Archives 2024

When experts talk about the dangers of excessive drinking, we often assume those warnings apply mostly to people with alcohol use disorder, a health issue sometimes referred to as alcoholism.

But people who don’t meet formal criteria for this disorder can still experience toxic effects and suffer other serious harms from alcohol, says Dr. John F. Kelly, professor of psychiatry in addiction medicine at Harvard Medical School. And as research turns up new evidence about alcohol, many people are considering the benefits of drinking less, even if they’re not ready to stop imbibing entirely.

How does alcohol affect the body?

That depends on how much you drink. Drinking more than moderate amounts of alcohol (defined as one drink per day for women and two for men) increases your risk for developing

• liver disease
• several types of cancer including breast, liver, and colon cancer
• cardiovascular problems such as high blood pressure and atrial fibrillation.

What if you’re not drinking daily? “Even people who only drink on weekends can have serious accidents if they become intoxicated — for example, by falling or driving under the influence,” says Dr. Kelly.

What’s more, growing evidence suggests that even small amounts of alcohol may harm your health.

How could cutting down on alcohol help you?

If you’re not ready to give up drinking entirely, cutting back can lower the likelihood of all of these harms. For example, cutting down on alcohol, or stopping entirely, is linked with lower cancer risks, according to a report from the American Association for Cancer Research.

You might also notice some immediate benefits, like sleeping more soundly, memory improvements, and generally feeling more mentally sharp. And because you’ll be taking in fewer calories, you may also shed some weight.

Ready to try cutting back on alcohol? Start here

These five suggestions are a great way to start cutting back.

Keep a drinking diary

Tracking how much alcohol you drink and when can help you target your efforts to drink less. It’s also a good idea to put your reasons for cutting back in writing: for example, “I’d like to sleep better,” “I feel sharper,” “Better heart health is important to me.” That practice can reinforce your resolve to follow through with your plan.

Try alcohol-free days — or even a month of not drinking

Taking a break from alcohol can be a good way to start, allowing your brain and body to recalibrate. Decide not to drink a day or two each week. You may want to abstain for a week or a month, to see how you feel physically and emotionally without alcohol in your life. Consider doing Sober October — a variation of Dry January.

Drink slowly and with food

Sip your drink. Alternate alcoholic drinks with nonalcoholic alternatives like sparkling water, soda, or juice. Don’t drink on an empty stomach, because you’ll feel intoxicated more quickly. That can lower your inhibitions and break your resolve to stick to lower amounts of alcohol, Dr. Kelly says. Drinking with a meal slows alcohol absorption and appears to minimize the drug’s health risks.

Try low-alcohol or zero-alcohol substitutes

Alcohol-free beer, nonalcoholic distilled spirits, and similar products have become more widely available in recent years. It’s a result of the alcohol industry’s response to stay profitable, as health harms of small amounts of alcohol have been confirmed and the sober curious movement gains momentum.

If you drink beer, wine spritzers, hard seltzer, or similar products, check the alcohol content

While light beers have fewer calories, they don’t necessarily have much less alcohol than regular beer. The average light beer is about 4.3% alcohol, versus 5.0% in regular beer.

Also, be aware that some craft or specialty beers contain far higher amounts of alcohol — up to 12% or 14% or even higher. Beverages that combine wine or hard liquor with seltzer or other mixers also vary widely in their alcohol content.

Cut down on temptation

Two more tips can help you meet success when changing drinking habits.

Don’t keep alcohol in your house. Making your home an alcohol-free zone takes away the risk of immediate temptation.

Avoid temptation. Steer clear of people and places that make you want to drink. If you associate drinking with certain events, such as holidays or vacations, make a plan for managing these situations in advance. Check in with your feelings. When you’re worried, lonely, or angry, you might be tempted to reach for a drink. “Think about other ways you might alleviate those feelings, such as going for a walk or calling a friend,” Dr. Kelly suggests.

Finally, try this interactive tool from the CDC, which can help you make a personalized plan to drink less.

About the Author

Julie Corliss, Executive Editor, Harvard Heart Letter

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

About the Reviewer

Howard E. LeWine, MD, Chief Medical Editor, Harvard Health Publishing; Editorial Advisory Board Member, Harvard Health Publishing

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

Not so long ago, a friend texted me from a coffee shop. He said, "I can't believe it. I'm the only one here without a tattoo!" That might not seem surprising: a quick glance around practically anywhere people gather shows that tattoos are widely popular.

Nearly one-third of adults in the US have a tattoo, according to a Pew Research Center survey, including more than half of women ages 18 to 49. These numbers have increased dramatically over the last 20 years: around 21% of US adults in 2012 and 16% of adults in 2003 reported having at least one tattoo.

If you're among them, some recent headlines may have you worried:

              Study Finds That Tattoos Can Increase Your Risk of Lymphoma (OnlyMyHealth)

              Getting a Tattoo Puts You At Higher Risk of Cancer, Claims Study (NDTV)

              Inky waters: Tattoos increase risk of lymphoma by over 20%, study says (Local12.com)

              Shocking study reveals tattoos may increase risk of lymphoma by 20% (Fox News)

What study are they talking about? And how concerned should you be? Let's go through it together. One thing is clear: there's much more to this story than the headlines.

