Tonsillectomies are one of the most common surgeries performed on children — but the decision to do one should not be taken lightly.
In 1965, there were about a million tonsillectomies (with or without adenoidectomy, a surgery often done at the same time) performed on children younger than 15 years old. By 2006 that number had dropped by half, and by 2010 it had dropped by half again.
Why the drop? Well, complications are common. In fact, one in five children who have a tonsillectomy has a complication. The most common is breathing difficulty, which can affect one in 10. Bleeding affects one in 20, and can happen days after the surgery, after a child has gone home. While the complications are treatable and death is very rare, it’s clearly an operation that should only be done when truly necessary.
There are two main reasons to do a tonsillectomy, but neither is black and white. Each patient and each situation is different. It’s important to understand the gray area (there is a lot of it) in order to make the best decision.
The first reason for tonsillectomy: obstruction
Tonsils (and adenoids) can grow large enough to block the airway, making it difficult to breathe. This can be especially noticeable when a person is lying down, such as during sleep, when gravity brings the tonsils down onto the airway. This leads to a condition called obstructive sleep apnea (OSA), which can be serious and lead to health and behavioral problems in children.
Snoring during sleep isn’t enough to diagnose OSA. “Apnea” means that the person actually stops breathing — so what parents should listen for is not just snoring but pauses in breathing. It can sound like a choking noise followed by silence. Parents whose children suffer from this often find themselves getting up during the night to adjust their child’s position in bed.
Sometimes the story is so clear (smartphone videos from parents can be very helpful), and the tonsils so large, that the decision to do surgery is straightforward, and the surgery is very helpful. But often it’s not so clear, especially when the tonsils (or adenoids) aren’t that large. When it’s not clear, very often the doctor will order a sleep study, called a polysomnogram (PSG). During this study, the child is monitored during sleep to get a better sense of exactly what is happening.
These studies are very helpful, but they aren’t perfect. Not only are they a measure of just one night, which may or may not be typical, but they don’t always predict whether or not a child will have the health and behavioral problems we worry about, or whether they will get better after surgery. This can be especially true when a child is overweight, as being overweight can cause or worsen apnea, and the apnea may or may not get better with a tonsillectomy. Also, PSGs are expensive and not always widely available. That’s why doctors differ in how often they order PSGs and how they use the results.
There are other ways to manage OSA besides surgery, including continuous positive airway pressure (CPAP) machines and other devices, medications, and positioning. When it’s not clear that a tonsillectomy is needed, when parents prefer not to do it, or there are other reasons not to do it (like known bleeding problems or other medical problems that make surgery risky), these other measures can be tried.
Another reason for tonsillectomy: recurrent infection
Children who are severely affected by recurrent throat infections (more than seven episodes in one year, five in each of two years, or three in each of three years) may be helped by a tonsillectomy. However, just having a sore throat doesn’t count. To meet criteria, there needs to be fever, enlarged lymph nodes, pus on the tonsils, or a positive strep culture — and the child should have been seen and all the details confirmed and documented.
In cases where children are severely affected, tonsillectomy can reduce the number of infections — but when this has been studied, children who don’t get tonsillectomies have fewer infections over time too. That’s the thing: either way, children get better. “Tincture of time,” or just waiting it out, can work too.
Making a decision about tonsillectomy
So if you are thinking that your child might need a tonsillectomy, or if your doctor has suggested one, talk it over carefully with your doctor. Ask lots of questions. Spend some time understanding both the risks and benefits. It’s certainly true that for some children tonsillectomy makes a huge difference, especially those with obstruction — but for many others, just giving it some time, perhaps with some medication or other treatments, can do the trick too.
My life is extraordinary. Such a hyperbolic-sounding statement and yet, in so many ways, so very true.
Extraordinary because a decade ago I was told I had three to five months left to live. Diagnosed with non-small cell lung cancer (NSCLC) three years earlier, the removal of most of my left lung followed by chemotherapy had done little to slow down the cancer. Too diffuse for radiation, we had run out of options.
