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Updated November 20, 2018.

Your provider just ordered blood work and you’re gearing up to get it done. Here’s what you should know ahead of time to ensure a comfortable and easy draw.

Before Your Blood Test

Your provider should let you know whether you need to fast prior to having your blood drawn. If you’re not sure, confirm any requirements with your provider beforehand.

Fast Smartly

Fasting for a blood test entails avoiding all food and beverages (except for water) for 8 to 12 hours prior to the test. Drink plenty of water and take your medications as usual. Note that a small number of tests have stricter requirements, such as the H. pylori breath test, which involves consuming nothing, including water, for one hour prior to the test.

Tip: Come prepared with snacks. If you’re fasting, head to the lab early in the morning and bring a healthy snack to eat following the test.

Drink Water

Many people believe they should avoid water before a blood draw, but this couldn’t be further from the truth. Drinking water will not only make you feel better if you’re fasting, it will also make for a smoother blood draw. Blood is about 50 percent water, so the more water you drink, the plumper your veins become and the easier it is for the phlebotomist–the technician trained to draw your blood–to locate your veins and remove blood.

Urine tests are frequently ordered along with blood tests, and the fuller your bladder, the easier it will be for you to provide a sample. (Note: The urine test for chlamydia and gonorrhea requires that you not urinate for one hour prior to the test.)

Tip: Get a head start on hydration. Drink extra water beginning the day before your blood draw to ensure you’re adequately hydrated the day of the draw.

Insurance Coverage

Having an unusual test done and wondering whether your insurance will cover it? We recommend calling your insurance to find out. If you have questions about how to do that, our staff can assist you. If you don’t have insurance or discover that your insurance will not cover the cost of a test, let us know so we can discuss payment options with you. Some of the labs we work with provide considerable discounts if you pay upfront at the time of service.

Make Sure You Have a Lab Order

You’ll need a lab order from your provider in order to have your blood drawn. If you’re not sure whether you have an order on-file, call our office and we’ll take a look. If you’d like your provider to order blood work, we recommend booking an appointment so you can discuss your concerns and come up with a set of tests tailored to you.

What to Expect During the Draw

No one looks forward to getting their blood drawn, but the procedure is usually brief and uneventful. Most people are in and out of the lab room in under 15 minutes. The phlebotomist will begin by gently pressing his or her fingers against your skin to locate the best vein. Then he or she will don gloves, clean the area with an alcohol pad, tie a tourniquet around your upper arm to increase blood flow, ask you to make a fist, and insert the needle.

Tip: Chatting helps. One Medical phlebotomists make a point of engaging you in conversation to help you relax so that the needle prick is a little less painful. Chat up your phlebotomist and distract yourself from the draw!

Shy Veins

Our phlebotomists are skilled at drawing blood from a variety of patients. Some veins are trickier to draw from than others. To coax out a shy vein, the phlebotomist might tighten the tourniquet, spend additional time palpating your veins, or place a warm pad against your skin. Taking the time upfront to locate the best vein is time well spent. A phlebotomist’s goal is to draw your blood as easily and painlessly as possible–and only once! If the phlebotomist is not successful after two sticks, he or she may recommend that you come back another day.

Tip: Know your limits. If you’ve fainted in the past or have a phobia of needles, let the phlebotomist know right away. They can position you so you’re less likely to faint, keep their needles out of your line of sight, or use the right words to soothe you during the draw.

After Your Blood Test

Bruising Is Normal

After the blood draw is completed, your phlebotomist will remove the needle, hold gauze against the puncture site, and ask you to apply pressure. Applying pressure directly following a blood draw mitigates the common side effect of bruising.

Even with these precautions, minor bruising and swelling around the puncture site can occur. Because every person’s veins are different, and veins move frequently, bruising can occur even with the most experienced phlebotomists. If you do bruise, it should go away within a few days.

Getting Your Results

At One Medical, your blood samples are sent to an outside laboratory that’s in network with your insurance. Once the lab processes the samples and sends us the results, a provider will email you with an interpretation of the results as well as a file of the results for your reference. If it’s been more than ten days since your blood draw and you haven’t received an email, call our office.

Blood Test FAQs

Do I need to get yearly blood tests?

Only if it makes sense based on your health history. At One Medical, we don’t order a standardized set of tests for every patient. Instead, providers test only for select concerns based on your symptoms, personal and family history, and risk factors. Testing only for specific concerns rather than ordering every test under the sun helps ensures that you won’t end up receiving potentially harmful treatments for diseases you don’t have. It should also help keep your health care costs lower.

If you’ve developed new symptoms, have experienced significant lifestyle changes, or are interested in getting a particular test done for any reason, book an appointment with your provider so you can discuss it together and determine whether a blood test is the best course of action.

Where do I go for a blood draw?

One Medical Group provides on-site lab services on a walk-in basis at the majority of our offices across the country. This means that you can have your blood drawn directly following a visit, or at your convenience throughout the week. Our lab hours vary by location, so check our website or call ahead to ensure the lab is open when you plan on arriving.

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Updated November 20, 2018.

STD screening may not be dinner table talk, but if came up, would you know how to handle it? Everyone who is sexually active should be screened for STDs at some point — but which tests, and when, depend on your personal risk factors. Sometimes testing isn’t necessary. But if it is recommended, and you do get diagnosed, there is some good news: Most STDs are curable, and all of them are treatable.

What’s the Difference Between STDs and STIs?

STDs are sometimes referred to as sexually transmitted infections (STIs). Many providers use this term since there’s less stigma attached to the word infection. It’s possible to have an infection without symptoms, and the infection may cause disease (when you do experience symptoms) in the future. In the absence of symptoms, the only way to diagnose an STI is to screen for it.

