7 ways to exercise in the heat, plus some indoor alternatives

Working on shoulders in this age is important for women

Staying in shape during the summer is easy, right? You can finally go for a jog or play a sport outside. But what about when it’s too hot? These tips will help you stay safe when breaking a sweat during the summer, or even find an alternative to being in the sun.

If you’re exercising outdoors

1. Stay hydrated

Drinking enough water is perhaps the most important part of working out, as even mild dehydration can cause headaches, dizziness and fatigue. As a rule of thumb, aim to drink half of your body weight in ounces everyday. During your workout, don’t forget to stop for a water break every 15 to 20 minutes.

According to WebMD, you should follow these guidelines:

  • One to two hours before your workout, drink 15 to 20 ounces of water
  • 15 minutes before you begin, drink between 8 and 10 ounces of water
  • During your workout, drink another 8 ounces every 15 minutes.

2. Dress cool

The summer months may be time to put away your favorite pair of workout leggings. Opt for lightweight, breathable materials and try to include a hat to shield your face from the sun, if possible. Stay clear from black clothing, as it will only attract the heat and make you more prone to overheating.

3. Start slow

For your first workout of the summer, don’t go all-out right away. Take it slow and let your body get used to the heat gradually. For example, go for a 15 minute jog the first day, a 20 minute jog the second and so on.

4. Eat right

Before your workout, eat foods that contribute to your fluid intake, such as cucumbers, strawberries and watermelon. After your workout, replenish the salt you lost through sweat with salty snacks such as nuts or olives.

5. Listen to your body

If your body is telling you it’s time to stop, it’s time to stop. Don’t ignore feelings of nausea or dizziness and know when it’s time to end your workout early if you need to. According to Barnabas Health Medical Group, signs of heat stroke include headache, dizziness, disorientation and fatigue.

6. Work out in the early morning or late afternoon

According to Barnabas Health Medical Group, it’s idea to schedule your workout for cooler parts of the day. Try to get your exercise in early in the day or in the late evening. The sun won’t be so unbearable and it’s much easier to avoid any heat-related issues.

7. Don’t forget the sunscreen

Protect your skin, too! Make sure to cover your body in a sunscreen that has at least a 45 SPF to block harmful rays from the sun during your workout session. Also, consider wearing a visor that will shield your eyes and skins from the sun when exercising.


Cancer patients’ grey hair unexpectedly darkens in drug study

Fourteen patients in the study found that their grey hair darkened after taking the new drugs. Photograph: Barry Diomede/Alamy

A group of cancer patients’ grey hair has unexpectedly darkened after they took new types of drugs, researchers have revealed.

Chemotherapy is known to make patients’ hair fall out, but the 14 people involved were all being treated with new immunotherapy drugs that work differently and have different side effects from chemotherapy. A Spanish study suggests those may include restoring hair pigment, at least in patients with lung cancer.

Noelia Rivera, a dermatologist at Autonomous University of Barcelona, said they thought it could be an isolated case when it happened with the first patient. But the research team found the same thing when they asked other patients for photographs of themselves from before treatment.

The 14 people were among 52 patients with lung cancer being followed to see whether they developed bad side effects from the drugs — Keytruda, Opdivo and Tecentriq.

While most patients did not have a hair colour change, the 14 cases suggest it is not an isolated finding. In 13 patients, hair turned darkish brown or black; in one patient, it turned black in patches.

The same drugs have been linked previously with hair losing colour in patients with another cancer, melanoma.

All but one of the 14 patients in the Spanish study responded better to treatment than other patients, suggesting that hair darkening might be an indication that the drugs are working, the researchers said.

Rivera said they were continuing with the study to search for an explanation.

“It’s a fascinating report – one of those things that comes out of the blue,” said June Robinson, a Northwestern University research professor in dermatology. Robinson is also editor of the medical journal JAMA Dermatology, which published the study online this month.

She said the results deserved a deeper look but cautioned that it was too soon to suggest that they might lead to new treatments for unwanted grey hair.

