Posts in category: Health

Asking for a Friend is BuzzFeed News’ health advice column. Ask us anything about your body! If you’re too afraid to google or too embarrassed to ask a friend or family member, let alone a doctor, submit your questions here. 

Dear Asking for a Friend, 

I can’t breathe through my nose very well when I’m sleeping. I have to prop up my head to get better airflow. Is this normal or a sign of something more serious? (nasal polyps maybe?)

—Congested Sleeper

Dear Congested Sleeper, 

Stuffy noses are the worst, especially when they prevent you from getting a good night’s sleep. The result: a crappy morning that fails to set you up for a pleasant and productive day. 

In fact, nighttime congestion has been linked to daytime fatigue, shortness of breath, headache, bad mood, drowsiness, and…you guessed it: sleep problems. Poor sleep has been further associated with a variety of health issues, including type 2 diabetes, high blood pressure, depression, a compromised immune system, and low sex drive. Not to mention, a stuffy nose at night forces you to breathe through your mouth, which may lead to dryness and bad breath, as well as brain fog and irritability when you wake up. 

The most natural way to breathe during sleep is through your nose, according to Dr. Raj Dasgupta, a pulmonary and sleep medicine doctor and spokesperson for the American Academy of Sleep Medicine. Inhaling through your nose helps humidify and warm the air, prevents debris and toxins from entering your lungs, and can lower blood pressure.

It’s a well-established yet frustratingly confusing cycle: Why, if you can breathe through your nose perfectly fine during the day, does your nose clog up and betray you at night?

Before we get into the specifics, Congested Sleeper, know that nighttime congestion is common and not usually a cause for concern as long as it’s not accompanied with other symptoms, particularly ones that also affect you during the day, Dasgupta said. This can include green or yellow mucus with a bad smell, bloody mucus, fever, headache, pain in the face, and sleep disruptions that last for more than a week. 

Try propping your head up while sleeping 

The simplest reason for unexplained nighttime congestion is that when you lie in bed, blood flow increases to your head. More blood in your head also means more blood in the vessels that line your nasal passages, Dasgupta said, similar to what happens when you hang upside down. 

When blood vessels become engorged, they push fluid into surrounding tissues, causing swelling and congestion, despite the absence of excess mucus. This inflammation of the nose is called rhinitis. 

Lying horizontally also makes it hard for your sinuses, which will always have small amounts of mucus in them, to drain naturally because you’re fighting gravity, Dasgupta explained, “so you can imagine that might make your stuffy nose even worse.”

So, by propping your head up in bed, you’re already one step ahead of the problem. Manipulating your sleep positions with pillows, for example, is one of the best ways to avoid a stuffy nose at night, experts say.

If possible, you’ll want to avoid sleeping on your back as well because that could block and narrow your airways, making it harder to breathe, especially if you have obstructive sleep apnea. (Sleep apnea is a disorder where the upper airway collapses and blocks breathing — sometimes hundreds of times a night — and is linked to snoring, hypertension, and other health problems.)

Eliminate irritants and allergens in your home, especially your bedroom 

Your home is filled with tiny and mostly invisible irritants and allergens that can aggravate your nose and make you congested at night. There’s pet dander (microscopic flakes of skin from your dog or cat), dust, mold, pollen, chemicals, and more that could be lurking on your mattress, pillows, bedside tables, window curtains — just about everywhere.

Researchers found that more than 99% of the nearly 7,000 homes they collected dust samples from had at least one of the eight common allergens they looked for: dog and cat dander; proteins shed by cockroaches, mice, or rats; mold; and two types of dust mites, according to a 2017 study. Overall, 74% of the homes had three to six allergens. Homes with animals and pests were most likely to have multiple allergens, as well as rental, mobile, and older homes, and those in rural areas. 

Even if you’re not specifically allergic to any of these particles, your nose can still recognize them as foreign and ramp up mucus production to kick them out. This is called nonallergic rhinitis. The tissue lining inside your nose will become inflamed in the process, blocking mucus from draining and leading to even more congestion, as well as pain, pressure, and, in some cases, infection. 

Allergic rhinitis triggers similar symptoms, but in this case your body has a specific type of inflammatory reaction to an allergen. Your immune system detects the invaders and pumps inflammation-causing chemicals such as histamine into your bloodstream that cause the blood vessels in your nose to widen and feel clogged.  

Your first step to eliminate irritants and allergens from your home and specifically your bedroom:

• Don’t let pets sleep on your bed or in your bedroom.
• Run an air purifier throughout the night to improve air quality.
• Remove carpets or rugs in your bedroom because they tend to trap allergens more than bare wood or tile.
• Close windows and run an air conditioner during pollen season or when air quality is poor outside.
• Vacuum your mattress weekly.
• Wash bedsheets and pillowcases once a week, or every three to four days if you have allergies or asthma. 
• Vacuum and dust your bedroom frequently.
• Run a dehumidifier in your bedroom. Dust mites thrive in high-humidity environments and survive by drinking moisture from the air, so aim to keep your house at less than 50% humidity. (Cockroaches love damp indoor environments too, so low humidity will help there as well.) During colder months, you can run a humidifier to help moisten your nasal tissues and ease the irritation that can happen when the air is too dry.
• Take an antihistamine before you go to sleep if you need to, but follow the manufacturer’s suggestions as to when and how long you should take it.

