Jimmy Kimmel Gives New Look at Son's Health Journey: 'Vote With Your Heart'

Brave Billy. Jimmy Kimmel and his wife, screenwriter Molly McNearney, shared never-before-seen footage of their 3-year-old son’s health journey on Thursday, October 22.

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“We’re two weeks away from the election, and there is so much more than the election on the line,” the Jimmy Kimmel Live! host, 52, said on his ABC show. “I want to bring us back to focus on something we can’t afford to forget, [which] is healthcare.”

The New York native went on to introduce a video segment, explaining, “My wife made a video that deals with our experience when it comes to preexisting conditions. We’d like you to watch this and pass it around to anyone who may have forgotten what this election is about.”

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In the footage, McNearney, 42, documented their baby boy’s congenital heart condition, from his tetralogy of Fallot with pulmonary atresia diagnosis to the three heart surgeries that followed. The Missouri native showed the little one’s scars as well as photos of him hooked up to different machines and tubes over the years.

“Over 60 doctors’ appointments in three years,” the actress, who also shares daughter Jane, 6, with Kimmel, wrote alongside the video.

McNearney urged viewers to “vote with your heart” before sharing videos of Billy laughing and playing with his family. “We are raising him to fight for less fortunate kids,” she concluded. “Americans take care of one another.”

Kimmel first revealed his youngest child’s heart condition in May 2017, explaining that Billy’s pulmonary valve was blocked and there was a hole in his heart wall. “On Monday morning, Dr. Vaughn Starnes opened his chest and fixed one of the two defects in his heart,” the Emmy nominee said at the time. “He went in there with a scalpel and did some kind of magic that I couldn’t even begin to explain. He opened the valve, and the operation was a success. It was the longest three hours of my life.”

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Two years later, the Serious Goose author exclusively told Us Weekly that the toddler was “doing great,” adding, “He thinks he’s Spider-Man now, so we’re safe from crime. He wears the costume all the time. He’s shooting webs all over the house.”

The comedian is also the father of Katie, 29, and Kevin, 27, with his ex-wife, Gina Kimmel.

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Now That's Crafty! How-to DIY Your Halloween, from Cupcakes to Costumes

This Halloween may look and feel a little different than years past, but that doesn’t mean it needs to be less fun! From decorating to baking to building your own costumes, there are lots of activities families can do together to help create fun and memorable bonding experiences. Best of all, there’s one simple solution to help mom and child alike learn the ropes together.  Meet Sawyer!

This interactive education platform provides a wide range of learning opportunities for children of all ages, with endless hours of guided instruction at your fingertips. From music and sewing lessons to art and science classes, Sawyer provides valuable resources designed to enrich childhood development, especially from the safety of one’s home.

Here are some of the fun ways Sawyer can help you build fun memories this Halloween.

Get Your Bake On:

What’s better than sweets on Halloween? Rather than relying on going house-to-house for candy, have your child trick-or-treat around your own house! Each room could be a new adventure full of yummy surprises. From Giant Jack O’Lantern Brownies  to Bloody Red Velvet Cupcakes to Day of the Dead Sugar Cookie Skulls, Sawyer has baking from home virtual classes designed to provide endless fun (and yums!) for the whole family.

Get Crafty:

From fun Halloween-themed bracelets to superhero wristbands that light up when you run (say what?!) Sawyer provides hands-on instruction for unleashing your child’s imagination. And what’s better than seeing their own creations come to life! Best of all, if you need materials, Sawyer will even ship them to you!

Get Messy:

What’s Halloween without painting a funny face on a jack-o’-lantern? Or drawing a spooky picture that can be hung around the house for decoration? Sawyer has a host of at-home DIY Halloween ideas that bring the fun, especially with your fingers!

Sawyer has plenty of fun for older kids too, from cooking lessons, to learning how to code (yes, code!), to music and dance. Perhaps even mom can learn a thing or two for her next TikTok video?

Sound incredible? It is!  There’s tons of FREE classes too, from Spanish lessons to making marbled paper! Visit hisawyer.com to get started on building your family fun today!

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What is ketosis – and is it good for your body?

There are certain buzzwords in the fitness world that just baffle us.

We may nod along and pretend we know what they mean in order to save face in front of the protein shake gang, but we are secretly Googling the moment we have a free second.

High on this list of confusing fitness terms is ketosis. 22,340 Brits search for the meaning and benefits of ketosis every month.

If the word itself sounds a bit scarily scientific – that’s because it is. But, if you’re serious about fitness, diet and improving your overall health, it might be useful to know exactly what it means, and if it could be good for you.

What is ketosis?

Ketosis is essentially a state where the body is using fat as its main fuel. This happens when the body doesn’t have enough carbohydrates to use as fuel, and can be intentionally triggered by following a very low carb, ‘ketogenic’ diet.