And so, I did what the dying do. Grieving as preparations began. I bid adieu to friends and family, held my children even closer, and sought the help of a thoracic social worker. The day I walked through her door, my first words were, “I need you to help me learn how to die.”
Life can be so strange, so surprising. I never thought I’d be diagnosed with lung cancer at the age of 45 and that I’d be facing death at 48. But the biggest surprise was yet to come.
Obviously, I didn’t die. Just in the nick of time, medical science intervened as I was found to have a newly identified driver in lung cancer, an ALK (anaplastic lymphoma kinase) mutation. On October 1, 2008 I became the fourth person in the world with NSCLC to enroll in a first in-human trial targeting ALK. And, to all of our surprise, I had an amazing response.
In the years hence, I have returned to chemotherapy, but also enrolled in two more phase I clinical trials. And life has gone on. My youngest child was only seven when I was diagnosed; two years ago I had the immense privilege of seeing him graduate cum laude from Phillips Exeter Academy. He is now in his second year at MIT and my other two adult children are thriving in both their relationships and careers.
Four years ago, own marriage ended, in no small part because of the differences in the way we approached my cancer, which, though still considered terminal, had also become a chronic illness.
Living alone has had its challenges, but I can truly say that I have never been happier. For the first time since my early 20s, I am focusing on my own goals. Upon leaving our marriage, I moved to a converted mill housing a community of creatives. I call it the art dorm, and my loft — the art fort. I recently had my first solo art show, and it was a big success. It is safe to say I’m on a creative roll. I am also working on a book (or two), a DIY MFA (that’s another blog), and I devote more time than ever to patient advocacy, with a focus on clinical trial participation and medical research.
Last year a little white Shiba Inu came into my life — a rescue that I actually helped rescue — and we walk several miles every day. Five months ago I also started online dating and, contrary to the experience of many, I’m having a blast. I attribute that to my extraordinary (yes) self-confidence and my willingness to go all in, without regard to being hurt. These are qualities that I did not possess prior to my diagnosis with cancer.
It’s such an odd and unexpected paradigm — living with a terminal illness. The downsides are obvious and yet, I have learned so very much. Forced to face my greatest fears, I have become far more courageous; in fact, there is little I fear now. This means my anxiety has gone way, way down and my ability to enjoy life, way, way up. Because I have learned to sit with uncertainty, I am no longer married to outcomes. It’s all good. I liken this to loving/living life unconditionally; I simply cannot be disappointed. Each new morning is opened like a present — a gift I simply did not expect to receive.
Perhaps it is this awareness that has sharpened both my perception and my appreciation; I refuse to waste a moment. And although I would prefer to not have an illness that is terminal, I would wager that I am infinitely more alive than many who do not.
I play poker in a weekly game hosted by an 80-year-old man named Mort. During a recent game, I noticed a stack of composition books, scribbled-over yellow pads, and Bic pens spread over his dining table.
What was he up to? Mort said he had lost his sense of purpose and identity, so he turned to something he knew a lot about — his life story — and began to write his memoirs.
Mort’s reaction is quite common among older adults, as is his response. As people age, they may begin to feel irrelevant to those around them, especially their families, which often leads to low self-esteem, greater isolation, and a higher risk of depression.
But engaging yourself in an endeavor like writing your memoirs can be rewarding for you and others.
“You would be surprised at how interested your peers and family members are in your stories and personal history,” says Brendan Kearney, Vitalize 360 Wellness Coach at Harvard-affiliated Hebrew SeniorLife. “You have a unique firsthand account of your culture and history that others don’t, and leaving a recorded history of your life can be an important gift to both you and your descendants.”
Words of wisdom
Writing your memoirs offers many benefits beyond simple storytelling. For instance, they can be an opportunity to pass along specific wisdom and life lessons. “Even if you write about parts of your life that you have never told anyone because they were unhappy or painful memories, revisiting them can show others the strength it takes to overcome life barriers when they face their own,” says Kearney.
The actual writing aspect also can be a therapeutic tool as you explore issues that may still trouble you. A study published in the March 2018 JAMA Psychiatry found that writing about a specific upsetting memory was just as effective as traditional cognitive processing therapy in treating adults with post-traumatic stress disorder.