Ask your doctor about medication side effects

Certain drugs like ibuprofen and aspirin, beta blockers used to treat conditions like high blood pressure and heart arrhythmias, birth control, and antidepressants have been found to cause nasal congestion. If your nighttime congestion is seriously affecting the quality of your sleep, Dasgupta recommends speaking with your doctor about dosage adjustments or alternative medicines, as well as remedies to reduce stuffiness. 

Pregnancy could also cause nasal congestion that can worsen at night for reasons already listed, Dasgupta said; it’s called pregnancy rhinitis, and it’s not caused by an infection or allergies, although those conditions can make it worse. It’s thought that an increase in sex hormones such as estrogen and progesterone play a role by triggering inflammatory processes in the body. 

Birth control, menopause, and hypothyroidism could influence hormone levels enough to affect your nasal passages too. 

You can have structural issues in your nose

Structural abnormalities in the nose, including nasal polyps, a deviated septum, or swollen turbinates (small structures that hang from the inside of your nose), could certainly make you congested at night. 

However, Dasgupta said that if this was your problem, you’ll likely notice at least some congestion during the day as well. These abnormalities are prone to increased swelling at night, which is why people who have them experience worse congestion when trying to go to sleep. 

Reduce stress 

Once you’ve tried to eliminate allergens and irritants and addressed other conditions or medications you may be taking, it can make sense to address other issues like your stress levels.

You may feel relaxed when slipping into bed at night, but the stress you’ve accumulated throughout the day can still be silently wreaking havoc — yes, even on your sinuses, Dasgupta said. 

There isn’t a clear cause–effect relationship between stress and nighttime congestion, but experts speculate that stress weakens the immune system, making you more vulnerable to allergens, bacteria, and viruses. 

Practicing calming techniques like meditation or even playing a relaxing music playlist before bed may help prime your brain for sleep.

Other tips to prevent or alleviate a stuffy nose at night

• Drink plenty of water. Staying hydrated throughout the day will help thin your mucus and boost your sinuses’ mucus-clearing abilities. You can also try drinking warm teas before bed for similar effects. 
• Take a warm or hot shower right before bed. The steam can open your nasal passages and make it easier to breathe. 
• Avoid caffeine and alcohol before bed.
• Use an over-the-counter nasal spray, but pay close attention to usage instructions. Some nasal sprays are meant to be used for no more than three days due to a rebound effect that causes more inflammation and congestion. 
• Irrigate your nose with a neti pot, but only with distilled bottled water or cooled boiled water. Rinsing your nose with tap water could expose you to rare but deadly organisms. (It’s not enough to filter water, you need to sterilize it.)
• Put a warm, wet towel over your face to help loosen mucus and relieve pressure.
• Apply a nasal strip to the outside of your nose, which can make it easier to breathe and reduce snoring. 
• Avoid acidic foods and beverages like carbonated drinks, citrus fruits, chocolate, fried food, and fatty meats like bacon or sausage. Acid reflux has been linked to rhinitis. 

If you can’t seem to remedy your stuffy nose, it’s probably a good idea to get it checked by an otolaryngologist (ear, nose, and throat doctor).

If you do plan on seeing a doctor to address your stuffy nose concerns, Dasgupta said it can be helpful to document the nights you feel congested alongside information like the foods you ate that day, whether you’re menstruating, if you had a stressful day at work, etc. 

“It never hurts to be a Sherlock Holmes,” Dasgupta said.

Investigators from the FDA have discovered a new outbreak of infections from Salmonella Enteritidis.

According to the Food and Drug Administration’s notice, the outbreak has already sickened 66 people. The agency has not reported the patients’ ages or locations.

FDA investigators have begun onsite inspections and sample testing, but the agency has not yet reported what locations are being inspected or what food is being tested. However, the Centers for Disease Control and Prevention reports that a Salmonella outbreak has been traced to eggs produced by Milo’s Poultry Farms and sold under the Milo’s brand and Tony’s Fresh Market brand. Milo’s has initiated a recall of all of its eggs.

Symptoms of Salmonella infection can include diarrhea, abdominal cramps, and fever within 12 to 72 hours after eating contaminated food. Otherwise, healthy adults are usually sick for four to seven days. In some cases, however, diarrhea may be so severe that patients require hospitalization.

In other outbreak news, the FDA continues to search for the cause of an E. coli O157:H7 outbreak that has sickened 26 people. The agency first reported the outbreak on Aug. 28. Traceback efforts have begun, but the FDA has not reported what foods are being traced.

The FDA has begun sample collection for a Listeria outbreak that has sickened three people but has not yet reported what food is being sampled. The agency first reported the outbreak on Aug. 21.

