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Breast cancer… sometimes misunderstood!

Since October is Breast Cancer Awareness Month, I thought I’d dedicate a blog to this terrible disease that affects 1 in 8 women in North America, not to mention the impact it has on their families and those they love.

So here are some myths about breast cancer, and what the experts say about them…

Myth #1

A breast injury can cause breast cancer. Although a breast injury can sometimes cause changes in the breast tissue that might mimic the look of a cancer in a mammogram, it cannot cause cancer. But just to be sure, your doctor may want to do a needle biopsy, removing a small amount of breast tissue with a needle and syringe to examine in a lab, if an area looks different than usual due to a previous injury.

Myth #2

Underwire bras increase the risk of breast cancer. The wires do not cause cancer, but they can irritate the skin under the breasts, causing it to break down. Irritated skin is less resistant to bacteria and fungi which could cause an infection or abscess in the breast. Also non-wired bras are more comfy!!

Myth #3

IVF increases the risk of breast cancer. In vitro fertilization (IVF) involves the use of estrogen-like drugs to stimulate the ovaries to produce eggs. This led some experts to wonder whether the treatment could increase the risk of hormone-sensitive cancer cells developing, or at least speed the growth of any of this type of cancerous cells that might be forming. Although no studies have specifically been done to confirm this doesn’t happen, one trial compared the cancer risk of women who had had IVF with those who had not, and found no difference.

Myth #4

I won’t develop breast cancer because no-one in my family has had it. Most women who are diagnosed with breast cancer have no family history—only 5-10% of breast cancers are caused by a genetic mutation that was inherited. In fact, many diagnosed women have no known risk factors at all. Obviously, we’re missing something… (perhaps an environmental connection?) More research into the causes, please!!

Myth #5

Stress can cause breast cancer. While too much stress can certainly affect our health, there is evidence to show there is no association between stress and breast cancer. On the other hand, breast cancer most certainly causes stress! We can all benefit from learning effective ways of dealing with the stresses of modern life…

Myth #6

A healthy lifestyle eliminates breast cancer risk. A healthy lifestyle can reduce the risk of breast cancer, but it can’t eliminate it. Refer back to Myth #4… we need more research into the causes of breast cancer!

Myth #7

Breast cancer only occurs in older women. It is true that most cancers occur in older women. Age is a known risk factor—one we can’t do anything about. Screening mammograms are recommended only after age 50 in most countries, and after 40 in the US, as they are less accurate in younger women with more dense breast tissue. But about 5% of cancers are diagnosed in women under 40 years, typically in those with a strong family history of the cancer. It is recommended to watch for any unusual breast changes, like lumps, puckering of the skin or a nipple pulling inward (inverted nipple) and to see your doctor right away if any of these occur.

Myth #8

All breast lumps are cancerous. Actually, most new breast lumps are not cancer. A cyst (a pocket of liquid surrounded by a membrane) feels like a lump, and these are fairly common. However, always see your doctor right away for an evaluation if you notice a new lump or any other unusual breast change.

Myth #9

An abortion increases the risk of breast cancer. An abortion interrupts the normal hormone cycle of pregnancy (and pregnancy before age 30 is believed to reduce breast cancer risk), causing some to wonder whether it could increase the risk of a hormone dependent breast cancer. However, a large observational study in Denmark and several other smaller studies found no link between abortion and breast cancer.

Myth #10

Nipple piercings increase breast cancer risk. Piercings do not increase cancer risk, but they can lead to increased risk of infection, abscess, nerve damage, scars, cysts and difficulty breastfeeding (due to blocked ducts from scar tissue).

Myth #11

Sugar causes breast cancer. Refined sugar in excessive amounts is bad for our general health, but there is no evidence it directly causes breast cancer. I have read reports of research looking at very low sugar/high fat diets (an extreme form of the keto diet) to slow the growth of cancer cells in general, but the studies are not yet conclusive. Studies specifically looking at sugar and breast cancer have had “mixed and inconclusive” results, according to experts.

Myth #12

Men do not get breast cancer. Yes, they do! One in every 100 cases of breast cancer occurs in men. Men also should stay alert to any changes in the breast area, particularly as it can spread more quickly in males since they do not have as much breast tissue to contain it. As well, men are not screened for this cancer and tend to have less support when they are diagnosed with it.

Myth #13

Mammograms and biopsies can cause breast cancer to spread. The thinking here is that the squeezing and poking of a potential cancer could cause the cells to seed in another part of the breast. Some women also worry that the radiation of the mammogram could cause a cancer to begin. However, very low doses of radiation are used in current mammograms, and these are considered safe (although the operator, being there daily, needs to protective themselves from work-related exposure). No evidence has been found that these tests cause cancers to spread and they give valuable diagnostic and early-detection information that save many lives.

