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Wellness Library articles contain step-by-step guides to diseases and conditions, ranging from how a baby develops and grows, to memory care for Alzheimer's patients. Resources include information on disease and condition management, prevention and self-care, when to consult a physician, what to ask the physician and educational quizzes to test knowledge and track symptom progression.

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Arthritis Treatments: How to Get Pain Relief From Arthritis

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THURSDAY, April 20, 2023 (HealthDay News) -- There are more than 100 types of arthritis and related conditions, and they affect at least 54 million adults and 300,000 children in the United States, according to the Arthritis Foundation.

Fortunately, there are also many medications, non-medication options, lifestyle changes and surgeries available to help you manage arthritis pain and other symptoms.

“We’ve really come a long way in the past decade in terms of helping our patients live relatively symptom-free lives,” Scripps Clinic rheumatologist Dr. Kavitta Allem explained in an interview for San Diego Health.

Let’s take a look at the most common arthritis treatments recommended by experts, whether they're for osteoarthritis, rheumatoid arthritis or psoriatic arthritis.

Arthritis medications

The Arthritis Foundation lists six main types of medication to help treat arthritis symptoms:

  • Analgesics: painkillers such as over-the-counter acetaminophen and prescribed opioids
  • Nonsteroidal anti-inflammatory drugs (NSAIDs): inflammation and pain-reducing medications, including over-the-counter aspirin and certain prescribed drugs like celecoxib (Celebrex)
  • Corticosteroids: fast-acting medications that mimic your natural cortisol to help reduce joint inflammation, especially over the short term
  • Disease-modifying anti-rheumatic drugs (DMARDs): slow-acting anti-inflammatory medications to treat arthritis symptoms over the longer term
  • Targeted DMARDs: synthetic DMARDs that block parts of the immune system to reduce inflammation
  • Biologics: natural (cell-derived) DMARDs that block parts of the immune system to reduce inflammation.

U.S. National Institutes of Health (NIH) joint specialist Dr. Michael Ombrello noted in a newsletter that biologics can be particularly helpful for treating severe arthritis in children.

“Biologics have really changed the face of juvenile arthritis,” he said, explaining that the medication helps reduce children’s reliance on wheelchairs and crutches.

For additional on arthritis medications, American Physical Therapy Association (APTA) spokesperson Maura Iversen recommends the Arthritis Foundation’s Drug Guide as a useful tool to help understand ”what the medication is, what it targets in your body, how long it takes to work, [and] what are some potential side effects.”

Non-medication arthritis treatments

There are several natural ways to manage your arthritis pain. The Arthritis Foundation states that eating a healthy diet, exercising regularly, applying heat and cold to your joints, and taking short 15-minute breaks to rest throughout the day can help improve your symptoms. Research published recently in the Annals of Internal Medicine showed that even light exercise can help ease the pain of arthritic knees and give you wider range of motion.

Therapies for arthritis include massage, acupuncture, biofeedback and cognitive behavioral therapy. The foundation also recommends working with a physical therapist to improve your posture and range of motion.

Iversen, who is also dean of the College of Health Professions at Sacred Heart University in Fairfield, Conn., pointed out that when physical therapists create an exercise plan, they consider the type of arthritis you’re diagnosed with, where in the body it manifests, its severity and whether you’re in remission or are experiencing a flare-up.

“All of that is taken into account, into the individual exercise programs that a physical therapist would prescribe,” she explained.

Iversen suggested several physical activity programs that are supported by APTA to help improve arthritis pain and other symptoms, including those offered through the Arthritis Foundation.

“The YMCA has a long, long history, at least in my 30-year career, of partnering with the Arthritis Foundation to offer aerobic programs for patients with arthritis,” she noted. “There’s also a walking program [and] we are fortunate nowadays with mobile apps where you can download a health app.”

Arthritis surgery treatments

Dr. Paul DeMarco, Rheumatology Fellowship Training Program Director at the National Institute for Arthritis and Musculoskeletal and Skin Diseases (NIAMS), explained that “surgery can be very helpful in the right situation, and especially important before joint pain affects sleep, results in an inability to exercise or causes the joint to be limited.”

You have several surgery options to choose from to help treat your arthritis pain, depending on how it affects your body, according to the Arthritis Foundation:

  • Arthroscopy: surgeons use a camera and a small incision to find and repair damaged tissues, cartilage and ligaments around the knees, shoulders, hips and other joints
  • Total joint replacement (arthroplasty surgery): a joint (typically in the hip or knee) is replaced with an implant
  • Joint resurfacing or partial joint replacement surgery: part of a joint is replaced with an implant
  • Joint revision surgery: a damaged, malfunctioning or infected implant is replaced
  • Arthrodesis or fusion surgery: hardware such as pins are used to join two or more bones together to keep the joint locked in place
  • Osteotomy: a wedge is added to a bone or the bone is partially or completely removed to move weight off of an area that’s been damaged by arthritis
  • Synovectomy: the lining of a joint is partially or fully removed to help limit the damage to surrounding cartilage.

If you’d like more information on arthritis treatments, Iversen recommends the APTA’s ChoosePT and Find a PT resources. You can also check out Arthritis Foundation’s Treatment Guides for additional therapies and surgeries to help improve your arthritis pain.

SOURCES: Paul DeMarco, MD, Rheumatology Fellowship Training Program Director, National Institute for Arthritis and Musculoskeletal and Skin Diseases (NIAMS); Maura Iversen, PT, DPT, MPH, dean, College of Health Professions, Sacred Heart University, Fairfield, Conn.

Does Cracking Your Knuckles Cause Arthritis?

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THURSDAY, April 20, 2023 (HealthDay News) -- Have you heard the old wives’ tale that knuckle cracking will enlarge your knuckles? What about the one that cracking your knuckles causes arthritis?

There are many beliefs about this common behavior, but it's time to debunk the myths about knuckle cracking.

Why do people crack their knuckles?

Harvard Health cites several possible reasons.

"Knuckle cracking is a common behavior enjoyed by many," saidDr. Robert Shmerling, a rheumatologist and senior faculty editor at Harvard Health. "It can become a habit or a way to deal with nervous energy; some describe it as a way to 'release tension.' For some, it’s simply an annoying thing that other people do."

Sometimes people crack their knuckles out of habit. Like cigarette smoking, excessive knuckle cracking can become a hard habit to break. Stress relief is another reason why people crack their knuckles.

What causes the popping noise when you crack your knuckles?

Dr. Thanda Aung, an assistant clinical professor in UCLA's Division of Rheumatology, explains there haven’t been enough studies to explain the mechanism behind the cracking noise. However, she says there are two hypotheses.

The first is the popping noise “could be from the movement of all the structures” in the finger such as the bones, tendons and ligaments.

The second hypothesis has to do with the synovial fluid (the fluid that lubricates the joints) and the gas created from the synovial fluid. Aung explains the cracking sound may result from the movement of this gas in and out of the tight space in the finger joints.

Now, does cracking your knuckles cause arthritis?

Aung referenced an older study on habitual knuckle cracking and hand function.

The study determined that “habitual knuckle crackers were more likely to have hand swelling and lower grip strength” compared to those who don’t regularly crack their knuckles.

But the study also concluded there is “no clear evidence this habit is associated with osteoarthritis,” Aung added.

“Nonetheless, in theory, although we don’t have enough studies to support the association between knuckle cracking and osteoarthritis, if you manipulate your joints significantly, multiple times, for a significant duration of time, it can cause damage,” she noted.

The bottom line: Knuckle cracking is a common behavior and Aung suggested there should be more studies conducted over a longer period of time to further understand its link to degenerative joint disease.

How can you stop cracking your knuckles?

Aung reports many of her patients ask questions about knuckle cracking. They disclose the primary reason they crack their knuckles is in response to stress and anxiety.