In an outbreak of infections from the Cyclospora parasite, the patient count has increased from 41 to 50 cases in the past week. The source of the parasites has not yet been identified, but the FDA has initiated traceback, onsite inspections, and sample testing. The agency has not reported what food is being tested or what location is being inspected. The FDA first reported the outbreak on Aug. 7.

The patient count for an outbreak of Salmonella Newport has increased from six to seven in the past week. The source of the pathogen has not yet been identified, but the FDA has begun traceback efforts and is conducting an on-site inspection. The agency has not yet reported what food is being traced or what facility is being inspected. The FDA first reported the outbreak on Aug. 7.

The FDA has initiated an on-site inspection for an outbreak of Salmonella Typhimurium that has sickened 89 people. The agency has not reported what facility is being inspected. Traceback efforts and sample testing are also underway, but the FDA has not reported what food is being traced or sampled. The agency first reported the outbreak on June 19. 

(To sign up for a free subscription to Food Safety News,click here)

In a video posted to Reddit this summer, Lucie Rosenthal’s face starts focused and uncertain, looking intently into the camera, before it happens.

She releases a succinct, croak-like belch.

Then, it’s wide-eyed surprise, followed by rollicking laughter. “I got it!” the Denver resident says after what was her second burp ever.

“It’s really rocking my mind that I am fully introducing a new bodily function at 26 years old,” Rosenthal later told KFF Health News while working remotely, because, as great as the burping was, it was now happening uncontrollably. “Sorry, excuse me. Oh, my god. That was a burp. Did you hear it?”

Rosenthal is among more than a thousand people who have received a procedure to help them burp since 2019 when an Illinois doctor first reported the steps of the intervention in a medical journal.

The inability to belch can cause bloating, pain, gurgling in the neck and chest, and excessive flatulence as built-up air seeks an alternate exit route. One Reddit user described the gurgling sound as an “alien trying to escape me,” and pain like a heart attack that goes away with a fart.

The procedure has spread, primarily thanks to increasingly loud rumblings in the bowels of Reddit. Membership in a subreddit for people with or interested in the condition has ballooned to about 31,000 people, to become one of the platform’s larger groups.

Since 2019, the condition has had an official name: retrograde cricopharyngeus dysfunction, also known as “abelchia” or “no-burp syndrome.” The syndrome is caused by a quirk in the muscle that acts as the gatekeeper to the esophagus, the roughly 10-inch-long muscular tube that moves food between the throat and the stomach.

The procedure to fix it involves a doctor injecting 50 to 100 units of Botox — more than twice the amount often used to smooth forehead wrinkles — into the upper cricopharyngeal muscle.

Michael King, the physician who treated Rosenthal, said he hadn’t heard of the disorder until 2020, when a teenager, armed with a list of academic papers found on Reddit, asked him to do the procedure.

It wasn’t a stretch. King, a laryngologist with Peak ENT and Voice Center, had been injecting Botox in the same muscle to treat people having a hard time swallowing after a stroke.

Now he’s among doctors from Norway to Thailand listed on the subreddit, r/noburp, as offering the procedure. Other doctors, commenters have noted, have occasionally laughed at them or made them feel they were being melodramatic.

To be fair, doctors and researchers don’t understand why the same muscle that lets food move down won’t let air move up.

“It’s very odd,” King said.

Doctors also aren’t sure why many patients keep burping long after the Botox wears off after a few months. Robert Bastian, a laryngologist outside of Chicago, named the condition and came up with the procedure. He estimates he and his colleagues have treated about 1,800 people, charging about $4,000 a pop.

“We hear that in Southern California it’s $25,000, in Seattle $16,000, in New York City $25,000,” Bastian said.

Because insurance companies viewed Botox charges as a “red flag,” he said, his patients now pay $650 to cover the medication so it can be excluded from the insurance claims.

The pioneering patient is Daryl Moody, a car technician who has worked at the same Toyota dealership in Houston for half his life. The 34-year-old said that by 2015 he had become “desperate” for relief. The bloating and gurgling wasn’t just a painful shadow over his day; it was cramping his new hobby: skydiving.

“I hadn’t done anything fun or interesting with my life,” he said.

That is, until he tried skydiving. But as he gained altitude on the way up, his stomach would inflate like a bag of chips on a flight.

“I went to 10 doctors,” he said. “Nobody seemed to believe me that this problem even existed.”

Then he stumbled upon a YouTube video by Bastian describing how Botox injections can fix some throat conditions. Moody asked if Bastian could try it to cure his burping problem. Bastian agreed.

Moody’s insurance considered it “experimental and unnecessary,” he recalled, so he had to pay about $2,700 out-of-pocket.

“This is honestly going to change everything,” he posted on his Facebook page in December 2015, about his trip to Illinois.

The year after his procedure, Moody helped break a national record for participating in the largest group of people to skydive together while wearing wingsuits, those getups that turn people into flying squirrels. He has jumped about 400 times now.

People have been plagued by this issue for at least a few millennia. Two thousand years ago, the Roman philosopher Pliny the Elder described a man named Pomponius who could not belch. And 840 years ago, Johannes de Hauvilla included the tidbit in a poem, writing, “The steaming face of Pomponius could find no relief by belching.”

