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Brittany Jordan-Arthur was at loggerheads with her 7-year-old daughter one recent morning. The little girl simply did not want to head out the door to summer camp, finding any and all excuses to hang back.

But instead of expressing exasperation or annoyance — knowing that would make her daughter dig in her heels even more — Jordan-Arthur, a psychologist at Harvard-affiliated McLean Hospital, decided to use a valuable communication technique: validation. Like many skills, the more you practice validation, the easier it becomes to apply when it’s most needed. Here’s what to know and do.

What is validation?

An approach that can help people feel heard and understood, validation is especially useful when navigating emotionally charged situations. Validating someone shows you understand their feelings and point of view, even when you disagree. It establishes trust, helping the other person feel supported and open to discussing solutions.

And that’s precisely what happened in Jordan-Arthur’s stalemate with her daughter.

“I just sat with her and said, ‘You really don’t want to go.’ It was a great example of saying, ‘I hear you,’ and ultimately I didn’t tell her she had to go or why — she came to that conclusion herself,” Jordan-Arthur says. “We walked out the door without all the need for explanations.”

Many try validation but don’t succeed

Validation is fundamental to a type of talk therapy called dialectical behavior therapy (DBT), which is geared toward people who experience emotions very intensely. Many people use some aspects of validation in everyday communications with family members, friends, and colleagues, but usually fall short, Jordan-Arthur says. How?

“They jump into problem-solving, saying something validating, but then immediately tell the person what they should have done or what they should do next,” she says. “They don’t let that validation sink in. It’s like putting on anti-itch cream and then immediately washing it off.”

How can you offer validation?

Jordan-Arthur shares these pointers for validating another person:

• Give them your full attention.
• Make eye contact and nod appropriately, saying “uh huh” while showing your interest.
• Reflect what you’ve heard by restating their message, such as, “It sounds like you feel worse about this situation today than yesterday.”
• Verbalize the unspoken, such as, “I hear that you feel you can’t get anything done because of this obstacle,” or “It sounds like you’re frustrated.”
• Give it time to work! Be sure to let the validation sink in before attempting to problem- solve.

Does validation condone troubling behavior?

Validation isn’t the same as condoning someone’s bad or frustrating behavior, Jordan-Arthur notes. It’s not akin to reassuring them when reassurance isn’t appropriate.

“You may be afraid you’re going to communicate that you approve of their behavior or agree with their actions or choices,” she says. “But if you slow down and validate how someone feels in the moment, before a poor decision is made, validating accomplishes exactly the opposite.”

Try this phrasing instead:

• “I hear that this is important to you.”
• “I can see how this has been so upsetting/difficult/scary for you.”

How can you validate teens?

Validating teenagers isn’t dissimilar from the tactics Jordan-Arthur used with her 7-year-old — the problems just tend to be bigger. For example, teens often feel stuck with teachers they don’t like or complain that teachers seem overly harsh.

“Parents have lots of urges to say, ‘Oh, the teacher isn’t that bad’ or ‘I’m sure they mean well,’ defending the teacher and his or her perspective,” Jordan-Arthur says. “The odds are, by the time a kid is a teen, they also have that skill, but it’s going to take them a moment to get there.”

Here’s what to say instead:

• “I hear that you don’t feel respected.”
• “It’s so hard to feel helpless.”
• “It’s difficult to feel your teacher has control over how well you do in class.”

“You can validate their feelings even if you feel the teacher is being respectful,” Jordan-Arthur adds.

How can you validate adults?

Validating other adults in your professional or personal life involves much the same approach. With a colleague who’s feeling undervalued at the office, for instance, try saying, “It makes total sense that you’re feeling really frustrated. I know how important your work is to you.”

If you’re arguing with a spouse or partner, you can believe them as being genuine, Jordan-Arthur says, despite a difference of opinion. Try saying, “I can tell that this issue feels really important to you and you want me to pay attention to what you’re saying.”

It’s also wise to pay attention to the other person’s body language during heated moments. After validating them — but before offering a potential solution to a problem — look for clues that they’re calming down, such as breathing and gesturing more slowly.

“I encourage people to count to 10 in their heads, because we still tend to jump the gun and not wait for the other person to feel that validation,” she says. “If we do that, they’ll often move past the idea that ‘this person wronged me’ and start solving the problem on their own.”

About the Author

Maureen Salamon, Executive Editor, Harvard Women's Health Watch

Maureen Salamon is executive editor of Harvard Women’s Health Watch. She began her career as a newspaper reporter and later covered health and medicine for a wide variety of websites, magazines, and hospitals. Her work has … See Full Bio View all posts by Maureen Salamon

About the Reviewer

Howard E. LeWine, MD, Chief Medical Editor, Harvard Health Publishing

Dr. Howard LeWine is a practicing internist at Brigham and Women’s Hospital in Boston, Chief Medical Editor at Harvard Health Publishing, and editor in chief of Harvard Men’s Health Watch. See Full Bio View all posts by Howard E. LeWine, MD

While the FDA rules for blood donation were revised twice in the last decade, one group — men who have sex with men (MSM) — continued to be turned away from donating. Now new, evidence-based FDA rules embraced by the American Red Cross will focus on individual risk rather than groupwide restrictions.

Medical experts consider the new rules safe based on extensive evidence. Let’s review the changes here.

The new blood donation rules: One set of questions

The May 2023 FDA guidelines recommend asking every potential blood donor the same screening questions. These questions ask about behavior that raises risk for HIV, which can be spread through a transfusion.

Blood donation is then allowed, or not, based on personal risk factors for HIV and other blood-borne diseases.

