Showing posts with label Health. Show all posts
Showing posts with label Health. Show all posts

Monday, 19 August 2019

A Fitness Tracker Masquerading as a Smartwatch

Lenovo has today launched its digital smartwatch in India, priced at just Rs. 1,999. At that price, getting a smartwatch from a well-known brand such as Lenovo sounds like a pretty sweet deal, doesn’t it? So, is it actually a sweet deal, and should you consider buying the Lenovo EGO for your needs? Well, I’ve been using the Lenovo EGO for almost a week now, and here are my thoughts on the watch, what it can do, what it can’t do, and whether or not it’s worth buying.
Design and Build

At first glance, the Lenovo EGO gives off the distinct impression of being a regular digital watch, and might even trick you into thinking it’s a Casio G-Shock. That’s not a bad thing, per-se, after all, smartwatches that look like regular watches to the point of being deceptive aren’t a bad thing — they can blend right in. However, take a couple of seconds to look at this watch, and you’ll easily be able to tell that it’s meant to be a very-low priced smartwatch.

lenovo ego design build

The design here is bulky, and I’m pretty confident that Lenovo wanted to make it look like a rugged watch at first blush, and it works out fine. There are unnecessary design touches in places but they all come together just fine and I didn’t really find a lot to complain about it. Keep in mind, this is a watch that comes in at Rs. 1,999, and I reviewed it with that in mind.



The build, on the other hand, is clearly where the company cut considerable costs. Don’t get me wrong, the EGO is by no means a fragile watch. I’ve used it carelessly, tossed it in my bag for formal outings when I preferred wearing my regular watch instead, and just treated it like a rugged watch for the most part, and it has held up surprisingly well. However, the quality of the plastic on the casing, and the rubber straps is very obviously not that great. It looks decidedly cheap to the eyes, and it feels thin and weird when you touch it. Even comparing it to the Mi Band’s silicone strap, the EGO’s strap is not at the same level.
Display

The display on the EGO is definitely not what you’d expect from a smartwatch, or even most fitness trackers. This is a typical display you’d find on a digital watch, and that might be a good thing or a bad one depending on what you’re actually looking for in a watch. Personally, I think the OLED display on the Mi Band 3 is a better deal than this one — it can show a lot more information, and that’s something where the Lenovo EGO falls back substantially as we’ll discuss in the features section of this review.

lenovo ego display

The display also has another annoying issue — pressing too hard on the buttons usually screws it up, and in my experience with the watch, sometimes even restarting the smartwatch wouldn’t fix it. However, pressing on the ‘Mode’ button a bunch of times usually did. It’s mostly a hit or miss experience though, and I’d suggest you treat the buttons with care. This watch might look rugged, but when it comes to the buttons, I don’t think rugged is the word I’d use to describe it.

Other than that though, the display does its job just fine. It doesn’t show a lot of information, which might be good for you if you don’t like smartwatches that bombard you with information, but the information it does show, is well organised and is just enough to justify wearing this watch regularly. There’s also a ‘Light’ button here, since the display itself isn’t backlit like what you’d see on the Mi Band 3, and that button is something you’ll not realise the importance of until you find yourself driving at night, and trying to check the time on your watch (or in another, similar situation).
Buttons

Oh, the buttons. I have a lot of mixed feelings about these buttons. These buttons feel tactile enough to not make you wonder whether you pressed them or not, which is a great thing, but Lenovo did this thing where it labelled these buttons with things like ‘Light’, ‘Start’, ‘Mode’, and ‘Reset’ and this naming scheme will throw you off unless you read the manual and figure out what each of these buttons is actually meant to do.

Here’s what I mean. The ‘Mode’ button switches between the date, step-count, distance-measurement, and sleep tracking. That sounds about right, doesn’t it? However, if you’re looking to get to the stopwatch, or if you want a heart-rate measurement from the watch, you won’t find that in one of the modes. Those two features are accessed by pressing the ‘Reset’ button, which is just incredibly unintuitive. But hey, even when you’ve found the stopwatch, starting it is yet another exercise in frustration. You might be tempted to press the button labelled ‘Start’ but that doesn’t do anything. In fact, you’ll have to press and hold the ‘Mode’ button to enter the ‘Pause’ state of the smartwatch, and then press the ‘Mode’ button again to actually start the smartwatch.

Also, when you’re done with the stopwatch, resetting it is not accomplished by the ‘Reset’ button. You’ll have to pause the watch with the ‘Mode’ button, and then press and hold the ‘Mode’ button to actually reset it. It’s just a lot of confusing mess.

What I’m trying to tell you is “Do yourself a favour and read the manual.”

From what I can tell, the button labelled ‘Light’ is probably the only one that actually has a decent label to it. Other than that, all of these buttons are pretty weirdly labelled, and perform wildly different functions than what one would expect.

Once you get used to them, however, this will most likely cease to be a problem for you, but in my experience with technology, you shouldn’t have to “get used” to something… you know, like notches.
Features
Step Tracking

If there is one good thing I can say about the EGO, it’s that it does come with most of the features you are likely to be expecting from it. There’s a step counter, and it’s decently accurate, although it does count around 10-15% less steps than I was taking, based on my own counting of the steps. Still, it’s not that big an issue.

lenovo ego step count

Anyway, as far as step tracking is concerned, the EGO also shows you the distance you’ve walked, and the calories you’ve burnt, which is great, but the watch does sometimes mistake driving in a car as walking so you might get discrepancies in the calories burnt and the steps taken if you drive to and from work often, as I sometimes do.
Heart Rate Measurement

There’s also a heart-rate sensor which, by default, takes a continuous heart rate measurement. Well, I say continuous, but the Lenovo Life app which the watch connects to and syncs with, simply calls it ‘Automatic Measurement’ and says that the watch takes measurements “every once in a while”. The heart rate sensor feels pretty accurate too, and for the most part, readings from the watch and from my Galaxy S10’s built-in step tracker were close enough.

Sleep Tracking

The watch also has sleep tracking capabilities, and while it does track sleep pretty accurately, I didn’t really like the feeling of sleeping with a bulky watch strapped to my wrist every night, and I’m not sure if a lot of people will, either. That said, if you do sleep with the watch on your wrist, the sleep tracking is pretty good, and I don’t really have complaints with it. Also, the watch apparently can track swims as well — that’s something I didn’t test out though.

Remote Camera

Another feature that I thought would be cool, but actually wasn’t, is the remote camera feature. This isn’t an entirely new concept, I could do this with a third party app on my first generation Moto 360 back in the day, but the Lenovo EGO comes with a remote camera feature built in. However, using it can be a pain.

First off, you can’t use your phone’s stock camera app, and you’ll have to go to the Lenovo Life app, tap on Profile, head over to the watch under devices, and then tap on ‘Take Photo’ which will launch an in-app camera. The problem here is two-fold. First, the camera quality of this app is pretty bad; the image gets distorted around the edges and it just looks weird. Two, taking a picture doesn’t come as easily as pressing a button. Instead, you’ll have to shake your watch-wearing hand pretty ruthlessly to actually take a picture. It not only looks weird, but it’s also a pretty annoying gesture to make; plus, it doesn’t work half the time. Or at least I wasn’t able to get it to work properly. If you’re better at shaking your hand than I am, your mileage may vary.
Alarm Clock

The Lenovo EGO doesn’t have a built-in speaker, but that doesn’t hold it back from becoming a pretty solid alarm clock. If you set an alarm using the Lenovo Life app, the watch uses vibrations to wake you up, and yes, it sounded pretty silly to me too, but it’s pretty effective at waking me up. I mean, sure, on the first day I ended up setting my regular alarms on my phone as well, but I decided to risk it on a weekend when oversleeping wouldn’t be an issue, but the watch could easily wake me up, which is great. Setting the alarm isn’t the most easy task to accomplish, since you’ll have to depend on the Lenovo Life app for it, but hey, at least it works and it works well.
Notifications

The EGO wouldn’t qualify as a smartwatch unless it had the capability to notify you of, well, notifications on your phone, and this watch does that, just not as well or as effectively as you’d expect from something like the Mi Band.

Basically, you can enable notification support from the app, and choose the apps you want to receive notifications from. The feature works reliably, and the vibration is strong enough to alert you easily. However, when you receive a notification for something like a message, the watch simply says ‘Message’ on the display, and doesn’t show who the message is from, or what the message says — that’s something the Mi Band 3 can do, and it does it pretty well.

Even for calls, the Lenovo EGO simply mentions ‘Call’ on the display, and there’s no way to reject or answer the call, or even to know who’s calling without checking your phone. To me, this feels like it kind of defeats the purpose of having a watch that can show you notifications. Weirdly enough, the Lenovo Life app does ask for ‘Contacts’ permission as well as the ‘Phone’ permission, which led me to believe that the watch will show at least the name of the person calling, but it doesn’t. I’m not entirely sure why Lenovo wants my contacts if it won’t even show me the name of the person calling, so I have since revoked that permission from the app.
Battery

One of the things that really impressed me about this smartwatch is the battery. Now, Lenovo hasn’t mentioned the battery specifications of the watch, but it does claim a 20-day battery life on it, which is pretty neat on paper.

In real life, the battery life feels somewhat less than claimed. In my entire week of usage, starting from 100%, the watch has dropped down to 40%, which makes it look like it’ll last about 10-15 days on a charge — that’s still pretty impressive, although you’ll have to keep in mind that this display is clearly not a battery hog.

Charging takes place via pogo-connectors on the back of the watch which magnetically align with the charging module that you get in the box, and it takes around an hour to fully charge the EGO, after which it’s good to go for another 10 to 15 days.
Lenovo EGO Review: Should You Buy It?

