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How to talk to someone with depression

Everyone has their ups and downs in life, but major depression is different than feeling sad for a short while after a negative event. Mood disorders, like depression, are very real illnesses that can have serious and sometimes fatal results. They are one of the most common mental illnesses and can affect the body as well as the mind, with physical symptoms like fatigue, stomach complaints, or muscle/joint pain as well as changes in mood.

There are several depressive mood disorders, including bipolar disorder (or manic-depressive illness), and perinatal depression, but major depression (also called clinical depression) is the most common mood disorder. The 2012 Stats Canada survey found that 4.7% of respondents met the criteria for major depression in the previous 12 months, and almost 1 in 8 (12.6%) met the criteria for a mood disorder at some point in their life. American statistics show that over 17 million adults (7.1% of the population) and 1.9 million children aged 3 to 17 experience depression in the United States each year. Women are twice as likely as men to be diagnosed with depression.

Causes

There is no single cause of mood disorders. Several risk factors interact to increase the chance of developing a mood disorder:

  • Family or personal history – Having already experienced an episode of depression or having an immediate family member who is affected don’t guarantee a person will develop depression, but they do increase the risk. Over 50% of those who have had an episode of major depression will develop a recurrence.
  • Traumatic life events – Some are more susceptible to depression when in a difficult or abusive relationship, after a divorce, after a death of a loved one, as a result of low income, poor housing or workplace stress or from other distressing major life events.
  • Chronic medical conditions – Chronic conditions such as stroke, heart disease, obesity, Parkinson’s disease, epilepsy, arthritis, cancer, AIDS, chronic obstructive pulmonary disease (COPD), and dementias like Alzheimer’s Disease can trigger depression, especially if the person suffers from more than one of these.
  • Physical changes – Changes in hormones, neurotransmitters (the chemicals that pass signals from one nerve to the next) or the immune system, a disability or poor quality of life itself are thought to be contributing causes. New research suggests that gut bacteria may also have an influence on brain function and mood.

Symptoms

Although each person is unique and will have different symptoms, there are some that are common:

  • Depressed mood
  • Feelings of guilt, worthlessness, helplessness, or hopelessness
  • Loss of interest or pleasure in activities usually enjoyed
  • Change in weight or appetite
  • Decreased energy or fatigue, even without physical exertion
  • Thoughts of death
  • Poor concentration or difficulty making decisions

Symptoms can be mild or so debilitating the person has difficulty getting out of bed. If these symptoms persist on most days for more than 2 or 3 weeks, it is advised to contact a doctor or mental health professional. It is very important to get medical help right away if a person has recurring thoughts of suicide.

What should you say to someone who has depression?

There are no magic words that will heal a major depression, although talking with a professional over time (“cognitive therapy”) is a form of treatment that can be successful. For family and friends, being comforting and supportive is the best way to help someone manage their symptoms.

Without being forceful or exerting pressure, it helps to ask a person with depression how they are feeling. This gives them space to talk and vocalize thoughts, making them less powerful. Not everyone feels like talking all the time, though, and it’s important to respect that, so ask if they want to talk.

Sometimes just being there can help too. Ask if they’d like some company. Offer to do something fun to distract them from their thoughts, like watching a movie, sharing a meal, or going for a walk or outing. Even being there quietly without speaking can give comfort.

Let the person know you care, even if you don’t understand or know what to do or say. Ask them how you can help or what is best to do or avoid doing. Know that simply saying “I love you” can be supportive.

The best time to talk is when both of you are calm and not distracted or tired. Never bring up depression during an argument or times of high stress. Avoid spending all your time together talking about mood problems and be sure to take care of your own needs, too, if you feel uncomfortable. Often talking about good times or doing activities the person once enjoyed can be helpful.

What NOT to say…

But here are some examples of things you might want to say that are not usually helpful:

  • “Have you tried eating better/exercising more/ getting outside?” Although lifestyle changes can help improve the effectiveness of depression treatment, it is better to be supportive, leaving treatment to the professionals. Some people may find these suggestions disrespectful, as though you think a minor change in lifestyle could easily cure their major depression.
  • “It’s not that bad.” Or “But you look fine!” If you appear to doubt or disbelieve what they are saying, you are invalidating their feelings and they may be unlikely to talk about them in the future. Minimizing their feelings can make the person feel ashamed and alone.
  • “I know how you feel.” Even if you have suffered a major depression yourself, you cannot know what another person is feeling. You also don’t want to shift the discussion to yourself when a person is expressing their deep feelings.
  • “You’re making me feel bad.” While listening to a person sharing their thoughts and feelings of depression can be overwhelming, don’t blame them or make them feel guilty. However, loving a person who is depressed can be difficult and it’s OK to set boundaries if necessary or get external support for yourself from friends, family or a therapist.

Like everyone else, I’ve had times when life events have made me sad and depressed but, fortunately, not a major depression. My husband has always helped by encouraging me not to focus on the event for long periods of time and to keep it in perspective and balance with the good parts of life. We can all try to be that person for others, whether they are dealing with major depression or a depressing life event, by being loving and supportive and asking what they need.

References:

What to say to someone with depression – Medical News Today

What is Depression? – Government of Canada website

#depression

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How to Spot Fake News

The internet can be an amazing source of information, but some health news reports we see there can be based on sketchy science, and many social media posts are often simply an opinion based on hearsay and rumors. How do you tell what is real news and important information we should act on?

McMaster University’s Optimal Aging Portal suggests 6 tips to identify health information we can trust:

  1. Look at the source – Look for claims or recommendations that are supported by studies, ideally published in a credible academic journal, or ones that are based on information from a government, university or other site that is unlikely to have a biased agenda.You may have noticed I almost always have a list of references at the bottom of my blogs. I want you to be able to check out where my information and facts came from.
  2. What’s in it for them? – Years ago, when the internet was new, I had a pharmacy student with me while searching for information on the herbal medicine, ginko. I quickly found what looked like a perfect site. My student didn’t say a word, but scrolled down and pointed to a button that said, “click here to buy”. The purpose of the website was to sell product. I looked through the site with a different eye and quickly noticed the statement “this medicine is safer than aspirin”… as a pharmacist, I know that aspirin can cause severe bleeding in the digestive system in some people. Suddenly, I realized information can be presented in a way that encourages people to buy when they have something to sell you, rather than just to inform. Even studies will skew to emphasizing the positive and explaining away the negative if they are trying to keep their sponsor happy. We can all learn from our students, and she was much more savvy than I was back in the mid-90s!
  3. How large was the study? – The larger a study is, the less likely the results happened by chance, and the more likely the results will apply to the general population. If, say, a new vaccine was tested on 10 people and none got sick on exposure to the virus, there would still be the possibility that all 10 could be individuals who were naturally resistant. But if it was tested on 1000 people, it is more likely this group would be representative of the general population.
  4. Was there a control group? – Good quality studies are “randomized” (they select participants randomly) and they compare the treatment group to a “control” group that does not receive the treatment. The control group helps to account for factors other than the medication or procedure being studied that could influence the result. Studies of pain medications, for example, sometimes find that as many as 90% of the control group can respond to a placebo (or sugar pill that looks like the medication). This shows that medications can sometimes have a positive effect based simply on the belief that they will work. Scientists believe this happens through an action of our immune system, and it is known as the “placebo effect”. Amazingly, the placebo effect can work even when the patient knows it’s a placebo. So, it’s very important to factor in this effect when evaluating a medicine or procedure.
  5. How long did the study continue? – Short-term benefits from treatments are important (e.g. how quickly does an antibiotic cure an infection?) but studying for a longer time can provide information about long-term benefits and what side-effects or harms can be caused by the treatment. Also, repeating the study in a different location and, ideally, with different researchers is important to verify the study results.
  6. Does this information/study apply to me? – We are all individuals with our own characteristics, but studies are designed to predict average results in a large population. Vaccines are a good example of this: overall, vaccines reduce the chance a disease will spread through the population. But there are certain individuals who have experienced negative reactions and should not take vaccines, and others (e.g. with a weak immune system) who do not respond to vaccines. It is important to identify these individuals and find other ways to protect them from the disease. However, the overall benefit to the rest of the population from vaccines is still valid. In fact, when most of the population is vaccinated against an infection, it cannot spread and this will protect those who cannot take the vaccine or who do not respond to it.
  7. — You may also have your own needs, preferences and circumstances to consider when you make a health decision. For example, those with breathing problems such as emphysema or asthma, may not be able to tolerate wearing a filtering mask to protect them from exposure to the coronavirus when in public. However, if those around them wear one, even a simple cloth mask, they will be protected.
  8. — It is beneficial to talk to a health professional that knows you, like your doctor, nurse practitioner or pharmacist, to help you interpret health information and make health decisions.