‘With the popularity of the keto diet, there is some confusion about what ketosis is,’ says MyVitalMetrics founder, Owen Hutchins.

‘At its most basic, ketosis is the result of burning fat for fuel when the body doesn’t have any carbs in the system.

‘Specifically, when the body burns fat as fuel, as part of that process it creates chemicals called ketone bodies. These ketone bodies are then normally burned in another energy production process which takes some glycogen (stored sugar) and uses it together with the ketones to create more energy.

‘However, if there is no glycogen available this process cannot be completed, so the ketone bodies remain in the blood and urine. This is ketosis.’

Is ketosis good for your body?

There is contrasting evidence about whether ketosis and the keto diet are actually healthy and good for your body. And the one hand, it can help you to maintain a healthy weight, but experts say it is not without its risks.

Doctors say that being in a state of ketosis can help you lose weight, which can be beneficial for preventing all kinds of health problems.

Beyond weight loss, other benefits could include lowering your risk of heart disease, and could be helpful in preventing seizures in epilepsy patients.

However, a recent study branded the diet ‘dangerous’ and said it was found to weaken the bones of athletes and increase their risk of injury.

Other experts have even warned that a long-term keto diet can damage the heart muscle. And many have suggested that keto is only safe and effective over a short period of time.

Is the keto diet safe?

‘Renowned for its ability to source calories from protein and fats, as opposed to carbohydrates and sugars, in a bid to elevate weight loss and boost energy, the state of ketosis has been credited for aiding a range of health problems,’ nutritionist and founder of Nosh Detox, Geeta Sidhu-Robb, tells Metro.co.uk.

‘However it is not without its criticism, such as the safe longevity of the method. But what must be said is that the ketogenic diet is most definitely safe and is a viable dieting technique.

‘Before starting a keto diet its important to do your research – of your own body. It’s very important to examine your relationship with fats as a traditional ketogenic diet will have lots of them.

‘Have a meal plan in place and opt for the best quality products, even if this means a spike in the prices – bearing in mind the keto diet should not be a long term plan.’

Geeta says that there’s also another concern with consuming high volumes of meat on this diet.

‘While the upside of this plan is that people end up eating healthier fats, less sugar and see their insulin levels mellow, it can often mean that people become reliant on saturated animal fats in meat,’ Geeta tells us.

‘This is why vegan variations of the keto diet are much healthier options as you still reap the weight and health rewards of a keto diet but avoid the harmful fats in meat, which are hard to avoid when you consider the fact that carbohydrates are almost completely disregarded.

‘Vegan ketosis will see plant-based healthy nutrients maintained.

‘The ketogenic diet will see its best rewards when implemented between one and two weeks at a time. It certainly shouldn’t be a long duration diet method.’

Remember, always talk to your doctor before making any major changes to your diet. Particularly if you have an underlying health condition.

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How to boost your immune system in good time for flu season

Already starting to panic about flu season? You’re not alone.

Do you need a flu jab? How can you tell the difference between flu symptoms and coronavirus? How can you boost your immune system ahead of winter?

There has been an intense focus on health and immunity this year thanks to Covid-19 and now everyone’s starting to think about how best to protect themselves for the winter.

‘The immune system is one of the most complex and comprehensive systems in the human body,’ says Mike Wakeman, a clinical pharmacist and ambassador for health food supplement CurraNZ.

‘It’s also one of the most important. It’s the invisible barrier against all sorts of foreign assaults from micro-organisms (fungal infections, bacteria and Covid-19) and allergens (pollens, dust mites and chemicals) that we encounter on a daily basis.’

Our first level of immunity is called the innate immune system and is activated as soon as a disease-causing micro-organism is detected. It can detect invaders such as viruses, bacteria, parasites and toxins and attempt to kill them off, before they can enter the body.

‘Innate immunity is made up of things like skin, the gastrointestinal tract and the respiratory tract. Inside these parts of the body are barriers like mucus, secretion and gastric acid, which try to stop the invaders getting in. The innate system also has immune cells (called macrophages), which are some of the most abundant cells in the human body and specialise in detecting and destroying bacteria and other harmful organisms by engulfing and killing them,’ says Mike.

The second level of protection is called the adaptive immune system, which is activated to enhance the innate system.

‘This is mainly cells called lymphocytes,’ explains Mike. ‘They are a type of white blood cell that have the ability to recognise a unique part of a micro-organism, memorise it and produce specific pathogen-neutralising compounds known as immunoglobulins. So when the body encounters this particular antigen [foreign substance] again it can produce more of the immunoglobulins it knows can kill it. This is the basis of how immunisations and flu jabs work.’

Generally, our immune system does an amazing job of defending us but a recent review in the Journal of Sport and Health Science found that ageing, obesity, and inactivity have a negative effect on the immune system.

‘The idea of boosting your immunity sounds like a simple enough process, but it’s not like giving yourself an injection or taking a shot,’ says Mike.

