How To Fix Droopy Eyelids, Circles and Sags

As you age, your skin gradually loses its elasticity and begins drooping. This sagging effect is most obvious on your face, especially in the areas around your eyes.

In fact, it can often look like you have a droopy eyelid. “The term ‘droopy eyelid’ has a multitude of meanings,” says ophthalmologist and oculoplastic surgeon Julian Perry, MD. “It can be a droopy brow. In other cases, the lid is actually low. With other people, it can even be the skin in between these two things. They’re noticing that extra folding of skin.”

What causes droopy eyelids?

Determining the source and severity of a droopy eyelid is more complicated than you might think. “The first kind of drooping that we look at is the height of the eyelid,” says Dr. Perry. “And then the second kind that we look at is the height and position of the eyebrow. When people look in the mirror, a droopy eyebrow shows up and manifests itself as a full or heavy or droopy eyelid. Finally, we look at the skin that folds in between those two structures, in between the brow and the eyelids. We look at all three of those things.”

However, any bags and sags, as well as dark circles around the eyes, are related to aging skin.“The skin around the eyelids is some of the thinnest skin in our entire bodies, and it’s constantly moving,” says Dr. Perry. “It’s also exposed to the sun because it’s on our face. That combination of thin skin, constant movement with blinking, and exposure to the sun causes that particular area of skin to really stretch with time and gravity and age.”

Plus, as we age, our body composition also shifts. “Fat is a sign of youth,” says Dr. Perry. “If you think about a baby’s face, it’s chubby. And with age, we lose fat and we gain these hollows and we get skeleton eyes. That casts shadows and contours to our eyelids.”

What causes your eyes to look different as you age?

As you age, several other factors contribute to a potentially undesirable look of the area around your eyes.

• Extra skin. Excess skin causes wrinkles and bags under your eyes.

• Dark circles. Dark circles come about due to multiple aging-related processes, says Dr. Perry. “Periorbital hollows are one contributing factor. Another is when the area that separates the eyelid and the cheek becomes hollow. Other factors include the cheek descending with time, just like other tissues drop with time. As it descends, it leaves that hollow area in its wake. And then some people have a tendency to deposit extra pigment in the skin in that area, which can also contribute to the dark circles.”

• Fatty tissue deposits. If your upper or lower lid appears puffy, it can be from fatty tissue deposits. “That fat is actually normal, natural fat that exists behind our eyes to cushion all of the important structures there — the nerves, the vessels, the muscle,” explains Dr. Perry. “And then with time and gravity, it can herniate (move) forward and show up as ‘eyelid bags.’”

• Ptosis. The common condition ptosis, which is a weakness of the muscle that opens the eye, “refers to the height of the eyelid, where the eyelid crosses the pupil, basically,” says Dr. Perry. This can occur due to long-term contact lens wear, eyelid surgery or frequently rubbing your eyelids. “All those things can contribute ptosis of the eyelid,” he adds. “And it’s pretty common. A lot of people have it and don’t even recognize it.”

• Tear trough indentations. Tear trough indentations — or the area of skin under your eye, in the inner corner of your lower lid — become more obvious as you age. “We call it the tear trough, but that’s a name for one of the more major periorbital hollows,” explains Dr. Perry. “For example, a tear might fall and run along that pathway.”

How to fix droopy eyelids

If you’re bothered by drooping eyelids and sagging skin, you’re not alone. More and more people are investigating cosmetic fixes to smooth out the wrinkled skin around your eyes. “Treatment for aging eyelids focuses on the particular anatomical change that’s causing the problem,” says Dr. Perry.

Doctors divide the options for correcting these issues into nonsurgical and surgical approaches.

How to fix droopy eyelids without surgery

Nonsurgical treatments — including hyaluronic acid fillers, or injections like Botox® or Dysport® — can help you look more youthful. These treatments can smooth out wrinkles around your eyes, fill in hollows or tighten sagging eyelids. An oculoplastic surgeon or oculofacial plastic surgeon can assess the best treatment for your needs.

Injections

Injection of products that contain botulinum toxins (such as Botox or Dysport) can help tighten sagging skin and reduce wrinkles around your eyes.