Lately, there has been a lot of news about possible treatments and vaccines for the coronavirus. We are all anxious for a cure or prevention so we can get back to our normal lives, so early results of studies can make the news even though the testing process is really just beginning. Science takes time…results must be tested and proven and, as with hydroxychloroquine, initial suggestions of positive results may be proven incorrect as the testing process evolves. We all need to realize that “preliminary results” are just that… a suggestion that this might work, but just an early suggestion. We need to remember we’re in this pandemic for the long haul and continue the tested prevention strategies of physical distancing, hand washing, staying home and now, wearing a mask when in public when distancing cannot be maintained. It will take time to find a cure or prevention. We want to stop the current spread and prevent the second wave that scientists predict will happen.

So, it’s always a good idea to be cautious about health information in the news and especially on social media. Always look for the original source of the information—who is making the claim—before you act on it or share it with others, no matter how logical it might sound.

References:

Don’t believe the hype: 6 tips to identify trustworthy health information—McMaster Optimal Aging Portal

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Einstein and Feynman’s advice for learning…

I came across an article that really resonated with me on a site called Mind Café…about 2 secrets to learning faster and remembering more of what you learn, as suggested by Albert Einstein and Richard Feynman, 2 famous physicists. Let me summarize it for you…

The first tip, from Albert Einstein, is to enjoy what you are learning… my take on that is to learn about subjects you are interested in. For example, I’ve been studying Spanish. I love to go to Spain, and it’s been helping me to understand signs and menus there. I’m still trying to learn to speak better, and that’s my current challenge.

Of course, sometimes you need to learn something that is, shall we say, less than exciting to advance in your job or to continue to do the job you’re already doing correctly. But, at the very least, you can set yourself challenges and take satisfaction on the achievement when you finish.

Increasingly, learning is being presented in an entertaining way. “Gamification” of learning, where lessons are turned into a game, is designed to hold your attention on the material, make it more fun and challenging, and give you a series of rewards throughout the program to give a feeling of achievement. Some learning games even create a competition between users to inspire them to study harder and longer!

The second secret, from Richard Feynman, is to teach others what you are learning. In addition to repeating the material as you do this, you also need to understand a concept well to explain it to another person. Even being able to summarize the essentials of what you are learning, requires you to have a good understanding of what you’ve been reading or studying. Feynman explained that the hallmark of true genius is the ability to explain a complex subject very simply… simple enough for an 8-year-old to understand! He was noted for being able to do this with quantum physics.

Using the material you have learned is known to be a good way to remember more of it, especially for adults. And teaching it to someone else is an effective way to use your new knowledge. Often the person you are teaching will have questions that will make you think more deeply about what you have learned, solidifying the new memories you have formed.

I think these two tips, enjoying what you learn and teaching or explaining it to others, resonated with me because (without realizing it) this is what I’ve been doing since I retired. I use a game called Duolingo every day to learn Spanish, and I write this blog to tell others about what I’ve been reading and learning! With my blog, not only do I constantly read so I will have something interesting to write about, I learn more about writing through this weekly practice I really enjoy. Interaction with readers is the icing on the cake. It’s so nice to hear from people and know that some actually read or listen to my articles!

Life-long learning is something that was not only encouraged but required when I was a practicing pharmacist. I still review educational programs for Canadian pharmacists, so I guess I never stopped my pharmacy learning. The practice of pharmacy constantly changes—new drugs, new regulations and, these days, new diseases to learn about. With the current pandemic evolving, there is new information almost every day, requiring us to change our behaviour. Even the experts are learning constantly about this virus. While this learning may not be enjoyable, I think we all realize how important it is for us to get it right. For some, it could be illness or death, for those around us if not for ourselves.

Lastly, learning something new keeps your mind sharp and your brain functioning, helping you to age well. And it helps to make you a more interesting person to socialize with too! You’ll always have lots to talk about when you keep learning new things.

So, leave a note below in the comments about something you’ve enjoyed reading or learning recently. It will help you remember and learn better, and maybe you’ll interest other readers in your favourite topic!

Reference:

2 Secrets to Learning Anything Faster: Lessons From Albert Einstein and Richard Feynman — Mind Cafe

#agingwell #lifelonglearning

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COVID is in the air…

A new study has found that “Airborne transmission of COVID-19 represents the dominant route for infection” and “wearing of face masks in public corresponds to the most effective means to prevent interhuman transmission”.

These are conclusions from a study done by the PNAS (The Proceedings of the National Academy of Sciences of the USA), published June 16th. The combination of airborne transmission plus asymptomatic carriers is a recipe for an epidemic that is difficult to control. And that’s what we’re seeing.

Asymptomatic spread

We now know that there is a high rate of viral spread through asymptomatic carriers—people with no symptoms. Estimates vary from 25% to over 50% of cases originating from those who never get symptoms or have not yet started to show symptoms like fever and cough.

Airborne transmission

And, while 2 meters (6 feet) is known to greatly reduce virus transmission, other factors like air currents, temperature and humidity, can affect the length of time viral droplets and mists remain in the air and are able to infect those who inhale them. This makes it possible to transmit the virus in some situations even when physical distancing is maintained, and hands are washed properly. And we’ve all been in situations when you can’t keep even 1 meter (3 feet) distance.

Enter the mask…

This new study calculates that thousands of cases have been prevented in cities and countries where governments have mandated masks must be worn in public places. By examining changes in the rates of new infections after masks were mandated to be worn by everyone in public, the researchers estimate that over 78,000 infections were prevented by masks in Italy and over 66,000 in New York City from April 17th to May 9th.

The study looked at rates of new infection in various countries, and how the rates changed as they implemented various measures, as a way to scientifically determine the effectiveness of different strategies. While some countries, like China, mandated lock-downs, hand hygiene and wearing masks all at the same time, other countries made these changes separately, allowing researchers to determine the effect of each measure.

By analyzing the changes in the curve of disease cases when each new strategy was started in Wuhan, China, Italy and New York City between January 23rd and May 9th, they were able to illustrate the impact of each measure. The study showed that, while physical distancing made a small difference, the change was greater when masks were mandated to be worn by everyone when in public.

The reduction in new cases of COVID-19 when masks were mandated is clearly visible on graphs—with a “flattening of the curve” easily seen. This contrasts with the rest of the world where physical distancing, quarantine and isolation continued to be used alone. Here is one of the graphs… the circled dots show when masks were mandated to be worn in public in Italy and New York City:

You can see that the curve of the pink line representing NYC doesn’t change significantly as it crosses the 2 lighter blue lines representing social distancing and stay-at-home orders, but it drops noticeably after the circled dot marking the mandating of masks in public.