What Are the Most Common STDs?
  • Human Papillomavirus (HPV): The most common STI in the U.S., this virus causes genital warts, although the lesions don’t appear in everyone who has HPV. It’s highly contagious and easily transmitted sexually or even by skin-to-skin contact. When genital warts are present, we can usually make a diagnosis from inspection, but additional testing is sometimes useful, and can include biopsy or colposcopy in women.
  • Gonorrhea and Chlamydia: These infections are very common and are often grouped together because they’re screened for at the same time. The infection can be missed, particularly in women because the bacteria that cause them doesn’t always create symptoms. Infections are caused by oral, anal, or genital contact with someone else who has an infection.
  • Syphilis: Syphilis is a bacterial infection passed from one person to another by oral, anal, or genital contact with infectious but painless sores that are present during the initial stages of the infection.
  • Herpes: There are two strains of the herpes virus: type 1 and type 2. Type 1 has traditionally been associated with oral herpes (cold sores) and type 2 with genital herpes, but recent research has shown that most genital infections are also caused by type 1. A person may have either strain of the virus but never show any symptoms, or may have an “outbreak” with painful sores near his or her mouth, genitals, or anus. Herpes is most commonly transmitted via contact with infectious sores, but in some cases can be transmitted when the infected person has no symptoms at all. Because a person can be contagious even though no lesions are present, taking precautions only when there are visible lesions may not prevent spread of the infection to the partner.
  • HIV: This viral infection is transmitted via blood (e.g, in intravenous drug abusers who share needles with infected persons) or sexually, by having unprotected anal or vaginal sex. Very rarely, it can be transmitted by contact with other body fluids.
  • Hepatitis C: Hepatitis C is a viral infection that is transmitted most commonly through contact with blood or through skin exposure (e.g., sharing needles or coming into contact with an open wound or sore). Very uncommonly, hepatitis C can be contracted by having sex with someone who has hepatitis C; the risk is about 1 transmission per 190,000 sexual occurrences. This infection can cause chronic liver disease and liver cancer.
  • Hepatitis B: Hepatitis B is also a viral infection, transmitted by blood or semen, that can cause liver disease.
What is STD Screening, Exactly?

Getting a screening test means that we look for an infection when you may not have any symptoms. Just like you get a mammogram, or screen for colon cancer, it’s also important to screen for sexually transmitted infections (depending on your risk). There are no exact recommended times or tests that we recommend for everyone. These testing recommendations depend on your lifestyle and risk level.

Why Is It Important to Get Tested for STDs?

Most importantly, get tested to protect yourself, your partner(s), and to stay informed. Getting a diagnosis can alert you to an infection you may not know you had (e.g. many people hepatitis C, probably about 1 million in the U.S., have no idea they have been infected), or that may have long-term effects like infertility. It can also allow you to start treatment if you do have an infection, and create peace of mind when you think you may have been at risk.

What Types of Tests Are Out There?

There are plenty of tests that make staying informed accessible, but there’s no single test for every STD. Most tests require a urine or blood sample, or a swab of the area where the infection might be present. If you have a sore and we want to pinpoint the cause, a swab can additionally identify whether a specific virus or bacteria is present. There are also “rapid” HIV tests you can buy for home use; results are available in about 20 minutes.

What Should I Be Tested for and When?

People often say, “Just test for everything.” While that might seem to make sense initially, it’s important to talk to your health care provider about your specific risk factors and lifestyle. There are a few downsides to testing for everything that are important to consider. First of all, tests are expensive, and in a few cases, such as blood testing for herpes, a positive test can be a false positive. False positives may result in unnecessary anxiety when there may be virtually no risk of transmission and no required treatment.

Here are some instances that would prompt a screening test:

  • You’re sexually active. Everyone who is sexually active (even if you’ve only ever had one partner and always use protection) should be screened at some point. We recommend an HIV test for everyone who is sexually active. We also suggest women obtain a test for gonorrhea and chlamydia, because, unlike men, they frequently harbor these infections without developing symptoms. Keep in mind that if you’re practicing safe sex and are in a monogamous relationship, you can get tested less frequently.
  • You’re having unprotected sex. If you’ve had or want to start having sex — vaginal, anal, or oral — with a new partner, without a condom, it’s a good idea to get tested. Here’s how long after exposure we can get a reliable test result:
    • 2 weeks: gonorrhea and chlamydia (and a pregnancy test too!)
    • 1 week to 3 months: syphilis
    • 6 weeks to 3 months: HIV, hepatitis C and B
  • (You might be asking, “What about herpes?” We don’t recommend screening for the herpes virus for most people unless you have an outbreak of sores.)
  • You’re involved in riskier relationships. If your partner has a chronic or long-term infection, such as HIV or hepatitis C or B, it’s important to be tested more frequently. If you’re in an open relationship, or you aren’t sure that your partner is monogamous, those are also reasons to be screened regularly. Generally, that means about every 6 months or more depending on your personal situation.
  • You engage in high-risk sexual behavior. High-risk behavior includes intimate contact with a sex worker, IV drug user, men who have sex with men, and having multiple partners, or anonymous partners. In these cases, you’re at higher risk for coming into contact with HIV and hepatitis C, along with syphilis, gonorrhea, and chlamydia and should get tested after contact (remember, that includes oral and anal sex, too!)
  • You’ve had an infection in the past. You may be more likely to have in infection again, so it’s a good idea to be screened, about 3 months after you’ve been treated, if you are sexually active.
  • You’re a baby boomer. Because many baby boomers (people born between 1945 and 1965) may have contracted hepatitis C before we even knew the virus existed and could test for it, and because they may have no symptoms of infection, we recommend all baby boomers be tested once for hepatitis C.
  • You have symptoms. This is a good time to have a discussion with your health care provider. Your symptoms and history will allow you to make the best choice about the most informative tests to look for possible causes of your symptoms.

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Updated November 20, 2018.

