The holidays are near and "porch pirates" are on the prowl throughout Davenport.
When you have a newborn baby, you spend many hours in the day trying to prevent them from crying. Whether it’s popping pacifiers in their mouth, babywearing, or following a nursing schedule that ensures they’re never too full or too hungry, parents can run themselves ragged trying to avoid the dreaded newborn howl. It’s not hard to see why a sleep training approach known as the cry-it-out method might scare some people away. But, when you’re many months past exhausted, and the sleepless nights don’t seem to be getting any better, sleep training starts to sound pretty great. You probably have lots of questions: What exactly is cry-it-out? Does cry-it-out work? Is it safe? How long will it take, and how much crying is too much?
If you’ve ever wandered into a parenting Facebook group, you probably know that sleep training can be a highly charged topic, and that you can get strong opinions both celebrating the cry it out method as a gift to tired parents and those who are firmly against it. But getting straightforward answers to your questions can be another matter. Two experts who have worked in the field of infant sleep for years, and helped hundreds of families, have the answers to these questions, and more, so you can figure it out if the cry-it-out method is right for you.
The cry-it-out method — which goes by many other unpleasant monikers as well, including “extinction sleep training” or “full-extinction sleep training” — is due for a rebrand, says Alexis Dubief, author of Precious Little Sleep. “I don’t use the term ‘cry it out’ ever—’cry it out’ is a pejorative, used by a school of parenting philosophy that determined that this is terrible for infants. What we’re doing is making a change at bedtime.”
What change, exactly, does cry-it-out seek to bring about? With very young infants, it’s easy to get into a pattern of nursing, bouncing, or rocking them to sleep, then sneaking them, fully asleep, into their crib. The “change at bedtime” that you’re making with the cry-it-out method is to put your baby into their safe sleeping environment at bedtime when they’re drowsy but awake. This sounds intimidating to first time parents especially, but it allows baby to adjust to their surroundings before falling asleep so that they’re not frightened or surprised to find themselves in their crib as they go in and out of deep sleep during the night. But, if being put to bed awake is new to them — and it is new to most babies at some point — it often results in some crying or fussing as they figure out a new skill: How to self-soothe.
The cry-it-out method is similar to the “Ferber method” of sleep training, which is also known as graduated extinction (as opposed to full extinction). named for the pediatrician Richard Ferber, who coined it. With Ferber’s method, you check on your baby periodically, at increasing intervals, during the time that that they’re crying and not asleep. With the “full extinction” sleeping training method, you don’t do check-ins, and Dubief actually thinks that’s a good thing.
“After 15 years of working with families, check-ins don’t help, and make things worse,” Dubief tells Romper. When clients do check-ins, she sees that it can actually rev a baby up, rather than help them to sleep, and that the baby “gets more upset and more angry with them when they leave.” With the cry-it-out method, you can still look at your baby on the monitor and make sure they’re OK, but you trust them to be capable of falling asleep without your direct assistance.
This can vary a bit, and there is no hard and fast rule, but four months seems to be the earliest age that most pediatricians recommend sleep training. “Usually four months is the earliest I would try,” says Dr. Craig Canapari, director of the Yale Pediatric Sleep Clinic. How old your baby should be for the cry-it-out method will depend on many factors like whether they were premature and whether they have any health problems. That said, for most babies, sleep training — including the cry-it-out method — will get more difficult as they get closer to the one-year mark.
In addition to being over 16 weeks of age (adjusted for prematurity, if needed) experts agree that to be ready to cry-it-out, your baby needs to be able to distinguish between their days and nights, and have a “bedtime” that coincides with their longest stretch of sleep before you try any kind of sleep training. Dubief tells families to look for three signs of sleep training readiness in particular:
Sleep training a baby is intimidating, but the process typically only takes a few days and should result in much better sleep for everyone. It helps to feel confident in your plan, so Dubief has the following tips for parents doing the cry-it-out method:
Is there a number of minutes of crying that’s too long to let them cry? How long should you let your baby cry it out?Again, there’s not a magic number. A study by a team of sleep researchers found that the first night of sleep training tends to be the worst, with approximately 45 minutes of crying. “If the baby is crying for more than 90 minutes, or having extended crying for more than a few nights, I would press pause, check in with the pediatrician, and try again in a few week,” Dr. Canapari says.
It’s hard to listen to your baby cry — and of course, you want to get past the crying part to the sleeping part. If the method is working, you should be seeing rapid improvement within a few days, and certainly the first week. If you aren’t, it may be time to talk to your child’s pediatrician or to a sleep specialist. While the first night may involve crying and still a lot of night wakings, you should be seeing quick improvement. “You’re looking for rapid improvement within two days,” she says.
You’re right to be dubious as a parent of anyone selling something that they insist works for every single child. “Nothing works for every child,” Dr. Canapari notes. “That being said, if the child is developing normally, and ready for this (which will typically happen before 4-6 months) with no underlying medical issues disrupting sleep, it is a highly researched method.” In other words, while cry-it-out may not work for some babies, it is tried-and-true for many families.
Yes, the cry-it-out method can be used for naps, but it’s likely to be a harder road than bedtime. Some babies may not start consolidating their sleep cycles during naps until 7-8 months of age. “Longer naps may take time no matter what you do,” notes Dubief. “That said, you can still work to break the sleep associations that might be interfering with naps, and avoid rocking or nursing your child until they’re completely asleep. Helping them to learn to fall asleep in their crib is good practice, for both bedtime and naps.”
Cry-it-out is not something that’s mandatory to do if you’re uncomfortable with it, but it is not harmful to babies. “Sleep training is safe and does not damage babies,” Canapari says. And the idea that you’re interfering with the bond that you and your child have by sleep training just isn’t rooted in fact. “Attachment science tells us that parent-child bonds are not balsa wood. They are titanium,” Dubief says. “When we are generally responsive and emotionally available to our children, these bonds form.”
Sleep deprivation, on the other hand, is dangerous. Dubief has worked with families where the parents have crashed their cars, fallen down the stairs, or whose mental health has seriously suffered because of a lack of sleep. The cry-it-out method of sleep training is safe for babies, and may be sanity-saving for your whole household.
No one is required to do this sleep training method. “Not everyone is up for this,” Canapari says. “Likewise, if you are happy with how your baby is sleeping, don’t let anyone convince you that you need to change anything.” Some questions to ask yourself before you embark on a sleep training journey include:
No one likes to hear their baby cry, but, Dubief points out, being a parent often involves doing things your child doesn’t want you to do, be it preventing them from running into traffic as a toddler or helping them to learn to sleep on their own when they’re younger. “Sleep is a biological need,” she says. “If someone suggested to you to have children you should just deliver up drinking water—just a cup a day, just enough to stay alive—for 2 years, because your child needs it, we’d think that was absurd—but with sleep we act like it’s optional.”
Craig Canapari, MD Director, Yale Pediatric Sleep Center
Alexis Dubief author of Precious Little Sleep.
Honaker SM, Schwichtenberg AJ, Kreps TA, Mindell JA. Real-World Implementation of Infant Behavioral Sleep Interventions: Results of a Parental Survey. J Pediatr. 2018 Aug;199:106-111.e2. doi: 10.1016/j.jpeds.2018.04.009. Epub 2018 May 9.
What does world patient safety day mean and how seriously is it taken in our context?
Patient safety is critical and is taken very seriously by organisations such as ours that do a high volume of work. For eye care and healthcare in general, there are various processes involved in delivering the right treatment to the patients, including the right environment to provide patients advanced treatment facilities with assistive technologies. Most of our work in eye care is surgical, and any infection in the eye during surgery can be very serious, leading to the loss of the eye.
What are some examples of processes involved in eye care?
At Dr Shroff’s Charity Eye Hospital, when we come across a patient who requires surgery, there are protocols we follow regarding the kind of investigations they should undergo to determine how to have a safe surgery. Right now, most of the surgeries happens under local anaesthesia or even topical without injection but some surgeries require general anaesthesia.
Prior to any surgery, proper care is given to the patient. Adequate time is given to be mentally and physically prepared, for the surgery. During any eye surgery, we take care that the surgery is performed at a facility with required facilities to perform the surgery, and that equipment is properly sterilized.
Besides that, there are protocols to deal with latent infections that may happen in the environment and cause problems. Bodies like National Accreditation Board for Hospitals (NABH) define these protocols.
We also take care of infections, complications and postoperative follow-up rates. Shroff’s charity eye hospital tries to maintain a follow-up rate of 80-85% final follow-up. However, 50% of our patients come from primary-level and remote places, therefore, sometimes it becomes difficult for us to encourage patient from these geographies to come for follow-ups. Patients follow up treatment as soon as they start to experience better vision which happens after just one day of treatment. However, our focus is to accelerate follow ups with as many patients as possible to ensure patient safety and provide best eye care facilities.
How do you follow up with people coming from remote areas? Is it done telephonically?
Our organization follows two models, which help us to better cater to such areas: the cross-subsidy model and the hub-spoke model. These models are designed to ensure that those who do not have access to quality and affordable eye care are provided the same at minimal or no cost. They have designed to ensure access to people from the remotest of regions.
While the cross-subsidy model works on economies of scale by ensuring large number of surgeries for people from high income groups, the hospital is able to ensure that 50% of its surgical work is reserved for people with minimal or no access to quality eye care.
The hub and spoke model on the other hand, consists of doctors engaging in door-to-door screening at a village level which helps us identify ailments quickly and refer patients to primary eye care centres also called vision centres. And in case, if the condition cannot be treated at a vision centre level, they are referred to a secondary centre. While the Daryaganj (New Delhi) hospital is the hub and the base unit where all the super certified are present, the spokes (the secondary centres and clinics) are distributed across various district headquarters in the states of Rajasthan, Haryana, and Uttar Pradesh. These centres are well equipped with the latest technologies. Only in the rarest of cases are patients still referred to the main hospital in Delhi.
We have a network of these private care centres near remote areas, as well as block headquarters. For example, after day one, a follow-up with the surgeon is required, followed by the optometrist and technician at the vision centre, and these centres are linked to the main centre via teleophthalmology. Only after that is a decision made by the doctor as to whether the patient should travel. I would estimate that 70 to 80% of follow-ups after day one take place at these centres located closer to the patients.
What are the most common eye ailments that afflict Indians, especially those in rural India? Does our genetic makeup predispose us to some specific kind of ailments?
The condition which mainly causes blindness, loss of vision, or visual impairment is cataract. We aren't so sure about the genetic makeup, but Indians are more prone to early cataracts as compared to those in. the West. It could be hereditary too. There are some cataracts that are age related but then Indians are also prone to getting them as early as 40 years. Since 60-70% of our population is rural, a lot of agricultural injuries happen which cause corneal opacity, which is also the second most common cause of blindness in India, according to the National Family Health Survey.
Our environment also plays a role and effects our eyes. For example, our regions remain considerably hot and humid most of the times. These conditions are congenial for infection causing organisms to grow.
