Need Help Overcoming Social Anxiety? 6 Tips From an Expert

If you feel out of practice socializing after the last few years of social distancing, you’re not alone. If you feel more anxious than usual when leaving the house to socialize, that’s also totally normal, as is occasionally feeling overwhelmed or out of your element in large crowds.

However, when these nervous feelings persist — and cause you great anguish — you might have a social anxiety disorder.

“Social anxiety is one of those disorders where the name is pretty accurate in describing what it is,” says psychologist Dawn Potter, PsyD. “It’s anxiety that occurs in a social situation. If you have anxiety that routinely pops up in social situations that causes distress or inhibits you from doing things you want to do, then we might start to consider this a disorder. A person with social anxiety disorder would have frequent anxiety, panic or significant discomfort in a social situation. Then they would want to avoid that situation, or would enter that situation with a lot of distress.”

Dr. Potter adds that there are different kinds of social anxiety. While one involves being uncomfortable with or avoiding social situations — either big or small groups of people you might not know well, whether in public or private — there’s also a specific type of social anxiety around public speaking.

“It’s performance-based only,” says Dr. Potter. “You would have anxiety about public speaking, but wouldn’t necessarily have anxiety about going to a party, ordering at a restaurant or speaking on the phone to an unknown person.”

Contrary to popular belief, being quiet in social situations, or preferring to socialize in small groups, doesn’t mean you have social anxiety — and this disorder isn’t synonymous with being an introvert. “Even if extroverts are generally outgoing and talkative, and like meeting new people, they can also feel nervous, anxious or on edge when meeting new people and performing in front of groups,” says Dr. Potter.

How to get over social anxiety

Dr. Potter stresses that it’s important to address your social anxiety, even if this feels difficult, since it can have a major impact on your life. “It can have subtle negative effects on your career, friendships, dating life, or even family relationships,” she says. “It can affect you so broadly when you miss opportunities. When a person’s isolated, it can lead to depression because you miss opportunities to have a good time or enjoy yourself, and feel connected to other people.”

Luckily, Dr. Potter notes that social anxiety is very treatable, although strategies for overcoming social anxiety depend both on your individual personality and how much the disorder is affecting your life. For example, if you have panic attacks when going out in public because you are so overwhelmed, you might opt for medication, psychotherapy or a combination of both. Less severe anxiety might be better served by a different treatment option.

Here are a few other ways to approach getting over social anxiety.

Practice public speaking

For those who have mild-to-moderate social anxiety disorder — for example, maybe it’s not causing you panic attacks — finding ways to practice public speaking is a good approach. Dr. Potter suggests joining a group such as Toastmasters, which is for specifically practicing public speaking and rehearsing.

Try cognitive behavioral therapy

Among the different kinds of psychotherapy available, cognitive behavioral therapy — which involves making changes to the way you think and feel about a situation, which, in turn, can help you modify your behavior — is a helpful way to approach social anxiety. “With social anxiety specifically, you want to identify patterns of thinking that cause you to avoid social situations — like if a person’s always expecting the worst outcome, or a person is fixated on the fact that someone might see them blushing, or sweating or stammering,” says Dr. Potter. “You want to help them learn to challenge those expectations and adopt more positive self-talk rather than negative self-talk.”

Gradually introduce yourself to anxiety-inducing situations

Dr. Potter recommends what she calls “situational exposure.” Identify certain social situations you’re afraid of, and work your way up from easier to more difficult scenarios while practicing relaxation techniques so you can tolerate anxiety. “For example, if you have a fear of large groups, and you’ve been mostly avoiding group activities, start by going out with a friend one on one,” she explains. “Then work your way up to going out with a small group of friends.” Repeat as needed until you feel more comfortable before attempting to go to a restaurant, a bar or a party where there would be more people. You can also work on situational exposure with the support of a therapist, Dr. Potter says. “Like cognitive behavioral therapy, exposure therapy is a type of treatment a trained psychologist can provide.”

