP group took antibiotics, in accordance with physician preferences.

Results showed minimal differences in the cancer detection rate, which was 62% in the TP group and 74% among men who got TRUS biopsies. But importantly, 15% of men with cancer in the TP group had apex tumors that the TRUS biopsies "may have missed," the study authors wrote.

More complications with the TP approach

As far as complications go, one man in the TRUS group developed an infection that was treated with multiple rounds of oral antibiotics. None of the TP-biopsied men got an infection, but eight of them had other complications: one had urinary blood clots that were treated in the hospital, two were catheterized for acute urinary retention, three were medically evaluated for dizziness, and two had temporary swelling of the scrotum.

Why were the TP noninfectious complication rates higher? That's not entirely clear. For various reasons, doctors wound up taking more prostate samples (called cores) on average from men in the TP group than they did from men in the TRUS group. The authors suggest if an equivalent number of cores had been taken from men in either group, then the complication rates might have been more similar. (In fact, larger comparative studies performed in hospital-based settings show no difference in complication rates when equal numbers of cores are obtained). But doctors in the current study also had more experience with TRUS biopsies, and that might also explain the discrepancy, the authors suggest. And as doctors in general become experienced with the TP method, complication rates might fall.

In an editorial comment, Dr. Marc Garnick, the Gorman Brothers Professor of Medicine at Harvard Medical School and Beth Israel Deaconess Medical Center, editor of the Harvard Health Publishing Annual Report on Prostate Diseases, and editor in chief of HarvardProstateKnowledge.org, acknowledged positive findings from the study, particularly a reduced need for antibiotics with the TP method, and the discovery of apex tumors TRUS biopsies could have missed. Garnick also highlighted a "steep learning curve" with TP biopsies, and how some of the noninfectious complications required hospital-based care. "The ability to perform TP biopsies in an office setting should enable future comparisons with TRUS to help answer whether this new TP technology has enduring value," he wrote.

Thinking about holiday gatherings? Harvard Health experts weigh in

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Get expert advice on gathering safely from Harvard Health Publishing. Spoiler alert: vaccination is key to helping keep everyone healthy. Below, our faculty contributors share their own plans and advice for safely enjoying the holidays this year while answering three important questions.

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Roger Shapiro, MD

Associate professor of immunology and infectious diseases, Harvard T.H. Chan School of Public Health, Boston

What are your plans this year for gathering — or not gathering — with family or friends during Thanksgiving and other winter holidays, and why?

Unlike 2020, my family will be gathering for Thanksgiving in 2021. Everyone in the family is vaccinated, and most are now boosted as well. We are all comfortable with the protection that being vaccinated brings, and there is agreement that if a COVID-19 exposure were to occur, it is unlikely to cause severe illness.

What advice can you offer people planning to gather in person to reduce the chance of getting or spreading the virus that causes COVID-19?

Everyone who can get vaccinated should be vaccinated, and those who qualify for a booster should get one. Children 5 to 11 may not have their second shot by Thanksgiving but can certainly be fully vaccinated by Christmas. If there are unvaccinated members of your family, your situation is no different than in 2020: gathering is unsafe for the unvaccinated because the first exposure to this virus can be lethal without protection from a vaccine. Additionally, people who are unvaccinated are more likely to be infected before traveling, so they are more likely to bring the virus to the table, possibly causing illness (even if mild) among those who are vaccinated. For families that are all vaccinated and wishing to further reduce the possibility of transmission, taking a rapid antigen test prior to gathering can add a layer of protection.

For people planning to travel to gatherings, what would you advise?

If you are all vaccinated, enjoy the return to a normal holiday season. Vaccines are your main source of protection. If you want to add additional protection, you can consider using rapid antigen tests just before gathering to confirm that everyone is negative. If there are immunocompromised members of your family who may not be fully protected by a vaccine, you should discuss the risks case-by-case with your doctor.

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Suzanne Salamon, MD

Chief of clinical programs in gerontology, Beth Israel Deaconess Medical Center, Boston

What are your plans this year for gathering — or not gathering — with family or friends during Thanksgiving and other winter holidays, and why?

Let me start by saying my 99-year-old mother lives with us, and even though she’s had her third shot of the COVID vaccine, I’m very concerned about immune status. I also have a two-year-old granddaughter who cannot yet get the vaccine. So, everyone’s immune status is not equal. Certainly older people, even those who’ve had their third shot, may not have the same immune status as a 35-year-old.

We have really curtailed the size of our Thanksgiving dinner to under 10 people, since the CDC recommends smaller groups. Nobody wants to see people sitting at home alone during the holidays, but we have to make it as safe as possible for those who are there.

What advice can you offer people planning to gather in person to reduce the chance of getting or spreading the virus that causes COVID-19?

COVID cases are on the rise now in many places, even though a month ago the numbers were trending down. Unfortunately, we need to be more vigilant once again.