She offers some practical advice to her patients.

First, Aung recommends they practice breathing exercises and meditation. Experts agree there are clear physical and psychological benefits to these practices.

Harvard Health suggests following these simple steps to get started with breath work and meditation.

As with any new strategy, developing a routine is key to sticking to it and reaping the benefits. The more practice you get with breathing exercises and meditation, the easier it will be to use these strategies at a time when you’re feeling anxious or stressed out.

It’s understood that knuckle cracking is often done subconsciously or without awareness. For this reason, Aung suggests “keeping your hands busy doing something else” as a solution.

There are multiple ideas for this, including stress balls, fidget toys, therapy putty and drawing or doodling. The best advice is to find something that works for you and your situation.

Finally, Aung suggests trying common anxiety and stress relievers such as healthy eating, exercise, connecting with others and journaling.

While there’s no definitive evidence to suggest knuckle cracking causes arthritis, it may be worth pursuing healthier ways to deal with anxiety and stress and finally break this habit.

SOURCE: Thanda Aung, MD, assistant clinical professor, Division of Rheumatology, UCLA Health, Los Angeles

What Arthritis Surgeries Help With Pain and Other Symptoms?

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THURSDAY, April 20, 2023 (HealthDay News) -- Surgery may help you manage pain and other symptoms if you have certain types of arthritis or your arthritis is severe.

To help you decide if surgery is right for you, here's a breakdown of five of the most common arthritis surgeries, including what they involve, how they’re performed, who the best candidates are and what recovery may look like.

Arthroscopy surgery

With arthroscopy, a few small cuts are made by a surgeon and a tube with a camera on the end is inserted, along with specialized surgical instruments used to repair the joint. The camera projects your joint’s image onto a screen so doctors can see it better.

According to University of Washington Medicine, the surgery is used to take a tissue biopsy sample, repair torn cartilage, smooth a rough joint, remove torn tissue around a joint, reconstruct ligaments and even perform joint fluid repair. Since it’s a less invasive type of surgery, arthroscopy recovery times are typically faster than other surgeries.

The Mayo Clinic mentions that arthroscopy may be performed on those with infectious arthritis, while New York-Presbyterian notes that it can be somewhat beneficial for relieving rheumatoid arthritis symptoms.

The best candidates for arthroscopy are active individuals aged 40 and under, according to the Arthritis Foundation. However, the foundation does not recommend arthroscopy surgery for people with osteoarthritis (OA), since there’s a lack of evidence it relieves that condition’s pain symptoms.

Total joint replacement (TJR) surgery

During total joint replacement (TJR), the entire joint and surrounding damaged tissues are removed and replaced with an implant, according to Southcoast Health.

People with more severe forms of rheumatoid arthritis and osteoarthritis who aren’t responding to other treatments are the best candidates for this surgery. It’s mainly performed on the hips, knees and shoulders, although it’s sometimes done on fingers, elbows, ankles and other joints.

Accordington to Arthritis Australia, this surgery is also an option for people living with advanced psoriatic arthritis.

Although it is usually only performed on older adults, the Arthritis Foundation says that TJR is an option for children with juvenile arthritis as a way to help restore mobility in extremely damaged joints.

Joint resurfacing surgery

Joint resurfacing surgery is also called partial joint replacement. It’s similar to TJR, except that only part of the joint is removed and replaced with an implant.

The Arthritis Foundation notes that hip resurfacing is a good option for those under age 50, especially men with larger builds. It allows you to continue high-impact activities and maintain more flexibility than TJR. For the knee, resurfacing is recommended if your arthritis is only in one compartment.

Unlike TJR, however, knee and hip resurfacing is not recommended for slimmer people or anyone with osteoporosis. The surgery also tends to have higher complication rates than TJR.

Dr. Paul DeMarco, Rheumatology Fellowship Training Program Director at U.S. National Institute of Arthritis and Musculoskeletal and Skin Diseases, said that having a recovery plan for both partial and total joint replacement surgery is crucial because it’s one of the more challenging joint surgeries to recover from.

“It is important to think about available support systems in the postoperative period, so having family or friends available to assist is important,” he said. “Transport to postoperative physical therapy is equally important.”

Joint revision surgery

Revision surgery for joints involves replacing a previously implanted artificial device that was inserted during a TJR or joint resurfacing surgery. It’s recommended when your implant fails, becomes infected or is damaged.

Typically, the younger you are when you have your implant, the higher the chances that you’ll need revision surgery. This is because these artificial implants usually only last 15-20 years, according to the Arthritis Foundation.

In fact, an analysis published recently in The Lancet Rheumatologyrevealed that up to 35% of knee joint replacement surgeries are revised in younger males.

Hip revision surgeries have also increased significantly in the United States, according to a study published in The Journal of Joint and Bone Surgery, particularly among people ages to 45-64.

Osteotomy

The Arthritis Foundation states that osteotomy surgery involves cutting, removing and reshaping bone, typically in the knee or hip. It’s a procedure that is usually recommended for those under age 40 and may help delay a TJR by 10 to 15 years.

According to Brigham and Women’s Hospital, this surgery is often performed on people with the most common type of arthritis, osteoarthritis, to help shift weight off damaged joint cartilage and reduce pain.

If you choose any of these surgeries to treat your arthritis, DeMarco suggested putting together a post-surgery plan of action to “include an understanding of what type of medications the doctor will provide, and what type of alternative therapies will be useful for management and return to activity.”

SOURCE: Paul DeMarco, MD, Rheumatology Fellowship Training Program Director, U.S. National Institute of Arthritis and Musculoskeletal and Skin Diseases

The Most Common Arthritis Symptoms You Should Know

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TUESDAY, April 18, 2023 (HealthDay News) -- Most people think of joint pain when they think of arthritis but, depending on the type of arthritis, other symptoms can crop up.

Here's how to spot some of the most common signs of different types of arthritis.

Arthritis can cause painful symptoms that make daily activities challenging, according to the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS).

Dr. Paul DeMarco, NIAMS Rheumatoid Fellowship Training Program director, explained that “it is extremely important to understand the type of arthritis afflicting the sufferer, as some arthritis syndromes have effects throughout the body.”

To help you better understand just how arthritis can affect the body, here is a list of eight of the most common types:

  • Inflammatory arthritis
  • Psoriatic arthritis
  • Rheumatoid arthritis
  • Osteoarthritis
  • Gout
  • Juvenile arthritis
  • Infectious arthritis
  • Reactive arthritis

Here are some common arthritis symptoms, broken down by the type of arthritis the patient has:

Inflammatory arthritis symptoms

Inflammatory arthritis occurs when an overactive immune system causes joint inflammation, according to the Hospital for Special Surgery (HHS), in New York City.

Symptoms of inflammatory arthritis include:

  • Pain and stiffness, especially in the morning or after periods of inactivity
  • Warm sensations in and around affected joints
  • Joint swelling and redness
  • Inflammation of the skin or internal organs

These symptoms are often experienced as strong flare-ups, followed by a period of inactivity.

Psoriatic arthritis symptoms

Psoriatic arthritis (PsA) is a type of inflammatory arthritis, and it usually happens to people with psoriasis, according to NIAMS.

Psoriatic arthritis symptoms include:

  • Joint stiffness, pain and swelling, especially in the morning
  • Eye inflammation
  • Fatigue
  • Soreness in spots where tendons attach to bones
  • Inflammatory bowel disease
  • Nail crumbling, separating or denting
  • Flaky, swollen patches of skin

"PsA is usually not found on the same joints on both sides of the body, so it is asymmetric,” DeMarco noted.

Rheumatoid arthritis symptoms

Rheumatoid arthritis is also a type of inflammatory arthritis. More specifically, it’s an autoimmune disease, meaning the immune system attacks its own joint tissues. It can occur throughout the body, but usually affects the hands, wrists and feet, according to NIAMS.