Other conditions are like the rest of the world. Myopia is a worldwide phenomenon that is also occurring in India because of all these near vision activities (eg. screen time). Diabetes is much more common in the Indian population due to genetic susceptibility. There are many cases of diabetic retinopathy, particularly in South India. The cases are fewer in the north, but it is an emerging condition, and not much can be said about it for now.
For age-related cataracts, other than family genetics, are there other contributing factors?
Some of the responsible factors are:
a) People spend a lot of time outdoors and are affected by the ultraviolet rays as the country is sunnier
b) India is known to be a diabetes capital of the world. Co-morbidities like diabetes can lead to early cataracts and early maturity of the cataracts. Cataract in a non-diabetic patient, takes more time to get to a surgical stage than a person with diabetes or uncontrolled diabetes. Statistics show that 50% of our diabetes is undetected, and among the detected ones, only a few patients go for regular treatment.
Besides diabetes, what other co-morbidities affect the eyes?
Something that we see often are conditions related to blood pressure. Blood pressure does not cause any symptoms and is often detected late during a routine check-up. However, we have started observing some associated retinal ailments that are sometimes not very serious but can be vision threatening because of uncontrolled blood pressure. Hyperthyroidism can also cause serious complications in the eye at all levels, from the lid to the cornea, and may even infect the optic nerve present deeper inside the eye.
Is there a change in ailments over the years that you see in the Indian demographic?
It is difficult to say, but I believe that as we get older, we see more glaucoma and age-related macular degeneration. Myopia is becoming more common in people of all ages; previously, it was mostly seen in teenagers. Conditions such as dry eyes may have become more serious over time. It is attributed to the pollution level in which we live in as well as the amount of screen time we are exposed to. Dryness, which was never a problem for children, is now affecting young children and adults.
Are dry eyes reversible?
The condition can be improved to some extent through lifestyle changes. Fortunately, there are numerous lubricants available to help you get through the symptomatic period. These (lubricants) in general, have few side effects and can have a positive impact as well. However, it is always advised to consult an ophthalmologist if the condition stays for a while and causes disruption in daily activities. Normally dryness caused by prolonged screen activity is reversible. It may be irreversible if there are other eye diseases or systemic diseases like autoimmune disorders.
How does diet impact the health of our eyes?
For children, vitamin A deficiency, has both direct and indirect impact. Such situations can sometimes not only be eye-threatening but also fatal. Eating good and fulfilling foods such as fruits and green, healthy vegetables makes a big difference. If you are eating a balanced diet, there is no need for supplements.
Is it safe to use over-the-counter drops to enhance vision without a doctor’s prescription?
We need to know how much, if any, benefit they offer or are just placebos. There is a cost involved and these can also cause inconvenience to the patient. Regarding, homeopathic or allopathic drops, I strongly advise that any such drugs be used only after consulting a doctor because some of them contain potentially harmful ingredients. For instance, giving steroid drops for a minor ailment can have side effects and may worsen the condition.
Many problems arise when people stop going to the doctor but continue to use the drops, or when a chemist prescribes high-concentration medicines for minor ailments, which can lead to glaucoma and genuine vision loss. Besides, some of these drops frequently contain chemicals that may not be directly harmful, but their preservatives can cause a lot of corneal surface irritation, which would eventually be harmful in the long run, causing toxic corneal conditions. So, if you're thinking about putting drops in your eyes for both long- and short-term purposes, I'd recommend getting a consultation.
Is there also a marked gender differential in those who seek care for eye related problems?
According to global statistics, women account for 55% of all eye problems and impairment. One factor is that women have higher longevity than men. Most eye disorders, such as glaucoma, cataracts, and other diseases, worsen with age. We conducted a multicentric study based on access to cataract services and discovered that women had cataracts for a longer period and had poorer vision. Women also tend to wait until the condition turns very bad before seeking treatment for a simple one-time intervention surgery like a cataract.
Previously, primary eyecare was provided in camps where we saw a higher concentration of men because it was for a set period. Because of their ease of access and availability throughout the day, the eye care and vision centres, I mentioned earlier, have demonstrated greater gender equality.
Our focus is community-based projects and outreach camps. We're also focusing on door-to-door screening, eye screening, and awareness raising in villages.
Have you witnessed a regional divide in how women access healthcare in terms of the north and the south?
I haven't worked in the south or seen any studies comparing the north and the south, but generally primary healthcare is very developed in most southern states. That takes care of a lot of conditions including eye care. Big players from the NGO sector have been traditionally built, which may have caused some behaviour change over time, which could be why women there (in the South) have better access.
Screen time is a big challenge and we have come to the stage where perhaps it is futile to tell anyone to limit their it. With that given, what is the best that we can do for our eyes?
The first piece of advice is to turn off the devices when they are not needed. Follow the 20-20-20 rule, which means for every 20 minutes of staring at a screen, you should take a twenty-second break and look at something at least 20 feet away. It benefits both the eye strain and the muscles. It works out and relaxes the muscles. We advise professionals who must look at a screen to be aware of their blinking because you tend to blink less when looking at a screen.
They can also use supplementary aids such as anti-glare coating on their glasses and keep the brightness of these appliances as low as possible. They may occasionally require lubricants, which may be prescribed on an ongoing basis. Some of these lubricants are preservative-free and thus pose little risk. Not only should children limit their screen time, but they should also spend time outside to slow the progression of myopia.
Glasses are now being sold, touted as having special qualities to protect eyes from the screen. Are there any specific glasses one must invest in or can any O (zero) power glasses be used to protect your eyes from the screen?
You don't need very expensive glasses. But, if you're going to wear glasses, I think it's a good idea to have these anti-reflective coatings. It does provide glare protection. It will not protect you from muscle strain because you will still be focusing nearby, but it will protect you from the glare's dryness and irritation.
One of the components of the program that the Dr Shroff Charity Eye Hospital is training young women to provide ophthalmic care. How many of these women are able to continue in that role after marriage and/or childbirth?
There are no easy answers to that. We take them (girls) right after school for training. They are young and can devote more time to the job. Another thing we discovered during an impact study is that before taking the course, the average age they would consider good to marry is around 20-21, but after taking the course, the age had shifted to 25. The course prepares them to be self-sufficient, financially independent, to have a say in what happens around them, and to have more years on the job.
We are now seeing a trend in our organisation where we are recruiting women from local geographies. So, if you're working in, say, Saharanpur, we'll take them from Saharanpur as well as the blocks or villages where they'll eventually be stationed. We have noticed a trend where some of them are returning to work after their weddings.
It's difficult to return to work immediately after childbirth because it's a physically demanding job. We have flexibility in our screening programmes when it comes to training women. They do take a break (eg. for childbirth), and then return because these jobs are flexible enough that they can work 2-3 hours in the morning and 2-3 hours in the afternoon. However, in the hospital setting, this is generally not possible. Some of them (women) will leave you for a few years, but we always hope that once they are more stable in their household circumstances, they will return to eye care and help the eye care in general.
What are your five top tips to keep our eyes in good shape all our lives?
One is a regular checkup, which should be done before a condition develops, for both children and also for people over the age of 40. The second step is to take care of your way of life. The third factor is taking care of the co-morbidities that we discussed. If you have diabetes and a hypertensive thyroid, you should consult your doctor and get an eye exam as soon as they recommend it. And, if possible, avoid taking things over the counter while waiting for the right prescription.
In UP, have you been able to develop a road map of how to collaborate with and strengthen the government system? The ASHAs (Accredited Social Health Activists) for instance are the biggest resource for early identification and surveillance.
We are working in UP with a large organisation that works for government health structure strengthening, so we are indirectly involved in training at all levels, including that of ASHAs. We also includes paramedics, such as optometrists, who come to our hospital in UP to receive training and credentials.
There are surgeons coming from government institutes for training in some specific conditions other than cataract.
There is a consortium called Vision 2020 India, which is made up of approximately 150 to 200 non-profit hospitals and organisations in India. We are working on developing a strategy for integrating eyecare into primary care. What is currently lacking is trained manpower in the government at the primary level, so the eyes are sometimes overlooked by the health system.
Do eye exercises, such as those in yoga for instance, play a preventive and possibly reversible role in eye ailments?
They have been shown to help in computer vision syndrome- eye strain with computer usage.
We Indians love using home nuskhas (remedies) such as splashing our eyes with rose water. What are your thoughts on that?
People use it for comfort or because of the misconception that it may help to delay cataracts. Cataracts usually take years to develop in people who already have them. It is unproven if these drops can actually help delay cataracts. So, putting something in the eye which could have risky ingredients and paying for that is not the safest option. In the case of using rose water, I think it is best to avoid it if the purity of the product is unclear. Splashing of water is only recommended in case something falls in your eye and there is no immediate access to a doctor. On the eye surface, there is a tear-filled layer present that is meant to protect the eye and increase comfort. Regular splashing of eyes with water (the purity of which you are unsure of) which has minerals or using drops with potentially harmful ingredients can damage the tear-filled layer in the eye. Avoid doing anything regularly with the eye unless advised by the ophthalmologist.
Kajal is very popularly used in our country both as tradition and make up. How safe is it?
We have seen a lot of young kids with heavy amounts of Kajal in the eye, Kajal in itself is not harmful if applied in moderation and outside the eye. Sometimes is applied to children in such great quantity that it tends to go in and not only cause allergies and irritation but can also restrict the drainage of tears. Continued use of kajal can cause inflammation and can cause the problem of watering. So, it has to be applied in moderation and by making sure that it is not touching the inside of the lid or the eyeball.
People who use contact lenses and eye makeup should take extra care about using it in moderation. Also, make sure that the lenses are worn before applying any makeup and not after. Improper use of contact lenses over long periods of time will cause allergies. Some people become so intolerant that they cannot wear contact lenses in the future. Using everything in moderation and not putting it inside the eye is best.
What is the safest way to wipe off kajal?
Oil is not required to remove it, just water will be enough and if it is applied in moderation then there will be no issue.
(Dr Shalinder Sabherwal is the Head of Community Ophthalmology and Associate Medical Director, Dr Shroff's Charity Eye Hospital, which is India’s oldest eye and ENT care hospital.
The hospital performs 15,000 free cataract surgeries every year and 50% of its work is done at highly subsidised rates. In 2022, through its outreach programme the hospital covered 3000 villages and screened 30,00,000 people through door to door checking.)
Dr. Kaixuan Liu
Endoscopic Spine Surgeon Dr. Kaixuan Liu with Atlantic Spine Center Offers Tips to Reduce Risk of Wintertime Injury to SpineStay active in the winter, despite the temptation to cocoon on the couch. Walking or swimming at a local indoor pool are great ways to maintain the strength of one's core and back muscles.” - Dr. Kaixuan LiuWEST ORANGE, NJ, UNITED STATES, December 9, 2022 /einpresswire.com / --“Oh, the weather outside is frightful,” but your back – and neck -- may not be feeling so delightful unless you took the necessary precautions to protect the spine from winter's cold and activity perils, warns dr. kaixuan liu , MD, PhD, founder of atlantic spine center .