These products work to correct eyelid issues associated with aging by weakening muscles in the crow’s feet area around your eye, giving you a more youthful look when you smile, Dr. Perry says. “Interestingly, by weakening the muscles that pull the brows down, it can actually lift the brows,” says Dr. Perry. “We can achieve a Botox brow lift that can take some of those folds and heaviness of the upper lids and lift it out of the way.”

Fillers

Hyaluronic acid gel fillers, which include products such as Juvéderm® and Sculptra®, provide extra volume to fill in deeper crevices on your cheeks and around your lower lid areas.

“I’ve used fillers in the lower eyelids for a decade, and it often improves the hollowness that can form beneath the bag within the eyelid,” Dr. Perry notes. “It’s not perfect, though. Fillers can cause a bluish hue in those hollow areas, which can contribute to the appearance of dark circles.”

Plus, fillers are also temporary, require reinjections over time and can cause fluid buildup in the eyelids. “We call this fluid buildup festoons or malar mounds,” says Dr. Perry. “Those are also unsightly because they lead to shadows and contours in the junction between the eyelid and the cheek.”

In more serious cases, fillers in the tear trough periorbital hollow can even cause blindness. “The risk of that is incredibly low — but it is not zero,” Dr. Perry says. “If the filler gets into a blood vessel that tracks behind the eye, bad things can happen to the vision. And it can be permanent.”

Dr. Perry adds that it’s often a good idea to use both fillers and injections. Because each option treats different problems, you experience greater overall benefit. “Both products have their pros and cons but do work well to provide a more youthful appearance.”

However, fillers aren’t right for everybody. “If you have fluid blisters, inflammation, allergies, Graves’ disease — anything that causes a tendency for fluid buildup in the eyelids — you may not be a good candidate,” he notes.

Chamomile tea bags

You can use chamomile tea bags to improve the tear film, the layers that keep your eyes moist. Chamomile tea bags can also improve blepharitis, which is “basically dandruff, thick oils and inflammation around the eyelashes,” says Dr. Perry. However, these tea bags are not helpful at improving dark circles.

Surgical options

“Surgical options offer a more permanent solution that can treat more of the components that contribute to the aging process,” says Dr. Perry. “The surgical options are designed to treat structural issues around the eyelids, such as crow’s feet or deeper crevices due to aging.”

Eyelid surgery

Eyelid surgery — blepharoplasty and other procedures — can remove excess skin and fat, reposition fat and tighten your skin.

If you have excess skin, the surgeon can remove a small amount in your lower lids, but Dr. Perry says it’s important to realize that removing this skin doesn’t really treat the underlying problem of laxity and bags under your eye. This skin removal only treats part of the problem.

Fat removal

If you want a more dramatic, rejuvenating effect from surgery, you’ll need to undergo a deeper restructuring that treats the problem of excess fat and bags.

“Older surgeries involved simply removing this excess fat, which improves the undereye bag, but do nothing to improve the hollow area that forms beneath the bag,” Dr. Perry explains.

Fat removal can help you appear less tired and more alert, but can have a downside, he says. “You might think that removing the fat is the key to rejuvenation. In reality, removing the fat can sometimes add to aging changes and add to the hollows.”

Fat repositioning

For the hollow underneath eye bags, oculoplastic surgeons reposition the fat rather than removing it completely.

“Part of what we do with our cosmetic surgeries is use fat to our advantage to improve the shadows, hollows and the contours, rather than simply throwing it away,” Dr. Perry says. “Yes, those eyelid bags are made up of herniated fat. But it does not mean that we necessarily want to simply discard that fat.”

Taking fat from one area and repositioning it addresses both the bag and the hollow area underneath it. In fact, Dr. Perry says, this procedure treats dark circles and hollows better than hyaluronic acid fillers — but it requires a bigger commitment to surgery.

“When we move eye socket fat into the cheek, we’re crossing anatomic boundaries, which can result in longer healing time and little lumps and bumps that take some time to improve,” he says.

Do droopy eyelid exercises exist?

Unfortunately, no. Exercises don’t exist to prevent droopy eyelids or the effects of aging on your eyes.

“If you think about it, our eyelids are exercising all day long,” Dr. Perry says. “They blink 30,000 times a day. Our eyes are constantly moving. Our eyes are already getting a workout. There’s nothing extra we can do to prevent or delay or improve these aging changes.”