Myth #14

No lump means no cancer. Cancers that have formed “palpable” lumps (ones that can be felt with the fingers) have often been there, growing, for several years. The advantage of screening mammograms is that they can often detect a cancer before it is large enough to be palpable, greatly increasing the chance of a complete cure.

Myth #15

Anti-perspirants cause breast cancer. This myth started because many breast cancers occur in the upper outer area of the breast, the area closer to the armpit. However, very little if any of the ingredients in anti-perspirants are absorbed and there is no evidence that they would cause cancer if they were absorbed. At least one large well-conducted that compared breast cancer survivors with healthy women found no evidence of a problem with anti-perspirants or deodorants. The tiny grains of minerals left on the skin by antiperspirants do, however, show up on a mammogram, causing confusion for the radiologist interpreting the image. This is why they always insist that these products not be used on the day you are having a scan.

Myth #16

Carrying a phone in your bra can cause cancer. While most experts will say there is no evidence that cell phones cause any type of cancer, a few have reported case studies of unusual cancers that began in the same location where the woman carried her phone for several hours every day. Not proof of a cause, but one doctor was suspicious enough to publish a report after seeing several similar cases (which I linked to in my Sept 17th blog on environmental links to cancer). It might be a good idea to carry your phone in a purse or proper phone case, both to protect it and possibly also you! Cell phone manufacturers do recommend avoiding exposure of the phone to sweat, as the liquid could cause damage to the phone (as happened to my daughter, who no longer tucks hers into the waistband of her workout pants!)

So, there you go… less to worry about, right? I think the key in avoiding many diseases, including cancer, is to strive for as healthy a lifestyle as possible: eat well, exercise, limit alcohol to recommended amounts, and avoid exposure to nasty chemicals. And, since it’s Breast Cancer Awareness month, maybe make a little donation that might help researchers find the causes and cures for this disease that affects too many women…

References:

Medical Myths: 15 breast cancer misconceptions—Medical News Today

Antiperspirant Safety: Should You Sweat It?—WebMD

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Falling through the cracks…

Some patients have always fallen through the cracks of our medical system, with unnecessary delays in diagnosis. We’re all human… a significant symptom can be ignored or misinterpreted, or we can put off investigating the cause of a nagging problem that could suggest a serious condition. But during the COVID pandemic, the cracks in the system have become wider. With fewer in-person appointments, cancelled screening clinics and hesitation to seek treatment because of worry about virus exposure, experts are warning that diseases are likely being diagnosed later when they’re harder to treat.

They worry that because early-detection procedures like PAP tests, mammograms and the PSA test for prostate cancer are being postponed, we may see cases where the diseases these tests screen for are more advanced at diagnosis. This can sometimes mean more expensive treatment and worse outcomes because diseases are more likely to have spread when diagnosed. Just like a house fire, cancers and infections are best treated sooner before they have a chance to advance and spread.

It will take time for statistics to show how much of this is happening and to what extent the problem of decreased health screening is affecting our health and our chances of surviving health problems that are detected further along in the course of the disease. But, anecdotally at least, I’m seeing that this is happening.

Of course, for privacy reasons, I don’t want to describe the cases I’ve learned about amongst family and friends, but I can tell you my story. You may have noticed that I took a break from blogging this summer… but it wasn’t because I was having too much fun to write. The truth is, I haven’t been feeling well for the past several weeks. And I still don’t know the cause.

So, from my point of view, here are some of the “cracks” that it’s easy to fall through…

Crack #1: one thing at a time

In mid-May I noticed some abdominal discomfort—nothing too terrible. Then a week later a sudden severe pain sent me to Emergency… Crack #1 to avoid: try not to have 2 things going on at once (not that we really have that choice…). If you do, be sure to explain that there seem to be two unrelated things going on. Turned out I had a kidney stone (perhaps obvious from the level of pain…) but since they couldn’t see the stone on a CT scan it was diagnosed as a kidney infection. I spent the next 2 weeks on an antibiotic that made no difference. A later scan showed several smaller stones, confirming what I had suspected must be the cause at the time because the pain was so severe.

But in spite of visits with 4 doctors and a nurse practitioner, along with a series of tests, there’s still something else going on that hasn’t been diagnosed yet. At least I’ve progressed from phone appointments to in-person ones as my symptoms have gradually worsened.

Crack#2: describe symptoms clearly

I can see that the system is backed up, with longer delays than usual in getting appointments and results of tests. Crack #2: make sure the person on the phone understands your symptoms and how severe they are. Avoid the “Fine, thank you” automatic response when a health professional asks how you’re feeling—be truthful and accurate. Let them know how the symptoms are affecting your daily life.