Falls on ice, especially while carrying grocery bags and packages, and improper snow-shoveling techniques – putting stress on the back and neck rather than on the legs -- remain among the more obvious sources of spinal stress, injury, and pain, says Dr. Liu, a world-renowned endoscopic spine surgeon.
“In fact, a 17-year study published in the American Journal of Emergency Medicine ( ), estimates 11,500 snow-shoveling-related injuries are treated in United States hospitals annually, with more than 50 percent of them caused by 'acute musculoskeletal exertion' and another 20 percent, slips or falls,” Dr. Liu recalls. Adding to spinal dangers are those occasions when pushing a car out of a snow rut or climbing a ladder and reaching up precariously to hang December holiday lights.
“Many people also are unaware that the very coldness of winter temperatures takes a toll on the spine when outdoors. Muscles tend to tighten in the frosty weather and symptoms of chronic conditions – like sciatica, which is a painful compression of nerve roots in the lower back, and degenerative arthritis of the spine – can become a bit more acute,” Dr. Liu notes.
He cites a study appearing in the European Journal of Pain ( ). In it, authors report surveying nearly 6,600 people in Finland and finding that 50 percent of respondents experienced some form of musculoskeletal pain at temperatures of about 7 degrees Fahrenheit. Another study, published in the International Archives of Occupational and Environmental Health and focused on Swedish construction workers, indicates that those working regularly outdoors in winter temperatures are at increased risk for developing neck and lower back pain ( ).
The spine is a complex, columnar structure, whose myelin sheath, secured by bony vertebrae, protects the central nerve bundle linking communication between the brain and the rest of the body. Injury at any point along the length of this structure can have serious, life-changing consequences, including chronic, debilitating pain; loss of sensation; compromised physical or mental functions; decreased quality of life; and even death. Experts say the lumbar region – lower back – is the most frequently traumatized area of the spine. Spinal injuries can include stretched or damaged muscles and ligaments supporting the spine, rupture of one or more spinal discs, spinal and cervical fractures, and, in the most serious cases, paralysis.
Dr. Liu refers to research published in a 2022 edition of Spinal Cord ( ). There authors write,“Worldwide, traumatic spinal cord injuries have a considerable impact in terms of mortality and morbidity and represent a relevant burden for health care systems due to the expensive and complex medical support required by patients with spinal cord injury, in addition to [the] economic consequences deriving from loss in productivity. This condition is a leading cause of disability especially among younger people, with a high impact on years lived with disability.”
Of particular concern to Dr. Liu are winter activities – like sledding – that many people consider“innocuous” and often engage in without protective gear, such as helmets. A 2018 University of Wisconsin study in the Journal of Neurosurgery debunked theories that the“weight and bulk” of helmets make the wearers' necks more prone to cervical fractures. The scientists, instead, determined that helmets significantly reduce instances of cervical fractures in crashes.
Although the Wisconsin study focused on motorcyclists, the American Academy of Orthopaedic Surgeons has recommended fitted helmets – at least for children under age 12 -- in its guidelines for sledding safety ( ). The organization also suggests sliding down snow hills, whether by sled, inner tube, or other method, be done in a sitting position facing forward, and in an area free of hazards like trees, streets, parking lots, or ponds.
Meanwhile, a much earlier study in the Journal of Trauma and Acute Care Surgery ( ) suggests even the sitting position predisposes tobogganers to spinal injury if they are thrown off the board or hit a hard bump on the way down, Dr. Liu says.
And experts dismiss skiers' claims that helmets obstruct the field of vision as simply an“excuse.”
Of course, people cannot expect to eliminate all winter hazards from their lives, but Dr. Liu offers these tips to minimize risks and help keep wintertime as safe as possible:
.Stretch and do some warm-up exercises before engaging in strenuous outdoor activities like clearing snow from the porch or driveway.
.Follow all guidelines for shoveling snow. That means putting all the lifting stress on the back, pushing rather than lifting snow whenever possible, avoiding throwing snow up and over the head and back, and taking frequent breaks.
.Use protective gear, including a helmet, when enjoying winter activities and sports like tobogganing, sledding, skiing, and ice skating.
.Wear warm clothing and dress in layers during cold temperatures outdoors. Make sure the lower back is covered. Tuck shirt into your pants. Footwear should be conducive to safe walking on snow and ice.
Stay active in the winter, despite the temptation to cocoon on the couch. Walking or swimming at a local indoor pool are great ways to maintain the strength of one's core and back muscles.
“But should you experience any type of back pain or suspected cervical or spinal injury following activity, contact an orthopedic specialist as soon as possible to minimize the risk of developing a more serious or chronic condition,” Dr. Liu advises.
Atlantic Spine Center is a nationally recognized leader for endoscopic spine surgery with several locations in NJ and NYC.
Kaixuan Liu, MD, PhD, is a board-certified physician who is fellowship-trained in minimally invasive spine surgery. He is the founder of Atlantic Spine Center.
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The instructors travel from their home cooperatives to a training facility on the grounds of Nash Community College in Rocky Mount, North Carolina. Recently, the association elevated existing training by energizing the overhead lines through the Timpson Training Panel system, which provides real-world experience in a safe environment. They are the first cooperative association in the country to install this technology and are currently training students from across the state.
At the community college, students can learn the skills of the line trade by practicing in the overhead pole yard, underground simulated area and a training substation. Since 1998, N.C. Electric Cooperatives have been partnering with Nash Community College, which operates the Lineman Training Academy. Through the Nash Community College 12-week program, the students can learn the basics of line work and get their foot into the door in the electric utility industry.
While the community college focuses on training up-and-coming lineworkers, the co-op schools train apprentice and journeymen lineworkers who are already employed by North Carolina electric cooperatives. When the apprentices top out as journeymen from the cooperative program, they earn not only a state apprenticeship card, but also a federal apprenticeship card through the Department of Labor.
This year, the association will train more than 500 students at 16 different week-long classes offered throughout the year. To meet the scheduling needs of the students, facilitators are repeating some sessions multiple times, meaning that the cooperatives will host a total of 26 schools in 2022.
Participating lineworkers typically enroll in two or three schools a year, and it takes four to five years to complete all the training sessions. The training requirements are up to each individual cooperative, but many tie the training sessions into lineworkers’ job descriptions.
Back in 2019, the cooperatives were searching for a way to raise the bar in training from simulated “work like it’s hot” scenarios to energized, three phase circuit work in a controlled and safe manner. After doing research by practicing trade magazines and attending conferences, they discovered the Timpson Training Panel.
This control panel allows facilities to safely energize the overhead field and monitor the condition of the lines with sensitive redundant relay systems and interruption capabilities that carry a Safety Integrity Level of 3. The panel, which was designed to operate and offer protection similarly to a residential GFCI receptacle, allows lineworkers to train at full voltage while mitigating the risk to them.
To vet the equipment and its application, engineers from distribution cooperatives in the state researched the technical side of the panel’s operation. The Job Training and Safety team from North Carolina’s Electric Cooperatives visited the manufacturing facility and an genuine training yard. Observing the equipment in action at a training facility was key to the decision process.
In 2020, the statewide board granted approval to purchase and install the training system. Following COVID-related delays, the co-ops installed the unit and got it up and running in 2021. The team installed the 6-ft tall, 6-ft wide by 2 ft deep unit in an exterior 10 ft by 20 ft building. While the unit is waterproof, it was installed inside a building to secure it and keep it safe from severe weather conditions.
Training with the equipment began in 2022. The cooperatives’ Job Training and Safety team first offered a training session for the instructors, who are seasoned journeymen, so they would be familiar with the equipment and the process. After demonstrating the equipment and answering questions, the instructors and association safety team discussed expectations moving forward about the training system and how it could benefit trainees.
The first session for students brought in 20 lineworkers from 10 cooperatives across North Carolina to train using the technology. Due to the popularity of the class, the cooperatives will offer the same class three different times this year. At each session, the student-to-teacher ratio is limited to deliver the participants more one-on-one instruction.
At the first school using the Timpson panel, the students came for a half a day of training on Monday and Friday and a full day on Tuesday, Wednesday and Thursday. At the beginning of each day, the instructors Verified who was on the field, and they notified everyone that they were going to energize the line. Each day kicked off with a safety briefing to make the apprentices aware that they were going out to an energized training field and must follow all safety protocols.
When they turned the unit on, the system did a self-check. An alarm sounded and a red beacon lit up, which indicated the field was energized. Following the safety briefing, the instructors described how the equipment operates. The students then inspected their safety equipment and got to work. As in years past, they rotated through stations to complete several different tasks; however, instead of simulated energized training, the lines were energized.
Working in small groups, the apprentices performed the tasks assigned to them under strict supervision and observation. One of the students served as a designated observer for training purposes.
The participants, who all had at least two years of experience as lineworkers, were just starting to learn how to do bucket work at their cooperatives. Instructors expanded on these skills by requiring cross-arm change-outs and three-phase maintenance and construction work. The students all wear their personal protective equipment when training, as they would on the job.
Some of the students had experience working on energized single-phase lines back at their cooperatives, and when the system was turned on and they went up in the bucket at the training yard at the community college, they could tell the line had voltage on it. By providing true three-phase training, the co-ops are creating a real-world environment at the schools and enhancing the level of training beyond supervised energized on-the-job training that early-career lineworkers receive at their cooperatives.
This energized training had a significant impact on the students, who liked having the opportunity to go beyond simulation. In particular, they appreciated how the energized line required them to slow down and focus on not only the line work, but also the guidance from their instructors and communications with their fellow lineworkers.
“This is by far the best school I have gone to,” said one student. “The fact that it was ‘hot’ and we could work it hot just like real life on the job has stepped up training for us.”
Even though they were training in a safe and controlled environment, none of the apprentices wanted to be the one to knock the line out. If one of the students makes a mistake, the alarm will sound, the light will go off and the unit will shut down—giving the apprentices instant feedback that an error has been made. If the line is knocked out, then the exposure will be limited to 1.5 mA, and the system will shut down within about 20 milliseconds. The instructors plan to use any instances when contact with the line is made as teaching moments to investigate why the line was knocked out and how it could have been prevented. Following the safety briefing, the instructors will then reenergize the field and the apprentices will go back to work.
The implementation of energized training at the schools has also opened opportunities as new crew leaders join cooperative teams. In the future, the association plans to create a safety workshop for crew leaders to teach them about proper and effective coverup, which will help them in supervising and coaching lineworkers doing energized work out in the field back home.
Future plans also include building a new line to train the students about transformer banking, allowing apprentices to practice checking voltage and rotation and verify that they have wired the transformers correctly.
Through the Timpson Training Panel, the instructors can take training to the next level and elevate safety back at their own cooperatives. The students can also have a real-world experience with energized work in a safe training environment. This system changes the mindset of trainees and is an important and impactful investment in the workers in the field that will pay dividends over time.
With the technology, North Carolina’s electric cooperatives have elevated training to closely mirror a real-world environment. The goal is to provide value to all training in an effort to raise the lineworkers’ knowledge and skill levels and enhance safety across cooperative systems. The implementation of this project supports this mission.