However, preventing inflammation near your eyes is important. “Rubbing your eyes can lead to skin stressing, which is maybe why long-term contact lens wear can cause droopy eyelids,” Dr. Perry says. “Anything that causes inflammation is going to hasten or aggravate aging changes.” That’s why it’s important to treat allergies, dry eye and blepharitis, and avoid the sun. “All of those are inflammatory and those participate in the aging process.”

Are droopy eyelids serious?

Although droopy eyelids usually result in purely cosmetic issues, Dr. Perry says they can also sometimes cause vision problems. “Generally, it’s going to cause limited ability to see up above,” he explains. “Some people notice a shadow on the upper part of their vision. Some people notice that they’re needing to lift their brows up in order to see better, or even lift their eyelids up to see better.”

Other people might feel symptoms like fatigue, heaviness or weightiness, he adds. “And when the lower lid sags, that it can sometimes lead to tearing. That can affect vision as well.”

When should I seek treatment for droopy eyelids?

Generally, you should seek treatment if vision changes are having an impact on your daily activities. “That could mean affecting your ability to see, to drive, to read, to use a computer,” says Dr. Perry.

If facial changes are affecting your self-esteem, that’s also a valid reason to seek treatment, Dr. Perry adds. “If you’re not looking the way you feel — if you feel youthful, energetic and vibrant, and the mirror isn’t showing you that — that’s a reason to see a doctor.”

Your primary eye care doctor, especially one who has experience in oculoplastic surgeries, can be a good start if you have concerns. But if you do opt for surgery, be sure to have any procedures done by an oculoplastic surgeon or oculofacial plastic surgeon.

“There’s lots of doctors who perform cosmetic surgery around the face,” Dr. Perry says. “But when the eyes and vision are at stake, it makes sense to seek an expert in both vision and plastic surgery around the eyes. The two are intimately related.”

At a visit, you’ll receive a thorough examination to determine the source of visual issues that might be related to structure around your eyes, or cosmetic issues.

“First, we’ll ask you what type of symptoms you’re having,” Dr. Perry explains. “And then on examination, we’ll measure the position of your lids, brows and skin. Then we can do what’s called a field of vision test, which actually documents and demonstrates how much of the upper part of your vision is affected from various types of droops.”

From there, your doctor will look at your individual situation and discuss the best options for you. “We choose between these options after a careful assessment of your individual anatomy and desires,” Dr. Perry says. If you feel bothered by the way your eyes look as you age, there are solutions to make you look — and feel — more like yourself.

Source: https://health.clevelandclinic.org/the-best-options-for-droopy-eyelids-circles-and-sags/

Lucia and Dr. Laughlin to receive MS Hope Award, the highest award presented by the National MS Society

Immunocompromised Individuals May Now Be Eligible for Fourth Dose of COVID-19 Vaccine

The CDC now recommends individuals who are moderately to severely immunocompromised get three primary doses followed by a booster shot five months later. This population is the only group eligible to receive four doses at this time. The fourth dose is the booster for people in this group who have already received three shots of the primary dose of either the Pfizer-BioNTech or Moderna vaccine. 

Given the recommendation, immunocompromised individuals above the age of 18 who received their additional primary mRNA vaccine dose in August 2021 may now be eligible for their booster dose this month (January 2022).

Individuals are encouraged to talk to a healthcare provider regarding eligibility. 

As a reminder, for immunocompromised people who received a single shot of Johnson & Johnson COVID-19 vaccine, the CDC does not recommend additional primary doses, but advises that they get a booster shot of the Moderna or Pfizer-BioNTech vaccines two months after the first dose. 

Considering Bone or Joint Surgery? You May Not Need It

For many common problems of the knee, hip, shoulder, spine and wrist, nonsurgical options may be just as good.

By Nicholas Bakalar

Considering bone or joint surgery? In many cases, surgery may be no more effective than options like exercise, physical therapy and drug treatments.

Hip and knee replacements, surgery for carpal tunnel syndrome and other orthopedic procedures are among the most common elective surgeries performed today, but they involve cost, risk and sometimes weeks or months of recovery. Many of these surgeries are not supported by evidence from randomized trials, a review found. Even when surgery has been shown to be effective, the review concluded, it may not be significantly better than nonsurgical care.