A walk down memory lane
Where should you begin your life story? You don’t have to follow a straight year-by-year account. Instead, Kearney recommends creating a timeline of your life based on the places you have lived. “Begin with writing about your homes,” says Kearney. “Think about the house you grew up in, or the first house you owned. The places you’ve lived often invoke a wealth of visual memories and long-forgotten stories that are tied to those places.”
Another way to trigger ideas is to look through photo albums. Focus on a single picture and write about the story behind it. Or use writing prompts, by asking yourself questions such as, “One of my fondest memories of my best friend was …”; or “The time I was happiest or most scared was …” Or write about your favorite hobbies or sports.
Mort’s first chapter? His love of poker.
The write stuff
Writing can be tough for some people. Here are some strategies to help you find your rhythm.
Write at the same time each day to establish a routine. Choose a specific time to write, whether it’s in the morning while you drink coffee, or before bed, or any time in between.
Write for a set period. In the beginning, set a timer and write for 10 to 15 minutes. Gradually extend the time to 20 minutes or longer.
Don’t worry about spelling and grammar. Your writing is about record keeping and not publication, so write the way you speak, and don’t focus on correcting mistakes.
Use a recorder. If you aren’t comfortable writing, then record your stories on a tape recorder or your smartphone. There are many speech recognition programs that can convert audio into text documents, such as Sonix, InqScribe, and Dragon NaturallySpeaking.
Try writing longhand. Research has found that handwriting, especially in cursive, can activate parts of the brain associated with short- and long-term memory. The slower process also can help improve attention and information processing, since you have to focus on forming letters and words.
Look for writing groups. Some community centers offer memoir-writing workshops that can offer further support and give you a chance to share your writing with other people. Or reach out to friends about forming your own writing group.
A recently published clinical guideline on vitamin and mineral supplements reinforces every other evidence-based guideline, research review, and consensus statement on this topic. The bottom line is that there is absolutely no substitute for a well-balanced diet, which is the ideal source of the vitamins and minerals we need.
The brief article, co-authored by nutrition guru Dr. JoAnn Manson, cites multiple large clinical trials studying multiple nutritional supplements’ effects on multiple end points. The gist of it is, our bodies prefer naturally occurring sources of vitamins and minerals. We absorb these better. And because commercially available vitamins, minerals, herbs, etc. are lumped together as “supplements,” the FDA doesn’t regulate them. When we ingest processed, concentrated, and artificially packaged “supplements,” we may be doing ourselves harm. They may be toxic, ineffective, or contaminated (all of which are not uncommon).
In other words: Most people who eat a healthy diet are unlikely to benefit from nutritional supplements.
Does anyone need vitamin and mineral supplements? Well, yes
There are medical conditions that put people at high risk for certain nutritional deficiencies, and there are medical conditions that can be treated with certain nutritional supplements. This is important, and is why the authors support targeted supplementation. But who needs what and where to acquire these are important discussions to have.
There are guidelines for specific groups, such as pregnant women. Folic acid is especially important for healthy fetal development, and a deficiency can cause spina bifida, a neurologic condition. I advise my patients to start either a prenatal vitamin with folic acid, or at the very least folic acid itself, ideally before they begin trying to conceive. As pregnancy advances, mom needs to provide her growing fetus with everything, and so she will benefit from a prenatal vitamin (either by prescription or a well-vetted over-the-counter one) which contains things like iron and calcium.
Older adults can have difficulty absorbing vitamin B12, and I have a low threshold when checking this level; if someone is taking an acid-reducing medication, it is very likely that they will become deficient in B12, as well as iron, vitamin D, and calcium, among other things. These folks may very well benefit from a quality multivitamin.
Of course, there’s a long list of medical issues that predispose people to vitamin deficiencies. For example, people who have had weight-loss surgery may require a number of supplements including A, D, E, K, and B vitamins, iron, calcium, zinc, copper, and magnesium, among other things. People with inflammatory bowel disease (like Crohn’s or ulcerative colitis) may have similar requirements. People who have or are at risk for osteoporosis may greatly benefit from vitamin D and, depending on the quality of their diet and other factors, possibly also calcium supplements.