Why are researchers studying a possible link between tattoos and lymphoma?

Lymphoma is a type of cancer that starts in the lymphatic system, a network of vessels and lymph nodes that twines throughout the body. With about 90,000 newly diagnosed cases a year, lymphoma is one of the most common types of cancer.

Risk factors for it include:

• advancing age
• certain infections (such as Epstein-Barr virus, HIV, and hepatitis C)
• exposure to certain chemicals (such as benzene, or possibly pesticides)
• family history of lymphoma
• exposure to radiation (such as nuclear reactor accidents or after radiation therapy)
• having an impaired immune system
• certain immune diseases (such as rheumatoid arthritis, Sjogren's disease, or celiac disease).

Tattoos are not known to be a cause or risk factor for lymphoma. But there are several reasons to wonder if there might be a connection:

• Ink injected under the skin to create a tattoo contains several chemicals classified as carcinogenic (cancer causing).
• Pigment from tattoo ink can be found in enlarged lymph nodes within weeks of getting a tattoo.
• Immune cells in the skin can react to the chemicals in tattoo ink and travel to nearby lymph nodes, triggering a bodywide immune reaction.
• Other triggers of lymphoma, such as pesticides, have a similar effect on immune cells in lymph nodes.

Is there a connection between tattoos and lymphoma?

Any potential connection between tattoos and lymphoma has not been well studied. I could find only two published studies exploring the possibility, and neither found evidence of a compelling link.

The first study compared 737 people with the most common type of lymphoma (called non-Hodgkin's lymphoma) with otherwise similar people who did not have lymphoma. The researchers found no significant difference in the frequency of tattoos between the two groups.

A study published in May 2024 — the one that triggered the scary headlines above — was larger. It compared 1,398 people ages 20 to 60 who had lymphoma with 4,193 people who did not have lymphoma but who were otherwise similar. The study found that

• lymphoma was 21% more common among those with tattoos
• lymphoma risk varied depending on how much time had passed since getting the tattoo:
  • within two years, lymphoma risk was 81% higher
  • between three and 10 years, no definite increased lymphoma risk was detected
  • 11 or more years after getting a tattoo, lymphoma risk was 19%

There was no correlation between the size or number of tattoos and lymphoma risk.

What else should you know about the study?

Importantly, nearly all of the differences in rates of lymphoma between people with and without tattoos were not statistically significant. That means the reported link between lymphoma and tattoos is questionable — and quite possibly observed by chance. In fact, some of the other findings argue against a connection, such as the lack of a link between size or number of tattoos and lymphoma risk.

In addition, if tattoos significantly increase a person's risk of developing lymphoma, we might expect lymphoma rates in the US to be rising along with the popularity of tattoos. Yet that's not the case.

Finally, a study like this one (called an association study) cannot prove that a potential trigger of disease (in this case, tattoos) actually caused the disease (lymphoma). There may be other factors (called confounders) that are more common among people who have tattoos, and those factors might account for the higher lymphoma risk.

Do tattoos come with other health risks?

While complication rates from reputable and appropriately certified tattooists are low, there are health risks associated with tattoos:

• infection, including bacterial skin infections or viral hepatitis
• allergic reactions to the ink
• scarring
• rarely, skin cancer (melanoma and other types of skin cancer).

The bottom line

Despite headlines suggesting a link between tattoos and the risk of lymphoma, there's no convincing evidence it's true. We'll need significantly more research to say much more than that. In the meantime, there are more important health concerns to worry about and much better ways for all of us to reduce cancer risk.

About the Author

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

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

The daily bath or shower is a routine for many of us — and for our children, too. But is it really necessary?

The short answer is no.

Obviously, there are days when washing up makes good sense — like if your child is grimy from a day in the dirt; covered in sweat, paint, or other visible dirt; or had an explosive poop. It’s also a good idea to wash up if your child has spent the day in a pool (the chlorine may be irritating to the skin), a body of water (there could be things in the water that are irritating or unhealthy), or used bug spray to ward off ticks and mosquitoes. And certainly, it’s best for everyone in the vicinity when a stinky teenager takes a soapy shower.

Sometimes a doctor may recommend daily bathing for certain skin conditions. And we all need to wash our hands regularly to prevent infection. But full-body washing just for the sake of washing? Not so much.

Why not bathe a child daily?

Lots of bathing can lead to dry, irritated skin. But also, the skin has natural protective oils, and natural bacteria, that help to keep us healthy and safe — and that can get washed away with daily bathing.

If your baby or preteen looks pretty clean, isn’t stinky, isn’t covered in bug spray, and hasn’t been in a pool or other body of water, it’s fine to skip the bath or shower. Really, bathing two or three times a week is fine. In fact, for many kids, even just once or twice a week is fine. You can always do a quick wipe with a wet washcloth to the face, groin area, and any dirty spots.

Stinky teenagers might need more bathing or showering, depending on activity level and deodorant use. But even they may be able to get away with washing their face and using a soapy washcloth on their groin and underarms.

Tips for healthy bathing

When you do bathe children, here are some tips for healthy bathing.