Questions for potential blood donors

Screening questions focus on the risk of recent HIV infection, which is more likely to be missed by routine testing than a longstanding infection.

The screening questions ask everyone — regardless of gender, sex, or sexual orientation — whether in the past three months they have

• had a new sexual partner and engaged in anal sex
• had more than one sexual partner and engaged in anal sex
• taken medicines to prevent HIV infection (such as pre-exposure prophylaxis, or PrEP)
• exchanged sex for pay or drugs, or used nonprescription injection drugs
• had sex with someone who has previously tested positive for HIV infection
• had sex with someone who exchanged sex for pay or drugs
• had sex with someone who used nonprescription injection drugs.

When is a waiting period recommended before giving blood?

• Answering no to all of these screening questions suggests a person has a low risk of having a recently acquired HIV infection. No waiting period is necessary.
• Answering yes to any of these screening questions raises concern that a potential donor might have an HIV infection. A three-month delay before giving blood is advised.

Does a waiting period before giving blood apply in other situations?

Yes:

• A three-month delay before giving blood is recommended after a blood transfusion; treatment for gonorrhea or syphilis; or after most body piercings or tattoos not done with single-use equipment. These are not new rules.
• A waiting period before giving blood is recommended for people who take medicines to prevent HIV infection, called PrEP (pre-exposure prophylaxis). PrEP might cause a test for HIV to be negative even if infection is present. The new guidelines recommend delaying blood donation until three months after the last use of PrEP pills, or a two-year delay after a person receives long-acting, injected PrEP.

Who cannot donate blood?

Anyone who has had a confirmed positive test for HIV infection or has taken medicines to treat HIV infection is permanently banned from donating blood. This rule is not new.

Why were previous rules more restrictive?

In 1983, soon after the HIV epidemic began in the US, researchers recognized that blood transfusions could spread the infection from blood donor to recipient. US guidelines banned men who had sex with men from giving blood. A lifetime prohibition was intended to limit the spread of HIV.

At that time, HIV and AIDS were more common in certain groups, not only among MSM, but also among people from Haiti and sub-Saharan Africa, and people with hemophilia. This led to blood donation bans for some of these people, as well.

A lot has changed in the world of HIV in the last several decades, especially the development of highly accurate testing and highly effective prevention and treatment. Still, the rules regarding blood donation were slow to change.

The ban from the 1980s for MSM remained in place until 2015. At that time, rules were changed to allow MSM to donate only if they attested to having had no sex with a man for 12 months. In 2020, the period of sexual abstinence was reduced, this time to three months.

Why are the blood donation guideline changes important?

• Removing unnecessary restrictions that apply only to certain groups is a step forward in reducing discrimination and stigma for people who wish to donate blood but were turned away in the past.
• The critical shortage in our blood supply has worsened since the start of the COVID-19 pandemic. These revised rules are expected to significantly boost the number of blood donors.

The bottom line

Science and hard evidence should drive policy regarding blood donation as much as possible. Guidelines should not unnecessarily burden any particular group. These new guidelines represent progress in that regard.

Of course, these changes will be closely monitored to make sure the blood supply remains safe. My guess is that they’ll endure. And it wouldn’t surprise me if there is additional lifting of restrictions in the future.

About the Author

Robert H. Shmerling, MD, Senior Faculty Editor, Harvard Health Publishing; Editorial Advisory Board Member, Harvard Health Publishing

Dr. Robert H. Shmerling is the former clinical chief of the division of rheumatology at Beth Israel Deaconess Medical Center (BIDMC), and is a current member of the corresponding faculty in medicine at Harvard Medical School. … See Full Bio View all posts by Robert H. Shmerling, MD

The most common cause of chronic stomach pain in children isn’t anything you can find on a test or cure with a medicine. And that can make it very challenging to diagnose — and treat.

You may not have ever heard of functional abdominal pain. Yet it ranks as the most common cause of stomach pain lasting two months or more in children and teens.

What is functional abdominal pain?

The mind and the body are tightly connected in ways that we are still working to understand, and this is particularly true of the mind and the gastrointestinal tract. Stress — particularly chronic stress, depression, and anxiety — can lead to pain that is very real. Sometimes the pain is the only symptom of stress, especially in children who are high-achieving or tend to hide their emotions.

Sometimes the pain doesn’t start from stress but from an infection or other illness, and stays once the illness is gone or adds additional pain to the illness while it is being treated. Worry about the pain and its possible cause can make things worse. The nervous system of the gut can go into overdrive.

What are common symptoms of functional abdominal pain?

Children with functional abdominal pain can have mild symptoms that just show up occasionally, or they can have more severe symptoms that interfere with daily life. Along with stomachaches, they can have nausea, vomiting, constipation, or diarrhea — or some combination of all of them. They may have a poor appetite or complain of feeling full very quickly.

When should you contact your child’s doctor?

It’s important to check in with your doctor if your child is having chronic stomachaches. They should have a physical examination, and your doctor may want to do some testing, such as blood or stool tests, as there are many medical conditions that can cause chronic stomachaches.

It’s particularly important to call your doctor if your child

• is losing weight
• has blood in their stool
• has severe pain
• has fever, rashes, sore joints, or other signs of illness.

If your doctor finds that your child’s examination and tests are normal, and they aren’t losing weight, chances are that your child has functional abdominal pain.

For some families, getting this diagnosis sounds like the doctors are saying that it is all in the child’s head. But nothing could be further from the truth. It is very real pain — but it is not being caused by something dangerous, which is very good news.

How can you help a child diagnosed with functional abdominal pain?

