Month: January 2021

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Placebos-are they a real thing?

A placebo is a medication that looks real but doesn’t contain any active ingredients—sometimes referred to as a “sugar pill”. It’s hard to believe, but often a placebo can make a difference in how we feel. But how could they work if there’s no active drug?

A well-studied effect

When we believe we have been given a medicine, our bodies often respond by trying to heal. Placebos are understood to work by turning something on in our immune system or by activating processes in the brain. They come in many forms, just like standard treatments—as pills, capsules, injections, sham surgery or other treatments.

Many studies have been done to measure the placebo effect. Researchers found that the colour of the medicine and the care with which it is given can affect and increase the results. Red, yellow, and orange are associated with stimulating effects, while blue and green tend to have a relaxing effect. Larger pills can have a stronger effect than smaller ones, and 2 pills work better than one. Capsules work better than tablets, and injections can have a stronger effect than both. Sometimes the phenomenon will occur even when the person knows they were given a placebo. However, the effect is more common and usually stronger when the patient believes they are taking an active medicine.

In some conditions, the placebo effect can be quite remarkable. For example, 90% of tension headaches are reported to improve with a placebo. Because of this, placebos are usually required in most scientific studies to show that a medication works and that any changes did not happen because of the patient’s own reaction to being given a medication. In high-quality studies, neither the patient, the health professional treating the patient, nor the person collecting information knows who received the active medication and who was taking a placebo. This is done to eliminate the chance of bias in reporting.

When measuring the effectiveness of a medicine in a study, researchers and clinicians must look at the difference between the drug effect and the effect of a placebo. Sometimes the placebo can be almost as effective as the drug, with both creating an impressive difference in the patient’s outcome. This has been noted with some sleeping medications, antidepressants, anti-anxiety medications, irritable bowel syndrome, Parkinson’s Disease, pain medications, and others where the placebo effect can be remarkable.

Side effects and physical effects are possible too

We can also respond by developing “side effects”—effects from the treatment. Researchers refer to this as the “nocebo” effect and can include side effects such as headache, stomach upset, dizziness and others. The side effects of a drug being tested are compared to the “side effects” reported with the placebo used in the study.

Placebos are often thought to only work on conditions that have a psychological cause, but they can cause physical changes that can be measured. For example, a placebo can change heart rate or blood pressure or trigger the body to release its own pain relievers or dopamine, a feel-good neurochemical.

Techniques to use with standard meds

We can learn a lot from the action of placebos that clinicians could use when treating a person with standard medication. Any positive response that originates in the body would add to the action of the drug they are taking.

For example, pain medications have been found to be more effective if the person knows they are being given the drug. Medications that are prescribed and administered with caring and concern tend to work better. The placebo effect is also believed to play a large role in the effectiveness of treatments for depression and anxiety—this makes sense to me as, once you’ve taken a medication to help your problem, you are more likely to relax, worry less, and plan positive activities. Essentially, your brain and your medication are working together to achieve positive change.

So, how do placebos work?

There are several factors thought to be involved:

  1. Expectation and conditioning—Expecting to get better after taking a medication can help people to relax with a resulting drop in stress hormones. These hormones have many effects throughout the body that include increased heart rate and blood pressure, heightened senses, and alertness so lowering these hormones can result in positive health effects. A placebo can also trigger a release of our own opioid-like pain-relieving chemicals. People are used to feeling better after they take medication, so this conditioning may help people experience a positive effect from a placebo.
  2. Effects in the brain—Studies have shown measurable changes in activity in the brain stem, spinal cord, and other areas of the brain.
  3. Psychoneuroimmunology (psycho = mind, neuro = nerves, immunology = study of the immune system)—This is a fairly new area of scientific study that looks at how thoughts in the brain can change body function, through the nerves and immune system. It studies the connection between the mind and the body, through the nerves and immune system. We know that simply maintaining a positive attitude can prevent or improve illness, and this is the study of how that is achieved. There is still a lot to learn in this field.
  4. Evolution—Humans are constantly evolving, developing helpful responses to diseases. Some researchers have theorized that our health regulation has developed to allow the brain to decide when it will carry out a certain response. For example, fever helps slow growth of bacteria and viruses; if the patient is starving or pregnant, however, the body does not as readily develop a fever since this could use needed energy or harm the baby.

Placebos as treatment

Placebos are now being studied for use as a treatment in their own right. Of course, they can only be expected to work in conditions where the body can heal itself. However, by triggering the body’s healing response, a placebo would be expected to speed up this process. The plus is that this treatment would be free of negative side-effects (except any created by the mind, of course).