Rheumatoid arthritis symptoms include:

  • Joint stiffness that lasts longer than half an hour
  • Joint pain and inflammation
  • Fatigue
  • Loss of appetite
  • Mild fever
  • Nodules, or lumps beneath the skin
  • Medical issues in the lungs, heart, skin, nerves and eyes

Unlike PsA, rheumatoid arthritis typically occurs in the same joints on both sides of the body.

Osteoarthritis symptoms

Osteoarthritis is the most common type of arthritis, affecting over 32 million U.S. adults, according to the U.S. Centers for Disease Control and Prevention. It’s caused by wear and tear on joint cartilage as people age.

“Symptoms tend to occur more slowly over time, first occurring every now and then, and then becoming more chronic,” Scripps Clinic rheumatologist Dr. Kavitta Allem said in a recent interview for San Diego Health.

NIAMS states that osteoarthritis symptoms may include:

  • Joint stiffness that lasts less than half an hour
  • Pain and swelling during and immediately after activity
  • Unstable sensations in the joints
  • Scraping noises when walking, particularly in the knees
  • Radiating pain down the legs
  • Stiffness in the lower back and neck
  • Bone spurs (enlargements) in the hands
  • Difficulty standing and sitting
  • Fatigue, insomnia and depression

Gout symptoms

Gout is also a type of inflammatory arthritis, caused by too much uric acid in the blood. This triggers crystals to form on the joints. The CDC states that it usually affects just one joint at a time, usually in a foot, ankle, or knee.

Gout symptoms include:

  • Intense pain
  • Swelling
  • Inflammation and warmth

“The joints that have gout, the symptoms come on very suddenly, generally over the course of a night,” Allem noted.

Juvenile arthritis symptoms

The Arthritis Foundation explains that juvenile arthritis is a group of arthritis conditions that affect children under the age of 16.

Although symptoms may vary, here are some of the most common:

  • Joint pain, tenderness, stiffness and warmth, especially after a period of inactivity
  • Eye inflammation
  • Skin rashes
  • High fever
  • Fatigue
  • Loss of appetite
  • Shortness of breath (when the lungs are affected)
  • Diarrhea and bloating (when the digestive tract is affected)

Infectious arthritis symptoms

Infectious arthritis (septic arthritis) is caused by a bacterial, viral or fungal infection of the joint tissues and fluids. More children are affected than adults, according to the Cleveland Clinic.

The symptoms of infectious arthritis include:

  • Fever
  • Joint tenderness, inflammation, warmth and pain
  • Limited range of motion

Reactive arthritis symptoms

NIAMS states that reactive arthritis occurs due to an infection, but symptoms don’t start until the infection is cleared up. They may include:

  • Joint pain and stiffness, especially in the lower limbs
  • Eye and urinary tract inflammation
  • Inflamed fingers and toes
  • Fever
  • Fatigue
  • Skin rash
  • Abdominal pain and diarrhea
  • Nails that thicken
  • Weight loss
  • Mouth ulcers

When to seek help for arthritis symptoms

“If you’re feeling swelling or pain in your joints, or something is limiting your ability to be active, you should see a doctor,” Allem explained. “There are new treatments for arthritis to help you feel better and get back to what you enjoy.”

Get Pain Relief With the Most Common Arthritis Medications

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MONDAY, April 17, 2023 (HealthDay News) -- Arthritis is a common disease that causes pain and inflammation in different body joints, making it difficult to enjoy everyday tasks and physical activity.

Fortunately, there are many different medications for arthritis. Depending on what type of arthritis you have and its severity, an arthritis medication may help you manage pain and other symptoms. Here is a breakdown of the most common arthritis medications, how they work and their potential side effects.

The Arthritis Foundation lists the following as the medications used to treat arthritis:

  • Analgesics including acetaminophen (Tylenol) and opioids
  • Nonsteroidal anti-inflammatory drugs (NSAIDs)
  • Corticosteroids
  • Disease-modifying antirheumatic drugs (DMARDs) including biologics and targeted DMARDs

Analgesics

The Arthritis Foundation reports that analgesics may help with mild to moderate pain, but they will not help with the inflammation associated with arthritis. Analgesics work in the nervous system and alter how your brain perceives pain. They can be used to treat the pain associated with any type of arthritis, although more effective options are available. Analgesics can be opioid, non-opioid or a combination.

Common analgesics are:

  • Acetaminophen (Tylenol)
  • Codeine
  • Oxycodone
  • Fentanyl
  • Hydrocodone

Potential side effects:

  • Kidney damage
  • Liver damage
  • Addiction
  • Constipation
  • Gastrointestinal bleeding

Use caution when taking these medications; take only as prescribed.

NSAIDs

NSAIDs work by blocking prostaglandin. According to the Cleveland Clinic, one role prostaglandins play is forming clots and causing inflammation at the site of an injury. NSAIDs are used to treat the pain and inflammation associated with rheumatoid arthritis and osteoarthritis.

Common over-the-counter (OTC) NSAIDs are:

  • Aspirin (Bayer, St. Joseph, Anacin, Excedrin and more)
  • Ibuprofen (Motrin, Advil)
  • Naproxen sodium (Aleve)

Prescription NSAIDs are:

  • Celecoxib (Celebrex)
  • Diclofenac (Voltaren, available by brand name in topical form)
  • Fenoprofen (Nalfon)
  • Indomethacin (Indocin, available by brand name in liquid form)
  • Ketorolac tromethamine (Toradol)
  • Meclofenamate sodium (Meclomen)
  • Diflunisal (Dolobid)
  • Tolmetin (Tolectin)
  • Ketoprofen (Orudis)
  • Flurbiprofen (Ansaid)

Potential side effects of NSAIDs are:

  • Increased risk of stomach and bowel issues like ulcers and bleeding
  • Increased risk of stroke
  • Heart problems
  • Stomach pain
  • Nausea
  • Diarrhea/constipation

Corticosteroids

According to the Arthritis Foundation, corticosteroids mimic cortisol, a hormone your body produces naturally. They are used to treat inflammatory types of arthritis, including rheumatoid arthritis and psoriatic arthritis. They are great for short-term relief of inflammation but are not recommended for long-term use because of their side effects. Your doctor may prescribe a lower dose if you require them for long-term use.

Common corticosteroids:

  • Prednisone (Deltasone, Prednicot, Cotolone)
  • Prednisolone (Orapred, Omnipred)
  • Cortisone (Cortone)
  • Hydrocortisone (Cortef, Hydrocort)
  • Triamcinolone (Aristocort)
  • Dexamethasone (Decadron)

Common side effects of corticosteroids:

  • Blood sugar spikes
  • Weight gain
  • Bone loss
  • Risk of cataracts
  • High blood pressure
  • Infections
  • Mood changes

DMARDs

The Arthritis Foundation says that DMARDs work with the body to “stop or slow the disease process in inflammatory forms of arthritis.” They work by blocking inflammation. There are many different DMARDs on the market, and they all have different ways of working in the body.

  • Conventional DMARDs work by broadly suppressing the immune system. Often they are used in combination with other therapies.
  • Targeted DMARDs block specific pathways inside immune cells.
  • Biologic DMARDs are produced by live cells and work on specific immune proteins called cytokines.