Farris Leonard (firstname.lastname@example.org) is the director of job training and safety field services at the North Carolina’s Electric Cooperatives in Raleigh, North Carolina. He manages job training and coordinates safety programs.
Ask any Black woman about that study that dropped last month and she'll likely know what you're talking about. On October 17, new research from the National Institute of Health (NIH) came out linking hair relaxer use to increased rates of uterine cancer. The report followed 33,497 diverse women in the U.S. aged 35 to 74 for nearly 11 years and found that women who "frequently" use hair straightening products (defined as more than four times a year) were more than twice as likely to develop uterine cancer. Approximately 60 percent of the participants who reported using straighteners self-identified as Black women, and "although the study did not find that the relationship between straightener use and uterine cancer incidence was different by race, the adverse health effects may be greater for Black women due to higher prevalence of use."
The news made its way from the headlines onto Twitter and TikTok feeds and into many group chats, reigniting calls for Black women to ditch the chemicals and go natural for the sake of our health. But unfortunately, the quest to avoid harmful ingredients isn't as simple as just "embracing" our curls.
Black women are held to an impossible beauty standard (it's worth noting that hair-based discrimination is still legal in 31 states), and are expected to meet that standard with products that aren't designed with us in mind—which means piling on more and more products to achieve our desired look. Not only does this keep us tethered to an arsenal of beauty products, but it also heightens our exposure to potentially harmful ingredients—heightening the risk of turning our self-care routines into self-destruction.
In Black culture, whether you wear your hair natural or chemically treated, it must always look on point. We dedicate hours—and tons of products—to twisting, setting, laying, greasing, and wrapping so that no baby hair is out of place and no curl is undefined. "The big picture is that Black women, we use more personal-care products in general," says Heather Woolery-Lloyd, MD, a board-certified dermatologist in Miami. "It's not a roll-out-of-bed culture."
Black Americans spend more on beauty products than any other group. A 2021 study found that while Black people comprise 13 percent of the population, we account for 22 percent of the $42 billion spent on personal care. This all ties back to the ridiculously high standards Black people are held to both by others and ourselves.
"When you talk about beauty as currency for women in general and how complicated that gets for Black women, you understand the importance of trying to look as perfect as you can at all times," says Alese Adams, a 23-year-old beauty enthusiast from Nashville, Tennessee, whose relationship to beauty has been shaped by these pressures. "You're not only criticized for your race, you're criticized for your womanhood, so your looks are criticized twice as hard as everybody else's. There is a lot of pressure to try to look put together at all times."
So a decade ago, when millions of Black women began wearing their natural hair (in a move to step away from Eurocentric beauty standards while cutting down chemical exposure), the drive toward perfection didn't disappear—it shapeshifted. Though sales of hair relaxers marketed to Black women decreased by 40 percent between 2008 and 2015, sales of natural hair styling products increased by 27 percent between 2013 and 2015. And there's nothing "natural" about using half a bottle of conditioner to detangle, then layering on fifty 'leven products to smooth, define, and perfect.
"I felt a huge, huge, huge pressure to make my natural hair as perfectly coiled as I could possibly make it. I have 4C hair—it took everything to get my hair to try to force it to be what I wanted it to be," says Adams. "Having natural hair is so expensive, those products cost so much money, and you have to have five, six different products just to get through one wash day. And you have to use so much of the product to get your hair to be slippery enough to be able to detangle without losing half your head to shedding."
The issue with slathering on so many products is that the more of them you use, the more likely you are to expose yourself to potentially harmful ingredients—and this is especially true for Black women. In 2016, the Environmental Working Group (EWG) assessed almost 1,200 products marketed specifically to Black women and concluded that fewer products made without hazardous ingredients are available for this group; and in 2019, researchers found that the prevalence of endocrine-disrupting chemicals is higher in hair products used by Black women than in products used by white women.
These endocrine-disrupting ingredients were the focus of the NIH study, and according to Dr. Woolery-Lloyd, can bind to and activate hormone receptors, throwing off function and leading to a range of health issues. Phthalates and some parabens (which are commonly found in beauty products, including relaxers) are the most well-known ingredients under the endocrine disruptors umbrella, but they are only a small part of the problem. Even natural oils, like lavender and tea tree, are proven endocrine disruptors, and a small 2018 study linked the use of these oils on baby boys to breast development.
"It's not so clear-cut because, unfortunately, we're exposed to endocrine disruptors in things that we consider 'natural,'" says Dr. Woolery-Lloyd. "Someone who doesn't use a relaxer but puts 16 products on her hair every single day, she's getting a lot of exposure to endocrine disruptors too...it's not like she's safe."
It's also worth noting that potentially harmful ingredients can be even more harmful when they're found in hair products (than, say, in skin- or body-care products) because your scalp tends to absorb chemicals more easily than other areas of skin. Your hair routine shouldn't need to involve tons of different creams, oils, mousses, and sprays. (Not only is that expensive and potentially harmful on a hormonal level, but product overload can clog the scalp, creating an unhealthy environment that makes it difficult for your hair to truly thrive.)
"[As Black women], we're constantly covering our hair, scalp, and body with products that have endocrine-disrupting chemicals," says Dr. Woolery-Lloyd. "This study showed a higher rate of uterine cancer with relaxer use, but there are studies that have shown a higher rate of early periods with hair oil use. There's another study that shows a higher rate of breast cancer with hair dye use. I don't know if it's specific to relaxers—it's unique to all of the chemicals that we put on our skin and hair."
Though there's a mounting pile of research confirming that Black women are being put at risk by their beauty products (just look at the half-dozen examples linked above), we still don't have the full picture. Yes, hair relaxers have the potential to disrupt your hormones, but so do hair dyes and natural oils, and there isn't concrete evidence to show that one is better or worse than the others. Researchers still can't say for sure which ingredients are safe, which are not, and what levels of exposure constitute as harmful—which can make things confusing for anyone trying to figure out how to safely style their hair.
"I wish I could have more black-and-white answers for you but I don't. What I can tell you is that overall, Black women use more products that can influence hormones," says Dr. Woolery-Lloyd. "All of the stuff that we use is not well-regulated, and we need to do a lot of research to figure out what is safe and what we can avoid."
Even the NIH report doesn't deliver us clear results: The survey the report was based on asked how frequently respondents used "straighteners, relaxers, or pressing products," and it's unclear how many of the women were using chemical relaxers versus straightening their hair with heat; and each of the women enrolled in the study had a sister with breast cancer, which (though rare) could mean that they have a predisposition to certain types of cancer, including uterine cancer. And though relaxers can increase your risk of uterine cancer, your overall risk of contracting the disease is still relatively low: According to the NIH study, 1.64 percent of women who never used hair straighteners develop uterine cancer by age 70, compared to 4.05 percent of women who use them frequently. “This doubling rate is concerning. However, it is important to put this information into context: uterine cancer is a relatively rare type of cancer," said Alexandra White, Ph.D., head of the NIEHS Environment and Cancer Epidemiology group and lead author on the new study.
We've barely scratched the surface when it comes to understanding how beauty products impact our health, but the one thing we know for sure is that we need safer, more efficacious products. If Black women can achieve their desired styles by using less, it will lower their exposure, plain and simple. "There's an opportunity there for products that are a little more versatile," says Dr. Woolery-Lloyd. "We'll see a shift to minimalism with hair care where Black women won't need these six-step hair-care regimens."
In the past year, we've started to see strides being made in this direction. Increased funding to textured-hair research and Black-founded beauty brands has allowed for better product formulation. Plus, standards are shifting. The Crown Act has made hair-based discrimination in 19 states (with proposed legislation filed in 25 more), and we're seeing more Black women breaking the mold with minimalist natural hair routines gaining traction on TikTok.
And for what it's worth, Adams went back to a relaxer two days after the NIH study went viral. "I did what I could do to make me feel better about myself. Not that I feel like I look prettier straight-haired—that's not the case. But I just appreciate having something that's easier to manage," she says. "Being a Black person in America, everything I do is a risk. So at the least, I wanna enjoy my crown."
Many of us know lube to be the gel-like substance you can buy over the counter to help alleviate discomfort and even enhance pleasure during sex. And that’s just what it’s designed for—to increase lubrication, reduce vaginal dryness, and make sex more enjoyably for both partners (or by yourself if you're engaging is solo play!).
The trouble with lube, however, is that the majority of over-the-counter brands are typically toxic to sperm. In fact, research—including one study published in the journal PLoS One back in 2019—has shown that most lubes contain chemicals that can significantly reduce sperm motility, or the ability of sperm to move in the way they need to in order to successfully reach and fertilize an egg.
These same ingredients can also impact hormone balance, warns fertility-focused naturopathic doctor Rachel Corradetti-Sargeant, ND. These ingredients can also change the vagina's pH balance, which "can disrupt the flora found within the vagina, making it more common to have yeast infections, which can pass back and forth between partners and impact implantation,” she says.
While most fertility doctors, like Mark Trolice, MD, certainly recommend a lubricant for any couple experiencing painful intercourse (also known as dyspareunia), or folks who simply prefer to incorporate lube in their routine because they like how it feels, they do warn that some over-the-counter products have the potential to hinder your ability to conceive.
If you're trying to conceive, it’s smart to opt for a lube that won’t negatively affect your efforts to get pregnant. The first ingredient to avoid is parabens, or endocrine-disrupting chemicals found in many common lubricants, even fertility-safe options.
“Parabens are endocrine-disrupting chemicals that can impact hormone function and worsen hormonal disorders,” says Dr. Corradetti. She also warns against lubricants with marketing claims such as “warming,” “tingling” or “sensitivity,” as these have also been shown to contain ingredients that negatively impact the motility of sperm.
Allison Rodgers, MD, reproductive endocrinologist at Fertility Centers of Illinois, recommends seeking out a lube that has the “fertility-friendly” seal, which can identify lubrication with a neutral PH and osmolality that is less toxic to sperm.
Pre-Seed Fertility Lubricant — $19.00
Of all lubes on the market, this is probably the best known brand for couples trying to conceive. It was invented by a scientist who dedicated her life’s work to understanding the physiology of sperm. What’s more: One study published in the Journal of Assisted Reproduction and Genetics, which analyzed eight different lubes and their impacts on conception, found that Pre-Seed® to have the highest success rate.
Conceive Plus Fertility Lubricant — $20.00
This lube meets the FDA “fertility-friendly” designation, notes Natalie Stentz, M.D., double board certified OB/GYN and fertility specialist—and Dr. Corradetti agrees that it’s one of the safest from the perspective of vitality of the sperm. It was developed by Harvard fertility pros with the goal of helping couples get pregnant without the discomfort. It’s pH balanced to mimic cervical mucus, which helps the sperm reach the egg.
Good Clean Love Biogenesis Formula — $17.00
This is Dr. Corradetti’s top recommendation for lube for her fertility patients. “It is safe for sperm, friendly to vaginas and also contains clean ingredients—no parabens, petrochemicals or glycerin,” she says. It also helps maintain an optimal pH level in the vagina that won’t negatively impact sperm. It’s both water-based and gynecologist-tested.