Many people are afraid to insult family and friends by asking them about vaccine status before they come. Tell people that you really want to see them, but some family or friends may be immune-suppressed or at higher risk if they get COVID-19, and you’re trying to make the gathering safe for everyone. That’s why I’d ask people to let you know their COVID vaccine status. Even after the two-vaccine series, research is showing diminished antibodies after six months, which may put people at higher risk for getting and/or spreading the virus. I would ask people who are not vaccinated not to come.

When people gather, ventilation is really important in reducing the concentration of any virus that might be present. Have the gathering outside or on a screened porch, if at all possible. We hosted Thanksgiving last year in our garage. We left the garage doors open and set up small tables and little space heaters for warmth. People could be social yet stay separated, and ventilation was great. You can decorate small tables with colorful plastic tablecloths and candles, even put down a rug. If you’re inside, windows and doors can be kept open, which will help move the air around. Have some small space heaters and sweaters available.

Ask everyone to bring a mask, or keep a box of masks available. Wear masks while you’re all chit-chatting until you sit down to dinner. In the bathroom, have a roll of paper towels or paper guest towels rather than a cloth towel, and leave the fan on for ventilation.

For people planning to travel to gatherings, what would you advise?

Planes are thought to be very safe. In the air terminal, sit apart from people. Keep your mask on during the flight.

Traveling by car is pretty safe. If you get out to go to the bathroom or get coffee, wear a mask and wash your hands. Traveling by bus or train is tricky, because even though there is a mask requirement, people will take off their masks. Be sure to wear your own mask. I personally double-mask. Two surgical masks block out a lot and can be a bit more comfortable than the N95 masks we wear in the hospital. A plastic face shield over the mask may be a good idea for added protection.

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John J. Ross, MD

Hospitalist with specialty in infectious diseases, Brigham and Women’s Hospital, Boston

What are your plans this year for gathering — or not gathering — with family or friends during Thanksgiving and other winter holidays, and why?

We are having an unmasked, multigenerational, fully-vaccinated, traditional Thanksgiving dinner at my in-laws, just like the Before Times.

What advice can you offer people planning to gather in person to reduce the chance of getting or spreading the virus that causes COVID-19?

Everyone in attendance should have a primary COVID vaccination. Getting vaccinated against COVID reduces the risk of hospitalization or death due to COVID by more than 90%. It also reduces your risk of death from any cause. People who are eligible for booster shots should get them. That includes anyone over 65, and people over 18 with underlying medical conditions, high occupational risk, or those who live in high-risk settings such as group homes, shelters, and long-term care facilities.

Certain vaccinated people are more likely to get breakthrough COVID. This includes people of advanced age, and those with serious medical conditions or weak immune systems. These people should be extremely cautious around those who are not vaccinated or partly vaccinated. I would recommend that they mask around unvaccinated people, physically distance, and use extra ventilation (opening windows, or ideally moving the whole shebang outdoors). Rapid antigen tests may also be helpful in the setting.

For people planning to travel to gatherings, what would you advise?

For those who have long distances to travel, I would recommend flying if possible. Airplanes have excellent ventilation, and masks are mandatory. While masks are also required on trains, they are not as well ventilated as planes, and train travel has been associated with significant COVID risks.

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Amy Sherman, MD

Division of infectious diseases, associate physician, Brigham and Women’s Hospital, Boston

What are your plans this year for gathering — or not gathering — with family or friends during Thanksgiving and other winter holidays, and why?

This Thanksgiving, my fiancé and I are driving to New Jersey and New York (with our dog!) to visit our families. We will have dinner with 14 others from my close family — larger than last year’s Thanksgiving, but smaller than pre-COVID years. Everyone has been vaccinated, and most have received a third dose. We will then visit with my fiancé’s 94-year-old-grandma, choosing to see her independently instead of bringing her to a large gathering.

Although no measures can absolutely make an indoor gathering 100% safe, we will apply layers of protective measures to reduce risk, with vaccinations as the base layer. Additionally, everyone will get tested for the virus that causes COVID-19 before gathering, limit exposure risks in the week before Thanksgiving, avoid public transportation, and drive instead of flying. When we’re together, we’ll spend time outdoors as much as possible. Maybe this year will bring new traditions — an outdoor bonfire instead of nighttime movie marathons, or Friday morning jogs instead of Jazzercise with my aunt!

What advice can you offer people planning to gather in person to reduce the chance of getting or spreading the virus that causes COVID-19?

We are in a much better place this year compared to last year. Connecting with family and friends is important for our mental health and well-being. However, we still need to be cautious, especially when gatherings include people who are older, immunocompromised, or at risk of severe COVID-19. We also have seen recent outbreaks in school-age kids who are not yet vaccinated. I would encourage your family and friends to get vaccinated if they haven’t already. For those family members at higher risk, consider smaller and more intimate gatherings, or do hybrid in-person/Zoom meetings. And layer up with the other risk reducing strategies I suggested!

