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By Matt McMillen
WebMD Health News

Reviewed by Hansa D. Bhargava, MD

May 21, 2015 -- Some call it "$5 Insanity."

Flakka, a new designer drug, is surging in popularity. Poison control centers in states including Florida, Alabama, Mississippi, and Texas are responding to an increasing number of incidents involving it.

Here's what you need to know:

What is flakka?

It's a man-made stimulant called an alphaPVP. It's similar to "bath salts," another dangerous drug that's grabbed headlines in recent years.

Its off-white, coarse crystals sell for as little as $5 a hit. The name comes from la flaca, a Spanish club-slang term for a sexy, skinny girl.

"It looks like aquarium gravel," says Alfred Aleguas, PharmD, managing director of the Florida Poison Information Center, Tampa.

How is it used?

People have tried taking it in a number of ways, says Jeffrey Bernstein, MD, medical director of the Florida Poison Information Center, Miami.

Those ways include:

SnortingMixing with foodDrinking like a teaPressing into pill formInserting it into the rectumVaping in an e-cigaretteInjecting

"With injecting, you're really asking for trouble, because the drug is likely to be cut with ... dirt, with talc, who knows what else -- and you're putting all that in your veins," Bernstein says.

How does it work on the brain?

Users feel a sense of euphoria, Bernstein says. "It plays with your neurotransmitters, [brain chemicals] like dopamine and serotonin."

That can lead to a state called excited or agitated delirium in a high that lasts for several hours.

What are the risks?

People who are high on flakka often lose touch with reality, Aleguas says.

"They don't know what they're doing, they're hallucinating, they're paranoid, they're aggressive, they're super-agitated," he says. "That's why you see news stories of people running down the street naked, banging on cars in traffic and just crazy, crazy stuff."

Other health effects that Aleguas and Bernstein often see include:

Rapid or irregular heartbeatHigher blood pressureSeizures

Another dangerous effect is hyperthermia, or elevated body temperature, which Bernstein says can reach 108 degrees. At that temperature, he says, blood can no longer clot and a person starts to bleed internally.

"They bleed and they go into multi-organ failure," he says. "Lung, liver, kidney, and brain injury can each occur when their temperature stays too high for too long."

In an emergency room, doctors attempt to cool the person, to calm them. They may also use diazepam, midazolam, or another similar drug to slow a user's heartbeat.

"We give them symptomatic and supportive care, try to keep them from hurting themselves and hospital staff," he says.

Who's using flakka?

Bernstein says most users are male and in their teens, 20s, or 30s, although some are older.

"I haven't seen any regular users," he says. "It tends to be used sporadically and is associated with concerts and parties and things like that."

And those users don't always know what they're getting, says Bernstein, who gets a call about flakka every day, and more on the weekends. About one-third of calls are from users looking for help, he says, while the others are from emergency personnel caring for users and looking for guidance.

"There's no quality control on the street, so no one knows for sure what they're taking," he says. "Just because they bought something called flakka, no one knows if that's really what they used, much less what kind of concentration you're getting. It's an unknown drug at an unknown dose, and any dose is abuse."

SOURCES: Alfred Aleguas, BS Pharm, PharmD, D.ABAT, managing director, Florida Poison Information Center, Tampa, FL. Jeffrey Bernstein, MD, medical director, Florida Poison Information Center, Miami.

©2015 WebMD, LLC. All Rights Reserved.

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7 Crazy Stories About Twins That Will Have You Asking “What the F*ck?” Get ready to slide down a Google rabbit hole. Shutterstock

If it seems like twins are everywhere these days, it’s because they actually are. According to the Centers for Disease Control and Prevention, the twin birth rate rose 76 percent from 1980 through 2009, and one in every 30 babies born in 2009 (the most recent year data was collected) was a twin. 

Why are there so many twins lately? There are a lot of factors at play, says Lawrence Prince, M.D., Ph.D., division chief of neonatology at Rady Children's Hospital in San Diego and associate professor of pediatrics at University of California, San Diego. He cites in vitro fertilization (IVF) and genetics among the reasons. Research has also found that obese women, those who are taller, and women who wait until later in life to get pregnant actually have increased odds of having multiples, says reproductive geneticist and ob-gyn Susan Klugman, M.D., a representative of the American College of Medical Genetics and Genomics.

With any birth and new baby, unusual things can happen—but it seems like it happens more often with twins.

RELATED: 9 Things Only Women Who Have a Twin Understand

“There are a variety of interesting situations that can arise with twins,” says Prince. “All twin and multiple gestations are more likely to have certain birth defects and complications. Some are unique to non-identical twins, and some only occur in the instances of identical twins.”

He’s not exaggerating—there have been some very bizarre twin stories that have cropped up lately. We got Prince, Klugman, and twins expert Nancy Segal, Ph.D., director of the Twin Studies Center at California State University, Fullerton, to rank these headline-grabbing twin stories from most likely to happen to super rare, plus how they might have happened:

The Twins That Were Born with Two Different Skin Colors
People often do a double-take when they hear that Lucy and Maria Aylmer are fraternal twins. Why? They have different skin colors. “No one ever believes we are twins because I am white and Maria is black,” said Lucy, who has red hair and fair skin, in an interview with Barcroft Media. “Even when we dress alike, we still don’t even look like sisters, let alone twins.”