British researchers looked at studies of 10 common orthopedic operations, including surgeries of the knee, hip, shoulder, spine and wrist. They found good evidence of the superiority of surgery over other treatments for carpal tunnel syndrome and total knee replacement. For six other common surgeries, randomized trials found little advantage over interventions like exercise, weight management, physical therapy and drug treatment. The researchers found no controlled trials that had compared hip replacement or knee cartilage repair with nonsurgical care. The study is in The BMJ.

“Our study doesn’t show that these operations don’t make patients better,” said the lead author, Dr. Ashley W. Blom, a professor of orthopedic surgery at the University of Bristol in England. “And it does not say that treatments do not work if they have not undergone testing by randomized controlled trials. It’s just that some don’t work any better than the best nonsurgical treatments.”

Dr. Saam Morshed, a professor of orthopedic surgery at the University of California, San Francisco, who was not involved in the study, said, “I think it’s fair that we hold the mirror up to ourselves and scrutinize effectiveness for some of these operations. It’s important to understand where we have gaps in knowledge of the efficacy or non-efficacy of common surgical treatments.”

At the same time, he said, “It’s also important to understand that just because there isn’t a randomized trial supporting a given treatment, that doesn’t mean that the treatment is not effective.” Hip surgery, he said, is a good example. There may be no randomized trials of hip surgery, but there is overwhelming observational evidence for its effectiveness compared with nonsurgical treatment.

In other common procedures, the picture may be different. An arthroscopic operation to repair the anterior cruciate ligament, or ACL, in the knee, among the most common sports-injury surgeries in the United States, has a rate of success as high as 97 percent in some studies. But when the operation was compared with nonsurgical treatments, the review found, there was little difference in pain scores or the need for further surgical or nonsurgical treatment.

The researchers describe a large review of studies of the operation to repair the rotator cuff, the group of tendons and muscles that keeps the upper arm bone in the shoulder socket. Compared with exercise and steroid injections, the review found, there was little or no clinically significant difference in pain, function, quality of life or patient satisfaction with the results.

Some studies were randomized controlled trials, giving one group of patients real surgery and a matched group a placebo operation. In two such studies of surgery for shoulder impingement, a condition that causes pain on raising the arm, there was no difference between surgery and placebo surgery in patient-reported outcomes or adverse events.

Lumbar spine decompression is an operation to relieve the pain caused by a ruptured or bulging disk, sometimes called a pinched nerve, in the lower spine. Although the quality of the evidence was low, three analyses showed that surgery and nonsurgical treatments provided equivalent improvements.

There were no studies that compared surgical repair of the meniscus, the cartilage that covers the knee, with nonoperative care or a placebo. But in 10 randomized trials comparing a different procedure known as meniscectomy, or partial removal of the meniscus, with more conservative treatment, the operation did not provide meaningful improvement in knee pain, function or quality of life.

“The best nonoperative care is often multimodal and may involve a combination of physical, medical and psychological interventions, and it should not be assumed that these are necessarily the easiest or most cost-effective options for patients,” Dr. Blom said. “Clinicians should discuss both operative and the best nonoperative care with patients so that patients can consider all options and thereby make informed choices.”

Patient outcomes from these surgeries vary greatly, and these differences are important, Dr. Morshed said. “Future research is going to provide more nuanced inferences on the effect of surgery as we begin to understand on a patient level those characteristics that make them more or less likely to respond to a procedure,” he said.

Coping With COVID-19: 6 Tips to Protect Your Mental Health When You’re Sick

Health Hub from Cleveland Clinic

It’s normal to feel anxiety, worry and grief any time you’re diagnosed with a medical condition – and that’s certainly true if you test positive for COVID-19, or are presumed to be positive.

If your symptoms aren’t severe and you can recover at home, this will involve home isolation until it’s safe for you to be near others without potentially spreading the infection.

Isolation protects others from getting sick – but for the person who is sick, it might seem like one more thing on top of an already stressful situation.

“Being sick is not only hard on your physical well being but it can also significantly impact your mental health. Recovering from an illness can trigger stress, anxiety and depression which slow down your recovery processes. Tending to your emotional health during this time is key,” says psychologist Susan Albers, PsyD.