Some doctors prescribe placebos fairly often. One study in Denmark found that about half of doctors had prescribed a placebo at least 10 times in the previous year. Unfortunately, they often used an active medication as a placebo. For example, they would prescribe antibiotics for a viral infection—antibiotics only work on bacteria infections, not on viral ones. However, active drugs like antibiotics often have side effects, for example upsetting the stomach or killing off good bacteria in the gut that help our immune system to function properly. Another example was prescribing vitamins for fatigue—a better choice for a placebo, as these would be less likely to cause harm.

Homeopathy is an interesting medication system that has been used for over 200 years. It uses tiny doses of active ingredients—sometimes diluted so low that it is unlikely that a single molecule of the original substance remains. It seems likely that any results must be because of the body’s reaction to the medication, not the action of medicine itself. There is a debate over whether the response is a pure placebo effect or if the medication can still direct the actions taken by the body that result in the effect. Either way, homeopathic medications are thought to have a mechanism very similar to the placebo effect. From a medical standpoint, once a doctor diagnoses a patient, homeopathy would offer a convenient form of placebo that they could easily and safely recommend or prescribe in self-limiting conditions, rather than using an active drug that may have unwanted side effects.

A final thought

Since placebos work best when the patient believes they have received an active medication, it raises ethical questions. The prescriber is essentially misleading the patient but, if it works, we should consider it effective treatment. It would also be unethical to withhold an active treatment that a patient needs—an accurate diagnosis must be made before considering use of a placebo, and the patient would need to be monitored closely to ensure the placebo treatment is appropriate.

#placebo

References:

What is the Placebo Effect?—WebMD

What Is the Placebo Effect and Is It Real?—healthline

Is the placebo effect real?—Medical News Today

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Nosey News – All about the nose!

Did you know your nose has a “cycle” in which your breathing alternates between nostrils? Your brain signals one side of the nose to become congested for a while, slowing down the flow of air on that side, then it clears, and the other side does the same. Most of us are completely unaware of this phenomenon, but it happens in up to 80% of adults.

The nasal cycle is controlled by the autonomic nervous system (ANS), the unconscious controlling system of the brain. And here’s the really fascinating part – it accomplishes this feat by dilating or constricting blood flow to structures inside the nose similar to the tissues found in the penis and clitoris (called venous cavernous tissue)! This is the tissue that swells during sexual arousal without us thinking about it.

The length of the nasal cycle, on average, is 2 ½ hours on each side but can be anywhere from 30 minutes to 6 hours. While most people have a nasal cycle, about 20% do not and they breathe through both sides equally all the time. The length of the cycle varies in different people and in the same person over time, and the length of the cycle changes over our lifetime, too. Most newborns have no nasal cycles at all, they increase with age until adulthood, then decrease again in the elderly.

The nasal cycle has several benefits:

  • It helps keep the nose moist. When one side becomes somewhat congested, the flow of air through that side slows down, reducing the drying action of the air passing through and allowing it to rehydrate. Essentially, this gives that side of the nose a rest while the other side takes over for a while.
  • The nasal cycle tends to be longer at night, lining up with our REM (dream sleep) cycle and with sleeping position. Some researchers have suggested this may be a mechanism to encourage us to turn over in our sleep to prevent bed sores.
  • The nasal cycle also helps our sense of smell. To experience a scent, tiny molecules need to connect with the olfactory organ in the nose. Some molecules attach easily and benefit from faster moving air to reach the organ of smell before sticking elsewhere in the nose. Others are less sticky and benefit from slower air movement that allows them time to attach to the olfactory organ as they pass it. So, having a fast and a slow side to your nose allows more scent molecules to reach and attach to the smell mechanism in the nose, improving your sense of smell. As I learned this, I couldn’t help thinking that smelling something awful means tiny molecules of the substance must have entered the nose in order to detect the smell… but ignore that thought and let’s move on!
  • The rate of mucous clearance is also affected by the nasal cycle, although it’s debated which part of the cycle helps more. Drainage of mucous is thought to help sweep out particles and bacteria that our noses filter from the air we breathe so they don’t accumulate, causing problems in the nose.

Of course, the nasal cycle has nothing to do with infection or nasal disease. It’s a normal function of the body that operates without our knowledge or awareness. However, it is noticed more often in people with underlying conditions such as a deviated septum, where the internal dividing structure of the nose is off-center. It’s important to be aware of the nasal cycle, however, when diagnosing a potential problem in the nose.

Why does your nose run when you’re outside in cold weather?