There are many ways to help a child who has functional abdominal pain once the diagnosis is made. They include:

• Understanding and managing stressors in the child’s life, if there are any
• Medications recommended by your health care team can help with symptoms, such as laxatives for constipation
• Cognitive behavioral therapy, which is a kind of therapy that teaches strategies for managing pain, as well as managing any stress or sadness that can be contributing
• Meditation, yoga, and other ways for a child to relax and regulate how they react to their world
• For some children, a low-FODMAP diet can be helpful
• Probiotics, peppermint oil preparations, and some other supplements are sometimes used to help soothe and prevent pain.

Most children with functional abdominal pain can receive care from their pediatrician. Regular visits are a good idea, to check in to see how things are going and adjust any treatments. If things aren’t getting better, a referral to a gastroenterologist can be helpful.

Follow me on Twitter @drClaire

About the Author

Claire McCarthy, MD, Senior Faculty Editor, Harvard Health Publishing

Claire McCarthy, MD, is a primary care pediatrician at Boston Children’s Hospital, and an assistant professor of pediatrics at Harvard Medical School. In addition to being a senior faculty editor for Harvard Health Publishing, Dr. McCarthy … See Full Bio View all posts by Claire McCarthy, MD

Wriggling toes in the sand and wearing sandals are warm weather treats, unless you’d rather keep your toes under wraps due to thickened, yellowish nails. Nail fungal infections (known as onychomycosis) are common, affecting up to 14% of the general population. In advanced cases, nails can become brittle, crumbly, or ragged, or even separate from the nail bed.

While completely curing these fungal infections is difficult, the right treatments can discourage the problem from spreading and make your nails look better.

Do nail fungal infections only affect toenails?

No, fingernails can become infected, too. However, toenails are a more common target because of certain habits, including wearing shoes, so we’ll concentrate on them in this post.

How do people get toenail fungus?

“Feet are more likely to be sweaty and damp, which provides a better environment for the fungi, yeasts, and molds that are naturally present on your skin to flourish,” says Dr. Abigail Waldman, a dermatologist at Harvard-affiliated Brigham and Women’s Hospital.

People also can be exposed to various fungi, known as dermatophytes, by walking barefoot in locker rooms, spas, or near swimming pools, or getting a pedicure at a nail salon, she says. A fungal overgrowth can infect the area between your toes and the skin or your feet, causing athlete’s foot. The fungus can then spread to the toenails.

What makes toenail fungus hard to treat?

While antifungal creams can easily treat skin infections, toenails are another story.

“Nail tissue is harder and thicker, so these medications don’t penetrate very well,” Dr. Waldman explains. That’s also true for antifungal drugs taken as pills. Toenails grow slowly and the tissue isn’t very metabolically active. So although the medication gets into your bloodstream, only small amounts end up in your toenails. That’s why it’s hard to get rid of toenail fungus once it takes hold.

What counts as a cure?

Research reports so-called clinical cure rates between 60% to 80%, but this means only the absence of symptoms — that is, your toenails return to their normal appearance. The fungal infection may still be lurking under your nails, says Dr. Waldman.

In fact, in clinical trials when investigators recheck toenail clippings for any residual fungus after treatments applied to nails, only around 10% to 15% show no detectable fungal spores. As a result, recurrences of toenail fungal infections are fairly common.

Despite this, there’s a reasonable chance that different treatment approaches can improve your symptoms and the appearance of your toenails.

What works for treating toenail fungus?

Here is a rundown of the different treatment options, starting with Dr. Waldman’s go-to first-line suggestion, which uses inexpensive products you may already have in your home.

Home remedies

Soaking your toes to soften your nails before applying a fungus-fighting agent will help the remedy penetrate the nail. For the soak, Dr. Waldman recommends mixing one part white or apple cider vinegar to three parts warm water. Soak your toes for at least 10 minutes (but up to 40 minutes is better). Instead of vinegar, you can use Listerine, which contains thymol, the main compound in the herb thyme. Like vinegar, thymol has antifungal properties.

Then dry your feet well and apply an antifungal substance to all the affected nails. One option is a paste of crushed garlic, but most people will probably find the over-the-counter drugstore products listed below more convenient to use.

Over-the-counter products

The best evidence is for 100% tea tree oil, but another popular option is Vicks VapoRub (which also contains thymol and other essential oils that may fight fungus), Dr. Waldman says. Or you can use one of the various creams sold to treat athlete’s foot on your toenails.

Be sure to apply the product right after soaking. The clinical cure rates for each of these approaches vary between products, and depend on the severity and duration of the infection. But about 60% of people notice improvements after a few months of treatment, Dr. Waldman says.

Drugstores also carry several other toenail treatments, including a treated patch you put on your nails overnight. It contains urea, an acidic substance that improves the look of your nails by making them less brittle and discolored. Another product that promises similar results uses a tiny LED light that you clip onto your toenail after applying a liquid containing polyethylene glycol, which softens nails.

Prescription treatments to put on toenails

These topical products, which are best for milder infections, include amorolfine (Loceryl, others), efinaconazole (Jublia), tavaborole (Kerydin), and ciclopirox (Penlac). They are clear lacquers that you brush on your toenails once daily, usually for months. It may take as long as a year to see results. Clinical cure rates range from 35% to 60%.

Prescription pills

More severe infections may respond better to oral drugs, which include fluconazole (Diflucan), griseofulvin (Grifulvin), itraconazole (Sporanox), and terbinafine (Lamisil). These are taken daily in pill form for three months. While the clinical cure rates are higher (around 80%), these drugs have more side effects, including stomach upset, diarrhea, and (in rare cases) liver damage.