Ask your support system for a helping hand

It can be embarrassing or humbling to admit to people in your life that you’re anxious in social situations and might need help. However, letting a friend or loved one know you might need some extra support can be a major boost. “Many times, people are going to feel more comfortable if they’re in a social situation with somebody that they’re close to,” Dr. Potter says. “Especially if somebody has been fairly isolated in recent times, it can be helpful at first to have a buddy when you go back into a social situation.”

The key to this support is helping an anxious person become more independent over time. “Eventually, people with more generalized social anxiety will find it uncomfortable to go shopping or order food by themselves,” Dr. Potter explains. “You want to balance supporting a person and encouraging them to do it themselves.”

If you’re a friend or family member of somebody anxious in social situations, one way to offer support is to bring them into the conversation. “You might be like, ‘Oh, I think Sara has something she would probably like to say on that subject. She’s really interested in that,’” Dr. Potter says. “You can support them by bringing them out of their shells.” Before doing that, however, be sure to ask the person if that’s OK. “If you’re a person with social anxiety, you may not like being put on the spot to say something. Talk to that person in advance about how they want to handle certain things.”

Check in with yourself

When you’re out in public and start feeling anxious, it’s easy to spiral and become fixated on everything that appears to be going wrong, even if you’re the only one feeling that way. “In the moment, you need to focus outside of yourself, and remind yourself, ‘This is probably anxiety. I can’t read their mind. I do not know what they’re actually thinking of me,’” Dr. Potter says.

This is easier said than done, of course, so she suggests using a technique called “five senses” that can help you regain perspective and stay in the moment. “Do a check-in with yourself of all of your five senses to get yourself more externally focused. Distract yourself from unpleasant internal sensations and negative thoughts,” says Dr. Potter. “Then you can try to refocus on: ‘What are they actually saying to me? What else is going on right now? What can I see? What can I hear? What can I feel?’”

Look for silver linings — and be kind to yourself

If your social anxiety isn’t going away as fast as you’d like, that’s perfectly normal. “It might be that you moved too fast and need to spend more time practicing other social encounters before you’re up for the one you’re stuck on, or you need to work more on relaxation techniques and distraction techniques so you can tolerate that situation next time,” says Dr. Potter.

Analyzing after the fact what triggered a reaction, whether a panic attack or something else, can also help. “Try to break down, ‘How can I think about that differently?’ or ‘How can I change the situation next time?’” Dr. Potter suggests. “Let’s say you go to a concert and start to have a panic attack because you’re enclosed in by a lot of people. Maybe next time, you might sit in the back or on an aisle, or stay somewhere where you feel like there’s an exit route if you feel anxious or closed-in.”

Dr. Potter adds that other people are generally way more focused on themselves than they are on others. “They are most likely not scrutinizing your behavior in social situations, because they are busy thinking about what they are going to say or do next,” she says. “Your anxiety usually magnifies the negative and minimizes the positive — so the things you’re acutely aware of about yourself may not be particularly noticeable to others.”

When to worry about physical symptoms of anxiety

Social anxiety disorders can also lead to physical symptoms. “You might experience blushing, sweating, or a subjective sensation of feeling suddenly cold or warm,” says Dr. Potter. “You might also have physical tension, which could cause aches and pains, like a stomach ache.”

You can also experience symptoms associated with panic, even if you don’t have a full-blown panic attack. “Panic symptoms are your heart beating fast, shortness of breath, a subjective feeling of losing control or a fear of sudden, impending doom,” says Dr. Potter. “People with social anxiety will typically experience some of these symptoms, including at a lower threshold, too.”

Determining whether these symptoms are from anxiety, or a more serious medical condition, can be difficult. “If the pain goes away quickly after the anxiety-provoking situation has stopped, and if you have a subjective sense of knowing that you are currently afraid of something, then it’s more likely what you are feeling is probably anxiety,” says Dr. Potter. “But if you’re in doubt, you should definitely talk to a doctor about it and get advice on specific signs to look out for and what your risk factors are.”