Researchers concluded that “wearing of face masks in public corresponds to the most effective means to prevent interhuman transmission, and this inexpensive practice, in conjunction with simultaneous social distancing, quarantine and contact tracing, represents the most likely fighting opportunity to stop the COVID-19 pandemic.” They also stated, “Other mitigation measures…are insufficient by themselves in protecting the public.”

Virus behaviour

We now know the main way of passing the coronavirus is breathing in air after an infected person has exhaled. Because of the high rate of asymptomatic transmission, chances are, this person wouldn’t even know they were infected. Washing your hands won’t prevent you from inhaling infected droplets. But masks can. This virus likes to hang out in the nose (as compared to SARS and MERS that preferred to stay in the lungs) so it is more likely to be breathed or coughed out that those previous similar infections. Shouting, singing, and even talking loudly can send a mist of tiny viral droplets into the air, some as an aerosol that can linger for much longer than suspected initially. Hand washing can protect you from virus in larger droplets that have settled on surfaces, and physical distancing reduces the number of particles that reach you, but masks are needed to prevent those who are sick but not diagnosed from unknowingly creating a contaminated aerosol mist that others can inhale.

World Health Organization (WHO)

However, the World Health Organization (WHO) insists that “masks alone are not a replacement for physical distancing, hand hygiene, and other public health measures.” But, they say, cloth masks may provide a “modest reduction in transmission” by:

· “reducing the risk of asymptomatic carriers spreading the virus”

· “reminding the population that the pandemic is ongoing and everyone can play a role in stopping it” as well as

· Stimulating the economy by “encouraging the public to create their own masks.”

They also suggest there are disadvantages to cloth masks worn by the public:

· Touching the mask too often (usually due to a poor fit)

· Potential to cause headaches, breathing difficulties or skin irritations and

· The possibility of creating a “false sense of security” as they are not 100% protective

Note that these disadvantages are not supported by objective research. I find it odd that a high level of proof is required to recommend a measure, but they readily share disadvantages with no objective studies. I can’t help wondering why they are so hesitant to recommend a safe measure like masks, especially now that plenty of supporting science is emerging for this strategy. You can read or listen to more about reasons to wear or not wear a mask in my blog “Masks 4 All” (Blog or audio track).

And this week (to add to the confusion) the WHO stated there was no evidence of asymptomatic virus spread, despite many studies that found this is a major problem with COVID-19. They later explained that they were referring to non-symptomatic people who never showed symptoms but had had a positive test, not those who were pre-symptomatic and developed symptoms within a day or two. Pre-symptomatic people are known to be highly infectious. There are plenty of examples of “super spread” events involving infected individuals who progressed to symptoms soon afterward.

This certainly demonstrates the importance of clear communication. As one friend said, whatever they tell us today will probably change by next week. Confusing messages create mistrust of advice from authorities and result in fewer people following recommendations to limit viral spread. We are seeing this especially in increased numbers of infections in young people in their teens and 20s.

Meanwhile, the WHO reported the highest number of new cases yet on June 8th, bringing the global total to 8 million, and they stated that the pandemic is worsening. We need to continue physical distancing, hand washing, and staying at home as much as possible. And there’s enough evidence now to know that adding a mask whenever we cannot stay away from others will further reduce new cases. It’s so easy to become complacent… but we’re not out of the woods yet. In fact, you could say we’re still in the middle of the forest!

In Canada…

In Canada, British Columbia and New Brunswick (my province!) are leading the way with good control and low numbers of cases. Experts attribute this to:

· strong leadership with clear communication and quick decision-making,

· better data transparency with open reporting of cases and

· a high level of cooperation by the public. New Brunswick’s mainly rural population is also believed to be a helpful factor.

So, why do I keep talking about masks?

I feel compelled to keep talking about masks when I read they work but still see how few people in my community wear them. While reports suggest there are very few cases in our area, it’s only a matter of time until one arrives here, as happened recently in northern NB, and without masks the virus can quickly spread until it’s detected and those affected are traced and isolated. It’s even more important in urban areas with higher population density.

Governments are too often slow to respond, but the evidence is clear now. If at least 80% of people wear masks when in public places, the pandemic can be controlled. If you can’t wear a mask for health reasons, it’s OK as long as the people around you wear one. If you dislike wearing a mask or can’t wear one, minimize your time in public places—and just stay home. That works too! But, most of us need to do our part and find some type of face covering we are comfortable wearing, if we want to stop the spread of COVID-19.

So, what’s your favourite type of mask? Are you able to adjust it properly so it feels comfortable? I keep searching for the perfect design…

References:

Identifying airborne transmission as the dominant route for the spread of COVID-19 – PNAS

A modelling framework to assess the likely effectiveness of facemasks in combination with ‘lock-down’ in managing the COVID-19 pandemic – Proceedings of the Royal Society

Geography, leadership and sheer luck: Why BC and NB flattened the curve so quickly – CTV News

#domaskswork #howdoesCOVIDspread

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Masks and Condoms…More in common than you think!

Oooh… really?

I have a riddle for you this week. How are face masks and condoms alike?

Answer: Most people would rather not use either of them! But…

Masks and condoms both protect the person wearing them, they reduce the chance of passing a disease to the person you are with (even if you don’t know you don’t have one), they are a minor inconvenience and they’re inexpensive. They both have also become more popular because of dangerous diseases—COVID-19 for masks, and HIV/AIDS for condoms. And neither works perfectly…but they’re better than using nothing at all! But some people still don’t want to use them, even though they know they really should!

People all over the world are wearing masks in public now as part of the strategy to slow the spread of the coronavirus and save lives. But some North Americans are refusing to use this minor inconvenience even though there is plenty of evidence now that face coverings of any kind can make a difference. Are people just too uncomfortable? Embarrassed? Don’t believe the experts? I was curious so, of course, like any typical baby boomer, I started reading… and I learned there are many different reasons people will refuse to wear a mask.

Culture

First, wearing a mask isn’t part of our culture here in North America (except among health care workers) and people often feel uncomfortable with change. Other parts of the world, like Asia, had already started using masks in public when previous viruses that didn’t reach here caused deaths. They also used them to protect themselves from high levels of pollution in dense cities. Apparently, wearing a mask when you’re ill there is so imbedded into the culture, it is considered very rude and inconsiderate to cough or sneeze into your hand or sleeve—you are expected to wear a mask if you are sick, even with a cold. So, the culture was already different in Asian countries. However, masks were accepted quickly in Europe and Scandinavia when they were threatened by COVID-19, so that’s only a small part of the explanation.

Vanity

Our face is what we show the world—part of what makes us attractive to others and recognized by friends. Women wear makeup to enhance their looks. Men show their character through grooming, facial hair, and a healthy smile.

One article I read, even suggested some people feel wearing a mask makes them appear weak and overly worried about an invisible threat. Healthy, strong people usually only get a mild case, so wearing a mask must suggest you aren’t healthy and strong, right?

But, because we now know that the virus is easily spread by those with no symptoms, we all need to think about the people we could unknowingly pass the virus along to. How could you not feel guilty if you caused someone else to suffer and possibly die? Young, healthy people wear masks to protect others more than themselves… caring for others isn’t a weakness.

Communication

A large part of communication is visual. The expression on a face tells a lot of what a person is thinking. A smile brightens someone’s day. Some people worry about that loss of communication, and it’s important. But they say the eyes are the window to the soul…perhaps we can learn to read expressions in the eyes better, just like those who are blind become more sensitive to sounds. And, like the blind, we can learn to be more sensitive to the tone of voice that speaker is using.

But another option to improve visual communication and facial recognition, is the face shield. Although not considered quite as effective as a well-made mask, shields still make a difference in reducing dispersion of droplets so use will reduce the spread of the coronavirus. There is also an option for children, who might have difficulty with a mask, with the shield attached to a sun hat. Note that masks are not recommended for children under age 2.