Rivera noted that the drugs used in the study had serious side effects that made them unsafe for healthy people. But if it is confirmed that they do change hair colour, a different drug could be developed to treat grey hair, she said.

The pharmaceutical industry has previously capitalised on unexpected drug side effects. Examples include the male pattern baldness drug Propecia, the eyelash growing drug Latisse, and Botox anti-wrinkle injections. Active ingredients in these drugs were initially approved to treat enlarged prostates, eye pressure problems, and eye muscle spasms.

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Yoga should be mandatory in school

Photo: Sonu Mehta/Hindustan Times.

Photo: Sonu Mehta/Hindustan Times.

This will probably irritate you, I’m quivering as I write it. I can picture myself on stage, making eye contact with stern, unblinking you, knowing I’m on the less popular side of the “yoga should be compulsory in schools” debate because, of course, you believe in the freedom to choose.

But our educational institutions have never been known for offering choices right from the limited third language options to the Shakespeare play in the syllabus. You can’t tell the teacher that you would rather learn Hamlet over Twelfth Night and most of us grew up thinking rote learning was education.

As ideas go, insisting that children learn yoga in schools works perfectly alongside Prime Minister Narendra Modi’s other initiative to encourage girls to play sport, which he says builds, err, SPORTS (skill, perseverance, optimism, resilience, tenacity, stamina). Aside: The title of this column is a favourite essay topic for aspiring management students these days, along with “mankind should end war before war ends mankind” and “leaders are born, not made”.

How the government will find yoga teachers when we are already short of one million primary and secondary school teachers is a question beyond the scope of this column. It’s like asking me how the state will teach Indian men to give up the great outdoors for the subsidized toilet installed in their homes as part of Swachh Bharat Abhiyan.

It took me a lifetime of attempts and many injuries to find a teacher who could help me fall in love with yoga. Now I believe everyone should do yoga, especially geeks and couch potatoes. You don’t have to worry about taller, stronger, fitter people being better than you—yoga is the ultimate equalizer.

I’m happy the All India Council for Technical Education has said yoga will now be one of five compulsory extracurricular activity options for students from engineering and technical colleges if they want their degree. Until recently, extracurricular activity was optional. Oh stop moaning! You only require 25% attendance.

If I’m evangelizing it’s because yoga got rid of my beer belly (almost), strengthened my core and back muscles, improved my immunity and upped my lung power significantly. When I went on a high-altitude trip last year, I didn’t have to pop a headache pill or carry a barf bag like some of my younger travel companions. One recent British study quoted in the Time magazine found that mind-body activities such as yoga can “reverse stress-related changes in genes linked to poor health and depression”. That almost sounded like Baba Ramdev, who has an ambitious plan to popularize yoga across the world.

It’s now easy for me to identify people who Suryanamaskar their way to health and I am confident that many of the ministers who strike poses for the camera are not regular yoga practitioners. From the government’s perspective, compulsory yoga is an idea that has more chance of making it to prime time television than boring education reforms such as training teachers or encouraging more innovative methods of teaching.

Let’s do it, I say. As long as yoga lessons don’t go hand-in-hand with lectures about India’s bovine bounty or fraudulent medical knowledge that convinces you from an early age that yoga can fix everything from your mother’s overactive thyroid to your father’s arrhythmia, I’ll be a cheerleader for the cause.

If we work together, it’s possible to reclaim yoga from its khaki shorts practitioners. As Nata Menabde, the World Health Organization’s executive director at the UN, said recently: “Yoga is for people of all religions, races and nationalities because yoga is not a religion. Yoga is a lifestyle.”

Now that I’ve taken politics and Patanjali off the mat, you’ll surely agree that our children need yoga for their physical and mental well-being? At 14.4 million and growing, India now has the highest number of obese children in the world after China, according to a paper published in The New England Journal Of Medicine. Our schools no longer have playgrounds; and our neighbourhood parks specialize in saying no (no playing ball, no cycling, no stepping on the grass). Most Bengaluru parks shut their gates from 10am-4pm—even on weekends. How often have you seen children trying to dodge traffic while learning to cycle on busy roads?