Natalist The Lube — $23.00
This fertility supplement brand has risen the ranks of TTC products, which prioritize high-quality ingredients that don’t pose harm to either partner during the journey to conception. It’s FDA-cleared and helps mimic the natural texture of cervical mucus. It’s also paraben-free and comes in single packages so that it’s a clean use each time.
Lola Fertility Friendly Water-Based Lubricant — $20.00
Here’s a water-based lube that is pH-balanced for optimal sperm and vaginal health that won’t negatively affect your trying-to-conceive efforts. It’s made with natural ingredients—no petrochemicals, glycerin, synthetic colorants or fragrances—and is FDA cleared for reproductive care.
#LubeLife Water-Based Actively Trying Fertility Lubricant — $14.00
#LubeLife is known for its highly rated and reviewed original formula, but it also offers a water-based TTC lubricant that’s fertility-friendly. Aside from being safe for sperm, the formula is totally vegan and free of parabens, glycerin, silicone, gluten, and hormones. It’s also toy-safe, and cleans up easily. Folks like this lube most for its consistency, which feels really natural.
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By the time Talya Vexler got pregnant at 39, she and her husband of ten years reckoned that they were prepared, financially and emotionally, to do this parenting thing right. “We were so committed,” says Vexler. “We were not going to be those tired, stressed parents who can’t handle their stuff.” She meant the small stuff – they wouldn’t flood their “nice adult life with plastic crap”. But she also meant the large stuff: they wouldn’t fall to pieces under the pressure of one, seven-pound human.
Vexler runs a gymnastics centre in Amherst, Massachusetts, and her husband works in banking. They consider themselves discerning but not particularly materialistic. Yet as her belly expanded, Vexler soon found herself deep in a ritual of modern parenthood: the online scroll. What was the best nappy? Bottle? Stroller? Swaddle? Suddenly, there were car-seat safety ratings to cross-reference and non-toxic detergents to read up on.
As a steady stream of boxes bearing all the “necessities” piled up in Vexler’s nursery, one purchase eluded her: an appropriate vessel for her impending arrival to sleep in. The search for the perfect cot threw up warnings about flame retardants, polyurethane foam, perfluorinated compounds and other possible dangers that loomed ever larger as she went down the rabbit hole of “all-natural” baby product websites. “Wait, a crib mattress is going to off-gas onto my baby,” she thought, growing increasingly frantic.
A few months before her son was due in 2019, Vexler splurged on an eco-certified bassinet. When it arrived, however, there was a large warning label in the precise place where she’d soon be glancing every time she looked at her precious bundle: “DO NOT LEAVE INFANT UNATTENDED”, it read, followed by a list of potential disasters. It might as well have screamed: “YOUR BABY COULD DIE IN HERE!” She snipped out the label with scissors. That didn’t help. Little by little, Vexler was becoming someone unfamiliar to herself. “I was absolutely terrified,” she said. “You make yourself crazy.”
Vexler found the answer to her mounting anxiety, or at least an answer, when she spotted the Snoo Smart Sleeper Bassinet online. Its inventor, paediatrician-turned-parenting guru Harvey Karp, billed it as “the safest bassinet ever made”. The price tag would have made most parents flinch: it’s now $1,695 to buy and $159 a month to rent (or $99 if you sign up for six months).
From the outside, the Snoo is an achingly tasteful piece of nursery decor – a sleek, cream-coloured bassinet, trimmed in wood and perched on mid-century-modern hairpin legs. But the real value of the Snoo to the new parent is the tech hidden inside. Sensors detect when its tiny occupant wakes and automatically turn on gentle vibration, oscillation and white noise, delivering swaddle, shush and swing – three techniques Karp used to usher infants back to dreamland in his bestselling book of 20 years ago, “Happiest Baby on the Block”.
The Snoo combines the AI know-how of MIT’s Social Machines lab with the aesthetic sensibility of one of America’s best-known product designers – all funded with seed money from Hollywood mums Jessica Biel, Gwyneth Paltrow and Scarlett Johansson. As a feat of design and a telling artefact of modern life, the world’s first child-care robot sits in the permanent collections of both the Victoria & Albert museum in London and the Cooper Hewitt in New York. It has made cameo appearances on “Grey’s Anatomy” and staked a spot beside Serena Williams’s super-king bed on “Being Serena”, the tennis star’s docu-series about pregnancy and early motherhood.
To the anxious new mum, the warning tag in her baby’s bassinet might as well have screamed: “ Your baby could die in here!”
Karp pitches the Snoo as a solution to countless ills, from the modern-day absence of the extended family to post-partum mood disorders. Before the pandemic, 15-20% of pregnant women and new mothers in America reported experiencing depression and anxiety. These numbers appear to have risen substantially since then. A study released in late 2020 found that more than a third of pre- and post-partum women in America suffered from depression. And the psychiatrists and other maternal experts I spoke to believe that a subclinical level of anxiety is also more common than ever, fuelled by online overshare about the horrors of new motherhood, consumer marketing that peddles a risk-free world and real existential threats to future generations: the pandemic, global warming, school shootings.
Of all the claims Karp makes about his wonder-cot, the greatest is about its safety. Unlike the warning label that spooked Vexler, Karp talks as if your baby cannot die in the Snoo. The unanticipated death of an otherwise healthy-seeming child under one – commonly called SIDS, Sudden Infant Death Syndrome – occupies a special rung on the hierarchy of parental anxieties. That isn’t just because it is the very worst thing that can happen. It’s also a disaster that parents often feel they can prevent – as long as they follow the rules, that is, as long as they do everything right.
According to the American Academy of Paediatrics, a trade body, the most important aspect of doing it right means putting your baby to sleep on their back in an empty crib. That sounds simple. And, for some infants, it is. But many babies sleep more soundly, and longer, on their stomach or side; being on their backs can mean no sleep, or that sleep is far more interrupted, without major input from an adult to feed, shush or rock them. Consider that a three-month-old needs 14-17 hours of sleep a day: if yours can’t do so in the recommended position, the whole household can be plunged into misery.
Enter the Snoo’s trademarked swaddle: the Snoo Sack. The zip-up pod has soft bands inside that, when pulled around the child and velcroed together, hold their arms in place. Flaps clip the baby into the edges of the bed to keep them secured on their back at all times. In short, it works like a miniature straightjacket.
Karp says that if there were a Snoo in the bedroom of every family, you could virtually eliminate SIDS, formally known as Sudden Unexplained Infant Death (SUID). To this end, he frequently mentions that the Food and Drug Administration (FDA), America’s federal health regulator, is on the verge of approving the bed as a medical device to prevent the syndrome.
It might seem almost reckless to ignore such a promise, especially in this age of high parental anxiety – driven ever higher, it often seems, by exactly the products that offer to calm our worries. Less than 0.1% of babies die of SUID each year in America. It’s a small number, but that’s still around 3,400 children and 3,400 families whose lives are scarred for ever by loss. But is sudden infant death a risk that parents can buy their way out of? Or is it a medical mystery, more a description of a tragic outcome than anything else – and far more complicated than Karp, or the prevailing public health advice, suggest?
An image of a nursery pops up on the computer screen, its colours bleached to the familiar greyscale of a baby monitor’s electronic eye. The scene is peaceful. Next to an armchair and a cabinet laden with children’s books is a cot. Between its slats, the top of a small head and the curve of narrow shoulders are visible, enough to see that this child is sleeping. She is lying on her stomach, which, since she’s 18 months old, is considered safe. The little girl turns her head once, twice, as if trying to find the most comfortable spot, and then settles.
I’m supposed to be watching the video, but this slight, silent motion of a baby’s head takes me out of this room to the nights my husband and I lay in our own bed studying our own young sons, now five and eight, on the baby monitor. I find myself searching my memory for the exact fuzziness of their heads when they were this size, the scent of their skin. Then Richard Goldstein breaks my reverie.
“There,” Goldstein says suddenly. “That’s it.” Wait, that’s what? I blink at the screen, not wanting to believe what I know I’m being told. Goldstein, a paediatrician at Boston Children’s Hospital, is saying that this small turn of the head – left, then right – is the final movement of this child’s life. As far as I could see, nothing happened. What the hell just happened?
There are references to children dying suddenly in their sleep dating back to the Bible. The condition was first labelled SIDS at a medical conference in 1969; it was nearly 30 years later that the overarching classification was changed to Sudden Unexpected Infant Death. Most people continue to use SIDS to refer to all sleep-related infant deaths, though really it’s a sub-category: among the roughly 3,400 SUID deaths reported in America in 2020, nearly 1,000 were attributed to accidental suffocation or strangulation (being trapped beneath a pillow or some such), 1,000 to “unknown causes” and 1,400 to SIDS.
Death from “unknown causes” sounds identical to SIDS, which by definition is unexplained. The distinction is that SIDS cases have been thoroughly investigated without a cause being determined, whereas “unknown” fatalities haven’t been as closely scrutinised, for whatever reason. There is considerable “blurring among categories”, however, says Sharyn Parks Brown, a senior epidemiologist at the Centres for Disease Control (CDC). In a survey she helped conduct in 2017, several hundred medical examiners across America reviewed identical case information: there was no consensus on which deaths should be ruled SIDS and which ascribed to unknown causes.
When researchers like Goldstein discuss SIDS, they’re talking about children who seem perfectly healthy then die suddenly, at least partly due to an undetected health vulnerability. The baby in the video I watched was older than one, and so was technically a case of Sudden Unexplained Death in Childhood, which is much rarer than SIDS. Goldstein showed it to me because it captured so well what SIDS looks like.
When “normal” infants lose oxygen during sleep – perhaps because their face is pressed against a mattress, causing them to rebreathe their own carbon dioxide – an auto-resuscitation reflex kicks in. They gasp for air, just as an adult would, and their heart pumps harder, to get the oxygen their bodies need. On the rare occasions when SIDS babies have been caught on video, they slip away with devastating stillness: the resuscitation reflex fails completely. It’s why babies can die of SIDS in crowded nurseries, with watchful attendants standing by. It looks like nothing happened.
Why don’t these babies fight for breath? In 2000 Hannah Kinney, now a colleague of Goldstein’s in Boston, discovered something that could explain infants’ difficulty in rousing: a link between SIDS and the regulation of serotonin, a neurotransmitter which plays a key role in mood and sleep, among other things.
Is Sudden Infant Death Syndrome a risk that parents can buy their way out of? Or is it more of a medical mystery than prevailing public health advice suggests?
A standard check-up wouldn’t detect the brain-stem abnormality that could account for off-kilter serotonin levels. Yet that dysregulation is present in about 40% of SIDS infants, Kinney’s work suggests. This is just one of several suspected causes. Researchers are also investigating genetic mutations linked to irregular heartbeat, as well as something called epilepsy-in-situ – when the autopsies of hundreds of SIDS babies were studied, 41% had brain architecture similar to that of epileptics. It’s possible some SIDS deaths are first-time catastrophic seizures.