• Don’t use hot water — use warm water instead.
• Keep it short — preferably just enough time to get the washing done.
• Avoid antibacterial soaps and bubble baths. Use mild, unscented soap and shampoo.
• Make sure bathing is supervised for all babies and young children.
• Pat dry rather than rubbing dry. If your child tends to have dry skin, using a mild, unscented greasy moisturizer after the bath can be helpful.

If your child has eczema or any other skin condition, check with your doctor to get tailored advice for bathing your child.

About the Author

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

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

Celiac disease is a digestive and immune disorder that can keep the body from absorbing necessary nutrients. “Our conception and awareness of celiac disease has evolved over the past few decades, but there are still aspects that remain poorly understood,” says Dr. Ciaran Kelly, medical director of the Celiac Center at Beth Israel Deaconess Medical Center and professor of medicine at Harvard Medical School.

Perhaps not surprisingly, misconceptions are widespread among the general public. One example? Many people assume that everyone who has celiac disease is plagued by abdominal pain, bloating, or diarrhea. But actually, many adults newly diagnosed with this inherited gluten intolerance don’t have these symptoms.

What’s more, gluten — the sticky protein found in grains such as wheat, barley, and rye — can cause gastrointestinal distress and other symptoms in people who don’t have celiac disease. Read on for a deeper dive into four myths and facts about celiac disease and related digestive conditions.

Myth # 1: Celiac disease is usually diagnosed at a young age

Not typically. While celiac disease can develop any time after a baby’s first exposure to gluten, it’s usually diagnosed much later in life. According to the National Celiac Association, the average age of diagnosis is between 46 and 56. Around 25% of people are diagnosed after age 60.

Celiac disease is slightly more common in women and among people with other autoimmune conditions, including type 1 diabetes, Hashimoto’s thyroiditis (a common cause of low thyroid levels), and dermatitis herpetiformis (a rare condition marked by an itchy, blistering rash).

“We don’t know why some people go from being susceptible to actually having celiac disease,” says Dr. Kelly. The prevailing theory is that some sort of physical or emotional stress — such as a viral infection, surgery, or anxiety from a stressful life event — may “flip the switch” and cause the disease to appear, he says. “Increasing numbers of people are being diagnosed at midlife and older, often after they’re found to have conditions such as anemia or osteoporosis caused by nutrient deficiencies,” says Dr. Kelly.

Myth #2: Celiac disease only affects the gut

When people have celiac disease, eating gluten triggers an immune system attack that can ravage the lining of the small intestine. A healthy small intestine is lined with fingerlike projections, called villi, that absorb nutrients. In celiac disease, the immune system attacks the villi, causing them to flatten and become inflamed — and thus unable to adequately absorb nutrients.

While gastrointestinal problems can occur, they aren’t always present. In fact, celiac disease can present with many different symptoms that affect the nervous, endocrine, and skeletal systems. A few examples are brain fog, changes in menstrual periods, or muscle and joint pain.

Myth # 3: Celiac disease versus gluten intolerance

If you feel sick after eating gluten, you probably have celiac disease, right? Actually, that may not be true. Some people have non-celiac gluten sensitivity (also called gluten intolerance), which can cause uncomfortable digestive symptoms after eating gluten. But gluten intolerance differs from celiac disease.

• Celiac disease is diagnosed with blood tests that look for specific antibodies. If antibodies are present, a definitive diagnosis requires an intestinal biopsy to look for signs of damage that characterize the condition.
• Non-celiac gluten sensitivity does not trigger antibodies or cause intestinal damage. Yet some people with this problem say they also experience brain fog, trouble concentrating, muscle aches and pain, and fatigue after eating gluten-containing foods.

“Non-celiac gluten sensitivity appears to be a real phenomenon, but it’s not well defined,” says Dr. Kelly. It’s unclear whether people experiencing it are intolerant to gluten or to something else in gluten-containing foods.

• One possibility is sugarlike molecules known as FODMAPs, which are found in many foods — including wheat. Short for fermentable oligosaccharides, disaccharides, monosaccharides, and polyols, gas and bloating can occur when gut bacteria feed on FODMAPs.
• Another possibility is an allergy to wheat, which can cause symptoms such as swelling, itching, or irritation of the mouth and throat after eating wheat. Other symptoms include a skin rash, stuffy nose, and headache, as well as cramps, nausea, and vomiting. Some people may develop a life-threating allergic reaction known as anaphylaxis.

Myth #4: A gluten-free diet always relieves the symptoms and signs of celiac disease

The sole treatment for celiac disease — adopting a diet that avoids all gluten-containing foods — doesn’t always help. This problem is known as nonresponsive celiac disease.

“About 20% of people with celiac disease have ongoing symptoms, despite their best efforts to stick to a gluten-free diet,” says Dr. Kelly. Others have intermittent signs and symptoms, particularly when they are accidentally exposed to gluten. Accidental exposures often happen when people eat prepared or restaurant foods that claim to be gluten-free but are not. Cross contamination with gluten-containing foods is another potential route.

Potential solutions to nonresponsive celiac disease are being studied. Three promising approaches are:

• Enzymes that break down gluten, which people could take alongside gluten-containing foods. “It’s a similar concept to the lactase pills taken by people who are lactose intolerant to help them digest dairy products,” says Dr. Kelly.
• Dampening the immune response to gluten by inhibiting an enzyme called tissue transglutaminase that makes gluten more potent as an antigen.
• Reprogramming the immune response to prevent the body from reacting to gluten.