Crack #3: know your receptionist

One important lesson I’ve learned is that the receptionist is the gatekeeper of the doctor’s time. While it may seem weird to be describing details of an illness over the phone to someone who isn’t a health professional, she is the person who decides how soon you need to be seen. So, heed Crack #3 and treat the receptionist like the important person that they are… describe what’s going on politely and carefully along with any frustration or desperation that you may be experiencing! And thank them profusely for helping you to be seen in a timely manner—it’s probably due to their actions. Usually, they’re the ones who manage the doctor’s schedule and often are the ones with the connections to the receptionists in the specialists’ offices.

Crack #4: communicate well

Crack #4 is about lack of communication. If you go to an after-hours clinic or emergency department, your doctor may or may not know about it afterward. Even if the Nurse Practitioner in your Family Doctor’s office sees you and documents her observations on your chart, your doctor may not see it until your next visit with them. Your family doctor should be the central hub of your healthcare and seeing them regularly, especially when you have a health issue, helps keep your care from various sites coordinated. Make sure they are well informed and aware of any care you receive outside their office. At least now we have electronic health records in most areas, so information about various treatments in different locations is accessible to everyone who is treating you and needs it. They just need to know it’s there and to look.

Crack#5: avoid vacations!

And Crack #5 is: don’t get sick during vacation (as if we have a choice!). Many doctors are not able to find locums to cover the office when they take vacation, leaving patients to rely on after-hours clinics and emergency departments. Even our local blood collection/lab sample drop off clinic, usually lined up daily to overcapacity, just closed up for a week to take a holiday. For many like me, we were left wondering where to go and this resulted in yet another extra week’s delay for me and many others in getting test results needed to help find a diagnosis.

My story…

So, where am I now? I just learned this week that my latest test, the one that should finally provide a diagnosis and the test I’ve waited 2 months to get, has a 2 to 3 month wait for results. I can’t believe it. I’m unbelievably frustrated that any lab could take 2 months to process a sample and that, as the receptionist told me, it could take an additional month in this age of electronic communication to send me a letter by snail mail with an appointment to hear the results. I think I cried on the phone in frustration. I’m hoping my newest favourite receptionist may be able to work some magic and expedite this process somewhat for me, the way the receptionist in my family doctor’s office was able to get me into the specialist more quickly. The words “possible carcinoma” on a June 30th test should have resulted in quick action but here I am, 2 months later, still waiting for a diagnosis. Whatever it is, I just want to know. It’s more than a little stressful and certainly not the norm in any medical system, including ours. Might be time to send an email to my local politician…

The bottom line

I guess, the bottom line is that we all need to be proactive about our health. Even in these days of the continuing pandemic, we still should insist that routine care and screening tests are completed in a timely manner. Vaccines and well-fitting masks are tools we have to make sure we stay safe from the virus while we do this. If you have unusual unexplained symptoms, insist that they be diagnosed. Keep asking for investigations until the problem is resolved. Remember that your family doctor is usually the most important healthcare professional to work with you and to coordinate and oversee your care.

So, if you’ve missed any screening tests in the past year and a half, now is the time to book an appointment. Just like a house fire, it makes a big difference if you catch it early. If something seems to be wrong with your health, check it out right away and keep pushing until you get an answer… that’s what I’m doing, even though it seems to be taking much longer than it should.

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Could non-alcohol beer benefit people with fatty liver disease?

Fatty liver disease, a condition of extra fat buildup in the liver, is a growing problem in North America, affecting 20 to 40% of the adult population. As the disease progresses, it can cause inflammation and damage to the liver. Eventually scar tissue can form (called fibrosis) and, when extensive, it is known as cirrhosis of the liver. Cirrhosis can lead to liver failure and liver cancer…

I always thought that fatty liver and cirrhosis were only caused by drinking too much alcohol. But there are two main forms of fatty liver disease: alcoholic and non-alcoholic. About 5% of the disease is the alcoholic type, caused by heavy drinking. The balance, those with non-alcoholic fatty liver, occurs in people who aren’t heavy drinkers. Although the underlying cause isn’t known for sure, being very overweight, having Type 2 diabetes, or metabolic syndrome (a combination of insulin resistance, high blood pressure, high cholesterol, and/or high triglycerides) are associated with risk. About 1 in 10 children are reported to be affected by non-alcoholic liver disease.

Symptoms of fatty liver disease

Those with fatty liver often have no symptoms until it progresses to cirrhosis of the liver. Symptoms can include abdominal pain or a feeling of fullness in the upper right side of the belly, nausea, loss of appetite, weight loss, yellowish skin and whites of eyes (jaundice), swollen belly and legs (edema), extreme tiredness or mental confusion and weakness.

Because early fatty liver disease often has no symptoms, it is sometimes elevated liver enzymes, found in a routine blood test, that first alert your doctor that something may be wrong (increased liver enzymes in the blood are a sign of liver injury of some kind). An ultrasound or CT scan of the liver may show suspicious changes, but a liver biopsy (a sample of the liver) is the best test to confirm the diagnosis and see how advanced the damage is.