There are other medical conditions that can be treated with supplements. One that immediately comes to my mind is inflammatory arthritis (or other inflammatory conditions) and turmeric. While quality scientific studies are lacking, there are plenty of smaller studies as well as historical experience suggesting that turmeric has anti-inflammatory properties, and I see some of our rheumatologists routinely recommending this to patients for pain relief. Then there’s prediabetes/diabetes and cinnamon, which has blood sugar-lowering properties. With these compounds, I advise that people use the regular spice in normal culinary amounts, not a processed/concentrated packaged supplement.
Not all vitamins are created equal
And here is another key point that bears repeating: Manson suggests choosing vitamins that have been tested by independent labs such as US Pharmacopeia, Consumer Lab, and NSF International, and certified to have the labeled dosage of the correct ingredient, and not have toxins or contaminating organisms. Many commercially available supplements here in the US will bear a label from one of these labs.
On that point, gummy vitamins are often not certified and often do cause cavities. Yes, everyone loves them, because they’re basically candy. I do not recommend gummy vitamins for anyone, but especially not for pregnant women.
I’ll also add in a warning: I often hear about providers who are selling supplements or other products directly to their patients. This is a conflict of interest, and it’s unethical, as well as fraught with all sorts of potential problems. Please use caution if purchasing anything directly from the provider who is prescribing it.
The bottom line
In summary, enjoy a varied, colorful, healthy diet, consider supplements when they may be needed or helpful, and choose your sources carefully.
A newly approved drug called apalutamide is giving hope to thousands of men confronting a tenacious problem after being treated for prostate cancer. Prostate-specific antigen (PSA) levels should plummet to zero after surgery, and to near zero after radiation therapy, but in some men, they continue rising even when there’s no other evidence of cancer in the body. Doctors typically respond to spiking PSA with drugs that block the production of testosterone, which is the male sex hormone that fuels prostate cancer. However, this type of medically induced castration, called hormonal therapy, doesn’t always reduce PSA. Moreover, prostate cancer cells can become resistant to hormonal therapy, after which PSA resumes its upward march. This is called non-metastatic castration resistant prostate cancer (nmCRPC), and it often precedes the appearance of metastatic tumors that show up later.
The dearth of approved treatments for nmCRPC has long frustrated patients and their doctors alike. But in February, the US Food and Drug Administration approved apalutamide for men who have nmCRPC after results from the SPARTAN clinical trial showed the drug could delay metastases by up to two years. “Based on these clinical trial results, apalutamide should be considered the new standard of care for nmCRPC,” said Dr. Matthew Smith, a medical oncologist at Massachusetts General Hospital who led the study. “The drug addresses a great clinical need and holds the promise of longer survival for men whose cancer defies hormonal therapy.”
The SPARTAN trial enrolled 1,207 men whose PSA levels doubled within 10 months or less after initial treatment despite ongoing hormonal therapy. Enrolled men were assigned to either daily apalutamide tablets combined with hormonal therapy, or to hormonal therapy combined with placebo. Doctors usually stick with hormonal therapy even after PSA levels rise, since it prevents the body from recovering its ability to make testosterone. Men continued on the study until the first metastases were detected, and then they were given other drugs used for treating metastatic prostate cancer.
According to the results, those taking apalutamide avoided metastases for a median of 40.5 months (meaning half were free of metastases for longer than that, and the other half for less). The placebo-treated men, meanwhile, remained free of metastases for a median of 16.2 months, about two years less. Furthermore, apalutamide treatment “delayed symptomatic progression, pain, and other symptoms that patients experience as a consequence of their cancer,” Smith said. But apalutamide, which prevents testosterone from interacting with its receptor on cancer cells, was also associated with more frequent significant side effects, such as fatigue, rash, weight loss, falls, and skeletal fractures.