Here are some ways to keep anxiety and sadness from creeping in while you recover from COVID-19:

Focus on what you can know and control

You may not know how you got infected, or how long it will take to recover. Instead of focusing your energy on regret or what ifs, double down on what you can do. Your job now is to take care of yourself, get well and avoid spreading the infection to anyone else.

Engage your support network

Ask loved ones to check in on you regularly via phone, email or video chat. Talk to them about how you’re feeling. If you’re worried about taking care of children, pets or household duties while you’re sick, identify family members, friends or members of your community who aren’t part of a high-risk population and may be able to help.

Eat well, stay hydrated + meditate

Feed your body nutritious food (over comfort food) when your appetite allows, and stay hydrated. If you’re able, take deep breaths, meditate or stretch to help relax your body.

Do activities you enjoy and find relaxing

Keep yourself distracted to help prevent worry, ruminating or catastrophizing.  Read a book, watch a show, do a puzzle. Many people find it difficult to focus on tasks while ill. Try calming music. It can help you to relax and distract your mind, Dr. Albers says.

Make sure you’re sleeping enough

Give yourself permission to just rest. You don’t have to do or achieve anything besides taking care of yourself. Now isn’t the time to stay up till 3 a.m. binge watching a new show.

Step back from the news and social media

All the chatter online can make you feel even more upset and overwhelmed. “Slow down the scroll of your social media feed or simply put it aside. Viewing what other people are doing 24/7 can make you feel like you are missing out or depressed about your situation. Remember that this will pass,” Dr. Albers says.

Being socially isolated can increase your risk of depression and anxiety. While you recover, watch out for these common red flags:

• Feelings of worthlessness, hopelessness or guilt.

• Changes in your appetite that aren’t related to your illness or symptoms.

• Trouble falling or staying asleep.

• Trouble concentrating on things.

• Thoughts of hurting yourself.

Dr. Albers notes that many behavioral health professionals are still seeing patients virtually, so if you can’t seem to control your negative thoughts, or experience any of these signs for more than two weeks, ask your healthcare provider to refer you to someone.

How to Design a Home Gym That You’ll Actually Use

By Tim McKeough

A new year often comes with new resolutions, and for many, those resolutions center on physical fitness. Whether you want to work off all those holiday cookies or stretch your way into a healthier year, a home gym can make that more convenient — and safer, as the pandemic rages on.

A dedicated home gym isn’t a necessity, of course, but if you’re fortunate enough to have the space, it can be a real luxury — especially if it’s well designed. To make it a place where you’ll enjoy spending time, give it some thought and concentrate on the design, advised Sara Story, a New York-based interior designer and exercise enthusiast. “It should have a good atmosphere and good lighting,” she said, much like any other room in your home.

For tips on designing a hard-wearing gym that’s a joy to use, we asked designers how they approach workout spaces.

Choose the Room

Although it’s nice to have an expansive space for your gym, it doesn’t need to be a huge room. Nicole Hollis, an interior designer, turned a small, awkward room on the top floor of her San Francisco townhouse — roughly the size of a walk-in closet — into her home gym.

“We have this little room that’s too small to be a bedroom, so we set it up as our gym,” Ms. Hollis said. Rather than trying to de-emphasize the tight quarters, she played them up, painting the walls and floor in dark colors to create a sense of drama, a strategy that many designers use for powder rooms.

Basements are a popular place for home gyms because they often have leftover space, but for the fitness-obsessed, it’s perfectly acceptable to put a gym in a more prominent spot — like an unused guest room, or a home office.

Olga Hanono, an interior designer, recently completed a four-story home in Mexico City with a gym on the top level, which has glass doors and views over neighboring rooftops. “It’s not the deepest, most obscure corner of the home,” she said. “On the contrary, it’s a space filled with natural light.”

If possible, it’s best to put the gym near a bathroom, said Jimmy Crisp, the principal of Crisp Architects, in Millbrook, N.Y., because “chances are, you’re going to want to shower after you work out.” And if you’re going all out, consider installing spalike features like a steam shower or a sauna.

Take Stock of Your Equipment

There are many ways to work out, from free weights to elliptical machines, so knowing which equipment you’ll actually use is important. And if you want a gym that is as attractive as it is functional, you’re in luck: Finding good-looking equipment with a compact footprint is easier than it used to be.