This is rare but is becoming more common now that biracial marriages are more prevalent, says Segal. “It’s not surprising, especially if the parents have very distinct genetic backgrounds,” says Prince, who explains that this can only happen with fraternal twins, and obviously, that it can only happens with parents who have different skin colors. It's basically the same as any other kid a biracial couple would have, he says, since fraternal twins have two different eggs and sperm. It's just like parents with different eye and hair colors having children with different traits.

The Twins Who Were Conjoined and Shared Their Chest, Abdomen, and Intestinal Tract
Twin boys Carter and Connor Mirabel were successfully separated via surgery in early May when they were five months old, the New York Daily News reports.

Conjoined twins happen when the fertilized egg divides later than usual during development in utero, and it doesn’t happen often. “It’s not common, which is fortunate,” says Prince, adding that roughtly one in every 200,000 identical twin births are conjoined.

The Twins Who Had Two Different Fathers
A woman in New Jersey found out that her twins were fathered by two different men during a paternity case. During the testimony, she admitted to sleeping with a man who was different from her partner a week after she thought she conceived the twins, the New York Times reports.

Segal says this is “supposedly rare, but my guess is it occurs more often that we think” since we only know about the cases that are discovered. (Hey, there are plenty of women who cheat on their partners and don’t ‘fess up.)

This can happen when a mom releases two different eggs at the same time, says Prince, and he cites estimates that say about two percent of twins have different fathers.

RELATED: This Couple Didn't Tell Anyone They Were Having Twins Until the Babies Were Born

The Twin Sisters Who Both Got Pregnant with Sets of Twins
Fraternal twin sisters Ashlee Spinks and Andrea Springer both gave birth to twin boys on the same day in Georgia. What?

“It’s a blessing,” said Springer in an interview with the Associated Press. “It’s hard enough for a lot of people to get pregnant, especially pregnant with twins.”

She’s right…sort of. The odds of twins giving birth to twins on the same day is almost unheard of, but it’s not unusual for twins to give birth to other twins, says Prince. “The chance of a mom having non-identical twins seems to run in families,” he says. (The genetic history of the dad, interestingly, doesn’t come into play, though.)

 

 

Mommy is feeling good after the c-section! All 4 babies have dark hair!! ♥️♥️♥️♥️

Posted by A Miracle Unfolding-Gardner Quadruplets on Sunday, December 28, 2014

 

The Woman Who Had IVF and Delivered Two Sets of Twins
A woman in Utah gave birth to two sets of identical twins last year. Yup, that’s four babies at once, and half of them look like the other. Ashley Gardner became pregnant with the help of IVF and was on bed rest for a month leading up to the births, says CNN.

While Prince admits he’s never heard of this happening before, he says that “all bets are off with IVF.”

RELATED: This Woman Didn’t Know She Was Pregnant—BOTH TIMES

Corpus Christie Medical Center

The Woman Who Gave Birth to Identical Triplets, Two of Them Conjoined
Sylvia Hernandez gave birth to identical triplet girls this month in Texas, which the Washington Post reports, happens in one in 50 million births. Even more rare: Two of the triplets are conjoined.

Prince points out that conjoined babies only occur with identical multiples. He says it implies that there was an earlier split of the egg and then a later split that didn’t fully separate. But, as he says, this is a rarity on top of another rarity.

The Woman Who Had Two Wombs—and Got Pregnant with a Set of Twins in One and Another Baby in the Other
British woman Hannah Kersey gave birth to twins and another baby at the same time—and carried them in two different wombs. The 23-year-old is believed to be the first woman in the world with uterus didelphys (i.e., having two wombs) to give birth to triplets, BBC News reports. 

Prince calls this “extremely rare,” especially since it can be difficult for women with uterus didelphys to carry twins to full term in the first place.

Twins run in your family? Don’t freak out: Klugman stresses that all of these situations are extremely unlikely.

7 Things No One Tells You About Going Paleo Everything one writer learned after eating caveman-style for Lent Shutterstock

I’d had a severe case of the blahs for a few months. My insomnia was getting worse, every month I got a pimple in the same spot smack-dab in the middle of my left cheek, and those last five pounds I wanted to lose had slowly turned into those last 10 pounds I wanted to lose. Overall, I felt gross, and I needed to do something drastic to break out of my slump. But what?

In search of inspiration, I turned to the source of all my recent life decisions: Pinterest. I scrolled past the myriad “ways to be a thrifty country bride” pins and found a link to a 30-day Paleo challenge.

I’d heard that Paleo meant eating like a T-Rex or something, but that was the extent of my knowledge. The blog included recipes and exercise videos, though, and seemed fairly easy to follow. I knew that I would slack if I tried to do the challenge on my own—because TV and snacks—so I asked my friend/boss Anne if she would like to try it with me (how could I possibly cheat on my diet if I had to check in every day with the person responsible for my paychecks?). She did, but she suggested that we turn things up a notch by going Paleo for Lent, the solemn 40-day period before Easter when many Christians make sacrifices, often food-based ones in the form of fasting—you know, when your normally burger-loving Catholic friends eat fast-food fish sandwiches on Fridays because they gave up red meat.