It’s a pretty difficult thing to recommend or not recommend this watch. After all, Lenovo is offering a very watch-like smartwatch at just Rs. 1,999 and it does a lot of things really well. It’s decently accurate at measuring steps, measuring your heart rate, waking you up in the morning, and telling you the time (duh!). Plus it has a nice battery life. However, it’s also annoying how the buttons are labelled, the notification support isn’t robust enough and is easily beat by the Mi Band 3 (Rs. 1,999), and on a personal note, I don’t find the design to be very attractive.

That said, if you’re looking for a fitness tracker, and you love the design of Casio’s G-Shock line of watches, the Lenovo EGO is definitely worth a look-see. However, if you want more features, a sleeker design, better support for notifications, I’d still recommend the Mi Band 3 over the EGO. Or, if you can extend your budget a little, you can get a color OLED display with the Honor Band 4 (Rs. 2,599)  Asus’ TUF Gaming line of gaming laptops have always been a pretty solid deal with great performance. So when the company sent us the TUF Gaming FX505DT with the new Nvidia GTX1650 GPU, I was definitely excited, and why not? The laptop gets a lot of things right, and Asus claims to offer high-end gaming experiences on this laptop, at a relatively affordable price of Rs.81,990. I have been using the TUF Gaming FX505DT for quite some time now, and this is my detailed review of the laptop, so you can make up your mind about whether or not you should buy this, and if you do, what you can expect from it.
Asus TUF Gaming FX505DT Specifications
Display    15.6-inch FullHD Anti-glare display @120Hz
Processor    Ryzen 7 3750H @2.3GHz
Storage    1TB HDD + 256GB PCIe SSD
RAM    8GB
Graphics    Nvidia GeForce GTX1650 GPU with 4GB GDDR5 VRAM
Connectivity    WiFi 802.11ac; Bluetooth 5.0
I/O    2 x USB 3.0 Gen1
1 x USB 2.0
1x HDMI 2.0
1x RJ-45 Jack
1x 3.5mm headphone and microphone combo jack
1x Kensington lock
Battery    48Whr
Price    starts at Rs. 81,990

For Rs. 81,990, the TUF Gaming FX505DT does offer quite a lot of power. There’s a Ryzen 7 in there, along with the new Nvidia GTX1650 GPU, and an HDD+SSD storage set up.
Design and Build

The FX505DT comes in a very familiar design, which is fine, since the TUF Gaming line up has always had a decent design language that’s neither too out there, nor too shy to show off its beastly side. The outer lid of the laptop has a nice matte finish with an Asus logo in the center which lights up in a soft golden-yellow hue instead of the usual red colors you’d find on other gaming laptops, including the TUF Gaming FX505DY that I reviewed a while back. Personally, I like the combination of black and gold on this laptop.

Other than that, the entire outer chassis of the laptop is devoid of any lighting whatsoever, which might be something RGB lovers won’t like, but makes the laptop suitable not only as a gaming laptop, but also as a work laptop that you can take into meetings without looking silly.

Once you open the lid up, you’re treated to the big, bright, 15.6-inch Full HD display on the laptop, which, as is the case with most gaming laptops these days, has minimal bezels on the top and the sides, and a huge bezel on the bottom with the Asus logo there as well.

asus fx505dt display image

Opening the lid will also throw a huge glow of RGB lighting on your face, thanks to the RGB backlit keyboard, along with the power button on the top right corner, and the trackpad on the bottom. It’s a pretty nice keyboard, even though it doesn’t feel any different from any other TUF Gaming laptop, and it has transparent WASD keys to make them easily discernible from the rest of the keys.

On the sides you’ll find the variety of ports, and the cooling vents with Asus’ anti-dust cooling system.

Build wise, the TUF Gaming series is meant to be, well, tough. It’s right there in the name, and the TUF Gaming FX505DT conforms to US military grade tests, and can apparently handle drops, high temperatures, humidity, and solar radiation. I obviously didn’t test any of these things out, but in my usage of the laptop, I didn’t find myself being too careful with how I handled it and it still looks flawless and works perfectly, so I’m sure you don’t have anything to worry about.

All things considered, the FX505DT is a sturdily built laptop that looks good, and won’t be out of place in a gaming room as well as a meeting, which makes it a pretty solid option for people looking for a gaming laptop that can double up as their daily driver.
Display

The TUF Gaming FX505DT comes with a 15.6-inch FullHD IPS display with a refresh rate of 120Hz, and it looks great. Since this is a 120Hz panel, everything on the laptop feels more natural and fluid. Animations look nice and smooth, and playing games like Far Cry 5 is a treat on this laptop.

What’s more, the display on this laptop can get pretty bright, and really dim if you want it to, so not only can you use it outdoors or in the presence of lights falling directly on the display (thanks to the anti-glare coating), you can also use it late at night without stressing your eyes out too much.

asus fx505dt display image 2

Media consumption on this laptop is great, thanks to the bright panel, and the awesome color reproduction. Viewing angles are decently good enough as well, but I don’t think you’ll find yourself in a situation where you have to look at your laptop from a side very often anyway.

Overall, the display on the FX505DT is a really great one. It’s not the best at separating shades of black, as I found out while testing the display in the black test, but it’s good at gradients, and as far as gaming and everyday use is concerned, the display will not let you down. If anything, games look amazing on this panel.
Performance

With a Ryzen 7, 8GB RAM, and the GTX1650 GPU, the FX505DT brings in pretty solid performance, especially at this price. Having never used a GTX1650 powered gaming laptop before, I wasn’t entirely sure what to expect from this one in terms of gaming, but it’s safe to say that the FX505DT doesn’t disappoint in terms of performance at all.

I tried all the usual things on this laptop, from running synthetic benchmarks like Geekbench, Cinemabench R20, and 3DMark, to playing games like PUBG and Far Cry 5, and the laptop handles everything really well.
Synthetic Benchmarks

In synthetic benchmarks, the laptop scores decently well. Geekbench got a score of 3878 in the single core, and 10550 in the multi-core test, which is good, but I find it slightly weird that thee FX505DY with the Ryzen 5 scored better in thee multi-core test on Geekbench when I reviewed it… not by a lot, but better for sure.

Anyway, in 3DMark, the FX505DT scores 3363 in the Time Spy test, which is ridiculously higher than the score I got on the FX505DY with the AMD RX560X GPU. The laptop also scored 1640cb in Cinebench R20 which is a pretty solid score for a laptop in this price range.
1 of 2

So yeah, as far as synthetic benchmarks are concerned, the FX505DT looks like a pretty solid laptop, but what about real world performance?
Real World Performance

In regular day to day tasks, the FX505DT didn’t even break a sweat, and that’s not really a big deal since my usual workflow includes some Chrome tabs with wordpress and news sources, a Photoshop session, and maybe a couple of tabs with YouTube and Spotify open in them, and that’s about it. Clearly, that’s not nearly heavy enough of a workload to make any difference to this laptop.

However, in gaming too, the FX505DT runs really well. In PUBG, the game defaulted to basically High settings, with just Shadows set to Medium and I was consistently getting frame rates over 70FPS which is awesome.

With everything set to High, PUBG ran smoothly over 70FPS at all times, and when there wasn’t a lot happening around me, the frame rate jumped as high as 90. Sure, you could set the graphics to Medium or Low and get slightly better frame rates, but 70+ FPS is perfect, and I didn’t find the need to set a lower graphics quality in the game.

Far Cry 5 did a weird thing where it chose the integrated AMD GPU by default and ran at, like 12FPS in low settings, but change that to the Nvidia GPU inside this laptop, and it can run Far Cry 5 decently as well. Far Cry 5 is a very heavy game, though, and at Ultra settings, I got an average frame rate of 44FPS. That’s not too shabby, but the frame rates dropped as low as 23FPS sometimes, and that can be really annoying.

In High settings on Far Cry 5, I got an average frame rate of 47FPS, with the frame rates dropping as low as 35FPS and going as high as 59FPS.

That’s decent enough, but personally, I think playing the game on Normal will be the best bet for this laptop. At those settings, I got an average frame rate of 50FPS, with a high of 62FPS and a low of 38FPS.

So yeah, performance wise, the FX505DT is a solid laptop, but it does struggle a bit with heavy games like Far Cry 5. Don’t get me wrong, Far Cry 5 is completely playable on this laptop, especially if you’re good with choosing ‘Normal’ graphics settings in the game, but if you’re thinking of a laptop that can run Far Cry 5 buttery smooth on High or Ultra, this is not it.
I/O and Ports

In terms of ports and I/O, the FX505DT brings all the ports you may need, and nothing extra. There are 2x USB 3 ports, 1x USB 2 port, an HDMI 2.0 port, an RJ-45 ethernet port, and a 3.5mm headphone and mic combo. That’s a pretty decent selection of ports, and I honestly don’t think a lot more than this is truly needed on a laptop, but the lack of a USB Type-C or Thunderbolt 3 port does make this laptop slightly less future proof than something more expensive that you could buy.

In terms of connectivity though, the FX505DT is on-par with current standards. There’s support for WiFi b/g/n/ac (which means you can connect to both 2.4GHz and 5GHz networks on this) and the laptop also comes with Bluetooth 5.0, so you get better Bluetooth connectivity, including lower latency, and a higher range when using Bluetooth accessories with the laptop.
Keyboard

The Asus TUF Gaming FX505DT comes with what Asus calls the ‘HyperStrike Gaming Keyboard.’ Now, I’m not too certain about the HyperStrike thing here, but I have absolutely no complaints with the keyboard on this laptop. The keys have ample travel, and still actuate at a nice distance to make typing or even long gaming sessions comfortable on the laptop, the slight curve on the keycaps makes it easier to discern between keys while typing or playing games without having to actually look at the keyboard.

Another thing I really appreciate on this keyboard is the full sized arrow-key layout, which is such a treat to use instead of the cramped layout a lot of laptop makers are now going with.

Typing on this laptop is a great experience, and even while typing for hours on end, I didn’t feel fatigued thanks to the nice responsive keys here, and the fact that I didn’t need to press them too hard to get them to actuate.