“Now there’s a blending of luxury and technology in the gym, and that’s the best thing that could happen to us,” Ms. Hanono said. “It allows us to place not only useful, but also beautiful, objects in these places.”

Interactive fitness systems like Mirror, Tonal and Forme are as unobtrusive as a wall-mounted mirror or picture frame. Peloton has streamlined stationary bikes and treadmills. Wahoo and Tacx make stationary smart trainers that allow carbon-fiber racing bicycles to be used indoors. Ergatta and WaterRower make rowing machines that look almost as handsome as finely crafted rowing shells. And companies like Bala and Kenko are rethinking what weights should look like.

Develop a Plan

There’s more to designing a home gym than just piling equipment into an unused room — it requires creating a layout with good spatial flow.

“We really like to consider the program and how the client will use the space, including what types of cardio equipment they’ll be using,” said Heather Hilliard, an interior designer in San Francisco. For instance, she said, “if there’s a treadmill, you have to have space behind it, in case someone falls off. And you need space for navigating between machines.”

With electronic machines like treadmills and Peloton bikes, she added, it’s critical to have electrical outlets nearby, so you don’t have extension cords snaking across the room. When possible, Ms. Hilliard likes to add floor outlets directly below the machines.

It’s also important to leave space for floor exercises, Ms. Story said. “You don’t want to go into a gym where it’s just all machines,” she said, because it could feel claustrophobic. Leaving open space at the center of the room will make your gym feel less cramped, while also providing room for yoga, stretching and calisthenics.

Address the Floor and Walls

The flooring and walls in a gym should be durable and easy to clean.

“Some form of resilient floor is always a good idea,” Mr. Crisp said. That often means interlocking rubber-tile or vinyl flooring, similar to the kind commercial gyms use, installed wall-to-wall or as a large area mat on top of other flooring.

Another option is to use cushioned mats that can be rolled out individually, in discrete workout zones, across a hard floor of wood, laminate or concrete, Ms. Hollis said. (Carpet is not ideal, because it’s difficult to clean.) She suggested “a couple of different types of mats — one for weights and one for yoga.” Individual mats can also be placed under equipment like stationary bikes, to dampen noise and catch drops of sweat.

For the walls, Ms. Hollis recommended paint with an eggshell sheen, as it’s easier to clean than a matte surface.

Or, you could cover the walls with a more durable material. Ms. Hilliard used plywood on the walls of one home gym she designed. Crisp Architects, working with Valerie Grant, an interior designer, created shiplap wainscoting using wood planks for another gym.

All of the designers interviewed for this story also suggested adding mirrors — either mirrored walls or large framed mirrors — to enlarge the sense of space and let you check your form as you work out.

Pay Attention to Lighting

You don’t have to blast your workout space with the kind of overhead light you’d find in a commercial gym. Installing layers of lighting with multiple fixtures — and using dimmers to control those fixtures — can create a more inviting atmosphere and allow light levels to be adjusted for various activities.

“We incorporate a mood light and ambient light for the experience,” Rush Jenkins, the chief executive of WRJ Design, in Jackson, Wyo., wrote in an email.

And because it’s a home gym, you can choose fixtures you’d never see in a commercial gym, like chandeliers, pendants and sconces. “Depending on the height of the gym space, the main lighting could be a beautiful chandelier, or it could be a subtle flush mount,” Mr. Jenkins noted.

It’s also important to consider where the fixtures are positioned in relation to the workout zones, he added: “You don’t want to be down on a mat during exercise and looking up directly into a bright light.”

To bring in relaxing, atmospheric light without installing new wiring, one option is a portable LED lantern, said Ms. Hollis, who uses an Uma Sound Lantern from Pablo, which doubles as a speaker. “It’s like a candle,” she said. “And it moves around with me.”

Finish It Off

Using furniture and accessories that make it easy to keep your gym clean and tidy — and complete your workout without interruptions — will help you stick with an exercise routine.

If you’ll have foam rollers, resistance bands or boxing gloves, think about where those items will live when you’re not using them, Ms. Hilliard said. Cabinetry and case goods are ideal, but even a group of baskets on the floor can help.

Adding a bench, stool or chair provides a place to catch your breath between exercises, as well as a spot to throw a towel. And if you like watching TV or listening to music while you work out, and you don’t plan to use a portable speaker or headphones, add audiovisual equipment to the room.