‘You need to think more about optimising your immunity on a daily basis as some vitamins and minerals take longer to generate their effect than others. Vitamin C is water soluble so absorbed straight away, while vitamin D is fat-soluble so is stored in fat cells rather than circulating in the body.

‘Autumn is the best time to think about how to build up immunity for winter and a good quality multi-vitamin is a cheap way to start optimising your protection.’

Spot the signs of a weakened immune system

Don’t wait until you become poorly to start looking after yourself – if you are suffering from any of these problems it’s worth taking stock and taking some extra care, says Mike.

Spot the signs

Cracks in the corner of the mouth

‘This can indicate some aspects of the immune system might be under stress. Vitamins and minerals are vital as they can help to resolve minor issues like this.’

Constant cold symptoms or infection

‘Constant and repeated colds are not only a sign of a weakened immune system, but also place extra demands on immune micronutrient status.’

Wounds take longer to heal

‘Poor healing is a typical symptom of a challenged immune system, and a number of vitamins, such as vitamin C can help improve the skin function.’

Bleeding gums

‘Often poor oral hygiene can be a major challenge to the immune system, so brush your teeth regularly, twice daily and don’t forget to floss.’

Constantly tired and over-stressed

‘Stress can really impact on our immune function, so take time out to look after yourself, get some exercise and relieve stress and exhaustion as much as possible.’

A weakened immune system can be helped with simple diet changes. ‘Most of us are deficient in vitamin D which is produced by the body when we’re exposed to sunshine,’ says Mike.

‘We don’t get enough of it during the summer and definitely not in winter. Oily fish, like pilchards, sardines, mackerel and some salmon are a good source of vitamin D and also high in omega-3 fatty acids, which may also help enhance the function of the immune cells.’

Mike is keen to emphasise that lots of what you need to bolster the immune system can be found in food. ‘You should be eating at least five portions of fruit and veg a day,’ he says.

‘Not only do vitamins and minerals optimise the immune system, they have an anti-inflammatory effect too, so if the immune system over-responds, these micronutrients can help resolve the inflammation this causes. These vitamins and minerals also help the body produce anti-bacterial compounds that fight infection within the body while compounds known as polyphenols support immunity.’

So, a healthy diet has never been more important. When teamed with a good quality multi-vitamin you should stand a better chance of fighting off the winter nasties.

Supplements to help boost your immune system

Five of the best supplements to give a helping hand

1. Extra special

Vitabiotics Immunace Extra Protection contain lycopene, resveratrol, astaxanthin, alpha lipoic acid and vit D. £10.15 (30 tablets)

2. Gum deal

Sambucol ImmunoForte Gummies contain black elderberry flavonoids, plus vitamin C, zinc and high levels of antioxidants. Suitable for vegans. £11 (30 gummies)

3. Vit blitz

Urgent-C Everyday Immune Support contains 1,000mg of vitamin C, plus vitamin D, zinc, selenium, beta glucans and elderberry extract which all help the normal function of the immune system. £14.95 (30 sachets)

4. Berry nice

Blackcurrants offer anti-viral and anti-microbial properties to help the body ward off infection. A single capsule of CurraNZ is equivalent to a handful of berries. £21.75 (30 capsules)

5. Sweet Treat

Made with all-natural ingredients and boosted with 100 per cent NRV vitamin D, C and B12, these new Perkier +Immune bars are tasty plant-based snacks to boost immune health. £15.99 (15 bars)

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Why absence could make your heart go longer

Why absence could make your heart go longer: As Britain sees a gradual shift towards so-called remote medicine, we take a look at the inventions that are changing the face of cardiac care

  • Britain is seeing a gradual shift towards so-called remote medicine for patients
  • Complex tests now performed without patient needing to step outside house   
  • However there may be caveats if the device needs to be surgically implanted

A doctor monitoring your health without even setting eyes on you used to be the stuff of science fiction.

But thanks to modern technology, Britain is seeing a gradual shift towards so-called remote medicine, where patients are supervised round the clock by high-tech implants or devices while at home.

Complex tests and check-ups that once required bulky hospital equipment are now performed without the patient needing to step outside their front door — with the results transmitted via smartphone technology straight to their doctor’s computer.

There may be caveats if the device needs to be surgically implanted, as this carries a chance, albeit low, of triggering life-threatening infections.

A 2015 study suggested that faulty heart implants could be responsible for up to 2,000 deaths a year in the UK, although this has been strongly disputed by the British Heart Foundation. (Stock image)

Some implantable devices have also been known to go wrong. 

A 2015 study suggested that faulty heart implants — including pacemakers — could be responsible for up to 2,000 deaths a year in the UK, although this has been strongly disputed by the British Heart Foundation, which insists the devices have a good safety record.

Martin Cowie, a professor of cardiology at Imperial College London, says remote monitoring will transform patient care.