In May this year the internet lit up when an Australian sleep researcher, who lost her own son to SIDS in the 1990s, announced that sudden infant death would soon “be a thing of the past”. She’d discovered a potential biomarker for the syndrome, an enzyme known as butyrylcholinesterase, which could potentially be detected using a blood test. “Good Morning America” introduced it as a “very, very important study”. It quickly became apparent that the researcher had oversold her findings, however. Within a week the Atlantic magazine had written off the kerfuffle as “a media train wreck”.
Goldstein thinks the Australian finding has potential but is probably only a small piece of the intricate diagnostic puzzle behind any case of sudden infant death. Scientists are nowhere near developing a blood test for butyrylcholinesterase. Yet the flare of excitement the announcement elicited speaks to what many long for: a means to detect the ticking time-bomb.
Though researchers still can’t be sure what causes SIDS, parents – and many paediatricians – have come to believe that they know how to prevent it. In 1994 the American Academy of Paediatrics flipped the accepted wisdom on child sleep, literally, with its landmark Back to Sleep campaign. For decades, parents had been advised to put babies to bed on their stomachs, partly to stop them choking on their own vomit, partly because most children sleep soundly in that position. Overnight, every paediatrician and maternity-ward nurse started telling parents to do the opposite: put babies on their back or side (this was soon revised to only their back) in an empty cot, with no stuffed toys or loose bedding.
Back to Sleep – later rebranded Safe to Sleep – thrust SIDS to the forefront of child-safety issues in the 1990s, as other countries took up similar efforts. In America, Tipper Gore, then-wife of Vice-President Al Gore, was recruited as the campaign’s national spokesperson; parents who called an advice line run by Gerber, a baby-food company, for help with infant feeding would hear Tipper coaching them on the rudiments of safe sleep.
The Safe to Sleep campaign was widely celebrated as a success. By 2000, the number of deaths in America from SUIDs had roughly halved. But since then the figure has barely budged, either in America or in other countries with comparable sleep guidelines.
The American Academy of Paediatrics has continued trying to push the numbers lower by adding to and refining the rules of infant sleep. These days there are countless guidelines for the new parent. Not to co-sleep with your baby (something many cultures have done since time immemorial). Not to drink heavily and not to smoke, either while pregnant or around your infant. To sleep in the same room as the child until they’re six months. To deliver them a dummy (another reversal, since breastfeeding mothers had long been told that a pacifier might make their baby suffer “nipple confusion” and refuse the breast). And to breastfeed where possible, because research indicates that breastfed babies have a lower rate of SIDS (though experts can’t agree on why that might be).
These recommendations are based on the best studies we have, but the science behind them is rarely conclusive – most such advice comes with a string of caveats. Still, the instructions for infant-care keep getting longer. And parents – especially the kind who spend five hours googling a BPA-free, ergonomic sippy cup that won’t interfere with their baby’s breastfeeding latch – keep trying to follow every item on the list.
In 2012 Harvey Karp stood before a roomful of paediatricians in San Francisco delivering a cri de coeur. “If another country were killing 4,000 of our babies every year, we would go to war. We need to do more. This is a solvable problem.” Someone in the audience challenged him: “Well, you’re retired. Why don’t you do something about it?” That night, back in his hotel, Karp did a sketch. The bed he drew was very close to what the Snoo looks like today.
Over Zoom, Karp’s voice has the rounded edges of a kindly doctor with a faint inflection of the New York of his youth. But there is something undeniably Hollywood about his expensive-looking haircut and cobalt-tinted glasses frames, a look befitting the founder and chief executive of a $100m baby-sleep empire. Beyond the 2.3m copies of his “Happiest Baby” and “Happiest Toddler” in circulation, Karp’s company, Happiest Baby Inc, also swaddles the masses: his entry-level product, the $33 Sleepea sleep sack, (which can be used without a Snoo), is sold at retailers like Target.
The Karp I met is a sharp upgrade of the hippyish looking guy who 20 years ago demonstrated the “5S” technique to a group of new parents in the blockbuster “Happiest Baby” video. The clip is captivating: Karp picks up one writhing, red-faced infant after another, does his thing – turns the baby on its side, shushes in its ear, jiggles it just so – and, in a matter of seconds, the child becomes almost eerily silent; eyes zoned out, tiny body loose and placid as a baby Buddha’s. “See that,” he tells the awed, exhausted parents, snapping the fingers of his left hand while still holding their docile infant in his right: “Instantaneous change.”
Listening to Karp talk about the Snoo on Zoom is almost as mesmerising. It was less a conversation than a TED-talk pitch from a medical man used to dropping pearls of wisdom into the laps of stressed new mums and dads. Karp touts the Snoo as allowing tots to sleep “one to two extra hours per night” – though his website advertises that the bed “adds 1-3+ hours of sleep”. The best evidence to support this is a short report that he and two co-authors published in Sleep, a scientific journal, collating data from an app used by over 7,000 Snoo owners, to see how long their babies slept compared with times included in unspecified earlier studies. The report, though not based on an independent, randomly controlled trial, showed that the Snoo babies slept 30 minutes to 1.5 hours longer a night than others.
“If another country were killing 4,000 of our babies every year, we would go to war”
In latest years Emily Oster, an economics professor at Brown University, has become the patron saint of information-craving parents like Tayla Vexler. Oster is the author of several books and a newsletter called ParentData, in which she digs into child-care studies to work out which dangers are real and which parents can ignore. When Oster’s followers started asking about the Snoo, she ran her own “totally unscientific” sleep poll, as she put it, because there were no rigorous studies for her to assess. Among the roughly 6,000 respondents, 60% said it helped their babies sleep and 40% said it didn’t. Some admitted they couldn’t be sure whether the Snoo deserved the credit for their baby’s shut-eye, since it was the only bed their infant had ever known. Oster’s conclusion was that you can get much of what the Snoo does from any swaddle, combined with a $14 white-noise machine. She gave the readers of her newsletter the equivalent of a shrug.
That hesitation reminded me of the experience of a friend, Elise. She raved about the Snoo until earlier this year, when her second daughter was born and, unlike her elder sister, remained squallingly immune to the bed’s comforts. “I think she’s allergic to it,” Elise moaned after another sleepless night.
If Karp had simply billed his bassinet as a luxury item that can help some infants sleep better, the Snoo might still have found success as another trendy sleep aid. But from that first hotel-room sketch his mission has been far loftier. Without irony, Karp compares the invention of the Snoo to the discovery of penicillin. He gently corrected me when I referred to it as a “bed”: it’s “a 24-hour caregiver” that can stand in for “five unpaid nannies”, he said – a reference to relatives who, in times gone by, might have stepped in to help when a new baby arrived.
Karp also contends that the Snoo helps reduce post-partum depression. (Happiest Baby’s publicity rep shared unpublished data from a sleep researcher at the University of Colorado who found that, among 93 Snoo-using mothers with a prior history of depression, rates of the condition were 20-50% lower than reported in other studies.) He also claims that the cot cuts obesity levels in mothers (by reducing sleep deprivation) and in babies (from being overfed to calm fussiness); lowers the incidence of stress-injuries in mothers who have to hold their babies in a particular way to soothe them; curtails middle-of-the-night trips to the hospital, because parents think there must be something wrong with a baby who won’t stop crying; and eases marital strife – even, potentially, child abuse – because the sound of a wailing infant is a form of torture. (Karp often mentions that the US Special Forces, as part of their training, have to endure sleep deprivation while the sound of a baby bawling is played over a loudspeaker.)
The way Karp states these beliefs, it’s as though they’re established fact rather than what they are – preliminary data or extrapolations of existing studies, some completely unrelated to the Snoo, and, in certain instances, even unrelated to infants. But what many of his fellow medical professionals find most unsettling are his claims about SUID: Karp says that the Snoo could reduce the incidence of sudden, unexplained infant deaths by a stunning 90%.
When I asked him to explain how he got that figure, he said – unsurprisingly – that the main advantage of the Snoo was keeping babies on their backs and keeping them there longer. Between four and six months, most children become strong enough to flip over, at which point paediatricians recommend releasing them from their swaddles and letting them settle on their stomachs. But Karp says that babies can remain content on their backs in the Snoo for a full six months, the age at which the incidence of SIDS drops significantly. “That right there – that’s 50% of infant sleep deaths, just keeping them on the back,” he told me. Eliminating bulky bedding and keeping babies happier in the crib lessens the likelihood of co-sleeping because frazzled parents are tempted to pull fussy kids into bed with them, he says. By doing that, “you reduce another 40% of sleep death”, Karp went on.
There is, in fact, no way to add up the various statistics about the sleeping conditions associated with SIDS and arrive at these sweeping figures. Later, via email, Karp seemed to acknowledge this by adding a new word to his claim: hope. “Our hope is that the Snoo may reduce SIDS and SUID by as much as 90%. Not fully proven yet.” But the first time Karp volunteered these numbers, he did so with an air of consummate certainty, and finished by brushing his palms together briskly. The gesture was like his finger-snap in the “Happiest Baby” video: all done, see how simple that was?
Giving the Snoo a further sheen of medical legitimacy, Karp said that it is “brick-to-forehead obvious” that the FDA will approve it. He’s been talking this way since the agency deemed it a “breakthrough device” in January 2020. That classification means, however, only that the product-makers claim that what they’re selling provides “more effective” treatment – not that its success at doing so has been proved. The FDA has tagged 657 products as breakthrough devices over the past seven years, but has so far approved only 44 of them. The agency does not comment on pending reviews, and Karp would not say what research he has submitted to support his application.
One reason Karp focuses on FDA clearance is that it could mean government health insurance would help poorer people buy the Snoo. And broad insurance coverage would be crucial, because the families least able to afford a $1,695 crib are those whose infants are most likely to die of SIDS. Babies whose mothers are young, single and less educated – factors often associated with lower incomes – are at much higher risk. One of the most comprehensive studies of its kind, a review of all 369 SIDS deaths over 20 years in the English county of Avon, found that children from “deprived socio-economic backgrounds” accounted for three-quarters of all fatalities. The only way Karp’s invention would ever come close to achieving a sweeping reduction in SIDS, therefore, would be if many people got it free.
I mentioned Karp’s vision for securing insurance coverage and thereby eradicating SIDS to Sharyn Parks Brown of the Centres for Disease Control. She paused. “OK,” she began, as if willing herself to be patient. “For the ones who are neediest, it’s still out of reach.” And that isn’t just because government insurers might refuse to pick up the tab.
According to Parks Brown, there is a long history of SIDS prevention programmes distributing safe travel cots to poor families – and their lack of impact can be heartbreaking. “Sometimes, when investigators go to a scene, the Pack ’n Play is still in its packaging, sitting in the corner of the bedroom,” she said. If a mother is forced to bounce from one temporary home to the next, she may have neither the space for a crib nor the means to transport one; setting up a cot isn’t necessarily the first item on her list of priorities.