Even if you’ve had twenty-twenty vision all your life, as the birthdays pile up post-40, you might suddenly find yourself squinting or coping with other vision-related troubles for the first time. After your fortieth birthday, it’s time to get to know an eye doctor and sign up for a yearly checkup even if you’ve never worn glasses or contact lenses.

“Diseases like glaucoma and macular degeneration–while normally older person’s diseases–can start in your forties,” warns Liz Erley, an ophthalmologist at Wink Optical, Boulder, CO. “But if they are caught early, your vision can usually be saved.”

Not all age-related eye problems are serious enough to threaten your vision, but they can be uncomfortable and downright annoying on a daily basis. Here’s what to expect from your eyes after 40–and what you can to do to help ensure that you keep seeing clearly for many years to come.

Dry Eyes

What’s causing it: Dry eyes can be a problem for both men and women, but women will often find that all of their mucous membranes–including their eyes–start to dry out sometime after age 35, thanks to shifts in hormones. In the years leading up to and after menopause, estrogen and progesterone levels drop, and that is a leading cause of dryness. Living in a dry climate can exacerbate the condition, as can dry indoor air. “And staring at the computer screen for hours increases eye strain and makes eyes more dry,” says Erley. “Normally people blink about 30 times a minute, but when you’re staring at a computer, you only blink about half that much.”

What can help: See your primary care provider or your eye doctor for relief, especially if you wear contacts (you’ll feel the effects of the dryness more when your lenses are in). Prescription eyedrops can help rebuild your tears to normal levels. You can also help cope with the discomfort, redness, itchiness, and burning with over-the-counter lubricating drops. Erley cautions patients to skip redness-relieving eyedrops, however. “That just deals with redness by constricting the blood vessels, but will do nothing to help with dryness.” Instead, she recommends a lubricant that you can use first thing in the morning and throughout the day as needed.

Your diet can also play a role in lubricating chronic dry eyes. Anything that keeps your body well hydrated will help your eyes as well–so drink plenty of water and avoid dehydrating things like alcohol (especially red wine). Erley also recommends upping your intake of omega-3s because those good fats are helpful for increasing lubrication throughout the body. Eat more cold-water fish like salmon and halibut and supplement your diet by taking 1,000 mg of fish oil twice a day.

Reduced Reading Vision

What’s causing it: If you suddenly seem to need more light to see what you’re reading, or find yourself holding your smartphone further and further away in order to read an email or text message, you’re in good company. After age 40, it’s common for your vision to change so that you require reading glasses. “As we age, the lens inside the eye becomes less flexible, so we have a harder time viewing things clearly when they are up close,” says Erley.

What can help: The only solution here (other than growing longer arms!) is to see your eye doctor for an eye exam. Depending on your prescription, you may be able to get away with buying inexpensive reading glasses at the drugstore, or you may need something customized. Luckily, these days the options are much less obvious than they used to be. Instead of the old-fashioned bifocal glasses, you can now get glasses with progressive lenses. They work virtually the same way as the old bifocals, but without the telltale line. Multifocal contact lenses serve the same purpose, enabling you to see at all distances without having to pull out reading glasses to read the menu.

Difficulty Seeing After Dark

What’s causing it: Reduced night vision is another common symptom of aging eyes. It’s caused by the aging of the photo receptors in the eyes, which results in a reduced ability to see clearly in dark situations, such as driving at night.

What can help: Unfortunately, there’s not much that can be done to really improve your night vision. Your best defense is to see your eye doctor annually to ensure that your glasses or contacts prescription is up to date to help keep your vision as sharp as possible in all conditions.

Glaucoma

What’s causing it: A buildup of pressure in the eye can cause damage to the optic nerve. Without treatment, vision loss–starting with the peripheral vision–is common.

What can help: Everyone over 40 should get a full eye exam every year during which your doctor tests the pressure in your eyes, examines the optic nerve, and dilates and examines the pupil. When diagnosed early enough, glaucoma can be treated.

Cataracts

What’s causing it: The lens of the eye is made up primarily of water and protein. As we age, the proteins can clump together and become a cataract. The result is that the lens of the eye gets clouded, making vision blurry, reducing night vision, and possibly creating the illusion of halos when you look at lights.

What can help: Wear anti-glare sunglasses whenever you’re outdoors because prolonged exposure to UV rays can exacerbate the problem. If a cataract is found early enough, non-surgical solutions, like a new glasses prescription, may be adequate. More advanced cases require surgery to remove the clouded lens and replace it with an artificial one.

Macular Degeneration

What’s causing it: The macula is located at the back of the retina and is made up of millions of light-sensing cells that work to provide you with sharp, central vision. When the macula breaks down, the layers start to separate and leak. Gradually, your central vision begins to get blurry.

What can help: A diet rich in antioxidants may be helpful as part of an overall preventive approach. Again, you need to see your eye doctor annually to be examined for any early signs of macular degeneration. When left untreated, it will lead to vision loss.

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Updated November 20, 2018.

If you’ve ever hiked Machu Picchu, climbed Kilimanjaro, or even skied some particularly intense slopes, you might be familiar with altitude sickness. It’s a common ailment — studies show that 25 percent of people show signs of it at elevations as low as 8,000 feet. In its most benign form, altitude sickness can put a damper on your vacation plans. In more severe manifestations it can be debilitating — and sometimes deadly. If you’re planning to travel to higher elevations, be sure you know how to prevent and treat altitude sickness.

What is altitude sickness?

The phrase “altitude sickness” is an umbrella term for several varieties of illness. The root cause is the same, however: lack of oxygen at high elevations. The symptoms vary, but can include headache, loss of appetite, vomiting, diarrhea, and abdominal pain, all of which can last anywhere from 12 hours to four days.

What are the different types?