If you have a known heart condition, this advice is even more important. “You want to be much more careful about seeking medical care for any of these types of symptoms,” she says. “And if you have cardiac conditions and you have anxiety, you should talk to your doctor about how to differentiate the two.”

Diet

No food or food group can prevent cancer and eliminating specific foods won’t eliminate your risk. But eating a diet based on plant foods like vegetables, whole grains, beans and fruit and following some basic guidelines can help you reduce your risk for cancer and several other chronic diseases.

Eat a plant-based diet

Eating a plant-based diet can give your body the fiber, vitamins, minerals and antioxidants it needs to stay healthy.

Eating plant-based does not mean you can’t eat meat, fish or animal products like cheese and eggs. It means at least two-thirds of what you eat is plants: vegetables, whole grains and beans. Fruit, nuts and seeds are included. So are plant-based proteins like tofu.

Not all plant-based foods are healthy. Highly refined and packaged foods like crackers have had much of their fiber and nutrients stripped away, and they can be high in salt, sugar and fat. Limit refined foods like regular pasta, white bread and white rice. Choose whole-grain items like whole-wheat bread and brown rice more often.

The benefits of eating mostly plants are not limited to reducing your cancer risk. A plant-based diet also has been shown to reduce your risk for heart disease, stroke, diabetes and some mental health illnesses.

Limit red meat

Research shows that eating too much red meat can increase your risk of colorectal cancer. Adult men and women should eat no more than 18 ounces of cooked red meat a week. Less is better. Red meat is any meat from a mammal. That includes beef, pork, veal, mutton and lamb.

Eating red meat, in modest amounts provides valuable nutrients, including protein, iron, zinc and vitamin B12. But keep in mind, you can get these nutrients from other foods such as fish, poultry, eggs, nuts, seeds and a healthy plant-based diet.

A serving size of red meat is about 3 ounces, or the size of a deck of cards. It’s best to eat it only occasionally, as part of a plant-based diet.

Limit processed meat

For cancer prevention, it's best not to eat processed meat. Processed meats are considered carcinogens and there is strong evidence that eating them increases your risk of colorectal cancer.

Any meat that has been preserved by smoking, curing or salting is processed. And meats with added chemical preservatives are also processed. Some processed meats include ham, sausage, hot dogs, pepperoni, beef jerky and deli meats, including roast beef and turkey.

Limit alcohol

For cancer prevention, it’s best not to drink alcohol. Drinking any amount of alcohol increases the risk for several cancers, including breast cancer,  colorectal cancer, esophageal cancer, liver cancer, oral cancer, pharynx and larynx cancers and stomach cancer.

While no alcohol is best, women who choose to drink anyway should have no more than one drink a day, and men no more than two drinks a day.

International alliance of health journals calls for emergency action on climate change

Two weeks ago, more than 200 health journals simultaneously published an editorial calling on health professionals, policymakers, and governments to support emergency actions to limit average global temperature increases to below 1.5 degrees Celsius. Asserting that increases above that level would "risk catastrophic harm to health that will be impossible to reverse," the editorial's authors advocate for "fundamental and equitable changes to societies" to alter the world's current catastrophic temperature trajectory:

Equity must be at the center of the global response. Contributing a fair share to the global effort means that reduction commitments must account for the cumulative, historical contribution each country has made to emissions, as well as its current emissions and capacity to respond. Wealthier countries will have to cut emissions more quickly, making reductions by 2030 beyond those currently proposed and reaching net-zero emissions before 2050.

In August, a landmark report from the Intergovernmental Panel on Climate Change (IPCC) concluded that human activities since 1850, primarily the burning of fossil fuels, have already warmed the planet by 1.1 degrees Celsius. At 1.5 degrees, the IPCC warned, extreme weather patterns would become more frequent, and rising sea levels, vector-borne diseases, life-threatening heat waves, and severe droughts would affect billions of people worldwide. Currently, the 10 countries with the greatest greenhouse gas emissions (China, the U.S., the European Union, India, Russia, Japan, Brazil, Indonesia, Iran, and Canada) account for more than two-thirds of global emissions.