For people planning to travel to gatherings, what would you advise?

Avoid public transportation if possible. If this is not possible, wear a mask on the bus, train, or airplane, even if you’ve been vaccinated. Vaccinations decrease the severity of disease, but you still could become infected and transmit the virus to others.

Read more advice on gathering for winter holidays this year, such as who can and should get a COVID-19 vaccine booster, whether to take a rapid test or PCR test before spending time with family or friends, how to navigate tricky relationships, and healthy eating through the holiday season.

Naps: Make the most of them and know when to stop them

During the first year of life, naps are crucial for babies (who simply cannot stay awake for more than a couple of hours at a time), and crucial for parents and caregivers, who need breaks from the hard work of caring for an infant.

But as children become toddlers and preschoolers, naps aren’t always straightforward. Children often fight them (following the “you snooze you lose” philosophy), and they can conflict with daily tasks (such as school pick-up when there are older siblings) or lead to late bedtimes.

Here are some tips for making naps work for you and your child — and for knowing when they aren’t needed anymore.

Making naps work for your baby

Most infants will take at least two naps during the day, and early in toddlerhood most children will still take both a morning nap and an afternoon nap. Naps are important not just for physical rest and better moods, but also for learning: sleep allows us to consolidate new information. As children get older, they usually drop one of the naps, most commonly the morning nap.

Every child is different when it comes to napping. Some need long naps, some do fine with catnaps, some will give up naps earlier than others. Even within the same family, children can be different. A big part of making naps work is listening to and learning about your child’s temperament and needs. Otherwise, you can end up fighting losing battles.

The needs of a parent or caregiver are also important: everyone needs a break. Sometimes those breaks are particularly useful at specific times of the day (like meal prep time). While you can’t always make a child be sleepy at the most convenient time for you, it’s worth a try — which leads me to the first tip:

Schedule the naps. Instead of waiting for a child to literally drop and fall asleep, have a regular naptime. We all do better when our sleep routines are regular, even adults. If you can, put the child down awake (or partially awake). Learning to fall asleep without a bottle or a breast, or without being held, is a helpful skill for children to learn and can lead to better sleep habits as they grow.

A couple of scheduling notes:

  • If you need a child to fall asleep earlier or later than they seem to do naturally, try to adjust the previous sleep time. For example, if you need an earlier morning nap, wake the child up earlier in the morning. It may not work, but it’s worth a try.
  • Naps later in the afternoon often mean that a child won’t be sleepy until later in the evening. That may not be a problem, but for parents who get tired early or need to get up early, it can be. Try to move the nap earlier, or wake the child earlier. If the problematic afternoon nap is in daycare, talk to the daycare provider about moving or shortening it.

Create a space that’s conducive to sleep. Some children can sleep anywhere and through anything, but most do best with a space that is quiet and dark. A white noise machine (or even just a fan) can also be helpful.

Don’t use screens before naptime or bedtime. The blue light emitted by computers, tablets, and phones can wake up the brain and make it harder for children to fall asleep.

When is it time to give up naps?

Most children give up naps between the ages of 3 and 5. If a child can stay up and be pleasant and engaged throughout the afternoon, they are likely ready to stop. Some crankiness in the late afternoon and early evening is okay; you can always just get them to bed earlier.

One way to figure it out, and ease the transition, is to keep having “quiet time” in the afternoon. Have the child go to bed, but don’t insist on sleep; let them look at books or play quietly. If they stay awake, that’s a sign that they are ready to stop. If they fall asleep but then end up staying up very late, that’s another sign that the afternoon nap needs to go.

Whether or not your child naps, having some quiet time without screens every afternoon is a good habit to get into. It gives your child and everyone else a chance to relax and unwind, and sets a placeholder not just for homework but also for general downtime as children grow — and just like naps for babies, downtime for big kids is crucial.

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Low-carbohydrate and high-saturated fat diet: Heart healthy, or more to learn?

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Various versions of low-carbohydrate diets have been popular for many years. The details of what is allowed and what is not vary quite a bit, and the amount of carbohydrates also differs. The common impression is a plate devoid of bread, pasta, and starchy vegetables, piled high with bacon, meat, eggs, and cheese, and maybe a small amount of vegetables and nuts. Due to the high saturated fat content in these diets, doctors and nutritionists worry about their potential adverse effect on cardiovascular disease.

Recently, a new study published in the American Journal of Clinical Nutrition has found that a low-carbohydrate, high-saturated fat diet might not be as bad as we feared. That sounds like good news, but is it that simple? Let’s take a look at what this randomized diet trial did and what the results really mean.

What did the study actually involve?

The 164 participants in this study were all considered overweight or obese, and had just finished a weight loss trial to lose 12% of their body weight. They were randomly assigned to one of three diets containing different proportions of carbohydrates and fat. Protein content was kept the same (at 20% calories) for everyone. They were not planning to lose any more weight.