‘The pandemic has highlighted how convenient it is, and now it’s here to stay,’ he adds.

Here, we take a look at the inventions that are changing the face of cardiac care, one of the areas where this advance has been the most rapid.


A high-tech pendant could make it easier to diagnose atrial fibrillation (AF), an irregular or ‘fluttering’ heartbeat, which affects around a million people in the UK.

Often triggered by high blood pressure, AF causes the heart’s electrical activity to go haywire, increasing the risk of a stroke. But patients can go days or weeks without an abnormal rhythm, making the condition hard to spot during a brief hospital visit.

The pendant, which is the brainchild of scientists at the University of Eastern Finland, is only the size of a 5p piece and can carry out pared down electrocardiograms (ECGs) — the measure of the heart’s electrical activity which is used in hospitals to diagnose AF.

Worn on a discreet silver chain, it contains an electrode, a recording device and a computer chip, which are all wirelessly connected to an app on the patient’s smartphone.

Pressed firmly against the chest for 30 seconds, it instantly transmits a read-out of the heart’s electrical activity via the app to the patient’s cardiologist. Readings should be taken several times a day.

Results of a study of 145 adults, presented at a European cardiology congress in May, showed that the gadget was as good at diagnosing AF as hospital-based ECGs. Larger trials are now planned.

‘I use devices like this a lot,’ says Richard Schilling, a professor of cardiology at Barts Health NHS Trust in London. ‘This kind of patient-performed ECG has transformed the diagnosis of some conditions.’


Getting a heart check usually means doctors attaching equipment to the outside of your body.

Now, an implant that does the tests from the inside — without the need for a medic even to be present — is undergoing trials at Queen Elizabeth Hospital in Birmingham and London’s Hammersmith Hospital.

The V-lap microcomputer monitors patients with heart failure, which is where the heart, weakened after a heart attack or by a condition such as untreated high blood pressure, is unable to pump sufficient blood around the body to deliver the oxygen vital organs need. 

Treatment for the 1.3 million Britons with heart failure usually starts with drugs to lower blood pressure and reduce water retention, a common symptom.

This new implant, which is inserted into the left atrium — one of the heart’s two upper chambers — during an hour-long keyhole operation, senses changes in blood pressure which are a sign of further deterioration of the organ.

Transmitted to a patient’s cardiologist twice a day, the data can give several weeks’ notice that heart function is deteriorating — enough time to increase drug dosage and stave off greater damage.

Professor Francisco Leyva-Leon, a cardiologist trialling the implant in Birmingham, says: ‘The benefits could be huge. In my hospital alone we admit more than 1,000 patients a year with heart failure.’


Home blood pressure monitoring is nothing new. But devices are fairly cumbersome, involving wearing a ‘sleeve’ that wraps round the upper arm, just like the one in a GP surgery.

That could be about to change, thanks to Japanese scientists working out how to shrink the key components of the equipment into a wristwatch.

HeartGuide, which can also be used as a normal watch, has a built-in cuff under the strap that inflates around the wrist when the patient presses the watch face.

Daily readings are beamed wirelessly to a smartphone app that shares the data with doctors, who then decide if the patient’s medication needs altering — without needing a consultation.

However, at around £500, it’s not a cheap option.

‘This smart watch is an interesting idea,’ says Professor Martin Cowie. ‘But it is important to remember blood pressure goes up and down in response to activity or sleep. The patient would need to take a large number of readings.’


Pacemakers have been around for more than half a century, but a new generation of miniature implants are capable of much more than just regulating the heart — they can also communicate with doctors remotely.

Alternative remedies

The aloe vera plant is often found in tropical climates

Pharmacist Gemma Fromage reveals the unexpected uses for everyday products. 

This week: Aloe vera for acid reflux.

The use of aloe vera, a plant often found in tropical climates, dates back to Ancient Egyptian times.

It is well known as a home remedy for scrapes and burns due to its anti-inflammatory properties.

The juice, derived from the inner lining of its leaves, has also been found to soothe acid reflux. A study in the Journal of Traditional Chinese Medicine showed purified aloe vera juice improved reflux symptoms as well as, and in some cases better than, traditional medications — possibly because it reduces acid production.

Pregnant women and those with diabetes are advised against taking aloe vera juice, as it may cause uterine contractions and affect blood sugar levels. 

Anyone using prescribed medicines for reflux should also consult their doctor before stopping their treatment regimen in favour of aloe vera, or adding the juice to it.


Pacemakers are matchbox-sized gadgets used to treat a range of conditions that affect the heart —from children born with cardiac defects to adults with AF. Implanted in the chest, they send electrical pulses to the heart to keep it beating regularly.

Older devices store readings on built-in microchips which can only be accessed by visiting a hospital up to four times a year to have them downloaded. But now doctors can gather the data without the patient needing to leave their home.