In these circumstances, learning an activity that works every muscle in your body and activates endorphins while utilizing only a modest square of floor space is nothing short of miraculous.

Countries across the world have discovered the benefits of yoga for children. Let’s not be the last to sign up.

Yoga can help children navigate New India where exam stress routinely leads to suicide and school bags exist only to weigh you down. Last year a study by the Associated Chambers of Commerce and Industry (Assocham) found that 68% of schoolchildren under the age of 13 suffer from mild back pain, which could later develop into chronic pain.

“Early slip disc, spondylitis, spondylolisthesis, persistent back aches, early degeneration of spine and postural scoliosis are some of the problems that these children face,” B.K. Rao, the chairman of Assocham’s health committee, told The Indian Express in September.

And if your attention-deficit child finds your yoga session “boring” because your routine doesn’t come with an accompanying playlist or fast-moving images on a screen, I’m sure you’ll think of something. I’ve almost convinced Babyjaan that yoga is the fastest route to becoming a star gymnast.



Yoga in the office? Firms should help us stay well, says public health chief

A standing desk is one of the ways firms can boost employees’ health.

Lunchtime yoga classes, providing help to remove ingrowing toenails and holding meetings while walking around the office – these are just some of the strategies that employers should use to boost staff fitness, according to the NHS public health chief.

Duncan Selbie, chief executive of Public Health England, is also backing workplace running clubs, standing desks to improve posture and staff uniting to try to quit smoking as useful ways businesses can improve employee wellbeing.

In an interview with the Observer, Selbie made clear that Britain’s 5.5 million small and medium-sized enterprises (SMEs) could do much more to tackle the £29bn annual bill for sickness absence while improving productivity and increasing profits at the same time.

“SMEs are the backbone of the nation’s workforce and can kickstart a revolution in helping their staff to improve their health. People spend 30, 40 or sometimes 50 hours a week at work. That’s a unique opportunity for employers to use that big chunk of someone’s week to care for their health,” said Selbie. His plea is aimed at the 5.5 million firms which make up 99% of all private sector businesses and employ 60% of those who work in the private sector.

“Forward-thinking companies are already offering help such as podiatry services to employees who are on their feet all day or group posture exercises for people who stand in the same position for a long time because of their job.

“Employers could adopt group exercise challenges, such as ‘Couch to 5k’ or lunchtime run clubs, and promote active travel like cycling to work. Being regularly active is one of the best ways to prevent and manage poor musculoskeletal health and combat stress, which are both major causes of sickness absence,” he added.

Employers should take a “bottom-up” approach to improving staff health and wellbeing by putting in place ideas that employees want, rather than things that would be “nice to have”, he said.

“We want to see every business take a custom-made approach to employee health by looking at what staff need. We encourage employers to create dynamic environments, workplaces where people can be more active, move more and change positions, with things like standing desks.”

Firms could encourage staff to hold “walking meetings” in the local park rather than sitting down in an office and always eat lunch somewhere other than their desk, Selbie said. Ergonomic assessments of posture could help identify stiffness and pain that may indicate that back problems are emerging which can then be tackled early.

He wants action to encourage more staff to cycle to work. HR Magazine recently found that 33% of employers believe that cyclists are more productive at work than non-cycling colleagues. In addition, 44% of bosses polled said cyclists were more productive

Firms could also use camaraderie between staff to help smokers quit. Selbie suggested using group workplace challenges, such as smokers all signing up to take part in Stoptober together, and that employers could alert workers when mobile bus clinics were due to be in the area.

The PHE boss wants businesses to help staff with their mental health too. “The main way to reduce stress levels is through training line managers in mental health and educating workforces to increase their mental health literacy, and to recognise the signs which indicate that they need support,” he said.

Mike Cherry, national chairman of the Federation of Small Businesses, said that small firms did not have the advantage of large corporations in being able to use their employees to get discount deals for gym memberships or private health providers, for example.