Based on accumulating evidence, Smith anticipates that longer freedom from metastases equates with longer overall survival in men with nmCRPC. However, whether that’s true remains to be seen. “So far, outcomes suggest men will live longer on apalutamide,” said Dr. Marc Garnick, the Gorman Brothers Professor of Medicine at Harvard Medical School and Beth Israel Deaconess Medical Center, and editor in chief of HarvardProstateKnowledge.org. “The anxiety most patients experience when PSA increases after what was thought to be curative is significant. Continuing with this new therapy should be considered between appropriately selected patients and their doctors after a full discussion of the potential benefits and risks.”
Does diet affect anxiety? If so, what should I eat, and which foods should I try to avoid?
People who suffer with anxiety should remember a few simple rules:
Low blood sugar, poor hydration, use of alcohol, caffeine, and smoking can also precipitate or mimic symptoms of anxiety.
Eating regular meals and preventing hypoglycemic states are therefore important.
Adequately hydrating with plain water is best, at least 6 to 8 glasses a day.
While nicotine does not cause anxiety, withdrawal from nicotine can mimic anxiety, and people with anxiety may smoke to soothe themselves. It may become a problematic behavior, as nicotine can also raise blood pressure and heart rate, which are also symptoms of anxiety.
People who feel anxiety may lean on alcohol to calm their nerves, but excessive drinking can lead to its own set of emotional and physical problems.
Many sodas contain caffeine and have a high sugar content. Being aware of these factors and substituting plain water or sparking water for soda can be a healthier option.
Working toward a well-balanced diet with adequate fruits, vegetables, lean meats, and healthy fats remains a good recommendation for those who struggle with anxiety. Avoiding processed foods and foods high in sugar means the body experiences fewer highs and lows of blood sugar, which helps to further reduce feelings of anxiety. Very simply put, a sugar rush can mimic a panic attack.
For example, eating a frozen dinner and ice cream will affect you differently than eating chicken and broccoli with a pasta made from whole grains or quinoa. The second meal includes whole, unprocessed foods, and you control the amount of sugar, if any, added to the meal. It takes longer for your body to metabolize these foods, which helps you feel fuller for longer and keeps blood sugar levels steady, rather than yo-yoing up and down.
Does sugar increase anxiety symptoms?
Yes! And there are many hidden sugars in the foods we eat, including savory foods. Many people don’t realize this. One example is a popular store-bought Tomato Basil Sauce. One half-cup serving (and very few people would eat just half a cup at a meal) contains 12 grams of sugar, which is 3 teaspoons (4 grams sugar = 1 teaspoon). Food labels in the US use grams, and many people do not really know how to interpret these. Recipes use ounces, pounds, teaspoons, and tablespoons, so this conversion becomes important for the consumer. So, if you used 1-1/2 cups of the pasta sauce, you would be consuming 36 grams or 9 teaspoons of sugar just from the sauce in your meal!
While your body needs a healthy balance of sugar, carbohydrates, fats, and proteins to function, it is also that very balance that helps keep us healthy. Consuming sugar through natural sources such as a piece of fruit, and not fruit juice or dried fruit, affects your body differently than candy or hidden sugars in your foods.
The FDA has a new nutrition label law coming into effect which will list the added sugars on the nutrition label for consumers and provide some other helpful data.
Do anxiety symptoms improve when you cut back on sugar and feed your body the right foods?
It’s a good idea to talk with your doctor before making dramatic changes in what you eat. Involve a nutritionist (your doctor can refer you to one) if you need some extra guidance.
As with any dietary change, your body will need some time to adjust. If you are otherwise healthy and cut back on processed sugar, you may feel your anxiety slowly improve thanks to fewer ups and downs caused by the excess sugar. If you are only using diet to combat anxiety, this change may not be obvious or immediate. You may also need to speak to a doctor about a medication. An integrated treatment approach including talk therapy, mindfulness techniques, stress relief, good sleep hygiene, and a balanced diet are all equally important parts of your care.
What else should I know about diet and anxiety?
