Category Archives: Integrative Medicine

A Sino-U.S. collaborative study has demonstrated that acupuncture regulates inflammation by activating pro- or anti-inflammatory signaling pathways, while mitigating cytokine storms in mice with systemic inflammation, the study authors reported in the Aug. 12, 2020, edition of Neuron.

The study also found that the acupuncture site, intensity and timing determined how it affected response, which has important implications for acupuncture use in inflammatory diseases and as adjunctive cancer therapy.

Acupuncture was further shown to influence how mice coped with the aberrant immune system reaction of cytokine storm due to rapid excessive release of pro-inflammatory cytokines.

Our study provides an insight into how acupuncture can drive distinct autonomic pathways and modulate inflammation in acupoint-, stimulation intensity- and disease state-dependent manners, said study leader Qiufu Ma, a professor in the Dana Farber Cancer Institute and the Department of Neurobiology at Harvard Medical School.

Cytokine storms are a characteristic of inflammatory diseases, notably bacterial or viral infections causing sepsis, an organ-damaging, often-fatal inflammatory response.

Cytokine storms can also be caused by excessive inflammatory responses to traumatic tissue injury, some surgeries, and cancer immunotherapies such as immune checkpoint inhibition, but currently there are no FDA-approved treatments for severe cytokine storms, noted Ma.

For cancer patients receiving immunotherapy who develop inflammatory side effects, milder symptoms might be relieved by corticosteroids, which have their own side effects, he said.

In COVID-19 patients, early pilot studies have suggested using an antibody against the cytokine, interleukin-6 (IL-6), but larger clinical trials are needed to confirm the efficacy and safety of this approach, he told BioWorld.

A traditional Chinese medicine technique, acupuncture has become increasingly integrated into Western medicine, particularly for treating chronic pain and gastrointestinal disorders.

It involves mechanical stimulation of acupoints, supposedly triggering nerve signaling and affecting the function of internal organs corresponding to those acupoints, but acupunctures basic underlying mechanisms have not been fully elucidated.

In their new study, Ma and his research team investigated the use of electroacupuncture stimulation (ES), in which ultra-thin electrodes offer better control of stimulation intensity than traditional needles.

The researchers investigated two cell types secreting the neurotransmitters known to be important inflammatory mediators: adrenal gland chromaffin cells, the main producers of adrenaline, noradrenaline (NA) and dopamine, and peripheral NA neurons.

To determine the precise role these cells play in inflammatory responses, the researchers used a novel genetic tool to ablate chromaffin cells or NA neurons.

We genetically introduced the human diphtheria toxin receptor (DTR) selectively to molecularly defined sympathetic cells, such as those marked by expression of neuropeptide Y (NPY), explained Ma.

Injecting a modified diphtheria toxin that does not cross the brain-blood barrier can selectively ablate DTR-expressing cells, creating mice lacking both NPY-expressing chromaffin cells and NA neurons, or those with a more selective ablation of NPY-expressing chromaffin cells via injecting low-dose toxin only into the adrenal gland.

That allowed inflammatory response comparison in mice with and without those cells, to determine their role in modulating inflammation. The markedly different responses then identified those cells as key regulators of inflammation.

Hind-limb administration of low-intensity ES to mice with a bacterial toxin-induced cytokine storm was shown to activate the vagus-adrenal axis, inducing dopamine secretion from chromaffin cells.

We used the induction of a neuronal activation marker to show that low-intensity ES activated hind-brain vagal efferent neurons, which are known to innervate thoracic and visceral organs and tissues, said Ma.

We then showed that low-intensity ES could reduce cytokine storms and promote survival, and that these ES effects were lost in mice with transected vagal efferents or in those with ablation of NPY-expressing adrenal chromaffin cells, suggesting involvement of the vagal-adrenal anti-inflammatory axis.

Specifically, treated animals had more than 50% reductions in the cytokines, tumor necrosis factor-alpha (TNF-a), IL-6 and IL-1b, than untreated controls, and prolonged survival rates of 60% vs. 20%, respectively.

In addition, the vagus-adrenal axis was shown to be activated by hind-limb ES, but not by that using abdominal acupoints, demonstrating the importance of acupoint selectivity in driving specific anti-inflammatory pathways.

Treatment timing was also found to be critical, with high-intensity abdominal stimulation producing markedly different outcomes, depending on when treatment occurred.

For example, animals treated before developing cytokine storm had lower levels of inflammation during subsequent disease and their survival increased from a range of 20% to 30% to a range of 70% to 80%.

Conversely, those treated after disease onset and during the cytokine storm peak experienced worse inflammation and more severe disease.

Together, those findings suggest that ES could be a versatile treatment modality, from adjunct therapy for sepsis to targeted treatment of site-specific inflammation, such as in inflammatory intestinal diseases.

Acupuncture might also help modulate inflammation due to cancer immune therapy, which can trigger cytokine storms, and is currently used in integrative cancer treatment to help patients tolerate treatment side effects.

However, before considering any therapeutic use, those findings must be further confirmed in animals and humans, optimal ES parameters must be defined and its safety established.

Safety

High-intensity ES can drive spinal-splenic noradrenergic sympathetic neuronal pathway, potently reducing inflammation if performed before cytokine storm induction, said Ma.

However, after the first cytokine storm wave has peaked, high-intensity ES can exacerbate inflammation and increase fatality rates, due to altered NA receptor profiles in immune cells switching from anti-inflammatory to pro-inflammatory dominance.

As such, high intensity ES may be associated with unforeseen safety issues, but fortunately low intensity ES is sufficient to drive the vagal-adrenal axis and safely attenuate inflammation in a disease state-independent manner, Ma said.

In the future, he said, inflammation modulation needs to be fine-tuned, since excessive suppression could reduce the ability of the immune system to fight with infection, necessitating future human studies to optimize stimulation parameters.

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Acupuncture shown to regulate inflammation in mice - BioWorld Online

Yoga improves symptoms of generalized anxiety disorder, a condition with chronic nervousness and worry, suggesting the popular practice may be helpful in treating anxiety in some people.

Led by researchers at NYU Grossman School of Medicine, a new study found that yoga was significantly more effective for generalized anxiety disorder than standard education on stress management, but not as effective as cognitive behavioral therapy (CBT), the gold standard form of structured talk therapy that helps patients identify negative thinking for better responses to challenges.

Generalized anxiety disorder is a very common condition, yet many are not willing or able to access evidence-based treatments, says lead study author Naomi M. Simon, MD, a professor in the Department of Psychiatry at NYU Langone Health. Our findings demonstrate that yoga, which is safe and widely available, can improve symptoms for some people with this disorder and could be a valuable tool in an overall treatment plan.

For the study, 226 men and women with generalized anxiety disorder were randomly assigned to 3 groupsCBT, Kundalini yoga, or stress management education, a standardized control technique.