RELATED: The Delicious Way to Get More Iron—Without Loading Up On Red Meat

Though there are many approaches to going Paleo (often called the caveman diet) and not all experts agree on the same guidelines, typically it means cutting out some carbohydrates and all refined sugars, grains, legumes, and dairy, as well as meats containing added hormones and antibiotics and processed foods containing preservatives. Instead, you chow down on the nutrient-dense foods our primitive ancestors would have hunted and gathered back in the day. While it may sound fairly straightforward, there are a few things I wish I had known before I started the journey.

1. Lots of Meals and Snacks You Used to Think of as Healthy Are Off-Limits
I used to regularly eat peanut butter and jelly on whole-wheat bread as a quick, nutritious breakfast. After I started Paleo, though, every part of that sandwich was verboten—yes, even the peanut butter since peanuts are technically legumes. Soy (also a legume!) was out, too, so I had to forget about stopping for a coffee in the morning and patting myself on the back for requesting soymilk instead of regular (not to mention that coffee minus sugar equals a thumbs-down emoji for me). And I definitely couldn’t have edamame appetizers at my favorite sushi place—as a matter of fact, I had to skip sushi altogether because eating only sashimi with no soy sauce seemed kind of sad (rice is banned). No more corn (a starchy grain) meant no more tortilla chips—which, okay, I shouldn’t have been surprised about, but it’s my favorite food, and I had told myself certain lies about their healthiness. I decided that if I had to go through life without chips, I’d at least need a drink, so I kept wine on my menu (in moderation, of course).

2. You Might Feel Sick at the Beginning
By my third day of eating Paleo, I had a headache that would not go away. I felt super nauseated, and I didn’t want to eat or drink anything.

“Whenever you drastically change your diet, your body’s going to react," says Alexandra Caspero, R.D., a dietitian in Sacramento. "Your body has to get used to a new way of eating.” Anne, who had previously completed the Whole30 program, told me that because I’d abruptly slashed my intake of carbohydrates, I probably had "the low-carb flu." Kristin Kirkpatrick, R.D., manager of wellness nutrition services at the Cleveland Clinic Wellness Institute, says a lack of the good-for-you glucose that carbs provide can cause nausea and headaches. “It’s a little bit of a shock to the system because you’re taking away the fuel that you’re used to,” she says. Caspero adds that people can feel similar withdrawal-type symptoms after cutting back on caffeine or refined sugar in general. I had to snap out of my no-carb-zone mentality to get my swagger back. Then, in walked the sweet potato...

RELATED: The Best Carbs for Weight Loss

3. Sweet Potatoes Will Become Your BFFL
Like many people, I had been led to believe that all carbs were evil. So when I decided to cut them from my diet, I showed no mercy. Fact is, humans actually need carbs for energy. “All carbohydrates are converted into sugar in the body,” says Kirkpatrick. “You need that fuel, but you want to get it from the right sources.” The difference between the carbs you should be filling up on and the ones you should minimize your intake of is that the former contain fiber, which aides in their digestion, keeps your insulin from spiking, and helps you feel full. An unpeeled apple, for example, is a carb filled with soluble fiber, says Kirkpatrick, while a treat like ice cream is a carb, yes, but one that's lacking in the fiber department. “The less carbohydrates have been processed, the better,” says Caspero, adding that fruits and vegetables are healthful carbs, while we should nix “concentrated sources of sweetness,” like soda, cookies, and cake. In my opinion, the yummiest "good carb" by far is the sweet potato—even Oprah loves them.

So to get over my “flu,” I tried out a bunch of delicious sweet potato recipes and gradually realized I’d been wasting my time dating rice and pasta when I could have settled down with sweet potatoes years ago. If this root vegetable just isn’t your jam, maybe you can get all turnt over butternut squash or something. But finding a go-to carb filled with fiber will make Paleo a lot easier on you (and your poor stomach!).

4. You Might Have to Stop Tracking Calories
I’ve been tracking my calories on My Fitness Pal on and off for about two years. When I started to do Paleo, I logged back on as an additional way to keep an eye on my nutrition. Once I really got the hang of the diet, my meals became more filling and more satisfying. A lunch of half an avocado cut up and wrapped in slices of nitrate-free roasted turkey breast kept me full hours longer than my typical leftover-pasta lunches ever did. As a result, I didn’t need to eat as much or as often to get through the day. There were a few times when My Fitness Pal warned me that I wasn't consuming enough calories.

The thing is, I felt great, not hungry. Kirkpatrick speculates that this lack of hunger was probably a symptom of ketosis, when the body burns fat for energy instead of carbs. And Caspero explains, “The benefit of eating less-processed, nutrient-dense foods is that the calories in them aren’t going to be that high.” (Side note: MFP also regularly warned me that I was eating way too much fat, but Paleo’s increased protein consumption often comes with a side of fat. Besides, “fat is not the enemy,” says Caspero.) It made me rethink our national obsession with counting calories over what exactly we’re putting in our mouths. “It’s more important to get quality calories than to focus on one specific number,” says Kirkpatrick.