Altitude sickness is typically divided into three distinct syndromes:

  • Acute Mountain Sickness (AMS): Considered the most common form, AMS involves the symptoms people typically associate with altitude sickness and hangovers: headache, fatigue, loss of appetite, nausea, and occasional vomiting. Symptoms usually resolve within 24 to 72 hours of acclimatization.
  • High Altitude Cerebral Edema (HACE): If AMS progresses, it can turn into HACE, which involves the build-up of fluid in the brain. Symptoms include headache, dizziness, blurry vision, and disorientation. Although an important prevention and treatment strategy is hydration, people with more severe forms of altitude sickness often can’t keep water down. HACE is rare but potentially fatal, and can become life-threatening in just a few hours. Descent is the only real treatment.
  • High Altitude Pulmonary Edema (HAPE): HAPE typically occurs at higher elevations and involves a build-up of fluid in the lungs. HAPE can happen to anyone at any altitude above 8,000 feet. Even experienced athletes can experience it, so while preparation and training are important, they aren’t guaranteed safeguards. Mild symptoms can include a dry cough and shortness of breath after mild exertion, but more severe types of HAPE involve shortness of breath at rest, confusion, and fever. The only way to alleviate HAPE is to descend — oxygen and descent are life-saving and essential.
How can I prevent altitude sickness?

Luckily, there are ways to sidestep the symptoms of altitude sickness and avoid the more serious complications before and during your trip.

Before You Go:

Take Ibuprofen

Ibuprofen was found to significantly reduce the incidence of altitude sickness in a double-blind, placebo-controlled trial of 86 men and women. Take 400 mg of Motrin or Advil in the morning, and then every six hours while at elevation.

Hydrate

Drink two to three liters of water a day to prepare for your trip. Dehydration decreases the body’s ability to acclimatize to higher altitudes.

Caffeinate

If you are a regular coffee drinker, make sure that you have caffeine prior to climbing. The effects of caffeine withdrawal mimic the effects of altitude sickness, and are alleviated by caffeine. It’s also a good idea to bring caffeine-containing Excedrin along on the trip for a quick pick-me-up.

Stay Home if You’re Sick

What seems to be a small cold at lower elevations can be serious at higher elevations. It’s imperative to be completely healthy when you begin your journey. Your lungs are already working their hardest to adapt to the thinner air at altitude; any cough or wheeze can compromise that. Use your best judgment and if you’re unsure about whether it’s safe to go, contact your health care provider for advice.

Take the Right Medication

Acetazolamide is a medication often used to prevent and reduce the symptoms of altitude sickness by increasing respiration. The side effects, however, such as increased urination and tingling in the hands and feet, can be similar to the illness itself, so it may not be helpful for everyone. If for some reason you can’t take acetazolamide, speak to your health care provider about other options.

Bring Snacks

Because it’s important that you continue to eat while at altitude, make sure you are bringing food that is easily tolerated. Treats like chocolate or snacks such as pretzels can be great portable options. Stick with simple flavors; sometimes spicy food can be very nauseating at high altitudes.

During the Trip:

Acclimatize

Don’t go too high too fast. Acclimatization is the most important way to avoid symptoms of altitude sickness, so plan for a night or two at 8,000 feet, then ascend no more than 1,600 feet per day.

Climb High, Sleep Low

The old climber’s adage holds true: climb high, sleep low. It’s important to head to higher altitudes during the day as you are trying to acclimatize, but to sleep lower in order to get oxygen. Never sleep at an altitude if you are feeling symptoms of altitude sickness; head down the mountain to sleep in thicker air.

Hydrate More

You’ll know if you’re drinking enough water if you’re urinating regularly. If you haven’t urinated in three to four hours, drink more. Higher altitudes require extra fluid consumption.

Cover Up

Protect yourself from the sun by wearing a hat, lip protection, and sunblock. Be sure to wear sunglasses as well to avoid snow blindness, a condition that can occur at higher elevations.

If You Get Sick

If, despite your best efforts, you do begin to feel some of the mild signs of altitude sickness like headache and difficulty breathing, there are a few strategies you can try. Often you can alleviate the symptoms with a few simple tricks:

  1. Hydrate as much as possible with water and Gatorade
  2. Take a dose of ibuprofen or Excedrin
  3. Walk slower, especially while climbing. Try this pattern: Step, step…breathe….step, step…breathe. Sometimes all you need to do is slow down.

If the headache and difficulty breathing continue despite all of the above, the most important thing you can do is descend. Never ever try to “sleep it off” — that could be a deadly decision. Remember, the mountain will always be there.

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Updated November 20, 2018.

Candida, a type of yeast, is a normal inhabitant of even the healthiest bodies. It loves warm, dark, moist places, particularly the gastrointestinal tract and the vagina where as many as 20 percent of women of reproductive age harbor Candida. The most common species by far is Candida albicans. Candida normally dwells innocently in these locations, kept in check by the body’s bacterial flora, but when the body’s ecology is thrown out of whack, these yeasts can start to overgrow.

And these overgrowths of yeast like Candida albicans can affect men, as well as women.

What causes yeast infections?

Common culprits for this imbalance are antibiotic use, frequent sexual intercourse, irritating soaps or deodorants, wearing tight-fitting undergarments, or any exposure to a hot and humid environment. The role diet plays in increasing the risk of a yeast infection is unclear, but candidal infections are more common in people with diabetes. They are sometimes the first clue to the presence of diabetes.

How serious are they?

When Candida causes disease, it’s usually local, mild and easily treated. One-third of all cases of vaginitis in women are caused by Candida. Another common manifestation is oral thrush, which has similar symptoms to a sore throat — altered taste and pain with swallowing. Your provider will diagnose thrush by identifying the typical white lesions, often on a reddish background, commonly found on the tongue and oral mucosa.

Serious, even life-threatening yeast infections can occur, but these are almost exclusively limited to immunocompromised patients or patients who have undergone an invasive procedure (e.g., placement of a central venous line) with contaminated equipment.