The day I met Goldstein, I was still in shock from the baby-monitor video when he told me we were running late for what I’d officially come to see: his team’s weekly case review. In 2012 Goldstein and Hannah Kinney founded Robert’s Programme on Sudden Unexpected Death in Paediatrics, named after an infant who died in his sleep. This multidisciplinary group of clinicians and researchers, unique in the SIDS world, investigates individual deaths, both for the sake of science and to try to deliver bereaved families some answers.
When we arrived, case number RP22618 was already cued up on a large screen: this was a two-month-old girl who died last year. She was dropped off for her second day at nursery at 8.30am. At noon a member of staff put her down on her back for a nap in a cot with no pillows or toys. She was wearing a nappy, a cotton onesie and cotton trousers. Two hours later, she was still on her back when staff discovered she wasn’t breathing. Her extremities were already cold.
Karp picks up one writhing infant after another, turns the baby on its side, shushes in its ear, jiggles it just so and, in seconds, the child becomes almost eerily silent
In the weeks before this meeting, Goldstein had spent hours interviewing the child’s family. Other members of staff had combed through her medical records; a genetic counsellor had tracked down the forensic examiner in the baby’s hometown to unearth all available information. Now the group debated the consequence of every shred of data. Was it important that the baby hadn’t put on weight as fast as expected? Did it matter that the mother took medication both for depression and asthma, both of which are known to affect serotonin levels? (They decided not, as both medications are commonplace.) The team scrutinised each limb of a large family tree, too: the uncle with psoriatic arthritis; the paternal grandfather with ulcerative colitis; the young cousin with a developmental delay. Finally, they reviewed the genetics. Robert’s Programme has compiled a list of nearly 300 variants which the team monitors for a correlation to sudden death.
As they spoke, I found myself thinking about the parents. Surely anyone who loses a child to SIDS deserves at least this meticulous a search for answers. Goldstein’s reviews are free, but his programme can handle only 50 or so cases a year; to Goldstein’s chagrin, these are usually families well-off and connected enough to seek out the services of a leading research centre. Only in about 15 of those cases is the team able to identify a probable cause, such as brain architecture associated with epilepsy or a gene variant linked to SIDS. Even then, the most they can offer the devastated family is a strong guess as to what happened.
Goldstein wishes that more people knew that such a meeting, this frustrating quest to find answers, is what SIDS really looks like. Earlier this year, he and Kinney published a paper in the New England Journal of Medicine, along with Alan Guttmacher, former head of the National Institute of Child Health. Even in its academic language, it was something of a call to arms. “Since the 1990s”, they wrote, “the perception of SIDS has shifted from a medical mystery to a sleep accident, and public health campaigns warning about risk factors in the infant-sleep environment have supplanted the search for medical causes.”
“The popular view is that SIDS is something responsible parents can prevent,” Goldstein told me, adding that he struggles to convince even some paediatricians that it’s less clear-cut than that. The syndrome can be ameliorated by putting the baby in the proper position, he believes, but marketing a crib on its ability to eradicate sudden infant death is, at the very least, misleading.
Later he showed me a graph with two lines, one charting the SIDS rate between 1982 and 2012, the other the overall change in infant mortality over the same period. The lines were virtually identical. Goldstein thinks that much of the miraculous-looking decline in SIDS in the 1990s was the result not of back-sleeping and uncluttered cribs but of sweeping improvements in health care: child anti-poverty programmes, enhanced pre-natal care and better intensive-care for newborns.
Again, however, the facts aren’t clear. A study of Danish babies, published in March, showed a sharp drop in SIDS mortality after back-sleeping was introduced without an accompanying decrease in other kinds of infant deaths – pretty much the opposite of the American data Goldstein laid out. (Importantly, the Danish study conditions were better than most: there, nurses make several home visits to new parents, so they could accurately report on sleep practices.)
Of course, no one says safe sleep practices are all that matters. The prevailing “triple-risk theory” attributes SIDS to a convergence of factors: the baby’s vulnerable age, an underlying health problem and an unsafe sleep environment. So putting a baby on her back could deliver her a better chance of surviving a hidden physical predisposition to SIDS – isn’t that right? I asked Goldstein.
Yes, but, answered Goldstein. Here he touched something of a third rail in the SIDS community, showing me a study Kinney co-authored that examined the brain-stems of 72 SUID infants with roughly equal levels of serotonin dysregulation. Some had been found on their backs; some in other positions. Goldstein’s point was that babies with a latent condition can die of SIDS, even if a carer follows exactly the recommended safe-sleep conditions.
Within the past year, Robert’s Programme investigated the case of a baby who died in a Snoo, Goldstein said. He told me this not because the Snoo caused the death, but to caution against accepting an overly neat narrative or buying into a false sense of security. It’s not that he doesn’t think safe-sleep practices should be followed. He “100%” does, he said, adding that they’re the best prevention we have, considering that the physical anomalies that lead to SIDS remain ambiguous and undetectable.
But Goldstein’s stance has been shaped by working on the front line. “A parent whose baby has died from SIDS…They never come out from under it,” he said. And though the cause of the syndrome lies in a Gordian knot of class, genetics, disease and safety measures, the blame always seems to land on the parents: You should have known better. Goldstein shakes his head.
The families least able to afford a $1,695 crib are those whose babies are most likely to die of SIDS
In the conference room, I’d asked Goldstein and his team whether they had any potential answers for what happened to the infant they’d just discussed. “We don’t know why the baby died,” Sanda Alexandrescu, a neuropathologist, told me flatly. I studied their faces – how many times had each of them had to say that in the course of such work?
Later, on the way back to his office, I wondered aloud how Goldstein coped with the constant sense of defeat. Defeat? No way. Didn’t I remember the gene they had discussed for longer than any other, the one they were considering adding to the 300 already on their watchlist? Zeroing in on that gene was progress. This is how they work, in a battle won by increments. Every shred of information gathered, every theory formed, is compiled, added to the menu of possibilities. For them, the maybes and what-ifs are not anxieties. They could provide answers.
I didn’t interview a single medical professional who believed a Snoo was necessary to follow the Safe to Sleep guidelines. Still, did the souped-up bed help parents themselves? Did it make them less anxious about their baby’s safety? The answers I got weren’t as murky as the causes of SIDS – but they weren’t straightforward, either.
Elise, the friend who swore by the Snoo until her second child was born, got pregnant for the first time in 2019. At the urging of Snoo-owning friends, she bought a used model online but soon realised she didn’t know how it worked. That led her to one of several unofficial Snoo support groups thriving on Facebook, where thousands of users swap tips on sleep and safety, and lament or celebrate the nightly sleep reports generated by their Snoo apps.
In this realm, dread of SIDS reigns supreme, and Elise – who experienced “pretty gnarly” post-partum depression and anxiety – found herself pulled into an almost perfect baby-product feedback loop. The posts made her fear SIDS more acutely than ever before and simultaneously reassured her that, by using the Snoo, she was doing the best thing she could to prevent it.
That perception – or illusion – of control, mixed with the “primal fear” of something awful happening to one’s child, can make it easy to tumble into a kind of obsessive worry that is often mistaken for virtue. Megan, who used to work in a paediatric intensive-care unit, was already deeply afraid of SIDS when she got pregnant, haunted by worst-case scenarios she’d witnessed first-hand. To safeguard her newborn son, she told me she relied on both a Snoo and an Owlet sock.
The $300-plus Owlet is arguably the other zeitgeisty baby-safety gadget of latest years, originally marketed for its ability to track an infant’s pulse rate and blood-oxygen level – the latter a potential problem that most parents had never thought to worry about before this high-tech “solution” came along. The idea was that the sock could alert parents to a SIDS crisis in real time. But last year the Owlet’s maker got a wrist-slap from the FDA for making medical claims without clearance. (The sock has since been re-released, without the blood-oxygen component.)
Even with this arsenal of baby safety, Megan found herself tumbling into obsessive-compulsive disorder after her baby was born, plugging and unplugging the light by her child’s bassinet to check the electrical socket, and constantly putting on and removing the crib sheet to ensure it was absolutely smooth and therefore “safe”. The Snoo certainly didn’t save her from anguish, but she thinks she would have been in worse shape without it. When we spoke she had already put a rental Snoo on hold for her second baby, who has since arrived.
And Talya Vexler? She told me that she took some comfort in the belief that her son was secure in the Snoo. But it didn’t get rid of her anxiety. “He was a terrible sleeper, and I pretty much didn’t let the Snoo do its work at all,” she recalled. “Every time he breathed a little differently, we were up.” ■
Maggie Bullock is a writer who lives in Amherst, Massachusetts
PHILADELPHIA — The volunteers were handing out the staples of harm reduction: safe injection and smoking kits, condoms, and Narcan, the opioid overdose reversal medication. Down the line, they were distributing hats, socks, coats, and blankets to the people who use drugs who came to this outreach event on a latest Saturday, a bright, cold morning a few days before Thanksgiving.
Just before the final table, where two mothers who had lost children to overdoses were passing out sandwiches, was evidence of the latest evolution in the increasingly dangerous U.S. drug supply. A wound care station.
“You have any wounds you need looked at?” volunteers asked people as they came through the event, held in this city’s Kensington neighborhood.
“Do I ever,” replied one man.
The spike in wounds among people who use drugs in Philadelphia reflects the surge in the local supply of a compound called xylazine. A veterinary tranquilizer, xylazine, or “tranq,” exploded in latest years to the point that in 2021, it was found in more than 90% of heroin and fentanyl samples. With its ascendance has come a wave of wounds — sometimes called abscesses, lesions, or, in the words of one volunteer nurse here, something that looks like “it’s eating away your flesh from the inside out.” The city saw the number of emergency department visits for skin and soft tissue injuries quadruple between the beginning of 2019 and the end of 2021.
“The wounds, for lack of a better term, are gnarly,” Jen Shinefeld, a field epidemiologist at the city’s health department, told STAT earlier this year.
These are not the same type of wounds that sometimes occur from injecting drugs generally. For one, they are sprouting on skin far from where people inject; there are reports that even people who snort or smoke xylazine-contaminated opioids — what’s called tranq dope — are developing these wounds. While they’re not caused by an infection, the wounds can get infected if they’re not taken care of.
And it’s not just the wounds. Xylazine is complicating overdose responses and withdrawal for people trying to reduce their illicit drug use. A powerful sedative, it can also knock people out for hours, leaving them vulnerable on sidewalks or even in the middle of the street.
The fear is that what’s happening in Philadelphia — and what drug users, harm reduction groups, and medical providers are having to contend with — could be a preview of what’s headed to more places. Already, researchers have found burgeoning prevalences up and down the East Coast, and it’s starting to crop up in Chicago, Texas, and elsewhere. A study earlier this year raised the possibility of xylazine spidering out from the Northeast into markets westward, similar to the pattern illicit fentanyl took as it embedded itself in the drug supply. Researchers caution they can’t predict xylazine’s path or what prevalence it will reach, but warn that a lack of testing for xylazine is limiting detection.
Just last month, the Food and Drug Administration warned about the impact of xylazine as it infiltrates supplies of heroin and fentanyl.