RELATED: 15 Healthy High-Fiber Foods That Make You Feel Full and Satisfied

5. It’s Super Time-Consuming
Most people go into Paleo well aware that their grocery bills will jump at least a little bit since organic fruits and vegetables and grass-fed, antibiotic-free meats typically cost more. But I wish I had known that Paleo would take up so much of my time. This lifestyle is not for those addicted to grab-and-go foods. Since takeout is usually not an option for people strictly sticking to the plan (even if you find a restaurant that claims to use only organic ingredients, you can’t be sure they cook everything in Paleo-friendly oils, like olive oil), there’s a lot of meal prep involved, especially for dinner. Not gonna lie: I wasn’t always excited to start roasting a chicken after a long day of work.

On my darkest days, I wondered if the staff at my favorite Chinese carryout place were worried by my disappearance. (If you’re reading this, Jade Garden guys, I’m okay—promise.) Along those lines...

6. You’ll Start Eating Before You Meet Friends for Dinner
March Madness was in full swing right in the thick of my Paleo journey, and my team was (briefly) in the mix. Group game watches at a local bar required me to pretend to be unfazed as pulled pork sandwiches, fried pickles, and beer after delicious-smelling beer crossed the table.

But I didn’t just struggle at game watches. As I mentioned above, it’s hard to vet a Paleo-friendly restaurant. So not wanting to be That Girl, I always went along with whatever place my dinner companions wanted, then tried to pick something from the general menu. More than once, I forgot before ordering that most restaurants drown their house salad in cheese, even if cheese isn’t mentioned on the menu. More than once, I endured a bland burger suffering from a serious lack of oomph without ketchup and a bun. One (not the brightest) waitress even told me she could not “accommodate” my request for a lettuce “bun”…despite the fact that I had also ordered a side salad, so they clearly had lettuce in the kitchen. To avoid disappointment, I’d often eat before meeting friends and then act like I was fine nursing just a glass of white wine as they stuffed their stupid, annoying faces. (If any of my friends out there are reading this, I'm of course just kidding. Kind of).

7. You Won’t Be Able to Shut Up About It
I’d love to tell you that the entire time I was on my cavewoman journey, I was bright-eyed and enthusiastic. I’d love to tell you that, more in tune with nature, I did yoga on some sun-soaked rooftop every morning and handed strangers daisies on the street. But there were times when I was downright crankypants. I vividly remember texting Anne that I was so beyond over it when the Paleo chocolate cake I whipped up from a recipe I found on Pinterest turned out to be an insult to both chocolate and cake. At first, I would vent to anyone who would listen about how difficult my new eating plan was. But as I started feeling better physically, I couldn’t stop singing Paleo’s praises. Even with the annoying parts, Paleo is still the best decision I’ve made in a long time. I’d fall asleep within five minutes of my head hitting the pillow, that pesky pimple stayed gone, and I dropped six pounds. I no longer felt sluggish the way I did when most of my meals included processed carbs, dairy, or packaged foods. And I wanted my friends to know, too—whether they asked or not. Most said they were worried Paleo was too restrictive and boring to try themselves. “I could never live without cheese” is something I heard over and over. It was nice to help dispel some of the myths. For example, I love cheese, too, but it wasn’t making me feel good at all, so I broke up with it—and it really wasn’t even that hard.

Now that Lent is over, I’ve decided to eat Paleo at least 75 percent of the time. It would be awesome to still be hardcore about it, but it’s too difficult to maintain in social situations, and I am (#humblebrag) quite the social butterfly. Plus, I have to believe that our ancestors would have washed down their brontosaurus steaks with beer if they could have, so I’m totally honoring their memory by hoisting a few on their behalf now.

--

Telisha Bryan is a writer and copy editor in New York.

9 Guys Wax Poetic About The Women They Loved Who "Got Away” They’ll never quite get over them. Shutterstock

If you don’t have a “one who got away” story, then count yourself among the fortunate. It’s never a fun tale to tell or reminisce about, but it is one that stays in the back of the mind probably forever, just waiting to pop up out of nowhere one day when you hear a certain song or smell a certain scent or see an otherwise unremarkable object that throws you into a super-strong fit of nostalgia where you ask yourself over and over something like, “What would have happened if we had made it work?”

For me, the woman who got away is named Cara. I fell in love with her shortly after we met at a local swimming pool when I was 13 years old. She was the first girl I ever had real, genuine romantic feelings for. And even as I've gotten older and had other experiences, I still can't help but think about the first girl I was truly in like with. When I smell suntan lotion or hear Van Morrison’s “Brown Eyed Girl” or see a Pirates of the Caribbean movie on TV (it was our first date; my dad drove me to the theater), I am immediately jettisoned back to the brief times we were together through high school. I still think about her and I can’t help it. I actually just had a sex dream involving her not too long ago.

It didn’t work out because I f**ked things up. And she’s happily married now. But we remain friends, so I have that going for me. Which is nice.