Can men get yeast infections?

Although uncommon, men can get a yeast infection by having unprotected sex with a woman with candidal vaginitis. It usually appears as small white spots, redness, or a dry, peeling rash on the penis accompanied by itching, irritation, or burning. Men who have not been circumcised are at an increased risk.

How do you treat a male yeast infection?

Even untreated, it often goes away by itself, but it can sometimes spread to the scrotum, inner thighs and buttocks. Luckily, treatment is simple: Over-the-counter or prescription antifungal creams used twice a day for between one to three weeks will clear the infection. An oral antifungal drug such as fluconazole is also almost always effective. Although various herbal remedies have been touted for women with yeast infections, there’s no data on their efficacy (or lack thereof) in men, and traditional treatment is so safe and simple that there’s no compelling reason to explore these possibilities.

Because the infection is transmitted to men by sexual intercourse, both partners should be treated so you don’t keep re-infecting each other. However, if only the woman has evidence of a yeast infection, the risk of transmission is so low that there’s no need to treat the male partner. There’s no compelling reason to limit sexual intercourse during treatment, but you should use a condom.

What about thrush?

Oral yeast infections, or thrush, aren’t unique to men, and there’s no data about the risk of acquiring thrush from oral sex with a woman or man with a genital candidal infection. Treatment, again, is simple and effective — either an oral pill such as fluconazole, an antifungal mouthwash, or antifungal lozenges. Rarely, patients don’t respond to one of these regimens. In that case, thrush may be a symptom of candidal esophagitis, an irritation, inflammation, or swelling of the esophagus. Your provider will need to perform an upper endoscopy and sometimes a biopsy to diagnose candidal esophagitis.

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Updated November 20, 2018.

Of course you still want to look and feel attractive during your pregnancy, but which beauty products are safe to use during pregnancy? Although there isn’t a lot of definitive data — most products are probably fine when used sparingly — there is evidence that you should exercise caution with certain ingredients.

For a safe and healthy beauty regimen during pregnancy, consider this list of potentially problematic ingredients in common beauty products, and be sure to check out safer alternatives offered by pregnancy-friendly beauty lines.

Nail Polish and Hair Spray

A group of chemicals known as phthalates is once again in the news. Found in in many household items, such as shower curtains and plastic wrap, and beauty products like nail polish, hair spray, and synthetic fragrances, phthalates are known to disrupt hormones. A recent study has linked prenatal exposure with the disruption of hCG, a pregnancy hormone, which may impact a male fetus’s reproductive development. Women with a higher hCG level during pregnancy were more likely to give birth to male babies with a short anogenital distance (the distance between the anus and scrotum), which is associated with low sperm count and infertility.

Scientists and consumer groups have long expressed concern about the ubiquity of products containing phthalates. In 2008, Congress restricted the usage of phthalates in baby toys and other infant-care products after studies reported that infants exposed to these products had significantly higher levels of phthalates in their urine. The FDA concluded that the phthalates used in cosmetics do not pose a health risk to adult humans, but the growing evidence against phthalates gives us pause.

What should I do?

We advise caution. Most likely, painting your nails or using hair spray from time to time poses little risk to you or your developing baby. But to be on the safe side, follow these recommendations:

  • Look for phthalate-free products. Avoid products that have “fragrance” on the ingredient list.
  • Paint your nails and use hairspray in a well-ventilated space. Once polish dries, it poses virtually no risk because it’s not absorbed through the nail.
  • Since hairspray is likely to be inhaled, exercise caution if you use it frequently. Consider using mousse or gel instead.
Lipstick

Additives are often introduced to lipstick to make the color last longer. The problem? These additives may contain small amounts of lead. The FDA has found no link between the low levels of lead found in lipstick and safety concerns, but research is limited and consumer groups have pushed for lead levels to be capped. Although ingestion is unlikely, lead does cross the placenta, so caution is warranted.

What should I do?

Although the potential risks of lead in lipstick are slim, we recommend looking for lead-free products.

Skin Care Products

Two skin care ingredients are definite “no’s” during pregnancy: retinoids and salicyclic acid. Both have been labeled category C drugs by the FDA — animal studies have shown a link between the product and birth defects.

A type of vitamin A, retinoids speed up cell division and can be found in anti-aging creams and certain acne medications. Applied topically, they don’t appear to pose a significant health risk, but consumed orally in substances like Accutane, an oral acne medication, they have been linked to birth defects. To be safe, experts recommend that pregnant women avoid all retinoid products — including topical forms.

A common topical acne medication, salicyclic acid is also found in aspirin and poses similar concerns. In oral forms, it may cause birth defects and other pregnancy complications. Like retinoids, avoid topical salicyclic acid as well.

What should I do?

Avoid retinoids and salicylic acid. A dab here or there on the skin is unlikely to cause harm but prolonged exposure — such as rubbing a large amount of a retinoid product into the skin or using a face mask containing salicylic acid — could be risky.

To avoid retinoids, steer clear of these ingredients and products:

  • Differin (adapelene)
  • Retin-A
  • Renova (tretinoin)
  • Retinoic acid
  • Retinol
  • Retinyl linoleate
  • Retinyl palmitate
  • Tazorac
  • Avage (tazarotene)

To avoid salicylic acid, do not use products with beta hydroxy acid (BHA) listed as an ingredient.

Hair Dye

A 2005 study found an association between hair dye use during pregnancy and a type of childhood cancer called neuroblastoma, and providers recommended that pregnant women forgo dyeing their hair until after they give birth. Since then, numerous studies in humans and animals have not found the same association. The prevailing wisdom today is that hair dye is safe during pregnancy.

What should I do?

According to the available research, dyeing your hair during pregnancy appears to be safe.