Laser therapy

Lasers penetrate and break down nail tissue, helping to destroy the fungus. There are many different types of lasers and protocols. Clinical cure rates are hard to pin down, but some have been reported as ranging between 60% and 75%.

Advice on toenail clippers, nail polish, new shoes, and more

During and after treatment, Dr. Waldman advises people to use two sets of toenail clippers — one for infected nails and one for noninfected nails — to prevent fungal spread. If you’re embarrassed by the appearance of your toenails, it’s okay to use nail polish for short periods of time, she says.

Once you finish treatment, buying new shoes will help avoid reinfection. “I also always recommend people do a diluted vinegar soak once or twice a week after finishing treatment, which helps prevent any lingering fungus from reinfecting the nail,” says Dr. Waldman.

About the Author

Julie Corliss, Executive Editor, Harvard Heart Letter

Julie Corliss is the executive editor of the Harvard Heart Letter. Before working at Harvard, she was a medical writer and editor at HealthNews, a consumer newsletter affiliated with The New England Journal of Medicine. She … See Full Bio View all posts by Julie Corliss

About the Reviewer

Howard E. LeWine, MD, Chief Medical Editor, Harvard Health Publishing

Dr. Howard LeWine is a practicing internist at Brigham and Women’s Hospital in Boston, Chief Medical Editor at Harvard Health Publishing, and editor in chief of Harvard Men’s Health Watch. See Full Bio View all posts by Howard E. LeWine, MD

When it comes to limiting side effects from radiation therapy, the name of the game is precision. Doctors want to treat the cancer while avoiding healthy tissues, and fortunately technological advances are making that increasingly possible.

One newer technique called stereotactic body radiotherapy (SBRT) can focus precisely targeted beams of high-dose radiation on a tumor from almost any direction.

The entire course of therapy requires only five individual treatments over two weeks, making SBRT more convenient than earlier low-dose methods that require more visits to the clinic. The treatment relies on specialized types of medical imaging scans that allow doctors to visualize where cancer exists in the body.

Advances in technology

Recently, doctors have begun to integrate SBRT with imaging scans that can visualize a tumor's movements in real time. Simple acts such as breathing, swallowing, or digesting food can shift a tumor's position. But this new technique — which is called magnetic resonance–guided daily adaptive SBRT, or MRg-A-SBRT for short — continually adjusts for those motions, so that doctors can focus more precisely on their targets.

Now, a new study helps to confirm that MRg-A-SBRT has fewer side effects than a related method called CT-SBRT, which uses computed tomography for imaging.

According to the study's lead author, Dr. Jonathan Leeman, a radiation oncologist at Harvard-affiliated Brigham and Women's Hospital in Boston, MRg-A-SBRT offers several advantages over CT-SBRT: one is that doctors using it can adjust treatment plans to account for a tumor's daily motions (this is called adaptive planning). The technology collects multiple MRI images per second during a radiation procedure, thus ensuring accurate real-time targeting. And finally, MRI visualizes the prostate with better resolution.

Analysis of studies

During the new study, Dr. Leeman and his colleagues searched the medical literature for every published clinical trial so far evaluating SBRT for prostate cancer, either with MRI or CT guidance. (This type of study is called a systematic review.)

The team ultimately identified 29 clinical trials that monitored outcomes for a total of over 2,500 patients. Short-term data on side effects was collected for up to three months on average after the procedures were completed.

Leeman's team used statistical methods to pool results from the studies into combined datasets. They found that the MR-SBRT-treated patients had fewer side effects. Specifically, 5% to 33% of men treated with MR-SBRT had genitourinary side effects, compared to between 9% and 47% of men who had the CT-guided treatments. Similarly, the risk of gastrointestinal side effects in the MR-SBRT-treated men ranged from 0% to 8%, compared to between 2% and 23% among men whose treatments were guided by CT.

Conclusions and comments

The authors concluded that "technical advances in precision radiotherapy delivery afforded by MRg-A-SBRT translate to measurable clinical benefit" (i.e., better tolerated treatments). But precisely why the treatments were better tolerated remains unclear. Is it because MR-scanning has better resolution? Did adaptive planning (and real-time targeting) account for the lower risk of side effects, or can that be attributed to some combination of all these factors? Dr. Leeman says that adaptive planning is "likely the main differentiator," but he adds that further studies are needed to confirm where the benefits come from.

To place this important work in perspective, we reached out to the authors of the new paper, as well as Dr. Anthony Zietman and Dr. Nima Aghdam, two Harvard-affiliated radiation oncologists who are also on the editorial board of the Harvard Medical School Annual Report on Prostate Diseases. All these experts feel this new technology has very promising potential.

But both groups cautioned that as with all newly developed innovations, results from additional studies — including clinical trials that are currentlyongoing — will be needed before more widespread uptake of the technology is warranted. Dr. Marc B. Garnick, the Gorman Brothers Professor of Medicine at Harvard Medical School and Beth Israel Deaconess Medical Center, says he "agrees with this conservative, yet optimistic assessment."

About the Author

Charlie Schmidt, Editor, Harvard Medical School Annual Report on Prostate Diseases

Charlie Schmidt is an award-winning freelance science writer based in Portland, Maine. In addition to writing for Harvard Health Publishing, Charlie has written for Science magazine, the Journal of the National Cancer Institute, Environmental Health Perspectives, … See Full Bio View all posts by Charlie Schmidt

About the Reviewer

Marc B. Garnick, MD, Editor in Chief, Harvard Medical School Annual Report on Prostate Diseases; Editorial Advisory Board Member, Harvard Health Publishing

Dr. Marc B. Garnick is an internationally renowned expert in medical oncology and urologic cancer. A clinical professor of medicine at Harvard Medical School, he also maintains an active clinical practice at Beth Israel Deaconess Medical … See Full Bio View all posts by Marc B. Garnick, MD

When you first learned the facts about pregnancy — from a parent, perhaps, or a friend — you probably didn’t learn that up to one in three ends in a miscarriage.