Modern pacemakers have a transmitter that ‘talks’ to a mobile-phone sized monitor. It uses an internet connection to send encrypted data straight to the doctor’s computer.

‘We already use remote monitoring for thousands of pacemaker patients,’ says Professor Francisco Leyva-Leon.

‘It means we can screen them on a regular basis and only need to call them in for a consultation if there is a potential problem.’


A stick-on chest patch called Zio that you can even wear in the shower is increasingly being used to diagnose irregular heart rhythms without going to hospital.

The matchbox-sized patch has built-in electrodes and a recording device to pick up the heart’s electrical activity as the patient goes about their day.

Made from waterproof plastic, the patient wears it on their upper chest for up to two weeks to record their heart’s activity, before sending it back to the supplier, Surrey-based firm iRhythm.

The company uses the results to compile a report for the patient’s doctor.

A 2019 study at King’s College Hospital in London found the Zio patch was almost eight times more effective than current portable monitors at detecting heart rhythm problems.

The cost to the NHS is £800 per patch, including the analysis and the report provided for GPs.

‘Devices like the Zio skin patch are easier to wear than monitors during exercise and may even perform better,’ says Dr Sarah Clarke, a cardiologist at the Royal Papworth Hospital in Cambridge.

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There’s No Magic Formula to Slow Your Dog’s Aging

FRIDAY, Sept. 18, 2020 — Despite the deep desire to help your dog age gracefully and stay mentally sharp, new research suggests that even the best diet and training won’t slow the ravages of time for your furry friend.

Just like their human owners, dogs can experience thinking declines and behavioral changes as they age. They might display less curiosity about novel objects and show decline in social responsiveness, memory and attention, the researchers explained.

Studies have suggested that lifelong training and an enriched diet could slow dogs’ mental aging, but few have explored aging in pet dogs in real-life settings.

In this latest study, an international team of researchers led by Durga Chapagain, from the University of Veterinary Medicine in Vienna, Austria, found that middle-aged to elderly dogs who were trained throughout their life and fed a nutrient-enriched diet for a year performed no better on thinking tests than dogs who received less training and ate a regular diet.

The study included more than 100 pet dogs over the age of 6 years and of varying breeds. The participating dogs were split randomly into two groups: half were fed a nutrient-enriched diet, including antioxidants and omega fatty acids, while the other half consumed a regular diet. The researchers also collected information from the pets’ owners about their dogs’ previous training.

After a year on the diet, the researchers evaluated the dogs’ mental capacities using a cognitive test that is designed for older canines.

Sadly, diet and training were found to have no significant impact on mental decline, the study authors said.

The aging dogs experienced declines in four particular areas: problem-solving, sociability, boldness and dependency. However, the findings showed that their trainability and activity independence appeared to remain sharp.

The study was published online Sept. 16 in the journal PLOS ONE.

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How even a short walk can boost your memory

How even a short walk can boost your memory: Exercise improves concentration and problem-solving skills, scientists discover

  • Scientific review found people improved on memory tests after exercising 
  • Findings come from 13 studies which were analysed by Swedish researchers 
  • Exercise is believed to increase levels of a protein called ‘brain-derived neurotrophic factor’ which is thought to be important for memory function

A short walk, run or bike ride could provide a memory boost in less than an hour.

A scientific review looked at people aged 18 to 35 who walked, ran or cycled at moderate to high intensity and then took tests such as remembering a list of 15 words.

The participants, who exercised in bursts of two minutes, or 15 minutes, half an hour or an hour, improved on tests and showed better concentration and problem-solving skills.

The findings come from 13 studies which were analysed by Swedish researchers.

A short walk, run or bike ride could provide a memory boost in less than an hour

The authors, from Jonkoping and Linkoping universities, conclude: ‘This systematic review strongly suggests that aerobic, physical exercise followed by a brief recovery… improves attention, concentration, and learning and memory functions in young adults.’

Exercise is believed to increase levels of a protein called ‘brain-derived neurotrophic factor’ which is thought to be important for memory.

But not everyone is a natural athlete or has hours to work out. 

The review wanted to see if a single bout of exercise could have an effect, so looked at studies exploring this with young adults over ten years.

The review, published in the journal Translational Sports Medicine, found exercise from two minutes to an hour improved memory and thinking skills for up to two hours.

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4 ways to end your day positively

Some days — who are we even kidding, most days — it seems like we really are running a rat race, and the rats are definitely winning. All day long, we’re scrambling to keep up with everything we’ve got to do, and when nighttime comes, we sink into bed, exhausted, hoping and praying we’ll be able to get just enough sleep to allow us to run, run, run from the moment the alarm goes off again the next day.

While it may seem counter-intuitive to be told to slow down when it seems we’re always running behind, it’s nonetheless important to try to take a few moments for yourself at the end of every day to relax, gather your thoughts, and renew your energy. ICF Certified Life and Spiritual Coach Ryan Haddon, who’s also a certified hypnotherapist and meditation teacher, suggests several nightly practices you can adopt that will not only let you end your day in a positive way, but will help some of that positivity carry over into the next morning.