Common DMARDs:

  • Apremilast (Otezla)
  • Baricitinib (Olumiant)
  • Cyclophosphamide (Cytoxan)
  • Cyclosporine (Gengraf, Neoral)
  • Hydroxychloroquine (Plaquenil)
  • Leflunomide (Arava)
  • Methotrexate (Otrexup, Rasuvo, RediTrex)
  • Mycophenolate mofetil (CellCept)
  • Sulfasalazine (Azulfidine)
  • Tofacitinib (Xeljanz, Xeljanz XR)

According to the Cleveland Clinic, common side effects of traditional DMARDs include:

  • Loss of appetite
  • Nausea
  • Diarrhea
  • Abdominal pain
  • Rash, allergic reaction
  • Liver problem
  • Increased risk of infection
  • Low blood cell counts

Common side effects of biologic DMARDs include:

  • Increased risk of common and serious infections
  • Reactivation of tuberculosis, herpes zoster, and hepatitis B and C
  • Increased cholesterol levels, increased liver enzymes and low blood cell counts
  • Increased risk of clotting

When prescribed DMARDs, inform your doctor of any other medications, including over-the-counter medicines, you are taking to avoid drug interactions. Some of these medications can cause teratogenicity (defects in a developing fetus.)

Writing recently in the Journal of the American Academy of Physician Assistants (JAAPA), physician assistant Michelle DiBiase and Dr. Samantha Kohn remind people that "The mainstay of pharmacologic therapy is early intervention with use of nonbiologic and biologic DMARDs together with adjunctive medications such as NSAIDs, oral and intra-articular corticosteroids, and analgesic medications, including opioids."

Your primary care provider or rheumatologist will work closely with you to determine which medications are best for your treatment. It is vital to keep them apprised of any side effects and let them know if the treatment is ineffective. They can work with you to find a treatment that helps relieve the pain and inflammation caused by arthritis.

How to Find a Therapist Who Fits Your Needs

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MONDAY, April 17, 2023 (HealthDay News) -- Deciding to go into therapy is a big move, one that people sometimes struggle with for a variety of reasons.

But now that you’ve realized therapy would be helpful for you, how to find a therapist? It’s important to know what outcome you’re hoping for and what you feel you need help achieving.

It will take a little research to determine which professionals your insurance will cover and how you’ll pay any out-of-pocket costs, but asking the right questions can help you ensure you have a qualified therapist who’s also the right fit for you.

Know your options

While numerous types of therapy exist, perhaps the best known is cognitive behavioral therapy (CBT), which is used to treat a number of mental health issues, from anxiety to eating disorders.

It focuses on uncovering unhealthy patterns of thought and exploring how a person's thoughts, feelings and behaviors affect each other, according to the National Alliance on Mental Illness (NAMI).

“Cognitive behavioral therapy is going to be an approach to treatment that looks at or tries to understand current functioning problems and address what's maintaining those and how might a person's current behaviors and cognitions be contributing to those challenges,” said Lynn Bufka, a clinical psychologist in Maryland and the American Psychological Association’s associate chief for practice transformation.

Another type is relational psychotherapy, often focused on couple or family relationships.

Working through the red tape

Cost was one of the top reasons that people who felt they needed therapy didn’t pursue it, according to the American Psychological Association, which cited data from the U.S. Substance Abuse and Mental Health Services Administration.

This may be resolved by checking to see if your health insurance company offers coverage for mental health therapy and if certain practitioners are “in network.”

Ask a potential therapist about their fees and whether they’ll bill your insurance or provide you an invoice that you can submit to your insurance company.

Finding a therapist

Sometimes word-of-mouth recommendations are the best bet.

You can find a provider by asking your insurance company for a list or asking a doctor you’re seeing to refer you to someone. You may also ask clergy, a friend or a family member for a recommendation.

The American Psychological Association can help you find a psychologist by ZIP code, or you can look through the National Register.

The American Psychiatric Association also offers a locator to help find a psychiatrist.

“I will say it can be a lot of work,” Bufka noted. “And that's really unfortunate, particularly because when we're looking for a therapist we're typically looking for a therapist when we're not feeling great.”

She suggests that if you have a family member or close friend who might be willing to help, ask them to make some of the necessary research calls.

Other important questions to ask

Some mental health issues are quite common, such as anxiety and depression, but other conditions may require asking more questions when seeking the right therapist for you.

“I think it's really important to ask, ‘Do you have experience treating this? Here's what I think's going on with me,'” Bufka said.

Treatment for bipolar disorder and obsessive-compulsive disorder can be more specialized. And someone who has a history of trauma may want to find a provider who has worked with others who have experienced similar issues.

“If something that's really important to you is your spirituality or your sexual orientation or your relationship with X, Y or Z, and you know that's going to be part of your treatment, ask ‘How comfortable are you with this?’” Bufka suggested.

You can also ask, “How long do you think it might be before I start to see some change?” and “About how long do you think I might be in therapy overall?” she added.

Online vs. local

Fortunately, mental health care delivered via the internet appears to be just as helpful for many mental health conditions as that delivered in person, Bufka said.

A grayer area is whether a patient can get the same qualified counseling services and security through one of the new all-virtual platforms as they can with a local provider online or in person.

“If you go to some of these larger platforms where there might be hundreds or thousands of therapists, it can be a little bit harder to verify the credentials of who you're seeing and what their expertise is,” Bufka cautioned. “So just do a little more due diligence around that.”

Verify that the therapist you’ll be seeing is licensed, Bufka advised. That protects you by ensuring your therapist has met a minimum standard of education, training and other licensing requirements. Ask what happens to your data if the clinician you’re seeing leaves the practice.

If you do find a therapist and later discover that person isn’t a good fit for you, it’s OK to make a change.

“You should feel comfortable saying, ‘I don't think this is working for me. I need to find somebody else,’” Bufka said. “Many therapists can help you find someone else. They may be thinking that, too.”

SOURCE: Lynn Bufka, clinical psychologist, Maryland, and associate chief for practice transformation, American Psychological Association

What Are the Major Types of Arthritis?

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MONDAY, April 17, 2023 (HealthDay News) -- Arthritis strikes millions of Americans, leaving them with aching, inflamed joints that make it hard to move around without pain.

It is the leading cause of disability and most common in women, but is it the same for everyone?

Absolutely not. There are over 100 different forms of arthritis and they aren't all treated the same, according to the Arthritis Foundation.

Here are the four main types of arthritis, and more about their differing symptoms and treatments:

  • Osteoarthritis
  • Autoimmune inflammatory arthritis
  • Infectious (reactive) arthritis
  • Gout (metabolic arthritis)

Osteoarthritis

The National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) states that osteoarthritis is the most common type of arthritis, especially in older people. The tissues in the joint break down, and as the disease develops, it can damage the entire joint. The joints most commonly affected are:

  • Hands (ends of fingers and base of the thumb)
  • Knees
  • Hips
  • Neck
  • Lower Back

Common symptoms of osteoarthritis are:

  • Pain in the joint
  • Joint stiffness
  • Limited range of movement in the joint
  • Swelling in and around the joint
  • Feeling that the joint is loose or unstable

Treatments for osteoarthritis:

According to the Mayo Clinic, the following treatments for osteoarthritis cannot reverse the disease, but they can help reduce pain and improve movement:

  • Acetaminophen (Tylenol).
  • Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil, Motrin IB and others) and naproxen sodium (Aleve). Use caution with NSAIDs; long-term use can cause bleeding problems or liver and kidney damage.
  • Duloxetine (Cymbalta) is an antidepressant also approved to treat osteoarthritis pain.
  • Physical and occupational therapy may help manage arthritis.
  • Transcutaneous electrical nerve stimulation (TENS) uses a low dose of electrical current and may provide short-term relief for people with osteoarthritis.
  • Surgery and other procedures may be helpful.
  • Cortisone or lubrication injections may help.
  • Physical activity: According to Susan Bartlett, a professor of medicine in the division of rheumatology at Johns Hopkins' Arthritis Center in Baltimore, exercise helps. “Physical activity is essential to optimizing both physical and mental health, and can play a vital role in the management of arthritis," she noted in a recent article. "Regular physical activity can keep the muscles around affected joints strong, decrease bone loss and may help control joint swelling and pain. Regular activity replenishes lubrication to the cartilage of the joint and reduces stiffness and pain.”