After three months, both CBT and yoga were found to be significantly more effective for anxiety than stress management. Specifically, 54 percent of those who practiced yoga met response criteria for meaningfully improved symptoms compared with 33 percent in the stress education group. Of those treated with CBT, 71 percent met these symptom improvement criteria.

However, after six months of follow-up, the CBT response remained significantly better than stress education (the control therapy), while yoga was no longer significantly better, suggesting CBT may have more robust, longer-lasting anxiety-reducing effects. The results were published online August 12 in JAMA Psychiatry.

The study involved an evidence-based protocol for CBT treatment of generalized anxiety disorder, including psychoeducation, cognitive interventions (focused on identifying and adapting maladaptive thoughts and worrying), and muscle relaxation techniques.

Kundalini yoga included physical postures, breathing techniques, relaxation exercises, yoga theory, and meditation and mindfulness practice.

The stress management education control group received lectures about the physiological, psychological, and medical effects of stress, as well as the antianxiety effects of lifestyle behaviors, such as reducing alcohol and smoking, and the importance of exercise and a healthy diet. Homework consisted of listening to educational material about stress, nutrition, and lifestyle.

Each treatment was administered in groups of 3 to 6 participants, over weekly 2-hour sessions for 12 weeks with 20 minutes of daily homework assigned.

According to researchers, generalized anxiety disorder is a common, impairing, and undertreated condition, currently affecting an estimated 6.8 million Americans. While most people feel anxious from time to time, it is considered a disorder when worrying becomes excessive and interferes with day-to-day life. CBT is considered the gold standard first-line treatment. Medications, including antidepressants and sometimes benzodiazepines, may also be used. Yet, not everyone is willing to take medication, which can have adverse side effects, and there are challenges with accessing CBT for many, including lack of access to trained therapists and long waitlists.

Many people already seek complementary and alternative interventions, including yoga, to treat anxiety, says Dr. Simon. This study suggests that at least short-term there is significant value for people with generalized anxiety disorder to give yoga a try to see if it works for them. Yoga is well-tolerated, easily accessible, and has a number of health benefits.

According to Dr. Simon, future research should aim to understand who is most likely to benefit from yoga for generalized anxiety disorder to help providers better personalize treatment recommendations.

We need more options to treat anxiety because different people will respond to different interventions, and having more options can help overcome barriers to care, she says. Having a range of effective treatments can increase the likelihood people with anxiety will be willing to engage in evidence-based care.

Along with Dr. Simon, other authors of this study are Stefan G. Hofmann of Boston University; David Rosenfield at Southern Methodist University in Dallas; Susanne S. Hoeppner and Eric Bui of Massachusetts General Hospital, Harvard Medical School in Boston; Elizabeth A. Hoge of Georgetown University Medical Center in Washington, D.C.; and Sat Bir S. Khalsa of Brigham and Womens Hospital, Harvard Medical School in Boston.

Funding for the work came from the National Center for Complementary and Integrative Health grants R01 AT007258 and R01 AT007257 to Dr. Simon and Dr. Hofmann.

Ashley WelchPhone: 212-404-3511ashley.welch@nyulangone.org

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Yoga Shown to Improve Anxiety, Study Finds | NYU Langone News - NYU Langone Health

Kayla Brim laughed when she learned it could take 10 days to get her COVID-19 test results back. I thought, Okay, well, within 10 days I should be fine, she remembers.

That was on July 2. More than a month later, Brim is still far from fine.

Prior to the pandemic, the 28-year-old from Caldwell, Idaho, juggled homeschooling her two kids with her work as a makeup artistshe was supposed to open her own salon in July. Now, she suffers daily from shortness of breath, exhaustion, excruciating headaches, brain fog, neuropathy, high blood pressure and loss of taste and smell. She feels like a little old lady, completely knocked out by simple tasks like making lunch for her children. Shes working just enough to help pay the bills and the lease on her empty salon, but she has no idea when shell be able to work full-time again, and no idea how she and her husband will manage financially if she cant. Half of my day is spent trying to sleep, and the other half of it is trying to pretend like Im okayand I dont know when Ill be okay, Brim says.

This is long-haul COVID-19. Even young, healthy people can become long-haulers (as many call themselves), left unable to work, lead a normal life or, some days, get out of bed. The consequences for each individual can be devastatingand at scale, theyre staggering. Over time, long-haul coronavirus may force hundreds of thousands of people out of work and into doctors offices, shouldering the double burden of lost wages and hefty medical bills for the indeterminate future. To treat them, the health care system may have to stretch already-thin resources to the breaking point.

Its going to be an impending tsunami of patientson top of all the [usual] chronic care that we do, says Dr. Zijian Chen, medical director of the Center for Post-COVID Care at New York Citys Mount Sinai Health System, one of the countrys only clinics devoted to caring for patients in the aftermath of coronavirus infection. At some point it becomes very unsustainablemeaning, the system will collapse.

When most people think of COVID-19, they imagine two possibilities: a flu-like illness that clears on its own, or a life-threatening condition that requires ventilation and a hospital stay. Its not hard to see how the latter scenario leads to long-term damage. Mechanical ventilation is incredibly hard on the lungs, and days or weeks spent sedated in a hospital bed can sap physical and mental strength. In a small study published in 2011, nearly all the participants who needed intensive treatment for a severe lung injury reported decreased physical ability and quality of life five years after leaving the hospital. Some took years to return to work. Hospitalized coronavirus patients may face a similar fate.

But with COVID-19, its not just the sickest who face a long road back. A July 24 report from the U.S. Centers for Disease Control and Prevention (CDC) found that, out of about 300 non-hospitalized but symptomatic COVID-19 patients, 35% were still experiencing symptoms like coughing, shortness of breath and fatigue up to three weeks after diagnosis. (By contrast, more than 90% of non-hospitalized influenza patients fully recover within two weeks.) Recovery from COVID-19 can be a drawn-out process for patients of all ages, genders and prior levels of health, potentially leading to prolonged absence from work, studies, or other activities, the report noted.

The CDCs surveyors only checked up on people a few weeks after they tested positive for coronavirus, but emerging evidence suggests a large subset of patients are sick for months, not just weeks, on end. Dr. Michael Peluso, who is studying long-term COVID-19 outcomes at the University of California, San Francisco, says about 20% of his research participants are still sick between one and four months after diagnosis.

Kayla Brim with her family, outside their home in Caldwell, Idaho, on Aug. 11. Brim has been sick with COVID-19 since early July.

Angie Smith for TIME

The implications of that problem are enormous. If even 10% of the more than 5 million (and counting) confirmed COVID-19 patients in the U.S. suffer symptoms that last this long, half a million people are already or could soon become chronically ill for the foreseeable future.

When Mount Sinai opened its Post-COVID Center in May, the hospital advertised it as the first in the country; since then, a handful of others have opened in states including Colorado, Indiana and Illinois. Mount Sinais clinic was modeled after the practice the hospital opened to treat survivors of the 9/11 terrorist attacks. Its very similar. Its a new group, and they need special care, Chen says. The biggest difference, he says, is the size of the group. Significantly more people have survived COVID-19 than were directly affected by 9/11. Mount Sinai has only scratched the surface of that demand, treating about 300 people so far. The wait time for new patients extends into October.