RELATED: Confession: I Haven’t Had Sex in Almost Six Months

ANYWAY. Here are some other men's stories—you'll probably find them a little more insightful than mine.

“I loved her, but she was kind of crazy. I’m not saying crazy in the way that guys are like 'Oh, all girls are crazy!' I could tell you some stories. There was a lot of verbal abuse and stuff like that, but when we were in the middle of a good time, it was amazing. We loved being around each other, and the sex was awesome. Those are the things I can’t forget—the really, really good times. I was infatuated. But I also can’t forget the really, really bad times. Remembering those is how I keep from ever trying to go back to a relationship with her.” —Ryann C.

RELATED: Why Do Guys Often Call Their Exes “Crazy”? One Such Guy Offers Valuable Insight

“Her name was Claire, and I think the reason I can’t forget her is that she was definitely the first girl I really loved, which means that, for better or worse, I’ll probably be comparing all other women to her for the rest of my life. I think it’s unrealistic that we would have stayed together all through high school and then gotten married, especially since we ended up going to college across the country from one another, which is essentially why we eventually called it quits. But I still wonder what it would have been like if we did. I probably wouldn’t ever reconnect with her or anything, though. She dropped all contact with me a couple years ago because her boyfriend wanted her to. She could be engaged by now. Or dead. I really don’t know.” —Sam H.
 

“I think what we had, when we had it, it was so easy. I don’t know if it’s because I was younger or if it’s more of a credit to the great chemistry we had…it might be some combination of both, actually. I know that relationships aren’t exactly supposed to be easy, but we just really got along, never fought, really understood and respected each other. It didn’t end badly, just sadly. I chose to take a job opportunity that would put us far away from each other, and she did not want to do long distance or move from our hometown, so that was that. Maybe someday if both of us don’t end up married and we end up in the same town I’ll try and reconnect romantically with her, but I don’t think that’s going to happen. That’d be some serious Nicholas Sparks stuff.” —Vincent F.

RELATED: 4 Guys Share the Mushy Stuff They Would Write in Love Letters to Their Ladies

“We had a lot of problems that ultimately did us in, but my 'one who got away' was amazing. I still think about her all of the time. What I loved most about her was that she was one of the few people I’ve ever known who truly couldn’t care less what other people thought about her or what she was doing—like just literally did not give a sh*t, which mean she also didn’t care what people thought about what I was doing. It was amazing. I haven’t been with another girl like that since. I don’t think there will be any rekindling, though, because, like I said, we had a lot of other problems, ones that I think would probably creep back into our relationship if we tried to go another round.” —Noah R.
 

“Lisa was definitely the one. I still can’t get over hot pretty she is. In fact, I should probably stop following her on Instagram. It just hurts too much. I know this probably sounds shallow that her looks are what I always think about, but it’s true. I can’t believe I ever even had sex with her. I was totally batting out of my league, really outkicking my coverage. Sometimes, I still reach out to her, but nothing really comes of it. We’re friends, but that’s probably the extent of it. I bet she gets really good-looking guys a lot.” —Brad S.

“I miss her smile a lot. Is that corny? Yeah, for sure, but I do miss it. I sometimes remember how hard I would try to make her smile and how rewarding it was when she did.” —Simon M.

“Love can be a terrible thing because I’m pretty sure I’m still in love with this girl named Renee. It actually makes me mad at myself since we broke up because she cheated on me. She just had this kind of hold or power over me that I haven’t been able to really forget about. But we'll never be together again. Because she cheated on me!” —Amir L.
 

“We had a good thing going, but then when we were in 11th grade, her family moved. We tried to keep it going for a while, I even went and visited, but eventually, she called things off and moved on. It’s understandable. I don’t hold it against her, but I wish things would have been different. The thing I always think about is what the future might have been like if she hadn’t moved. But none of that matters now. She met another guy and married young. She has a couple kids now.” —Tyler F.

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Scott Muska is a writer in New York City. You can follow him on Twitter @scottmuska or e-mail him at srm5082@gmail.com.

4 Things You Should Know About Cracking Your Knuckles …Including whether it really gives you arthritis. Shutterstock

If you’re a knuckle-cracker, you know how it goes: Sometimes you just don’t feel right until you pull, bend, or push your fingers until they pop and you’re flooded with satisfaction. On the other hand, if you’re not prone to cracking your knuckles, the urge might seem bizarre or even a little gross. Regardless of where you stand, you've no doubt been curious at one point or another about your (or your boyfriend's or your sister's) knuckling-cracking habit and how it's even possible. 

What Causes That Popping Sound?
For decades, scientists have been trying to figure out what goes on physically to elicit that signature popping noise. A recent study in PLOS ONE has cracked, so to speak, the code behind this weird bodily function, revealing that the sound happens as a result of an air bubble that forms when a joint is pulled apart. The process is technically called “tribonucleation,” or the quick separation of two surfaces followed by a cavity formation, say the researchers in the study.

PLOS ONE / University of Alberta

A team of University of Alberta researchers had a study participant place his fingers into a tubular finger trap one at a time. A cable attached to the finger’s tip then slowly pulled until a knuckle cracked. The cracks were caught on MRI video so researchers could investigate what was going on, and each happened in the space of one frame (a.k.a. in 310 milliseconds).