Autoimmune inflammatory arthritis

According to the Arthritis Foundation, when you have autoimmune inflammatory arthritis, the immune system attacks healthy tissue, including joints in the spine, hands and feet. It can become systemic, affecting the eyes, skin, heart and other organs. Rheumatoid arthritis is the most common form; there is also psoriatic arthritis, axial spondyloarthritis and juvenile arthritis.

Common symptoms of autoimmune arthritis are:

  • Rheumatoid arthritis: Joint pain, tenderness, or stiffness that lasts longer than six weeks. Morning stiffness that lasts 30 minutes or longer. More than one joint is affected, and the same joints on both sides of the body are affected. Fatigue is also a symptom.
  • Psoriatic arthritis: Itchy, painful, red patches or a silvery build-up of dead skin cells. Cracking, pitting and white spots on the nail bed. Fatigue, inflammation and swelling where tendons and ligaments connect with a bone.
  • Axial spondyloarthritis: Pain and stiffness that starts gradually and lasts three months. The pain improves during exercise and stretching but worsens at rest — morning stiffness.
  • Juvenile rheumatoid arthritis: Swollen, stiff, painful joints, light sensitivity, rash, fatigue, hardened patches of skin.

Treatments for autoimmune inflammatory arthritis include:

  • NSAIDs
  • Corticosteroids
  • DMARDs — Disease-modifying anti-rheumatic drugs that reduce inflammation and prevent the worsening of the disease. Biologics and Janus kinase (JAK) inhibitors are special types of DMARDs.
  • Surgery
  • Physical and occupational therapy

Infectious (reactive) arthritis

NIAMS states that reactive arthritis occurs after a bacterial infection. The arthritis symptoms typically begin after recovery from the initial illness. The knee and ankle joints are frequently affected, as well as the lower back.

Symptoms include:

  • Joint pain and stiffness, inflamed fingers or toes, pain in the heel or foot
  • Morning stiffness
  • Inflammation of the urinary tract after an infection of the urinary tract or genitals
  • Eye inflammation
  • Fatigue
  • Fever
  • Diarrhea and abdominal pain
  • Ulcers in the mouth
  • Skin rash
  • Thickened nails

According to the Mayo Clinic, treatment typically includes:

  • NSAIDs
  • Steroid injections
  • Rheumatoid arthritis medications
  • Physical therapy

Gout

The U.S. Centers for Disease Control and Prevention defines gout as an extremely painful form of arthritis. Uric acid crystals build up in the affected joint, typically affecting one joint at a time, usually the big toe. It can go into remission or flare up. Untreated, it can lead to gouty arthritis.

Symptoms of gout in the affected joint are:

  • Intense pain
  • Swelling
  • Redness
  • Heat

Treatment for gout includes:

  • NSAIDs
  • Limit purine-rich foods (the body breaks them down into uric acid), such as red meat or organ meat
  • If possible, change or stop medications associated with hyperuricemia (high uric acid levels in the blood)
  • Medications to lower uric acid levels, including allopurinol, febuxostat and pegloticase

'Baby-Proofing' Your House: A New Parent's Guide

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TUESDAY, April 11, 2023 (HealthDay News) -- There are too many heartbreaking stories of babies and young children suffering serious injury or even death due to an accident in the home. You hope it doesn’t happen to your family, and taking preventive measures is the first step in ensuring it doesn’t.

Baby-proofing the house is a rite of passage for new parents and caregivers. It helps keep your baby safe from hazards at home.

“Research shows that children are more likely to be injured at home than anywhere else,” pediatrician Dr. Kimberly Giuliano said in a recent Cleveland Clinic article. “Part of that may be because kids spend a lot of time at home compared to other places.”

Children also typically have less direct supervision at home.

“At school, the teachers are always watching. And the coach is there during your child’s game or practice,” Giuliano added. “At home, there’s more likely to be some alone time.”

On top of that, babies are accident-prone.

Naturally curious, they love to explore by touching and putting things in their mouths.

Experts from Yale Baby School -- a Yale University research and education initiative -- say “your baby’s mouth is their primary tool for exploring new objects.”

Also, babies trip and fall easily because they lack the coordination required to maneuver around furniture, appliances and stairs.

Finally, risk and danger aren’t concepts babies understand. They don’t consider the danger involved in risky behaviors such as getting too close to a flight of stairs.

In a recent report, safehome.org claimed close to “40% of parents said that their child’s injury could have been avoided had they taken proper childproofing precautions.”

Putting safety first is key to reducing the likelihood of injury to your baby or small child.

What to safeguard

  • Baby-proof cabinets and drawers: Dangerous items like chemicals, breakable items and sharp objects are kept in cabinets and drawers in just about every room in the house. Household chemicals like pesticides and cleaning supplies can be lethal if ingested. The American Academy of Family Physicians (AAFP) recommends moving household chemicals out of cabinets to a spot in the house completely out of reach of babies and small children. If that’s not possible, it’s critical to baby-proof drawers and cabinets, to secure these items. Safety locks and latches are commonly used to baby-proof cabinets and drawers, especially lower cabinets and drawers in the kitchen, bathroom, bedroom and laundry room. There are many affordable and easy-to-install choices.
  • Baby-proof door handles: Door knobs might not seem like a problem, but as soon as babies can climb, they will be able to reach door handles. At that point, anything behind that door is fair game for your curious young child. Baby-proof door handles for rooms that present danger and should remain off-limits, the AAFP says. These rooms include bathrooms and rooms with low window ledges that pose a fall hazard. Depending on the door handle style, you can buy door lever locks or door knob safety covers. Another option is a child safety door lock installed high on the door out of your child’s reach. Both are affordable items for keeping young children out of certain rooms in the house.
  • Baby-proof fireplaces: A cozy fire grabs the attention of adults and children alike. Your fireplace is a high-risk zone for two reasons: The hearth is frequently made of brick or tile (both unforgiving surfaces) and the fire itself is dangerous. The most effective way to create a baby-proof a fireplace is to completely block access to it, including the hearth. A gate that encloses the fireplace and is attached to the wall on each side is a smart option. If you don’t want to keep a gate up during months when the fireplace isn’t used, covering the corners of the hearth with padding is the best option to protect your baby from falling from or onto the hard surface.
  • Baby-proof stairs: Stairs pose a threat to babies because of their inability to understand the danger, as well as their lack of stability and coordination. Babies aren’t able to navigate stairs alone; therefore, stairs should be blocked with a gate at the top and bottom, according to Safe Kids Worldwide. There is an assortment of gate styles that are either temporary or semi-permanent. The temporary gates are taken up and down each time you access the stairs. The semi-permanent gates, which are screwed into a stud in the wall, are easier to open and close and don’t fall down.

Regardless of how you decide to baby-proof your home, you can buy most materials at your local home improvement store or online. It’s just a matter of finding something you like that's within your budget.

Toddler Constipation: How to Help Your Child Get Relief

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TUESDAY, April 11, 2023 (HealthDay News) -- Constipation is no fun for toddlers, but you can help your child move through a bout of it.

What is toddler constipation?

According to the Cleveland Clinic, your toddler may sometimes have hard, dry stools that are painful to pass. Up to 20% of toddlers experience constipation at one time. A constipated toddler typically poops less than two times per week. While it is hard to watch your toddler suffer from constipation, here are some recommendations to help your child have a healthy bowel movement and prevent constipation in the future.