The challenge for doctors like Chen is that nobody really knows why long-haul COVID-19 happens, let alone how to treat it. Other viral diseases with long-term symptoms, such as HIV/AIDS, offer some clues, but every day in the clinic is essentially uncharted territory. One hypothesis is that the virus persists in the body in some form, causing continuing problems. Another is that coronavirus pushes the immune system into overdrive, and it stays revving even after the acute infection passes. But at this point, its not clear which theory, if either, is right, or why certain patients recover in days and others suffer for months, Peluso says.

Plus, just as theres huge variation in acute COVID-19 symptoms, not all long-term patients have the same issues. A researcher from the Indiana University School of Medicine in July surveyed 1,500 long-haulers from Survivor Corps, an online COVID-19 support group. They reported almost 100 distinct symptoms, from anxiety and fatigue to muscle cramps and breathing problems. A JAMA Cardiology study published in July suggested many recently recovered patients had lingering heart abnormalities, with inflammation the most common.

Some long-term COVID-19 patients have abnormal test results or damage to a specific organ, giving doctors clues as to how they should be treated. But for others, theres no obvious reason for their suffering, making treatment an educated guessing game. We dont know why they [still] have symptoms. We dont know if our techniques are working, Chen says. We dont know if theyre going to get back to 100%, or 90%, or 80%.

With little evidence, some doctors turn coronavirus long-haulers away or try to convince them their symptoms are psychological. Marcus Tomoff, a 28-year-old in Tampa, Fla. who is in his second month of debilitating fatigue, back and chest pain, nausea and anxiety after a bout of coronavirus, says he hasnt been taken seriously by friends or even his doctors. Several times Ive cried in front of my doctors and they say, You need to deal with this, youre young, he says.

The haphazard testing system in the U.S. has further complicated patients searches for care. Mount Sinais Post-COVID Center, for example, only accepts patients who tested positive for COVID-19 or its antibodies, and Chen fears potential patients who couldnt get tested or got false-negative results may be falling through the cracks. The best he can do right now is refer them to specialists and hope they find a doctor who can help.

For 46-year-old Andrea Ceresa, getting better is a full-time jobminus the paycheck. Ceresa had to stop working as a New Jersey dental office manager after she got sick in mid-April with what she and her doctors believe was COVID-19. (She tested negative for the virus and its antibodies, but her doctors think they were false negatives.) More than 100 days later, shes in regular contact with her primary care physician, an integrative care doctor and a rotating cast of specialists who she hopes can treat her lingering gastrointestinal problems, hearing and vision issues, weight and hair loss, heart palpitations, migraines, brain fog, neuropathy, fatigue, nausea and anxiety. She finally got an appointment at a post-COVID program after weeks of waiting, but shes mostly been left to cobble together her own care team.

Ceresa has paid for her own health insurance through the federal COBRA program since she stopped working, which has put her in a precarious financial state. I have a stack of bills and I just am starting to open them now, she says. Im definitely, at this point, going to be in the hole thousands of dollars. Im collecting unemployment. I know Im going to have to go on disability. Even then, she says, it may not be enough to pay her bills.

There may soon be a lot of patients like Ceresa, says Dr. Bhakti Patel, a pulmonologist at University of Chicago Medicine who studies the long-term effects of critical care. Patel says patients with long-term issues after surviving coronavirus may face a number of obstacles. Patients who remain too sick to return to work (or who are unemployed due to the economic climate) may lose employer-sponsored health insurance at the moment they need it most. Younger patients who do not qualify for Medicare but need public insurance will likely be funneled toward Medicaid, which Patel says is already over-stretched. The services long-haul coronavirus patients may needlike physical therapy and mental health carecan be difficult to access, especially via public insurance networks like Medicaid, Patel says. That bottleneck will only get worse if more people need public aid.

As patients with an emerging disease, long-haulers also need an intensity of outpatient care and expertise, that goes beyond what the average primary care physician can offer, Peluso says. Very few doctors are experienced in treating long-haul symptomsand even among those who are, experienced is a relative term. This wasnt a specialty three months ago, says Chen.

People who cant get into a dedicated post-COVID program may need to try a slew of specialists before they find one who can help, an expensive and tiring game of trial-and-error. (Thats assuming patients can get appointments with specialists like pulmonologists and neurologists, who are often few and far between outside of densely populated areas.) The sickest long-haul patients may also require pricey and difficult-to-access rehab or in-home care, on top of other medical costs. If a family member has to give up work to become a caregiver, that can also have serious economic consequences.

Some long-haulers will likely have to file for disability benefits, a byzantine system of its own thats at risk of becoming overwhelmed. From 2008 to 2017, only about a third of people who applied for disabled-worker benefits in the U.S. were initially approved, according to Social Security Administration (SSA) data. It can be especially difficult for patients without a clear diagnosis or cause of illness, since SSA requires claimants to provide objective medical evidence of an impairment.

With few other resources available, thousands of long-haulers have sought help from virtual support groups like Survivor Corps and Body Politic, where members talk about their symptoms and celebrate signs of recovery. Programs like COVID Bootcamp 101, an online rehab series run by the nonprofit Pulmonary Wellness Foundation, are also trying to fill gaps in care. The scientific community is doing its best to catch up, but Chen says the government may need to help develop long-term solutions that address the economic consequences of long-term coronavirus symptoms, like a medical safety net program (as it has done for HIV/AIDS patients) or financial assistance for COVID-19 patients (as it did for 9/11 survivors).

Without clear answers about what happens next, all doctors can offer the public is yet another plea to take coronavirus seriouslybecause right now, the only surefire way not to become a long-hauler is to not get COVID-19 at all.

That doesnt help people like Ceresa, though. After more than 100 days of feeling sick, Cersa says shes still baffled this happened to her, an active and healthy woman whos been a vegan for decades. She stayed home all April except for a couple trips to the grocery store and still had her life destroyed by the virus. She cant work, sing in her band or plan her wedding after getting engaged a few weeks before the pandemic hit. She tries to comfort herself by thinking about ways it could be worseit could be cancerbut the truth is, things are bad. You try to be hopeful and think somehow, miraculously, youre going to be better, and it doesnt happen, she says. I cant imagine living like this for another day, let alone the rest of my life.

At this point, no one knows if shell have to.

This story has been updated to reflect Andrea Ceresas admission to a post-COVID program.

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Write to Jamie Ducharme at jamie.ducharme@time.com.

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Some Coronavirus Patients Are Reporting Symptoms That Last Months. Nobody Knows Exactly How to Treat Them - TIME

Henry Ford Health System is providing even more services to Dearborn area patients, with an expanded emergency room and the creation of its new Center for Integrative Medicine.

We are really proud of our ER expansion, said Mary Finn, Group Practice Director for the Henry Ford Medical Group. It has been modified, so all of our bays are private treatment rooms, which was never the case before.