“The average small employer has around seven employees and their approach is often more akin to a family unit than it is a large business. So while many small businesses are not sedentary or desk-based in their work, we know that many are encouraging fitness breaks for running or gym classes, while others have indeed innovated through things such as walking meetings.

“The key is not to instruct or compel them, but for the small business owner and their team to come up with ideas that work for them.”

Selbie added: “Everyone benefits from a healthier workforce: employees, who will enjoy better health and be less likely to be off sick; employers, who will reap the benefits of increased productivity; and the NHS, which will have less poor health to deal with.”

and 89% thought that those who used two wheels had more energy during the day. Research by the National Institute for Health and Care Excellence has found that physically active staff take 27% fewer sick days.


A Top Dermatologist Shares Her Secret for Looking 30 in Her 40s

For 44-year-old Louisville, KY, dermatologist Tami Buss Cassis, MD, there’s one go-to treatment that she personally relies on to keep her skin looking youthful and fresh. “Just like everyone else, I have the normal aging skin worries: fine lines, wrinkles, brown spots, larger pore sizes and sunken eyes.” As a skin care expert, Dr. Cassis has access to a multitude of noninvasive options for facial rejuvenation. To treat her own skin, she chooses microneedling as an easy and effective way to treat the common signs of aging, leaving her with a complexion that makes her look more than a decade younger than her actual age.


Before the Treatment

Using a small, roller-like device with tiny needles, microneedling works by making miniscule holes spaced apart in a given area of your skin. This creates a controlled skin injury that your body will respond to by sending collagen and elastin to heal the entire area. “When the trauma happens to the skin, it is forcing collagen remodeling,” says Dr. Cassis. “There is some slight pain associated with it, so we make patients sit with numbing cream about 20-30 minutes before the procedure. But beyond that, it’s a very safe, effective and fast treatment. The procedure takes about 30 minutes. Afterward your skin is very raw, swollen and a little bloody. You will have very specific skin care instructions to follow after the procedure. Sun avoidance is an absolute must!”

Immediately After the Microneedling Treatment

The collagen and elastin heals the damaged area and smooths out minor scars, flattens out fine lines and wrinkles, and promotes elasticity in the skin. “I love the glow it gives my skin,” adds Dr. Cassis. “My brown spots have diminished, and under the layers of skin that peeled off after my treatment, I can see an improvement in my fine lines.”

8 Days Post-Procedure

“My after picture was taken eight days after the procedure, and I am very happy with results,” says Dr. Cassis. “Most people will need a series of three treatments about a month apart. Results are ongoing and it really depends on what you are trying to treat. It’s a great option for acne scars, wrinkles and hyperpigmentation.”

The cost for a microneedling treatment varies by the physician, geographic region and the complexity of the procedure (some use radio frequency, platelet-rich plasma and special serums). “In Kentucky, the cost is about $300, plus the cost of the post-op care, which is about $100,” says Dr. Cassis. “Everyone will react differently, so make sure you are having this done in a board-certified dermatologist or plastic surgeon’s office.”




27 Contact Lenses Are Found in Woman’s Eye, Doctors Report

Seventeen contact lenses removed by an anaesthetist. A further 10 were found during examination under a microscope by the surgeon. CreditBMJ

For years, she had assumed that the strange sensation in her right eye was just a part of a changing body, nothing worth troubling over.

Fortunately for the unidentified 67-year-old woman, doctors preparing her for routine cataract surgery last November discovered the source and removed it. Unfortunately for the squeamish, the cause was the stuff of nightmares: The woman’s eye had become home to a hard, bluish mass of nearly 30 contact lenses held together by mucus.

The lump the medical team discovered was composed of 17 contact lenses, they reported this month in BMJ, a medical journal. On further examination, they found 10 more.

“We were all shocked she had not noticed!” Dr. Rupal Morjaria, an ophthalmologist in Britain and one of the three authors of the report, said in an email.