Asus has rated this keyboard for 20 million keypresses, which, well, I’m not counting my keystrokes on this laptop, but that’s definitely a lot, and this keyboard somehow instills me with a confidence that it won’t just break on me — that’s something Asus’ TUF Gaming laptops probably have in common, since my experience with the FX505DY was similar as far as the keyboard was concerned; including things like the extended spacebar that makes it easier to press in the middle of an intense game, and the fact that this is a full sized keyboard, complete with a numpad that I never used, but FIFA players will definitely appreciate.

asus fx505dt keyboard wasd keys

It’s a great keyboard, and I don’t see any reason to not like this, whether it’s for typing, or for playing games — the FX505DT’s keyboard is amazing.
Trackpad

The FX505DT features a trackpad design that will be remarkably familiar to anyone who has used or seen a TUF Gaming laptop before. In fact, it’s basically the same trackpad — not that that’s a bad thing.

The trackpad here is not too big, but it’s not small either, but if you’re used to using laptops with bigger trackpads, like I am with my MacBook Pro, this might feel slightly cramped. In all fairness though, this is one of the bigger trackpads you’d find on Windows laptops, especially in this price range, so I’m not really going to dock points by claiming that the trackpad here is small. It’s actually pretty nice.

I did have to get used to the trackpad, but it works really well, and while clicking on this trackpad isn’t as nice a feeling as it is on something like the HP Spectre, it’s not bad either. If anything, it’s better than most laptops in the price bracket.

All that said, as gamers, I’m fairly confident you’ll be connecting a mouse to this laptop anyway, but for usual day to day usage, this trackpad will definitely suffice.
Audio

I know what you’re thinking: you’ll be wearing headphones most of the time when you’re gaming, but that’s not all you’d do on your laptop, is it? If you’re watching a movie, or bingeing on a TV show, chances are you’ll rely on the built-in speakers on your laptop.

asus fx505dt speakers

Fortunately, you can rely on the speakers on the FX505DT. They can get decently loud, and they don’t distort at maximum volumes, and while the bass isn’t all that great (were you really expecting that?), the overall sound quality of the speakers here is solid, and I didn’t find myself looking for a Bluetooth speaker every time I wanted to watch something on the laptop, which is awesome.
Battery

The FX505DT comes with the same 3-cell 48Whr as the FX505DY I reviewed earlier, and it performs pretty much the same way. The laptop lasts around 4.5 to 5 hours on regular usage, which is actually pretty great for a gaming laptop, and is also very similar to the battery life you’d find on other TUF Gaming laptops. Still, if you’re planning on using this laptop as a regular work machine as well, you’ll need to carry your charger along everyday.

asus fx505dt battery

For gaming, however, I don’t think the battery life needs to be a consideration, since you’ll not be playing games without the charger plugged in anyway, so this part shouldn’t be that big a deal for you.
Pros and Cons

At Rs. 81,990, the FX505DT seems like a pretty solid laptop, but as it is with everything, there are two sides to this proverbial coin as well. So let’s summarise those.

Pros:

    Solid build and design
    120Hz display
    Good performance
    Great keyboard

Cons:

    No Thunderbolt 3, or USB-C ports
    8GB RAM might not be enough

Asus TUF Gaming FX505DT: A Gaming Laptop Worth Checking Out

All things considered, the FX505DT is a gaming laptop that worth checking out. It brings a lot to the table. There’s a good processor in the Ryzen 7, a solid GPU in the GTX1650, a great keyboard, design that’s subtle but not too much so, and a solid build. Sure the selection of ports might feel slightly constricting to some, but it’s not a deal breaker for sure. However, if you’re looking for other options, there are laptops you can check out. Personally, I’d suggest you take a look at the MSI GF63 (Rs. 82,990), which also brings the same GTX1650 GPU, but comes with a Core i7 processor, a 512GB SSD, and even a USB-C port for just Rs. 1,000 extra.

However, if you’re looking for a gaming laptop that’s built to be tough and can run games well, the TUF Gaming FX505DT is definitely worth checking out once it launches in the next week or so.
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Sunday, 28 July 2019

Wellness And Fasting

There truly is no set in stone answer with regards to choosing whether you ought to take an interest in a clinical preliminary at a disease research focus. It is one of the most close to home choices that you will ever make, so it is basic that you talk with your primary care physician and investigate the majority of your choices.

You and your primary care physician will presumably examine your finding, considering how best in class your sickness is and what type you have. This dialog will incorporate a forthright evaluation of your guess, and how successful the standard treatment that you are experiencing is probably going to be.

There are a few sites that you can counsel to discover data in regards to clinical preliminaries in a malignant growth research focus that you might consider. You might most likely discover subtleties on the sort of preliminaries that are being led and the sorts of malignant growth that they address.

Before you take an interest in any kind of preliminary, you have to ask yourself a few inquiries. Discover the reason for the preliminary and why specialists believe that it might be viable. You'll need to know whether the treatment has been tried before in preliminaries like the one that you might take an interest in, and what the consequences of those preliminaries were. Ensure you realize what number of patients are required, to what extent you will be relied upon to partake, and how you will discover the outcomes.

Inquire as to why specialists figure this preliminary will be of advantage to you, and what your other treatment alternatives might be on the off chance that you don't join. Gain proficiency with the majority of the potential dangers of joining, and ask how you will know whether it functions. You'll likewise need to realize whether you'll have to remain in the medical clinic and how regularly you'll have to visit the malignancy research focus that is leading the preliminary.

On the off chance that you do choose to take an interest, realize that you will almost certainly leave the preliminary whenever and in any capacity whatsoever. There is a plausibility that on the off chance that you leave the preliminary the human services suppliers will presumably need to keep observing you for quite a while a short time later with the goal that they can check whether you are having any long haul impacts from the treatment that you got.

Your protection strategy might be approached to pay for any standard methodology, medicines, or tests that you would typically experience through ordinary treatment. Any exploration related expenses are typically dealt with by the patron of the preliminary. Make sure that your protection supplier will take care of the expenses of customary treatment in the event that you do take part. On the off chance that you have any inquiries at all, converse with your primary care physician or the malignancy research focus that is directing the preliminary. In the event that we characterize health as the general prosperity of our entire body, it is astounding what advantages discontinuous fasting can have for us. Fasting has been a segment of wellbeing for a long time. In Bible occasions Jesus said that on the off chance that you had the confidence the size of a grain of a mustard seed, you could move mountains and nothing would be incomprehensible for you. He proceeded to state that was just conceivable through petition and fasting.

Give me initial a chance to characterize the contrast between discontinuous fasting and ordinary fasting. In normal fasting one would refuse all eating and just beverage water for somewhere in the range of 24 hours to up to a month. In discontinuous fasting you would go without eating anything from 16 to 20 hours per day.

Discontinuous fasting has demonstrated extremely gainful in normalizing body weight. It is prescribed that you would have an enormous breakfast comprising of entire grains, natural products, and protein. Your supper would then comprises of in any event 75% plant-based sustenances. The less prepared the better. Research demonstrates that 10 hours after your last dinner your body will meet half of its vitality needs from put away fat.

When you consider the measure of poisons and toxins that are in our lives today irregular fasting bodes well. Research has demonstrated that this sort of fasting disposes of about 35% of the poisons that aggregate inside our bodies.

This sort of fasting when joined with moderate exercise causes you to have better mental clearness, a feeling of enthusiastic prosperity, feel physically better, and improve our otherworldliness. This sort of fasting with the end, or if nothing else incredibly decreasing, the measure of handled sustenances that we take in has been demonstrated to be very successful and weight reduction.

It is significant that the eating some portion of the day begins toward the beginning of the day. This takes into account your stomach to be unfilled while you are dozing and enables the body to apply all its vitality to cleaning and reestablishing your body. We regularly don't understand how much vitality is expended in the absorption of nourishment.

It appears that a considerable lot of our social exercises rotate around nourishment. A large number of these occasions appear to occur at night. One of the upsides of irregular fasting is that it doesn't need to be done each day. 4 to 5 days seven days appears to bring great outcomes for a great many people.

There are a few people who discover better achievement when they crush the juice of a crisp lemon into a quart of water and after that taste the water regularly to decrease any appetite desires. The lemon juice is by all accounts a guide in the purging and detoxifying of the body too. Moderate exercise, for example, strolling is likewise valuable to the purging and detoxification. Any person with glucose issues needs to screen and change the fasting as required. Much has been going on and have not had the option to take care of the dialogs of gluten free living! However my concentrate every day is to keep on staying sound, and on tract in my solid way of life! Some of the time it is difficult, yet I have had the option to keep with it with my methodology in living gluten free.

On the off chance that you are gluten touchy or living with Celiac Disease for what reason is it essential to your wellbeing to stay on a gluten free eating routine? A considerably increasingly significant inquiry is the reason should your eating routine incorporate just genuine nourishment? No prepared, fabricated, boxed, garbage horrible sustenance! As per Dr. Osborne of the Gluten Free Society the best way to mend is to wipe out every one of those nourishments that are fabricated! There are such a large number of fixings that are not the slightest bit valuable in those made nourishments for anybody eating a gluten free eating regimen for wellbeing reasons.

In the voyage of living gluten free the time has come to get genuine and understand that a tad of gluten is a gigantic medical issue. The time has come to understand that on the off chance that you need to turn into a more advantageous rendition of you, you should start to set aside the effort to discover that this awful bundled "gluten free" sustenance is basically an advertising bargain that isn't to your greatest advantage.

The aim of the message today is to enable you to understand that carrying on with a sound way of life is tied in with eating genuine sustenance. You realize that sustenance you get from the nourishment store that does exclude a fixing list.

Nourishments that you get ready in your very own kitchen that in spite of the fact that you may at the outset state take more time to cook truly don't. For instance, we can make a pork tenderloin supper with sweet potato and kale in 30 minutes. All fixings are originating from the ranch, fed pork, natural veg, natural flavors that have no additional gluten to them!