Anxiety is linked with many physical illnesses. In addition to taking guidance from your doctor about options for treating anxiety, you should augment that treatment by paying attention to how and what you eat. A review of the literature examining the effects of diet on anxiety-related behavior highlighted that foods high in fat and/or sugar, or that are highly palatable, can affect behavior in animal models, and may do the same in humans. More human studies are needed.
When we think of a depressed person, we tend to think of someone who, well, acts sad. The picture we have in our head is of someone who doesn’t want to get off the couch or out of bed, who is eating much less or much more than usual, has trouble sleeping or wants to sleep all the time, who has trouble with usual daily activities, and doesn’t talk much.
Children and teens with depression can certainly look like that. But depression can play out in different ways, too. Numbers are hard to come by in younger children, but among 12-to-17-year-olds, almost 13% have had a major depressive episode. It’s important to be aware of the signs; depression is a treatable illness — and untreated depression can lead to long-term mental health and physical problems, and possibly even suicide.
Here are some possible signs of depression in youth:
Dropping grades. Now, there are lots of reasons why grades can drop — including learning disabilities, ADHD, bullying, or substance use. But whenever a child’s grades are dropping, it’s important to think about depression as a possible cause.
Irritability and anger. There are many reasons for this, including temperament, and teens are often irritable and angry. But if it’s new and persistent, or if a child or teen is getting in trouble much more than usual, think about depression.
When a child who used to be interested in things is suddenly bored all the time, it can be a warning sign.
Dropping out of activities. It’s certainly fine for interests to change. But if new ones don’t take their place, that too can be a warning sign.
Difficulty with relationships. When children and teens are fighting with friends, or simply spending much less time than they used to with them, that’s a red flag.
Dangerous behavior. A certain amount of risk-taking is normal, especially in teens, but if it’s new and persistent, it may not be normal. Any self-injurious behavior, like cutting, merits attention right away.
Persistent physical complaints, such as stomachaches, headaches, or other pain. Obviously you need to get a thorough checkup for any persistent pain. But the mind-body connection can be very strong; sometimes people who are depressed have physical pain that feels very real.
Fatigue. This is another symptom that needs to get checked out thoroughly, as there are many medical reasons why a person can have chronic fatigue. But depression is one of them.
If you are seeing any of these in your child — or any other changes in behavior that you can’t explain and don’t seem right to you, talk to your doctor or seek out a mental health professional in your area. Don’t ignore the behaviors or try to explain them away. Better safe than sorry, and as with so many conditions, the sooner you catch depression, the easier it is to treat.
For most people trying to lose weight, it’s a struggle. It takes more than good intentions and a lot of will power. One reason is that in order to lose weight, we are, in a way, fighting our own biology.
As we lose weight, the body adapts to resist it by lowering the resting metabolic rate — that’s the amount of energy spent while at rest, when the “engine” of the body is idling. Lowering the resting metabolic rate is a good thing if food is scarce and weight loss is occurring due to starvation. In that situation, it’s good that the body slows down to conserve energy and limit further weight loss.
But this evolutionary adaptation works against you if you are overweight or obese, and excess weight is a bigger threat to your health than starvation.
The experience of The Biggest Loser
Researchers have studied weight loss for decades to determine how the body responds to it. Among them are studies that enrolled participants in the television series The Biggest Loser. If you aren’t familiar with it, The Biggest Loser is a reality television series in which obese individuals compete to lose the most weight through an intensive program of exercise and dietary changes. A prior study found that after losing lots of weight, participants in The Biggest Loser had markedly reduced metabolic rates. But it was unclear how long those changes would last or whether they predicted regain of weight once the competition ended.
A new study of The Biggest Loser
A recent study looked at how participants in The Biggest Loser fared six years after their 30-week competition. Researchers publishing in the medical journal Obesity found that:
At the end of the competition, average weight loss was nearly 128 pounds. Since the average starting weight was about 327 pounds, that’s a drop of nearly 40% of body weight.
On average, participants experienced a 23% drop in their resting metabolic rate.
Six years later, competitors regained an average of 90 pounds, but the significant slowing in metabolic rate persisted.
There was not a direct correlation between the amount of metabolic slowing and the amount of weight lost during the show. However, after six years those who kept the most weight off had the most slowing.