What causes miscarriage? How is it treated? And why is appropriate health care for miscarriage under scrutiny — and in some parts of the US, getting harder to find?

What is miscarriage?

Many people who come to us for care are excited and hopeful about building their families. It’s devastating when a hoped-for pregnancy ends early.

Miscarriage is a catch-all term for a pregnancy loss before 20 weeks, counting from the first day of the last menstrual period. Miscarriage happens in as many as one in three pregnancies, although the risk gradually decreases as pregnancy progresses. By 20 weeks, it occurs in fewer than one in 100 pregnancies.

What causes miscarriage?

Usually, there is no obvious or single cause for miscarriage. Some factors raise risk, such as:

• Pregnancy at older ages. Chromosome abnormalities are a common cause of pregnancy loss. As people age, this risk rises.
• Autoimmune disorders. While many pregnant people with autoimmune disorders like lupus or Sjogren’s syndrome have successful pregnancies, their risk for pregnancy loss is higher.
• Certain illnesses. Diabetes or thyroid disease, if poorly controlled, can raise risk.
• Certain conditions in the uterus. Uterine fibroids, polyps, or malformations may contribute to miscarriage.
• Previous miscarriages. Having a miscarriage slightly increases risk for miscarriage in the next pregnancy. For instance, if a pregnant person’s risk of miscarriage is one in 10, it may increase to 1.5 in 10 after their first miscarriage, and four in 10 after having three miscarriages.
• Certain medicines. A developing pregnancy may be harmed by certain medicines. It’s safest to plan pregnancy and receive pre-pregnancy counseling if you have a chronic illness or condition.

How is miscarriage diagnosed?

Before ultrasounds in early pregnancy became widely available, many miscarriages were diagnosed based on symptoms like bleeding and cramping. Now, people may be diagnosed with a miscarriage or early pregnancy loss on a routine ultrasound before they notice any symptoms.

How is miscarriage treated?

Being able to choose the next step in treatment may help emotionally. When there are no complications and the miscarriage occurs during the first trimester (up to 13 weeks of pregnancy), the options are:

Take no action. Passing blood and pregnancy tissue often occurs at home naturally, without need for medications or a procedure. Within a week, 25% to 50% will pass pregnancy tissue; more than 80% of those who experience bleeding as a sign of miscarriage will pass the pregnancy tissue within two weeks.

What to know: This can be a safe option for some people, but not all. For example, heavy bleeding would not be safe for a person who has anemia (lower than normal red blood cell counts).

Take medication. The most effective option uses two medicines: mifepristone is taken first, followed by misoprostol. Using only misoprostol is a less effective option. The two-step combination is 90% successful in helping the body pass pregnancy tissue; taking misoprostol alone is 70% to 80% successful in doing so.

What to know: Bleeding and cramping typically start a few hours after taking misoprostol. If bleeding does not start, or there is pregnancy tissue still left in the uterus, a surgical procedure may be necessary: this happens in about one in 10 people using both medicines and one in four people who use only misoprostol.

Use a procedure. During dilation and curettage (D&C), the cervix is dilated (widened) so that instruments can be inserted into the uterus to remove the pregnancy tissue. This procedure is nearly 99% successful.

What to know: If someone is having life-threatening bleeding or has signs of infection, this is the safest option. This procedure is typically done in an operating room or surgery center. In some instances, it is offered in a doctor’s office.

If you have a miscarriage during the second trimester of pregnancy (after 13 weeks), discuss the safest and best plan with your doctor. Generally, second trimester miscarriages will require a procedure and cannot be managed at home.

Red flags: When to ask for help during a miscarriage

During the first 13 weeks of pregnancy: Contact your health care provider or go to the emergency department immediately if you experience

• heavy bleeding combined with dizziness, lightheadedness, or feeling faint
• fever above 100.4° F
• severe abdominal pain not relieved by over-the-counter pain medicine, such as acetaminophen (Tylenol) or ibuprofen (Motrin, Advil). Please note: ibuprofen is not recommended during pregnancy, but is safe to take if a miscarriage has been diagnosed.

After 13 weeks of pregnancy: Contact your health care provider or go to the emergency department immediately if you experience

• any symptoms listed above
• leakage of fluid (possibly your water may have broken)
• severe abdominal or back pain (similar to contractions).

How is care for miscarriages changing?

Unfortunately, political interference has had significant impact on safe, effective miscarriage care:

• Some states have banned a procedure used to treat second trimester miscarriage. Called dilation and evacuation (D&E), this removes pregnancy tissue through the cervix without making any incisions. A D&E can be lifesaving in instances when heavy bleeding or infection is complicating a miscarriage.
• Federal and state lawsuits, or laws banning or seeking to ban mifepristone for abortion care, directly limit access to a safe, effective drug approved for miscarriage care. This could affect miscarriage care nationwide.
• Many laws and lawsuits that interfere with miscarriage care offer an exception to save the life of a pregnant patient. However, miscarriage complications may develop unexpectedly and worsen quickly, making it hard to ensure that people will receive prompt care in life-threatening situations.
• States that ban or restrict abortion are less likely to have doctors trained to perform a full range of miscarriage care procedures. What’s more, clinicians in training, such as resident physicians and medical students, may never learn how to perform a potentially lifesaving procedure.