About the Author

Julie Corliss, Executive Editor, Harvard Heart Letter

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

About the Reviewer

Howard E. LeWine, MD, Chief Medical Editor, Harvard Health Publishing; Editorial Advisory Board Member, Harvard Health Publishing

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

Recently, a friend asked me about tonsil stones. He has sore throats several times a year, which are instantly relieved by gargling to remove them. When I told him I thought tonsil stones were pretty rare, he asked: “Are you sure about that? My ear, nose, and throat doctor says they’re common as rocks.” (Get it? stones? rocks?)

It turns out, my friend and his doctor are on to something. Tonsil stones are surprisingly common and often quite annoying. Here’s what to know and do.

What are tonsil stones?

Tonsil stones (medical term: tonsilloliths) are small white or yellow deposits on the tonsils. They develop when bacteria, saliva, food particles, and debris from cells lining the mouth get trapped in tiny indentations called crypts.

They vary considerably between people, including:

• Size. They may be so small that you can’t see them with the naked eye. Or they may grow to the size of gravel or, rarely, much larger.
• Consistency. They’re often soft but may calcify, becoming hard as a rock. Hence, the name.
• How long they last. Tonsil stones can last days to weeks, or may persist far longer before they break up and fall out.
• How often they occur. New tonsilloliths may appear several times each month or just once or twice a year.

While they’re more likely to form if you have poor oral hygiene, good oral hygiene doesn’t provide complete protection. Even those who brush, floss, and see their dentists regularly can develop tonsil stones.

How common are tonsil stones?

You’ve heard of kidney stones and gallstones, right? Clearly, those conditions are better known than tonsil stones. Yet tonsil stones are far more common: studies suggest that up to 40% of the population have them. Fortunately, unlike kidney stones and gallstones, tonsil stones are usually harmless.

What are the symptoms of tonsil stones?

Often people have no symptoms. In fact, if tonsil stones are small enough, you may not even know you have them. When tonsil stones do cause symptoms, the most common ones are:

• sore throat, or an irritation that feels as though something is stuck in the throat
• bad breath
• cough
• discomfort with swallowing
• throat infections.

Who gets tonsil stones?

Anyone who has tonsils can get them. However, some people are more likely than others to form tonsil stones, including those who

• have tonsils with lots of indentations and irregular surfaces rather than a smooth surface
• smoke
• drink lots of sugary beverages
• have poor oral hygiene
• have a family history of tonsil stones.

How are tonsil stones treated?

That depends on whether you have symptoms and how severe the symptoms are.

• If you have no symptoms, tonsil stones may require no treatment.
• If you do have symptoms, gargling with salt water or removing tonsil stones with a cotton swab or a water flosser usually helps. Avoid trying to remove them with sharp, firm objects like a toothpick or a pen, as that can damage your throat or tonsils.
• If your tonsils are inflamed, swollen, or infected, your doctor may prescribe antibiotics or anti-inflammatory medications.

Is surgery ever necessary?

Occasionally, surgery may be warranted. It’s generally reserved for people with severe symptoms or frequent infections who don’t improve with the measures mentioned above.

Surgical options are:

• tonsillectomy, which is removing the tonsils
• cryptolysis, which uses laser, electrical current, or radio waves to smooth the deep indentations in tonsils that allow stones to form.

Can tonsil stones be prevented?

Yes, there are ways to reduce the risk that tonsil stones will recur. Experts recommend the following:

• Brush your teeth and tongue regularly (at least twice a day: in the morning and before sleep).
• Floss regularly.
• Gargle with salt water after eating.
• Eliminate foods and drinks that contain a lot of sugar, which feeds bacteria that can help stones form.
• Don’t smoke, because smoking irritates and inflames tonsils, which can encourage stone formation. The same may apply to vaping, though there is limited research to rely upon.

The bottom line

Considering how common tonsil stones are and how bothersome they can be, it seems strange that they aren’t more well known. Maybe that’s because they often get better on their own, or people figure out how to deal with them without needing medical attention.

I hope you aren’t one of the many millions of people bothered by tonsil stones. But if you are, it’s good to know that they’re generally harmless and can be readily treated and prevented.

Now that you know more about them, feel free to spread the word: tonsil stones should be a secret no more.

About the Author

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

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

When you live in a coastal area, preparing early for potential hurricanes is a must. Storms can develop quickly, leaving little time to figure out where you’ll be safe or which items to pack if you have to evacuate. And health care necessities, such as medications or medical equipment, are often overlooked in the scramble.

“People might bring their diabetes medication but forget their blood sugar monitor, or bring their hearing aids but forget extra batteries for them,” says Dr. Scott Goldberg, medical director of emergency preparedness at Brigham and Women’s Hospital and a longtime member of a FEMA task force that responds to hurricane-damaged areas.

Here’s some insight on what to expect this hurricane season, and how to prioritize health care in your hurricane kit.

What will the 2024 hurricane season look like?

This year’s hurricane predictions underscore the urgency to start preparations now.

Forecasters with the National Oceanic and Atmospheric Administration's National Weather Service expect above-normal activity for the 2024 hurricane season (which lasts until November 30).