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She said the only part of the ER that still has curtain separators is the fast track area, for quick turnover patients, such as someone who might need simple stitches or a straightforward need for medicine.

Henry Ford Health System Fairlane has an expanded emergency room, and has a Center for Integrative Medicine, and well as pain management and anxiety care facilities.

The idea is to try to keep the ER from being as congested, so thats a nice feature, Finn said. So, we have the fast track, we have a new trauma area and we have more patient care spaces and treatment bays, so more than double when we are all done.

She said another effort of the expanded ER is to get people out of the waiting room and into a treatment bay as quickly as possible.

Our goal, with our new strategy with more rooms now, and with more treatment bays, we are trying to get everybody back without waiting in the waiting room, Finn said. It has been rare that I have seen anybody in the waiting room for the last couple months.

She said that even with ER volumes being down across the country because of the pandemic, the Fairlane ERs volume is beginning to approach what it was pre-pandemic, and they are still focusing on not having the waiting room fill up with patients.

Finn said many of the doctor offices have moved to the nearby Henry Ford Medical Center on Ford Road in Dearborn.

She said all three of the Internal Medicine offices are now on the third floor of the Ford Road Center.

Its been a great change, because it allowed everybody to be one, as opposed to three separate spaces, Finn said.

She said Behavioral Services have also moved from nearby office space to the third floor of the Ford Road Center as well.

Finn said the second floor of the Ford Road Center has been utilized to expand the Pain Management Program, which is run through the Department of Anesthesia.

They do a very comprehensive evaluation of the cause of pain and the underlying issues, and if they are able to do treatments for the patient, it could be involving any kinds of procedures or blocks or other measures that can be done, she said. They also have a relationship with the acupuncturist, and they have a pain psychologist.

Finn said the Center for Integrative Medicine is also on the second floor of the Ford Road Center, which houses the acupuncturist, chiropractors, functional medicine (which focuses on holistic or alternative medicine), yoga and massage.

With these moves, the relationship between the Pain Management Program and the Center for Integrative Medicine is growing, she said, especially with respect to acupuncture, adding that HFHS is on the leading edge of the changes that are taking place in health care across the country, including integrated medical records, which can keep a patient safer.

We all have important history, allergy information and things that have happened, that a doctor would want to know about, Finn said. And so, the more a doctor and a medical team can easily access that information, the better off you are.

She said tests dont have to be repeated, and there can be a better focus on a patients medical problems, as well as their history, and what has already been tried.

Some of this is very hard for people to be really good historians on, Finn said. No matter how well educated you are, if you arent a member of the medical field, it can really be very challenging to navigate.

She said she is proud of what the HFHS team is accomplishing, especially in the midst of a pandemic.

Youre seeing a greater push to include more Integrative Medicine and more alternative treatments to augment traditional treatments, Finn said. So thats where there is synergy between the Pain Program, the Center for Integrative Medicine and even Internal Medicine. We have a dietician in the program, as well, and they are recognizing that everyone has something to offer.

Alice Cooper, Peter Frampton, George Thorogood, Don Felder and members of Slipknot, Stone Sour, Bush, Halestorm, Alter Bridge, Black Stone Cherry and more will take part in Rock For Relief, a virtual benefit for Feeding America at 8 and 11 p.m. Friday, July 3 via rockforrelief.net. Cooper and Joe Satriani will also be conducting interviews with other artists during the event, a collaboration between United Stations Media Networks and Storic Media Podcast Network.

Crunch Fitness, 5601 Mercury Drive, in Dearborn, was cited for being open to patrons June 28, in violation of the governors pandemic closure

A press conference is scheduled for Friday in Dearborn to update an ongoing dispute between the American Moslem Society (AMS) and its neighbor

The Confidence Connection, a recently launched podcast, hosted by Dearborn native Suzanne Sena, provides people with ways to build belief an

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HFHS Fairlane expands ER, creates Center for Integrative Medicine; Pain management to be at the forefront - Dearborn Press and Guide

Former Louisville point guard Peyton Sivas Alba Berlin team won the German Basketball Bundesliga final this past Sunday, narrowly defeating MHP Riesen Ludwigsburg. Thats right there was a month of professional basketball played in Germany, where COVID-19 containment efforts have been largely successful. As professional and college leagues in the United States continue to mull over the feasibility of resuming play amid the pandemic, I wanted to know about Peytons experience playing in a country that actually made it work. The newly-crowded champ was kind enough to take a break from celebrating to answer a few questions.

Colby: Firstly, how are you and your family holding up, and whats it been like weathering a global pandemic in a foreign country?

Peyton: My family and I are great. We just been keeping to ourselves and following the guidelines put in place to try and keep us safe. We came back to the States right when COVID hit world-wide and everything shut down. As for me being in Germany right now, things are pretty calm, and the government here have opened everything back up.

Colby: Professional sports remain completely shut down in the United States, but youve been back to playing in games since the beginning of June. How did you feel about going back to work? Were you nervous at all?

Peyton: At first, I didnt want to come back and play because I didnt want to have to leave my family during this time. I was nervous because there were a lot of unknowns. But the league has done a great job at putting in rules and protocols to keep us safe while playing.

Colby: What steps are Alba Berlin and the Basketball Bundesliga taking to ensure the players and staff stay safe from COVID-19? (virus testing, temperature checking, mask wearing, social distancing, no fans at games, etc.) And has it been more challenging to practice and play under these conditions?

Peyton: When we first got back to Berlin, we had to quarantine for a week and do testing every two days. We had to test every two days for 14 days and then every 4/5 days. We had to wear mask every time we went outside and changed locations to and from the hotel and to the gym. No fans were allowed in the games, and media had to quarantine in the hotel with us along with the other teams and referees. It hasnt been challenging playing without fans; only challenging thing was the short schedule and games played in such a short time.

Colby: Since resuming the season on 6/7, you guys have won 9 games straight to make the Basketball Bundesliga Final against Ludwigsburg. I know Alba Berlin has had a lot of success since you joined the team was making the Final the expectation all season or has returning from hiatus due to Coronavirus helped to inspire this string of wins in some way?

Peyton: No, the expectations is always to make the championship.

Colby: Europe seems to have done a much better job of containing the virus than the United States has, thus allowing for the resumption of normal life, work, sports, etc. with EuroLeague set to resume in October, do you foresee any issues with international play?

Peyton: As of now, I dont see a huge problem with the resumption of next season. That was the great thing about coming back and playing it showed that the sport could carry on.

A couple UofL basketball questions:

Colby: Louisville announced it will have Cincinnati back on its schedule for the first time in years. From your time playing in the Big East, what does that rivalry mean to you?

Peyton: I didnt view it as a huge rivalry in a sense. The reason is because we played them every year in the Big East. I think rivalries are more a fan thing. I viewed all opponents the same, especially in the Big East, because it was such a tough league.