Ultimately, legislation or court rulings that ban or restrict abortion care will decrease the ability of doctors and nurses to provide the highest quality miscarriage care. We can help by asking our lawmakers not to pass laws that prevent people from being able to get reproductive health care, such as restricting medications and procedures for abortion and miscarriage care.

About the Authors

Sara Neill, MD, MPH, Contributor

Dr. Sara Neill is a physician-researcher in the department of obstetrics & gynecology at Beth Israel Deaconess Medical Center and Harvard Medical School. She completed a fellowship in complex family planning at Brigham and Women's Hospital, and … See Full Bio View all posts by Sara Neill, MD, MPH

Scott Shainker, DO, MS, Contributor

Scott Shainker, D.O, M.S., is a maternal-fetal medicine specialist in the Department of Obstetrics and Gynecology at Beth Israel Deaconess Medical Center (BIDMC). He is also a member of the faculty in the Department of Obstetrics, … See Full Bio View all posts by Scott Shainker, DO, MS

Think of prostate cancer surgery and what likely comes to mind is a radical prostatectomy, which is an operation to remove the entire prostate gland along with the seminal vesicles that produce semen. However, men with localized prostate cancer — meaning cancer that is still confined to the prostate — have another surgical option.

Called focal therapy, this alternative procedure treats only the cancerous part of the prostate and leaves the rest of the gland intact. The aim is to remove “clinically significant” tumor tissue, cancer that would spread further if it wasn’t treated at all. While there is a small risk that some cancer may be left behind after treatment, focal therapy also has the benefit of minimizing risks for erectile dysfunction and urinary incontinence, which are both potential side effects of radical prostatectomy. And growing evidence shows it can be an effective strategy.

Last year, researchers reported that 1,379 men treated with focal therapy or radical prostatectomy had similar cancer outcomes after five years of follow-up. The men were 66 years old on average, and doctors treated them with a technique called high-intensity focused ultrasound, or HIFU. This approach destroys cancer by subjecting it to high-energy ultrasound waves that heat tumors to high temperatures.

Now, findings from the same research team show that focal therapy is also an effective option for older men with prostate cancer. During this newer study, researchers assessed outcomes for 649 men ages 70 and above who were treated at 11 sites in the United Kingdom. Two-thirds of the men had cancer with an intermediate risk of further spread, and the remaining third had more aggressive, high-risk prostate tumors that are more dangerous.

All the men were treated with HIFU or a different type of focal therapy, cryotherapy, that destroys cancer by freezing it. The primary goal of the study was to assess “failure-free survival,” whereby treated men avoid a prostate cancer death, or worsening disease leading to further interventions.

What the data reveals

After follow-up durations ranging up to five years, 96% of the men were still alive, and the overall failure-free survival rate was 82%. No differences in outcomes between HIFU- and cryotherapy-treated men were reported. The men with high-risk cancer had worse outcomes: their failure-free survival rate was 75%, compared to 86% among men with intermediate-risk disease.

But 88% of the high-risk men and 90% of the intermediate-risk men also avoided hormonal therapy, a treatment that — because of its side effects — most men don’t want. The authors concluded that focal therapy may be an acceptable treatment that controls prostate cancer in older men as well as radical prostatectomy does.

It’s important to note that complications from focal therapy are possible. For instance, a small percentage of men in the new study developed urinary tract infections, and some also wound up with urinary retention, a treatable condition that occurs when the bladder can’t empty completely. The authors didn’t assess functional outcomes after surgery, such as erectile dysfunction or urinary incontinence. But mounting evidence from other studies shows that long-term urinary incontinence after focal therapy is very rare.

The findings are encouraging, but Harvard experts emphasize that more evidence with focal therapy is still needed. “Despite promising results such as those reported in this and other studies, long-term outcomes (e.g., 10 to 15 years or more) following focal therapy must still be assessed to fully determine how this treatment option compares to radical prostatectomy or radiation therapy,” says Dr. Boris Gershman, aurologist at Beth Israel Deaconess Medical Center and an assistant professor at Harvard Medical School focusing on prostate and bladder cancer. “Additional studies can also help us refine the types of prostate cancer that focal therapy is most appropriate for, and which types should be given therapies that treat the entire prostate gland.”

About the Author

Charlie Schmidt, Editor, Harvard Medical School Annual Report on Prostate Diseases

Charlie Schmidt is an award-winning freelance science writer based in Portland, Maine. In addition to writing for Harvard Health Publishing, Charlie has written for Science magazine, the Journal of the National Cancer Institute, Environmental Health Perspectives, … See Full Bio View all posts by Charlie Schmidt

About the Reviewer

Marc B. Garnick, MD, Editor in Chief, Harvard Medical School Annual Report on Prostate Diseases; Editorial Advisory Board Member, Harvard Health Publishing

Dr. Marc B. Garnick is an internationally renowned expert in medical oncology and urologic cancer. A clinical professor of medicine at Harvard Medical School, he also maintains an active clinical practice at Beth Israel Deaconess Medical … See Full Bio View all posts by Marc B. Garnick, MD

Just about everyone has met or seen someone who has a tic disorder. Many tic disorders are diagnosed during childhood. Less often, a tic disorder like Tourette syndrome is diagnosed in adulthood — as was the case for Scottish singer Lewis Capaldi.

What are tics?

Tics are very common, with as many as one in five children experiencing them at some point. They can be a motor tic, which is a sudden brief movement — like a shrug, finger tap, or grimace — or they can be a noise, such as a word, grunt, or throat clearing.

In some cases, the movements or noise can be more complex, such as an unusual way of walking, saying particular words, or echoing the words of others (echolalia). Tics are involuntary, although they can sometimes be suppressed.