The three diets were:

  • Low carbohydrates (20%), high fat (60%), saturated fat comprising 21% of calories: this resembles a typical low-carbohydrate diet and has much higher saturated fat than recommended.
  • Moderate carbohydrate (40%), moderate fat (40%), saturated fat comprising 14% of calories: this is not far from the typical American diet of 50% carbohydrates and 33% fat, and it is quite similar to a typical Mediterranean diet, which is slightly lower in carbohydrates and higher in fat than an American diet.
  • High carbohydrate (60%), low fat (20%), saturated fat comprising 7% of calories: this meets the recommendation of the Dietary Guidelines for Americans and is a typical high-carbohydrate diet, including a lot of grains, starchy vegetables, and fruits or juices.

The study participants received food prepared for them for 20 weeks. They had their blood measured for a number of risk factors of cardiovascular disease, and in fact some cardiovascular risk markers improved the most in this group.

The researchers found that at the end of eating these diets for five months, the low-carbohydrate group, which also had consumed the highest amount of the presumably worrisome saturated fat, did not have the worst cardiovascular disease blood markers. The amount of good and bad cholesterol in the blood was not different from the other groups. In fact, the LPIR cardiovascular risk score and two other disease markers (Lp(a) and adiponectin) also were improved the most in this group. This seems to suggest that we can go ahead and not worry about the saturated fat that typically goes with a low-carbohydrate diet.

What were the participants actually eating?

Alas, those who were eating the low-carbohydrate diet were not piling up their plate with steak and bacon, and those eating the high-carbohydrate diets were not drinking unlimited soda. All three diets were high in plant foods and low in highly processed foods (it is easier to stick to a diet when all the food is prepared for you). Even the low-carbohydrate group was eating lentils, a good amount of vegetables, and quite a bit of nuts.

And although the diet was quite high in saturated fat, it was also high in the healthy poly- and monounsaturated fats as well. The meat was a combination of higher amounts of healthy (salmon) and a small amount of unhealthy (sausage) choices. In addition, fiber intake (at about 22 grams/day) was slightly higher than the average American intake (18 grams/day). Overall, except for saturated fat being higher than recommended, the diet as a whole was quite healthy.

What is the take-home message?

It seems that among a relatively young and healthy group of people, higher amounts of saturated fat in the context of a healthy diet do not seem to adversely affect certain cardiovascular risk markers in the short term. How it would affect actual disease — such as heart attack, stroke, and diabetes — in the long run is unknown. However, there is ample evidence showing that a diet that consists of healthy foods and has moderate amounts of carbohydrate and fat can lower the risk of these diseases.

Preventing diseases is a long-term process; a healthy diet must not only be effective, but it should also be flexible enough for people to stick to in the long run. Therefore, a healthy diet with moderate amounts of healthy carbohydrates and ample healthy fats may be the easiest with which to achieve good health. Lower-carbohydrate diets might be promising, but further long-term testing is needed.

Gift giving for family or friends in assisted living

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Have family or friends in assisted living facilities? Finding the right gift can be complicated. Health issues may rule out some gifts: cross off sweets or chocolates for those who need to keep blood sugar under control. There isn’t much space for extra belongings in the apartment or room. In some cases, your giftee’s physical or mental capabilities (or both) are declining.

"Any gift you give will probably be appreciated," says Dr. Suzanne Salamon, associate chief of gerontology at Harvard-affiliated Beth Israel Deaconess Medical Center. "But it helps if it’s something the person can really use and will enjoy. Tailor it to their particular ailments, needs, and interests." Below is a roundup that can help you select a great gift for the holidays — or any other occasion.

Gifts for social engagement

"Many people feel lonely and isolated in assisted living facilities. Keeping loved ones socially connected combats that, and also helps ward off chronic disease and cognitive decline," Salamon notes. Gifts that may fit the bill include:

  • A simple phone. The easier a phone is to operate, the more likely your loved one will be able to use it. That could be a landline phone with large, easy-to-read numbers ($25 and up), a flip phone ($35 and up), or a smartphone with few buttons and apps ($50 and up). Remember that cell phones come with monthly service costs; prices depend on the carrier.
  • A smart speaker. If phone use is too hard for your loved one, consider a smart speaker ($20 and up) that can be programmed to dial important numbers (like yours). Commands can be said aloud at any time to make a call. Check if your loved has internet service, which is needed for smart speaker use.
  • A photo book. A loose-leaf photo album (less than $20) or easily created photo book ($10 and more) with recent photos of family and friends may be a warm reminder of connections, or can be a gift to share with others in the assisted living facility. That social interaction is important for health. Plus, it will make the person feel good to see all of those photos of people who love them.

Gifts to aid independence

Health problems can make simple activities challenging. These gifts can give your loved one a little independence.