How is fatty liver treated?

There is no specific treatment for fatty liver disease. Instead, the focus is on changing lifestyle to control factors that contribute to the condition, such as:

  • Avoiding alcohol
  • Losing weight (even 5 to 10% loss can help)
  • Controlling diabetes, cholesterol and triglycerides
  • Taking vitamin E
  • In some cases, taking certain diabetes medications (thiazolidinediones) can be helpful

What about prevention?

Preventing a disease is always better than trying to cure it, especially when there aren’t good treatments available. Strategies to prevent fatty liver disease are similar to those for any healthy lifestyle. Stay at a healthy weight, exercise regularly, limit alcohol consumption, and treat other health conditions, such as diabetes or metabolic syndrome as recommended by your doctor. Getting regular check-ups can help to detect elevated liver enzymes that are often the first sign of fatty liver disease.

Make sure you aren’t taking medications that can damage the liver or, if you need to take one that does, be sure to monitor liver function as your doctor advises. Note that taking more than the recommended dose of acetaminophen (Tylenol), included in many pain and cold medicines, can cause liver damage.

Hepatitis viruses can also cause liver damage, but vaccines are available for hepatitis A and B. If you are at risk of exposure to either of these viruses, ask your doctor (or pharmacist in some areas) about getting vaccinated.

The liver is amazingly able to heal itself. Avoiding alcohol, changing your diet, or losing extra weight can reverse early liver damage. Fatty liver disease by itself won’t kill you, but it can develop into a more serious problem if it progresses to cirrhosis of the liver that can become liver failure or liver cancer.

The Mediterranean diet, which is high in vegetables, fruit and good fats (like omega-3s) and low in added sugar, is considered an example of a good diet for those diagnosed with or worried about developing fatty liver disease. If you are overweight, it is recommended to lose weight slowly, but steadily, as rapid loss can actually make fatty liver worse.

Although older medical textbooks warn that ketogenic (“keto”) diets can cause liver damage, newer studies that actually measured the effect on fatty liver disease have shown that these diets improve the fat content of the liver, in spite of increasing fats in the blood (which led earlier researchers to wrong conclusions). Studies have shown that the fat content of the diet, even if unrestricted, does not block the beneficial improvement in fatty liver from a diet low enough in carbohydrates to induce production of ketones (“ketogenesis”).

Generally, restriction to less than 20 grams of carbohydrate daily (or up to less than 50 grams, depending on the person) is required to stimulate ketone production. Test strips are available to detect ketones in the urine. Those with diabetes need to avoid dangerously high amounts of ketone production (called ketoacidosis) that can occur when insulin is too low, causing the body to become too acidic. But a diet just low enough in carbs to cause a low level of ketone production is sufficient to improve fatty liver.

Here is a quote from a study (see reference #4 below) on the effects of the keto diet on fatty liver disease (with the “science-ish” terms translated…): “The common belief that increasing dietary fat intake invariably leads to fatty liver and prevents fat mass loss has been recently proven wrong by an elegant experiment, showing that a normocaloric HFKD (normal calorie high fat ketogenic diet) inhibits de novo lipogenesis (new formation of fat) and induces fatty acid oxidation, leading to weight loss and reduced hepatic (liver) fat content. On the contrary, a hypercaloric (high calorie) balanced diet decreases intrahepatic fatty acid oxidation (oxidation of fats in the liver) and increases de novo lipogenesis (new formation of fat) primarily from carbohydrate, and not lipid (fat) substrates, leading to non-alcoholic fatty liver disease (NAFLD) development.” These researchers are telling us it’s the carbohydrates from sugar and white flour in our diet, not the fats, that create fat deposits in the liver and fatty liver disease!

So, besides cutting out added sugar and staying away from anything made with flour (which can be tough to do), how can you get the benefits of a mild ketone-producing diet? Well, I’m a big fan of substitution! Although I’ve always been leery of sugar substitutes, the newer ones use more natural substances that taste sweet but don’t have the carbohydrates of regular sugar. Erythritol, monk fruit and stevia (from the leaf of the stevia plant) are three I know about, that seem better than older sweeteners, like saccharin and cyclamates that were suspected of increasing risk of cancer. Almond and coconut flour can be used to make almost carb-free substitutes for bread, cake and muffins, and there are tons of recipes for keto-friendly desserts and snacks on the internet now. All you have to do is search for something that looks tasty!

But the best way to lower your carbohydrate intake, is to adjust your taste to less-sweet foods. I’ve found that, as I gradually reduce the amount of sugar I add to my food, I have started to prefer my food (even desserts!) to be less sweet, just as my taste adjusted to less salty food when we cut back on salt years ago. It’s interesting what “creatures of habit” we are, even in our taste preferences…

So, could beer (regular or non-alcoholic) be good for fatty liver disease?