It is not clear how long the lenses were in the woman’s eye, but she had worn monthly disposable lenses for 35 years, the doctors said. The cataract surgery was postponed because of a greater risk of infection, but it was later carried out with no long-term complications, Dr. Morjaria said.

She and her colleagues speculated that the patient’s poor vision and deep-set eyes may have contributed to her not noticing the accumulating mass.

“She said she had felt an uncomfortable and gritty eye, ‘like something was inside,’ but she didn’t think it was anything to worry about,” Dr. Morjaria said.

While lenses in Britain may be obtained only following an exam with a specialist, they are easy to buy online, Dr. Morjaria said. In the case of the patient, the lenses were lodged so high up under the eyelid that they would not have been easily spotted, she added.

The team decided to publicize the case to raise awareness about safe contact lens use, she added. While contacts can be an effective way to correct vision, experts note that they must be treated with care.

“This patient was lucky, however contact lens overwear can cause sight threatening complications,” Dr. Morjaria said.

Last summer, the Centers for Disease Control and Prevention reported that about 41 million people in the United States wear contact lenses. Only a small percentage get serious eye infections.

To reduce the risk of infection, the agency recommended not sleeping in contact lenses without discussing doing so with an eye doctor, not combining old and new contact lens solution, and replacing lenses as recommended.

The mass was discovered by Dr. Richard Crombie, an anesthesiologist, and was removed by Dr. Amit Patel, an ophthalmologist. Both were authors of the report with Dr. Morjaria.


Experimental gene-silencing drug from Alnylam and Sanofi shows strong results in hemophilia

Alnylam CEO John Maraganore aims to compete with what is expected to be a blockbuster hemophilia drug from Roche.


n experimental hemophilia drug developed by Alnylam Pharmaceuticals continues to staunch bleeding in patients followed for almost one year in an ongoing, mid-stage clinical trial, the company reported Monday.

The promising results could intensify an already heated competition to develop novel treatments for the inherited bleeding disorder. The Alnylam drug, developed in partnership with Sanofi, uses a technology called RNAi to shut down dysfunctional genes. It’s a promising approach that’s attracted billions in research dollars, but hasn’t yet been used in an actual drug approved for sale.

The company says the new data support its recent decision to advance its RNAi hemophilia drug —  known as fitusiran —  into phase 3 clinical trials. If it succeeds, the drug could potentially compete against an expected blockbuster hemophilia drug from Roche.

In the current study, 33 patients have been injected once a month with fitusiran. The results so far: 48 percent have not bled after a median observation period of 11 months, according to data reported Monday at the International Society of Thrombosis and Haemostasis Congress in Berlin. Some patients in the study have been followed for up to 20 months.

Before starting the study, patients were reporting a median of 20 bleeding events per year. That number was reduced to 1 following the fitusarin injections.

The patients have two types of the disease, hemophilia A and B. Fourteen of the patients have inhibitors —  immune system antibodies that interfere with clotting factors commonly used to treat hemophilia. Patients with inhibitors are the hardest to treat effectively.

For this group, the median annualized bleed rate fell from 38 to zero, although the median observation period was shorter at six months.

Sixty-four percent of the inhibitor patients have not bled since starting treatment with fitusiran.

“These are really encouraging numbers,” said Alnylam Chief Medical Officer Pushtal Garg, in a phone interview from Berlin on Sunday. “To show annual bleed rates of one and zero is remarkable, particularly for a treatment that is administered once per month with a subcutaneous, low-volume injection.”

One third of the fitusiran-treated patients in the study reported elevated liver enzymes, a possible signal of liver toxicity, though all these patients also had hepatitis C, Alnylam said. One patient with increased liver enzymes stopped participating in the study; the rest had no symptoms and their liver enzyme issues were resolved.

There were no blood clots reported by patients in the fitusiran study. That could help the drug stand apart from Roche’s hemophilia drug emicizumab, which had a handful of serious blood clots reported in its phase 3 studies.