Tics may be temporary or long-lasting: about a third will go away entirely, a third improve with time (sometimes with treatment, though it's often not needed), and a third are long-lasting.

What is Tourette syndrome?

If someone has both motor and vocal tics that last more than a year, starting in childhood, they are said to have Tourette syndrome (TS).

It’s hard to know exactly how common Tourette syndrome is, as many children go undiagnosed. The Centers for Disease Control and Prevention (CDC) estimates that one in 162 children has Tourette syndrome. TS is about four times more common in boys than girls.

What causes Tourette syndrome?

We don’t know exactly what causes TS. There are likely some genetic factors, but psychological and environmental factors play a role as well.

Many children with TS also have either attention deficit hyperactivity disorder (ADHD) or obsessive compulsive disorder (OCD). Stress, fatigue, or excitement can make tics worse, as well. There has also recently been an increase in tic disorders — some meeting criteria for TS — among teens who have seen videos of others with tics on social media. These are called functional tic disorders.

What age is Tourette syndrome most likely to start?

TS usually begins between 2 and 15 years, with an average age of onset of 6 years, although in some cases it shows up later in the teen years. While TS usually gets better or completely resolves during adolescence and adulthood, it can be really tough for kids who have it. Having TS increases the risk of anxiety, school problems, sleep problems, mood disorders, and even suicide.

How is Tourette syndrome treated?

There is no cure for tics, but there are ways to make them more manageable and less frequent, which can make a big difference.

• CBIT. This approach involves training a person to recognize when the tics are going to happen and engaging a competing response that is more socially acceptable. It could be something like taking deep breaths, or substituting a different, more subtle movement for the disruptive one. This is called comprehensive behavioral intervention for tics, or CBIT. It can be very effective; the problem is that it can be difficult to find therapists trained in this form of treatment, and it is not always covered by insurance.
• Medications. If CBIT is not an option or not adequately helpful, medications are sometimes prescribed. Medication is usually not necessary, and is always a second choice behind behavioral therapy.

To learn more about TS and how to manage it, you can visit the CDC page, the NIH page, or the website of the Tourette Association of America.

About the Author

Claire McCarthy, MD, Senior Faculty Editor, Harvard Health Publishing

Claire McCarthy, MD, is a primary care pediatrician at Boston Children’s Hospital, and an assistant professor of pediatrics at Harvard Medical School. In addition to being a senior faculty editor for Harvard Health Publishing, Dr. McCarthy … See Full Bio View all posts by Claire McCarthy, MD

As a kid, I spent many Saturdays romping around my Florida neighborhood imitating Colonel Steve Austin, better known as The Six Million Dollar Man to avid TV watchers in the 1970s.

The popular show featured a bionic man — half human and half machine — who could jump from three-story buildings, leap over six-foot-high walls, and bolt into a full 60-mile-per-hour sprint. Naturally, these actions occurred in slow motion with an iconic vibrating electronic sound effect.

My own bionic moves involved jumping to pluck oranges from tree branches, hopping over anthills, and leaping across narrow ditches while humming that distinctive sound. I didn’t realize it, but this imitation game taught me the foundations of plyometrics — the popular training routine now used by top athletes to boost strength, power, and agility.

What are plyometrics?

Plyometric training involves short, intense bursts of activity that target fast-twitch muscle fibers in the lower body. These fibers help generate explosive power that increases speed and jumping height.

“Plyometrics are used by competitive athletes who rely on quick, powerful movements, like those in basketball, volleyball, baseball, tennis, and track and field,” says Thomas Newman, lead performance specialist with Harvard-affiliated Mass General Brigham Center for Sports Performance and Research. Plyometrics also can help improve coordination, agility, and flexibility, and offer an excellent heart-pumping workout.

Who can safely try plyometrics?

There are many kinds of plyometric exercises. Most people are familiar with gym plyometrics where people jump onto the top of boxes or over hurdles.

But these are advanced moves and should only be attempted with the assistance of a trainer once you have developed some skills and muscle strength.

Keep in mind that even the beginner plyometrics described in this post can be challenging. If you have had any joint issues, especially in your knees, back, or hips, or any trouble with balance, check with your doctor before doing any plyometric training.

How to maximize effort while minimizing risk of injury

• Choose a surface with some give. A thick, firm mat (not a thin yoga mat); well-padded, carpeted wood floor; or grass or dirt outside are good choices that absorb some of the impact as you land. Do not jump on tile, concrete, or asphalt surfaces.
• Aim for just a few inches off the floor to start. The higher you jump, the greater your impact on landing.
• Bend your legs when you land. Don’t lock your knees.
• Land softly, and avoid landing only on your heels or the balls of your feet.

Three simple plyometric exercises

Here are three beginner-level exercises to jump-start your plyometric training. (Humming the bionic man sound is optional.)

Side jumps

Stand tall with your feet together. Shift your weight onto your right foot and leap as far as possible to your left, landing with your left foot followed by your right one. Repeat, hopping to your right. That’s one rep.

• You can hold your arms in front of you or let them swing naturally.
• Try not to hunch or round your shoulders forward as you jump.
• To make this exercise easier, hop a shorter distance to the side and stay closer to the floor.

Do five to 15 reps to complete one set. Do one to three sets, resting between each set.

Jump rope

Jumping rope is an effective plyometric exercise because it emphasizes short, quick ground contact time. It also measures coordination and repeated jump height as you clear the rope.

• Begin with two minutes of jumping rope, then increase the time or add extra sets.
• Break it up into 10- to 30-second segments if two minutes is too difficult.
• If your feet get tangled, pause until you regain your balance and then continue.