It’s well established that heavy drinking can cause damage to the liver, but what about moderate amounts? And is any type of alcohol better than others?

There seems to be a debate over whether low to moderate drinking can contribute to fatty liver disease, with some researchers advising that no amount of alcohol is safe, while other studies suggest that moderate drinking (2 or less drinks per day) may be better than drinking no alcohol at all.

Part of the problem with the studies may be that only one factor (the alcohol) is being tracked, while we know that diets are complex and vary greatly from person to person and culture to culture. For example, if you substitute a sugary drink, like pop or juice, for an alcoholic one, you could be increasing added sugar enough to cause more fats to be stored in the liver, leading to fatty liver disease.

An interesting study done in mice suggests that the hops in beer may have a protective effect on the liver. When they dosed mice with pure alcohol (ethanol), beer with hops, and beer without hops (in equal amounts of alcohol), those who received the beer containing hops had significantly less fat deposited in their livers. This has led to the suggestion that dealcoholized beer with hops might be a good choice for people with fatty liver disease—both to cut back on alcohol consumption (for heavier drinkers) and to benefit from the possible liver protection hops might provide. Of course, we need to keep in mind that the study tested mice not humans. Note that hops give beer its bitter taste—a more bitter beer will contain higher amounts of hops.

Bitter beer has never been a favourite for me, but perhaps my taste can adjust to that too! Since 1/4 to 1/3 of us (statistically) have at least the beginnings of fatty liver disease, it’s something worthy of our attention. Here is a fun article on “10 Brilliant Benefits of Non-alcoholic Beer”, from having fewer calories to being a great choice when you’re the designated driver. Newer non-alcoholic beers have great taste–they’re real beer that has had the alcohol removed before bottling!

So, this was an interesting adventure down a complex rabbit hole, that started with a message from a regular reader! I love the ongoing communication I have with my subscribers, so drop me a note if you see something interesting or confusing, have a question you’d like answered or just want to make a comment on what I’ve written…

#fattyliverdisease #KetoDietandFattyLiver

References:

1. Fatty liver disease: What it is and what to do about it – Harvard Health Publishing

2. Type and Pattern of Alcohol Consumption is Associated With Liver Fibrosis in Patients With Non-alcoholic Fatty Liver Disease — The American Journal of Gastroenterology

3. Effect of a ketogenic diet on hepatic steatosis and hepatic mitochondrial metabolism in nonalcoholic fatty liver disease — Proceedings of the National Academy of Sciences of the United States of America

4. Beneficial effects of the ketogenic diet on nonalcoholic fatty liver disease: A comprehensive review of the literature – Wiley Online Library

5. Hops (Humulus lupulus) Content in Beer Modulates Effects of Beer on the Liver After Acute Ingestion in Female Mice — Journal of Alcohol and Alcoholism

6. Fatty Liver Disease – Cleveland Clinic

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Masks 4 All?

We are learning new information on COVID-19 every day. As much as we are saddened, stressed and fatigued with news of the virus, we do need to pay attention to the news because what we need to do—how we need to change our behaviour—is constantly changing.

The consensus on whether the public should wear masks is changing too. Various countries have taken a different approach to masks and researchers are noticing that masks for all is one of the strategies that successful countries, with the flattest curves on graphs of both cases and deaths, included masks along with physical distancing, washing hands, disinfecting surfaces regularly and staying home as much as possible.

The reasons given for not advising the public to wear masks when outside their homes include:

1. They have not been proven to be effective

2. They may encourage people to touch their faces to adjust the mask

3. Non-healthcare people don’t know how to put on and remove a mask properly

4. Masks need to be saved for healthcare workers, as there are not enough available for everyone (at least in North America)

In my opinion, reason #4 should be listed first…

There is no question that high-level masks should be reserved for those working directly with people who are infected. The N95 mask is designed to filter out 95% of particles from air the wearer is inhaling. This includes bacteria, viruses and fine mist that is generated during certain medical procedures. But simple, inexpensive, homemade cloth masks may be all the is needed by the general public.

The key function of masks worn by the public is to prevent people from exhaling bacteria and viruses when they talk or cough. It is known that some people have few or no symptoms of COVID-19 but can still unknowingly spread the disease. When you wear a mask to the grocery store or pharmacy, you are mainly protecting others, more than yourself. Wearing a mask doesn’t mean you don’t still have to wash your hands and avoid touching your face…it’s an extra measure of safety that is added onto what we are already doing to help protect others. Any of us could have the coronavirus but not realize we do because we do not have any symptoms. Because of the way they work, homemade cloth masks work best when everyone wears one.