Meteorologists anticipate 17 to 25 storms with winds of 39 mph or higher, including eight to 13 hurricanes — four to seven of which could be major hurricanes with 111 mph winds or higher.

What kinds of plans should you make?

Preparing for the possibility of big storms is a major undertaking. Long before ferocious winds and torrential rains arrive, you must gather hurricane supplies, figure out how to secure your home, and determine where to go if you need to evacuate (especially if you live in a flood zone). Contact the emergency management department at your city or county for shelter information.

If you’ll need help evacuating due to a medical condition, or if you’ll need medical assistance at a shelter, find out if your county or city has a special needs registry like this one in Florida. Signing up will enable first responders to notify you about storms and transport you to a special shelter that has medical staff, hospital cots, and possibly oxygen tanks.

What should you pack?

While a shelter provides a safe place to ride out a storm, including bathrooms, water, and basic meals, it’s up to you to bring everything else. It’s essential to pack medical equipment and sufficient medications and health supplies.

“It’s natural to just grab the prescription medications in your medicine cabinet, but what if it’s only a two-day supply? It might be a while before you can get a refill. We recommend at least a 14-day or 30-day supply of every prescription,” Dr. Goldberg says. “Talk to your doctor about the possibility of getting an extra refill to keep on standby for your go bag.”

Other health-related items you’ll want to pack include:

• medical supplies you use regularly, such as a blood pressure monitor, heart monitor, CPAP machine, wheelchair, or walker
• over-the-counter medicines you use regularly, such as heartburn medicine or pain relievers
• foods for specific dietary needs, such as gluten-free food if you have celiac disease (if you have infants or children, you’ll need to bring foods they can eat)
• healthy, nonperishable snacks such as nuts, nut butters, trail mix, dried fruit, granola bars, protein bars, and whole-grain bread, crackers, or cereals
• hygiene products such as soap, hand sanitizer, toothbrushes and toothpaste, shampoo, deodorant, infant or adult diapers, lip balm, moist towelettes, and toilet paper — because shelters often run out of it.

Remember the basics

In some ways, you can think of shelter living like camping. You’ll need lots of basic supplies to get through it, including:

• a sleeping bag or blanket and pillow for each person in your family
• clean towels and washcloths
• a few extra changes of clothes per person
• a first-aid kit
• flashlights and extra batteries
• chargers for your electronic gadgets
• rechargeable battery packs.

Bring important paperwork

In addition to supplies, bring important documents such as:

• a list of your medications, vitamins, and supplements (include the name, dose, and frequency of each one)
• a list of the names, addresses, and phone numbers of your primary care provider and any specialists who treat you
• a list of your emergency contacts and their phone numbers
• your pharmacy’s phone number and address
• copies of your birth certificate and driver’s license
• copies of home, car, or life insurance policies
• copies of your health insurance cards
• a copy of your advance directive — which includes your living will and health care proxy form.

“Store these documents on a flash drive. Also make photocopies of them, which are easiest for doctors to consult in an emergency setting. Place them in a plastic zip-top bag to keep them dry,” Dr. Goldberg advises.

Prepare right now

Start today. Gather as many go-bag supplies as you can, including the bags. A small suitcase, backpack, or duffel bag for each person in your family will work well.

And try not to put off these important preparations. “Hurricanes are major stressors. You might be worried, sleep deprived, fatigued, and emotional,” Dr. Goldberg says. “All of that will make it hard to think clearly. You’ll do yourself and your family a favor by having discussions now and getting started on your hurricane plan.”

About the Author

Heidi Godman, Executive Editor, Harvard Health Letter

Heidi Godman is the executive editor of the Harvard Health Letter. Before coming to the Health Letter, she was an award-winning television news anchor and medical reporter for 25 years. Heidi was named a journalism fellow … See Full Bio View all posts by Heidi Godman

About the Reviewer

Howard E. LeWine, MD, Chief Medical Editor, Harvard Health Publishing; Editorial Advisory Board Member, Harvard Health Publishing

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

Concussion is one of the most common injuries to the brain, affecting about two million children and teens every year. It is a particular kind of injury that happens when a blow to the head or somewhere else on the body makes the brain move back and forth within the skull.

It’s possible to get a concussion after what might seem like a minor injury, like a forceful push from behind, or a collision between two players in a football or soccer game.

What are the signs and symptoms of concussion?

Because the injury may not seem that significant from the outside, it’s important to know the symptoms of a concussion. There are many different possible symptoms, including

• passing out (this could be a sign of a more serious brain injury)
• headache
• dizziness
• changes in vision
• feeling bothered by light or noise
• confusion or feeling disoriented
• memory problems (such as difficulty remembering details of the injury) or difficulty concentrating
• balance or coordination problems
• mood changes.

Some of these are visible to others and some are felt by the person with the concussion. That’s why it’s important to know the signs and to ask all the right questions of a child who has had an injury.

Sometimes the symptoms might not be apparent right away, but show up in the days following the injury. The CDC’s Heads Up website has lots of great information about how to recognize a concussion.

How can further harm to the brain be avoided?

The main reason it’s important to recognize a possible concussion early is that the worst thing you can do after getting a concussion is get another one. The brain is vulnerable after a concussion; if it is injured again, the symptoms can be longer lasting — or even permanent, as in cases of chronic traumatic encephalopathy (CTE), a condition that has been seen in football players and others who have repeated head injuries.