An easier option is to go through the motions of jumping rope but without the rope.

Forward hops

Stand tall with your feet together. Bend your knees and jump forward one to two feet. Turn your body around and jump back to the starting position to complete one rep.

• Let your arms swing naturally during the hop.
• To make this exercise easier, hop a shorter distance and stay closer to the floor.
• If you want more of a challenge, hop farther and higher. As this becomes easier to do, try hopping over small hurdles. Begin with something like a stick and then increase the height, such as with books of various thicknesses.

Do five to 10 hops to complete one set. Do one to three sets, resting between each set.

About the Author

Matthew Solan, Executive Editor, Harvard Men's Health Watch

Matthew Solan is the executive editor of Harvard Men’s Health Watch. He previously served as executive editor for UCLA Health’s Healthy Years and as a contributor to Duke Medicine’s Health News and Weill Cornell Medical College’s … See Full Bio View all posts by Matthew Solan

About the Reviewer

Howard E. LeWine, MD, Chief Medical Editor, Harvard Health Publishing

Dr. Howard LeWine is a practicing internist at Brigham and Women’s Hospital in Boston, Chief Medical Editor at Harvard Health Publishing, and editor in chief of Harvard Men’s Health Watch. See Full Bio View all posts by Howard E. LeWine, MD

Your face plays an outsized role in your interactions with the world. It’s usually the first thing a person notices when they look at you. It’s home to the eyes, nose, and mouth, vital body parts that allow you to eat, drink, and communicate. But our facial features are also engineered for their own self-protection — and help protect our bodies in many surprising ways.

My brief career as a cowpoke

I learned how the human face is designed for self-protection while whipping around a lasso I’d been given as a birthday gift. At 8, I’d seen enough cowboy movies to think I knew how use it, at least until the rope struck me across my face. Within seconds a raised red streak ran across my forehead, eyebrow, and cheek. But it skipped my eye.

Once sure I was okay, my mom pointed out that being set back and surrounded by my eye socket bones had protected my eye from damage.

I learned two important lessons that day. First, facial anatomy is remarkably good at protecting itself. Second, using a lasso is harder than it looks.

How do your eyes help protect your body?

Our eyes help keep us safe by feeding detailed information about our surroundings to the brain. Having two eyes pointing ahead (rather than just one) allows for depth perception and a wider field of vision.

What’s more:

• Eyebrows help guide debris, sweat, rainwater, or other substances that find their way onto your forehead away from your eyes. They also communicate emotions, as is obvious if you compare the positions of a person’s eyebrows when they are angry, surprised, or fearful.
• Eyelashes act as guards at the front of the eyes, preventing dust, sweat, and other irritants from making it into the eye. And because lashes are sensitive to touch, they can also provide an alert when something is near the eye.
• The cornea protects your eyes from what may be harmful in the environment while allowing light to pass through to reach nerves at the back of the eye. The cornea is perfectly suited for these tasks: its tough outer coating shields the front of the eye, but is clear so that light can pass through it.

How does your nose help protect your body?

The nose that allows us to smell flowers, bread baking, and other pleasant scents also serves as an alarm system: if there’s a gas leak or if food has spoiled, a good sense of smell can be lifesaving. It also warms and humidifies air passing through. That’s important because cold, dry air can be irritating to the lungs.

Additionally:

• Nose hairs help filter larger particles, such as dust or soot, from the air.
• The nasal liningteams with immune cells ready to attack toxic particles from the air, viruses, or other intruders. It also produces protective mucus that can trap small particles and keep nasal passages from drying out.
• Sneezing expels small particles, such as microorganisms or chemical irritants, out through the nose.

How does your mouth help protect your body?

Eating, drinking, and speaking are among the most important functions of the mouth, but there are other ways it’s protective:

• A tight seal forms when you close your mouth. That’s helpful, because otherwise we’d have a hard time swimming — or even just walking around — and might be constantly swallowing bugs (among other challenges)
• Coughing allows you to expel unwanted particles or organisms through your mouth.
• Saliva contains antibodies to attack infectious organisms before these travel further into the body.
• The mucous membranes that line the inside of the mouth allow for the sensation of taste. That’s important for quality of life, and for avoiding eating something toxic. And the mucous membranes host key immune cells, serving as a first-line immune barrier against viruses and other infectious organisms.

The evolution of the human face

How is it that the human face developed to protect its host in so many ways?

As is so often the case with the human body, you can thank evolution. Over thousands of years, evolutionary pressure ensured that features favoring survival were preserved in our genetic makeup.

This includes facial anatomy: each element of your face is there for a reason, from its shape, form and function to its various attachments and orifices. Even features that humans consider attractive (such as symmetry, youthfulness, or familiarity) are partly due to evolutionary pressure: these features help attract mates, and therefore may increase the chances of passing on genes to offspring.

The bottom line

Remarkable features of the human face serve to protect itself and its host. Unlike communication and social interactivity, these features are less well known and probably underappreciated.

So, the next time you look at yourself in the mirror, go ahead: Check how good you look. Or for signs of aging. Or for lettuce in your teeth. But whatever you’re searching for, remember: there’s a lot more to the appearance of your face than how you look.

About the Author

Robert H. Shmerling, MD, Senior Faculty Editor, Harvard Health Publishing; Editorial Advisory Board Member, Harvard Health Publishing

Dr. Robert H. Shmerling is the former clinical chief of the division of rheumatology at Beth Israel Deaconess Medical Center (BIDMC), and is a current member of the corresponding faculty in medicine at Harvard Medical School. … See Full Bio View all posts by Robert H. Shmerling, MD