You can succeed in the event that you start to change your frame of mind. Eating an eating routine free of gluten can be astonishing, eating stunning sustenances is such a recuperating, superb approach to convey what needs be. Appreciating flavors that any boxed made nourishment impersonations will never permit.

Right now is an ideal opportunity to think about what are you doing today? On the off chance that you are gluten delicate or Celiac what are you eating? What is on your menu for today around evening time? These are significant inquiries in such a case that you "neglect to design, you intend to fall flat!"
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Wednesday, 17 April 2019

A mindful worker is a happier worker

When I gave a talk at Google a few months ago about using mindfulness to help relieve anxiety, depression, and other common forms of psychological distress, I was impressed by the company’s commitment to taking care of their employees. From the organic juice bars in every building to the gyms and meditation and yoga facilities scattered around the campus, it was clear that they’re thinking a healthy employee will be a productive employee (not to mention an employee who needs fewer expensive medical services). In fact, they had a whole team devoted just to teaching mindfulness meditation, and offered regular practice sessions that workers could attend either in person or online throughout the day.

But can mindfulness practice really help employees’ mental health? Is it something that more businesses should be investing in, or just another fad for ex-hippies in Silicon Valley? The results of the best-designed study to date that addresses this question are just in, and the answer is impressive: mindfulness really can help workers, even those far from California.
What the study found

The new study comes from Taiwan, where researchers surveyed 3,270 factory workers to identify those with high levels of psychological distress. They then invited these particularly unhappy workers to participate in the study. The 144 workers who ultimately agreed to participate were assigned to either an active intervention group, in which they completed an eight-week mindfulness training program consisting of two-hour classes each week at work and 45 minutes of daily meditation homework, or a control group, who reported regularly on their psychological well-being but didn’t receive any mindfulness training.

What did they find? Compared with the control group, the workers who took the mindfulness class reported feeling much better. They had less prolonged fatigue — that feeling of exhaustion that doesn’t go away even after having a chance to rest. They also felt less stressed, reported reduced anxiety and depression, and had fewer sleep difficulties, aches and pains, and problems getting along with others.

So what exactly was this mindfulness training that helped them? Mindfulness involves bringing our attention into the present moment and accepting whatever is happening here and now. That sounds very simple, but when we begin to try to actually practice mindfulness — by picking a sensory experience such as the breath, bringing our attention to it, and working to accept whatever arises in our awareness — most of us find not only that our minds quickly wander off into all sorts of thoughts about the past and the future, but they also generate all sorts of negative judgments about what’s happening.

The good news is that like any skill, mindfulness can be learned. It just requires a bit of instruction, and setting aside some time to practice. Numerous research studies have shown that by practicing mindfulness, we can actually change both the structure and the functioning of our brains in ways that are consistent with feeling happier and more engaged in our lives. These changes also help us to have an easier time dealing with both physical and emotional pain.
How you can reap the benefits of mindfulness

So how might you begin if you wanted to become more mindful? One way that doesn’t require any extra time is to simply pick a few activities, such as walking the dog, showering, or eating a meal alone, and decide to do them as mindfulness practices. That means instead of checking our smartphone, going over our to-do list, or listening to music, we try to bring our attention to the sights, sounds, and bodily sensations occurring during the activity. Since mindfulness practice is very dose-related, the more we try to do this throughout the day, the more mindful we become.

While these informal practices will indeed help you to develop some mindfulness, to develop more, it’s helpful to set aside time for meditation practice, like they do at Google. Most studies documenting the effectiveness of mindfulness involve people meditating regularly. It’s easiest to begin a regular meditation practice by following recorded instructions. While there are many sources for these, you can listen for free to some that I recorded It is abundantly clear that smoking damages the heart, the lungs, and virtually every other body system. According to the Centers for Disease Control and Prevention, smoking remains the leading cause of preventable death in the United States.

So why do people do it?

It’s the nicotine. This stimulant, found in all tobacco products, makes smokers feel calm and relaxed — and it can quickly lead to addiction. The more you smoke, the more you need to smoke to feel good. It’s the pull of nicotine that makes quitting so difficult.

But what if you could reduce the amount of nicotine available in cigarettes to begin with? Would it help people quit — or might it cause them to smoke more to compensate?

Recently, a team of researchers set out to answer this question by following more than 800 adults who smoked at least five cigarettes a day. These study volunteers had no desire to quit smoking. They were asked to either continue smoking their regular brand of cigarette or to smoke one of six types of investigational cigarettes that had varying amounts of nicotine, ranging from 15.8 milligrams (mg) of nicotine per gram of tobacco (the amount found in most commercial brands) all the way down to 0.4 mg per gram. The smokers were followed for six weeks. The results of the study were published in today’s New England Journal of Medicine.

These results were unexpected. The people given the lower-nicotine cigarettes smoked 23% to 30% fewer cigarettes per day than those who smoked the cigarettes with 15.8 mg of nicotine per gram. Perhaps even more surprising, the low-nicotine cigarette smokers also had reduced dependence on nicotine — and fewer cravings for cigarettes when they weren’t smoking.

This study lasted only six weeks, so we’ll need longer trials to help us really understand whether low-nicotine cigarettes are a “safer” option for people who are determined to smoke (as many as one in five Americans is a current smoker). However, these findings do suggest that if the nicotine content in commercial cigarettes could be lowered, users would smoke less and be less likely to get “hooked,” which could mitigate the health risks associated with smoking.

For those who do want to cut out nicotine, there are good options that can help them meet the challenge. They come in many forms, from nicotine patches and gums to lozenges and nasal sprays — not to mention e-cigarettes, which work by vaporizing nicotine. E-cigarettes have become wildly popular, but to date, we don’t know for sure that they are safer than regular cigarettes, or that they can actually help people quit. Prescription drugs like bupropion (Zyban) and varenicline (Chantix) can also help smokers quit. All of these methods work especially well when combined with behavioral supports, such as talk therapy. Of course, it often takes multiple attempts to quit before succeeding — but it can be done. Being an overweight child is no picnic — it can be hard to keep up with your friends on the playground, you can’t wear some of the same styles of clothing other kids do, and the teasing can be merciless. New research published in The New England Journal of Medicine shows that the damage goes beyond the social and emotional, too.

This study, entitled “Cardiometabolic Risks and Severity of Obesity in Children and Young Adults,” enrolled almost 9,000 children and adolescents ages 3–19 who were either overweight or obese (severely overweight). Doctors tested these young people for high blood pressure and cholesterol, diabetes, and other important risk factors for heart disease. On average, the most severely obese children and teens had higher blood pressures, worse cholesterol profiles, and higher blood sugar levels than those who were just overweight. This association was true even when taking into account race, ethnicity, gender, and age.

This was a cross-sectional study, meaning that it did not follow patients forward in time to see what happened to them. Rather, it examined each patient “in the moment” and identified factors that doctors believe affect the risk for future heart disease. So, based on the information in this study, we can’t tell which of these young people eventually went on to develop heart disease. However, we do know that, for adults, controlling blood pressure, cholesterol, and blood sugar are critical to preventing heart disease. It is reasonable to infer that this would also hold true for children.

The majority of the study volunteers were ages 12–19. So it also seems reasonable to conclude that the more severely obese a teenager is, the greater the likelihood that he or she will go on to develop heart disease. The study also found that the boys and young men tended to have more concerning test results, raising the concern that childhood obesity might be particularly hazardous for them.

This study is incredibly important because it supports what pediatricians have feared for many years now, ever since we noticed rising rates of obesity among our younger patients: if we don’t find ways to help our kids achieve and maintain a healthy weight, we are going to see them become adults who suffer from heart disease at higher rates and at younger ages than ever before.
Helping children achieve a healthy weight

The great news is that we can do something about this! Weight loss interventions do work for younger patients, and are becoming more accessible.  Most importantly, we should realize that even a little bit of weight loss can go a long way to living a healthy life, and this is important at every age.

If your child is overweight, I hope that learning about this study encourages you to talk to your pediatrician about helping him or her (or yourself!) lose weight. Ideally, make a plan as a family. Make it a goal for Mom, Dad, and all the kids to get lots of exercise and eat a healthy, well-balanced diet.

Before placing your child on a diet, or enrolling him or her in a weight-loss program, talk it over with your pediatrician. Don’t be embarrassed to do so! I can guarantee you that your doctor has seen many kids struggle with weight and has some expertise on the subject. Together you can create a plan of action that is right for your family and your child.
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Friday, 12 April 2019

Reversing the effects of the new anti-clotting drugs

Pediatricians and child behavior specialists who work with teens know that adolescence is an incredibly important time for social growth. Yet these years can be fraught with anxiety for the parents of teens. How will you know if your moody teen is hanging out with the right people? Which friends might be a bad influence? How can you help your son or daughter develop healthy relationships?

Recent research has addressed some aspects of these questions. One study entitled “Spreading of healthy mood in adolescent social networks,” published this year in the Proceedings of the Royal Society of London, investigated whether a teen whose friends have a healthy mood is less likely to be depressed. It also looked at how emotionally healthy friends affected a teen’s recovery from depression. Basically, the researchers wanted to find out: is a good mood contagious?

The study involved roughly 3,000 teens. Each study volunteer completed two surveys, six months apart, in which he or she listed up to five male and five female friends. Each teen was then followed over time, to see how his or her mood changed.

One of the interesting things about this study is that these researchers defined depression as a behavior, not necessarily as a disease that someone could get. This allowed them to do their statistical analysis a little differently from previous studies looking at the same subject matter, and it uncovered the potential power of positively minded friends.