Products That Are Safe During Pregnancy

Pregnancy doesn’t mean you have to forgo your entire beauty regime. Although it’s still important to carefully check labels, many companies offer products specifically tailored for pregnant women, including these lines:

  • Belli makes products ranging from face wash and acne-controlling cream to sunscreen and lip balm, all designed for pregnant and nursing women.
  • Mama Mio offers a skin care line entirely for pregnant women.
  • Beauté de Maman was designed by an OB/GYN and features facial scrubs, breastfeeding nipple gel, body cream, and more.
  • Burt’s Bees has a Mama Bee line, which includes “belly butter” and body oil.
  • 100%Pure offers cosmetics made from fruit pigments, which are free of phthalates, artificial fragrances, chemical preservatives, and thickeners.
  • Acquarella‘s nail polishes are phthalate- and lead-free.
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Updated November 20, 2018.

If you’ve ever turned to Google for an answer to your health woes, you’ve likely run into a fair share of “surefire” home remedies. For the countless women who experience vaginal discharge, bacterial vaginosis (BV) is a common diagnosis — it’s responsible for half the cases of vaginal discharge in young women. Search the internet for how to treat it and you’ll find a curious home remedy making the rounds — hydrogen peroxide. But does it work? And is it safe?

What is BV?

BV is an infection caused by an imbalance of “good” and “bad” bacteria in the vagina, most commonly affecting women ages 15 to 44. The exact cause of the condition isn’t known, but certain activities like smoking and douching can increase your risk of getting it.

Though BV is not a sexually transmitted disease (STD), starting a sexual relationship with a new partner can also upset the balance of bacteria in the vagina, and having BV can increase the odds of actually contracting an STD.

What are the symptoms?

Common symptoms include a thin, white-grey discharge, a fishy odor, pain, itching, and burning, but many women don’t experience any symptoms at all.

How do you treat it?

BV rarely leads to any other issues and can go away on its own, but if it persists, your health care provider will prescribe antibiotics like metronidazole (Flagyl, MetroGel), clindamycin (Cleocin, Clindesse), and tindazole (Tindamaz) to kill the problem bacteria. These can be prescribed for oral or vaginal use. The trouble with antibiotics is that they don’t treat the cause of the bacterial imbalance. Therefore, recurrence is very common—symptoms return in about one out of three women—leading to concerns about antibiotic overuse.

Does hydrogen peroxide work?

One of the popular home remedies for recurring BV is hydrogen peroxide. One study suggests that douching with 30 milliliters (ml) of hydrogen peroxide every day for a week eliminated BV symptoms in 89 percent of participants. But what do the experts think?

“It was a very small cohort of women in this study, but it’s worth considering for women who have recurrent BV issues,” says One Medical’s Beth Pferdihirt, FNP-C. “The caveat: 30 ml every evening for a whole week is a lot of hydrogen peroxide. It’s probably much easier to just use MetroGel or other vaginal prescriptions first, and discuss this possible treatment with your provider for recurrent issues.”

Is there a downside to trying the hydrogen peroxide cure?

“Hydrogen peroxide can be really irritating for the skin in general,” Pferdihirt adds. “I would be reticent to have patients use it in the vulvar area unless I had solid data to back it up.”

So is there anything other than antibiotics that does work?

“I typically recommend boric acid vaginally twice a day for one to two weeks,” says April Blake, a naturopath. “This usually treats BV and yeast and works very well.”

Pferdihert agrees that data supports the use of boric acid suppositories. Now the Centers for Disease Control (CDC) is also recommending 600 milligrams (mg) of vaginally-administered boric acid in a gelatin capsule for two weeks for recurrent cases. According to Malcolm Thaler, MD, a seven-day course of antibiotics plus 21 days of vaginal boric acid is the combo that’s really been shown to reduce the number of recurrences.

You can also restore balance after BV by replacing the good bacteria that’s been wiped out. Though probiotics alone aren’t proven to prevent recurrence, oral and vaginal probiotics in the form of lactobacillus can help to rebuild a healthy vaginal environment.

Before trying hydrogen peroxide, boric acid, probiotics, or any other home remedy for BV, be sure to talk to your health care provider.

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Updated November 20, 2018.

You’ve seen the ads promoting supplements that claim to aid everything from common cold relief to weight loss. Another problem many supplements claim to fix? Stress. And since two-thirds of Americans believe stress has a significant impact on their physical and mental health, it’s no wonder these products are flying off the shelves.

Although they aren’t for everyone, therapeutic doses of the right supplements can, in some cases, be reasonable stress-targeting additions to a healthy diet and lifestyle. Unfortunately, supplements aren’t regulated by the Food and Drug Administration (FDA), so it can be difficult to determine which ones are worth a shot. Here’s more insight into these supposed stress-busters, along with recommendations from One Medical’s Erica Matluck, ND, NP. Remember: Consult your health care provider before beginning any supplementation regimen.

Melatonin

What is it? A hormone produced by the brain’s pineal gland, melatonin helps control sleep cycles. Because sleep and mood are closely connected, supplementing with melatonin can alleviate stress. It’s considered safe, but can cause side effects like headaches, short-term feelings of depression, dizziness, and irritability.

Does it work? Research indicates that melatonin can be a helpful in promoting healthy sleep patterns. One small study found that the supplement significantly improved sleep, behavioral disorders, depression, and anxiety in elderly patients. In another study, melatonin produced significant improvements in sleep efficiency in insomniac patients 50 and older.

How to take it: “I advise starting with 3 milligrams (mg) at bedtime. If 3 mg isn’t effective, bump it up to 6 mg,” Matluck says. “Usually if 6 mg is not effective, melatonin isn’t the right fit. If you’re waking up in the middle of the night, try the extended-release preparation.”