Roche intends to submit emicizumab for approval this year to treat hemophilia A patients with inhibitors to standard therapy. Sixty-three percent of patients receiving emicizumab reported zero treated bleeds compared with 6 percent of patients treated with bypassing agents, according to phase 3 study results previously announced. (Those results were also presented Monday at the Berlin meeting and published in the New England Journal of Medicine.)

Some analysts have projected emicizumab’s peak sales could hit $2 billion per year for patients with inhibitors, although that figure is hotly debated given the drug’s blood clotting safety issue. This leaves a potential opening for fitusiran, though its phase 3 trial won’t report data until 2019.

The Roche drug may eventually have other competition, too. Biomarin Pharmaceuticals, Spark Therapeutics, and Uniqure are all developing gene therapies to treat — and potentially cure — hemophilia.

Hemophilia drug franchises from Shire and Novo Nordisk are at risk of losing billions of dollars in sales if these new hemophilia drugs are approved. Though there are just 20,000 patients with hemophilia in the U.S., it’s a highly lucrative market.

On Sunday, Shire took the unusual step of fighting back with a preliminary injunction from a German court against Roche. Shire accused Roche of disseminating “inaccurate and misleading” information about the safety and serious adverse events that occurred in the phase 3 clinical trial of emicizumab, according to Reuters. In a statement, Roche said it stood behind the emicizumab data.

Alnylam, which is based in Cambridge, Mass., develops drugs that work through a process called RNA interference, or RNAi. All of its drugs, including fitusiran, are snippets of genetic code known as RNA that turn off genes producing disease-causing proteins. Fitusiran blocks the production of antithrombin, a protein made in the liver that prevents blood from clotting. Monthly injections of fitusiran reduce antithrombin in patients and increase corresponding levels of thrombin, another protein that promotes blood clotting.

Last October, Alnylam shares fell sharply after another of its RNAi drugs caused more deaths than a placebo in a phase 3 study. Work on that drug was halted.

But Alnylam shares have recovered this year, up 125 percent to date, on renewed investor optimism for its late-stage drug pipeline, including another RNAi drug, patisiran, targeting a rare nerve disease.

At Friday’s $84.08 close, Alnylam carries an almost $8 billion market valuation. It doesn’t yet have a drug on the market, which means investors are giving the company a lot of credit already for its late-stage RNAi pipeline, including fitusarin.


Yoga teacher arrested for molesting woman in Mumbai

Image result for Yoga teacher arrested for molesting woman in MumbaiThe victim’s husband, who also attended Raut’s yoga sessions, said, “He has been running yoga classes for the last six years and exploiting women students. Following our complaint, another three-four women have come forward with similar complaints against the yoga teacher.” Further investigation into the case is on, police said. (Representational Image)

A 57-year-old yoga teacher has been arrested for allegedly molesting a woman during his classes in Sewri here, police said today. The accused, Shivram Raut, who has been conducting yoga classes for the last few years, was arrested from his residence in Wadala last night, a senior officer said.

“The accused conducts yoga classes every Sunday at a school in Sewri. During the sessions, he asked the woman to keep sexual relations with him to attain ‘moksha’ (liberation) and also indulged in indecent behaviour with her,” the officer said.

The woman and her husband approached R A K Marg police station in Sewri and filed a complaint against Raut last week. Based on the complaint, police conducted a probe and arrested the accused from his house.

“The accused has been booked under IPC sections 354 (assault or criminal force to woman with intent to outage her modesty), 509 (word, gesture or act intended to insult the modesty of woman),” the official said adding that he will be produced in the Metropolitan Magistrate Court today.

The victim’s husband, who also attended Raut’s yoga sessions, said, “He has been running yoga classes for the last six years and exploiting women students. Following our complaint, another three-four women have come forward with similar complaints against the yoga teacher.” Further investigation into the case is on, police said.


Hair loss in men: THIS shower habit could be why you’re going bald

Image result for Hair loss in men: THIS shower habit could be why you're going baldThe UK has the fifth highest number of bald men in the world.