American Family Physician, where I have been Deputy Editor since 2018, strongly supports this global effort to prevent future environmental catastrophes. Our first full-length clinical review article about the health impacts of global warming appeared in 2011. An accompanying editorial highlighted the physician's role in efforts to slow global warming, including reducing the carbon footprints of hospitals and health care facilities. In 2016, my Georgetown colleague Caroline Wellbery, MD, Ph.D. observed that the 2015-2020 Dietary Guidelines for Americans' "heart-healthy recommendations align with ... environmental concerns," making eating less meat a healthy and environmentally responsible dietary choice.

A 2019 update on managing health impacts of climate change discussed ways that clinicians can mitigate "morbidity and mortality from worsening cardiopulmonary health, worsening allergies, and greater risk of infectious disease and mental illness, including anxiety, depression, and posttraumatic stress disorder from extreme weather events." Health professionals must recognize how their workplaces directly contribute to making climates less healthy: "The U.S. health care sector is responsible for 10% of all greenhouse gas emissions, 10% of smog formation, 12% of air pollution emissions, and smaller but significant amounts of ozone-depleting substances and other air toxicants." The article also suggested counseling patients on the personal and environmental benefits of utilizing active transport and consuming plant-based diets.

Physicians' lack of training in climate science and global warming's negative impacts on health may be an obstacle to leveraging the collective authority of the medical profession to address the climate crisis. This gap is closing, though, as recent editorials in Academic Medicine have called for critical curricular reforms in medical school and residency education, and in some cases, medical students themselves have been leading these educational efforts.

The Challenge of correctly diagnosing Hypertension in Adults

Screening for high blood pressure in adults can be straightforward or quite complex. The U.S. Preventive Services Task Force (USPSTF) recently reaffirmed its longstanding recommendation to screen for hypertension with office blood pressure measurement but advises confirming the diagnosis with measurements outside of the clinical setting. The diagnostic standard for out-of-office measurement is 24-hour ambulatory blood pressure monitoring (ABPM), but ABPM is often unavailable, not covered by insurance, or inconvenient for patients.

A more accessible alternative, reviewed by Dr. Jeffrey Weinfeld and colleagues in the September issue of AFP, is home blood pressure monitoring (HBPM). In addition to confirming a hypertension diagnosis, HBPM can be used to identify white coat hypertension (elevated readings in the office but normal readings at home) and masked hypertension (elevated readings at home but normal readings in the office). Patients can purchase a clinically validated blood pressure monitor for $37 to $100 without insurance, and this expense may be reimbursed from a health care flexible spending account. The downside of HBPM is that patients sometimes forget to check their blood pressure at home or forget to record and bring in the readings. 

What is the role of automated oscillometric office blood pressure (AOBP) devices such as those used in the Systolic Blood Pressure Intervention Trial (SPRINT)? A systematic review and meta-analysis previously summarized in AFP found that AOBP systolic measurements were on average 14.5 mm Hg lower than manual blood pressures in patients with hypertension and better aligned with values obtained with ABPM. In a Letter to the Editor in the August issue, Dr. Lenard Lesser argued that the USPSTF "missed an opportunity to promote AOBP measurements as an easier-to-implement alternative to ambulatory blood pressure monitoring." Dr. Lesser pointed out that the only randomized trial of hypertension screening cited by the USPSTF that reported improvements in clinically meaningful outcomes actually used AOBP.

In the latest entry in JAMA's Rational Clinical Examination series, Dr. Anthony Viera and colleagues systematically reviewed studies that addressed the question, "Does This Adult Patient Have Hypertension?" Comparing AOBP with HBPM, they found that 

The thresholds for defining hypertension and the prevalence of hypertension were similar in-office BP measurement and home BP measurement studies, and the estimated predictive values of office oscillometric BP measures and HBPM were numerically nearly identical. ... The combination of results from office BP measurement and HBPM has better diagnostic accuracy than the independent results alone, and when concordant, is likely sufficient for diagnosis. However, 24-hour ABPM should be considered when results are discordant, especially for patients with a higher pretest probability of hypertension.