Reason #1: not proven to be effective

So, are masks worn by the public effective? As medical policy makers have been saying, there is no proof they are…until now. Research in Asian countries and in Czechoslovakia, where rates of coronavirus spread are impressively low, is suggesting that their policy of masks for all is making a difference. Countries, like South Korea, Japan and Hong Kong where wearing a mask in public when you are sick is a custom, are among those with the lowest curves showing numbers of cases. As China opens up businesses and people there return to work, we will see a further test of masks combined with other strategies as the world watches whether a second wave of coronavirus can be prevented there.

Meanwhile, growing evidence of virus spread by people without symptoms is prompting the World Health Organization and governments to reconsider their policies stating that masks do not need to be worn by the public. Masks are recommended to be worn by those with symptoms that suggest COVID-19 infection, but it is beginning to seem likely that it is also being spread unknowingly by people with the virus who do not have a cough, sore throat or fever.

Reason #2: “may” encourage people to touch their faces

My first question is: do healthcare workers touch their faces more when wearing a mask or to they adapt to it quickly when told they must not do this? This, again, has not been proven to be a problem when wearing a mask and, in fact, I’ve read the opposite expert opinion elsewhere: that a mask stops a person from touching their face…it physically block you from doing this. The jury is certainly out on this one… Let’s just say that the rule of avoiding touching the face is still an important one and must be remembered whether you wear a mask or not.

Reason #3: lack of education about how to use a mask

A significant cause of infections of healthcare workers is improper removal of contaminate protective clothing. Remember that the purpose of Personal Protective Equipment (PPE) in hospitals is to create a layer that blocks viruses from reaching the worker. In the process, the outside of the equipment (including the mask) is very likely to be contaminated. The worker must learn to remove the equipment without touching the outside as this would expose them to viruses and bacteria.

But is this also an issue for people who wear a mask in public? The main purpose (as stated earlier) is to prevent the public from expelling droplets that may contain viruses when they talk or cough. This makes removal technique much less important than for those who are surrounded by viruses as they work with sick patients every day. But, just like learning to wash our hands properly, members of the public can learn to take precautions when removing their masks.

When removing your mask, it is best to handle it only by the straps or elastic, avoid touching the outside or inside and put it directly into hot soapy water (soap kills the coronavirus) or a mild bleach solution (1 part bleach to 9 parts water). Leaving it in a laundry basket can create risk of exposure for the person doing the laundry later, although generally viruses do not live more than a few hours on porous surfaces like cloth or paper. You could also put your masks into a laundry bag or pillowcase to enclose them until wash day. After removing your mask, you should wash your hands…but if you’ve just returned from an “outdoor adventure” (like shopping 😊) you should be washing your hands anyway.

The mask also needs to be put on properly for best effectiveness…it should fit as snugly as possible to maximize the filtering effect, including squeezing the metal clip or wire that is (hopefully) inserted in the edge positioned over the nose. The mask must be kept over both the nose and mouth to be effective, and we’ve all seen photos of people who have only covered their mouth with the mask or (heaven forbid!) dropped it below their chin to talk.

Remember that it is also possible to catch viruses through the eyes (although less common than through the mouth and nose), so wearing glasses to protect the eyes is also a good idea.

Reason #4: not enough masks to go around

We know that there are problems providing enough masks for our front-line healthcare workers who really need them. If everyone starts competing for the limited supply currently available, the problem will become worse. We cannot allow that to happen.

The earliest masks were a piece of fabric tied across the face, first used during the bubonic plague. Even these simple masks were reported to result in fewer infections in those that wore them. In areas of the US hardest hit, seamstresses and quilters have started making masks from cloth and many have posted patterns on the internet to encourage others. I saw a photo of homemade masks left hanging outside in Czechoslovakia for anyone needing one to freely help themselves.

The initial thought was that, even though these homemade masks are untested, it was better to have an untested one than nothing at all. But there have been preliminary tests that show this: a cloth mask does not filter as well as an N95 mask, but it does make a difference. Patterns that allow a filter to be inserted may provide even better protection. Paper towel is suggested as a simple filter that adds to the effectiveness while still allowing you to breathe easily. A double layer is more effective. And stay tuned as researchers look at what materials work best. We may need to use these for 12 to 18 months, until a vaccine is available.

So, I made 27 masks this week. I distributed some of these to my friends, family and neighbours along with the pattern so they can make more. A double layer of cotton t-shirt fabric or tightly woven cotton are suggested as effective fabrics and the stretch allows a comfortable and snug fit without using darts or tucks, keeping the construction simple and quick. Five to six adult- and 2 child-sized masks can be made from one large adult cotton t-shirt. The sewing so limited the mask could be sewed by hand if you don’t have a sewing machine. I will post the pattern and instructions for use below. This design fits best if the top straps pass over the ears and the bottom straps are pulled up and fastened at the top of the head. Note that woven cotton, cut on the bias (diagonal) provides some stretch.