Indeed, almost 40 per cent of men in this country are losing their hair.

It’s often hereditary – male pattern baldness or androgenic alopecia, which is related to genes and male sex hormones, accounts for 95 per cent of hair loss in men.

Other reasons for thinning hair include stress, anaemia, protein deficiency and low vitamin levels.

Hair loss: It affects 40 per cent of men in the UK
Bald man
However, surprisingly, a recent study published in JAMA Dermatology found there’s no relationship between hair loss and testosterone levels in men.

If you want to maintain your head of hair for as long as possible, start to pay more attention to your daily grooming habits.

Jumping in and out of the shower as quickly as possible might mean more time in bed, but it could be speeding up you going bald.

That’s because taking the time to massage your head as you shampoo stimulates hair growth.

Man combing hairGETTY

Grooming habits: Not spending long enough in the shower can make a difference

Ananbel Kingsley, trichologist at Philip Kingsley, said: “Scalp massage can be beneficial for those experiencing a gradual reduction in hair volume or hair loss.”

It does this by improving blood flow directly to the area, and by removing dead skin cells which have been proven to cause or worsen hair loss.

She explained: “It should ideally be done for five to ten minutes once to twice a week. It should be gentle yet firm with consistent pressure.

“Using both hands, gently knead your scalp in circular movements starting at the front hairline and gradually working your way back down to the nape of your neck.

“Repeat three to four times, then, with a gentle sweeping action, smooth your hands over the top of your scalp.”

Dr Chris reveals shorter men are more prone to hair loss

Man checking hairGETTY

Thinning hair: It could be due to stress and vitamin deficiency

Additionally, a study published in the International Journal of Neuroscience found that massaging your scalp also lowers hair loss-inducing stress levels.

However, Anabel added: “Scalp massage alone will not have a vast impact on hair growth. Its benefits are highly dependent on what is used during massage – try a stimulating scalp mask.

“Additionally, one of the most common causes of hair loss is the result of iron and ferritin – stored iron – deficiency.

“A healthy diet, eating adequate iron and proteins and taking care of your general health will help prevent both hair loss and hair thinning – and will often improve the general appearance of the hair.”


Opioid prescriptions dropped for the first time in the modern drug crisis

According to the CDC, opioid prescriptions are on the decline.

According to the CDC, opioid prescriptions are on the decline.

The number of prescriptions for opioids written by health care providers declined between 2012 and 2015, the government reported Thursday, introducing a glimmer of progress in efforts to quell the worst drug epidemic in U.S. history.

The Centers for Disease Control and Prevention said prescriptions for highly addictive painkillers such as oxycodone dropped 13.1 percent over the three-year period, from 81.2 per 100 people to 70.6.

[Opioids hospitalize nearly 23 Mainers a day]

But Anne Schuchat, the CDC’s acting director, expressed tempered optimism about the first national decline in opioid prescriptions that the CDC has reported since the crisis began in the late 1990s. She said the prescription rate is still triple the level it was in 1999 and four times as much as it is in some European countries. Even at the reduced prescribing rate, she said, enough opioids were ordered in 2015 to keep every American medicated round-the-clock for three weeks.

“It looks a little bit better, but you really have to put that in context,” Schuchat said in an interview. “We’re still seeing too many people get too much for too long.”

The overprescribing of legal opioids sparked the addiction crisis, but some addicts eventually move to cheaper or stronger drugs, especially if they run into difficulty obtaining prescription opioids. In recent years the overdose death rate from illicit drugs, such as heroin and fentanyl, has risen much faster than the rate of overdoses from medical narcotics. That means the decline in prescriptions may trigger fewer first-time addictions in the future, Schuchat said.

The improvement should be viewed “as prevention,” she said. “The fewer we get started, the fewer we get addicted to opioids.”

[The Penobscot County Jail is trying something new to fight the opioid crisis]

Gary Mendell, founder of the anti-drug advocacy group Shatterproof, noted “the improvements being made,” citing estimates that 80 percent of opioid abusers first become addicted to prescription narcotics, not street drugs. But, he said, the reduction is “not even close to what could occur in this country.”