RELATED: How To Get Younger-Looking Hands

While research from 1971 suggested the popping sound was due to the collapse of pre-existing bubbles in joints’ synovial fluid, this finding confirms a 1947 study that found it’s actually the creation of bubbles in the synovial fluid that causes the noise. Think of synovial fluid as the lubricant that exists between two joints. It’s necessary for proper joint and bone movement and comfort.

In the video below of the action in progress, the joint separates, a dark bubble appears in the intervening fluid, and then everything settles back into place. Although the joint looks like it’s back to normal, it has to undergo a refractory period before it can crack again. “The fluid takes time to refill and create the same dynamics it had before," says Michael Suk, M.D., chairman of the department of orthopedic surgery at Geisinger Health System. "It’s like pouring oil through a very small hole in an hourglass—it takes time for it to fill up again."

RELATED: The Super-Common Habit That’s Hurting Your Nails

Why Do People Even Crack Their Knuckles in the First Place?
“There’s both a mental and physical component,” says Suk. “From a mental standpoint, it’s almost a nervous habit for some people, much like drumming their fingers or biting their nails. I think to some degree, there’s a feeling associated with doing it as a mental stress reliever.” Meanwhile, “from a physical standpoint, I think what this study shows is as you create space in the knuckle, you’re decompressing the joint," says Suk. "In many cases, that can result in greater fluid movement in the joint itself, so your finger feels less constrained.”

Are Some People Just Not Capable of Doing It?
Although it seems like some people can crack their knuckles without an issue and others can’t no matter what, that’s likely not the case. “If we understand joints to be what they are, everyone has the potential to crack their knuckles,” says Suk. “The difference is that some people have a lower threshold of pressure for separating them, but others require much more force to create the separation.” Don’t take that as license to apply a ton of pressure just to hear the pop, though. “There have been some reports that people can tear or stretch tendons based on how they crack their knuckles,” says Suk. “Some people pull, while others bend their fingers. Depending on how forcefully you do so, you can injure your hand.”

RELATED: Why You Can’t Stop Picking Your Skin (Or Hangnails, Or Pimples…)

Can Cracking Your Knuckles Really Cause Arthritis?
As for that rumor that you’re going to pay for your knuckle-cracking ways with arthritis, there’s not much truth to it, says Suk. “There’s no scientific merit to that,” he says. “A couple studies have looked at habitual knuckle-crackers and discovered there’s no difference in the quality or quantity of arthritis in their hands.” So even though it’s not the prettiest of habits, contrary to what your parents said when you were little, it likely won’t cause any long-term damage if you’re gentle.

Be aware, though: Although all joints share some common characteristics, they’re not all the same. “It’s probably hard to extrapolate from this study about the safety of cracking all joints across the board,” says Suk. You hear that, habitual back-crackers?

Gif courtesy of giphy.com

The findings of a new survey investigating American's knowledge of miscarriage and its causes reveals there are widespread misperceptions about the condition.
Only 45% of respondents with a history of miscarriage received adequate emotional support from health care professionals.

Dr. Zev Williams, director of the Program for Early Recruitment and Pregnancy Loss (PEARL) at Yeshiva University's Albert Einstein College of Medicine and Montefiore Medical Center - both in New York, NY - and colleagues publish their findings in the journal Obstetrics & Gynecology.

According to Dr. Williams, miscarriage is a "traditionally taboo" subject that is rarely discussed in public. "We initiated this survey to assess what the general public knew about miscarriage and its causes and how miscarriage affects them emotionally," he adds.

Miscarriage is defined as the unexpected loss of a fetus prior to the 20th week of pregnancy. More than 1 million miscarriages occur in the US annually, with the condition ending 1 in every 4 pregnancies.

The majority of miscarriages are caused by chromosomal abnormalities that prevent the fetus from developing. There are a number of other possible causes, however, including hormonal problems, abnormalities of the female reproductive organs, smoking, obesity and substance abuse.

Most miscarriages occur before a woman realizes she is pregnant. Among women aware of their pregnancy, the miscarriage rate stands at around 15-20%, with the majority occurring in the first 7 weeks of pregnancy.

Widespread belief miscarriages are rare, primarily caused by lifestyle choices

The survey compiled by Dr. Williams and colleagues consisted of 33 questions - 10 of which applied solely to men or women with a history of miscarriage.

Using Amazon.com's crowdsourcing web service, MTurk, the team posted the survey online. Over a 3-day period in 2013, the team gathered 1,084 valid survey completions.

The surveys were completed by anonymous adults aged 18 and older from 49 US states, of whom 45% were men and 55% were women. A history of miscarriage was reported by 15% of respondents.

Respondents' gender, age, geographical location and household income mirrored 2010 national census statistics, according to the researchers.

One major finding of the survey was that - despite miscarriages being the most common of all pregnancy complications - 55% of respondents believed they were "uncommon" - defined in the study as occurring in less than 6% of all pregnancies in the US.

Twenty-two percent of respondents believed that lifestyle choices during pregnancy - such as smoking and substance abuse - are the primary cause of miscarriage, when 60% are actually caused by chromosomal abnormalities. This misperception was more common among men and less-educated individuals.