Magnesium

What is it? Magnesium is a mineral essential for nerve and muscle function. Although most people who eat a balanced diet get enough magnesium, an analysis of data from the 2005-2006 National Health and Nutrition Examination Survey (NHANES) found that a majority of Americans consume less than they should. The supplement is considered safe, but side effects can include stomach upset, nausea, vomiting, and diarrhea. Rarely, large doses can cause irregular heartbeat and low blood pressure.

Does it work? Magnesium is known to promote relaxation; therefore, a deficiency can cause stress to have detrimental effects on the body. In addition, research indicates magnesium seems to play a major role in the hormonal axis and regulation of the stress response, and some research indicates it can be an effective part of depression treatment.

How to take it: “I usually recommend 600 mg of magnesium citrate before bed,” Matluck says. “If 600 mg causes loose stools, taper to 300 mg, which is very well tolerated.”

Valerian Root

What is it? Valerian is an herb commonly used to treat insomnia, anxiety, and stress. Although it’s considered safe for most adults, the effects of long-term use are unknown. Short-term side effects include headaches and sluggishness in the morning, especially if taken at higher doses.

Does it work? Early research indicates it could be helpful in reducing blood pressure, heart rate, and feelings of pressure when under stress.

How to take it: “I usually use valerian in a tincture form and recommend three droppersful before bed,” Matluck says. “If it doesn’t make you too sleepy, try it during the day as needed for stressful situations.”

Vitamin B-Complex

What is it? The vitamin B-complex refers to all of the known essential water-soluble vitamins except for vitamin C: thiamine (B1), riboflavin (B2), niacin (B3), pantothenic acid (B5), pyridoxine (B6), biotin, folic acid, and the cobalamins (B12). B vitamins are important for cell metabolism. Most people who eat a balanced diet should have adequate B vitamins, but a vegan diet or an immune disorder such as lupus can lead to B12 deficiencies.

Does it work? Some research indicates B-complex vitamins are linked to improved mood.

How to take it: “I recommend a B-complex that contains at least 1 mcg B12 and 50 mg B6,” Matluck says. “B-complex is best taken in the morning because it may boost your energy.”

Theanine

What is it? An amino acid found in green tea, theanine is often used for treating anxiety and high blood pressure.

Does it work? There’s limited evidence that theanine may help people who aren’t stressed feel more tranquil. However, those with elevated stress levels didn’t experience the same effect. Another study indicated theanine may reduce anxiety and lower blood pressure increases in high-stress response adults.

How to take it: “Theanine should be taken at 200 to 400 mg on an empty stomach,” Matluck says. “Most of my patients find that it takes the edge off their anxiety without sedating them. If it doesn’t cause sleepiness, I encourage theanine two to three times a day, depending on stress levels.”

Phosphatidylserine

What is it?: Phosphatidylserine (PS) occurs naturally in the body and supports cellular function, especially in the brain. Although the supplement form is considered safe for most adults and children, it can cause side effects like insomnia and stomach upset, particularly at doses over 300 mg.

Does it work?: Some research suggests that athletes taking PS during strenuous training might experience less muscle soreness, but there are conflicting results. One study found preliminary evidence that a combination of soy-based PS and lecithin may moderate the body’s reaction to stress.

How to take it: “PS is best taken in the evening or before bed at 200 mg. It tends to decrease levels of the stress hormone cortisol,” Matluck says. “Very rarely, it can cause people to feel awake and energized. If you are one of the few that has this reaction, try it in the morning.”

Gamma-Aminobutyric Acid

What is it? Gamma-Aminobutyric Acid (GABA) is a chemical made in the brain and often taken as a supplement to relieve anxiety, improve mood, reduce PMS symptoms, and treat symptoms of attention deficit hyperactivity disorder (ADHD).

Does it work? There’s limited evidence to suggest that orally-administered GABA supplements can help promote relaxation and immunity and reduce anxiety during times of stress.

How to take it: “It tends to be calming without being sedating, so people usually do fine with GABA during the day,” Matluck says. “I recommend 500 mg as needed in times of stress from one to three times a day on an empty stomach.”

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Last updated November 12, 2018.

Ah happiness, that elusive state of being that everyone wants. It can’t be bought or sold. So how do you find it?

Poets and philosophers have pondered this question for ages. And as writer Eric Weiner explores in The Geography of Bliss, people travel to the ends of the earth to find the secret to happiness, while many natives of Iceland and Bhutan seem to have perfected the art of contentment.

More and more, scientific studies are showing that happiness is a choice.  Each of us holds the key to our own personal version of contentment – like Jill Scott sings in One is the Magic Number.

When I lived in San Diego, these cool photographers I knew would have an 11/11 party every year. They thought it made a perfect day to focus on yourself, and making the things you want happen in your life.

Some people believe all those ones add up to a positive message from the Universe. But even if you’re not into new-agey stuff or numerology, it’s a great day to remember each of us has a lot of power over how happy and fulfilled we feel.

Here are 11 easy ways to get closer to your happy place:

1. Interact with five or more people daily.

There’s a lot of research if you can connect to five or more people in a day you actually are happier, says naturopath April Blake, based in Marin. It turns out people who work at home alone with no company besides their laptop tend to be more depressed than the rest of us. Force yourself to go out for lunch, join a professional group or a play group if you’re home with kids.

2. Laugh.

That old saw about laughter being the best medicine? It’s turning out to be true. Laughter increases production of endorphins, the body’s natural feel-good chemicals. Laughter also brings more oxygen to your cells and it boosts your immune system, says Blake. Watch a funny movie, or try laughter yoga. Yogis lead as you sit in a chair and do silly movements with your arms and legs and laugh. Your body doesn’t know the difference,  and pretty soon you’re laughing for real.

3. Write down 11 things you’re really thankful for in your life.

Got your list? Now take a few minutes to appreciate them, suggests Erica Matluck, a naturopath and nurse practitioner with One Medical in San Francisco. “Everyone in our culture is so focused on everything that’s wrong and there’s not enough attention to the things that are going well,” says Matluck.