The investigators found that having a social network made up of friends with a healthy mood cut a teenager’s probability of developing depression in half over a 6- to 12-month period. It also significantly improved the chances of recovering from depression for teens who already suffered from it. While the data don’t show a direct cause and effect, this study does suggest that having friends with a healthy mood may reduce the risk of depression and make it a little easier to recover from depression should it occur.
Surprising findings on from social networking research

This study is a nice example of a recent trend in epidemiology — using data about an individual’s social network to learn things about that person. This type of research has led to numerous interesting findings, and has really shaped an entire new area of inquiry. A study published in 2007 in The New England Journal of Medicine was one of the first of this kind. It showed that people who had obese friends and family were themselves more likely to be obese. Since then, additional research has looked at how social networks influence an individual’s risk of developing (or sidestepping) specific health conditions, such as obesity, smoking, and depression.

Results of these studies have been, at times, surprising, thus giving the medical community valuable new information. For example, I myself led a study in 2011 called “The influence of social networks on patients’ attitudes toward type II diabetes.” When I started this research, I supposed that patients would be less concerned about having diabetes if more of their friends and family members had diabetes. I had guessed that these patients might have become so used to the idea of diabetes that the disease would seem common and almost normal. But in fact, my team found the opposite! Patients with a higher prevalence of diabetes within their social networks expressed greater concern about their illness. This unexpected result gave me information that helped me to better take care of my patients.
Using social network data to improve your teen’s mental health

This type of research is not only helpful to doctors, but it also provides important information for anyone trying to improve his or her own health, or the health of one’s family. The study on positive mood in teens’ social networks suggests that parents may be able to reduce their teen’s chances of developing depression — or improve her or his mood if she does have depression — simply by promoting and supporting friendships with emotionally healthy peers. With much controversy about using antidepressants in teens, results such as these can give parents a simple way to promote emotional health and well-being in their adolescent children — with no medications involved. The oral anticoagulant warfarin (Coumadin) became available for prescription in 1954. This anti-clotting drug commanded national attention when President Dwight Eisenhower received the drug as part of his treatment following a heart attack. No other oral anticoagulant was successfully developed and marketed in the United States until 2010.

Warfarin is a dangerous drug. Along with insulin, it is responsible for the most emergency hospitalizations due to adverse drug reactions. Whereas insulin causes low blood sugar, warfarin is notorious for the complication of major bleeding. Warfarin is plagued by hundreds of drug-drug and drug-food interactions. The optimal dose is determined by monitoring the level of anticoagulant in the blood. Standard-intensity anticoagulation with warfarin is usually targeted to achieve prothrombin blood test results, expressed as international normalized ratio (INR), within a range of 2.0 to 3.0. If the INR is greater than 3.0, the warfarin dose is decreased to prevent excessive bleeding. If the INR is lower than 2.0, the warfarin dose is increased to prevent excessive blood clotting. This approach is slow, cumbersome, and frustrating. Even when the INR tests within the desired range, catastrophic bleeding complications, such as bleeding into the brain, can still occur.

Patients and health care providers complain about the difficulties and inconveniences of trying to use warfarin properly. Multiple algorithms and even genetic testing have been undertaken with the hope of deriving an easy-to-follow dosing scheme, but these efforts were disappointing overall.
Enter the new anticoagulants

In a remarkable five years spanning 2010 through 2014, four novel oral anticoagulants underwent pivotal trials for stroke prevention in atrial fibrillation, as well as treatment of pulmonary embolism and deep vein thrombosis. The four new drugs have better safety profiles than warfarin, and some are more effective than warfarin for stroke prevention in people with atrial fibrillation. All four were rapidly approved by the Food and Drug Administration to treat these thrombotic conditions. One, dabigatran (Pradaxa), is a direct thrombin inhibitor — that is, it inactivates clotting factor II (thrombin). The other three — rivaroxaban (Xarelto), apixaban (Eliquis), and edoxaban (Savaysa) — inactivate clotting factor X. None of these target-specific novel anticoagulants requires regular laboratory monitoring. They are administered in fixed doses. There are virtually no restrictions on foods such as green leafy vegetables, as there are with warfarin. And there are only about a dozen important drug-drug interactions.

As this wave of new oral anticoagulants came to market, there were predictions (which turned out to be false) that warfarin would rapidly become an infrequently used anticoagulant. At Harvard-affiliated Brigham and Women’s Hospital, we have about 3,500 patients in our Anticoagulation Management Service who still receive warfarin. So, why were the initial predictions wrong? And why does warfarin continue to command more of the “market share” than these target-specific designer-drug anticoagulants?

The biggest concern is that the novel oral anticoagulants have not, until now, had specific antidotes to counteract major bleeding. Warfarin is a vitamin K antagonist, so a dose of vitamin K is an antidote to warfarin — though one that works slowly and unreliably. But the fear with the novel oral anticoagulants has been that the rare episode of major bleeding might not be controllable or rapidly reversed.
New antidotes pave the way for greater use of the new anticoagulants

The landscape changed drastically in October 2015, when the FDA approved a dabigatran antibody as an antidote to dabigatran. After a rapid intravenous injection of the antidote, dabigatran is attracted to its own antibody at least 300 times more strongly than to thrombin (clotting factor II). When dabigatran and its antibody bond, thrombin is liberated from dabigatran and can do what clotting factors do best—stop the bleeding. In an ongoing clinical trial, laboratory evidence of anticoagulation from dabigatran was reversed within minutes of injecting the dabigatran antibody antidote. Hospitals across the United States now have the dabigatran antibody available for emergency use.

Though catastrophic bleeding from the novel oral anticoagulants is extremely rare, the availability of antidotes reassures health care providers, patients, and their families. It changes the psychology of prescribing and tilts the balance more strongly toward the novel agents.

As for rivaroxaban, apixaban, and edoxaban, a universal antidote is in late and successful stages of clinical development. This antidote is not an antibody, but it is an attractive “decoy” for these three anticoagulants, all of which target clotting factor X. The antidote is more attractive to the anticoagulants than factor X is, even though it is only slightly modified from the structure of factor X. The decoy, which is inert, “fools” these three anticoagulants. They then detach from clotting factor X and bind to the decoy instead, liberating the unbound clotting factor X to stop the bleeding.

In summary, these two antidotes are important “backups” to our arsenal of novel anticoagulants. They permit us to prescribe the new agents with increased confidence. Regular exercise is one of the cornerstones for maintaining good health. Regular physical activity helps to prevent heart and blood vessel disease, diabetes, dementia, and even some types of cancer. But while the health benefits of exercise are indisputable, there is still a question about exactly how much exercise is needed to promote optimal health.

According to a recent article in The Journal of the American Medical Association by Thijs Eijsvogels and Paul Thompson, the answer may be “not as much as you might think.”
Every little bit of exercise counts

Drs. Eijsvogels and Thompson reviewed several published studies and concluded that as little as 15 minutes a day of moderate-intensity exercise — and only 8 minutes a day of vigorous-intensity exercise — reduced the risk of death. They referred to this as the “lowest effective dose.” This means that even a small amount of exercise may have substantial health benefits compared with being sedentary, and even people who are “too busy to exercise” can find this amount of time.

Exercising beyond the lowest effective dose had further health benefits. For every additional 15 minutes of moderate-intensity exercise, there was a further 4% reduction in the risk of death. The greatest benefit was seen in people who exercised for an average of 63 to 88 minutes a day, and vigorous-intensity exercise was better than moderate-intensity exercise.

Another new study, published in JAMA Internal Medicine, found that young adults who were physically fit (as measured by endurance testing on a treadmill) had a lower risk of developing heart and blood vessel disease over the next three decades. For each additional minute a person was able to stay on the treadmill, there was a 15% reduction in the risk of death and a 12% reduction in the risk of heart and blood vessel disease.
Putting the “lowest effective dose” of exercise to work for you

Taken together, these two new studies further underscore a single conclusion: you don’t have to be a triathlete to achieve health benefits from physical activity. Even small amounts of exercise and modest increases in fitness can make a clear difference, and some exercise is always better than no exercise.

If you need to increase your level of physical activity, it may be a good idea to start by counting your daily steps using a Fitbit or similar device (there are also free apps for your phone or tablet that can count your steps). Gradually increase your daily goal, and before you know it, you will be on track towards having a longer and healthier life.
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Tuesday, 9 April 2019

How to maintain your health living status

My mother was lucid and alert when she was hospitalized for pneumonia. But by the middle of the first night, she was wondering how she had ended up at a “hotel” that allowed strangers to enter her room at all hours. The second night, she wandered into the corridor, slipped, and fractured a hip. She didn’t leave the hospital alive.
What is up guys it is I cannot hear and we got a very special episode because they I am back with

today’s Tips is why is French So Dan sexy because me personally as an American as someone who learn French I learned it you know little little bit because it has such a reputation for being so

happy. So and it’s funny because a lot of French people are Belgian people like French is not last section. But for us Americans. It really is like a language of this language of love. It’s a language of just just pure unadulterated sexiness heard that so many times when people are telling me all this sounds so sexy.

I mean it’s normal for me is true is cheating because you got a nice voice to you know, maybe to basically how this video is going to work is I’m going to have five sentences that I’m going to say well she’s going to say them in first and French and I’m going to say the English version and you guys can tell me what sounds sexier in the comments below. And then after that we have a little bonus.

So the other five senses is I’m going to be speaking in my other languages and where to be comparing those languages to French. So for example, like Japanese versus or Russian versus French etc. Alright, are you ready for this?

Yeah.

Alright, so the first one the sound sound as sexy as possible, you know, look into the camera do what you gotta do

now in English, your feet need to buy some so

I think French would add like a French sexiness. You know,

we will definitely video editor put that in A Meeting if you fall down 1000 times get back up 1000. I don’t know. I don’t know. What would you feel about that guys? Yeah, yeah, you guys have to tell us like best for every sentence you can put in the comments below. Like, for example, I was sentence number two. You just put like, you know, 1-234-567-8910 and you can say like, either friend or sexier or English or another language that the sexier right so got it done in English. That dude is

can’t even see this anymore. I don’t I don’t know what to do. I feel trapped.