Physical discomfort

Many people find wearing a mask just plain uncomfortable. It can be stuffy and hot, feeling your breath in your own face. The elastics can make your ears sore, the fabric can make your nose itchy…

The key here is to have a mask that fits properly. You want it snug but not so tight it pulls your ears forward. It should have enough room for your nose and be made of a material that is smooth enough not to irritate your face. It needs to fit closely enough that air doesn’t pass around the edges and be “breathable” enough that you can breathe easily through the fabric. And, especially as summer arrives, you want it to be absorbent so it will stay cooler on your face. I hope manufacturers and researchers are working on this! Since it is likely to be over a year until we have a vaccine for everyone, we need good quality reusable masks and information on the best materials to use if making them yourself.

Confusion

Another problem in convincing people to wear masks in North America, is the confusion over whether we really need to wear one in public. Initially, authorities told us masks were not necessary and might even increase our risk but, with research, this has been shown to be incorrect. Recommendations have gradually changed from “don’t wear a mask” to “they might help” to “you should/must wear a mask when you cannot stay more than 2 meters (6 feet) away from others”. The initial recommendations were based on a lack of information (because the virus is so new) and the worry that the public would buy all the available masks, leaving none for front line health care workers who needed them more. Enter, the homemade or store-bought reusable cloth mask…problem solved!

We know that staying at least 1 meter (3 feet) apart lowers the risk of catching the virus and that 2 meters (6 feet) is better, and that a mask isn’t needed if you can maintain that physical distance. But there are lots of places that this is just impossible…like at the Costco! There are just so many aisles and corners, and people going everywhere, that you never know when you’ll end up too close to someone you don’t know. And some services, like the post office, paying for purchases, or getting your hair done, require a small distance between people to complete the service. Wearing a mask in some cases is necessary for the worker and the client to stay safe. Essentially, masks allow more people to go back to work with much lower risk to their health and for the safety of those they serve.

Political

It’s hard to imagine, but the health-related issue of wearing a mask has become a political issue in some areas. Some people tolerate change better than others, and I suspect that the wholesale changes we’ve endured with self-isolation, quarantines, and physical distancing are taking their toll on the mental health of many. Demanding that they also cover their face has just been too much for some, adding to the mental stress that’s already sky-rocketed over the past few months. Refusing to wear a mask when required is a way of rebelling, of demanding a return to a normalcy we can’t safely have right now. Life is hard for so many in 2020. It will be difficult to find a cure for all of what’s happening, but we have to keep moving ahead, one step at a time.

And me? Do I wear a mask?

I’m what you’d call an “early adopter” … I started wearing a mask in mid-March when I arrived home from a winter vacation a month earlier than planned. My husband and I were in Spain as the country was shutting down due to the virus and we were lucky to get a flight home as quickly as we did. We tried to buy masks to protect ourselves on the 3 flights and 4 airports we had to pass through, but there were none left for sale anywhere. I started making masks for myself, friends and family as soon as I arrived home, knowing what was coming.

I also accepted covering part of my face more readily than many would because of my past experiences. As a hospital pharmacist, I prepared sterile medicines and was required to wear a surgical mask (sometimes for hours at a time) to protect the products I was making. We all breathe out little droplets containing bacteria when we talk and exhale and just a single droplet falling on the medicine meant it would no longer be sterile. Later, as a compounding pharmacist, I worked with potent drugs in powder form. I needed to upgrade to an N-95 mask then to filter the air I was breathing, so I wouldn’t inhale powders that escaped into the air. So, I was used to the concepts of protecting myself and others by wearing a mask.

Of course, some people cannot tolerate wearing a mask—for example, those with breathing problems like asthma or emphysema, those with mental health problems, or children under 2 years. But, as with vaccines, if those who can wear a mask do it, those who can’t will be protected. Recent modelling suggests that, if 80% of people wore a cloth mask in public, the spread of the virus could be stopped. Over 90 countries now require masks to be worn in public places and countries that adopted this policy early along with other measures all have had less than 1000 deaths due to COVID-19.

But we all need to realize that most of us only need to wear a mask for short periods of time—only when we are not sure we can stay at least 2 meters away from others. I keep one in my pocket or purse whenever I go out so I can slip it on when needed. Here in New Brunswick, Canada, we are told we must put one on when entering a public place, but we can remove it if we see that we will be able to keep our distance from others once inside.

I have never had to wear mine for more than an hour at a time. It is different for workers, though, and they should have several washable masks, so they can change to a fresh one every few hours. They would also benefit from breaks during the day in a place where it’s safe to remove the mask for a while. But, like health care workers, it’s something you just get used to because it’s necessary.

And what about you?

Have you started wearing a mask when you can’t keep the required physical distance from others? Are there other reasons not to wear a mask that I haven’t discussed? Please send me a comment!

References:

The psychology behind why some people won’t wear masks—CNN https://www.cnn.com/2020/05/06/health/why-people-dont-wear-masks-wellness-trnd/index.html

A Doctor Explains Why 45% of All Americans Refuse to Wear a Protective Mask—Forbes https://www.forbes.com/sites/johnbbrandon/2020/05/06/a-doctor-explains-why-45-of-all-americans-refuse-to-wear-a-protective-mask/#2a188b29213d

Why are people refusing to wear masks amid coronavirus threat?—KSAT.com https://www.ksat.com/news/local/2020/05/27/why-are-people-refusing-to-wear-masks-amid-coronavirus-threat/

Refusing to Wear a Mask Is a Uniquely American Pathology—SLATE https://slate.com/news-and-politics/2020/05/masks-coronavirus-america.html

Over 100 health leaders to governors: Require masks to help contain the coronavirus—USA Today https://www.usatoday.com/story/opinion/2020/05/14/require-masks-stop-coronavirus-spread-over-100-health-leaders-column/5182076002/

#whywearamask #howeffectiveareclothmasks

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Could screen time be good for you?Health Technology During COVID…

Working virtually—from home—has become a reality for an estimated one-third of workers, but what about health care? There are many forms of technology that can protect and improve our health…like apps and online sites designed to measure health information and motivate us to increase healthy activities and habits. And to avoid spread of the coronavirus, many doctors have been seeing patients virtually…by phone or video. Turns out it’s a convenient and efficient way to care for patients that may be the way of the future, even after we have a vaccine.

Virtual consultations

I first started thinking about how technology could help us be healthier when I was contacted by a Canadian health care company, Maple, who wanted to advertise on my blog. You may have noticed that I don’t advertise, mainly because I don’t want anything I say to be influenced or censored or even to appear to be biased in any way. But I found the concept of being able to contact a doctor through an app to be interesting. With this company, you can speak to a doctor within 24 hours, specialists as well as general practitioners are available, and the cost is $49 to $99 per consultation, depending on the time of day and day of the week. They also coordinate virtual staffing of a small hospital that lost its only doctor. I understand there are similar companies in other countries as well. Of course, in Canada, we have universal medical coverage, making this a less attractive option for the general public.

But then I realized my province offers virtual consultations with all our doctors, a new service that began being covered with the outbreak of COVID-19. And so do all other provinces and territories in Canada, with most advising doctors to provide telemedicine or virtual care when possible. Seems not that long ago, doctors were refusing to handle prescription renewals by phone because there was no compensation for the time required to complete this (often time consuming) task. Patients love the convenience and are happy to avoid the waiting room, especially with the current increased risk of disease. Doctors comment that they can see more patients in less time. I guess it takes an emergency to advance the system quickly.

But we’ve had an “811” line for several years, staffed by nurses, to give advice for health problems that aren’t a “911” emergency. It’s free for all, covered by Medicare, and has been working well to reduce the load on emergency departments, where people often end up when they aren’t sure what is wrong. So, I guess we’ve had virtual care for a while but, with the current health crisis, it’s been greatly expanded.