These findings confirm that weight loss may lead to significant changes in metabolism that, in turn, resist further weight loss. In addition, keeping weight off may be especially difficult because those changes persist over time. The metabolic slowing that accompanies weight loss varies, however, so it may create less resistance to weight loss for some than others.
The findings of this research may seem discouraging if you’re trying to lose weight.
On the other hand, maybe it should provide a measure of relief to know that the reason losing weight seems like an uphill battle is that it is! It’s not just that you aren’t trying hard enough —your efforts to lose weight are being actively undermined by biological adaptations of your body that developed centuries ago during evolution and are now hardwired into your DNA.
You might wonder: is there a diet, an exercise program, or a medication that can “reset” your metabolic rate or avoid its slowing during weight loss? In fact, you may have seen books or advertisements for certain diets or supplements claiming to do just this. Unfortunately, most have little convincing long-term evidence to back them up, or the changes are too small to matter much.
The bottom line
Knowing about the adaptations your body makes during weight loss and how that can frustrate your efforts to lose weight may make the effort seem futile. But it’s not. Determination, perseverance, and a sustainable plan are good first steps. It also helps to know what you’re up against. Contestants on The Biggest Loser know that well.
Ruts are indeed threatening and stultifying. But are we doomed to be in them once we fall into them, or can our brains be changed? To answer this question, psychologist and brain researcher Caroline Di Bernardi Luft and her colleagues conducted a study, drawing on what we already know about how we fall into ruts in the first place.
Why do we get stuck in ruts?
We become stuck in ruts due to our brains’ habitual electrical patterns. Past experience shapes present and future behavior. Faced with new situations, our brains will apply rules based on prior events to match the current context. And there’s a part of the brain that is especially wired to do this. Called the dorsolateral prefrontal cortex (DLPFC) — think of it as the brain’s “pattern seeker” — this brain region works hard to find old rules that can be applied to the here and now to circumvent the chore of new learning. Dr. Di Bernardi Luft and colleagues wanted to see if people could get out of ruts when the brain’s pattern seeker was blocked.
How to create a rut in an experiment
In order to explore this, they had to first get people into a rut. So they gave them four types of matchstick arithmetic problems, each with a different rule set. Once they got used to a rule, they were given a problem with another set of rules. So, to solve each new category of problem, they had to get out of the rut of the old way of thinking.
In a typical problem, matchsticks are used to form an incorrect equation consisting of roman numerals (I, II, etc.) and arithmetic operators (e.g., +, –). Participants would then have to correct the equations by moving only one matchstick. The problem is not just math, it’s creative too.
For each of the four types of matchstick problems (A, B, C, and D), there is a different rule. For example, for problem type A, you could move a matchstick within a numeral, so that IV = III + III becomes VI = III + III when you move the “I” in “IV” to form a “VI.” For B, you move a matchstick from a plus sign (e.g., I = II + II becomes I = III – II when the vertical part of the plus is moved to join the first “II.”). For C, you rotate a matchstick within a plus sign to create an equals sign (e.g., change “+” to “=”). And for D, you change an “X” into a “V” by sliding the matchstick of the right arm of the “X” to the right.
To solve the problems effectively, you have to forget prior rule sets, but this is difficult to do. As a result, you sometimes get stuck in a rut.
How to inhibit ruts with electricity
With this challenge at hand, the researchers then passed a specific kind of electrical current from positive (anodal) to negative (cathodal) electrodes through the scalp overlying the DLPFC. Called transcranial direct current stimulation (tDCS), this type of low level electricity can excite or inhibit the brain tissue beneath the scalp. Beneath the positive electrode, it stimulates the underlying brain tissue, and beneath the negative electrode, it inhibits the brain tissue. As a comparison, they also used a sham current. After each of these types of current was applied, participants were given the matchstick problems. Of the different problems, the “C” type problems were the most difficult, and required forgetting prior rules.