“I’ve been jumping up and down like a maniac for three years trying to get attention on this,” said Sarah Laurel LaCerra, the executive director of Savage Sisters, the harm reduction group that organized the outreach event at McPherson Square Park (sometimes dismissed as “Needle Park”). Even as Savage Sisters has increased how often it’s offering wound care in the community, and Laurel LaCerra has tried to spread the word to politicians and public health leaders and on TikTok, “what we’re doing is a Band-Aid on a bullet hole,” she said.
Or, as one recipient said as he took a sandwich-bag packed with alcohol pads, gauze, and antibiotic ointment from the wound care table, “It’s crazy this stuff, it’s burning through our bodies.”
As experts rush to learn more about xylazine — there’s been minimal study of it in people — advocates are also trying to share the information they do have. Doctors and people who’ve been affected are giving presentations complete with images of gruesome wounds that have taken over people’s limbs, with stretches that have turned black — a sign of necrosis, or dead tissue — and where skin has sloughed off. They’re trading tips for treating wounds, which they stress can be healed, and swapping suggestions for how to help people through xylazine withdrawal.
At the outreach event, Stacy Parisella, a former trauma nurse, was cleaning a wound on the left wrist of 38-year-old Bret. A swollen lump was intruding into Bret’s hand, while at the center of it, a white ring of skin surrounded an open sore. This was actually an improvement. About two weeks ago, Bret said, he had gone to the hospital to get it treated.
In more than a decade of IV drug use, Bret said, he had never had any issues with wounds before, but in the past two years, “that was the second abscess I’ve gone to the hospital for.”
A concern is that people who use drugs — because they are often treated poorly by medical providers — won’t seek help for their wounds until they’ve advanced to a dangerous point. Bret, who lacks housing, said he ultimately went to the hospital because the wound on his wrist had gotten so swollen and painful he couldn’t move his hand. The hospital told him that if he hadn’t come in then, he would have lost his hand, he said.
Parisella told Bret that the wound looked OK for now, but that if the swelling got worse, or if it turned black, he needed to go to the hospital again.
Later that morning, Laurel LaCerra ran down from the park and grabbed Parisella for help. A man was sitting on the grass, with wounds overrunning both his shins. Some skin had turned black. The volunteers cleaned and wrapped the wounds, but suggested to the man he needed more advanced care at a hospital.
He told them he was panic about getting “sick” if he went to the hospital — being unable to use and entering withdrawal — but that he’d consider it.
The takeoff of xylazine in Philadelphia, which began in the mid-2010s, in some ways echoes how the sedative became cemented in the Puerto Rican drug supply in the 2000s. Known as “anestesia de caballo” (horse anesthetic), it introduced similar problems there, but didn’t attract broader attention, said Rafael Torruella, a social psychologist who runs a harm reduction organization called Intercambios. In a 2011 paper, Torruella warned that xylazine “could also emerge as an adulterant in other markets to the levels currently experienced in Puerto Rico.”
“At the time, I wanted more resources for researchers and harm reduction organizations in Puerto Rico to better get to know xylazine and its effects, and we did not get that,” he recalled.
But while xylazine predated the rise of fentanyl and related synthetic opioids in Puerto Rico, it’s been the reverse in the continental U.S. Fentanyl — in addition to being so potent that it’s helped drive the U.S. overdose crisis to record highs — provides a high that doesn’t last as long as the heroin it supplanted. For dealers looking to appeal to customers, xylazine seemed to offer a solution. It gave fentanyl “legs,” making the effect more durable, according to researchers who’ve studied the Philadelphia drug market. Still, many people have reported they don’t like tranq because it leaves them so sedated.
If Philadelphia is the epicenter of tranq dope now, there are signs it’s growing in other places. In North Carolina, for example, researchers and harm reduction groups noticed an increase in skin issues in 2020. At the time, they thought it was a behavioral effect — that a change in how people were using drugs was causing the wounds. But when they analyzed the local supply, they found xylazine, said Nabarun Dasgupta, a pharmacoepidemiologist at the University of North Carolina. It all clicked together.
Increasingly, groups from around the country, disturbed about wounds they’re starting to see, are turning to Dasgupta’s team to test their local drug supply. The analyses typically uncover xylazine in some of a community’s samples, but not all of them.
“It feels like it’s spreading, it definitely looks like it’s spreading,” Dasgupta said. “But there are pockets in the U.S. where we see it much more commonly than others.” He noted, for example, that despite what’s happening in Philadelphia, he’s heard that tranq is not nearly as prevalent in Pittsburgh, for unclear reasons.
Experts and advocates are still trying to understand just how dangerous xylazine is and how it works. There’s some evidence, for example, that it can interfere with people’s blood sugar and blood iron levels in potentially harmful ways.
Experts are not even sure what’s causing the associated wounds. Is xylazine somehow prompting people to pick at their skin? Many researchers believe it’s something to do with how the tranquilizer behaves in the body: Maybe it’s eliciting some errant inflammatory response. Perhaps it’s restricting blood flow so the wounds can’t heal.
But they are also trying to get the word out that these wounds should be treated differently than the infection-driven abscesses that doctors are more accustomed to. In the latter case, surgeons often amputate the digit or limb so that the infection doesn’t spread. But xylazine-related wounds seem able to be healed with proper care, a distinction that Dasgupta said many doctors aren’t aware of yet.
“It’s devastating and heartbreaking,” Dasgupta said about the possibility of people unnecessarily losing limbs.
Researchers are also debating what role xylazine plays in overdoses — essentially, if it makes fentanyl use even riskier. Notably, toxicologists are not seeing people die with just tranq in their systems. It’s almost always accompanied by fentanyl — as well as other substances, from cocaine to alcohol — which means it might still be the fentanyl that’s killing people. Some experts have speculated, however, that xylazine is such a powerful sedative that it could exacerbate the respiratory depression that opioid overdoses cause.
Regardless, xylazine is changing what recovering from overdose looks like. Someone who overdoses on tranq dope might start to breathe again after being given naloxone — which only works for opioids — but will still be passed out from the sedative. Responders unfamiliar with xylazine may reach for another dose of naloxone, but it still won’t wake the person up.
“When it was just fentanyl, it was more straightforward,” said Claire Zagorski, a Ph.D student at the University of Texas and a harm reduction paramedic. With xylazine and other drugs like benzodiazepines being cut into fentanyl, “these kinds of unholy mixtures that bring down the level of consciousness in different ways are really making the overdose response picture tricky.” (Advocates have pointed to xylazine and other contaminants in the drug supply to bolster their argument that the United States should offer people a safe supply of opioids, as Canada does.)
At a training session before the outreach event here in Philadelphia, Laurel LaCerra showed the volunteers how to use Narcan, but she suggested other strategies as well. Besides the naloxone, Savage Sisters has also started giving people who overdose oxygen, a combination the staff think is more effective against tranq dope. They’re teaching people how to roll someone who’s unresponsive but is not suffering from an opioid overdose into the “recovery position” — lying on their side with their head protected, a position that will keep their airway open and circulation flowing.
“This is really important right now with the tranq dope because people will be sedated,” Laurel LaCerra told the volunteers. “They’re not going to be as responsive as they used to be.”
Savage Sisters is also providing people who use drugs with cards they can deliver to medical providers that demand, “Test me for xylazine.” The cards offer suggestions that providers can try to treat the symptoms of xylazine withdrawal, which include anxiety. Whereas there are protocols for easing someone off illicit opioids, there is no such method for xylazine.
Before the volunteers headed out for the outreach event, Laurel LaCerra, who used to use drugs herself, emphasized that the group should not gawk at the people they were there to help.
“The wounds are horrific,” she said. “They are in so much pain.”
This story is part of a series on addiction in 2022, supported by a grant from the National Institute of Health Care Management. Previous articles covered the spike in overdose deaths among Black Americans, the Americans with Disabilities Act’s protection of people with addiction histories, and the debate about “safer supply” programs.
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The holidays are near and "porch pirates" are on the prowl throughout Davenport.
Davenport Police Lt. Dennis Colclasure, head of the criminal investigations unit, this week said that police are dealing, "with a number of cases" of people stealing delivered packages from homeowners.
Colclasure highlighted porch piracy during a brief news conference, offering holiday safety tips to the public.
"There is not one area of Davenport where the thefts are more common," Colclasure added. "It happens all over the city. It is spread out into all kinds of areas.
"Overall, theft is the most common crime we see in the city, and that includes what is called porch piracy."
Simple steps, such as tracking delivery times and dates, installing doorbell or other surveillance cameras, and developing strong communication networks with neighbors, can help reduce the risk of theft from porches, vehicle, garages and homes, Colclasure said.
He also warned against pursuing porch pirates if they are caught in the act.
"We are talking about people desperate enough to walk up on someone's porch to take a package," he said. "You simply don't know just how desperate people will be.
"We strongly advise people to be good witnesses. Be able to describe the person, describe which direction they went, or the kind of vehicle they left in."
Colclasure also encouraged people to "be good neighbors."
"Open up lines of communication with the people who live around you," he urged. "Neighbors know who belongs in the neighborhood and who doesn't. Being a good neighbor and having good neighbors can prevent a lot of crimes."
He offered more tips to prevent thefts, such as warning people leaving for vacations or other trips against advertising their absence on social media. He also emphasized the need to pay attention to one's surroundings while shopping.
"Don't leave packages or purses in cars, even locked cars," he said. "Just as people cruise neighborhoods looking for packages, they cruise parking lots looking into cars.
"Don't leave packages where others can see them. That includes your home as well as your car."
Colclasure reiterated another frequent warning that police records suggest is not being heeded: "Please don't leave keys in your vehicles, even if they are in a locked garage," he said. "Please don't leave your car running.
"Car theft is still a big part of the theft problem. It is still an issue. Keep your car safe."
Knoxville Fire offers safety tips in regard to heat-producing appliances to prevent house fires this winter.
KNOXVILLE, Tenn. — The Knoxville Fire Department provided some tips to help keep homes warm and safe this winter.
Space heaters are often the cause of house fires during the colder months, but there has been a slight decrease this month due to warmer temperatures, according to KFD.
Assistant Chief Mark Wilbanks said that the number one tip he can offer to stay safe is to have working smoke alarms and to make sure they are tested once a month. He also suggests having working carbon monoxide alarms if you use propane or natural gas in your home.
Wilbanks said that safety is very important when it comes to heating devices.
"Heater safety is very important," Wilbanks said in an email. "Keep heating devices at least 3 feet away from combustible materials. Do not use extension cords on portable heaters."
Wilbanks also went on to say that portable heaters need to be plugged directly into the wall.
If you use a fireplace, Wilbanks suggests having them inspected and cleaned regularly.
Candles also happen to be a cause for fires in the winter, so KFD suggests that you never leave one burning unattended or sleep with one lit.
According to the Federal Emergency Management Agency, anything that can burn needs to be at least 3 feet away from the heat source. The agency also suggests that you keep portable generators outside and away from windows as well as keep cooled ashes in a metal container and stored outside.
Most house fires caused by home heating appliances occur from December until February and around one out of every seven fires are caused by some sort of heating device.