4. Go for a walk.

Exercise, whether it’s just walking, running or weight lifting, is a quick way to lift your mood. In fact, a study from the University of Bristol found that exercise improves your well-being and the way you see yourself. It’s so effective that it can be an effective treatment for anxiety and clinical depression.

5. Don’t be so picky.

Or as Malcolm Thaler, an MD in New York put it, studies show that “lowering your expectations is a key to happiness.” Being happy depends on not how things are going, but how what’s happening measures up to your expectations, according to an MRI study by the University College of London.

6. Spend some time outdoors.

“Every time you go outside and look at trees or sky it’s like ‘oh yeah, I’m supposed to be living in the relaxed state,'” says Blake. A 2014 study by the American Chemical Society found that living near green space can make people feel happier for years. To test the theory, they compared the mental health of people who moved from a gray urban area to a greener one, with people who made the opposite move. The people who relocated to the greener area were happier for a full three years after the move.

7. Add some play to your day.

“Play like a kid as often as you can, says Julia West, an RN who offers an online anxiety management program. “It could be playing games, indoors or out, crafts, athletics, or any pastime that strikes your fancy. Find something that’s totally engrossing, in-the-moment and outcome irrelevant.”

8. Narrow your choices.

“The more options there are, the easier it is to regret,” says Barry Schwartz, a Swarthmore College professor and author of The Paradox of Choice: Why More is Less. His theory is that the vast number of choices in everything – shoes, restaurants, online mates — that people in the west have makes us less happy. Studies have found it leads to depression and loneliness. Numerous studies back up his theory, including one of people offered chocolates. The subjects were more satisfied when they had fewer kinds of chocolate they had to choose from. Schwartz suggests deciding on on your goal, consider your different options. Pick the option that best fulfills your goal and don’t worry about the others.  Less really is more.

9. Listen to music you love.

When we listen to music we like, our brains release dopamine, a chemical that makes us feel good. Favorite songs caused chills of pleasure, and increases in heart rate, breathing and body temperature, researchers at McGill University’s Montreal Neurological Institute reported. In fact, we don’t even have to hear the song; just thinking about the sounds of Happy by Pharrell or Florence + the Machine’s Dog Days Are Over can make the brain release dopamine. Try it!

10. Do something nice for someone else.

Numerous studies have found that treating someone, volunteering or spending money on others makes people feel happy. That’s probably what explains random acts of kindness like shoveling snow for a neighbor, giving someone else the open seat on the train or holding a door open for a stranger. We feel good when we help someone else. Whether it’s buying coffee or paying a toll for someone in line behind you, why not pay it forward?

11. Just smile.

Growing up, one of my dad’s favorite sayings was, “Smile; it increases your face value.” Apparently, he was right. More than one study has found that when you smile, it reduces stress and elevates your mood, whether you’re happy or just going through the motions. Any smile made people feel better, even when University of Kansas researchers Tara Kraft and Sarah Pressman had subjects  prop up the corners of their mouths with chopsticks!  But the 2012 Grin and Bear It study found the biggest mood lift came from a genuine smile, aka smize that includes the muscles around the eyes.

What makes you feel happier? Tell us in the comments.

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Last updated November 12, 2018.

If you notice that your daily coffee ritual is often accompanied by a timely bowel movement, you’re not alone. For some people this can be an inconvenience, but for others, coffee can be one way of keeping regular. Some coffee drinkers will readily feel this gastrointestinal effect, some less so.

How Does It Work?

Researchers believe that the bowel-stimulating quality of coffee comes from caffeine and/or other substances contained within the coffee brew. Although there have been no large-scale studies on this subject, what we do know is that drinking coffee can stimulate movement of the colonic muscles, thus promoting peristalsis (the coordinated contraction and relaxation of intestinal muscles that causes bowel movements). One study noted that the magnitude of this peristaltic effect of caffeinated coffee is similar to one induced by eating a meal. It’s also 60 percent stronger than the effect induced by drinking water, and 23 percent stronger than the effect due to drinking decaffeinated coffee.

Aside from promoting bowel movements, coffee can also cause looser stools because increased peristalsis leaves less time for the colon to perform one of its key functions–reabsorbing water from fecal matter to produce well-formed stools. Be aware, however, that other common accompaniments to coffee can be culprits in this matter. Dairy products, excess sugar, even “sugarless” sweeteners like sorbitol (a well-known substance used as a laxative) can cause diarrhea.

How Much Caffeine Is in Coffee, Anyway?

So how much coffee is needed to get results? The above-referenced study used a black Colombian coffee containing 150 milligrams (mg) of caffeine, a fairly average caffeine content for an 8-ounce (oz) cup of joe. A 12-ounce “tall” drip coffee from Starbucks contains about 240 mg of caffeine, and single-shot latte drinks approximately 90 mg. In the end, the effect will vary by the individual.

But Isn’t Coffee Dehydrating?

You might be wondering about the dehydrating effects of coffee: Shouldn’t drinking coffee cause constipation instead? While we’ve been told for years that coffee (and caffeine in general) is a potent diuretic, research studies show that coffee only seems to have diuretic effects when consumed in larger amounts — adding up to more than 500 to 600 mg of caffeine a day. The most recent studies on this subject show that there is, in fact, no significant difference between urine output among people who drink caffeinated drinks compared to those who drink water or other comparable non-caffeinated drinks. Therefore, the typical coffee drinker shouldn’t experience significant dehydration from a one- or two-cup habit.

So now that you’ve learned more than you may have cared to about your colonic function, perhaps it’s time to test out your newfound self-awareness with a cup of coffee. However, if you care for the mental stimulant effects of caffeine without the gastrointestinal stimulation, try a cup of tea instead. Studies show that tea, by itself, doesn’t seem share the same bowel movement-inducing quality of coffee.

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