It took a few more centuries for clinical examples to pop up. In the 1980s, a few case reports in the U.S. described people who couldn’t burp and had no memory of vomiting. One woman, doctors wrote, was “unable to voluntarily belch along with her childhood friends when this was a popular game.”

The patients were in a great deal of pain, though doctors couldn’t find anything wrong with their anatomy. But the doctors confirmed using a method called manometry that patients’ upper esophageal sphincters simply would not relax — not after a meal of a sandwich, glass of milk, and candy bar, nor after doctors used a catheter to squirt several ounces of air beneath the stubborn valve.

André Smout, a gastroenterologist at the University of Amsterdam in the Netherlands, said he read those reports when they came out.

“But we never saw the condition, so we didn’t believe that it existed in real life,” he said.

Smout’s doubts persisted until he and colleagues studied a small group of patients a few years ago. The researchers gave eight patients with a reported inability to burp a “belch provocation” in the form of carbonated water, and used pressure sensors to observe how their throats moved. Indeed, the air stayed trapped. A Botox injection resolved their problems by giving them the ability to burp, or, to use an academic term, eructate.

“We had to admit that it really existed,” Smout said.

He wrote this summer in Current Opinion in Gastroenterology that the syndrome “may not be as rare as thought hitherto.” He credits Reddit with alerting patients and medical professionals to its existence.

But he wonders how often the treatment might cause a placebo effect. He pointed to studies finding that with conditions such as irritable bowel syndrome, 40% or more of patients who receive placebo treatment feel their symptoms improve. Awareness is also growing about “cyberchondria,” when people search desperately online for answers to their ailments — putting them at risk of unnecessary treatment or further distress.

In Denver, Rosenthal, the new burper, is open to the idea that the placebo effect could be at play for her. But even if that’s the case, she feels much better.

“I felt perpetual nausea, and that has subsided a lot since I got the procedure done,” she said. So has the bloating and stomach pain. She can drink a beer at happy hour and not feel ill.

She’s pleased insurance covered the procedure, and she’s getting a handle on the involuntary burping. She cannot, however, burp the alphabet.

“Not yet,” she said.

COVID-19 vaccine benefits

What are the benefits of getting a COVID-19 vaccine?

Should I get the COVID-19 vaccine even if I’ve already had COVID-19?

Safety and side effects of COVID-19 vaccines

What COVID-19 vaccines have been authorized or approved?

How do the COVID-19 vaccines work?

Can a COVID-19 vaccine give you COVID-19?

What are the possible general side effects of a COVID-19 vaccine?

Are there any long-term side effects of the COVID-19 vaccines?

Can COVID-19 vaccines affect the heart?

Things to know before a COVID-19 vaccine

Are COVID-19 vaccines free?

Can I get a COVID-19 vaccine if I have an existing health condition?

Is it OK to take an over-the-counter pain medicine before or after getting a COVID-19 vaccine?

Allergic reactions and COVID-19 vaccines

What are the signs of an allergic reaction to a COVID-19 vaccine?

Can I get a COVID-19 vaccine if I have a history of allergic reactions?

Pregnancy, breastfeeding and fertility with COVID-19 vaccines

Can pregnant or breastfeeding women get the COVID-19 vaccine?

Children and COVID-19 vaccines

If children don’t often experience severe illness with COVID-19, why do they need a COVID-19 vaccine?

After a COVID-19 vaccine

Can I stop taking safety precautions after getting a COVID-19 vaccine?

Can I still get COVID-19 after I’m vaccinated?

Editor’s note: This is part two of a two-part interview on AI and cybersecurity with David Heaney from Mass General Brigham. To read part one, click here.

In the first installation of this deep-dive interview, Mass General Brigham Chief Information Security Officer David Heaney explained defensive and offensive uses of artificial intelligence in healthcare. He said understanding the environment, knowing where one’s controls are deployed and being great at the basics is much more critical when AI is involved.

Today, Heaney lays out best practices healthcare CISOs and CIOs can employ for securing the use of AI, how his team uses them, how he gets his team up to speed when it comes to securing with and against AI, the human element of AI and cybersecurity, and types of AI he uses to combat cyberattacks.

Q. What are some best practices that healthcare CISOs and CIOs can employ for securing the use of AI? And how are you and your team using them at Mass General Brigham?

A. It’s important to start with the way you phrase that question, which is about understanding that these AI capabilities are going to drive amazing changes in how we care for patients and how we discover new approaches and so much more in our industry.

It really is about how we support that and how we help to secure that. As I mentioned in part one, it’s really important to make sure we’re getting the basics right. So, if there’s an AI-driven service that uses our data or is being run in our environment, we have the same requirements in place for risk assessments, for business associate agreements, for any other legal agreements we’d have with non-AI services.

Because at some level we’re talking about another app, and it needs to be controlled just like any other apps in the environment, including restrictions against using unapproved applications. And none of that’s to say there aren’t AI-specific considerations we would want to address, and there’s a few that come to mind. In addition to the standard legal agreements I just mentioned, there certainly are additional data use considerations.