What causes toddler constipation

The Mayo Clinic lists many causes of toddler constipation, which include:

  • Withholding: They don’t want to have a bowel movement because they are busy, they are away from home or they fear having a painful bowel movement because of a history of constipation.
  • Toilet training: If the child is too young to begin toilet training, they may hold in their stool.
  • Change in diet: A lack of fiber-rich fruits and vegetables or a lack of fluid in their diet may cause the constipation.
  • Change in routine: Any change in their routine, such as travel, stress, weather or starting school outside of the home, can lead to constipation.
  • Medication: Certain medications can lead to constipation.
  • Cow’s milk allergy: An allergy to cow's milk or simply consuming too many dairy products can cause constipation.
  • Family history: A genetic or environmental component may cause the constipation.
  • Medical condition: Rarely, it could indicate an underlying medical issue.

Symptoms of toddler constipation

According to Johns Hopkins, some common danger signs of toddler constipation are belly pain, bloating or cramps. The toddler may show signs of trying not to poop, such as clenching their teeth, crossing their legs or turning red in the face.

Encopresis, or soiling one's pajamas or underwear, is one symptom of constipation. Dr. Patrick Reeves and Dr. Christine Wassdorp Hurtado said in a recent American Academy of Pediatrics (AAP) article that “when poop overflows like diarrhea because of constipation, we call this encopresis. Encopresis can be very alarming to children and parents because it can look like diarrhea caused by infections. However, it is actually the child's body attempting to evacuate a large amount of poop.”

Anal fissures are another symptom of constipation. This is when the skin around the rectum and anus has small tears caused by the passing of the hard stool. It may cause minimal bleeding, which is noticed on the toilet paper after wiping.

Fecal streaking is caused when the child passes gas, and there are streaks or chunks of stool left in the underwear.

Toddler constipation relief

Both Reeves and Wassdorp Hurtado recommend Eat 5! to help with constipation. By eating five servings of fruit and vegetables daily, your child should have enough fiber in their diet to promote a healthy bowel movement.

Ensure that they are drinking enough water.

Encourage physical activity; this frequently helps with passing stool.

Using a potty stool may help your child pass stool more easily. A potty stool changes the body’s posture while sitting on the toilet, so it is anatomically easier for the stool to pass.

Over-the-counter (OTC) laxatives may be helpful with eliciting a bowel movement and establishing a good bowel routine. PEG 350 is a safe osmotic laxative that attracts more water to the colon to ease and soften the stool, according to the AAP.

Before using any OTC medications, speak with your child’s health care provider. They can provide you with information on the correct dose and how long to use it. Your provider may recommend that your child stays on this medication for maintenance after the initial “clean-out.” The goal is to have your child regularly move their bowels without pain.

Stool softeners and suppositories are also available treatments. Your child’s health care provider can work with you to find the most effective treatment. If the constipation doesn’t improve, then follow up with your pediatrician.

Constipation is rarely a medical emergency; however, if it is accompanied by fever, vomiting or stomach or rectal pain that lasts more than an hour, you should seek medical care, the AAP advises.

Stress, Stomach Pain: Diarrhea, Constipation, Ulcers & More

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FRIDAY, April 7, 2023 (HealthDay News) -- You may be struggling with stomach pain and digestive distress without understanding why, thinking it might be something you ate.

Can stress cause stomach pain?

Stress, especially chronic stress, can indeed increase your risk for gastrointestinal (GI) problems.

“Stress and anxiety are common causes of stomach pain and other GI symptoms,” Dr. Nina Gupta, a gastroenterologist at University of Chicago Medicine, said recently in an article. Stress impacts the digestive system through the nervous system, and can affect food movement and the gut’s bacterial balance. Stress can also cause people to eat poorly, smoke and/or drink too much alcohol or caffeine — all habits that can trigger stomach pain.

Outside the brain, the gut has the greatest area of nerves. This component of the autonomic nervous system — known as the enteric nervous system — is sometimes referred to as the “second brain.” According to Harvard Health, “neurons lining the digestive tract signal muscle cells to initiate a series of contractions that propel food farther along, breaking it down into nutrients and waste.”

The enteric nervous system communicates with the central nervous system and is known as the “brain-gut axis.” This connection explains why stress may cause digestive problems.

According to the American Psychological Association, stress may increase the risk for or exacerbate symptoms of the following gut diseases or dysfunction:

  • Bloating, burping, gas
  • Heartburn, acid reflux or gastroesophageal reflux disease (GERD)
  • Nausea and vomiting
  • Diarrhea
  • Constipation
  • Ulcers
  • Inflammatory bowel disease or irritable bowel syndrome

Bloating, burping, gas

Stress can contribute to bloating, burping or gassiness by making swallowing foods difficult or increasing swallowed air, per the American Psychological Association.

It can also slow the digestive process, allowing gut bacteria to create gas. For treatment, gastroenterologist Dr. Roshini Rajapaksa of NYU Langone Health in New York City recommends exercise: “Exercise actually helps your colon start moving and it moves that gas along, so it’s not going to stay in your system,” she said recently. She also suggested to avoid chewing gum, using straws or drinking carbonated beverages, to keep you from swallowing extra air.

Heartburn, acid reflux or GERD

Emotional stress can increase stomach acid production leading to heartburn and acid reflux, according to Harvard Health. It can also aggravate GERD, a disorder where acid rises up from the stomach into the esophagus. How to counteract that? Harvard Health experts suggest not smoking, eating a healthy diet, limiting coffee, tea and cola drinks, eating smaller meals, avoiding meals close to bedtime and using relaxation strategies like mindful meditation or deep breathing.

Nausea and vomiting

“Your anxious feelings can translate into a whole range of gastrointestinal symptoms, including stress nausea, abdominal pain, changes in bowel habits, and even stress vomiting,” Dr. Timothy Tramontana said recently in a Cleveland Clinic article. Tramontana recommends exercise, meditation and a healthy diet, with frequent smaller meals. Another option is to drink peppermint tea, which is known to settle the stomach.

Diarrhea

Can stress cause diarrhea?

“[Stress] hormones affect the body, including the gut, to shift swiftly into stress mode,” gastroenterologist Dr. Christine Lee said recently in a Cleveland Clinic article. Adrenal glands release hormones like cortisol, serotonin and adrenaline. “There are more serotonin receptors in the intestinal tract than in the brain… [Serotonin] can make your stomach turn. It stimulates the intestines, creating waves of contractions in the colon.”

“It can cause a constellation of symptoms of nausea, gas, bloating and crampy abdominal pains,” Lee explained, noting that the release of stress causes the diarrhea. “Everything relaxes, and what was on hold is released," she said. "This counter-response can cause symptoms of nausea, pain, flushing, diarrhea or even sweating.”

Treatment suggestions include mindful eating — a practice that involves slowing down and savoring each bite of food — and avoiding stressful environments when eating, like eating while driving. Listening to your body and eliminating waste when the urge occurs, rather than holding it in, also improves bowel movements.

Constipation

Can stress cause constipation?

Constipation results when food moves too slowly through the gut. According to the American Institute of Stress, when the body goes into fight-or-flight mode, it diverts blood flow away from the intestines that can cause intestinal movement to slow down, resulting in constipation. Another stress hormone, corticotrophin-releasing factor (CRF), slows down the intestines. Stress may also affect healthy gut bacteria, slowing digestion.

Treatment can include exercise, a healthy diet with plenty of fiber, maintaining proper hydration, allowing time when going to the bathroom and engaging in stress-relieving activities like listening to peaceful music, journaling or reading. If you have a history of trauma or are coping with anxiety or depression, professional therapy may be helpful.

Stomach ulcers

Stomach ulcers can be made worse by stress.

Ulcers are open sores or raw areas in the lining of the stomach or intestine. A gastric ulcer is in the stomach; a duodenal ulcer is in the intestines. According to the University of Pennsylvania Medicine, an imbalance between digestive juices and chemicals that protect the stomach lining causes ulcers, often from a bacteria called Helicobactor pylori. Stress does not cause ulcers, but it can exacerbate them.

Recommendations for treatment include professional care and lifestyle changes including smoking cessation, avoidance of alcohol and stress management.