The survey also revealed that 74% of respondents incorrectly believed long-term stress or a stressful event can trigger miscarriage, while 64% thought it could be caused by lifting heavy objects.

Forty-one percent of respondents believed a miscarriage can be caused by a sexually transmitted infection, while 28% linked it to prior use of an intrauterine device (IUD), 22% thought oral contraceptives could cause miscarriage, and 21% thought it could be triggered by getting into an argument.

Many miscarriage sufferers feel guilt, shame and loneliness

Among men and women who reported that they or their partner had experienced a miscarriage, 47% said they had feelings of guilt, 41% felt they had done something wrong, 41% reported feeling alone and 28% said they felt ashamed.

What is more, only 45% of these respondents said they felt they received adequate emotional support from health care professionals.

However, 28% of respondents with a history of miscarriage said celebrities reporting a miscarriage helped ease their own feelings of loneliness, while 46% said a friend revealing a miscarriage made them feel less alone.

Among all respondents, 36% said they felt experiencing a miscarriage would be "extremely upsetting" and on a par with losing a child.

Eighty-eight percent of respondents said they would want to know the cause of a miscarriage if it could help prevent another, while 78% said they would want to know the cause even if this were not the case.

The researchers believe their findings emphasize the need for greater education about miscarriage among the general public. Dr. Williams says:

"The results of our survey indicate widespread misconceptions about the prevalence and causes of miscarriage. Because miscarriage is very common but rarely discussed, many women and couples feel very isolated and alone after suffering a miscarriage. We need to better educate people about miscarriage, which could help reduce the shame and stigma associated with it."

"We want people who experience miscarriage to know that they're not alone," he adds, "that miscarriages are all too common and that tests are available to help them learn what caused their miscarriage and hopefully to help them in subsequent pregnancies."

In February 2014, Medical News Today reported on a study linking passive smoking to increased risk of miscarriage, stillbirth and ectopic pregnancy.

Written by Honor Whiteman

Why You Might Want to Think Twice About Using Waterproof Mascara Plus, other sneaky culprits that could be hurting your delicate eye area Shutterstock
Dark circles under your eyes that even concealer can't hide? The problem could be coming from your sleep habits or from rubbing your eyes—but there are even sneakier culprits you might not know about. Dermatologist Ellen Marmur, M.D., goes all super-sleuth to uncover them.
1. Waterproof Mascara
They often require rubbing to remove, which intensifies rings. Switch to a formula that's not marked long wear.
2. Eyelash Extensions
These faux lashes are applied with glue that many people are allergic to, resulting in irritation and circles around the eye area.
3. Swimming Goggles
They add suction and pressure to the under-eye area. Reach for a pair of open-water goggles—they rest on the outside of the orbital rim.
RELATED: How to Hide Blackheads, Under-Eye Circles, and All Your Other Annoying Skin Issues
For more triggers that may be causing those pesky under-eye circles, pick up the May 2015 issue of Women's Health, on newsstands now.

The Patient Support Corps at UC San Francisco Medical Center pairs interns with patients to provide support during visits. A sign with the student’s face hangs outside the exam room to remind patients to call their assigned note-taker (Photo by Heidi de Marco/KHN).By Guest Contributor | March 20, 2015

By Anna Gorman, Kaiser Health News

Rose Gutierrez has a big decision to make.

Gutierrez, who was diagnosed with breast cancer last spring, had surgery and 10 weeks of chemotherapy. But the cancer is still there. Now Dr. Jasmine Wong, a surgeon at UC San Francisco, is explaining the choices: Gutierrez can either have another lumpectomy followed by radiation, or she can get a total mastectomy.

“I think both options are reasonable,” Wong said. “It’s just a matter of how you feel personally about preserving your breast, how you feel about having radiation therapy.”

“I’m kind of scared about that,” said Gutierrez, 52, sitting on an exam table with her daughter on a chair beside her.

“Well if you made it through chemo, radiation is going to be a lot easier,” Wong told Gutierrez, who is from Merced, Calif.

In many hospitals and clinics around the country, oncologists and surgeons simply tell cancer patients what treatments they should have, or at least give them strong recommendations. But here, under a formal process called “shared decision making,” doctors and patients are working together to make choices about care.

It might seem like common sense: Each patient has different priorities and preferences; what’s right for one patient may be wrong for another. Of course patients should weigh in. But many aren’t accustomed to speaking up. Even the most engaged or educated patients may defer to their doctors because they are scared, they don’t want to be seen as difficult or they think the doctor knows best.

For their part, not all doctors want to cede control to patients who have far less medical knowledge or who may be relying on information they got from friends and the internet. Also, many physicians don’t have the time for long discussions and the health care system isn’t set up to pay for them.

Even so, hospitals and clinics in several other states, including Massachusetts, Minnesota and Washington, have created collaborative programs to ensure that information and concerns flow back and forth between patient and doctor. UCSF’s approach, in particular, has been a model for other programs around the nation.

The concept of shared decision making has been around for years, but it is gaining new traction with the nation’s health law, which specifically encourages its use.