If there is a chance that a child has had a concussion during a sports competition, they must stop playing — and get medical attention. It’s important to get medical attention any time there is concern about a possible concussion, both to be sure there isn’t a more serious brain injury, and to do a good assessment of the symptoms, so that they can be monitored over time. There are some screening questionnaires that are used by doctors that can be used again in the days and weeks after the concussion to see how the child is improving.

What helps children recover after a concussion?

Experts have struggled with figuring out how to protect the brain after a concussion. For a long time, the recommendation was to rest and do very little at all. This meant not doing any exercise, not going to school, not even reading or watching television. As symptoms improved, the restrictions were lifted gradually.

Over time, though, research showed that not only was this much rest not necessary, it was counterproductive. It turns out that getting kids back into their daily lives, and back into being active, is safe and leads to quicker recovery. Experts still recommend rest and then moving gradually back into activities, but the guidelines are no longer as strict as they once were.

One important note: A medical professional should guide decisions to move from rest to light activity, and then gradually from there to moderate and then regular activities based on how the child is doing. This step-by-step process may extend for days, weeks, or longer, depending on what the child needs. Parents, coaches, and schools can help support a child or teen as they return to school and return to activities and sports.

Some children will be able to get back into regular activities quickly. But for others it can take weeks or even months. Schools and sports trainers should work with children to support them in their recovery. Some children develop post-concussive syndromes with headache, fatigue, and other symptoms. This is rare but can be very disabling.

How can parents help prevent concussions?

It's not always possible to prevent concussions, but there are things that parents can do:

• Be sure that children use seat belts and other appropriate restraints in the car.
• Have clear safety rules and supervise children when they are playing, especially if they are riding bikes or climbing in trees or on play structures.
• Since at least half of concussions happen during sports, it’s important that teams and coaches follow safety rules. Coaches should teach techniques and skills to avoid dangerous collisions and other injuries. Talk to your child’s coaches about what they are doing to keep players safe. While helmets can prevent many head injuries, they don’t prevent concussions.

About the Author

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

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

Over the course of a lifetime, as many as seven in 10 adults in the United States will directly experience or witness harrowing events. These include gun violence, car accidents, and other personal trauma; natural or human-made disasters, such as Hurricane Katrina and the 9/11 terrorist attacks; and military combat. And some — though not all — will experience post-traumatic stress disorder, or PTSD.

New guidelines released in 2024 can help guide effective treatment.

What is PTSD?

PTSD is a potentially debilitating mental health condition. It’s marked by recurrent, frightening episodes during which a person relives a traumatic event.

After a disturbing event, it’s normal to have upsetting memories, feel on edge, and have trouble sleeping. For most people, these symptoms fade over time. But when certain symptoms persist for more than a month, a person may be experiencing PTSD.

These symptoms include

• recurring nightmares or intrusive thoughts about the event
• feeling emotionally numb and disconnected
• withdrawing from people and certain situations
• being jumpy and on guard.

The National Center for PTSD offers a brief self-screening test online, which can help you decide whether to seek more information and help.

Who is more likely to experience PTSD?

Not everyone who experiences violence, disasters, and other upsetting events goes on to develop PTSD. However, military personnel exposed to combat in a war zone are especially vulnerable. About 11% to 20% of veterans who served in Iraq or Afghanistan have PTSD, according to the National Center for PTSD.

What about people who were not in the military? Within the general population, estimates suggest PTSD occurs in 4% of men and 8% of women — a difference at least partly related to the fact that women are more likely to experience sexual assault.

What are the new guidelines for PTSD treatment?

Experts from the U.S. Department of Veterans Affairs and Department of Defense collaborated on new guidelines for treating PTSD. They detailed the evidence both for and against specific therapies for PTSD.

Their findings apply to civilian and military personnel alike, says Dr. Sofia Matta, a psychiatrist at Harvard-affiliated Massachusetts General Hospital and senior director of medical services at Home Base, a nonprofit organization that provides care for veterans, service members, and their families.

The circle of care is widely drawn for good reason. “It’s important to recognize that PTSD doesn’t just affect the person who is suffering but also their families and sometimes, their entire community,” Dr. Matta says. The rise in mass shootings in public places and the aftermath of these events are a grim reminder of this reality, she adds.

Which treatment approaches are most effective for PTSD?

The new guidelines looked at psychotherapy, medications, nondrug therapies. Psychotherapy, sometimes paired with certain medicines, emerged as the most effective approach.

The experts also recommended not taking certain drugs due to lack of evidence or possible harm.

Which psychotherapies are recommended for PTSD?

The recommended treatment for PTSD, psychotherapy, is more effective than medication. It also has fewer adverse side effects and people prefer it, according to the guidelines.

Which type of psychotherapy can help? Importantly, the most effective therapies for people with PTSD differ from those for people with other mental health issues, says Dr. Matta.

Both cognitive processing therapy and prolonged exposure therapy were effective. These two therapies teach people how to evaluate and reframe the upsetting thoughts stemming from the traumatic experience. The guidelines also recommend mindfulness-based stress reduction, an eight-week program that includes meditation, body scanning, and simple yoga stretches.

