Gani

It’s been more than 17 years since the FDA last approved an Alzheimer’s drug. Will Biogen’s drug, called aducanumab, end this drought? The FDA will decide by March 2021, based on its own analysis of clinical trial data and an advisory panel’s review of the evidence. How does the drug work? Aducanumab is a monoclonal antibody engineered in a laboratory to stick to the amyloid molecule that forms plaques in the brains of people with Alzheimer’s. Most researchers believe that the plaques form first and damage brain cells, causing tau tangles to form inside them, killing the cells. Once aducanumab has stuck to the plaque, your body’s immune system will come in and remove the plaque, thinking it’s a foreign invader. The hope and expectation is that, once the plaques are removed, the brain cells will stop dying, and thinking, memory, function, and behavior will stop deteriorating. Will the FDA’s decision be important? If aducanumab works, it would be the first drug that actually slows d...

Soon after the coronavirus pandemic began, we learned that older adults and people with certain chronic conditions , such as high blood pressure or diabetes, are at increased risk for severe COVID-19. One condition on that list is an immunocompromised state (a weakened immune system). This can be due to a number of conditions, including having had an organ transplant, having HIV, or taking medications that suppress the immune system. If you have an autoimmune condition such as rheumatoid arthritis or lupus (also called systemic lupus erythematosus), you may wonder how this affects your risk. It’s thought that these conditions occur because the immune system misfires and attacks organs in the body. And many people with these disorders are treated with medications that suppress the immune system. Two newly published studies examine this. While the results are not definitive, they do provide some reassurance. Most people recovered from COVID-19, and most of their prior treatments did ...

Being an early bird has long been associated with a go-getter attitude. Early birds, or those who tend to wake early and go to bed early, are people who naturally feel sleepy earlier in the evening and naturally wake early in the morning. For an early bird type, a 9 pm bedtime may be the norm, and rising at 5 am without an alarm clock feels relatively effortless. Our internal clock controls more than sleep patterns Being an early bird, or the opposite night owl, is usually not something that is thought of as being highly under our control. Some people seem to be hardwired to sleep early, while others get a second wind and tend to sleep late. This internal clock is called our circadian rhythm, each person’s unique internal timekeeper and the body’s own master controller of many functions. Most obvious is our sleep patterns; however, our internal clock also plays a role in our hunger and eating patterns, hormone levels, and maybe even our mood . Does being an early bird or night owl a...

If you are living with type 2 diabetes, you certainly are not alone. One in 10 people in the US has diabetes, according to the CDC. However, despite considerable progress in diabetes treatment over the past 20 years, fewer than half of those with diabetes actually reach their target blood sugar goal. In part, this may be because doctors can be slow to make changes to a patient’s treatment plan, even when a patient’s treatment goals are not being met. One reason for this may be the overwhelming number of medications currently available. And yet, waiting too long to adjust treatment for type 2 diabetes can have long-lasting negative effects on the body that may raise the risk of heart and kidney disease and other complications . What is type 2 diabetes? Type 2 diabetes is a chronic disease where the body’s ability to use glucose or sugar as fuel is impaired. Our bodies produce a hormone called insulin which enables sugar from carbohydrates in food we eat to reach the cells and be used...

I thought the pandemic would be over by now. And I’m not alone; there were sophisticated models predicting a dramatic drop in the number of infections by the summer. And while there was understandable worry about the second wave, re-infection, and the coming flu season, there was good reason to believe we’d have the worst of the first wave well behind us. Now, that all seems like wishful thinking. Here we are, over nine months into the pandemic, with more than 224,000 deaths, and more than 70,000 new cases and 800 deaths every day in this country as of late October. There are new hot spots popping up in the US and all over the world. Herd immunity, whether due to infection or vaccination, is still many months or even years away — if it happens at all. Despite these challenges, we do have some good news. Good news about COVID-19: my top 5 list It’s easy to miss some positive developments about how the fight against this pandemic is going, given all the gloomy news. Here’s my perspect...