When space allows, Ms. Hilliard also likes to install a small station similar to a kitchenette. “Sometimes we do custom cabinets, where we have a water cooler or water bottles,” she said, as well as an area for clean towels and a hamper for used ones. “As much as we can give it the look and feel of a high-end gym, so people actually want to go and use it, the better.”

Is the Flu Dangerous?

With the COVID-19 pandemic lingering, you may have set aside some concerns about catching the flu, but hold fast: The viral respiratory infection is still one serious illness that peaks between December and February in the Northern Hemisphere.

According to the Centers for Disease Control and Prevention, the flu has resulted in 140,000 to 170,000 hospitalizations and 12,000 to 52,000 deaths annually in the U.S. between 2010 and 2020. And while you may believe that you can easily survive the flu or that it’s as common as the average cold, many of these beliefs are misconceptions that should be taken seriously, says infectious disease specialist Sherif Mossad, MD.

“Even though the majority of people can get over the flu, clearly there are people who are sick and cannot function,” says Dr. Mossad. “And if you have an underlying disease — like heart disease or lung disease — that could get worse if you get the flu and it could put you in the hospital or keep you out of a job.”

How dangerous is the flu?

You may think you never get the flu, but Dr. Mossad says that’s a common misconception.

“The odds are about 10% to 20% of the population get infected with influenza every year, whether they have been diagnosed or not,” says Dr. Mossad. “If they think they never get the flu, they don’t know because they either didn’t get tested or because they think they never get sick from a viral illness.”

Common colds and the flu are different from one another, but they certainly have similar symptoms. The real trouble occurs when the flu makes other underlying conditions worse, such as heart disease, lung disease, emphysema, heart failure, liver failure and more. And even when you’re at peak health, the flu could lead to heart or muscle inflammation, making it difficult to move or be active, and even lead to secondary bacterial pneumonia.

Pneumonia is a lung infection in which the airways become inflamed and the air sacs of the lungs become filled with fluid. It can be life-threatening. Children under age 2, pregnant women, adults over 65 and people with compromised immune systems are most at risk for developing pneumonia.

“That could put people in the hospital and require them to be on a breathing machine,” says Dr. Mossad.

Serious symptoms to look out for

The flu spreads quickly through droplets made by people who cough, sneeze or talk while they’re infected. If you have the flu, you can be contagious as early as one day before you start feeling ill and up to five to seven days while you have symptoms.

Symptoms tend to set in suddenly. Some common symptoms of the illness include:

• Fever.

• Headache.

• Cough.

• Body aches.

• Chills.

• Fatigue.

But Dr. Mossad warns that if you’re experiencing shortness of breath, you should go to the hospital immediately.

“If I have progressively worsening shortness of breath, then that’s not right,” says Dr. Mossad. “I have to go to the hospital because if I’m having respiratory failure or heart failure, these can’t be managed at home, and may require oxygen, a breathing machine or heart medications.”

Who is most at-risk?

People 65 and older are most at-risk for complications of the flu due to aging immune systems, but Dr. Mossad says age can be relative depending on your overall health and wellness. Someone who is 65, athletic and has no underlying medical conditions may be as healthy as a 40-year-old who gets influenza. On the other hand, a 35-year-old diagnosed with obesity or diabetes and perhaps smoked for a significant amount of time will be at higher risk of complications of the flu. People with chronic conditions such as heart disease, lung disease or compromised immune systems are also at higher risk.

Preventing the flu

If you get the flu, the best thing to do is to stay home, get plenty of rest, drink fluids and take over-the-counter medications like acetaminophen and ibuprofen to relieve symptoms. If you recognize symptoms early on, you may be able to receive anti-viral medications from your doctor, which can help the flu not last quite as long. But what can you do to prevent the flu before it even occurs?

The simplest — and fastest — solution is to get the flu vaccine. The CDC recommends everyone over the age of 6 months gets a flu vaccine so long as you don’t have any further underlying conditions or allergies that could compromise your health. And if you’re concerned about whether the flu vaccine will make you sick, Dr. Mossad, who authored an article on vaccine effectiveness, says any sickness experienced post-vaccine is your body’s response to building up its defense against further infection.