Which medications are recommended for PTSD?

Some people with severe symptoms need medication to feel well enough to participate in therapy. “People with PTSD often don’t sleep well due to insomnia and nightmares, and the resulting fatigue makes it hard to pay attention and concentrate,” says Dr. Matta.

Three medicines commonly prescribed for depression and anxiety — paroxetine (Paxil), sertraline (Zoloft), and venlafaxine (Effexor) — are recommended. Prazosin (Minipress) may help people with nightmares, but the evidence is weak.

Which medications are not recommended for PTSD?

The guidelines strongly recommended not taking benzodiazepines (anti-anxiety drugs often taken for sleep). Benzodiazepines such as alprazolam (Xanax) and clonazepam (Klonopin) offer no proven benefits for people with PTSD. They have several potential harms, including negative cognitive changes and decreased effectiveness of PTSD psychotherapies.

What about cannabis, psychedelics, and brain stimulation therapies?

Right now, evidence doesn’t support the idea that cannabis helps ease PTSD symptoms. And there are possible serious side effects from the drug, such as cannabis hyperemesis syndrome (severe vomiting related to long-term cannabis use).

There isn’t enough evidence to recommend for or against psychedelic-assisted therapies such as psilocybin (magic mushrooms) and MDMA (ecstasy). “Because these potential therapies are illegal under federal law, the barriers for conducting research on them are very high,” says Dr. Matta. However, recent legislative reforms may make such studies more feasible.

Likewise, the evidence is mixed for a wide range of other nondrug therapies, such as brain stimulation therapies like repetitive transcranial magnetic stimulation or transcranial direct current stimulation.

About the Author

Julie Corliss, Executive Editor, Harvard Heart Letter

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

About the Reviewer

Howard E. LeWine, MD, Chief Medical Editor, Harvard Health Publishing; Editorial Advisory Board Member, Harvard Health Publishing

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

Trouble staying focused and paying attention are two familiar symptoms of attention deficit hyperactivity disorder (ADHD), a common health issue among children and teens.

When ADHD persists through early adulthood and on into middle age, it presents many of the same challenges it does in childhood: it’s hard to stay organized, start projects, stay on task, and meet deadlines. But now life is busier, and often expectations from work and family are even higher. Fortunately, there are lots of strategies that can help you navigate this time in your life.

Staying organized

Organizational tools are a must for people with adult ADHD. They’ll help you prioritize and track activities for each day or the coming weeks.

• Pick the right tools. Tools can include a pen and paper to make lists, or computer or smartphone apps to set appointment reminders, highlight important days on the calendar, mark deadlines, and keep lists and other information handy.
• Schedule updates. Set aside time each day to update your lists and schedules. Don’t let the task become a chore in itself; think of it like a routine task such as brushing your teeth, and do it daily so it becomes an established habit.
• Set a timer. And a word of caution: smartphones and computers can also turn into a distraction. If you have adult ADHD, you may find yourself spending hours looking at less useful apps or sites. If that’s a frequent trap for you, set a timer for each use or keep the phone off or in another room when you are trying to work.

Staying focused

Just being organized doesn’t mean your work will get done. But a few simple approaches can at least make it easier to do the work.

• Declutter your home and office. Give yourself an appealing work environment and keep important items easily accessible.
• Reduce distractions. This could mean changing your workstation so it doesn’t face a window, moving to a quieter space, or just silencing your smartphone and email alerts.
• Jot down ideas as they come to you. You may have an “aha” moment for one task while you’re in the middle of another. That’s okay; just write down that thought and get back to it later, after your more pressing work is finished.

Meeting deadlines

Deadlines pose two big challenges when you have adult ADHD. First, it’s hard to start a project, often because you want it to be perfect, or you’re intimidated by it so you put it off. Second, when you do start a project, it’s very easy to become distracted and leave the task unfinished.

How can you avoid these traps?

• Put off procrastinating. Put procrastination on your to-do list — like a chore — and fool yourself into actually starting your work.
• Deal with emails, phone calls, or other matters as soon as you can. That way there will be fewer things hanging over your head and overwhelming you later on.
• Be a clock watcher. Get a watch and get in the habit of using it. The more aware you are of time, the more likely you’ll be able to avoid spending too long on a task.
• Take one thing at a time. Multitasking is overrated for everyone — and it’s a nightmare for people with adult ADHD. Focus on completing one task, then move on to the next.
• Be realistic about your time. This can mean having to say no to new projects or other commitments.

Get more help

The ideas listed here can help you start coping with adult ADHD, but they may not be enough to help you overcome adult ADHD’s challenges.

Consider hiring an ADHD coach who can provide more strategies and give you additional tools to cope with your condition. Look for an ADHD coach who is a licensed mental health professional who specializes in treating ADHD, and may also have a certification in ADHD coaching from the ADHD Coaches Organization.

About the Author

Heidi Godman, Executive Editor, Harvard Health Letter

Heidi Godman is the executive editor of the Harvard Health Letter. Before coming to the Health Letter, she was an award-winning television news anchor and medical reporter for 25 years. Heidi was named a journalism fellow … See Full Bio View all posts by Heidi Godman

About the Reviewer

Howard E. LeWine, MD, Chief Medical Editor, Harvard Health Publishing; Editorial Advisory Board Member, Harvard Health Publishing

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

For neuroscientist Sara Lazar, a form of meditation called open awareness is as fundamental to her day as breathing.