Technology at home

The internet is a wealth of information, although some sources are better than others. It’s amazing what we can do on our phones and laptops now to improve or monitor our health. I have vetted the following sites/apps as best I can, but please check with your doctor before acting on any information contained in these online/virtual sources. To evaluate any online information source, look at who developed or posted it, when it was last updated, and whether they are selling you something… and ask your doctor, nurse practitioner or pharmacist to verify it is an accurate source of information.

So, the following is a list of apps and online information sites that I’ve found, several of which I use myself and others that look interesting. I hope you will find some of these useful:

  • Fitness trackers – There are many of these available, from simple pedometers to track your steps and distance walked or biked each day. It’s fun and motivating to see how far you’ve walked at the end of the day, week or month and to compare how you’re doing over time. I especially like to use one of these when on vacation to see how far we walked each day.
  • Exercise apps and websites – If you want to exercise at home, there are lots of sources of online sessions you can access for free with different levels of intensity or experience. Some will even send you reminders to exercise. Many require little or no equipment and often only limited space is needed.
  • Nutrition apps – While it’s time consuming and unnecessary for most of us to track everything we eat every day, it might be something you want to do for a while if on a special diet. Many have nutrition information built in to help track calories, carbohydrates, salt or specific nutrients in foods (for example, calcium might be of interest to someone with bone loss). Some are geared to specific diets, like Keto or Vegetarian. I noticed one (Veganized) that even tracks nutrients to ensure a balanced diet, as well as enabling meal planning and shopping lists. Others simply give a breakdown of nutrients in a measured amount of food for information purposes, like carbohydrates for those on a keto diet, without tracking everything you eat.
  • Mental health – Meditation guides, mood journals, sleep aids are designed to help you learn to meditate or relax to enable falling sleep. Two popular ones are Calm and Headspace, if you are interested in learning to meditate. Sleepwell.NS’s website: www.mysleepwell.ca is a site I often recommend to those who have problems sleeping and want to avoid medication.
  • Brain training – Like every part of the body, exercising the brain helps to keep it functioning well. While I use blogging to keep my brain active, some like to play brain games to stay sharp and have a little fun. Some people even find these relaxing and de-stressing after a busy day. From word games (Scrabble online, Wordscapes), logic puzzles (Sudoku, logic puzzles), and memory games to more specific exercises for those with brain injury, there are plenty to choose from, many for free. I like to play solitaire to pass the time and challenge my brain a little—once, as I was getting of a flight, a man who had been sitting a couple of rows back asked me if I won my game! My mom did the newspaper puzzles every day for years, and most of these (Cryptoquotes, crosswords) are available online now, with new ones each day. Just search “brain games” in Google Play or the App Store to find something you’d enjoy.
  • Disease monitoring — There are many apps for diseases like diabetes that require constant monitoring. Most blood glucose meters have an app from their manufacturer that stores the readings and helps interpret this information, and some will even automatically detect the results of tests you do. Your doctor can provide the monitoring information you need to set it up, for example, high and low blood sugar level limits for a diabetes program. He’ll also likely be interested in the reports it produces!
  • COVID-19 — There are even apps to track the coronavirus and keep us informed about our level of risk. The Canada COVID-19 app provides alerts for your area of Canada, a symptom tracker, daily updated stats, a self-check assessment, what to do if you get sick and more. And there are others, some designed to simply provide information or to track cases. Be sure to check on the privacy disclosure of how any data they collect is being used.
  • — If you are a health care worker, the Open WHO app from the World Health Organization provides courses to educate workers, decision makers and the public on various health emergencies and procedures, including COVID-19. Note: Choose your preferred language, as courses and information are provided in several languages.
  • — Some countries are using tracking apps to enable contact tracing—a potentially life-saving type of app that all countries may need to consider in anticipation of a second wave of infection.
  • Communication — And, of course, who hasn’t heard of Zoom? Our family has long been Skype users…there’s something special about being about to see as well as talk to someone. They say that communication is 70% non-verbal, so that’s probably why. I can tell you that my Mom always preferred Skype to a telephone call, even when she was in her 80s and 90s! Making video calls is even easier now with many choices of programs. Besides Skype and Zoom, there are Whereby.com, WhatsApp, Messenger and, I’m sure, others that allow you to communicate with messages, voice and video. Nothing like being able to talk face-to-face with someone you love when you’re isolated and can’t visit!

Our smart phones really are “smart” enough to help us stay healthy if we use them fully. Have you been using any helpful apps I haven’t mentioned in the past couple of months? Please let me know so I can add them to the list!

Reference:

Telemedicine and virtual care guidelines—Royal College of Physicians and Surgeons of Canada

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Severe COVID-19…who is at most risk?

Why do some people get sick and die from COVID-19 while others don’t know they’ve even had it? While we still don’t know all the answers, researchers are learning why this happens and who is at higher risk.

As we start to open businesses, it will be important to protect those at greater risk of the severe form of COVID-19 infection. So, who is at risk? And is there anything we can do to increase the chance of having a mild case of the virus when exposed? Knowing who is at higher risk of dying from this disease means we can take extra precautions to prevent them from exposure to this deadly virus. We can also ensure they are tested and treated at the first sign of symptoms.

Potential risk factors identified so far include age, gender, some medical conditions, certain medications, poverty and crowding, certain occupations, and pregnancy. It is likely that more risk factors will be identified as research progresses.

Age

First, we know that those over age 65 are at higher risk and those in care homes are at further increased risk. We have painfully watched, seemingly helpless, while the coronavirus has swept through too many nursing homes. In Canada, 82% of deaths from COVID-19 have occurred in long-term care residences as reported on May 7th, 2020. In the US, percentages of long-term care home deaths range from 20 to 80% by state, averaging 42%, based on data reported by May 22th, 2020. Clearly, we need to improve systems in our seniors’ residences to better protect our vulnerable elderly population.

Gender

While equal numbers of men and women contract COVID-19, several studies show men have been more affected with the severe form than women. Experts say one reason is that women tend to have stronger immune systems. Another is that men are more likely to not take early symptoms as seriously, on average, resulting in seeking treatment when the infection is more severe.

Medical conditions and medications

People with underlying medical conditions are also at increased risk of more severe viral infections, especially if not well controlled. These conditions include lung diseases, like emphysema and asthma, serious heart conditions and those whose immune system is weakened (“immunocompromised”). Conditions that affect the immune system include cancer treatment, smoking, organ or bone marrow transplantation, poorly controlled HIV or AIDS, and long-term use of corticosteroid treatment and other medications that reduce the immune response. The immune system generally weakens with age, which may explain the vulnerability of the elderly.

Even having low vitamin D, a vitamin that is essential for a properly functioning immune system, is thought to be a risk factor for more severe illness. Keeping up your general health by eating a healthy diet and getting exercise is a good recommendation to ensure your best chance at fighting the virus if you should catch it.

Being severely overweight (Body Mass Index “BMI” over 40) increases the risk of the severe form of COVID-19 and people with diabetes, chronic kidney disease requiring dialysis, and liver disease are also at greater risk. Even having insulin resistance, a pre-diabetes condition where higher amounts of insulin are needed to allow sugar into the body’s cells, has been noted as a risk factor. It is very important to continue medications and treatment, including emergency care, for these diseases during the pandemic to enable the maximum resistance should you contract the virus.

Poverty, overcrowding, homelessness

Those living in overcrowded or homeless situations have difficulty maintaining physical distancing, putting them at increased risk of contracting the coronavirus. As well, staying at home when there is little space and no access to outdoors creates stress for families. Elderly living alone can suffer from severe isolation.