I plan to make as many as I can—although I may be limited by my t-shirt supply (any donations welcome!)—and I want to encourage others to wear them and make them too! Will you join me in the movement to slow the spread of COVID-19 by helping to make “masks 4 all”?

Slogan for the mask campaign in Czechoslovakia:

“My mask protects you. Your mask protects me.”

References:

WHO considers changing guidance on wearing face masks- The Guardian

CSC considering recommending general public wear face coverings in public—The Washington Post

Alternative fitted face mask pattern–Unity Point Health (made with t-shirt fabric or woven cotton)

Jeannie Beaudin’s Simple Mask Pattern (with filter pocket)

Made from a t-shirt, preferably 100% cotton, heavyweight

Sides are left open so a paper towel (folded in half) can be inserted as a filter for extra protection. One large short sleeve t-shirt makes 5 or 6 adult and 2 child size masks.

Cut across the t-shirt, 13 inches up from the hem. Turn inside out and cut away seams from the sides. Save to use as ties. Cut 9-inch strips, so you have 9 x 13 rectangles with one 9-inch edge already hemmed (from the bottom of the shirt). This edge will form the top of the mask.

You will be able to get 2 from the bottom front, 2 from the bottom back plus 1 to 2 from the upper section , depending on the size of the t-shirt. Sleeves can be made into child-size masks or ties if necessary.

Insert wire of some kind into the pocket formed by the t-shirt hem. Four-inch pieces of pipe cleaner, or 2 to 3 twist ties can be used. Center the wire then stitch across the pocket on each side of it to keep it centered.

Fold up the bottom so it just overlaps the hem stitching. Zigzag along the overlap or hand sew with hem stitch if you don’t have a machine.

The ones from the upper back won’t have a pre-hemmed edge. Fold this 9 x 13-inch rectangle in half. Stitch a ¼-inch seam across the 9-inch side. Place your wire on top of the seam allowance, and stitch in place with a wide zigzag stitch that jumps over the wire or hand-stitch in place. Turn right side out and press lightly.

Cut strips ½ to 1 inch wide from leftover fabric for ties. There will likely be enough in the lengthwise fabric since most t-shirts are more than 18 inches wide, but they can also be cut crossways from the upper part of the t-shirt or the sleeves. If you want to be “fancy” you can pull lengthwise on the strips so they curl, then stitch with a zigzag stitch to keep them folded in half.

Stitch securely to each corner of the mask. Can tuck the end of the strap between the layers before stitching.

Child mask is made the same way from the sleeve fabric or other leftover sections. Trim to width needed to reach from front of one ear to the other. Depth can be adjusted to reach from bridge of nose to under the chin when folded in half.

To wear:

Fold a piece of paper towel in half and insert into the mask through the side opening. One piece of multi-size towel works perfectly. Place the wire edge over the bridge of your nose. Pass the upper ties over your ears and tie snugly behind the head. Pull the lower ties up and tie near the crown of your head. Tuck the sides in under the ties that are pulled upward, making a neat little pocket. Squeeze the wire so it fits snugly over your nose (this will keep your breath from escaping and fogging your glasses!). Wear glasses for extra protection for your eyes!

To remove:

Try to hold the mask by the ties when you remove it (the front could be germy…). Remove the paper towel from the pocket through one of the side openings and discard immediately. Drop the mask into hot soapy water, swish/ soak for 5-10 mins so mask is well exposed to soap (soap kills viruses!), rinse, wring, roll in a towel to absorb excess moisture and hang to dry. Wash hands!

P.S. Won’t we all be stylish this spring! You could make lots of different colours to match your favourite outfits this summer!! …Just like the Prime Minister of Czechoslovakia 😊

#Masks4all #shouldwewearamask #howtomakeafacemask

Categories
Health

4 Things you should do to avoid becoming a frail little old lady (or man)…

Becoming frail when you get old isn’t inevitable… Researchers have found 4 things you can change to increase your chances of being able to move easily and do all the things you want well into old age.

4 things you should do to to prevent becoming frail:

  1. Watch your weight. Keep your weight in the normal to overweight class. Those who are very overweight, classed as “obese” have a 7.9% chance of having difficulty getting around when they’re old compared to 2.9% of those who are a healthy weight.

    1. Not sure what’s normal? Here’s a link to a chart that can help you figure it out, or a calculator that will give you a Body Mass Index (BMI) number.

    2. Aim to have a BMI between 18.5 and 29.9, although some recent studies suggest people with a BMI between 25 and 29.9 live the longest. Being underweight is considered as risky to your health (statistically) as being obese.