For example, do you want your organization’s data to be used to train your vendor’s AI models downstream? The security of the AI model itself is important. Organizations need to consider options around continuous validation of the model to ensure it is providing accurate outputs in all scenarios, and that can be part of the AI governance I mentioned in part one.

There’s also adversarial testing of the models. If we put in bad input, does it change the way the output comes out? And then one of the areas of the basics I’ve actually seen changing a little bit in terms of its importance in this environment is around the ease of adoption of so many of these tools.

An example there: Look at meeting note-taking services like Otter AI or Read AI, and there’s so many others. But these services, they’re incentivized to make adoption simple and frictionless, and they’ve done a great job at doing that.

While the concerns around the use of these services and the data they can get access to and things like that doesn’t change, the combination of the ease of adoption by our end users, and frankly, just the cool factor of this and some other applications, really makes it an important area to focus on how you’re onboarding different applications, especially AI-driven applications.

Q. How have you been getting your team up to speed when it comes to securing with and against AI? What’s the human element at play here?

A. It’s huge. And one of my top values for my security team is curiosity. I would argue it’s the single skill behind everything we do in cybersecurity. It’s the thing where you see something that’s a little bit funny and you say, “I wonder why that happened?” And you start digging in.

That’s the start of virtually every improvement we make in the industry. So, to that end, a huge part of the answer is having curious team members who get excited about this and want to learn about it on their own. And they just go out and they play with some of these tools.

I try to set an example in the area by sharing how I’ve used the various tools to make my job easier. But nothing replaces that curiosity. Within MGB, within our digital team, we do try to dedicate one day a month to learning, and we provide access to a variety of training services with relevant content in the space. But the challenge with that really is the technology changes faster than the training can keep up with.

So really nothing replaces just going out and playing with the technology. But also, perhaps with a little bit of irony, one of my favorite uses for generative AI is for learning. And one of the things I do is I use a prompt where it says something like, “Create a table of contents for a book titled X, where X is whatever topic I want to learn about.” And I also usually specify a little bit about what the author is like and the purpose of the book.

That creates a great outline of how to learn about that topic. And then you can either ask your AI friend, “Hey, can you expand on chapter one? And what does that mean?” Or potentially go to other sources or other forums to find the relevant content there.

Q. What are some types of AI you use, without giving away any secrets, of course, to combat cyberattacks? Perhaps you could explain in broader terms how these types of AI are meant to work and why you like them?

A. Our overall digital strategy at MGB is really focused on leveraging platforms from our technology vendors. Picking up a little bit from part one’s vendor question, our focus is working with these companies to develop the most valuable capabilities, many of which are going to be AI-driven.

And just to give a picture of what that looks like, at least in general terms, to not give away the golden goose, so to speak, our endpoint protection tools use a variety of AI algorithms to identify potentially malicious behavior. They then all send logs from all of these endpoints to a central collection point where there’s a combination of both rules-based and AI-based analysis that looks for broader trends.

So not just on one system, but across the entire environment. Are there trends indicative of maybe some elevated risk? We have an Identity Governance Suite, and that’s the tooling that’s used to provision access to grant and remove access in the environment. And that suite of tools has various capabilities built in to identify potential risk and see access combinations that might already be in place or even look at access requests as they come in to prevent us from granting that access in the first place.

So that’s the world of the platforms themselves and the technology that’s built in. But beyond that, going back to how we can use generative AI in some of these areas, we use that to accelerate all kinds of tasks we used to do manually.

The team has gotten, I couldn’t put a number on it, but I’ll say tons of time savings by using generative AI to write custom scripts for triage, for forensics, for remediation of systems. It’s not perfect. The AI gets us, I don’t know, 80% complete, but our analysts then finalize the script and do so much more quickly than if they were running it or creating it from the beginning.

Similarly, we use some of these AI tools to create queries that go into our other tools. We get our junior analysts up to speed much faster by letting them have access to these tools to help them more effectively use the various other technologies we have in place.

Our senior analysts are just more efficient. They already know how to do a lot of this, but it’s always better to start from 80% than to start from zero.

In general, I describe it as my really eager intern. I can ask it to do anything and it’ll come back with something between a really good starting point and potentially a great and complete answer. But I certainly wouldn’t go and use that answer without doing my own checks and finishing it first.

CLICK HERE to watch the video of this interview that contains BONUS CONTENT not found in this story.

Editor’s Note: This is the tenth and final in a series of features on top voices in health IT discussing the use of artificial intelligence. Read the other installments:

Follow Bill’s HIT coverage on LinkedIn: Bill Siwicki
Email him: bsiwicki@himss.org
Healthcare IT News is a HIMSS Media publication.

I come from an emotionally close nuclear family. As we grew up or aged, our relationships were fed on good food, conversation, the arts, and talk of travel. A few years ago, my sister had her first child; I’m gay and childless. I’m happy for her; her kids are adorable – though I run out of things to say about every photo or sniffle. With friends who have begun starting families already, our friendships have evolved positively: I feel part of their lives. Within my family, it has worked out differently. We still chat frequently and meet up. I know they love me. But my sister’s family is now the centre of our wider one. Not just practically, but also in terms of what’s immediately asked about, how we talk about life, which conversations are the most successful.