Poverty is known to be a risk factor for poor health in general and having poor health status puts people at greater risk of the severe form of COVID-19. Being unable to afford good quality food and medicines, and, in some countries, health care increases the chance of a person having poor health and being less able to fight off infection.

One article I read suggested that the most likely place to catch the coronavirus was within your own residence! Essential workers are more likely to live in overcrowded living conditions and can be a source introducing the virus into the home. Many households do not have enough space to allow physical distancing and self-isolation when necessary allowing infection to easily spread to others living there. We have seen the result of living conditions in long-term care situations, with many sharing the same living space.

Occupations

Three factors are used to determine the amount of risk a worker faces:

  1. Contact with others – How much contact is required to perform the work?
  2. Physical proximity – How close does the worker need to be to others while working?
  3. Exposure to disease – How often is the worker exposed to hazardous conditions?

Although many workers have started to work from home (estimated at about 1/3 of workers), essential workers such as those in retail and health care are forced to risk their health and that of their families. Front line health care workers, of course, are at the top of the list but I was surprised to see that the dentistry profession was at greater risk than doctors and nurses, with dental hygienists at the top of the list (see reference below for details).

But as stores begin to reopen, the safety of retail workers and those who use their services depends on the preparations made by the employer. Will they be able to maintain physical distancing? Are there increased cleaning and hygeine procedures in place? Are the staff provided with masks and will customers also be required to wear masks?

And risk and pay are not aligned. Some of those at greatest risk because of an inability to avoid close contact with others include bus drivers and cashiers, while most jobs that can be performed at home are higher-paying ones.

Pregnancy

Because COVID-19 is such a new infection, we are still learning whether pregnant women or their unborn babies are at increased risk of complications if the mother becomes infected. While information is limited, so far there does not seem to be any indication that they are at higher risk of getting the infection or having more serious illness if they do. However, as pregnant women are at increased risk with other infections, like the flu, caution is recommended.

Additionally, a small study has noted some damage to the placenta caused by blood clots in pregnant women who contracted COVID-19, but most delivered healthy babies. This is an area that doctors and researchers will be watching closely.

The advice for pregnant women is to stay home as much as possible; avoid visitors, public transit, and crowded places; wash hands often, avoid touching frequently touched surfaces and don’t touch your face; and practice physical distancing. Talk to your doctor about whether you can have appointments by phone or videoconference. And check for updates as researchers gather evidence in the coming weeks and months (see reference below for the Public Health Agency of Canada or verify with your country’s health agency’s recommendations).

The bottom line?

Of course, these are things we all need to continue doing. While we may be able to loosen restrictions for periods of time while the virus isn’t present in our area, experts say it is almost certain that there will be a second wave of infection that will require us to self-isolate again. This will be our life for a while and the more we can do to limit the spread of the virus, the more freedoms we can earn for ourselves.

In my province, New Brunswick, Canada, we are in “Phase Yellow” which allows us to have gatherings of up to 10 people indoors or up to 50 outdoors (where sunlight, open air and wind lower risk). My friends are happy that their hairdressers are allowed to open too! We’re seeing only 1 or 2 new cases every couple of weeks here, but still unfortunately rates in neighbouring provinces rates are still higher so borders remain closed. I miss seeing family in Nova Scotia and Quebec, but we all need to do what we can to limit the spread of the coronavirus. We’ll get through it eventually, but it will take time and patience.

And I’m still making masks, although not as many these days, especially as the weather is warmer and we are allowed to join friends at our beach. I’ve lost track of how many masks I’ve made but it’s over 200 now. And I’ve been painting designs on them, now that I have more time.

I’m having some fun while still helping friends and family… and I hope you are all doing the same. Take care of your health, protect each other, and stay safe!

#COVID19risk #covid19 #coronavirus

References:

82% of Canada’s COVID-19 deaths have been in long-term care, new data reveals – The Star

Nursing Homes & Assisted Living Facilities Account for 42% of COVID-19 Deaths – FREOPP

Why COVID-19 is Hitting Men Harder Than Women – Healthline

Coronavirus Disease 2019—People Who Need Extra Precautions – Centers for Disease Control and Prevention

Poverty advocates call for protection of vulnerable amid COVID-19 pandemic – The Globe and Mail

Overcrowded Housing and COVID-19 Risk among Essential Workers – PPIC

These are the occupations with the highest COVID-19 risk – World Economic Forum

Pregnancy, childbirth and caring for newborns: Advice for mothers during COVID-19 – Public Health Agency of Canada

Insulin resistance marker correlates with COVID-19 morbidity, mortality – Univadis

How COVID-19 might affect a pregnant woman’s placenta – Live Science

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I’ve been talking to myself lately…

Years ago, when I was a pharmacy student, we did formal training with various pharmacists. One of the first I worked with, Carl, talked to himself. At first, I thought he was talking to me… “Excuse me?”, I’d say. But he explained that all pharmacists talked to themselves—some just did it silently, not out loud as he did. It kept him organized, helped him focus on the work, kept him “sane”, he said, or some such words. That was over 40 years ago…

After a while, I realized I was doing it too! Talking to yourself helps you organize your mind… OK, what’s next? What problems need to be resolved? Which are most important and need to be done first? I was consciously prompting myself to get organized and concentrate on what was most important.

Not just for work…

Now I realize this works, not just for work issues, but for the rest of my life too. Especially in this time of social distancing and isolation, we need to keep ourselves going, to plan ways to connect with others, to find new ways to make things happen. This is particularly true for connecting with family and friends that are farther away who we can’t visit due to travel restrictions.

And rather than puttering away the time, waiting for COVID restrictions to be lifted (which may last months at various levels!), talking to ourselves about what we’d like to get done helps to motivate us and prioritize what is most important right now.

But beyond using self-talk to help organize activities and communications, I’ve realized that you can change your thoughts by talking to yourself. Our subconscious mind loves to pull up unpleasant thoughts from time to time and it’s easy to focus and dwell on these thoughts. But unless there is something you need to do about those thoughts, problems or situations, why not just tell yourself to move on? Think about something pleasant instead?

Brain research tells us, the more we think about something, the better we remember it. Our brains build stronger memory connections to the information we think about most. While this is a useful practice to help learn a new skill, it can work against our overall happiness if we let our brains build stronger connections to bad memories. Do we want to remember the unpleasant experiences or the happy satisfying ones? Consciously turning off thoughts of unpleasant memories and turning them toward better ones can improve our mood and overall happiness. Similarly, doing what we need to do these days to stay safe then dwelling on how to make our situation better can prevent unnecessary anxiety.

Talk to yourself about what you want to happen…

Years ago, I stumbled across a book called The Secret. The basic message of the book was: if you want something, focus on it and think about it and it will magically appear in your life. At the time, I thought this was silly…things don’t just conjure up because of thoughts. But now I think I understand the idea. When you focus on something and think about it often, it can change your actions. You do what you think about. And actions make things happen. So, thinking about your goals or desires helps to direct your actions and increases the chance of achieving what you want. It’s not 100%, of course, but if you don’t think about what you want to accomplish, you’re unlikely to take any action to get there and chances are slim that what you want will happen.

Of course, the extreme version of this type of thinking—wishing for something impossible—isn’t productive either. The idea is to stop thinking about upsetting past events that can’t be changed, enjoy the present moment for all it has to offer, and to consciously direct your thoughts and actions to creating a happier healthier future.

We’ve seen dramatic changes in our lives over that past couple of months. It’s easy to dwell on the negative side of all this, but why not talk ourselves into finding some positive. I was touched by Andrew Cuomo, Governor of New York, talking about how he was creating a closer relationship with his adult children during the pandemic. Rather than a quick “How are you doing?”, then “Busy…have to go” conversation, he talked about how he was taking time to really understand how the crisis was affecting his children’s lives, getting to know them better as the adults they had become. They were having conversation on a much deeper level and it was improving their relationship.