Okay, that dude is so dirty he never wash. I would have to get that to French in French. I don’t know it sounded like you were just talking about it kind of felt like I was giving you some company yeah

Related Post: Best Way to Learn French at Home for Free

yeah was like it was like you know anyone anyone that was speaking English the walks by would be like

instead of you’re like, really? Like it was actually nice to know many languages because you never know if someone is talking shit behind your back. Yeah, happened to me so many times when I was traveling in so many fights, just because people were like talking shit behind me. But they didn’t know it’s being friends. They love to do it to do it. Unfortunately, for me, even though there’s like six languages that I understand. I haven’t actually had the experience. I don’t know why. I don’t think people will really talk shit about why

Next one

is we can Play play play. Oh please. Alright so it’s Can I have some eggs with bacon and cheese and do some little bit better French? I don’t know this is a big no

no, no. Sometimes people like my mom always says like sometimes at soccer like people are like yeah there’s like a recipe recipe boys and I like this and normal Yeah, but in some ways like this normal so you know, it’s

all right. Next one. Let me wait. Was that sexy? way too much. That was that was like I’m fine. The translation was follow me on Instagram I can I take the best photos that’s what’s up and you should her influence Mana Mana mine is I can obey and now we’re getting to the bonus round all right but obviously be sure don’t forget to comment what you thought one every single sentence little battle every single sentence and now we’re going on to sentence number six I am pretty sure I’m going to see some comments from American people home saying own lead different oh don’t do that to her no come on come on okay so it’s going to be Dutch and since it’s a different language I’m gonna say it first so first let me say the English translation you are unbelievable I’m very impressed to indulge it is a bet on hopefully you’ve been air under the intro Wow tell us what you think is in the next one is Chinese

New sure pretty good

not bad phrase I put in Chinese The next one is you know next one is Japanese

I’m really gonna try with this one

Facilitate Why are you taking

up the sexy we’re gonna crank up let’s crank up the the sexiness level that mean that means like from this point on forget about me

that’s become I don’t speak Spanish is my next language. So I got to put a little bit of spice in the Japanese for now. You know will be more. Okay, sure it is. We wait. I gotta be more.

Yeah. Oh

actually I wanted to do another Chinese one. Just

throw it in there again, iTunes, Joshua. Ciao. Ciao.

Basically what I said was love and french fries are basically the same thing.

Give it to give it some some prison one as far

Alright guys so we have come to the final one I hope it has been interesting so far but now it’s time to get serious and sexy to want to go with Russian and

yeah

because when you have to push it really sounds like you know what I said was I wanted tickle your belly but never know you never know when that phrase might you know might come up because like this the way you said it was very late so I will freak out freak out.



That was not bad. Not bad. I’m not sure which one sounds sexy though but obviously

I had to include at least one funny phrase in there otherwise

well yeah that was a little sexiness competition and I think for the most part French came out on top for a lot of different things but maybe one or two of the other languages or maybe even you find English to be sexy but you gotta let us know so definitely let us know in the comments again this is Brendan monitor Instagram right here definitely go follow her you know she’s on the quest to hit that 50 k myself I’m on the quest to hit that 10 k I’m getting close to I think I like 7000 something followers now so it would be dealt if you guys uh. You know show your support and give us a follow that’s my music to me and and she has a music coming soon. So definitely, you know, show your support give us some love and hate that follow one as well as of course subscribe And yeah, guys, thank you so much.

Her story, though extreme, is sadly typical. According to several major studies, about half of people over 65 have episodes of delirium — a sudden change in mental status — during hospital stays, and those who do are at increased risk for falling, requiring nursing home care, and developing cognitive impairment and dementia.

It’s easy to understand why hospitalization can be disorienting. Your daily routine is overturned, you are introduced to a stream of new caregivers, and it’s hard to sleep through the night. Anesthetics or sedative medications can also affect your mental state. But decades ago, Dr. Sharon Inouye, professor of medicine at Harvard Medical School, recognized that delirium in older patients isn’t an inevitable consequence of hospitalization.
HELP during hospitalization

Dr. Inouye and colleagues developed the Hospital Elder Life Program (HELP). Available at 200 hospitals in the United States, HELP involves identifying patients at risk for delirium when they enter the hospital and assigning them to receive special care to minimize six major risk factors associated with delirium — cognitive impairment, sleep deprivation, immobility, visual impairment, hearing impairment, and dehydration. Studies have found that HELP is associated with significant reductions in the percentage of patients who develop delirium. It is also linked to fewer falls while in the hospital, shorter hospital stays, fewer nursing home admissions, and a lower rate of cognitive and physical decline.
What you can do to avoid delirium

If you or a loved one is scheduled for a hospital stay, ask whether your hospital has HELP or another program for preventing delirium. If not, there are several things you can do as a patient or caregiver.

If you’re going into the hospital:

    Gather your records. Prepare a “medical information sheet” listing all your allergies, the names and phone numbers of your physicians and your usual pharmacy, all your medical conditions, and all the medications — both prescription and nonprescription — you’re currently taking. Have your medical records forwarded to the doctors who will be caring for you.
    Bring the essentials. You’ll need your glasses, hearing aids and fresh batteries, and dentures. Ask if you can bring a few familiar things like family photos, a good book, or an MP3 player with your favorite music or relaxation exercises.
    Set up a support team. Let family and friends know you’re being hospitalized and ask them to visit.

If you’re a caregiver:

    Arrange companionship. Schedule family and friends to visit in shifts — and stay overnight, if possible.
    Work with the nurses. See if they’d like your help in encouraging the person to eat, stay hydrated, and to participate in rehabilitation therapy.
    Be vigilant. If you notice signs of confusion, memory problems, or personality changes, let the nurses or physicians know immediately.
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Friday, 5 April 2019

Farewell to the fasting cholesterol test

Over the last year, the general public has been inundated with a steady stream of reports about the dangers of opiates — pain medicines like codeine, Percocet, and OxyContin. The harm in terms of ruined lives and death from illicit drugs such as heroin is not news. But what is new, and concerning, are the risks of prescription pain medicines — those doctors prescribe for pain due to a range of causes, including musculoskeletal problems like low back pain.
The history of using opiates for chronic pain

Back pain isn’t a new problem either, but the history of how doctors have treated it is probably new to many. A “cliff notes” version of what changed goes something like this. Studies showed that doctors weren’t adequately treating the pain of people with advanced cancer. Research also showed that pain medicines such as opiates improved quality of life for these terminally ill patients. This realization led to recommendations that doctors monitor pain as they would any other vital sign (like temperature or blood pressure) for all their patients — and that all types of pain receive aggressive treatment, including long-term (chronic) pain, such as low back pain. At the same time, drug companies promoted new formulations of opioid medications with longer duration of activity that made it easier for patients to take on a regular basis.

The problem was that this fundamental change in practice was really devoid of any proof that it would help people better manage pain and minimize its effect on their lives. Prior reviews of the medical literature have documented that there is little evidence supporting the use of opiates for chronic low back pain. The modest benefits seen were with short-term use. The practice of using these medicines for long periods of time has not been carefully evaluated. Few risks were seen in these short-term studies, but tolerance to the effects of the medicine, side effects and dependence/addiction have become clearer with longer use.

A recent study published in JAMA Internal Medicine adds to this knowledge. Dr. Abdel Shaheed and colleagues performed an updated literature review, and their conclusions reinforce that only short-term benefits have been proven and the amount of that benefit is modest. Moreover, they examined the doses of pain medicines used in these studies and found that the pain relief people actually experienced was not that great.
Opiates for chronic low back pain carry big risks with uncertain benefits

This and prior studies clearly show that the leap to widespread use of opiates for non-cancer pain was premature. We didn’t know the long-term benefits and risks. We still don’t know the benefits, but this dramatic increase in use of pain medicines hasn’t helped people return to their previous level of activity, and rates of disability haven’t gone down. What is becoming clear are the risks, specifically rates of addiction, overdoses, and the rise of deaths attributed to prescription opiates. And people who have become addicted to their prescribed pain medicines often switch to heroin, which is cheaper and more readily available.

Now this doesn’t mean that we should stop treating pain. For many, the pain is real, chronic, disabling, and they need help managing it. And it doesn’t mean that everyone prescribed opiates becomes addicted. Nor does it suggest that opiate medicines have no benefits at all. But what it should do is give all of us pause. The bottom line is that simply taking a pill (or a handful of pills) doesn’t fix low back pain — and can lead to a whole lot of trouble.
What you can do for back pain

Fortunately, there is growing evidence for treatments that can help with chronic low-back pain, but they aren’t simple fixes in the form of pills, shots or surgery. Instead, treatments should focus on getting back pain sufferers active again and learning to manage, not cure, the pain. A range of therapies including exercise, education about how to care for your back, yoga, and mind-body techniques have been shown to help control back pain. Over the last year, the general public has been inundated with a steady stream of reports about the dangers of opiates — pain medicines like codeine, Percocet, and OxyContin. The harm in terms of ruined lives and death from illicit drugs such as heroin is not news. But what is new, and concerning, are the risks of prescription pain medicines — those doctors prescribe for pain due to a range of causes, including musculoskeletal problems like low back pain.
The history of using opiates for chronic pain

Back pain isn’t a new problem either, but the history of how doctors have treated it is probably new to many. A “cliff notes” version of what changed goes something like this. Studies showed that doctors weren’t adequately treating the pain of people with advanced cancer. Research also showed that pain medicines such as opiates improved quality of life for these terminally ill patients. This realization led to recommendations that doctors monitor pain as they would any other vital sign (like temperature or blood pressure) for all their patients — and that all types of pain receive aggressive treatment, including long-term (chronic) pain, such as low back pain. At the same time, drug companies promoted new formulations of opioid medications with longer duration of activity that made it easier for patients to take on a regular basis.