  • Adaptive tools. Your loved one may be able to take back some control of dressing with a long-handled shoehorn, a button hook, or a zipper pull (less than $10 each).
  • A magnifying glass. Especially handy for those with impaired vision (and who hasn’t misplaced reading glasses?), having a magnifying glass ($5 and up) is handy for reading or seeing small objects. For a nice upgrade, make it a lighted magnifying glass ($15).
  • Handwriting aids. Hand arthritis or neurodegenerative conditions (such as Parkinson’s disease) make writing difficult. Ergonomically-shaped adaptive pens ($10 and up) can help your loved one jot down information or thoughts.

Gifts for sharper thinking skills

"Challenging your brain or learning new information promotes new brain cell connections, which help protect and maintain cognition," Dr. Salamon says. Give your loved one something that will make the process easy and fun, such as the following:

  • A daily trivia calendar. (About $15)
  • Large-print nonfiction or fiction books. ($5 and up). Audio selections are enjoyable, too.
  • Large-print books of brain games and puzzles. ($5 and up)
  • A print subscription to a health publication, such as the Harvard Health Letter ($24).

Gifts to ease health issues

A well-chosen gift can bring comfort and help ease health issues. Try addressing someone’s aches and pains with gifts such as:

  • A microwavable heat wrap ($15 and up).
  • A handheld massager ($5 and up).

Or you could address circulatory problems that make people feel cold or increase the risk for blood clots in the legs. Ideas include:

  • A soft fleece blanket ($10 and up).
  • Warm slippers with slip-resistant soles ($20 and up).
  • Brightly patterned compression stockings with fun designs ($15 and up). Be sure to check the size so they aren’t too small for your loved one.

Gifts to track health

Even though assisted living facility staffers monitor residents’ health, your loved one may find it useful to have one of the following gifts:

  • A blood pressure monitor ($30 and up). Look for one with a cuff that goes around the upper arm; inflates automatically; has a lighted background with large numbers; and is certified by the Association for the Advancement of Medical Instrumentation, the British Hypertension Society, or the European Society of Hypertension.
  • A digital "stick" thermometer ($10 and up). The right one will be large and easy to hold, with a lighted background and large numbers.

Not quite right?

Keep thinking. A nice, warm fleece sweater ($20 and up)? Extra reading glasses to place in favorite nooks ($15 and up)? If none of these ideas is right, consider giving a healthy treat. A great choice right now is fresh citrus (send a box for $30 and up). "Avoid grapefruit, which can interfere with certain medications," Dr. Salamon advises, "but oranges or tangerines are sweet and rich in vitamin C, which supports a healthy immune system. And that’s a great gift."

Why is topical vitamin C important for skin health?

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Topical vitamin C is a science-backed, dermatologist-favorite ingredient that may help slow early skin aging, prevent sun damage, and improve the appearance of wrinkles, dark spots, and acne. Vitamin C is an antioxidant, meaning it fights harmful free radicals (toxins) that come in contact with your skin from external sources like air pollution, or from inside the body as a result of normal processes like your metabolism. Free radicals can damage the skin, and applying topical vitamin C can combat free radicals and may improve the skin’s overall appearance.

Skin benefits of vitamin C

A few clinical studies have demonstrated that vitamin C can improve wrinkles. One study showed that daily use of a vitamin C formulation for at least three months improved the appearance of fine and coarse wrinkles of the face and neck, as well as improved overall skin texture and appearance.

Vitamin C may also help protect the skin from harmful ultraviolet rays when used in combination with a broad-spectrum sunscreen. Clinical studies have shown that combining vitamin C with other topical ingredients, namely ferulic acid and vitamin E, can diminish redness and help protect the skin from long-term damage caused by harmful sun rays.

Further, vitamin C can reduce the appearance of dark spots by blocking the production of pigment in our skin. In clinical trials, the majority of the participants applying topical vitamin C had improvement in their dark spots with very little irritation or side effects, but more studies are needed to confirm the brightening effects of vitamin C.

Additionally, topical vitamin C can help with acne through its anti-inflammatory properties that help control sebum (oil) production within the skin. In clinical trials, twice-daily application of vitamin C reduced acne lesions when compared to placebo. While no serious side effects were reported with vitamin C use in any of these studies, it is important to note that there are only a handful of clinical trials that have studied the effects for vitamin C, and more studies are needed to confirm the findings presented here.

Where to find topical vitamin C and what to look for on the label

Vitamin C can be found in serums or other skincare products. Different formulations of vitamin C can alter its strength and effects in the skin. Consider purchasing vitamin C products from your dermatologist’s office or a verified online retailer, with a clinical formulation that contains an active form of vitamin C (for instance, L-ascorbic acid), has a strength of 10% to 20%, and a pH lower than 3.5, as this combination has been studied in clinical trials. This information can be obtained from the manufacturer’s website under the ingredients section.