Irritable bowel syndrome (IBS) can be painful, annoying, and embarrassing. There is currently no cure for this complex condition, and managing its symptoms and flare-ups is tricky. So, coping mechanisms are a constant need. What are the symptoms of IBS? IBS is a gastrointestinal disorder in which your gut becomes more sensitive, and the muscles of your digestive system have abnormal contractions. People with IBS usually have abdominal pain along with frequent changes in bowel habits (diarrhea, constipation, or alternating between both). Other common symptoms include bloating and gas urge to move the bowels, but being unable to do so incomplete bowel movements urgent need to move the bowels. Because no one knows what causes IBS, it is impossible to prevent it. Once you have been diagnosed, the goal is to focus on managing the condition. You can do this by identifying specific triggers of your IBS symptoms and then adopting strategies to make them less severe and frequent. The ...

Let’s start with the bottom line: Parents of teens need to help them understand that just because they have been “challenged” to do something doesn’t mean it’s a good idea. But as simple as that sounds to us, it’s tough for many teens to grasp. The latest challenge in the news is the “Benadryl challenge” that appeared on TikTok, a popular social media video platform. The idea was to take a whole lot of Benadryl (diphenhydramine, a common antihistamine) in order to cause a high, with hallucinations. While it’s true that diphenhydramine can make you high and make you hallucinate, when you take too much of it you can also have seizures, pass out, have heart problems, or even die. And indeed, emergency rooms across the country have treated overdoses of diphenhydramine, and at least one death has been attributed to the challenge. Dangerous challenges appeal to teens To TikTok’s credit, they say that they have taken down the videos and are monitoring for any new ones. When I searched the ...

Intermittent fasting (IF) is an approach to eating based on timing. The idea is that fasting for long enough allows insulin levels to fall low enough that our body will use fat for fuel. Growing evidence in animals and humans shows that this approach leads to significant weight loss. When combined with a nutritious, plant-based diet and regular physical activity, IF can be part of a healthy weight loss or maintenance plan, as I described in an earlier blog post . Now, a randomized controlled trial published in JAMA claims that IF has no significant weight loss benefit and a substantial negative effect on muscle mass. News outlets picked up the story and ran headlines like A Potential Downside of Intermittent Fasting and An Unintended Side Effect of Intermittent Fasting . But what did this study actually look at and find? In the study, 141 patients were randomly assigned to 12 weeks of either a time-restricted eating plan (TRE) that involved fasting for 16 hours and eating only du...

When Jayden called our clinic to talk about worsening migraines, a medication change was one potential outcome. But moments into our telehealth visit, it was clear that a cure for her problems couldn’t be found in a pill. “He’s out of control again,” she whispered, lips pressed to the phone speaker, “What can I do?” Unfortunately, abusive relationships like Jayden’s are incredibly common. Intimate partner violence (IPV) harms one in four women and one in 10 men in the United States. People sometimes think that abusive relationships only happen between men and women. But this type of violence can occur between people of any gender and sexual orientation. Experiencing abuse can be extremely isolating, and can make you feel hopeless. But it is possible to live a life free from violence. Support and resources are available to guide you towards safety — and your doctor or health professional may be able to help in ways described below. What is intimate partner violence? Intimate partne...

Even in normal times, parents wrestle with decisions about how best to support their children’s development. Now, however, parents are faced with nearly-unprecedented choices, and problems with no clear solutions: What if in-person schooling is better for emotional health, but remote schooling is better for physical health? How can children foster social skills without typical social interactions? How can parents select among learning environments when all the options have clear downsides? These concerns and choices are even more difficult for parents of children with disabilities, who are among the most vulnerable students and who are at increased risk of regression during school disruptions. Special education: One size does not fit all Of course, students who receive special education are not a uniform group. They range in age from 3 to 22, attending preschool through post-secondary placements. They include students with a wide variety of mild to severe cognitive, physical, social...

A common refrain during the COVID-19 pandemic is, “I’m so tired.” After months of adjusted living and anxiety, people are understandably weary. Parents who haven’t had a break from their kids are worn out. Those trying to juggle working from home with homeschooling are stretched thin. Between concerns about health, finances, and isolation, everyone is feeling some level of additional stress during this unusual time, and that’s tiring. We all could use a good, long nap — or better yet, a vacation. But while a break would be nice, most people — except those who are actually sick with COVID-19 or other illnesses — are able to push through their fatigue, precisely because they aren’t sick. “Tired” is a nebulous word that covers a broad spectrum of levels of fatigue. A crucial distinction, however, is between regular fatigue and illness-related fatigue. Regular fatigue Everyday fatigue that is not illness-related starts with a baseline of health. You may feel sleepy, you may in fact be s...