“Cold-induced rhinitis” or “skier nose” is probably caused by a combination of factors:

  • Cold air irritates and dries the nasal membranes. In response, the mucosal lining of the nose produces more mucous to protect the lining and keep it moist. Cold air also needs to be warmed to protect the lungs from damage and the nose itself needs to be protected too. So, your brain increases blood flow to the nose and dilates the blood vessels there to maintain the warmth and warming action of the nose as the cold air passes through. This blood vessel dilation causes loss of fluid into the nose – up to 300-400 ml daily!
  • Condensation is also thought to be a factor, although likely minor in comparison. Cold air holds less moisture than warm so, when the warm air you exhale contacts the cold air outside, small droplets of condensation can form when the warm air from your lungs meets the cold air outside, mixing with the mucous from your nose. You sometimes see this as frost on moustaches and scarves in chilly weather.

Pre-warming the air that reaches the nose can help prevent cold-induced rhinitis. This can be done by wearing a scarf over the nose and mouth when you go outside in winter and breathing through the scarf. It keeps the end of your nose warm too! Of course, if you wear glasses, this could create problems with fogging. Taking a tip from COVID mask suggestions, however, you could try placing a folded tissue under the top edge of the scarf to block your breath from escaping upward toward your glasses. Another idea would be to fold the scarf over 2 or 3 twist ties that can then be bent to help seal the upper edge. And, of course, you could try wearing your COVID mask as a face/breath warmer, perhaps with an extra scarf over top to increase the insulation. I’ve noticed that a mask alone worn outside in cold weather quickly results in the mask becoming damp because of condensation. I’ll experiment this afternoon when I take my daily walk to the mailbox…

Meanwhile, my hubby jokes, “Up your nose with a rubber hose might be an alternative!”

#nasalcycle #WhyDoesYourNoseRunWhenItsCold

References:

The nasal cycle: a comprehensive review – Rhinology Online

Why does your nose run when it’s cold? – The University of Queensland, Australia, Faculty of Medicine

Cold Weather and Runny Noses – Verywell Health

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Do you talk to yourself?

One of the first pharmacists I trained with often used to quietly mutter things I couldn’t understand. I would ask “Excuse me… what did you say?” thinking he was talking to me. But he was just talking to himself. “All pharmacists do… it keeps us sane!” he joked!

And before long, I noticed I was doing it too. I found it helped me to organize and focus on what I was doing. Pharmacies are busy places with many distractions and stresses. I think most of us talk to ourselves at times but perhaps not always out loud so others can hear. This “self-talk” can be useful, or it can be detrimental. It all depends on what we say to ourselves…

There are 3 basic types of self-talk:

– Positive self-talk – words or thoughts that help motivate us, help us to focus on the task at hand, or reinforce positive thoughts and emotions. “Good job, Jeannie… keep it up!”

– Negative self-talk – criticizing or doubting ourselves, dwelling on negative emotions or events. “Why work so hard on that blog… you don’t know whether anyone actually reads it!”

– Neutral self-talk – neither positive or negative, usually giving oneself instructions. “OK that’s done… what’s next?”

Self-talk can also be referred to as either “overt talk” (when you say these thoughts to yourself out loud so others can overhear) or “covert talk” (when you say the words silently inside your head or by just mouthing the words with no sound). Either way, the benefits or self-harm are in the thoughts you are telling yourself and the resulting emotions you generate.

Benefits of talking to yourself

Self-talk can be a way of processing and controlling emotions, for example anger or anxiety. Of course, depending on what you tell yourself, self-talk can increase these emotions too. The key is to be aware of what you’re saying to yourself and use it to reach the result you want.

Self-talk is also useful for weighing the pros and cons of a decision when you don’t have someone to discuss it with. I often do this out loud, presumably speaking to my husband (who has learned to mostly ignore these “conversations”). By the time I’ve explained the details of my options ( often concerned with writing or publishing that he’s generally not involved in), I usually have reached a decision anyway.

Just saying the pros and cons out loud helps me weigh it all out. Interesting, isn’t it? I suppose I could write it all down and get the same result, but my one-sided conversation seems easier and works just as well. Fortunately I have a patient hubby!

Researchers have also discovered that referring to yourself in the third person can help even better when it comes to calming anxiety. They believe it may be because it tends to distance you from the emotion rather than being consumed by it, allowing you to analyze, process and regulate an emotion that can be harmful. Using 3rd person self-talk to control other emotions like anger or prolonged grief could be expected to work in a similar way.

Alternatives to self-talk

If talking to yourself is something you’d rather avoid (for fear of sounding silly!) there are alternatives. Writing these thoughts in a journal or a phone journaling app can work similarly for some people. Just getting the thoughts down on paper or a screen can help to clear your mind, organize thoughts or manage emotions.