CDC Update on the COVID-19 Pandemic and Delta Variant

TOP 5 THINGS TO KNOW ABOUT COVID-19 AND DELTA VARIANT

1.     Getting vaccinated prevents severe illness, hospitalization, and death; it also helps reduce the spread of the virus in communities.

o   Unvaccinated individuals should get vaccinated and continue masking until they are fully vaccinated.

o   With the Delta variant, this is more urgent than ever. The highest spread of cases and severe outcomes is happening in places with low vaccination rates

2.     Data show Delta is different than past versions of the virus: it is much more contagious.

o   Some vaccinated people can get Delta in a breakthrough infection and may be contagious.

o   Even so, vaccinated individuals represent a very small amount of transmission occurring around the country.

o   Virtually all hospitalizations and deaths continue to be among the unvaccinated.

3.     In areas with substantial and high transmission, CDC recommends that everyone (including fully vaccinated individuals) wear a mask in public indoor settings to help prevent spread of Delta and protect others.

4.     CDC recommends that community leaders encourage vaccination and masking to prevent further outbreaks in areas of substantial and high transmission.

5.     CDC recommends universal indoor masking for all teachers, staff, students, and visitors to K-12 schools, regardless of vaccination status. Children should return to full-time in-person learning in the fall with layered prevention strategies in place.

BACKGROUND ON VACCINATION AND DELTA MESSAGING

Vaccination is the most important public health action to end the COVID-19 pandemic.

Get vaccinated to prevent severe illness, hospitalizations, and death.

We need more people vaccinated.

Vaccination coverage by county in the U.S. ranges from 9% to 89%, and remains below 40% in over half of the counties.

Areas of low vaccination coverage have rapidly increasing cases

COVID-19 cases have increased over 300% nationally from June 19 to July 23,2021 driven by the highly transmissible B.1.617.2 (Delta) variant.

Importantly, while we are seeing case numbers similar to the wave we experienced last summer, there are over 70% fewer deaths due largely to the impact of the vaccines.

Healthcare systems are being strained in many states with surging cases, imperiling providers’ ability to deliver care not only for patients with COVID-19 but also those with other healthcare needs.

We are in a race against time to increase vaccination coverage before new variants emerge.

We continue to have good evidence that our vaccines are safe and effective and provide protection against the variants circulating in the United States.

Data demonstrate that the vaccines are preventing severe illness, hospitalization, and death, and are effective against the Delta variant.

Vaccination is the best way to protect you, your family, and your community.

High vaccination coverage will reduce spread of the virus and help prevent new variants from emerging.

The emerging evidence about the Delta variant demonstrates it is more formidable than the original virus.

Delta spreads more than twice as easily from one person to another, compared with earlier strains.

Delta has most recently surged to become the predominant variant –from <1% in May to over 80% of cases in July.

Delta is causing some “vaccine breakthrough infections,” meaning infections in fully vaccinated people, than other strains have. But, even so:

Most breakthrough infections are mild.

Vaccines are working as they should—they are preventing severe illness, hospitalizations, and death.

New data show that people infected with Delta have higher viral loads—meaning more virus in their body—than with previous variants.

In contrast to the Alpha strain, new data show that fully vaccinated people who are infected with the Delta variant might be infectious and might potentially spread the virus to others.

Causality in Medicine: Moving Beyond Correlation in Clinical Practice

A growing body of research suggests it’s time to abandon outdated ideas about how to identify effective medical therapies.

Paul Cerrato, senior research analyst and communications specialist, Mayo Clinic Platform, and John Halamka, M.D., president, Mayo Clinic Platform, wrote this article.

“Correlation is not causation.” It’s a truism that researchers take for granted, and for good reason. The fact that event A is followed by event B doesn’t mean that A caused B. An observational study of 1,000 adults, for example, that found those taking high doses of vitamin C were less likely to develop lung cancer doesn’t prove the nutrient protects against the cancer; it’s always possible that a third factor — a confounding variable — was responsible for both A and B. In other words, patients taking lots of vitamin C may be less likely to get lung cancer because they are more health conscious than the average person, and therefore more likely to avoid smoking, which in turn reduces their risk of the cancer.

