AstraZeneca's Farxiga granted fast track status for heart failure treatment

AstraZeneca's Farxiga granted fast track status for heart failure treatment
Reuters: Health
AstraZeneca Plc said on Monday the U.S. Food and Drug Administration (FDA) had granted fast track designation for the development of its diabetes drug Farxiga to reduce the risk of deadly heart attacks in some patients.


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When Is It Okay to Lie About Death?

This week, I sat, enthralled in a darkened movie theater watching a story unfold. Before the first scene, the line, “Based on an actual lie,” ran across the screen. The film is called The Farewell and is the story of the lung cancer diagnosis of the filmmaker’s grandmother. Lulu Wang is the director for whom art imitates life. Her alter ego is Billi, played by the actress and rapper Akwafina. Billi adores her Nai Nai (Chinese for grandmother), who assisted in raising her when her parents immigrated to the U.S. when she was a child. She discovers that her grandmother was diagnosed with end stage lung cancer and the family, spearheaded by her sister and reinforced by her two sons, chooses not to tell the octogenarian about her doctor’s prediction that she will likely die in three months. Chinese tradition is to withhold that information since they believe that it would hasten her passing and that people are more likely to die from the fear of death than the illness itself.

The elaborate hoax included the staged wedding of Billi’s cousin to a woman he had only been dating for three months. Bolstered by the belief that “benign shadows” were on her x-rays, Nai Nai takes the lead in planning this extravaganza for her grandson with a zeal and zest that belies her age and health condition. 

The concept of “family first” is evident throughout as in their culture, the needs of the individual take back seat to the needs of the collective. They all carry the burdens for each other. Much of the conversation about what to tell Nai Nai happens over food prep and heaping platters of sustenance, both physical and emotional. 

Even though the film is receiving world-wide acclaim, Wang has stated in many interviews that her grandmother doesn’t know the full content and focus of the movie. She does know that it is about her family. It is an amazing feat that no one has spilled the beans. At the time of this article, Nai Nai is still on this side of the veil, six years post diagnosis.

This begs the question, when is it acceptable to withhold the medical truth from someone? Is it in their best interest and will it likely increase longevity?

In the United States, it is not customary to do so and yet, in 2008, when my then 84-year-old father who was diagnosed with Parkinson’s Disease was about to be placed on hospice, my mother asked that no one use that term with him, since she feared he would die sooner. We agreed that he would know he was receiving additional nursing care at home and he accepted that explanation. The last few months of his life were spent at home with my mother, a live-in caregiver, as well as family and friends surrounding him. When he did pass (as predicted by his doctor) three months later, I was blessed to be by his side. I was convinced that, despite cognitive deficits related to the condition, he made peace with his eventual evolution to his next stage of life. He didn’t express fear of dying, since I sensed that his deep spiritual faith had him trusting what came next for him.

A few years later, my mother was diagnosed with congestive heart failure. She was cognizant and fully aware of her prognosis, verbalized vehemently that she wasn’t ready to die, and planned at least a few more years on the planet so she could see her grandchildren get married. That wasn’t to be, since by the time my son Adam married his sweetheart Lauren two years ago, she had been gone seven years. She would have adored her, as well as my sister’s granddaughter who is now a precocious 6-year-old.

Prior to her death, we had in depth conversations at all hours about her perceptions about what would happen when it was her turn to slip this mortal coil. Initially, she cried and expressed fear, but as the time drew near, humor was injected, and a sense of peace came over her. She didn’t embrace death, but she didn’t avoid talking about it either. She came to accept that it would happen sooner rather than later. Six months after entering into hospice care (and yes, she did know) she passed, with substitute caregivers (not her regular live in staff and regular hospice workers) by her side. My sister and I were not present either and it seems she orchestrated it that way. I have no regrets, since I said what needed to be shared. A slight sense of wistfulness remains coming up on nine years this November 26th, that I wasn’t there when she took her final breath, since she was present when I took my first.

I read an article this morning, that was written by a mother whose 8-year-old son died of cancer. She had to come to terms with what I have heard is the most horrific loss; that of a child. She found the courage to share three pieces of wisdom that helped him to pass as peacefully as possible, exceeding the doctor’s estimate by a few weeks, I imagine, as a result. She told him that he would not die alone; that she would be there. He would not be in pain and they would be okay after he died, although they would certainly miss him.