The problem was that this fundamental change in practice was really devoid of any proof that it would help people better manage pain and minimize its effect on their lives. Prior reviews of the medical literature have documented that there is little evidence supporting the use of opiates for chronic low back pain. The modest benefits seen were with short-term use. The practice of using these medicines for long periods of time has not been carefully evaluated. Few risks were seen in these short-term studies, but tolerance to the effects of the medicine, side effects and dependence/addiction have become clearer with longer use.

A recent study published in JAMA Internal Medicine adds to this knowledge. Dr. Abdel Shaheed and colleagues performed an updated literature review, and their conclusions reinforce that only short-term benefits have been proven and the amount of that benefit is modest. Moreover, they examined the doses of pain medicines used in these studies and found that the pain relief people actually experienced was not that great.
Opiates for chronic low back pain carry big risks with uncertain benefits

This and prior studies clearly show that the leap to widespread use of opiates for non-cancer pain was premature. We didn’t know the long-term benefits and risks. We still don’t know the benefits, but this dramatic increase in use of pain medicines hasn’t helped people return to their previous level of activity, and rates of disability haven’t gone down. What is becoming clear are the risks, specifically rates of addiction, overdoses, and the rise of deaths attributed to prescription opiates. And people who have become addicted to their prescribed pain medicines often switch to heroin, which is cheaper and more readily available.

Now this doesn’t mean that we should stop treating pain. For many, the pain is real, chronic, disabling, and they need help managing it. And it doesn’t mean that everyone prescribed opiates becomes addicted. Nor does it suggest that opiate medicines have no benefits at all. But what it should do is give all of us pause. The bottom line is that simply taking a pill (or a handful of pills) doesn’t fix low back pain — and can lead to a whole lot of trouble.
What you can do for back pain

Fortunately, there is growing evidence for treatments that can help with chronic low-back pain, but they aren’t simple fixes in the form of pills, shots or surgery. Instead, treatments should focus on getting back pain sufferers active again and learning to manage, not cure, the pain. A range of therapies including exercise, education about how to care for your back, yoga, and mind-body techniques have been shown to help control back pain.

So what do I tell my patients? For those with chronic back pain who aren’t on opiates, steer clear. For those who are already take them, you can’t go cold turkey. Your body has adjusted to these medicines and stopping them abruptly is a bad idea. With help, people on opiate pain relievers can try to wean themselves off these medicines gradually and replace them with other treatments. This isn’t easy, but for many people it starts a long process of regaining control over the pain that has taken over their lives and can help them avoid the terrible consequences of opiate addiction. At a recent meeting I offered a visitor lunch which she declined with obvious regret. She was hungry, and it was noon. But she was headed to her annual physical, and eating beforehand would mean returning another morning for a fasting cholesterol level. Most of us can relate to her annoyance, but thankfully this may soon be a thing of the past.

Doctors have traditionally ordered cholesterol tests to be drawn after an overnight fast. But this requirement causes a significant burden on both sides of the health care equation. Most people hate to fast. Skipping meals is particularly difficult for active people, people with diabetes, and children. Yet coming back for another visit is even more of a hassle, so many people just don’t bother. And it has been a drain for doctors, too, resulting in repeat test orders, phone calls, and patient visits.

International guidelines published last month in the European Heart Journal became the latest official recommendation against routine fasting for cholesterol tests. These guidelines defend what many health care systems and many doctors (including me) have been practicing for several years already. They should be met with universal acceptance, even if takes a while. There are several scientific reasons supporting this change.
The history behind fasting cholesterol tests

When doctors test for cholesterol, we almost always order a group of tests called a lipid panel (lipids are fat-containing molecules). This panel typically includes four separate measures:

    Total cholesterol concentration.
    Low-density lipoprotein* (LDL) – cholesterol, often called the “bad” cholesterol. The amount of LDL in your blood strongly predicts your risk of cardiovascular disease, as higher levels are associated with development of plaque in the arteries.
    High-density lipoprotein (HDL) – cholesterol, often called “good cholesterol” because higher levels protect against heart disease.
    Triglycerides (a different type of lipid molecule). High levels of triglycerides are also associated with vascular disease, although this relationship isn’t as well defined.

*Lipoproteins are the “packages” that transport cholesterol in the bloodstream.

Lipids have traditionally been drawn after a fast for two main reasons. The first was to minimize variation, since eating can affect some lipid levels. The second was to produce a better calculation of LDL-cholesterol, which is often derived from an equation thought to provide highly distorted results after eating. However, more recent studies have largely negated these concerns.

Scientists now agree that eating has only slight, clinically insignificant effects on three parts of the lipid profile: total cholesterol, and both HDL- and LDL-cholesterol. Food does raise triglyceride levels for several hours, usually to a modest degree. After a high fat meal these increases can be striking. Therefore, a doctor may still order a fasting test of triglycerides if non-fasting values are significantly elevated.

Perhaps more important, large-scale analyses have shown that non-fasting lipids don’t weaken the connection between cholesterol levels and harmful events like heart attack and stroke. In fact, post-meal measures are thought to strengthen the ability of lipid levels to predict cardiovascular risk. This observation may stem from the fact that most people eat several meals plus snacks during the day. That means we spend most of our time in a “fed” state, not a fasting state. So lipid levels after eating may best reflect our normal physiology.
An end to the dreaded overnight fast?

Guidelines for lipid panels have evolved over the past decade, supported by evidence from studies involving hundreds of thousands of people. Most recommendations now support non-fasting cholesterol tests for routine testing. (You can find a summary of these recommendations here.)

Some fasting lipids tests will remain necessary, especially in people with very high triglycerides. And some people will still need to fast for blood sugar levels, although an alternative test for diabetes (hemoglobin A1c) has replaced much of this testing. But for most, including those having routine cholesterol tests to weigh cardiovascular risk and for those taking drug therapy, this news is good news.

So ask your doctor if you really need to skip breakfast before your next blood draw. Traditions die hard, but both science and convenience may ultimately steer this one to its end. This is one change doctors and patients should celebrate together.

So what do I tell my patients? For those with chronic back pain who aren’t on opiates, steer clear. For those who are already take them, you can’t go cold turkey. Your body has adjusted to these medicines and stopping them abruptly is a bad idea. With help, people on opiate pain relievers can try to wean themselves off these medicines gradually and replace them with other treatments. This isn’t easy, but for many people it starts a long process of regaining control over the pain that has taken over their lives and can help them avoid the terrible consequences of opiate addiction.
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Monday, 11 March 2019

Rethinking a healthy sex life

This past August, her exuberance, emotion and enthusiasm had already made Fu Yuanhui the most famous Chinese athlete at the Olympics. After winning a bronze medal in the women’s 100-meter backstroke with a personal best, she nearly exploded with excitement: “I was so fast! I’m really pleased! I’ve already… expended my primordial powers!” Her interview went viral with millions of hits worldwide.

Then she said something truly shocking: she was having her period. Noticing that the swimmer was grimacing after her relay team narrowly missed medaling, an interviewer asked if she had a stomachache. Yuanhui answered “It’s because I just got my period yesterday, so I’m still a bit weak and really tired. But this isn’t an excuse for not swimming well.”

When the New York Times, NPR and other media outlets covered the story of the Chinese swimmer who dared to mention that she was having her period as if it were the perfectly natural thing that it is, they focused on the fact that she’d violated a cultural taboo — indeed, it is virtually unheard of for women in China to publicly mention menstruation. But, they also missed an opportunity to counter the common misconception that menstruation impairs athletic performance or that it’s unsafe or inappropriate to swim while having your period.
Menstruation and athletics

I recall classmates in high school sitting out basketball practice because they had their periods. I assumed it was just because they weren’t feeling well. In fact, many girls have been told they are more likely to be injured, less likely to perform well, and that the best way to handle menses is to take it easy. Maybe. But the evidence for each of these is weak.
Injury

Much has been made about the apparent increased incidence of significant injuries — ankle sprains, anterior cruciate ligament (ACL) tears and others — in female athletes compared with their male counterparts. Blaming it on “hormones” is common. A 1989 study interviewed 84 female soccer players and found more reports of injuries during the premenstrual period and menstrual period, especially among those with premenstrual symptoms (such as irritability or breast discomfort). A 2007 study found that ACL injuries tended to occur more often during the first half of the menstrual cycle (in the week or two after the period). A 2009 study found that among eight healthy volunteers, hamstring flexibility increased at the mid-point of the menstrual cycle. That’s the point in the cycle that estrogen levels are rising or at their highest.

So it’s possible that variations in female hormones through the menstrual cycle change the function of bones, joints, tendons, or ligaments, and that these changes could have an impact on performance or likelihood of injury. Then again, these studies are simply observations of certain patterns — they don’t prove a connection between phases of the menstrual cycle and injury. In fact, we don’t know for sure whether the phase of the menstrual cycle truly has an important effect on tendency for injury. And if there is an effect, it’s not clear what to do about it.
Athletic performance

Studies find inconsistent effects on the impact of menstrual periods on athletic performance. For example:

    a group of swimmers were found to have poorer performance just before their periods started, and improved times during menstruation
    cross-country skiers were best just after their periods and after ovulation (which occurs midway between periods)

in yet another study, strength of handgrip and standing long jump distance were best during menstrual periods compared with other parts of the menstrual cycle.

A 1994 analysis reviewing the available research concluded that when it comes to having your period, “…for most women there is no significant effect… medals have been won and world records set in any phase of the menstrual cycle.”

Even so, many women don’t feel well just before or during their periods and it seems reasonable that this could affect athletic performance. Anyone who is in pain, tired, or just not as sharp as usual may not perform at their highest potential. And in elite athletics (such as Olympic events) in which the difference between a gold medal and last place may be fractions of a second, surely feeling poorly could make a big difference. A 2009 study concluded that taking an anti-inflammatory medication (called diclofenac, a drug that’s similar to ibuprofen) led to reduced menstrual cramps and improved exercise performance. In fact, some athletes try to avoid the issue altogether: they take oral contraceptive pills or other hormones to avoid having their periods during important athletic events.
The bottom line

There is much we don’t understand about the relationship between the menstrual cycle and athletic injuries or athletic performance in women. It’s probably true that individual factors, including overall health, type of exercise, degree of conditioning, and nutritional status matter more than the phase of the menstrual cycle.