“This is a foreign antigen to our body, and the intent of it is for our bodies to develop, not just antibodies, but specific cells to protect us from the infection,” says Dr. Mossad.

Of course, taking care of your overall health to strengthen your immune system is equally important as your body can fortify itself year-round against further infections with each and every flu season.

“In general, staying healthy, eating healthy, exercising and sleeping well are all things that help our immune system fight infections,” says Dr. Mossad.

Do the benefits of medical cannabinoids outweigh the harms?

A recent systematic review and accompanying BMJ Clinical Practice Guideline have been creating media buzz regarding medical marijuana and cannabinoids. The systematic review authors comprehensively searched a broad range of databases for randomized controlled trials of at least 20 participants with chronic pain who were followed for a minimum of 1 month. They identified 32 trials with a total of nearly 5200 participants to include in the systematic review. Study durations ranged from 1.0-5.5 months, and most (28) studied non-cancer-related chronic pain. Most studies (29) compared medical cannabis and/or cannabinoids with placebo. After analyzing the data, the authors concluded that:

Compared with placebo, non-inhaled medical cannabis probably results in a small increase in the proportion of patients experiencing at least the minimally important difference (MID) of 1 cm (on a 10 cm visual analogue scale (VAS)) in pain relief (modelled risk difference (RD) of 10% (95% confidence interval 5% to 15%), based on a weighted mean difference (WMD) of −0.50 cm (95% CI −0.75 to −0.25 cm, moderate certainty)). Medical cannabis taken orally results in a very small improvement in physical functioning (4% modelled RD (0.1% to 8%) for achieving at least the MID of 10 points on the 100-point SF-36 physical functioning scale, WMD of 1.67 points (0.03 to 3.31, high certainty)), and a small improvement in sleep quality (6% modelled RD (2% to 9%) for achieving at least the MID of 1 cm on a 10 cm VAS, WMD of −0.35 cm (−0.55 to −0.14 cm, high certainty)).

The authors interpreted these findings as "moderate to high certainty evidence" that the use of medical cannabis and cannabinoids was associated with a "small to very small" improvement in pain, functioning, and sleep. They also reported on adverse events that occurred more frequently in the medical cannabis and cannabinoids patients, including cognitive impairment and nausea/vomiting. 

This systematic review's findings informed an accompanying Clinical Practice Guideline in the same issue of BMJ, in which the guideline authors issued "a weak recommendation to offer a trial of non-inhaled medical cannabis or cannabinoids, in addition to standard care and management (if not sufficient), for people living with chronic cancer or non-cancer pain." The guideline development panel included three of the authors of the above systematic review, patients, and "clinicians with content expertise," who acknowledge that their recommendation "reflects a high value placed on small to very small improvements in self reported pain intensity, physical functioning, and sleep quality, and willingness to accept a small to modest risk of mostly self limited and transient harms." They acknowledge that their guideline contradicts previous guidelines issued by NICE, the American Society of Clinical Oncology, and Canadian Family Physician, arguing that those guidelines were limited by an overly "selective review of the evidence" and a "failure to consider patient values and preferences."

These conflicting guidelines attest to the continued controversy regarding the use of marijuana and/or cannabinoids in medicine. Currently, 36 US states and 4 US territories permit their use. As this recent JAMA editorial attests, "[t]his heterogeneous approach to policy making can directly affect patients and clinicians because they are left to interpret mixed messages from lawmakers about the safety and efficacy of medical cannabis use." The AAFP's position paper on "Marijuana and Cannabinoids: Health, Research, and Regulatory Considerations" acknowledges the burgeoning evidence base regarding these substances' potential medical benefit while also cautioning against their established harms. A 2015 AFP editorial, "Effectiveness, Adverse Events, and Safety of Medical Marijuana," affirms both benefits and harms while calling for reclassification of cannabis as a schedule II drug by the US Food and Drug Administration (FDA) to permit more rigorous outcomes-based research. 

Patients will doubtless continue to inquire about medical cannabis and cannabinoids while we await more definitive evidence; for those clinicians practicing in states where they are an option, discussing the balance of known benefits and harms can help patients make an informed decision. This AFP By Topic on Chronic Pain provides overviews of additional therapeutic options to consider, and stay tuned for "Cannabis Essentials: Tools for Clinical Practice," coming in next month's issue of AFP.