Colby: Louisville made two very interesting coaching hires this off-season: former Cardinal point guard Christen CC Cunningham and Spike Albrecht, who gave you guys hell in the 2013 National Championship game. What are your thoughts on these guys joining Coach Macks staff?

Peyton: I think it will be great for the team. It brings in guys who are closer in age and probably could relate to the players more in the sense both of them had different journeys in basketball but played at the highest level in college. I think they both will be great additions.

Colby: The city of Louisville is going through an intense moment of self-reflection and healing amid protests for racial equality and justice. Is there anything you would like to say to Louisvillians as they have this important conversation as a community, or is there anything you would like to share about your experience with the BLM movement as its unfolded in Germany?

Peyton: Justice for Breonna Taylor. Continue to let your voices be heard and stay safe. Black Lives Matter.

Thanks again to Peyton Siva for taking the time to talk to me. His team Alba Berlin has qualified for the EuroLeague, which at the time of writing is slated to begin play October 1. In the meantime, stay safe, wear a mask, and Go Cards!

Colby Helton is a Louisville native who pronounces it "Louie-ville." He has lived in Chicago, Germany, China, and San Diego, but people don't watch college basketball in those places, so he moved home. He did his undergraduate studies at Northwestern University and has a Master's of Science in Traditional Oriental Medicine and a Doctorate of Acupuncture and Oriental Medicine from the Pacific College of Oriental Medicine. Colby is also co-owner of AcuBalance Acupuncture & Integrative Medicine in Middletown. He is passionate about UofL basketball, bourbon, and enjoying the two together.

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Interview: Peyton Siva on Playing Pro Ball in the Time of COVID - The Crunch Zone

Is working from home a literal pain the neck? Many of us have spent long hours hunched over impromptu workstations on beds, coffee tables and kitchen islands since the onset of the pandemic. With elevated stress levels, fewer opportunities for movement and upended routines, working from home can be a recipe for back and neck pain.

Chiropractors specialize in correcting misalignments of the neck, back and head through careful manipulations of the spine. But since many of us dont have access to a chiropractor in person, here are some tips to help you reduce back and neck pain while working at home.

How can you maintain good posture while working from the kitchen table? Andrew Bang, D.C., lead chiropractor at the Center for Integrative Medicine at The Cleveland Clinic, recommends this checklist to properly position your head, arms and back.

Bang and Barbara Rosinsky, a chiropractor in Wantagh, New York. recommended these seven simple tips to keep you free of back or neck pain between visits.

Belly snoozing is the worst position to sleep in, said Rosinsky. You have to turn your head to the left or right, and that creates neck strain, she says. Instead, either sleep on your back with pillows under your knees or on your side with pillows between your knees. Both positions help maintain the spines natural curvature. In both positions, sleep with a small pillow under your head and pull the pillow down so its also supporting your neck, Rosinsky explained.

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Strong abdominals are key to reducing pain in your back, but if you have back pain, traditional crunches and sit-ups actually make the pain worse, Bang explained. Instead, hold yourself in a yoga plank pose lie on your stomach and then lift your body so youre balancing on your hands and your toes, like a push up. Hold the position as long as you can, increasing the time with each attempt.

Side planks will also firm up your core. From the plank position, rotate your body to the left so you are balancing on your outstretched left arm and on your left foot (either stack your right foot on top of your left or place your right foot down if it's necessary for balance). Reach your right arm upward. Hold it as long as you can and then switch sides.

I have more low back pain patients who sit at desk all day than are manual laborers, said Bang. Our hamstrings get locked up from spending so many hours sitting in a chair, Bang explained. So when we try to stand up from sitting, our hamstrings pull on our pelvis, causing misalignments in the spine and all kinds of pain."

But a few simple stretches can counter this effect. While lying on your back, wrap a yoga belt around your foot and pull your leg up, keeping it straight. Feel the stretch along the back of your leg. Then try to stretch your leg across the groin over the left leg to right and vice versa and then out and away from your body towards your hips and. Work yourself up to holding the stretches for 90 seconds.

Take a look at your phone. Notice what you just did? In all likelihood your chin went to your chest and your neck curved into a C-shape. Thats really bad for your neck, said Bang. Theres 12-15 pounds of weight in the human head. The further the head is away from our shoulders looking down at our smartphones, [the more it] strains the muscles. The bones and the discs start to mash together and you get pain. This goes for all handheld electronics, like iPads. To save your neck, prop up your arms so youre looking at your phone straight on. If youre using an e-reader in bed, hold it up on your bent knees instead of down on your lap.

This is going to be a hard one. If you sit at a desk all day, make sure your feet are parallel and planted firmly on the ground, says Rosinsky. If your feet dont reach the ground, use a box or foot rest to prop them up. This will reduce pressure on your lower back. Also remember to raise your computer screen so its at eye level to limit neck strain.

When your grandmother scolded you about slouching, she was doing more than trying to make you look better. She was likely saving you from a backache. Sit up on your sit bones, not back on the sacrum, says Rosinsky, referring to the fleshier part of your tush. Think about the curve in your lower back and try to preserve it as you sit. And whatever youre working on, your keyboard and your computer screen should be square with your body. So dont put your laptop on your lap and hunch over it. Youre much better off putting it on a table.

Too much time spent in any one position sitting or standing can trigger back pain. The more active you are, the more you stretch out your muscles and get your body accustomed to physical activity so you're the less likely to suffer pain, Bang explained. You need to eat well, drink well and move well, he says. If you get too sedentary you will have more pain.

All of these strategies can help you stave off pain, but chiropractors also recommend regular adjustments that can help keep the spine aligned, the nervous system functioning properly and reduce the risk of recurring pain. When the situation allows, seeing your chiropractor on a regular basis, whether youre in pain or not, will help you maintain your balance and your range of motion, Bang said.

A version of this story originally appeared on iVillage.

Excerpt from:
How to avoid back and neck pain while working from home - TODAY

There was a time when modern medicine was primitive. There were no antibiotics, so every infection took its own course, leading to decline in health. Hypertension and diabetes were largely untreatable. X-ray was new, and remedies had changed but little from medieval times. No one ever embarked on the goodness of preventative treatment, not to speak of predictive medicine, beyond taking a distasteful cod liver oil capsule.

During the last hundred years, modern medicine has undergone a sea change. Just think of it an ever-expanding repertoire of medicines, high-tech procedures, therapies and reams of clinical data to employ when one gets sick. Yet modern medicine remained (in)complete, notwithstanding the therapeutic advances.

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Things are now changing thanks to the integration of all such advances, from how a persons diet interacts with ones unique genetic profile to how environmental pollutants affect our thinking, not to speak of preventative medical approaches in health and wellness. The bigperestroikahas begun, and it is poised to transform health care for a growing number of people in the near future. Welcome to a whole new world of personalized, bespoke medicine.