Clearly, women with premenstrual or menstrual symptoms may not feel like exercising. But there is no compelling evidence that exercise or athletic activities should be avoided or altered based only on what part of the menstrual cycle you’re in. Good training may reduce the risks of injury and enhance performance much more than trying to time exercise around one’s periods.

Many have commended Fu Yuanhui for being so forthright about having her period even though it violated a longstanding taboo, but she could also be commended for avoiding the temptation to blame her period for a disappointing performance. “It’s a definite that you’re all going to screw up, but it’s not a definite that any of you will learn from that,” declared one of our medical school instructors, years ago. “Cultivate the attitude that allows you to own your mistakes, and then, not repeat them.”
How common are medical errors?

Medical errors are, frankly, rampant. A recent study used data analysis and extrapolation to estimate that “communication breakdowns, diagnostic errors, poor judgment, and inadequate skill” as well as systems failures in clinical care result in between 200,000 to 400,00 lives lost per year. What this means is that if medical error was a disease, it would be the third leading cause of death in the United States.

The article is specifically about fatalities secondary to medical errors, and how these are vastly underreported. They point out many reasons for this, the first being that cause of death on a certificate is usually listed as the physiologic cause of death. For example, “myocardial infarction” may be listed as cause of death for a patient who was sent home from the emergency room with chest pain and a diagnosis of acid reflux. We have no direct way of knowing that their fatal heart attack was due to misdiagnosis.

In the course of my training over a decade ago I saw many errors, such as a punctured lung during central intravenous line placement in the intensive care unit, postoperative morphine overdose requiring emergency intervention, cancer seen on an emergency room CT scan and never reported to the patient… I could go on. What was most common then was a culture of silence: there was not consistent nor complete disclosure to the patient. People would whisper about mistakes, never directly addressing the issue for fear of litigation, or even retaliation by the involved physician.
Preventing medical errors—and learning from the ones that do occur

As the BMJ article authors point out, we can’t develop safer healthcare without identifying and analyzing medical errors when they happen. They call for a national database of medical errors, so that the information can be compiled for quality improvement and prevention research.

Thankfully, I now work at an institution that recognizes this, and openly embraces errors reporting. We even have an easy-to-use online safety reporting system which my colleagues and I have used many times, for everything from blood test tubes being sent to the lab without labels, to the wrong vaccine being administered, to falls suffered by our patients while in the hospital.

Worried that these types of reports reflect more mistakes being made than normal? Think again: as the data supports, the vast majority of medical mistakes simply go unreported. The true number of medical errors, both fatal and non-fatal, is unknown. What we do know is that healthcare delivery cannot improve if these are not examined.

How does this work? I can pull an example easily from among my own recent mistakes:

A lovely patient of mine* in her late forties complained of fatigue, depression, and body aches, which I attributed to perimenopause and arthritis. She did have slightly elevated calcium levels, but I didn’t think much of it. I blamed it on her calcium supplements.

After more than a year, we finally discussed checking her calcium level OFF of supplements, and lo and behold, it was still high. We discovered that she had hyperparathyroidism, an overactive parathyroid gland that causes calcium to leach out of the bones. Indeed, hyperparathyroidism and high blood calcium levels can cause fatigue, depression, and body aches, among other things that she had, such as osteopenia (weak bones).

She asked for a referral to a surgeon and had her overactive parathyroid gland surgically removed. Her complaints resolved within a day after surgery.

I apologized for my error which had resulted in a delay of diagnosis of about two years, during which time she had not only felt awful, but also developed weakened bones. I offered to facilitate her transfer to a new primary care doctor. She declined, and said that she was appreciative of my honesty in discussing the error, and hoped it could serve as a valuable lesson.

I shared this error with my colleagues and in the system. I, for one, will never let any slight elevation in calcium go uninvestigated, and my colleagues have learned from my example.

My med school instructor was right: if we don’t own our errors, we are destined to repeat them. In medicine, honesty is truly the best policy.The 2016 summer Olympics had its share of exciting performances, upsets, and photo finishes. But for days after Michael Phelps’s first appearance at the games, it seemed all anyone could talk about was “cupping.” It’s an ancient therapy that left multiple circular discolorations on his skin. During “dry cupping,” suction is applied to the skin for several minutes; sometimes it is combined with massage, acupuncture, or other alternative therapies. (“Wet cupping” is similar except that blood is removed by making small cuts in the skin.)

Cupping is supposed to draw fluid into the area; the discoloration is due to broken blood vessels just beneath the skin, much like a bruise. Cupping has been popular in Egyptian, Chinese, and Middle Eastern cultures going back thousands of years, but increasing numbers of people worldwide have been adopting it. Celebrities and athletes have popularized it in the U.S. in recent years.
What is cupping supposed to do?

According to its advocates, cupping is supposed to promote healing and has been used extensively for sore muscles. But that’s only the beginning. Cupping has also been used for

    back and neck pain
    skin diseases such as acne and hives
    lowering cholesterol
    migraines
    knee arthritis
    improving immune function.

And there are many others. If cupping does help with these problems, it’s worth asking: how? From a biological perspective, it’s not clear how the application of suction and drawing blood into an area under the skin would provide all these benefits. A recent review of the treatment describes cupping as a treatment that can strengthen the body’s resistance, restore balance between positive and negative forces, remove disease-causing factors, and promote blood circulation. But exactly how is unclear.
Does cupping work?

A number of studies have examined this question, but unfortunately don’t seem to have  convincingly answered it. In fact, a 2015 review of the evidence found that cupping might provide some relief for chronic neck or back pain, but that the quality of the evidence was too limited to draw firm conclusions.

One problem is that it’s tough to perform a high-quality study on cupping. The best studies are “blinded placebo-controlled trials” in which neither the patient nor the researcher knows which treatment (real or placebo) has been given to a study subject. When medications are studied, coming up with a placebo pill is not difficult; it can be much more difficult to create a convincing placebo comparator for cupping. In addition, pain can be a difficult thing to measure and the placebo effect — improvement related to an expectation of benefit — can be quite powerful.

Still, there have been studies comparing actual acupuncture with convincing but fake (or “sham”) acupuncture.  Similar studies of cupping could be possible. And if cupping truly helped, you may not care if it’s due to the placebo effect.
Are there risks involved with cupping?

Most experts agree that cupping is safe. As long as those treated don’t mind the circular discolorations (which fade over a number of days or weeks), side effects tend to be limited to the pinch experienced during skin suction. It’s quite unusual that cupping causes any serious problems (though, rarely, skin infections have been reported).
So, what’s next?

If you want convincing evidence of effectiveness before trying a treatment, you may want to pass on cupping for now. But if you’d like to try something that’s safe and might help with certain aches and pains (and possibly other ailments), the main downsides seem to be the temporary skin discoloration and the cost — I found estimates online of $30 to $80 per treatment. Some people have it only “as needed” but others may have it monthly or even more often. Future research could prove that cupping is as good as the claims say it is — but we’ll have to wait for the results of high-quality studies to know if it’s true. Men have to accept many changes as they age — less hair, less muscle — but less sex doesn’t have to be one of them. In fact, 54% of men over age 70 are still sexually active, according to research in the January 2016 issue of Archives of Sexual Behavior.

What many men do need to change, however, is their mindset about this next phase of their sex lives. “Many continue to focus only on the physical aspect, so when issues like erectile dysfunction or unpredictable sex drives arise, it can trigger guilt, anxiety, and frustration,” says Dr. Sharon Bober, director of the Sexual Health Program at Harvard-affiliated Dana-Farber Cancer Center.

One way to overcome this barrier is to think less about intercourse and more about “outercourse.” This means to direct your attention and energy more on foreplay and manual stimulation with your partner. “The emphasis is on intimacy and closeness rather than performance,” says Dr. Bober. “This allows men to become less stressed and more engaged in connecting with their partner.”
What you can do

Here are some ways to better embrace outercourse:

Recreate date night. Make an effort to go out on a scheduled basis and experience something new together. It could be a hobby or an event you both have always wanted to check out, or even a quick day or overnight trip. “Doing something different can offer a sense of excitement that can bring you and your partner closer together,” says Dr. Bober. “Couples need to have romance and novelty to be emotionally, mentally, and physically stimulated.”

Focus on the nonsexual. When was the last time you and your partner just hugged, kissed, and explored each other’s bodies without the goal of sex? “Couples may say they don’t do that anymore because they are married, but do not underestimate the excitement of re-exploring the early rituals of courtship,” she says.

Mix up your sex routine. “Give each other a massage as part of foreplay, or try a different setting or time of day, like having sex in the morning when you both may be well rested,” says Dr. Bober. “Just having a conversation about how to change up the regular routine can be fun and exciting.”
Changes in desire

Men can lose interest in sex at times, but that is normal, says Dr. Bober. It often occurs because the sexual connection between your mind and body is out of sync. During these periods, it can be helpful to engage more in the mental side of sex, such as erotic thoughts, fantasy, and memories, says Dr. Bober. “This kind of mental engagement can be quite pleasurable for men without needing physical stimulation, and eventually it can help the mind and body reconnect.”

Desire also can wane if you are not involved with anyone. But again, do not feel under pressure to fill that part of your life. “You need to ask yourself if it bothers you,” says Dr. Bober. “If it is not something on your radar right now, no need to worry about it. You will know when you are ready for affection.”

Do not forget to take care of yourself so you can continue to enjoy your sex life. Many medical conditions can affect sexual drive and performance, such as obesity, diabetes, heart disease, high blood pressure, and high cholesterol. “If you want to be active, you have to stay active, and that means focusing on your exercise routine and being diligent about a proper diet and medical check-ups,” says Dr. Bober.
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