“I just become aware that I am aware, with no particular thing that I focus on,” explains Lazar, an associate researcher in the psychiatry department at Massachusetts General Hospital and assistant professor of psychology at Harvard Medical School. “This sort of practice helps me become more aware of the subtle thoughts and emotions that briefly flit by, that we usually ignore but are quite useful to tune into.”

But meditation doesn’t just change your perspective in the moment. Some studies show certain types of meditation offer an array of benefits, from easing chronic pain and stress and lowering high blood pressure to help relieve anxiety and depression. And, as Lazar’s research has shown, meditation can actually change the structure and connectivity of brain areas that help us cope with fear and anxiety.

“It’s become really clear that all of our experiences shape our brain in one way or another,” Lazar says. “A lot of people talk about meditation being a mental exercise. Just as you build your physical muscles, you can build your calm muscles. Meditation is a very effective way of training those muscles.”

What counts as meditation?

More than you might have believed. An intriguing if somewhat perplexing aspect of meditation is that it encompasses a broad range of practices. “It’s clear what is not meditation, but there’s less consensus on what it is,” Lazar says.

Open awareness, Lazar’s go-to meditation, joins other forms, including focused awareness, slow deep breathing, guided meditation, and mantra meditation, along with many variations. At their core, Lazar says, is an awareness of the moment, noticing what you’re experiencing and nonjudgmentally disengaging from intrusive thoughts that might interfere with your ability to attend to this task.

Meditation can also involve sitting with eyes closed and paying attention to your body and any sensations that are present. A regular meditation practice typically involves slowing down, breathing, and observing inner experience.

“Meditation can involve flickering candles, breath awareness, or mantras — all of these things,” Lazar says. “But there’s definitely an element of focusing and regulating your attention.”

A close look at how meditation alters the brain

Small MRI imaging studies have zeroed in meditation’s effects on the amygdala, an almond-shaped structure deep within the brain that processes fear and anxiety as well as other emotions.

Lazar and her colleagues have spent many years laying the groundwork to show how practicing mindfulness-based stress reduction (MBSR) alters the amygdala after only about two months. The MBSR practice in this research consisted of weekly group meetings and daily home mindfulness practices, including sitting meditation and yoga.

What has their research found?

One key study involved 26 people with high levels of perceived stress. After an eight-week regimen of MBSR, brain scans showed the density of their amygdalae decreased, and these brain changes correlated to lower reported stress levels.

Building on this, Lazar and colleagues designed a study that focused on 26 people diagnosed with generalized anxiety, a disorder marked by excessive, ongoing, and often illogical anxiety levels. The researchers randomized participants to either practice MBSR or receive stress management education. These participants were compared to 26 healthy participants.

In this first-of-its-kind research, participants were shown a series of images with angry or neutral facial expressions while their brain activity was gauged using functional MRI imaging. At the beginning of the study, anxiety patients showed higher levels of amygdala activation in response to neutral faces than healthy participants. This suggests a stronger fear response to a nonthreatening situation.

But after eight weeks of MBSR, MRI imaging showed increased connections between the amygdala and the prefrontal cortex, a brain area crucial to emotional regulation. The amygdalae in participants with generalized anxiety no longer displayed a fear response to neutral faces. These participants also reported their symptoms had improved.

“It seems meditation helps to down-regulate the amygdala in response to things it perceives to be threatening,” Lazar says.

How can meditation benefits help us in daily life?

Lazar believes training your brain to stop and notice your thoughts in a slightly detached way can calm you amidst the muddle of work deadlines, family friction, or distressing news.

“That’s one of the biggest translations” of meditation to everyday benefits, she says. “The person or situation that is stressing you out won’t go away, but you can watch your reactivity to the situation in a mindful, detached way, which shifts your relationship to it.”

“It’s not indifference,” she adds. “It’s sort of like a bubble bursting — you realize you don’t need to keep going on this loop. Once you see that, it totally shifts your relationship to that reaction bubbling through your brain.”

Want to try meditation — or expand your practice?

Haven’t tried meditating? To get started, Lazar recommends the Three-Minute Breathing Space Meditation. This offers a quick taste of meditation, walking you through three pared-down but distinct steps. “It’s simple, fast, and anyone can do it,” she says.

Simple ways to expand this basic approach are:

• adding minutes, just as you might for exercise
• meditating outdoors
• pausing to notice how you feel after you meditate.

“Or try either doing a longer session or short hits throughout the day, such as a three-minute breathing break four to five times a day,” Lazar suggests.

Another way to enhance your practice is to use ordinary, repetitive moments throughout the day — such as reaching for a doorknob — as a cue to pause for five seconds and notice the sensation of your hand on the knob.

“As you walk from your office to your car, for instance, instead of thinking of all the things you have to do, you can be mindful while you’re walking,” Lazar says. “Feel the sunshine and the pavement under your feet. There are simple ways to work meditation into each day.”

About the Author

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

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

About the Reviewer

Howard E. LeWine, MD, Chief Medical Editor, Harvard Health Publishing; Editorial Advisory Board Member, Harvard Health Publishing

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