Who shouldn’t use Vitamin C products?

Vitamin C has only been studied in adults and is not recommended for children. Always read the ingredient list before purchasing a vitamin C product. If you have sensitivity or a known allergy to any of the ingredients, consider a patch test or consult your doctor before use. If you have acne-prone or oily skin, consider using a formulation that also fights oils, or contains ingredients like salicylic acid that fight breakouts.

How to use topical Vitamin C

During your morning skincare routine

  • use a gentle cleanser
  • apply a few drops of a vitamin C serum to the face and neck
  • apply moisturizer and sunscreen.

You may experience a mild tingling sensation with the use of vitamin C. You may choose to begin applying it every other day, and if tolerated you may apply it daily. It may take up to three months of consistent use to see a noticeable improvement. If you experience substantial discomfort or irritation, please stop using vitamin C and consult with your physician.

Vitamin C does not replace the use of sunscreen or wearing sun-protective clothing. Be sure to use broad-spectrum, tinted sunscreen daily, and limit sun exposure during peak hours.

Follow Dr. Nathan on Twitter @NeeraNathanMD
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Yoga for weight loss: Benefits beyond burning calories

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If you have trouble losing weight despite your best efforts, this is because obesity is a complex disease with many causes. A family history of weight issues can make it more likely that you’ll have the same issues managing your weight. A diet high in ultra-processed foods, sugar, and fat and being sedentary also contribute to weight gain. Stress and struggles with mental health, including medications to treat certain mental health conditions, poor sleep, and hormonal changes, are all factors that further contribute to weight gain.

There are many ways to combat excess weight, but there is no single solution. If you are trying to lose or maintain your weight, you may want to try yoga. There is good research that yoga may help you manage stress, improve your mood, curb emotional eating, and create a community of support, all of which can help with weight loss and maintenance.

Yoga can also help you burn calories, as well as increase your muscle mass and tone. Yoga may reduce joint pain, which in turn allows you to exercise more and increase your daily activities. These are only some of the many benefits of yoga.

Yoga can help you manage stress that can impact weight gain

Yoga is derived from the Sanskrit word yuj, which means to unite the body, mind, and emotions. It is a holistic mind-body practice that improves many of the causes of weight gain.

Some people may experience stress as physical pain or sleep deprivation, or it may be psychological and cause feelings of anxiety and agitation. Stress leads to an increase in the hormone cortisol. Cortisol increases abdominal fat, decreases muscle mass, causes cravings for fat and sugar-rich food, and thus can lead to obesity.

Yoga can decrease stress and cortisol levels, enhance mood, decrease anxiety and depression, improve sleep, and improve chronic conditions such as hypertension and diabetes, reducing the need for medications that can cause weight gain.

Yoga is not a band-aid for excess weight, but it may work on the underlying causes. Its benefits extend beyond the calories-in-versus-calories-out equation.

Yoga can improve mindfulness related to eating behaviors

Most of us who crave ice cream after 9 pm or can’t stop eating potato chips know that these behaviors hurt our chances of losing weight. We all know that eating vegetables, whole grains, lean protein, etc. is good for our health and weight. While this knowledge is necessary, it seems insufficient to help us stick to our healthy eating plans.

One of yoga’s benefits is that it improves mindfulness of the body and awareness of body sensations. This is why yoga is called “moving meditation.” Research shows that you don’t have to do any formal sitting meditation to get the mindfulness benefits of yoga.

By improving mindfulness, yoga decreases emotional eating, stress eating, and binge eating. These habits sabotage our weight loss efforts and can cause a negative spiral of guilt and shame, which often leads to giving up.

A study published in 2015 showed that practicing yoga led to healthier eating, including lower fat intake and an increase in vegetables and whole grains.

The bottom line: the best diet plan is the one that you can stick with over the long term, and by improving mindfulness, yoga can help you make healthier food choices.

A yoga community can provide acceptance and support

Going to a gym can be intimidating, and may provoke feelings of not belonging for some people with larger bodies. By contrast, yoga culture embodies kindness, support, and self-acceptance.

Yoga teachers and advanced practitioners can serve as role models and inspire newer students to live a healthier lifestyle. Research shows that social networks influence behaviors that affect weight. The yoga network encourages positive health behaviors, and being a part of such a community can make a meaningful difference for weight loss. This type of community can be hard to find with other types of exercise.

Practitioners should look for a safe, comfortable environment. A welcoming yoga group may help you improve your self-esteem and confidence. Find a local studio that feels nurturing and not overwhelming, with other practitioners at your level. Teachers can help beginners or those with physical limitations by modifying poses. You might have to try a few different classes before you find an instructor or a class that you like. Don’t give up after the first one!

