Advance care planning Archive

With summer's approach come plans for travel, including flying long distances. But the prospect of a long flight often raises health concerns. Especially in passengers who are older or have certain conditions, air travel and the related stress can have an impact on health. Here are a few trouble areas and some precautions you can take.

Deep-vein thrombosis (DVT). Not all experts agree on an association between DVT (blood clots in the legs) and air travel. Symptoms may not occur for several days, so it's difficult to establish a cause-and-effect relationship. If there is one, it's likely due to prolonged inactivity. Limited airline space can discourage moving about. Dry cabin air may also increase the risk of DVT.

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Figuring out all the factors that can affect your vitamin D level is complicated. Your body makes vitamin D when sunlight hits the skin. You can also get the vitamin from food (mainly because it's been added; few foods are natural sources of vitamin D) or by taking a supplement.

The process by which the body makes vitamin D is complex. It starts when the skin absorbs rays in the invisible ultraviolet B (UVB) part of the light spectrum. The liver and the kidneys also participate to make a form of the vitamin that the body can use.

On call

Q. My knees have been cracking for a long time, but lately I've noticed my ankles and elbows sometimes crack and pop. Is this a sign of early arthritis?

A. The good news is that the usual painless joint cracking or popping does not represent an early form of arthritis, nor does it cause joint damage (despite what our mothers told us about cracking our knuckles). The cracking sound appears to come from tendons or muscles moving over the joint or from the popping of nitrogen bubbles normally found in the joint space.

Excess weight carries health risks. But how much is too much?

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The idea that someone can be "fat and fit" — that is, overweight but still healthy — has been around for some time. But don't be fooled.

"The latest science is quite clear that excess weight can carry considerable health risks, including a higher risk for heart attack and stroke," says Dr. Jorge Plutzky, director of preventive cardiology at Harvard-affiliated Brigham and Women's Hospital. "While there is no one-size-fits-all number when it comes to a person's ideal weight, men should not ignore significant weight gain and the implications it has for their future health."

Intestinal infection known as C. diff can spread through spores and cause diarrhea

Why would you get an intestinal infection, like C. diff, from treating a different illness with antibiotics?

When you're admitted to a hospital, you expect to receive tests and treatments that will make you feel better. When you get antibiotics in the hospital, you expect that the drugs will treat or prevent infection. But it doesn't always work that way. A distressing number of patients acquire infections while they are in the hospital. And antibiotic therapy can actually increase the odds of coming down with a hospital-acquired infection, particularly when the cause is a bacterium named Clostridium difficile. Although doctors are working hard to control intestinal infections caused by the bug commonly (if not fondly) known as C. diff, the problem is rapidly becoming more common, more serious, and harder to treat.

The nutrient appears to have modest prevention power.

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Vitamin C is often touted as a natural cold remedy. The nutrient is featured in supplements promising to boost the immune system. Nobel laureate Dr. Linus Pauling famously claimed that taking large doses of vitamin C helps thwart a cold. Is there something to these claims? "The data show that vitamin C is only marginally beneficial when it comes to the common cold," says Dr. Bruce Bistrian, chief of clinical nutrition at Harvard-affiliated Beth Israel Deaconess Medical Center.

About vitamin C

Our bodies don't make vitamin C, but we need it for immune function, bone structure, iron absorption, and healthy skin. We get vitamin C from our diet, usually in citrus fruits, strawberries, green vegetables, and tomatoes. The Recommended Dietary Allowance for men is 90 milligrams (mg) per day, and for women, it's 75 mg per day.

Fear of catching COVID-19 may keep you away from doctors' offices and emergency rooms. Will that hurt or help your health?

For many people, it's a daily debate: Do you risk getting COVID-19 by venturing outside your home and being around others — even if you wear a mask, observe social distancing, and use hand sanitizer? Or do you play it safe and stay inside? The answer is complicated, especially when the reason for leaving home is health-related.

People are understandably concerned about catching COVID while making a medical visit. But avoiding medical treatment because of this kind of thinking can be dangerous, and it appears to be taking a deadly toll.

Put the focus on food quality and healthy lifestyle practices to attain a healthy weight.

Most people have been taught that losing weight is a matter of simple math. Cut calories — specifically 3,500 calories, and you'll lose a pound. But as it turns out, experts are learning that this decades-old strategy is actually pretty misguided.

"This idea of 'a calorie in and a calorie out' when it comes to weight loss is not only antiquated, it's just wrong," says Dr. Fatima Cody Stanford, an obesity specialist and assistant professor of medicine and pediatrics at Harvard Medical School.

Switch the type of walking in your routine to stay motivated and active.

Putting one foot in front of the other is a simple way to trigger a cascade of health benefits. Regular brisk walks help lower LDL (bad) cholesterol; control blood sugar; and reduce the risk for high blood pressure, heart disease, stroke, and diabetes. Brisk walks also strengthen muscles, burn calories, and lift mood.

Just one problem: some people find walking boring. Boredom may diminish your motivation and interest in exercising. Before that happens, mix up your regimen with different types of walking that maximize physical, mental, and emotional health benefits.

We don't yet have a vaccine to prevent COVID-19, but it's still important to get your regularly scheduled shots.

You're not alone if you're avoiding doctor visits because of concerns about COVID-19. But forgoing medical care means you may be skipping needed vaccinations. "That's a huge problem already. Possibly over a hundred million people the world over have missed their vaccinations because of the pandemic," says Dr. Shiv Pillai, an immunologist and professor of medicine at Harvard Medical School.

Going without vaccinations may increase your risk for illness, such as influenza. "We still are just as vulnerable to infection, and we need vaccines to be protected; COVID-19 doesn't change that," says Harvard Health Letter editor in chief Dr. Anthony Komaroff.