Gastrointestinal disorders

Gastrointestinal disorders include irritable bowel syndrome (IBS), which is a group of symptoms that includes chronic abdominal pain and bowel changes like diarrhea, constipation or both. The underlying cause is unknown. Inflammatory bowel disease (IBD) refers to two conditions, ulcerative colitis and Crohn’s disease, and these are caused by a malfunctioning immune system, according to Harvard Health. IBD symptoms include abdominal pain, cramping, fevers, diarrhea, and bloody bowel movements. The relationship between stress and both IBS and IBD is unclear, but stress can make symptoms worse. Using stress management techniques and consulting with your health care provider are recommended.

Dealing With a Picky Eater: 5 Tips for Parents

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THURSDAY, April 6, 2023 (HealthDay News) -- Does it sometimes feel like your young picky eater is turning every meal and snack into an epic power battle — and you’re just not sure how to get them the nutrition they need?

If so, you’re not alone.

According to an article published recently in the journal Pediatrics, up to 50% of kids may be described as "picky eaters." And while there’s no one agreed-upon definition of picky eating, in general, if your child or adolescent is particular about the food they eat at least some of the time, you may have a picky eater on your hands.

“I think all parents have said at one time, ‘My kid is such a picky eater!’” clinical psychologist Rachel Busman said in a recent Child Mind Institute article. “It’s very normal for kids to go through stages where they’re a little more picky, especially when they are trying to assert their autonomy.”

Experts at the institute note that picky eating is one of the most “common complaints” of parents. Here, they and other child experts weigh in on the topic with five top tips for parents of picky eaters:

Grocery shop and cook together

Involving your child in grocery shopping can help extend their picky eater food list to include novel items, Busman explained. When they are shown a wide variety of food flavors and options, it can open their eyes to new tastes and textures they might enjoy.

Similarly, if you scroll through recipe books or websites together and pick a new dish or dessert to create, it helps make eating different foods a fun adventure instead of a battle.

Avoid forcing foods

Cleveland Clinic registered dietician Jennifer Hyland notes that forcing kids to eat food they don't like can make them doubt their own body signals surrounding hunger, especially when they’re toddlers.

“Forcing food can cause your child to distrust their own appetite and lead them to believe that they can’t regulate their own hunger cues,” she explained in an article.

Instead, allow them to eat until they’re full — even if that means some vegetables are left on the plate. This also helps ensure that eating food doesn’t become associated with stress and anxiety.

Have meals as a family

Both Hyland and the pediatricians at Healthychildren.org recommend eating together as a family, to help create a positive vibe around food. They also suggest cooking the same meal for everyone at the table and including at least one food in each meal that your picky eater enjoys, if possible.

“Try your best to cook the same meal for the whole family. The child may not eat all of it, but it’s important that you present it, and that you set an example of trying these foods yourself,” Hyland explained.

Take food rejection calmly

Teaching your child that unwanted food is still safe food is important, according to the Child Mind Institute. For instance, they may need to be shown that the tomato they are repulsed by isn’t actually full of bad germs just because they don’t like it.

One way to demonstrate this is to teach your child to offer unwanted food to others at the table. When your picky eater sees other family members enjoying it, they’re more likely to understand that it’s safe to eat.

Have fun with food

You may have thought that a good meal presentation was only for formal restaurants, but as it turns out making foods into fun shapes and including a variety of colors in your meals can help make them appealing to kids.

Hyland recommends offering your picky eater something they can shake onto their food if they don’t want it, to make it “more exciting.” Additions like herbs, seasonings or seeds can help turn an unwanted item into a winner.

“Sprinkles also go a long way,” said Hyland. “Sometimes it really is as simple as that.”

The Cleveland Clinic also notes that a child may try a food between 10 to 20 times, on average, before they like it. This means that your patience and persistence in re-offering previously rejected foods to your picky eater can really pay off.

Hyland explained that, “The most important thing a parent can do with a choosy eater is to be consistent and not give up.”

When Do Babies Sleep Through the Night?

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THURSDAY, April 6, 2023 (HealthDay News) -- Elation and exhaustion often go hand in hand when you’re a parent to a baby.

When sleep starts to seem like a fantasy, it’s good to know that the experts say there is a time when most babies will sleep through the night. Here, they share when that is, offer guidance on what impacts your baby’s sleep and give some tips on how you can help guide them to sleep longer.

What can impact your baby's sleep?

UC Davis pediatrician Lena van der List explained that one of the factors impacting your baby’s ability to sleep through the night is that they aren’t born with a clear idea of what night is.

“It takes a while for the baby to distinguish between day and night. This usually happens around 2 months of age,” she said recently in an interview.

The various stages of your baby’s development also play a key role in influencing their sleep patterns. Because of the changes at each stage, "baby sleep regression" can happen.

The Sleep Foundation has documented five stages when these sleep disruptions typically occur, and the main reasons why:

  • At 4 months, babies’ brains and nervous systems are developing by forming numerous links.
  • At 6 months, babies have an increased awareness of their environment, are more physically active and have a greater mental capacity, all of which can play a role in them waking up at night.
  • At 8 months, babies begin teething; become more active and aware of their environment; and develop emotionally, which may lead to separation anxiety.
  • At 12 months, a combination of babies’ physical, mental and emotional development may cause overstimulation, nightmares, restlessness, teething pain, separation anxiety and difficulty adjusting to schedule changes.
  • At 18 months, all of the 12-month developmental factors can cause sleep disruptions, plus many babies develop the ability to say “no” and exert their independence at bedtime.

Of course, another main factor that impacts babies’ ability to sleep through the night is that they wake up hungry. Babies eat every 2 to 3 hours up to about age 2 months and every 3 to 4 hours between the ages of 2 and 6 months, according to HealthyChildren.org.

When do babies sleep through the night?

The Sleep Foundation states that most babies sleep through the night by age 6 months, which means they have six hours of uninterrupted sleep.

However, parents who have babies 6 months and older who aren’t yet sleeping through the night shouldn’t necessarily worry.

A study published recently in the journal Sleep Medicine that followed 5,700 children found that sleep patterns varied considerably among babies during their first two years of life. The study was conducted by the Finnish Institute for Health and Welfare (THL) and the University of Turku.

"Now we know that the individual differences are very large and that patterns relating to falling asleep, waking up, staying awake at night and sleeping rhythms often develop at different rates," THL research manager Juulia Paavonen said when the research was published.

Research published in the journal Pediatrics revealed similar findings. About 38% of parents in the study said their babies didn’t sleep six hours straight by age 6 months, and about 28% said they weren’t doing so by age 12 months.

How can I help my baby sleep through the night?

Cleveland Clinic pediatrician Dr. Noah Schwartz explained in an article that sleep training techniques for parents are used to help babies realize they can fall asleep by themselves. He noted that you can start using these strategies once your baby reaches 4 to 6 months of age.

“Essentially, you’re getting your baby to realize they can put themselves to sleep or self-soothe,” Schwartz said.

Here are four sleep guidance methods that he recommends:

  • The Ferber Method: Put your baby to bed when they’re tired and check back in at timed intervals to comfort them — but don’t pick them back up again.
  • The Chair Method: Sit in a chair next to your baby until they fall asleep and keep moving the chair away from them by a few inches during their process of drifting off, until the chair is outside the room.
  • CIO (Cry It Out) Method: Put your baby to bed when they’re tired and avoid picking them back up until morning (or until their next feeding).
  • Pick Up, Put Down Method: Put your baby to bed, leave and return to pick them up and comfort them when they cry — but put them back down and leave again when they start to relax.

“Oftentimes, sleep training techniques overlap and parents combine methods, which is perfectly fine,” Schwartz noted. “It’s all about finding what works best for you as a parent and how your infant responds.”