If you can’t find a local studio, there are always online options on YouTube and Instagram, with classes at all levels. There are instructors who understand what it is like to be a larger size, and having an inclusive, body-affirming attitude shows that yoga is not just for “skinny people.” Some share inspirational stories of how yoga helped them overcome their own weight struggles, depression, and binge eating. If you are a beginner, consider signing up for a short challenge to get committed to the practice.

The benefits of yoga are universal — no matter what your shape or size. It can take weeks or months to establish a yoga practice, and frequent practice is key for long-lasting benefits.

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What it takes to achieve world-changing scientific breakthroughs

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In science, advances are a daily occurrence, but true breakthroughs are rare. What does it take to achieve world-changing scientific breakthroughs? Some are the result of a lucky accident, combined with curiosity: scientists traveling down one road suddenly find reason to veer onto another road, one they never planned to travel — a road that may well lead nowhere.

Other major breakthroughs stem from scientists pursuing a very specific dream. One day, usually early in their career, they get an idea that they can’t stop thinking about. It’s crazy, they say to themselves, but is it really impossible? They talk to respected colleagues who often remind them of all the reasons their idea might not work, and how damaging this could be for their career. It’s a sobering message, yet the idea won’t die. So, they scramble to find financial support and seek out colleagues willing to risk traveling that road with them — a road that may well lead nowhere. But sometimes the road leads to major breakthroughs like penicillin and mRNA vaccines.

Breakthroughs due to lucky accidents and curiosity

One day in 1928, Dr. Alexander Fleming at St. Mary’s Hospital in London was growing bacteria in a laboratory dish. Fleming was not pursuing a scientific dream. He was a microbiologist, just doing his job.

Then he noticed something odd: overnight, another kind of microbe, a fungus, had traveled through the air, landed on the laboratory dish, and started to grow and spread on the dish where the bacteria were growing. Fleming soon noticed that the growing fungus seemed to be killing the bacteria. He surmised that it was making some substance that killed the bacteria. Because the name of the fungus was Penicillium rubens, he called the substance the fungus was making “penicillin.”

When Fleming published a paper about his discovery, few were interested. It took another 10 years before other scientists tried to generate large amounts of penicillin to see if it might be able to cure bacterial infections and save lives. We all know how that worked out.

Fleming’s scientific breakthrough, like some others, occurred not because Fleming had a brilliant idea and exclaimed “Eureka!” Instead, it occurred because he noticed something and said, “That’s odd,” and then tried to figure it out.

Breakthroughs due to persistence and resilience in pursuit of a dream

The story of mRNA vaccines, like the Pfizer/BioNTech and Moderna vaccines for COVID-19, is very different from the story of penicillin. For 30 years, a small group of scientists believed that mRNA vaccines would have great advantages over traditional vaccines — if only several obstacles could be overcome. Many of these scientists gave up as they encountered those obstacles, but a few persisted and, ultimately, succeeded. (I described what mRNA vaccines are, how they work, and how obstacles were overcome in a previous blog post.)

One scientist, Dr. Katalin Karikó, joined the faculty of the University of Pennsylvania in the early 1990s with the dream of creating an mRNA vaccine. She applied for grants to support her work, but was repeatedly rejected: the reviewers stated that it was so unlikely that she or anyone could overcome the obstacles that supporting her research would be a wasted investment. Her university only agreed to continue supporting her work if she accepted a demotion and a pay cut. She accepted both, and doggedly pursued her dream.

One major obstacle to mRNA vaccines particularly fascinated her: the violent reaction of the immune system when it encounters mRNA from a virus. Ten years of dogged work helped Karikó and her colleague Drew Weissman figure out how to make a small change in mRNA that prevented that violent immune response — a major step in making all mRNA vaccines possible. Without this, the world wouldn’t have mRNA COVID vaccines today.

Two other scientists who created the Pfizer/BioNTech COVID vaccine, Uğur Şahin and Őzlem Turëci, are Turkish immigrants to Germany who met, fell in love with the idea of creating an mRNA vaccine, and then fell in love with each other. According to The Wall Street Journal, one day in 2002 they took a break for lunch, got married, and then returned in the afternoon to their laboratory to finish an experiment — just one more among many conducted over 30 years. Each experiment was one more possible step toward their ultimate dream until finally, in 2020, they achieved that dream: their mRNA vaccine for COVID-19 proved to be very safe and effective.

Holding hard to their dreams

Whichever path scientists who achieve lifesaving breakthroughs travel, they often endure disinterest, like Fleming, or repeated skepticism, ridicule, and rejection, like Karikó, Weissman, Şahin, and Turëci. Only through sheer persistence did these scientists bring their dreams to life. They have been rewarded with fame and wealth and something even more valuable: the knowledge that because of their work hundreds of millions of people around the world never got sick, and millions never died before their time.

Of course, a relentless obsession with an improbable dream fails to pay off for many scientists. Their ideas, while quite brilliant, in the end are proved wrong: nature doesn’t turn out to operate the way they predicted. In the end, their beautiful theory is murdered by a brutal gang of facts.