As this example illustrates, confounding variables are the possible contributing factors that may mislead us into imagining a cause-and-effect relationship exists when there isn’t one. It’s the reason interventional trials like the randomized controlled trial (RCT) remain a more reliable way to determine causation than observational studies. But it’s important to point out that in clinical medicine, there are many treatment protocols in use that are not supported by RCTs. Similarly, there are many risk factors associated with various diseases but it’s often difficult to know for certain whether these risk factors are actually contributing causes of said diseases. 

While RCTs remain the good standard in medicine, they can be impractical for a variety of reasons: they are often very expensive to perform; an RCT that exposes patients to potentially harmful risk factor and compares them to those who aren’t would be unethical; most trials require many exclusion and inclusion criteria that don’t exist in the everyday practice of medicine. For instance, they usually exclude patients with co-existing conditions, which may distort the study results.

One way to address this problem is by accepting less than perfect evidence and using a reliability scale or continuum to determine which treatments are worth using and which are not. That scale might look something like this, with evidential support growing stronger from left to right along the continuum: 

In the absence of RCTs, it’s feasible to consider using observational studies like case/control and cohort trials to justify using a specific therapy. And while such observational studies may still mislead because some confounding variables have been overlooked, there are epidemiological criteria that strengthen the weight given to these less than perfect studies:

• A stronger association or correlation between two variables is more suggestive of a cause/effect relationship than a weaker association.
  
  

• Temporality. The alleged effect must follow the suspected cause not the other way around. It would make no sense to suggest that exposure to Mycobacterium tuberculosis causes TB if all the cases of the infection occurred before patients were exposed to the bacterium.
  
  

• A dose-response relationship exists between alleged cause and effect. For example, if researchers find that a blood lead level of 10 mcg/dl is associated with mild learning disabilities in children, 15 mcg/dl is linked to moderate deficit, and 20 mcg/dl with severe deficits, this gradient strengthens the argument for causality.
  
  

• A biologically plausible mechanism of action linking cause and effect strengthens the argument. In the case of lead poisoning, there is evidence pointing to neurological damage brought on by oxidative stress and a variety of other biochemical mechanisms.
  
  

• Repeatability of the study findings: If the results of one group of investigators are duplicated by independent investigators, that lends further support to the cause/effect relationship.

While adherence to all these criteria suggests causality for observational studies, a statistical approach called causal inference can actually establish causality. The technique, which was spearheaded by Judea Pearl, Ph.D., winner of the 2011 Turing Award, is considered revolutionary by many thought leaders and will likely have profound implications for clinical medicine, and for the role of AI and machine learning. During the recent Mayo Clinic Artificial Intelligence Symposium, Adrian Keister, Ph.D., a senior data science analyst at Mayo Clinic, concluded that causal inference is “possibly the most important advance in the scientific method since the birth of modern statistics — maybe even more important than that.”

Conceptually, causal inference starts with the conversion of word-based statements into mathematical statements, with the help of a few new operators. While that may sound daunting to anyone not well-versed in statistics, it’s not much different than the way we communicate by using the language of arithmetic. A statement like fifteen times five equals seventy five is converted to 15 x 5 = 75. In this case, x is an operator. The new mathematical language of causal inference might look like this if it were to represent an observational study that evaluated the association between a new drug and an increase in patients’ lifespan: P (L|D) where P is probability, L, lifespan, D is the drug, and | is an operator that means “conditioned on.”

An interventional trial such as an RCT, on the other hand, would be written as X causes Y if P (L|do (D)) > P(Y), in which case the do-operator refers to the intervention, i.e., giving the drug in a controlled setting. This formula is a way to of saying X (the drug being tested), causes Y (longer life) if the results of the intervention are greater than the probability of a longer life without administering the drug, in other words, the probability in the placebo group, namely P(Y).