“It’s a massive cultural change,” said Glyn Elwyn, who researches shared decision making at The Dartmouth Institute for Health Policy and Clinical Practice. “It’s going from ‘I’m the expert, take my recommendation’ to ‘I am going to inform you and respect your wishes.’”

“Patients and families need to be in the driver’s seat with their doctors, making decisions that are the right choice for them for their unique circumstances,” said UCSF associate professor Jeff Belkora, who runs the shared decision-making program also known as the Patient Support Corps.

That way, he said, patients avoid “a rocky, bumpy ride” of either too much or too little treatment.

At UC San Francisco, patients receive DVDs, pamphlets or links approved by the physicians that explain available options for treatment. During appointments, the doctors not only explain carefully the benefits and the risks of those options but also ask about patients’ priorities and goals.

Patients are paired with college students or recent graduates who help them make a list of questions for the doctor beforehand. These young people also record the visit and type notes for the patients, who then leave with a definitive account of what was said.

That’s important because patients are nervous and emotional after a cancer diagnosis and often freeze up, said premed student Edward Wang. Wang said his presence helps put them at ease. “You’re just making a question list and you’re just taking notes,” he said. “But these simple things really do matter to the patient and to the doctor as well.”

Shared decision making has been used for patients with breast and prostate cancer, heart disease, back pain and other conditions for which there are multiple treatment options that offer similar results.

“It’s a massive cultural change,” said Glyn Elwyn, who researches shared decision making at The Dartmouth Institute for Health Policy and Clinical Practice. “It’s going from ‘I’m the expert, take my recommendation’ to ‘I am going to inform you and respect your wishes.’”

Elwyn and other researchers have found that patients are more satisfied with their care when they have a say in it. Also, it may save money. Some research shows that patients who are involved in their treatment decisions are more likely to be conservative, opting against costly procedures or surgeries.

That doesn’t mean the decisions are easy – even for knowledgeable patients.

Candace Walls, 41, and daughter Jessica Walls, 19, look over a list of questions Candace created with the help of Edward Wang, a student intern, prior to her medical visit. The Stockton resident was diagnosed with breast cancer six years ago and had reconstructive surgery last year (Photo by Heidi de Marco/KHN).

Ilene Katz, a UCSF nurse who often works with cancer patients, was recently diagnosed with breast cancer and became a patient herself.

At first, she wanted a mastectomy. “My knee jerk reaction, which probably a lot of women have … is there is cancer in my body, cut it out, cut all of it out,” she said.

But on this February day, she came out of the exam room feeling different. A long conversation with the surgeon and the oncologist helped her decide that, for her, there was no real benefit to having a mastectomy over a lumpectomy.

Katz said she was relieved someone was there taking notes so she could go over it later. “I don’t remember everything,” Katz said, her eyes red from crying. “It’s all a black cloud.”

Katz’s doctor, Laura Esserman, said some patients want her to make choices for them. But Esserman, head of the UCSF breast care center, sees herself more as a coach, often asking questions to make sure patients don’t act out of fear or lack of knowledge: What’s the most important thing to you? How do you feel about your body image? What complications are you worried about?

Typically, Esserman said, she tells patients, “I need to know more about your thought process … and how you are going to feel a year from now.”

Candace Walls, 41, appreciates having some control over her care. Diagnosed with cancer six years ago in Stockton, Walls said the doctor recommended a mastectomy and then did the surgery.

“I didn’t have lots to choose from,” Walls said. “It was just kind of like, ‘This is what I think you should do.’”

Since coming to UCSF a year ago, however, she has been very involved with her decisions about breast reconstruction, even asking the doctor to redo part of the surgery when she didn’t like how it turned out. At a February appointment, Dr. Wong answered her questions one by one. “It is a very good feeling to know you can say what you want to your doctor,” Walls said afterward.

That same day, Gutierrez, the patient from Merced, sat nervously in Wong’s exam room as the doctor explained more about her surgery choices.

“With the partial mastectomy we just need to take a little bit more tissue out … and then we would have to do radiation,” Wong said, as a note taker sat typing quickly. “With the [total] mastectomy, you probably wouldn’t need radiation but obviously it’s a bigger operation.”

Gutierrez said that as a single woman in her 50s, she wasn’t too concerned about keeping her breast. But she was worried about how her body would react to radiation. Most important, she wanted to be sure doctors got rid of the cancer.

“I have 12 grandbabies,” she said. “I want to be here for them.”

Still, Gutierrez told the doctors she was leaning toward the lumpectomy, saying she felt nervous about the pain. “I’m a big sissy,” she said.

“No, you are doing great,” Wong said. She encouraged Gutierrez to take the time she needed to talk over the choices with her family and to call if she needed to talk more. “I don’t want you to feel like you are pressured to make a decision.”

A few days later, Gutierrez decided on a mastectomy, mostly to avoid the radiation and the worry about cancer’s return. She had surgery in early March.

Reached by telephone the next day, Gutierrez said she felt good about her decision – and how she made it with her doctors. “It makes us seem like we are a team,” she said.

Kaiser Health News (KHN) is a nonprofit national health policy news service.