Personalized medicine is, in essence, tailored or customized medical treatment. It treats while keeping in mind the unique, individual characteristics of each patient, which are as distinct as ones fingerprint or signature. It also includes scientific breakthroughs in our understanding of how a persons unique molecular and genetic profile makes them susceptible to certain illnesses. Personalized medicine expands our ability to envisage medical treatments that would not only be effective but also safe for each patient while excluding treatments that may not provide useful objectives.

Personalized medicine is, in simple terms, the use of new methods of molecular scrutiny. It is keyed to help better manage a patients illness or their genetic tendency toward a particular illness or a group of diseases. In so doing, it aims to achieve optimal therapeutic outcomes by helping both clinicians and patients choose a disease management approach that is likely to work best in the context of the patients unique genetic and environmental summary. In other words, it allows to accurately diagnose diseases and their sub-types while prescribing the best form and dose of medication most suited to the given patient.

Personalized, or precision, medicine is not rocket science it is, in essence, an extension of certain traditional approaches to understanding and treating disease. What jazzed up the therapeutic fulcrum of personalized medicine are tools that are more precise. This is what also offers clinicians better insights for selecting a treatment protocol based on a patients molecular profile. Such a patient-specific methodology, as has been practiced for long in certain complementary and alternative medical (CAM) or integrative approaches, not only curtails harmful side effects but also leads to more successful outcomes, including reduced costs in comparison to the current trial-and-error approach to treatment, which has distressingly come to the fore during these extraordinary and unprecedented times of COVID-19.

It is still early days, but the fact remains that personalized medicine has changed the old ways of how we all thought about, identified and managed health issues. As personalized medicine increasingly bids fair to an exciting journey in terms of clinical research and patient care, its impact will only further expand our understanding of medical technology.

What personalized medicine has done is bring about a paradigm shift in our thinking about people in general and also specifically. We all vary from one another what we eat, what others eat, how we react to stress or experience health issues when exposed to environmental factors. It is agreed that such variations play a role in health and disease. It is also being incrementally accepted that certain natural variations found in our DNA can influence our risk of developing a certain disease and how well we could respond to a particular medicine.

All of us are unique individuals, perhaps with the exemption of identical twins, albeit the genomes are unique in them, too. While we are genetically similar, there are small differences in our DNA that are unique, which also makes us distinctive in terms of health, disease and our response to certain medicinal treatments.

Personalized medicine is poised to tap natural variations found in our genes that may play a role in our risk of getting or not getting certain illnesses, along with numerous external factors, such as our environment, nutrition and exercise. Variations in DNA can, likewise, lead to differences in how medications are absorbed, metabolized and used by the body. The understanding of such genetic variations and their interactions with environmental factors are elements that will help personalized medicine clinicians to produce better diagnostics and drugs, and select much better treatments and dosages based on individual needs not as just fixing a pill or two, as is the present-day conventional medical practice.

It is established that a majority of genes function precisely as intended. This gives rise to proteins that play a significant role in biological processes while allowing or helping an individual to grow, adapt and live in their environment. It is only in certain unusual situations, such as a single mutated or malfunctioning gene, that our apple cart is disturbed. This leads to distinct genetic diseases or syndromes such as sickle cell anemia and cystic fibrosis. In like manner, multiple genes acting together can impact the development of a host of common and complex diseases, including our response to medications used to treat them.

New advances will revolutionize bespoke medical treatment with the inclusion of drug therapy as well as recommendations for lifestyle changes to manage, delay the onset of disease or reduce its impact. Not surprisingly, the emergence of new diagnostic and prognostic tools has already raised our ability to predict likely outcomes of drug therapy. In like manner, the expanded use of biomarkers biological molecules that are associated with a particular disease state has resulted in more focused and targeted drug development.

Molecular testing is being expansively used today to identify breast cancer and colon cancer patients who are likely to benefit from new treatments and to preempt recurrences. A genetic test for an inherited heart condition is helping clinicians to determine which course of treatment would maximize benefit and minimize serious side effects while bringing about curative outcomes.

Such complexities exist for asthma and other disorders too. This is precisely where molecular analysis of biomarkers can help us to identify sub-types within a disease while enabling the clinician to monitor their progression, select appropriate medication, measure treatment outcomes and patients response. Future advances may make biomarkers and other tools affordable and allow clinicians to screen patients for relevant molecular variations prior to prescribing a particular medication.

It is already clear that personalized medicine promises three strategic benefits. In terms of preventative medicine, personalized medicine will improve the ability to identify which individuals are predisposed to develop a particular condition. A better understanding of genetic variations could also help scientists identify new disease subgroups or their associated molecular pathways and design drugs to target them. This could also help select patients for inclusion, or exclusion, in late-stage clinical trials. Finally, it will allow to work out the best dosage schedule or combination of drugs for each individual patient.

Yet not everything is hunky-dory for personalized medicine. Critics of precision medicine believe that the whole idea is too much of overhyped razzmatazz, among other things. Proponents, however, argue that when it comes to managing our own health, most of us are used to the idea of taking a one-size-fits-all approach be it medicines, supplements, diets and diagnoses. This may be wrong.

What works, as they put it, for one may be a gaffe for another. As the award-winning oncologist and medical technology innovator, Dr. David B. Agus, author of the groundbreaking bookThe End of Illness, puts it, each patients individual risk factors are based on ones DNA, the environment and a preventative lifestyle plan in response. He begins with simple, profound pointers: How is your sense of smell? and Is your ring finger longer than your middle finger? He explains with statistics-backed guidelines that moving and walking regularly is mandatory because exercising and then sitting is equivalent to smoking cigarettes, while eating and sleeping at consistent hours is imperative because irregularity causes inflammation.

The inference is obvious: We should all understand our physiology and quiz doctors with the thorough, exploratory frame of mind of a gadget buyer. This holds the key to making medicine truly personal, more humane, effective and safe while keeping in mind the individual in us all as unique and distinctive, the sum of the whole not just the parts.

The views expressed in this article are the authors own and do not necessarily reflect Fair Observers editorial policy.

Continued here:
The Future of Medicine Is Bespoke - Fair Observer

Patanjali Ayurvedas claimed cure for COVID-19 has been criticised for making unsubstantiated claims of efficacy. However, can Ayurveda, or alternative medicine in general, be evaluated in the same way as modern medicine?

Host: Jacob Koshy

Guests: Dr. BhavanaPrasher,senior scientist at the CSIR-Institute of Genomics and Integrative Biology.

Dr. S.P. Kalantriis a Professor at Mahatma Gandhi Institute of Medical Sciences, Wardha

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Can alternative medicine be subject to scientific rigour? | The Hindu Parley Podcast - The Hindu

Patanjali Ayurvedas claimed cure for COVID-19 has been criticised for making unsubstantiated claims of efficacy. However, can ayurveda, or alternative medicine in general, be evaluated in the same way as modern medicine? Jacob Koshy discusses the question with Dr. S.P. Kalantri and Dr. Bhavana Prasher. Edited excerpts:

Dr. Prasher, could you begin by explaining what really is the process of testing a new investigational drug in ayurveda? Does it follow the phased system of clinical trials as in modern medicine?