This innovative technique also uses causal graphs to show the relationship of a confounding variable to a proposed cause/effect relationship. Using this kind of graph, one can illustrate how the tool applies in a real-world scenario. Consider the relationship between smoking and lung cancer. For decades, statisticians and policy makers argued about whether smoking causes the cancer because all the evidence supporting the link was observational. The graph would look something like this.

Figure 1:

G is the confounding variable — a genetic predisposition for example — S is smoking and LC is lung cancer. The implication here is that if a third factor causes persons to smoke and causes cancer, one cannot necessarily conclude that smoking causes lung cancer.  What Pearl and his associates discovered was that if an intermediate factor can be identified in the pathway between smoking and cancer, it’s then possible to establish a cause/effect relationship between the 2 with the help of a series of mathematical calculations and a few algebraic rewrite tools. As figure 2 demonstrates, tar deposits in the smokers’ lung are that intermediate factor.  

Figure 2:

For a better understanding of how causal inference works, Judea Pearl’s The Book of Why is worth a closer look. It provides a plain English explanation of causal inference. For a deeper dive, there’s Causal Inference in Statistics: A Primer.

Had causal inference existed in the 1950s and 1960s, the argument by tobacco industry lobbyists would have been refuted, which in turn might have saved many millions of lives. The same approach holds tremendous potential as we begin to apply it to predictive algorithms and other machine-learning based digital tools. 

Why You Shouldn’t Eat Raw or Undercooked Chicken and How To Keep it Fresh

Eating raw or undercooked meat is something most people don’t worry too much about, but it can happen from time to time. Whether you’re being adventurous for your next meal or chowing down on some chicken that needed a little more time on the grill, it’s a danger you need to keep in mind.

To better understand the dangers of eating raw or undercooked chicken and what you can do to protect yourself, we spoke with registered dietician Mia DiGeronimo, RD.

Why you shouldn’t eat raw or undercooked chicken

Despite whatever reason you may hear, you should never eat raw or “rare” chicken. “Raw chicken can have bacteria that can cause food poisoning,” says DiGeronimo. The most common bacterial food poisoning from chicken include:

• Campylobacter.

• Salmonella.

• Clostridium perfringens.

• E. coli.

And food poisoning isn’t just a brief thing, either. Symptoms can begin within a few hours of consuming the food and, depending on the bacteria, DiGeronimo notes, the illness can last up to a week.

“Symptoms of food poisoning can include fever, stomach cramping, diarrhea, and sometimes nausea and vomiting,” she says. Plus those symptoms – particularly diarrhea and vomiting – can lead to dehydration, too, so drink plenty of water.

Additional dangers

But there’s a possibility of even more lasting damage, depending on your immune system. “Patients with weakened immune systems, such as those with a diagnosis of AIDS or those going through chemotherapy, can have worsened symptoms and more severe complications from food poisoning,” says DiGeronimo.

“Depending on the bacteria, you may need an antibiotics prescription, too,” she adds. “Patients can get a stool test done to determine what type of bacteria it is.” Bacteremia – where bacteria spread to different parts of the body via your bloodstream – is also a danger, particularly for those with immunity issues.

How to protect yourself against food poisoning

The big thing about protecting yourself from food poisoning, DiGeronimo says, is making sure you cook your chicken to an internal temperature of 165 F. Don’t just trust your instincts when cooking; use a clean meat thermometer for accurate temperature readings.

Besides properly cooking your chicken, though, there are other ways to make sure your chicken stays fresh.

How to properly store raw chicken

If you’re refrigerating raw chicken, keep it in its original packing for no more than two days, says DiGeronimo. “Store your raw chicken on the bottom shelf of the refrigerator, away from any fresh fruits, vegetables and other foods,” she says.

If you’re storing your chicken longer than two days, it’s best to freeze it, she adds. And, yes, you can freeze it in its original packaging. Just be sure to thaw it out over time in your refrigerator and cook it as soon as it’s thawed. 

How long until raw chicken goes bad? 