  2. Be active, ideally every day, but at least for 30 minutes 3 times a week. This recommendation just makes sense – muscles that aren’t used wither and become weak over time. As some will say, “use it or lose it”!

    1. Note that it doesn’t have to be strenuous exercise, just walking will do. And it doesn’t have to be 30 minutes straight of exercise. Ten minutes 3 times during the day works just as well.

    2. If you carry a phone around with you, an easy way to measure your activity is to install a free pedometer on it. I tried out a few and the one I like best is called Pedometer Step Counter. It tracks steps, distance, calories burned and time, and allows you to set goals if you want. You can look back by day, week or month to see how you’ve been doing. It’s really fun to see how far you’ve walked when on vacation… I walked over 150 km a month when we were in Spain last fall!

    3. By the way… the photo above is of a 90-year old who teaches yoga! Here’s her story as told on ABC News in 2013…

  3. Don’t smoke. This one probably has something to do with losing lung function… 5.4% of smokers became frail in old age, compared to 3.5% of non-smokers. But smoking also causes inflammation (see #4) so could be causing frailty and contributing to the aging process in several ways. There are so many reasons to quit… Smoking makes your skin age more quickly too, by the way, so quitting will help keep you looking your best!

  4. Reduce chronic inflammation. Two proteins are found in your blood that tell doctors how much inflammation might be hiding in your body.

    1. The first is called interleukin-6, and it is an indication of inflammation levels in the body. Higher interleukin-6 means you have more inflammation, and that’s an important factor in aging and disease. More about that later…

    2. The other is C-Reactive Protein (CRP), another marker of inflammation. Some doctors have started checking CRP levels to determine their patients’ risk of heart disease.

      1. Production of both interleukin-6 and CRP proteins can be decreased by cutting down on sugar intake and reducing stress.

Chronic inflammation

A Harvard Health article refers to inflammation as a “unifying theory of disease”. Often thought of as a result of disease, inflammation has been shown in newer studies and observations to be part of the cause of many diseases. Mounting evidence suggests that coronary artery disease (that leads to heart attacks), diabetes, cancer and Alzheimer’s Disease all include inflammation as part of their causes.

We recognize acute inflammation by the heat, pain, redness and swelling it causes. This is part of the body’s response to injuries, like cuts, scrapes, and sprains, to foreign substances, and disease-causing organisms like bacteria and viruses. Acute inflammation is part of our immune system’s protective action. The problem occurs when the helpful inflammation is not turned off afterward. This leads to chronic inflammation that can cause aging and disease.

We all have a certain amount of chronic inflammation and for many it stays under the radar, only to be noticed by a blood test. Anti-inflammatory drugs like aspirin and ibuprofen reduce inflammation and this is likely part of the reason that low-dose aspirin helps to prevent heart attacks along with its ability to prevent blood clots.

But many chronic diseases have been observed to occur less often in people who are taking anti-inflammatory drugs for other reasons, such as for pain or arthritis. Over a hundred years ago, it was observed that sugar levels in the urine of people with diabetes were reduced when they took high doses of sodium salicylate, a form of aspirin. It was even documented that sugar in the urine could be eliminated in some people with milder cases of diabetes. Of course, that doesn’t say that their blood sugar, the more important reading, was completely reversed, but it was a very interesting observation.

Cancers of the liver, cervix and stomach which make up about 15% of cancers, are closely tied to levels of chronic infectious diseases, generators of chronic inflammation. Cigarette smoke, a known cause of lung cancer, and asbestos, associated with a type of cancer of the lining of the chest, both contain ingredients that cause inflammation.

Inflammatory reactions produce reactive forms of oxygen that can damage cell DNA, and this damage can lead to the initiation of a cancer. Fruits and vegetables contain many anti-oxidants that can neutralize these free oxygen radicals, and this is likely one way that these foods help to prevent heart disease and cancer. They probably help to prevent diabetes and Alzheimer’s, too, through the same mechanism… reducing inflammation in the body.

Here’s what you can do…

The good news is that there is lots you can do to reduce inflammation in your body and keep your cells from aging more quickly. Eat a healthy diet with lots of fruits and vegetables, and avoid high amounts of added sugar, refined carbohydrates (like white flour), and processed foods, especially those containing trans fats. Reduce stress as much as you can and exercise regularly, as it reduces the negative effects of stress on your health as well as keeping you fit.

Make sure you seek treatment for any infection, complete the treatment and go back if it’s not completely cleared. And talk to your doctor about whether you would benefit from a low dose of the anti-inflammatory, aspirin.

Other research

In an earlier blog “On family dinners and living longer” I described research on Blue Zones, areas where significant numbers live beyond the age of 100 years… click here if you missed it.

References:

Old before your time? Daily Mail, UK

Inflammation and Insulin Resistance, Journal of Clinical Investigation

BMI Calculator

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