Viral change

Last week, my youngest daughter sent me a letter…a real letter on paper. We text almost every day and video chat often, but a letter is something different, something special, a surprise! It was a Mother’s Day letter that arrived late—deliveries are slow these days—and she expressed the love and pride she had for her Mama, and how much she missed being able to come to visit. She lives in Nova Scotia—and like so many, has been laid off due to the coronavirus—and the border to New Brunswick where we live is closed. So, we can’t be together, but reading her letter makes me feel closer. I’ve re-read it a lot…

She inspired me to try to give this same feeling to others…pay it forward. I decided to send some homemade cookies to my son and his family. I added a note to say how much we miss them and to ask my grandchildren to pretend that each cookie is a hug from Memere and Pepere. Today I watched a live “unboxing” video of our grandchildren opening the package, reading my note and enjoying the cookies, as my daughter-in-law connected us by video chat!

So, I think we all can talk to ourselves about how we can create something good from the forced isolation caused by the coronavirus. Life is always changing but the pandemic is forcing us to do this more quickly. Which of the changes we’ve made will we decide to keep in the future? What else can we do to make a better world and a better life for ourselves and others? We can look at this time of rapid change as a chance to improve our world and take the opportunity to consciously make good choices about our relationships, our environment, our thoughts.

Time to start talking to ourselves… to create positive changes we want and need!

#selftalk #COVID19emotions

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Hair Loss in Women

Losing your hair can be very distressing, especially for a woman, but it can often be treated successfully. Getting a correct diagnosis of the cause of the hair loss is the first step and your family doctor can often help.

To make a proper diagnosis, your doctor will likely ask you about your recent history and your family history of hair loss. They will also examine your scalp and check for other symptoms you may have that suggest a disease that could cause hair loss. They may even do some blood tests. While hair loss can be caused by conditions of the scalp, it can also be caused by other conditions in the body.

Some hair loss is normal

Hair grows in a cycle. At any given time, 90% of your hair is actively growing, while about 10% is in a stage of degeneration, eventually resulting in shedding. This is normal. The hair growth phase is called “anagen”, the degenerating phase is “catagen” and the shedding is referred to as “telegen”. We see these terms pop up in the names given to different types of hair loss, described below.

We all lose about 50 to 100 hairs every day. One test for hair loss that is sometimes used (although not highly reliable) is the Pull Test. When 40 to 60 hairs are grasped and pulled gently; not more that 4 to 6 hairs should pull away from the scalp. However, this test is difficult to standardize, and a negative result does not rule out a diagnosis of hair loss. Trying it immediately after shampooing or brushing the hair will result in a false negative, as loose hair is already removed.

Hair loss can occur in patches or diffusely, across the top and sometimes the sides of the head, depending on the cause. In women usually the hairline at the forehead is not affected while men generally have receding of the hairline on both sides, and/or thinning on the top. Some hair loss is self-limiting, regrowing after several weeks or months, while other types of loss can progress for many years. If the hair follicle is lost, it is referred to as scarring of the scalp, and the hair loss can be permanent. This condition is rare and a consultation with a dermatologist is recommended.

What causes increased hair loss?

The most common type of hair loss is caused by hormone changes, usually too much or too little testosterone (an androgen). This is called androgenetic alopecia, and it results in diffuse hair loss in women, “male-pattern” loss in men. In women, too high levels of testosterone [or its metabolite, dihydrotestosterone (DHT)] is often accompanied by acne and oily skin, and can be the result of Polycystic Ovary Syndrome (PCOS), or cysts on the ovaries that produce androgen hormones. Too little testosterone is also associated with scalp and body hair loss (underarms and pubic hair), fatigue and decreased muscle mass. A rapid decrease in female hormones, estrogen and progesterone, such as occurs after a pregnancy or when stopping hormonal birth control, can also cause temporary hair loss.

Thyroid disease (low thyroid), iron deficiency and malnutrition (e.g. lack of protein) are other causes of diffuse hair loss that do not originate in the scalp. Hair products, like dyes and straighteners, and treatments, such as blow dryers and curling irons, can cause diffuse hair loss through breakage close to the root. In these cases, the hair will usually regrow once the cause is corrected or once the woman has overcome or adapted to the stress.

Other causes of hair loss that often result in patchy hair loss, include scalp infections and habitual nervous pulling on the hair, eyebrows or eyelashes. A physical stress, such as an illness with high fever, or an emotional stress can also cause hair loss that often comes out in clumps.

Types of hair loss

The names of types of hair loss are, unfortunately, quite complex and confusing. However, I’ll list them below with their details, causes and treatments.

Androgenetic alopecia – likely a hormonal cause, most common type (mentioned above), often a family history.f

  • Diffuse hair loss in women, male-pattern loss in men (sides of front hairline and top of head) caused by increased levels of dihydrotestosterone (DHT)
  • Women usually develop this after menopause when estrogens drop and androgens (male-type hormones) dominate.
  • Can be treated by using Minoxidil 2% scalp lotion
  • Note that Minoxidil 5% sometimes works better in men than 2% but gives no extra benefit in women, according to studies.
  • Alternative treatment for men is the drug finasteride, that blocks conversion of testosterone to its stronger form, dihydrotestosterone (DHT). However, it has many side effects.
  • Sharp decreases in hormones in women, such as after childbirth or after discontinuing birth control pills, can result in temporary hair loss.
  • Hair loss due to low thyroid, iron deficiency or malnutrition can mimic androgenetic alopecia. Low testosterone in women is also associated with thinning of hair but often not recognized.

Alopecia areata – autoimmune hair loss (the body attacking itself)

  • Patchy hair loss, broken hair shafts, short thin hairs, yellow or black dots
  • Usually sudden, acute onset
  • Treated with steroid injections into the scalp, creams or ointments, or recovery can be spontaneous

Tinea capitis – fungal infection of the scalp, patches of hair loss, red, scaly, itching, pustules

  • Although antifungal shampoos are available, in a severe infection they do not reach the infection in the root of the hair adequately, and it is necessary to take a prescription anti-fungal medication by mouth

Telogen effluvium – caused by physical or emotional stress

  • Non-inflammatory, non-scarring, scalp appears normal
  • Caused by an intense emotional shock or physical stress, for example, surgery or rapid weight loss
  • Usually hair will regrow when the cause is resolved (person adapts to stress, recovers from surgery, etc)

Trichotillomania or traction alopecia – physical tension on the root of the hair

  • Habitual pulling on hair, usually front/sides but can also include eyebrows and eyelashes
  • Tight hair styles, like buns, ponytails, braids, cornrows, extensions
  • Treated with cognitive behavioural therapy (CBT) to reverse the damaging habits or changing hairstyle to a looser one

Trichorrexis nodosa – trauma sufficient to cause hair shafts to break

  • Caused by overuse of hair products (dyes, straighteners, perms) or styling techniques (hairdryers, curling irons)
  • Treated by changing or stopping use of offending product or tool

Anagen effluvium –interruption of hair growth cycle causing abnormal diffuse hair loss

  • Common with some chemotherapy, radiation
  • Can also be due to malnutrition with a nutrient essential for hair growth being missing
  • Cooling the scalp during treatment sometimes helps reduce hair loss with certain chemotherapies
  • Hair will regrow when the growth cycle is no longer interrupted

Medications – Certain medications can cause hair to fall out as a side effect

  • Blood thinners (warfarin), Accutane (a strong acne treatment), antidepressants (Prozac, Zoloft, etc), beta-blockers, some cholesterol drugs

Nutritional deficiencies – Certain nutrients are needed for hair growth

  • Low protein, iron or vitamins in the diet can result in temporary hair loss
  • Replacing the nutrient in the diet allows hair growth to return to normal

So, as you see, there are many different causes of hair loss. Some types are treatable while other will resolve on their own once the cause is eliminated. It’s important to get a diagnosis of the cause to give you an idea of what treatment would work best to improve hair growth.