“Your raw chicken should stay fresh up to two days in the refrigerator (at or below 40 F) but up to one year in the freezer (at 0 F),” says DiGeronimo.

And how long can raw chicken sit out of the refrigerator when you’re preparing it or grocery shopping? ​Ideally, DiGeronimo says, you should get your perishable items into your fridge as soon as possible. Sometimes, though, you might have to make multiple stops on a grocery run and you can’t get your chicken into the fridge right away.

If that’s the case, or if you just happen to accidentally leave your chicken out on the counter once you get home, you still have some time. “It’s safe to leave items needing refrigeration out on the counter at room temperature for up to two hours,” she says. 

How can you tell when raw chicken has gone bad? 

Raw chicken should be cold to touch when buying at the store or before cooking at home, says DiGeronimo. The chicken should also be pink and moist – but not slimy. If the color of your chicken is off or it’s slimy, that’s a sign it’s gone bad.

And, of course, there’s the smell test. Fresh raw chicken should have a slight smell, but if it’s a funky, rotten odor, you need to ditch that fowl meat.

To ensure your chicken doesn’t go bad, don’t thaw it in the sink or on the counter. “The best way to thaw chicken is in the refrigerator, in cold water or the microwave,” she says.

Source: http://feedproxy.google.com/~r/ClevelandClinic/HealthHub/~3/iEdG3LsZjDE/

Skipped Your Mammogram Due to COVID-19? Schedule One Now

Q: You missed your regular mammogram in 2020 while quarantining due to COVID-19. How important is it to get a breast screening scheduled this year?

A: It is extremely important, and here’s why.

Regular screening mammograms are the best way to find breast cancer early. And when caught early enough, patients have that many more options for treatment and the best chance for a cure.  

A mammogram uses X-rays to look for any signs of breast cancer before symptoms (such as a lump) develop. Sometimes, mammograms will find a breast cancer months, or even years, before a patient notices any symptoms. 

It is not an understatement to say that the results of a mammogram can be life-saving. Catching cancer early and beginning treatment increases your chances of survival. It really is that simple.

Breast cancer stands as the world’s most commonly diagnosed cancer, according to the World Health Organization. The disease claimed the lives of more than 685,000 women across the globe in 2020.

In the United States, the American Cancer Society estimates that more than 280,000 women will receive a diagnosis of invasive breast cancer this year. An additional 50,000 will learn they have ductal carcinoma in situ, an early and non-invasive form of breast cancer.

Breast cancer survival rates have steadily increased in recent years largely due to earlier detection and treatment. Regular mammograms – particularly for women age 50 and older – helped drive that trend.

A recent study looked at how many patients did not have their mammograms during the pandemic. This study showed a nearly 60% drop in the rate of screening mammograms. This is concerning.

It’s impossible to look at those numbers and not wonder how many women missed an opportunity for an early diagnosis.

COVID-19 certainly disrupted the screening cycle. And while a short-term delay may have little to no effect on a patient’s diagnosis and course of the disease, there’s worry that longer delays may lead to a later-stage diagnosis that requires more intense treatment.

So when should you schedule your screening mammogram?

ASAP! 

There are timing issues to consider, however, with the COVID-19 vaccine. We strongly encourage women to have their screening mammograms prior to getting the vaccine or at least four weeks after receiving their final vaccine dose.

The reason? The COVID vaccine – like other vaccines – can cause the lymph nodes under your arm to swell. This is a normal (and temporary) response to vaccination.

Swollen lymph nodes, however, also can be a sign of disease. Scheduling your mammogram around a COVID-19 vaccination will better allow a radiologist to determine the exact cause of any swelling.

But let’s get back to the central point: scheduling your mammogram. I urge anyone who has postponed visiting their healthcare provider because of COVID-19 to get back on track. Make your appointment and encourage your family and friends to do the same.     

– Diagnostic Radiologist Laura Shepardson, MD

Source: http://feedproxy.google.com/~r/ClevelandClinic/HealthHub/~3/FjV_BSKGU-o/