Bhavana Prasher: There are two aspects to the use of ayurvedic drugs for clinical use. Some are those described in classical text and listed in the Drugs and Cosmetics Act of India. These have formulations that prescribe use in certain [conditions]. These are classical medicines that have been used for several hundreds of years in our country as well as in many parts of the world. If these drugs are to be used for a new condition, as we are seeing in the case of COVID-19, and there is some textual evidence to suggest that they could be useful, then they can straight away progress to human trials. We dont need studies on toxicity or pre-clinical aspects as these are already well-understood. However, if the drug is an entirely new formula, for a new set of conditions, then it has to follow the same path of toxicity, pre-clinical efficacy and subsequent clinical trials.

In a typical drug trial, an investigational drug is tested on various groups. Theres phase one, phase two... all the way up to multicentre phase three, etc. Then, it is medical statistics that decides whether the drug is actually safe and measurably improves outcomes. You also have to separate out the placebo effect. Do those same standards also apply to ayurveda?

Bhavana Prasher: For evaluating safety and efficacy, there is no difference in testing standards. But when it comes to trial design, what is an effective placebo for COVID-19? Right now, I dont think theres any medicine, or standard of care, that we can reliably compare a new drug with. However, as far as the trial design is concerned, what is more important is the outcome measures that you decide. In the context of disease management, it is not the case that one drug would work for the entire population and a single one would be useful for that patients lifetime. Drugs are evaluated based on what specific endpoint is expected. There is a very clear-cut flowchart or diagram given by the CCRS (Central Council for Research in Ayurvedic Sciences) guidelines. They say that the drug must not ignore the parameters on which it is judged by modern medicine.

Dr. Kalantri, In the case of COVID-19, several drugs are being re-purposed by pharmaceutical companies. Many times, drugs are hyped as potential antivirals, and they edge through the appraisal process by the expected outcomes being changed. We saw that in the case of remdesivir. So, dont you think that in some sense, you know, the pharmaceutical drugs, have it slightly easier, and a higher burden of proof is applied on alternative medicine?

S.P. Kalantri: Well, a science is a science is a science. I have great respect for ayurveda and its basic philosophy gels well with the Eastern approach of health and disease, in sharp contrast to the Western approach. But my point is that any drug or any intervention must figure out if the drug is safe and effective. For that, you need to follow certain rules. By merely drawing from experience in the past, quoting literature for which the drug might have worked in the past, does it mean that this drug will be as simple, as effective for a new disease? Ebola would be a great example. We thought that certain drugs worked well in Ebola and then we tried to extrapolate the results of those drugs to COVID-19, but they did not work. So often, what works in petri dishes might not work so far as actually human beings are concerned. My point is that no matter what branch you are practising, whether it is modern medicine or alternative medicine, comprising unani, siddha or homeopathy, there are certain scientific principles that absolutely must be followed. These scientific principles are basically aimed at making sure that you are minimising the bias as much as you can.

In the pharmaceutical world, normally what happens is, results of a trial are peer-reviewed and published in a journal. Independent experts can then evaluate the drugs benefits or non-efficacy. How often does that happen in alternative medicine? Are negative results reported?

Bhavana Prasher: There is a problem in that ayurvedic research publications dont appear as frequently in high-impact journals. However, I think that in general there is a paucity of negative outcomes being published and is not really a problem of ayurveda alone. Ayurvedic knowledge does not just come from experience but also relies on extensive documentation.

There are several universities and research counsellors who keep doing clinical trials that appear in ayurveda journals and thesis reports of research students. There is definitely the case that this reporting needs to be upgraded and the quality of journals improved.

Also read | Ayush Ministry lens on Baba Ramdevs COVID-19 cure

It is now well-understood that when disease reaches a certain level, you need technological interventions like, in the case of COVID-19, ventilators and pulse oximeters. However, ayurveda and other branches of alternative medicine mostly rely on natural concoctions. So, how do you integrate devices that are known to be life-saving into an ayurvedic framework?

Bhavana Prasher: They are absolutely integrated into the ayurvedic framework. I would recommend you to visit any of the modern ayurvedic institutes where the examination of the patient with respect to all these objective methods is very much adopted. There is no allergy to modern technological devices being integrated in the clinical protocols of ayurveda. Nevertheless, ayurveda also retains the methodology of assessment of disease in ayurvedic style, which is not only about focusing on the virus, but also looks at the baseline health parameters like diet and sleep. These are the immediate indicators of whether treatment is working.

Also read | Patanjali to sell Coronil as 'immunity booster,' not 'cure for COVID-19'

Dr. Kalantri, is there a way in which these two systems of medicines can be integrated? Or are they two different schools that cannot really exist under one roof but can only run parallel paths?

S.P. Kalantri: I guess an integrated approach would be a win-win situation for both disciplines because modern medicine approaches treatment from a left-brain perspective it is more rational, more analytic, more structured. Ayurveda has a holistic, more intuitive approach. It takes into consideration the person as a whole. So, while modern medicine is obsessed with a cell, or an organ, or a disease, which is a part of a body, ayurveda considers the person as a whole and believes that the whole is more important than some of the parts that it is composed of. I completely agree with this. But when we are integrating them, we should not forget the principles of science and ethics.

The way the Patanjali trial was publicised, the results were shared with the media without getting published. The most meaningful outcome we are looking at from a drug is that it should be able to save lives. A strength of modern medicine is that it looks very strongly at these endpoints (saving lives and recovery). We need to look at the large trials conducted in the last two months, the solidarity trial and the recovery trial. Both not only produced some positive results, but [the researchers] also had the humility and transparency to say that hydroxychloroquine does not work, remdesivir does not reduce mortality, the dual combination of antiviral drugs does not work.

Editorial | Science vs nonsense: On Patanjalis COVID-19 claim

Dr. Prasher, would you agree that the benefits of Patanjalis drug were hyped? And didnt it do more harm to ayurveda in the process?

Bhavana Prasher: In the case of this particular trial, I would agree that their claims were disproportionate to what was clinically proved. However, I would disagree with Dr. Kalantri in that if we are indeed looking purely at how many lives are saved, I do not know if, anywhere, ayurvedic medicine has even had a chance of [being tested] in ICUs. So, the Patanjali trial was only restricted to mild and moderate cases; all asymptomatic cases were only mildly positive, so as an endpoint, they could only test viral clearance.

There arent tests allowed anywhere where ayurveda can be tested in severe or critically ill situations which could improve outcomes. A confidence has to be built in the modern medical world as well as in society that these things can be tested in those conditions as well.

Also read | FIR against Baba Ramdev, others on COVID-19 cure claim

Ayurveda is said to be a highly personalised system of medicine. So, by definition, can treatments so customised to an individual be sold to a general population? Modern medicine, on the other hand, recommends a drug for anyone who presents a certain set of conditions.