End your day positively by taking an inventory

Haddon says that if you do a personal inventory at the end of every day and try to let yourself be guided by the lessons you find there, you will, over time, be able to “move the needle forward on becoming the best version of yourself.” This is the ultimate goal of all self-improvement, right? You’re always going to be you, but you might as well be the very best you you can be.

As to how you perform a personal inventory, Haddon says you should think of three things you did that went well, and three more things that didn’t go so well. If, in analyzing the latter actions, you find that you owe anyone an apology or think you really ought to make amends for something that was your fault, you should plan to do so the very next day. That way, Haddon assures, you’ll be “keeping your side of the street clean and waking up with a clean slate.”

End your day positively by taking a deep breath

Adopting a practice of nighttime meditation or breath work, according to Haddon, can provide you with “a powerful time to drop into stillness by preparing the mind and body for deep rest.” She also says that meditation and deep breathing make for ” a nice way to connect to who you are outside of all the roles you play in your waking hours.” 

As to how you meditate — they’ve got an app for that; actually, a whole bunch of apps. Breath work (not the holotropic, rapid-breathing type) is even easier — all you need to do, according to Haddon, is to set a timer for 10 minutes and spend that time breathing easily, yet intentionally. Feel each breath coming in and out, counting one as you breathe in, then two as you breathe out. Count up to 10 with these in-out breaths, then start over again at one. Breathe and count, count and breathe. Sounds very peaceful and relaxing — but no worries if you do drop off, since your body has sense enough to keep on breathing even when it’s not intentional.

End your day positively by giving thanks

An attitude of gratitude never hurt anyone, and in fact, it can do you a lot of good remembering how much you have to be thankful for, even when things are rough. Since it can sometimes be hard to remember to send those thank-you notes to the universe, Haddon advocates keeping a “gratitude journal” by the side of your bed and writing in it every night before you turn off your light. 

She says you should try to come up with 10 things you are grateful for each day. While it may seem difficult to do, especially if you don’t want to keep reproducing the same cut and paste list every day, Haddon explains that “try[ing] not to repeat the same gratitudes over and over, the magic starts to happen during the day when [you] look for the good happening in real time.” She says that you’ll learn to appreciate the more subtle things, which, in turn, will allow your mindfulness to increase. You will also start to see that “there are always positives unfolding in your life when you’re present for them.”

End your day positively by saying these magic words

One particularly powerful bedtime practice is that of nighttime affirmations, repeated to yourself just before you drift into sleep. Haddon describes the subconscious mind as “the part of you that runs your operating system beneath the surface” and says that this part “holds all your beliefs about yourself and the life around you.” The subconscious, it seems, is most receptive to new ideas when brain wave activity slows, as it does while you’re nodding off. If you feed your subconscious with ideas about love, abundance, and success, then, Haddon promises, “you’ll wake up with success codes built into your blueprint for the day ahead.”

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Why is wildfire smoke so bad for your lungs?

If I dare to give the coronavirus credit for anything, I would say it has made people more conscious of the air they breathe.

A friend texted me this week after going for a jog in the foothills near Boise, Idaho, writing: “My lungs are burning … explain what’s happening!!!”

A wildfire was burning to the east of town — one of dozens of fires that were sending smoke and ash through communities in hot, dry western states. As an environmental toxicologist, I research how air pollution, particularly wood smoke, impacts human health and disease.

I gave my friend the short answer: The state had issued a yellow, or moderate, air quality index warning due in part to wildfires. The high temperature for the day was expected to reach 100 degrees Fahrenheit, and it was already approaching 90. That combination of high temperatures and elevated levels of particles from a fire can affect even healthy lungs. For someone with lung damage or respiratory illness, moderate levels of smoke particulate can exacerbate respiratory problems.

That’s only the start of the story of how wildfire smoke affects humans who breathe it. The rest, and how to stay healthy, is important to understand as the western wildfire season picks up.

What’s in wildfire smoke?

What exactly is in a wildfire’s smoke depends on a few key things: what’s burning — grass, brush or trees; the temperature — is it flaming or just smoldering; and the distance between the person breathing the smoke and the fire producing it.

The distance affects the ability of smoke to “age,” meaning to be acted upon by the sun and other chemicals in the air as it travels. Aging can make it more toxic. Importantly, large particles like what most people think of as ash do not typically travel that far from the fire, but small particles, or aerosols, can travel across continents.

Smoke from wildfires contains thousands of individual compounds, including carbon monoxide, volatile organic compounds (VOCs), carbon dioxide, hydrocarbons and nitrogen oxides. The most prevalent pollutant by mass is particulate matter less than 2.5 micrometers in diameter, roughly 50 times smaller than a grain of sand. Its prevalence is one reason health authorities issue air quality warnings using PM2.5 as the metric.