Still other scientific dreamers ultimately prove to have been on the right track all along and would have achieved their dream — if only they had done the experiment a little differently, if only they had persisted a little longer, or if only the support for their work had not run out. As a result, neither they nor the rest of us benefitted from what would have been — until other scientists rediscovered their work years later.

Ultimately, scientific breakthroughs are possible only if a society is willing to invest in dreamers, recognizing that not all investments will lead to major breakthroughs. However, the investments that do lead to breakthroughs bring an economic return that is far greater than the investment — as well as preventing suffering and death and changing the world.

Want to participate in COVID-19 research? Download the COVID Symptom Study app to help researchers track symptoms and hot spots across the US. Click here for information.

Do weighted blankets help with insomnia?

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Insomnia is a sleep disorder that affects approximately 10% of adults in the United States. It is characterized by difficulty with falling asleep, staying asleep, and/or waking up too early, at least three times per week for a period of three months or more. Contrary to some beliefs that insomnia will get better by itself over time, evidence suggests that it will persist if not actively treated. In one study, 37.5% of patients with insomnia reported that their insomnia was still a problem five years later.

What are common treatment options used for insomnia?

Perhaps the most common nonpharmacological intervention used for insomnia is something called sleep hygiene. It describes a series of good sleep habits to engage in (such as keeping your bedroom quiet at night) and ones to avoid (turning off electronic devices before going to bed).

Unfortunately, as many patients know, sleep hygiene is not a very effective treatment for insomnia when implemented by itself. When sleep hygiene is used as one part of a multimodal approach, such as cognitive behavioral therapy for insomnia, it can be an effective complement to other important strategies. While cognitive behavioral therapy for insomnia is recommended as the gold-standard treatment by the American Academy of Sleep Medicine and the American College of Physicians, finding a clinician with expertise in behavioral sleep medicine can be a challenge — even via telemedicine.

Integrative treatment approaches are popular

Many people are interested in pursuing other treatment options for insomnia that do not involve prescription medications. Increasing evidence suggests that a number of approaches may be beneficial, including mindfulness-based practices and mind-body movement practices like yoga. Some people may use dietary supplements such as valerian, melatonin, chamomile, and cannabis, though evidence is more limited regarding their efficacy. You should always tell your doctor if you are taking any dietary supplements, as these may interact with other prescription medications.

An integrative option for people with insomnia and a psychiatric disorder

Insomnia is a common issue for people with a psychiatric disorder, possibly because of overlapping neurobiology. For example, someone with insomnia is 10 times more likely than someone without insomnia to also have depression. Among patients receiving psychiatric care, compression and weight have been used therapeutically. It has been hypothesized that the calming (and possibly sleep-promoting) effects of such an approach may be similar to what is experienced with acupressure or massage.

A team of researchers at the Karolinska Institute in Stockholm, Sweden conducted a study to determine whether a weighted metal chain blanket could improve insomnia symptoms compared to a light plastic chain blanket. They recruited outpatients with elevated insomnia symptoms who were being treated for one of several mood disorders: major depressive disorder, bipolar disorder, generalized anxiety disorder, or attention deficit hyperactivity disorder (ADHD).

Participants were randomly assigned to receive either a weighted metal chain blanket or a light blanket with plastic chains that were sewn on, which were the same shape and size as the metal chains on the weighted blanket. Those who were provided with a weighted metal chain blanket first tried on an 8-kilogram (17.6 pound) blanket. If this was too heavy, a 6-kilogram (13.2 pound) blanket was then provided. Over a four-week period, their sleep was assessed using surveys and a wrist-based device called an actigraph.

What did the researchers learn?

Participants who used the weighted metal chain blanket reported that their insomnia symptom severity declined significantly, while those who had used the light blanket did not experience such notable improvements. Furthermore, depressive symptoms and anxiety symptoms decreased much more for those who used the weighted blanket than those who used the light blanket. This secondary finding is consistent with other work showing that interventions designed to treat insomnia can have a meaningful impact on mood.

These promising findings are tempered by data showing that there were no significant improvements to key insomnia metrics, such as the amount of time spent awake after falling asleep, when sleep was tracked objectively using the actigraph. Other research conducted in children has also failed to demonstrate that weighted blankets significantly change sleep outcomes when measured using an actigraph.

Should you buy a weighted blanket?

While these findings are intriguing, more research is needed. It is important to note that there is a very real placebo effect for insomnia symptoms. This means that if you are someone who believes a weighted blanket could have a positive effect on your sleep tonight… well, it's quite possible that it will. For healthy adults, weighted blankets are considered safe as long as the individual can lift the blanket off when necessary. Because sleep is such a subjective experience, the cost of a weighted blanket may be money well spent — as long as you don’t forget that there are other options available to treat insomnia, with much more research data to support their effectiveness.