I never felt like the outsider in my family before, and I’m sure they’d object to that description: I am not consciously left out. They ask about things, but homeliness and daily routine is the default when it comes to conversation. With friends, I don’t feel the same way, despite children also being the centre of their own lives (and, I’d like to think, mine – I do enjoy being around kids). If I withdraw from my family, I feel guilty for creating precisely the perceived distance that bothers me. If I speak about my feelings, my parents try to understand, but assume that I’m jealous; my sister sees it as lack of empathy. Perhaps it is indeed a natural transition, though a change where I grieve a closeness I remember. I know that only I can alter the situation in the way that I think about it, but I go round in circles. Any suggestions?

It’s really interesting that despite your friends also having families, you don’t feel pushed out by them, but with your own family, you do. So what’s the difference? I wondered if you were the “baby” of your family and now there’s a new baby. Maybe you miss your sister being there for you. If this is the case, or even if not but you do feel jealous or left out, this is nothing to feel ashamed of. We try to run away from less than ideal feelings, but if we do that we can’t ever diffuse them.

As I’ve said before, babies shake up a family in ways that are hard to imagine. Everyone’s role is different, and there is sometimes a subconscious jostling for position. It doesn’t help when people dominate the conversation – any conversation – with things that aren’t inclusive to all. Over time it can feel exactly what it is: excluding, isolating and quite boring. Empathy, by its very nature, is a two-way emotion.

I contacted AFT-registered family psychotherapist John Cavanagh. He wondered about you “describing yourself being gay and childless and how that sat in terms of expectations in your family, how that’s led you to view yourself, perhaps as ‘othered’ in your own family? And whether your relationship to not being a father is planned or unplanned?”

Cavanagh explained that when you’re gay, your life cycle may not follow the curve of a heteronormative family, and that can take some adjusting to. Sometimes a baby can bring up all sorts for everyone. We wondered what it brought up for you. There was such a sense of loss in your letter, and I’m glad you are able to acknowledge that. It sounds like you and your family were so close, no wonder you miss that. I wondered how much effort they make to create space for you now. Perhaps it’s worth aconversation. If your parents say you’re jealous, would it be terrible if you said, “You know, I am a little”?

You and your friends probably have a more rounded relationship, and one that is constantly evolving, in a way that perhaps your parental/sibling relationships haven’t. Maybe, also, you can be more honest with them. Could you try to find some new, common ground with your family? It’s tiresome that you have to be the one to do this, but it may be worth it.

Finally, a really big thing to remember: parenthood is pretty all encompassing, but the landscape changes. Your nieces/nephews will grow up, there will be new relationships there to be forged, you could end up being the centre of their lives. Your sister will also want to flex her muscles outside of matrescence again. Family dynamics change and change again.

Every week, Annalisa Barbieri addresses a personal problem sent in by a reader. If you would like advice from Annalisa, please send your problem to ask.annalisa@theguardian.com. Annalisa regrets she cannot enter into personal correspondence. Submissions are subject to our terms and conditions.

Comments on this piece are premoderated to ensure the discussion remains on the topics raised by the article. Please be aware that there may be a short delay in comments appearing on the site.

The latest series of Annalisa’s podcast is available here.

Submaximal balloon angioplasty for symptomatic intracranial atherosclerotic stenosis (ICAS) improved outcomes over aggressive medical management alone, the BASIS trial from China showed.

The incidence of the composite of any stroke or death within 30 days or any ischemic stroke or revascularization of the qualifying artery from 30 days to 12 months after enrollment was lower with the procedure compared with medical management alone (4.4% vs 13.5%; HR 0.32, 95% CI 0.16-0.63, P<0.001).

Even when excluding the softer endpoint of revascularization from that composite endpoint, the procedure held the advantage (3.6% vs 9.1%; HR 0.39, 95% CI 0.18-0.85), reported Zhongrong Miao, MD, PhD, of Beijing Tiantan Hospital in China, and colleagues in JAMA.

“Although the study has limitations, the results provide important proof-of-concept evidence that endovascular treatments still have the potential to improve stroke risk in ICAS,” wrote Tanya Turan, MD, MSCR, of the Medical University of South Carolina in Charleston, and Colin Derdeyn, MD, of the University of Virginia in Charlottesville, in an accompanying editorial.

“Prior endovascular trials comparing percutaneous angioplasty and stenting with medical therapy failed largely due to unacceptably high rates of periprocedural complications, primarily ischemic stroke and brain hemorrhage,” they explained.

And indeed, BASIS showed that angioplasty with a smaller-diameter balloon and no stenting paid a price in early events, with 3.2% of patients having any stroke or death from any cause within 30 days compared with 1.6% in the medical therapy-alone group.

While the editorialists called that an acceptable rate, the researchers noted that it’s a risk that “should be considered in clinical practice.”