What does that smoke do to human bodies?

There is another reason PM2.5 is used to make health recommendations: It defines the cutoff for particles that can travel deep into the lungs and cause the most damage.

The human body is equipped with natural defense mechanisms against particles bigger than PM2.5. As I tell my students, if you have ever coughed up phlegm or blown your nose after being around a campfire and discovered black or brown mucus in the tissue, you have witnessed these mechanisms firsthand.

The really small particles bypass these defenses and disturb the air sacks where oxygen crosses over into the blood. Fortunately, we have specialized immune cells present in the air sacks called macrophages. It’s their job to seek out foreign material and remove or destroy it. However, studies have shown that repeated exposure to elevated levels of wood smoke can suppress macrophages, leading to increases in lung inflammation.

What does that mean for COVID-19 symptoms?

Dose, frequency and duration are important when it comes to smoke exposure. Short-term exposure can irritate the eyes and throat. Long-term exposure to wildfire smoke over days or weeks, or breathing in heavy smoke, can raise the risk of lung damage and may also contribute to cardiovascular problems. Considering that it is the macrophage’s job to remove foreign material — including smoke particles and pathogens — it is reasonable to make a connection between smoke exposure and risk of viral infection.

Recent evidence suggests that long-term exposure to PM2.5 may make the coronavirus more deadly. A nationwide study found that even a small increase in PM2.5 from one U.S. county to the next was associated with a large increase in the death rate from COVID-19.

What can you do to stay healthy?

The advice I gave my friend who had been running while smoke was in the air applies to just about anyone downwind from a wildfire.

Stay informed about air quality by identifying local resources for air quality alerts, information about active fires, and recommendations for better health practices.

If possible, avoid being outside or doing strenuous activity, like running or cycling, when there is an air quality warning for your area.

Be aware that not all face masks protect against smoke particles. In the context of COVID-19, the best data currently suggests that a cloth mask benefits public health, especially for those around the mask wearer, but also to some extent for the person wearing the mask. However, most cloth masks will not capture small wood smoke particles. That requires an N95 mask in conjunction with fit testing for the mask and training in how to wear it. Without a proper fit, N95s do not work as well.

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Establish a clean space. Some communities in western states have offered “clean spaces” programs that help people take refuge in buildings with clean air and air conditioning. However, during the pandemic, being in an enclosed space with others can create other health risks. At home, a person can create clean and cool spaces using a window air conditioner and a portable air purifier.

The EPA also advises people to avoid anything that contributes to indoor air pollutants. That includes vacuuming that can stir up pollutants, as well as burning candles, firing up gas stoves and smoking.

This article was originally published at The Conversation. The publication contributed the article to Live Science’s Expert Voices: Op-Ed & Insights.

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Ever heard of a surgical assistant? Meet a new boost to your medical bills

Izzy Benasso was playing a casual game of tennis with her father on a summer Saturday when she felt her knee pop. She had torn a meniscus, one of the friction-reducing pads in the knee, locking it in place at a 45-degree angle.

Although she suspected she had torn something, the 21-year-old senior at the University of Colorado in Boulder had to endure an anxious weekend in July 2019 until she could get an MRI that Monday.

“It was kind of emotional for her,” said her father, Steve Benasso. “Just sitting there thinking about all the things she wasn’t going to be able to do.”

At the UCHealth Steadman Hawkins Clinic Denver, the MRI confirmed the tear, and she was scheduled for surgery on Thursday. Her father, who works in human resources, told her exactly what to ask the clinic regarding her insurance coverage.

Steve had double-checked that the hospital; the surgeon, Dr. James Genuario; and Genuario’s clinic were in her Cigna health plan’s network.

“We were pretty conscious going into it,” he said.

Isabel met with Genuario’s physician assistant on Wednesday, and the following day underwent a successful meniscus repair operation.

“I had already gotten a ski pass at that point,” she said. “So that was depressing.” But she was heartened to hear that with time and rehab she would get back to her active lifestyle.

Then the letter arrived, portending of bills to come.

The Patient: Izzy Benasso, a 21-year-old college student covered by her mother’s Cigna health plan.

The Total Bill: $96,377 for the surgery was billed by the hospital, Sky Ridge Medical Center in Lone Tree, Colorado, part of HealthONE, a division of the for-profit hospital chain HCA. It accepted a $3,216.60 payment from the insurance company, as well as $357.40 from the Benassos, as payment in full. The surgical assistant billed separately for $1,167.

Service Provider: Eric Griffith, a surgical assistant who works as an independent contractor.

Medical Service: Outpatient arthroscopic meniscus repair surgery.