So what did they find? The main finding of the study was encouraging: when a negative current was applied over the DLPFC, it was easier to break former habit patterns for “C” type problems. The implications of this were quite exciting. Breaking former habits makes you more creative. You behave less like an automaton, and look at things in a unique way. In effect, you become unstuck and get out of your mental rut. It is possible to get out of a mental rut after all!
So, while you are waiting for a product that delivers this electrical zap to help relieve boredom and get you out of a rut, why not try out one of the simple methods above for 15 minutes a few times a day? When you do, you will likely prepare your brain inevitably for a much more exciting and creative life. And ruts will become far less detrimental to you too. In essence, you will have taken advantage of your brain’s ability to rewire itself, which Dr. Di Bernardi Luft and her colleagues demonstrated so elegantly.
If you’ve ever passed a kidney stone, you probably would not wish it on your worst enemy, and you’ll do anything to avoid it again. “Kidney stones are more common in men than in women, and in about half of people who have had one, kidney stones strike again within 10 to 15 years without preventive measures,” says Dr. Brian Eisner, co-director of the Kidney Stone Program at Harvard-affiliated Massachusetts General Hospital.
Where do kidney stones come from?
Kidney stones form develop when certain substances, such as calcium, oxalate, and uric acid, become concentrated enough to form crystals in your kidneys. The crystals grow larger into “stones.” About 80% to 85% of kidney stones are made of calcium. The rest are uric acid stones, which form in people with low urine pH levels.
After stones form in the kidneys, they can dislodge and pass down the ureter, blocking the flow of urine. The result is periods of severe pain, including flank pain (pain in one side of the body between the stomach and the back), sometimes with blood in the urine, nausea, and vomiting. As the stones pass down the ureter toward the bladder, they may cause frequent urination, bladder pressure, or pain in the groin.
“If you experience any of these symptoms, see your primary care physician,” says Dr. Eisner. “He or she will likely perform a urinalysis and a renal ultrasound, abdominal x-ray, or CT scan to confirm kidney stones are the source of your pain and determine their size and number.”
Let kidney stones pass
Stones typically take several weeks to a few months to pass, depending on the number of stones and their size. Over-the-counter pain medications, like ibuprofen (Advil, Motrin IB), acetaminophen (Tylenol), or naproxen (Aleve), can help you endure the discomfort until the stones pass. Your doctor also may prescribe an alpha blocker, which relaxes the muscles in your ureter and helps pass stones quicker and with less pain.
If the pain becomes too severe, or if they are too large to pass, they can be surgically removed with a procedure called a ureteroscopy. Here, a small endoscope (a device with a miniature video camera and tools at the end of a long tube) is passed into the bladder and up the ureter while you are under general anesthesia. A laser breaks up the stones, and then the fragments are removed.
Take steps to bypass kidney stones
Even though kidney stones can be common and recur once you’ve had them, there are simple ways to help prevent them. Here are some strategies that can help:
1. Drink enough water. A 2015 meta-analysis from the National Kidney Foundation found that people who produced 2 to 2.5 liters of urine daily were 50% less likely to develop kidney stones than those who produced less. It takes about 8 to 10 8-ounce glasses (about 2 liters total) of water daily to produce that amount.
2. Skip high-oxalate foods. Such foods, which include spinach, beets, and almonds, obviously raise oxalate levels in the body. However, moderate amounts of low-oxalate foods, such as chocolate and berries, are okay.
3. Enjoy some lemons. Citrate, a salt in citric acid, binds to calcium and helps block stone formation. “Studies have shown that drinking ½ cup of lemon juice concentrate diluted in water each day, or the juice of two lemons, can increase urine citrate and likely reduce kidney stone risk,” says Dr. Eisner.
4. Watch the sodium. A high-sodium diet can trigger kidney stones because it increases the amount of calcium in your urine. Federal guidelines suggest limiting total daily sodium intake to 2,300 milligrams (mg). If sodium has contributed to kidney stones in the past, try to reduce your daily sodium to 1,500 mg.
5. Cut back on animal protein. Eating too much animal protein, such as meat, eggs, and seafood, boosts the level of uric acid. If you’re prone to stones, limit your daily meat intake to a quantity that is no bigger than a pack of playing cards.