In addition, 17.4% of patients in the balloon angioplasty group had procedural complications, and 14.5% had arterial dissection. Symptomatic intracranial hemorrhage occurred in 1.2% compared with 0.4% in the medical management group.

“Submaximal balloon angioplasty without stenting has long been proposed as a ‘gentler’ procedure that results in less trauma to the arterial wall but provides sufficient reduction of stenosis to potentially restore flow and reduce the risk of recurrent stroke,” Turan and Derdeyn noted. Many of those strokes after angioplasty and stenting are from local perforator occlusion, which submaximal angioplasty may address, along with lower hemorrhage risk from the smaller-diameter balloon, fewer devices, and less manipulation.

The trial included 512 adults ages 35 to 80 from 31 centers across China who had an ischemic stroke in the prior 14 to 90 days or a transient ischemic attack (TIA) within 90 days due to severe ICAS (70% to 99% stenosis of a major intracranial artery) and who were on treatment with at least one antithrombotic drug or standard risk factor management.

Aggressive medical management included 100-mg aspirin daily for the duration of follow-up; clopidogrel 75 mg daily for the first 90 days, or ticagrelor (Brilinta) or cilostazol (Pletal) for patients with clopidogrel resistance; and risk factor management, including blood pressure control to 140/90 mm Hg, a low-density lipoprotein cholesterol target under 70 mg/dL, and a hemoglobin A1C target under 7.0% for those with diabetes, along with smoking cessation and physical activity.

The balloon angioplasty group was recommended to undergo the procedure with a dedicated intracranial balloon under general anesthesia with the Neuro RX and Neuro LPS devices (approved in China but not the U.S.) inflated to a balloon diameter 50% to 70% of the proximal artery diameter.

Driving the primary endpoint benefits with balloon angioplasty were lower rates of any ischemic stroke in the qualifying artery territory past 30 days through 1 year after enrollment (0.4% vs 7.5%) and less revascularization of the qualifying artery in that same timeframe (1.2% vs 8.3%).

The editorialists noted that revascularization is a controversial component “because it is typically performed for a TIA, and the decision to perform revascularization in this setting is subjective, which is particularly problematic in an unblinded trial.”

They also cautioned that aspects of the study design might have biased the results in favor of the angioplasty group, including exclusion of patients with ischemic stroke within the first 2 weeks after the qualifying event to decrease the risk of periprocedural complications despite the “very high” early recurrent stroke risk in this population, as well as inclusion of a large proportion of patients presenting with border zone infarcts, suggesting hypoperfusion as the mechanism of stroke.

The editorialists also pointed to generalizability questions raised by participation requirement for “very experienced” centers with an annual volume of at least 50 angioplasty cases, but uneven enrollment of more than half of the patients at the main site, while one-third of the remaining sites enrolled only one patient each.

The primary endpoint rate in the balloon angioplasty group was lower at that main center than the rest combined (2.9% vs 6.3%), suggesting “either neurointerventionist or clinical site experience likely played an important role in the low event rate in the angioplasty group,” Turan and Derdeyn wrote. “Therefore, it remains to be seen whether angioplasty would be superior to medical therapy alone if studied in an international cohort with a lower prevalence of ICAS and less ICAS angioplasty experience.”

They called for additional studies comparing angioplasty with medical therapy in high-risk patients, particularly in more diverse populations, noting that this is “imperative before angioplasty is widely adopted as an alternative treatment for ICAS in the U.S. and worldwide.”

Report an unsafe product

“I woke up every morning for four days and had to ice my lips, take Benadryl, and drink lots of fluid for the swelling to go down only a little bit. My lips peeled for over a week and blistered and bled, and I had to use steroid cream on my lips for it to heal quicker.”

Wilburn said it was “extremely embarrassing” to walk around looking like she had botched lip filler or a cosmetic procedure. 

Although Wilburn said it might have felt like she had “free lip injections,” she would not recommend that people wear Aquaphor in the sun. 

Because the internet is going to internet, however, some people on the social platform are already posting themselves applying Aquaphor in hopes of achieving a full-lipped pout without lip plumpers or injections.

The search “sunburn Aquaphor” has 2.1 billion views on TikTok, with some users commenting about how they can’t wait to try the trend for themselves on their next trip to the beach. 

“This is my sign to wear aquaphor in the sun ☝️,” one user commented on the post. “Thanks I’ll be trying,” another said. 

However, dermatologists are warning users of the risks of sun damage. A spokesperson for Aquaphor also told BuzzFeed News about the brand’s thoughts on the TikTok trend. 

“We only encourage usage of Aquaphor as directed on the label and for its main purpose, which is to hydrate lips and provide long-lasting moisture,” said Leslie Kickham, external communications leader at Beiersdorf, the company that owns Aquaphor. “People who are following TikTok trends and applying Aquaphor in unapproved ways should not do so.” 

The company recommends that people use a specific product it makes, Aquaphor Lip Protectant + Sunscreen, if they are going to be in the sun.

Here’s what to know about Aquaphor, sunburns, and why you shouldn’t apply this on purpose to plump up your lips in the sun.

Why do some products cause lip sunburns?