What Gives: The Benassos had stumbled into a growing trend in health care: third-party surgical assistants who aren’t part of a hospital staff or a surgeon’s practice. They tend to stay out-of-network with health plans, either accepting what a health plan will pay them or billing the patient directly. That, in turn, is leading to many surprise bills.

Even before any other medical bills showed up, Izzy received a notice from someone whose name she didn’t recognize.

“I’m writing this letter as a courtesy to remind you of my presence during your surgery,” the letter read.

It came from Eric Griffith, a Denver-based surgical assistant. He went on to write that he had submitted a claim to her health plan requesting payment for his services, but that it was too early to know whether the plan would cover his fee. It didn’t talk dollars and cents.

Steve Benasso said he was perplexed by the letter’s meaning, adding: “We had never read or heard of anything like that before.”

Surgical assistants serve as an extra set of hands for surgeons, allowing them to concentrate on the technical aspects of the surgery. Oftentimes other surgeons or physician assistants—or, in teaching hospitals, medical residents or surgical fellows—fill that role at no extra charge. But some doctors rely on certified surgical assistants, who generally have an undergraduate science degree, complete a 12- to 24-month training program, and then pass a certification exam.

Surgeons generally decide when they need surgical assistants, although the Centers for Medicare & Medicaid Services maintains lists of procedures for which a surgical assistant can and cannot bill. Meniscus repair is on the list of allowed procedures.

A Sky Ridge spokesperson said that it is the responsibility of the surgeon to preauthorize the use and payment of a surgical assistant during outpatient surgery, and that HealthOne hospitals do not hire surgical assistants. Neither the assistant nor the surgeon works directly for the hospital. UC School of Medicine, the surgeon’s employer, declined requests for comment from Genuario.

Karen Ludwig, executive director of the Association of Surgical Assistants, estimates that 75% of certified surgical assistants are employed by hospitals, while the rest are independent contractors or work for surgical assistant groups.

“We’re seeing more of the third parties,” said Dr. Karan Chhabra, a surgeon and health policy researcher at the University of Michigan Medical School. “This is an emerging area of business.”

And it can be lucrative: Some of the larger surgical assistant companies are backed by private equity investment. Private equity firms often target segments of the health care system where patients have little choice in who provides their care. Indeed, under anesthesia for surgery, patients are often unaware the assistants are in the operating room. The private equity business models include keeping such helpers out-of-network so they can bill patients for larger amounts than they could negotiate from insurance companies.

Surgical assistants counter that many insurance plans are unwilling to contract with them.

“They’re not interested,” said Luis Aragon, a Chicago-area surgical assistant and managing director of American Surgical Professionals, a private equity-backed group in Houston.

Chhabra and his colleagues at the University of Michigan recently found that 1 in 5 privately insured patients undergoing surgery by in-network doctors at in-network facilities still receive a surprise out-of-network bill. Of those, 37% are from surgical assistants, tied with anesthesiologists as the most frequent offenders. The researchers found 13% of arthroscopic meniscal repairs resulted in surprise bills, at an average of $1,591 per bill.

Colorado has surprise billing protections for consumers like the Benassos who have state-regulated health plans. But state protections don’t apply to the 61% of American workers who have self-funded employer plans. Colorado Consumer Health Initiative, which helps consumers dispute surprise bills, has seen a lot of cases involving surgical assistants, said Adam Fox, director of strategic engagement.

Resolution: Initially, the Benassos ignored the missive. Izzy didn’t recall meeting Griffith or being told a surgical assistant would be involved in her case.

But a month and a half later, when Steve logged on to check his daughter’s explanation of benefits, he saw that Griffith had billed the plan for $1,167. Cigna had not paid any of it.

Realizing then that the assistant was likely out-of-network, Steve sent him a letter saying “we had no intention of paying.”

Griffith declined to comment on the specifics of the Benasso case but said he sends letters to every patient so no one is surprised when he submits a claim.

“With all the different people talking to you in pre-op, and the stress of surgery, even if we do meet, they may forget who I was or that I was even there,” he said. “So the intention of the letter is just to say, ‘Hey, I was part of your surgery.'”

After KHN inquired, Cigna officials reviewed the case and Genuario’s operative report, determined that the services of an assistant surgeon were appropriate for the procedure and approved Griffith’s claim. Because Griffith was an out-of-network provider, Cigna applied his fee to Benasso’s $2,000 outpatient deductible. The Benassos have not received a bill for that fee.

Griffith says insurers often require more information before determining whether to pay for a surgical assistant’s services. If the plan pays anything, he accepts that as payment in full. If the plan pays nothing, Griffith usually bills the patient.

The Takeaway: As hospitals across the country restart elective surgeries, patients should be aware of this common pitfall.

Chhabra said he’s hearing more anecdotal reports about insurance plans simply not paying for surgical assistants, which leaves the patient stuck with the bill.

Chhabra said patients should ask their surgeons before surgery whether an assistant will be involved and whether that assistant is in-network.

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