Bhavana Prasher: Personalisation refers to the disease type or the stage of severity. If, for a given presentation, a certain drug has been useful and tested, then it can be given to others. But the clinical indication has to be very clear. However the one-drug-fits-all notion in modern medicine is itself getting challenged everyday.

Both ayurveda and modern medicine are systems of medicine. However, their products are frequently in the hands of commercial pharmaceutical companies, who deploy similar means to sell more and extol benefits over harm. So, does that undermine medicine in both systems?

S.P. Kalantri: I completely agree. In the case of a drug called Favipiravir, that has now been approved, the company charges 13,000 for a 14-day therapy for a drug that only addresses fever and cough. Most people in our country can never afford such a drug. We must, at this time, de-link this nexus between pharmaceutical companies and medicine.

Bhavana Prasher: In the desperation for a panacea, drugs that are given over the counter compromise with the principles of treatment in Ayurveda too. This does create a lot of problems and sometimes can bring more harm than benefit.

Dr. Bhavana Prasher is an ayurveda doctor and senior scientist at the CSIR-Institute of Genomics and Integrative Biology; Dr. S.P. Kalantri is a Professor at Mahatma Gandhi Institute of Medical Sciences, Wardha

Excerpt from:
Can alternative medicine be subject to modern rigour? - The Hindu

On May 22, Google announced a company holiday for all its employees. Why? So that they could all switch off from work for a day. Work from home burnout is a real thing and a matter of concern, for employees and employers alike. Being constantly wired and connected, working without time boundaries, feeling isolated, not being able to interact with colleagues or go for tea or coffee breaks with them, can all lead to anxiety. There is no avenue to even blow off steam post work anymore.

According to a recent survey done by Monster, more than 50 per cent of the respondents working from home due to the coronavirus pandemic are feeling burnt out. During the pre-Covid days, work-from-home (WFH) was considered to be a cool and progressive way of working. Now it has become a norm. This change in work culture had to be done overnight with a lack of preparedness, no control or choice in it. There is no doubt that WFH comes with perks like zero commute time, flexible work schedule and more bonding time with the family. However, says ontological coach and author Geeta Ramakrishnan, As the novelty of this new reality is wearing off, it is resulting in increased mental health issues, such as high anxiety, apathy, physical and mental fatigue, and a range of depression-related concerns.

Understanding the problem

Before Covid, WFH was a privilege extended by employers as a special benefit to retain certain employees. Now, things have changed. With work for home, one doesnt have well-defined boundaries between work and life, so mixing the two can become very easy, says Luke Coutinho, holistic lifestyle coach, integrative medicine.

Dr Prerna Kohli, clinical psychologist, corroborates this. She says, Previously there was a clear distinction between the workplace and home. Employees dressed in their corporate uniforms, packed their lunches, and left for work, leaving their home problems at home, and returned home at the end of the day, leaving work at work. Today, this line has been blurred. People start working in their nightwear or casual clothes and hurriedly grab lunch while working. In the fear of being laid-off, employees are working longer hours and harder during WFH and its resulting in work-life imbalance.

If this burnout is not managed, it can lead to loss of manpower hours and the workforce suffering from lifestyle diseases.

Signs of the problem

Simply put, burnout is the state of feeling depleted in terms of energyphysical and mental. So, does it have telltale signs? Quite a fewirritability, lack of patience, low tolerance level, emotional breakdowns, backaches, neck pain, lethargy, mind fog, carpel tunnel syndrome, insomnia, demotivation and reduced productivity. Take the example of Abhishek Gupta (name changed on request), an investment banker who lives alone in his penthouse in Mumbai. A workaholic and type-A personality, he has always been a go-getter and a team player at work. After the lockdown was announced on March 24, he too, like so many others, began his WFH. But, for a month now he has been feeling demotivated, stressed and irritable. On the request of his senior, he did a video consultation with his company doctor and was diagnosed with symptoms of clinical depression, as a result of work pressure and no time off. Coutinho says, WFH at times can be so bad that it could transcend into our emotional self and disturb our capacity to handle stress, which, at a time like this, is at its lowest. The lack of social contact and being confined to a small space can be intimidating. Added to the already existing string of stress is the fear and uncertainty about ones future. Will I lose my job? Will I get COVID? Will I have enough money to sustain myself?

Most often, when one has to deal with changes in lifestyle and work without giving the mind a chance to recalibrate, one tends to automatically go in survival modefight or flight. The brain is on an all-time high stress alert with your analytical and problem-solving skills at an all-time low. WFH in a pandemic is a perfect example. The high stress mode of operating becomes your new normal and this auto alert process saps your physical and mental energy causing what we now call a WFH burnout, says Ramakrishnan. Apart from getting tired fast, one gets bored and restless easily. A degree of apathy creeps in. One feels disinterested and sad for no reason and is unable to distinguish the border between work and no-work. This inability to cope can lead to frustration and irritable behaviour. You procrastinate more and your focused attention span decreases. Your hunger and need to eat either reduces or increases drastically. You manage to get some sleep but still feel sleep deprived, she adds.

Addressing the problem

Time management and self-discipline are key. Its important to have a routine similar to what you followed before the lockdown. Maintain a consistent sleep cycle, ensure adequate physical exercise, and take some time out for yourself to do the things you enjoy. Pick up a hobby such as art, music or reading, and use this opportunity to upskill. Take it one day at a time and set short-term targets to feel a sense of accomplishment, suggests Dr Samir Parikh, director and head of department of mental health and behavioural sciences, Fortis Healthcare.

Its a good idea to dress in your work attire as well, work out of a dedicated space like a desk and chair and avoid working in bed. Take regular breaks to avoid fatigue. Try to achieve a regular sleep cycle and exercise at home, practice yoga and meditation.There are various tools and techniques, like Pomodoro [a technique in which a 5-minute break is recommended after every 25 minutes of work], to help you schedule breaks in between work and use it well, says Coutinho. Use these breaks to stretch, get some fresh air, wash your face to freshen up, do eye exercises, lie down for two minutes and close your eyes. But, most importantly, value your Sundays. There is no pride in working seven days a week.

WFH may be something we have to adapt to with no choice in the matter, or it could be a temporary, but accepting it as the only way right now will help bring positivity to it. Ramakrishnan says, Defining clear boundaries is important. It could be small acts of discipline like avoiding the temptation to read office emails or taking work calls or attending webinars outside of work hours; or prioritising your work by labeling them as urgent or not-urgent.

Employers also need to play an active role in ensuring that the mental health of their employees does not suffer. They should not expect them to be available 24x7 and be productive all the time. Dr Kohli, who recently counselled a young software developer, says, He was missing the structure of working in the office and was also anxious about his parents in Lucknow. His chief complaint was that for the last few days he hadnt written a single line of code. I believe the employers must engage mental health counsellors for their staff dealing with this situation.

Going forward, the work culture will include lots of WFH as companies implement a once or twice a week only work from the office set up. In order to avoid burnout, balance your personal and professional life, and stay productive, set office hours and work only during that time.

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Is WFH burning you out? |India Today Insight - India Today