First up, we need to point out that there’s nothing special about Aquaphor in this case. Applying any petroleum-based product, like Vaseline, to your lips before spending time in the sun can lead to sunburn because the products don’t contain SPF, which protects against UV rays. 

Although petroleum and oil products are great for locking in moisture on dry and cracking lips — dermatologists warned against using the products in the sun, and instead, told us to opt for an SPF lip balm. On other parts of the body that produce sweat, petroleum- or oil-based products can block pores and trap sweat. 

“It looks like some people are purposely applying petroleum-based products on their lips to make them bigger. This is incredibly unwise,” said Ranella Hirsch, a board-certified dermatologist based in Cambridge, Massachusetts. “Since a key component of this hack is to cause a sunburn, you put yourself in a direct line for hyperpigmentation, pain, infection, and skin cancer.” 

Lips are a combination of muscle and connective tissue and are automatically positioned to be exposed to the sun just like the rest of your face. As a result, a sunburn can manifest as the immune system tries to protect the body from UV ray–induced damage. 

Since the lips are a different type of tissue (mucosal tissue, which is a soft tissue), Dr. Elizabeth Bahar Houshmand, a fellow at the American Academy of Dermatology, told BuzzFeed News, there are specific risks of using petroleum- and oil-based products on thinner and more sensitive skin. 

“Lipcare products with SPF protect against sun damage, but products with petroleum like Aquaphor or Vaseline put you at risk for a sunburn, as they do not have photoprotection or SPF,” Houshmand said. “This is why you are seeing the swelling, redness, and enlargement of the lips and even blister formation with excessive sun exposure. Similar to applying baby oil to the skin and getting a sunburn.”

Compared to other parts of the body that typically have 15 to 16 layers of skin, lips are made up of three to four layers, one of the thinnest layers on the body. That means that our lips don’t have a layer of protection like the rest of our skin does. 

The 10 to 30 upper layers of skin are called the stratum corneum, where cells are a bit tougher and ready to fight against the sun’s radiation. Additionally, sebaceous glands, or sweat glands, aren’t found on the lips like they are in other areas of the body. Sweat controls body temperature and serves as the first layer of defense from environmental factors. 

As a result, chronic sun exposure can cause a precancerous lesion, actinic cheilitis, also known as sailor’s lip, which often forms on the lower lip. The lesion can develop into squamous cell carcinoma, a common form of skin cancer. 

Although the majority of squamous cell carcinomas are successfully treated, lesions can become disfiguring, dangerous, and deadly. 

Squamous cell carcinomas typically are not as likely to spread as some types of skin cancers, but when they form on the lips they are 11 times more likely to metastasize than those that develop elsewhere on the body. (There is also a risk of basal cell carcinoma appearing on the top lip.) 

With an estimated 1.8 million cases of squamous cell carcinoma diagnosed each year in the US — and a 200% increase in the past three decades — it’s important to practice sun safety, including applying SPF, wearing protective clothing, and avoiding tanning. 

Symptoms of sunburned lips 

Swelling, redness, peeling, and blistering are all signs of a lip sunburn, Houshmand said. 

“The risks are having a decreased skin barrier meaning dryness irritation, dehydrated lips, and excessive temperature extremes,” Houshmand said. “Applying petrolatum and going out in the sun can cause a burn which leads to the swelling making the lips bigger. This is being called ‘instant filler.’ It is a sunburn and sun damage.”

A sunburn can present in many different ways. The skin on the lips might feel warm and swell as blood flow increases and immune cells reach the affected area. 

“Applying sunscreen is just as important as applying it on other areas of your body,” Hirsch said. “Since the skin on the lips is the most susceptible part, sun damage can be a significant risk factor for developing skin cancer.”

Here’s what you can do to help with swelling 

It’s important to avoid petroleum and oil products in the sun, and experts told BuzzFeed News, it also might be harmful to apply after a sunburn as well. 

“If you have a mild sunburn, use a cool compress on your lips to help with swelling and to decrease the heat in your lips. With a sunburn, do not use any lip products with petroleum; this will keep the heat in and prolong the burn and the symptoms,” Houshmand said. “Taking an anti-inflammatory may be helpful.”

Like other parts of the body, adding an extra step to your routine can lower your risk of skin cancer. 

A broad sunscreen that protects both UVA and UVB rays, or has an SPF of 15 or higher on all exposed skin can prevent skin cancer. Additionally, finding a chapstick with an SPF of 15 or higher can protect against sun damage. 

“The goal is cooling and pain relief,” Hirsch said. Staying hydrated, avoiding additional sun, gently applying a cold compress soaked in whole milk, taking an anti-inflammatory medication like ibuprofen or Tylenol, and staying away from spicy foods can be helpful. 

If your skin is peeling, Hirsch also added that it’s critically important to not “help it along” by peeling off the skin on the lips. Additionally, if blisters do appear, don’t pop them. 

“They are functioning as a biological wound dressing,” Hirsch said. “Interfering with them such as unroofing or popping them increases the risk of developing an infection.”

“Learn from the experience and always apply, and reapply, sunscreen to the lips,” Hirsch said.