In particular, Mendell said, prescribing practices should be measured and responded to in real time. The cumbersome CDC process of collecting data from states and counties is inefficient, he said.

“Can you imagine being on a conference call with a company and they announce data that’s two years old?” said Mendell, a former hotel executive. “There’s a simple saying in business: What doesn’t get measured doesn’t get done.”

The opioid crisis appears to have left no community untouched as it’s mushroomed into an epidemic since the turn of the century. Prescription opioids alone killed nearly 180,000 people from 2000 to 2015 and those overdoses, abuse and dependence on medical narcotics created an annual “economic burden” estimated at $78.5 billion, according to the new report.

In 2015, the latest year for which the CDC has released data, more than 33,000 people died of overdoses that involved an opioid, including more than 15,000 who had taken a prescription narcotic. Nearly 13,000 more were killed by overdoses of heroin.

State data and a nationwide survey conducted by the New York Times indicate that those figures may be rising sharply in 2016.

More than two million people are addicted to opioids, the government estimates. In 2014 alone, there were 1.27 million emergency room visits or inpatient hospital stays for opioid-related health problems, another government agency reported in June.

The critical shortage of treatment for people with opioid use disorder also has complicated plans by the President Trump and Republicans in Congress to repeal and replace the Affordable Care Act. States confronting major drug problems have resisted federal proposals to roll back Obamacare’s expansion of Medicaid, which is helping to fund treatment for many people.

[Maine’s health care providers have a chance to save lives lost to opioids. It’s time they seize it.]

There are also indications that prescriptions for opioids have been dropping since 2015. In the past year, some private-sector data collectors have reported prescription declines on par with the data in the CDC report. Customers of Cigna Health Insurance, for instance, have consumed nearly 12 percent fewer opioids in the past year, according to Will Lopez, senior medical director of Cigna Behavioral Health.

The CDC report also confirmed another critical factor in the crisis: It found wide disparities in opioid prescriptions in counties across the nation. Doctors in some counties in hard-hit parts of Appalachia, the southwest and New England prescribed the equivalent of 958 to 5,543 milligrams of morphine per capita in 2015. In other locations, prescribers authorized zero to 454 milligrams in the same year.

The report also determined, as other researchers have, that opioids are more heavily prescribed in small town America, in counties with larger white populations, and in places where unemployment and Medicaid enrollment are higher. It also found that they are prescribed more frequently in counties where arthritis and diabetes rates are higher than average.

Still, those factors only explain about a third of the variation among counties, Schuchat said. “That suggests to me that clinicians may not know what the right amount of prescribing is. They may be prescribing based on custom and tradition and what they were taught” in medical school, she said.

In the last few years, medical and public health authorities, including the CDC, have been urging doctors to cut back on the number of pills, the dose and the duration of the prescriptions they offer – a turnaround from just 15 years ago, when a nationwide movement urged physicians to more aggressively treat their patients’ pain. Even before the CDC issued guidelines last year, studies were warning prescribers of the dangers of dispensing too many opioids.

The data indicate that at least some prescribers are heeding the message. Nationally, prescribing peaked at the equivalent of 782 milligrams of morphine per person in 2010, declining to 640 milligrams per person in 2015.

The study also found a continued increase in long-term prescribing of opioids. The average length of prescriptions rose steadily from about 13 in 2006 to about 18 in 2015, the data show. But Schuchat cautioned that as fewer people are receiving short-term prescriptions, those who take opioids for years for chronic pain may have skewed the average. The CDC has said that there is no evidence that opioids are effective long-term and suggests that people with chronic pain, one of the most common reasons for visiting a health-care provider, seek alternatives.

“Improving the management of chronic pain is very important,” Schuchat said. “There are multiple approaches. Larger-scale studies suggest that opioids, even high-dose opioids, are not in the long run effective for chronic pain, and in the long run may even be dangerous.”