What if we knew our expiration date? Would it allow us the time to prepare for our exit? Would it enable us to make peace with the end of this existence? Would it help us to say what we might not otherwise have said to loved ones and to make amends for interactions we wish would have been different? 

Would you want to know?

Getting Off the Emotional Carousel

We all have strong emotions from time to time. We have all had that experience of feeling “emotionally hijacked” in which we feel powerless against the influence our emotions have on our behavior, mood, and general perspective. Strong emotions can prompt powerful thoughts, and sometimes, repetitive thoughts. If we are struggling with a persistent emotion, it can be difficult to put the feeling down or let it go. We carry the worry with us day and night. 

But if we can remove ourselves from the subjective experience of any given emotion, we might be able to size up its impact on our lives a little more realistically. What is it that really drives our emotions, anyway? How much power do they really hold over our lives and our decisions?

When I feel like I am trapped on an emotional carousel, I remember this information about the physiological lifespan of emotions within our bodies. It comes from Dr. Jill Bolte Taylor, a neuroanatomist that suffered a stroke and chronicled her recovery from neuro trauma in her book, My Stroke of Insight: A Brain Scientist’s Personal Journey:

When a person has a reaction to something in their environment, there’s a 90-second chemical process that happens in the body; after that, any remaining emotional response is just the person choosing to stay in that emotional loop.

Something happens in the external world and chemicals are flushed through your body, which puts it on full alert. For those chemicals to totally flush out of the body it takes less than 90 seconds.

This means that for 90 seconds you can watch the process happening, you can feel it happening, and then you can watch it go away.

After that, if you continue to feel fear, anger, and so on, you need to look at the thoughts that you’re thinking that are re-stimulating the circuitry that is resulting in you having this physiological response over and over again.

Ninety seconds. That’s one and a half minutes. 

Have you ever spent ONLY one and a half minutes with any given emotion?

Probably not! Emotions, both positive and negative, we all spend more time with than that. So, what kind of fuel do these emotions run on? What perpetuates their presence beyond their physiological lifespan?

We do. We perpetuate their presence.

Of course, it should be said, that patterns of behavior over time reinforce emotional responses and behaviors, which can become very difficult to be aware of, much less overturn. But understanding the chemical process of emotions helps to empower us that at any given point — we can stop, take a deep breath, and examine how our thoughts are contributing to the continued circuitry of an emotion. 

When I’m giving a presentation at work and I make a mistake that embarrasses me, once I’m back in the cozy confines of my office, I’m replaying the moment mentally, which sends the emotional response around again. 

When I’m making a big decision for my family, and I’m feeling torn between the pros and cons, every rollercoaster loop the emotion makes around my body, it seems like more passengers are piling on every time: What if that plan fails? What if this is the wrong decision? What if you negatively impact the other members of your family?

Round and round the carousel goes, gaining momentum with each completed cycle. But there is a quick way to reverse this phenomenon and regain control of emotions that seem to run rampant. However, it takes practice.

Consider yourself an investigator, allow yourself time to turn over the emotion for a while, how it feels, what it means, what it impacts, and then?

Put it away. Let it go.

This is different from suppression of emotions. Emotions are healthy for us to have and they help us navigate our experiences. They need attention, expression, and evaluation. But they need not run away with us. We have control over how many times we revisit worry and concern that does not help us move forward. When the emotional circuitry is running on autopilot and we’ve tuned out of our own ability to manage our emotions that is when we put ourselves at risk. 

This practice is more about allowing your emotions to play out without judgment. We can feel embarrassed about making a mistake in front of a crowd of people and then move on. We can feel stressed about an important decision we need to make for our family and then move on. But when we attach to these emotions judgmental thoughts of anxiety, grief, worry, concern, or anger, and we revisit those thoughts over and over, we only continue to fuel the impact of our emotions long after their initial purpose. 

So, next time you catch yourself watching reruns of an emotional response, try allowing yourself ninety seconds to complete the emotional circuit and then let it go.