Or you could train yourself to say the words internally rather than out loud. I think we all have a certain level of filter that stops us from saying things that we know would be inappropriate in a particular setting or in the presence of certain people.

And it may be helpful to actually talk to someone you trust who is a good listener. For some, verbalizing thoughts is more linear while internal thoughts can easily run in repetitive circles in your mind.

Of course, speaking with a mental health professional would be advised if negative self-talk is affecting a person’s quality of life. They would have additional suggestions and advice to help adjust self-talk to a more positive and encouraging focus as well as other useful strategies and treatments.

However, if talking to yourself is accompanied by hallucinations, this could be a sign of a serious condition such as schizophrenia. Hallucinations are when a person senses things that are not really there through their vision, hearing, smell, taste or touch. Hearing voices and answering them, for example, is a common hallucination in schizophrenia.

Bottom line?

Talking to yourself is a normal behaviour and is usually not part of a mental health condition. It can be a useful tool to help organize your thoughts, boost your mood or get yourself motivated… whether you say the words out loud, in your mind or write them down.

Lastly, just a comment about my example of negative self-talk above – we writers do sometimes wonder whether anyone actually reads our work! The only way we really know we’re doing something useful is when you comment or “like” an article. Fortunately, I do get comments and questions fairly often and sometimes they turn into a conversation.

Feedback keeps us going! So, let me know what you’re thinking after you read my blog… I’d love to hear from you! And please share and/or like any articles that you find interesting or helpful so others can find them more easily too.

Reference:

Is it normal to talk to yourself? – Medical News Today

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Resolutions? or Word of the Year?

Have you made New Year’s resolutions in past years that you’ve never achieved? Most of us have. The beginning of a new calendar year is a good time to take stock of the past and look forward to what we can change and improve. But making a resolution for change with no focus and no plan to get there rarely works.

This year I’ve noticed several articles and blogs about choosing a Word of the Year (WotY) instead of making resolutions. The word can be a noun, verb or descriptive word or even a word for an emotion or attitude. The important part is that it provides a focus for the changes you want to make in your life.

Here are a few examples:

  • Next (as in “2020 done, 2021 next”) – This word creates a focus on looking forward. Many of us had a rough year in 2020. This is for a person who wants to focus on planning for the future and avoid dwelling on the past.
  • Discipline – This can mean concentrating on spending more time exercising, controlling spending, being more productive at work, and much more.
  • Joy – This word would inspire a person to look for happiness wherever it can be found and could be used to maintain a more positive outlook on life.
  • Uncomfortable – A focus on this term might inspire a person to get out of their comfort zone and try new things they haven’t done before. Change makes many of us uncomfortable, but we need to face this discomfort to grow and improve.
  • Flow – This is a word that can have more than one meaning or use as a Word of the Year… “go with the flow”, flow with whatever life throws your way, and “flow”, the state of mind where you’re completely focused on the present, sometimes called mindfulness, common in high level athletes, musicians and artists who are totally immersed in an activity, concentrating only on the present.
  • Hope – After such a difficult year in 2020, a focus on hope for the coming year can help to look forward to a better future. Having hope helps us to take actions that will create improvements in our lives.

What’s the difference between resolutions and a WotY?

In the end, you still need to make stepwise changes to achieve your goals. But rather than looking at a long list, you are focusing on a single word that represents a change in attitude. Many successful improvements begin with a change in attitude and focus.

Of course, changes don’t happen without a plan of some sort. You have to DO something to create the positive changes you want in your life. But focusing on a single word that represents the attitude you need to make changes is a place to start.

So, choose a Word of the Year that encompasses the state of mind you will need to achieve your goals for the future. Post it where you will see it often – one suggestion is to write it on your bathroom mirror in dry-erase marker! – and take time each day to think about how it applies to your life. Then use the change in attitude to plan the steps you need to take to achieve the changes you desire.

So, what word will I choose?

I want to have a focus on my health this year, but I also have an urge to do more art and writing. So, now that I’ve thought about this for a while, I think I will choose Create as my “WotY” to focus on for 2021. I can create a healthier lifestyle, create closer ties with my children and create artistically too. A single word can be interpreted in several ways, creating inspiration to achieve several goals or become the person you want to be.

The photo above is of my first attempts at creating “Mandela Stones”. Still some learning to do, but they’re starting to look pretty…

Have you chosen a Word of the Year? Or, if you’ve decided on New Year’s resolutions, what single word could you choose to keep your focus over the coming year? Leave a comment below or send me an email… Perhaps your word can become an inspiration for others!

Wishing you all a happy, healthy and inspired 2021…

#WordoftheYear #NewYearsResolution