Stress Rash: What Is It and How to Treat It

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WEDNESDAY, April 5, 2023 (HealthDay News) -- We know that stress can take a toll on the body, but many may not realize it can produce a rash.

“Stress can increase the level of the hormone cortisol, increasing inflammation in your body, which can lead to hives, acne, eczema, and hair loss, among other symptoms," dermatologist Dr. Elizabeth Farhat said in a recent article.

Typically, hives are caused by an allergic reaction but can actually be triggered by stress. According to Scripps, you are more likely to develop a stress rash if you have experienced asthma, eczema, rosacea or allergies.

Here is everything you need to know to manage a stress rash.

What does stress rash look like?

According to the Cleveland Clinic, hives can appear on your face, hands and neck. The hives will look like raised bumps that are reddish on lighter-colored skin. They can look like tiny pinpoints or welts and may develop into raised red clusters. Hives can change size and shape. When you press on the bumps, the skin will turn lighter in the center. When you have a stress rash on your face, you may also experience painful swelling of your lips, eyes and the inside of your throat. The rash can burn, itch and cause pain.

Where does a stress rash appear?

Hives can appear anywhere on the body. However, according to Scripps, when a stress rash causes hives, they are more likely to appear on the face, neck, chest or arms. The hives can be as small as a pinpoint or merge into an area the size of a dinner plate. They can come and go within a few days, but can then return. The rash can wax and wane for up to six weeks or even years.

How to get rid of a stress rash

If you have swelling of the mouth or throat, this is considered a medical emergency. Call 911 immediately.

The Mayo Clinic recommends using non-drowsy anti-itch medications (antihistamines). They will calm the itching and reduce the swelling associated with the rash. They are available over the counter and by prescription.

Mount Sinai suggests adding an over-the-counter antacid along with the antihistamine for more robust help. The American Institute of Stress recommends trying milk compresses. The fat in whole milk can soothe skin; skim milk won’t work here. Cold compresses may also provide relief from itching and swelling. Topical steroids, like hydrocortisone, can also help.

The Mayo Clinic also recommends taking a cool bath. Adding baking soda and oatmeal to the tub can relieve the itching associated with hives. Wear loose-fitting clothing to avoid irritating the rash further.

You should seek medical assistance:

  • If you experience swelling of the throat or mouth or you are experiencing wheezing.
  • If the rash persists for more than six weeks
  • If the discomfort is not relieved by over-the-counter medications.

The good news is that although hives can be uncomfortable, they are usually harmless and disappear on their own.

How to prevent a stress rash

The best way to prevent stress rashes is to manage your stress levels:

Thea Gallagher, a clinical assistant professor in the department of psychiatry at NYU Langone Health in New York City, gave HealthDay some tips for managing stress. They include:

  • Get moving: Exercise helps your body combat stress
  • Decompress daily: Incorporate mindfulness, meditation, yoga and deep breathing to relieve stress
  • Get better sleep: Six to eight hours of sleep per night is ideal
  • Eat a healthy diet: Incorporate fruits, vegetables, whole grains and lean protein into your meals
  • Connect: Connecting with loved ones is great for stress relief
  • Ask for help: See your doctor if the stress is persistent
  • Keep your perspective: Focus on the good in your life.

Post-Traumatic Stress Disorder (PTSD): Symptoms & Treatment

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TUESDAY, April 4, 2023 (HealthDay News) -- Post-traumatic stress disorder (PTSD) often develops following a traumatic event in someone's life, leaving the sufferer to struggle with vivid flashbacks, nightmares and panic attacks.

The U.S. National Center for PTSD estimates that about 6% of Americans will experience PTSD at some point in their lives. Women are twice as likely to experience the condition as men, and veterans and children may also be more susceptible.

To help you better understand PTSD, let's examine what the condition is, plus learn its main symptoms, causes, risk factors and treatments, including medications and therapies that are backed by science.

What is PTSD?

“Clinically when we think about PTSD, it is a reaction to a traumatic event,” Cleveland Clinic staff psychologist Dr. Chivonna Childs said in a podcast.

“That reaction can be flashbacks, nightmares about the event, feeling as if we're reliving the events, being triggered by people, places, things, situations that remind us of the event. That can send us into what we would normally feel like is a panic attack,” she explained.

According to the U.S. National Institute of Mental Health (NIMH), people can develop PTSD from:

  • Experiencing a traumatic event firsthand
  • Witnessing a trauma happening to others
  • Learning about traumatic events after the fact.

The condition may also manifest as complex PTSD (C-PTSD). The CPTSD Foundation states that C-PTSD is the result of trauma that’s inescapable and happens repeatedly over a period of time, especially during childhood. It usually develops because of firsthand traumatic experiences and involves betrayals of trust and security.

“PTSD is often associated with a one-time experience or a single-incident trauma,” Brickel and Associates director and lead therapist Robyn E. Brickel said in an article. “C-PTSD is different, however, from single-incident trauma because the impact on the nervous system around attachment or relationships becomes more deeply ingrained. C-PTSD is relationship trauma."

PTSD symptoms

The NIMH states that you may be diagnosed with PTSD if you experience some combination of the following symptoms, they last for over a month and they’re severe enough to interfere with your work or relationships:

  • Having terrifying thoughts or flashbacks
  • Having nightmares
  • Feeling tense and jumpy
  • Experiencing outbursts of emotions
  • Having sleeping issues
  • Suppressing your feelings and thoughts about the trauma
  • Steering clear of people, places and things that might make you recall the trauma
  • Experiencing a lack of clarity about the trauma
  • Losing interest in people and activities you once enjoyed
  • Having an unfavorable view of yourself and the world around you
  • Experiencing distorted feelings like guilt.

Common causes of PTSD

While the causes of PTSD are not fully understood, NIMH notes that it can be triggered by several types of events and situations in your life, such as:

  • Living through dangerous events and traumas
  • Getting hurt
  • Seeing another person hurt, or seeing a dead body
  • Childhood trauma
  • Feeling horror, helplessness or extreme fear
  • Having little or no social support after the event
  • Dealing with extra stress after the event, such as loss of a loved one, pain and injury, or loss of a job or home
  • Having a history of mental illness or substance abuse.

PTSD risk factors

Not everyone who experiences, witnesses or learns about a traumatic event develops PTSD. NIMH outlines several factors that can increase your PTSD risk:

  • A history of mental health or substance abuse issues
  • Trauma in childhood
  • High levels of stress in your daily life
  • A lack of social support
  • Experiencing dangerous or traumatic events
  • Feeling or being helpless
  • Feeling extreme fear
  • Witnessing others being traumatized or hurt.

Racial trauma also increases the risk of developing PTSD, according to the National Center for PTSD.

PTSD treatment

For those diagnosed with PTSD, psychiatry.org states that several types of cognitive behavioral therapies (CBT) may be used to treat the condition, including:

  • Cognitive processing therapy: to change negative beliefs by identifying and addressing them
  • Trauma-focused CBT: to use with children and teens and includes cognitive behavioral techniques, family support, trauma-sensitive interventions and human-centered philosophies
  • Eye movement desensitization and reprocessing for PTSD: focuses people on the trauma while using certain eye movements that help reduce the emotions surrounding traumatic memories
  • Prolonged exposure therapy: gradually exposes people to their trauma triggers and reduce their impact over time.

PTSD medications such as selective serotonin reuptake inhibitors (SSRI) and serotonin-norepinephrine reuptake inhibitors (SNRI) may also be used to treat the condition. In addition, alternative therapies like breathing retraining can calm you down, while recent research published in the journal PLOS ONE showed that service dogs can help you better manage and improve your PTSD symptoms.

“It's a multilayered issue so we need multilayers of treatment, so that we can be well-rounded, well-grounded and very well-supported," Childs said. "Because at the end of the day, that's what we all deserve... a quality of life.”

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