Note: My latest activity is an online course on how to create an audiobook. As a learning project, I created an “audioblog” from one of my most popular blogs Masks 4 All. I even figured out how to add music to fade in at the beginning and out at the end! If you care to listen, it’s on my blog homepage, http://jeanniebeaudin.wixsite.com/author (only 11 minutes long). Let me know what you think!

References:

Hair Loss: Common Causes and Treatment – American Family Physician

How much hair loss is normal? – Medical News Today

Causes and treatments for hair loss – Medical News Today

What’s to know about alopecia areata? – Medical News Today

Finasteride (Propecia) — RxList

#hairlos

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“Sorry, dear, not tonight…”

Some years ago, when my husband and I owned a pharmacy, we attended huge pharmacy buying shows in Toronto each year to find new products to sell in our pharmacy. At one of these, I saw an interesting display of “Play” brand products… essentially a line of sex toys designed to be sold in a pharmacy. I was quite surprised to see it there (aren’t these things only sold in sex shops?)

The company representative explained that sex is part of a healthy lifestyle, and some just need a little help to get things going, especially as they get older. But many people would be too embarrassed enter a sex shop, and some might hesitate to even bring up their problem with their doctor.

But everyone goes to a pharmacy and might consider a discreetly packaged aid to improving their sex life. Pharmacists have private counselling areas where women could discreetly ask a woman pharmacist about ways to address a minor problem, such as dryness or irritation.

Of course, what’s considered “normal” can very from person to person, and in the same person over time. A reduced interest in sexual activity is only a problem if you feel it is, or if it creates friction with your partner.

Sometimes the problem can be “in our head”

Problems in the bedroom, or even being interested in the first place, can originate in our mind as well as our body. It can happen at any age but becomes more common in women as we move into the mid-life years.

For example, many of us can become “sandwiched” between caring for teenagers and elderly parents while still working at full-time jobs. Being stressed and overtired is a recipe for a lack of libido, our interest in sex. “Please, not now, I just want to sleep.”

For some, just creating time and the environment for intimacy is all that is needed – booking a “date night” to spend unpressured time together. For others, it may mean addressing an underlying worry that is taking too great a toll.

Depression can be a reason for low libido but I’m sure anyone who is depressed has more worries on their mind than a lack of sex. Always best to talk to your doctor if blue feelings seem to hang on longer than they should and are affecting your quality of life.

There are psychologists who specialize in helping overcome the psychological side of low libido. Of course, I’m not a psychologist but I used to work with such a professional – we referred patients to each other when we felt the other could better address a woman’s problem. If, after her analysis she believed the source of the woman’s low libido was hormonal, she referred her to me; if I saw no signs of a hormone imbalance that would contribute to a lack of sexual interest, I would suggest the woman see my colleague.

There can be physical causes too…

Mis-matched libidos can cause difficulties in a relationship or they can be the result of a problem unrelated to sex in a relationship. Presuming that you have a good relationship with your partner that is not contributing to a disinterest in sex, and don’t have any overwhelming stresses in your life, the root of the problem might be something physical that can be quite easily solved by your pharmacist.

A common cause of sexual problems in women is lack of lubrication. As we age our production of vaginal mucous generally decreases. Taking a little time to “warm up” with extra foreplay may be all that is needed. Let your partner know this. Being a little dehydrated can also result in less lubrication and alcohol is dehydrating. Try drinking a glass of water along with that wine and avoid overdoing the alcohol to prevent dehydration.

There are also lubricants made especially for intimate use. If you are treating dryness avoid ones with ingredients added to create a “warming sensation”, flavours or scents at least initially, as these extra ingredients increase the chance the product itself will cause irritation. KY Jelly is a popular brand and there are several generic ones also available. Look for a water-based “personal lubricant” as a good choice. There are also silicone- and oil-based lubricants but there can be compatibility issues with condoms or sexual aid products. Note that silicone lubricants tend to last longer, while oil-based ones last less time. In a pinch, a kitchen oil can be tried, but regular use of these can increase risk of a vaginal infection. Many stores display lubricants next to their selection of condoms, or you may find them in the feminine hygiene product section.

Be aware that there is also a higher-level product for dryness, called Replens. This gel contains added ingredients that help the product cling to the surface of the vagina, prolonging its action. It is designed to be used less often than a personal lubricant, usually every 3 days, as the product stays effective for several days.

Vaginal atrophy

The tissues of the vagina depend on both estrogen and testosterone for growth and health. With very low levels of either of these hormones, or if sexual activity has been out of the picture for a long time, the vagina can wither or atrophy. Sex itself increases the blood circulation to the vaginal area, keeping it healthier.

Taking hormone replacement supplies the vagina with hormones along with the rest of the body but, if the only problem is vaginal atrophy, there are hormone replacement products that can be applied directly and only a low dose is needed. There are suppositories and creams available for vaginal use, and compounding pharmacists commonly make a cream or gel from a weak estrogen, called estriol, that works well on vaginal tissues. You would need to see your doctor to discuss these options.

Vaginal infections

If you experience irritation of the vulva area (the outside of the vagina), consider the possibility of a vaginal infection. Symptoms of infection vary with the type. You will note that these involve irritation but also a discharge, not actual dryness. Here are two common types of vaginal infections:

  • Yeast infection (vaginal candidiasis)—itchiness; thick, white, cottage-cheese-like discharge; soreness or burning during intercourse or while urinating; no odour
  • Bacterial vaginosis—itching; burning during urination; thin, grey, white or greenish discharge, “fishy” odour
  • If you haven’t experienced an infection before you will need to see your doctor for a diagnosis. Many women recognize the symptoms when an infection reoccurs. Yeast treatments can be purchased without a prescription but treatments for a bacterial infection usually require one. Depending on laws in your jurisdiction, a pharmacist may be able to renew a prescription based on your description of symptoms similar to a previous episode.

Back at the show…

So, when I saw this interesting line of products at the trade show designed to help with common problems with sexual function that can arise during and after the menopausal change, I decided to write an article for a pharmacy journal, where I had a monthly column, to bring these to the attention of other pharmacists. As I often did my own photography for my articles, I asked for some samples to take home. I didn’t want the boxes crushed in my suitcase, so I decided to just carry them home carefully in a plastic bag. As we approached the security check at the airport, I felt a little embarrassed that the agents would be examining the parcel I was carrying. I asked my husband if he would take the bag through the checkpoint for me.

We ended up in different security lines for some reason. And as my husband went though, the agent examining his things looked over at me, smiled and waved. How odd. Afterward, I asked my hubby what that was about… He said, “I told him these were sex toys that belonged to my wife in the next line, and I was just carrying them for her!” I thought I’d die laughing…

I shouldn’t have been so embarrassed really. But, especially in North America, sex is something that almost everyone has done but never talks about, even when problems develop that could easily be resolved. We should feel comfortable discussing low libido or physical difficulties that prevent us from enjoying a wonderful part of our relationship with our partner. And remember, if it’s a minor problem, such as mild vaginal dryness, you can ask to speak to your pharmacist about it in a private area.

Lastly, we should realize that a sexual relationship doesn’t necessarily need to include sexual intercourse. Couples can still enjoy intimacy that fosters a close relationship and displays their love, even if they are no longer capable of performing the actual act. It’s all about loving, enjoying and giving pleasure to each other, and being close, after all.

References:

Can I Speak to the Hormone Lady? J Collins Beaudin

Yeast infection (vaginal)—Mayo Clinic

Bacterial vaginosis—Mayo Clinic

FAQ Replens

#lowlibido #causesoflowlibidoinwomen