Since the beginning of the pandemic, we’ve had to find new ways to do almost everything — and the same is true of this year’s Halloween celebrations. Two mainstays of Halloween, trick-or-treating and Halloween parties, could be very risky this year. Going from house to house, sticking your hands in bowls of candy that many other hands have touched, or being close to people indoors or out, are all activities that could spread the virus. Even if people feel perfectly well, there’s no guarantee that they aren’t sick, and therefore contagious. That doesn’t mean we have to ditch Halloween entirely. On the contrary, we need some fun — and as much as we can, we need to keep some traditions. We just need to do some tweaking to make Halloween not only fun but safe. The fact that Halloween falls on a Saturday this year is helpful: you can truly make a day of it, and there’s less worry about getting to bed on time. A fun and safe Halloween If you think about what makes Halloween fun, it’s dr...

The gastrointestinal (GI) tract is a remarkable organ: it resides on the inside of our bodies, but is regularly in contact with the outside world by virtue of what we ingest. It is quite incredible that the immune cells of the GI tract are not activated more regularly by the many foreign products it encounters every day. Only when the GI tract encounters an intruder that risks causing disease do the immune cells of the GI tract spring into action. That is, of course, under normal circumstances. In people with Crohn’s disease, the normally tolerant immune cells of the GI tract are activated without provocation, and this activation leads to chronic or relapsing — but ultimately uncontrolled — inflammation. Crohn’s disease: A primer First described by Dr. Burrill B. Crohn and colleagues in 1932, Crohn’s disease is a complex inflammatory disorder that results from the misguided activity of the immune system. It can involve any part of the GI tract from the mouth to the anus, but most co...

We’ve all been there before. A minor injury leads to a sore ankle, achy shoulder, or sore neck. You could do nothing, try to ignore it, and see if it gets better. Or you may be tempted to take something, especially if significant discomfort prevents you from doing your usual activities or keeps you up at night. So, what’s the best initial treatment? For minor injuries, your options are many, including: Home remedies. Common approaches are the “RICE” treatments — Rest, Ice, Compression, and Elevation: applying cold to the sore area, wearing an elastic wrap to compress the sore area, rest, and elevation (such as propping up your sore ankle on pillows). Nondrug approaches. For instance, massage or acupuncture. Pain medicines. Examples are acetaminophen, anti-inflammatory drugs like ibuprofen, or other pain relievers. New guidelines have been developed Recently, the American College of Physicians and American Academy of Family Physicians gathered experts to develop new recommend...

Children get sick; it’s part of life. They catch colds, they get fevers, they throw up and get diarrhea. Most of the time, it’s nothing at all. But this year, as we struggle through the COVID-19 pandemic, every sniffle will be complicated. The problem is, the symptoms of COVID-19 can be not just mild, but similar to the symptoms of all the common illnesses kids get all the time. Symptoms can include fever, even a mild one cough (that you don’t have another clear reason for) breathing difficulty sore throat or runny nose (that you don’t have another clear reason for) loss of taste or smell headache (if with other symptoms) muscle or body aches nausea, vomiting, or diarrhea. And even if there is another explanation for that sore throat or cough, it doesn’t mean that your child couldn’t also have COVID-19. People can get two germs at once. Set the bar low for keeping sick children home This is not a year when you can send your child to school or daycare with that cough, or ...

Your thyroid, a tiny, butterfly-shaped gland located in front of your windpipe (trachea) and below your voice box (larynx) can have a profound impact on your health and well-being. Throughout life, your thyroid is constantly producing hormones that influence your metabolism. These hormones affect your mood, energy, body temperature, weight, heart, and more. A brief overview of hypothyroidism Your thyroid produces two kinds of thyroid hormones: T4, or thyroxine, and T3, or triiodothyronine. These hormones influence every cell, tissue, and organ in your body, from your muscles, bones, and skin to your digestive tract, brain, and heart, by controlling how fast and efficiently cells convert nutrients into energy — a chemical activity known as metabolism. The thyroid gland is under the influence of the pituitary gland. No larger than a pea and located at the base of the brain, the pituitary gland controls your thyroid’s production of thyroid hormone by releasing thyroid stimulating hormo...