11 Surprising Uses For Botox

This article originally appeared on Time.com.

Though it’s best known for smoothing wrinkles, Botox, which is derived from one of the most deadly toxins known to man, has repeatedly stunned the medical community for its seemingly endless applications. Though the drug is approved for nine medical conditions and several cosmetic ones, Allergan, the company that owns Botox, holds close to 800 more patents for potential uses of the drug. Since it was approved nearly 30 years ago, Botox has indeed become a staple of cosmetic enhancement, but today, more than half of its revenue comes from its therapeutic uses for conditions as varied as chronic migraines and back pain to excessive sweating and twitching eyelids.

Botox is generally considered safe if used in tiny amounts and administered by a licensed professional, but the drug is not without risks. In 2009, the U.S. Food and Drug Administration (FDA) required Botox carry a black box warning—the strongest type of warning label on any drug—cautioning the drug had been linked to serious side effects. For Botox, those can include the effects of the drug spreading from the injection site, which can cause muscle weakness, vision problems, trouble breathing and difficulty swallowing. There have also been a number of high-profile lawsuits brought against Allergan in which plaintiffs claimed that off-label uses of Botox for ailments like a child’s cerebral-palsy symptoms or an adult’s hand tremors caused lasting side effects.

Once a drug is approved in the U.S. for one medical condition, doctors are legally allowed to prescribe it for any medical issue they think it could benefit, regardless of whether it’s been proven to work for that condition. The practice is common in medicine, but some experts caution that more research is needed to understand how Botox works and whether it’s safe for all health problems before off-label use balloons.

The off-label use of this particular toxin has helped turn Botox into a blockbuster, as TIME reports in an in-depth cover story. Here are some of the most intriguing uses for Botox:

Chronic migraines (FDA approved)
In 1992, a Beverly Hills plastic surgeon named Dr. William Binder observed that when he gave people Botox for wrinkles, they reported fewer headaches. Allergan later tested the drug on people with chronic migraines, and Botox was approved for the disorder in 2010. Some doctors question whether the drug is truly effective for migraines, or whether placebo effect deserves the credit. “Even if it’s placebo, the patients have fewer migraines,” says Dr. Denise Chou, an assistant professor of neurology at Columbia University Medical Center (who has no financial ties to Allergan). “Right now the other medications we have are antidepressants, anti-seizure, or anti-blood pressure drugs—other medications that have also accidentally been found to help migraines.” Today people who receive Botox for migraine prevention get 31 injections in different spots on their head and neck, and the effects can last around three months.

Excessive underarm sweating (FDA approved)
When doctors noticed that their patients being treated for facial spasms were sweating less, scientists at Allergan and outside of the company began studying whether Botox could be a successful therapy for people with a condition called severe primary axillary hyperhidrosis. Botox was approved for the treatment in 2004. Some people also use Botox to treat overly sweaty hands and feet.

Overactive bladder (FDA approved)
“In my 30 years of medical practice, Botox was one of the most impactful treatments I had never seen” for overactive bladder, says Dr. Linda Brubaker, dean and chief diversity officer of the Loyola University Chicago Stritch School of Medicine. In one study, Brubaker found that about 70% of women she treated with Botox reported about three leaks a day, compared with the average of five leaks a day at the start of the study. But there’s a catch. Sometimes, Botox can shut down the bladder too much, and people may need to use a catheter, she says.

Crossed-eyes (FDA approved)
One of the first Botox approvals was for a disorder that affects about 4% of Americans: strabismus, where the eyes do not line up in the same direction.

Depression (not FDA approved)
Though many experts are still skeptical, early trials suggest Botox may alleviate symptoms in people with depression. The proposed mechanism is based on what’s called the facial feedback hypothesis, which holds that a person’s facial expressions can influence their mood. One small 2014 study of 74 people with major depressive disorder found that 52% of people who received Botox reported a drop in symptoms six weeks later, compared with 15% of the people given a placebo. Allergan is currently conducting clinical trials to see if Botox can treat depression.

Premature ejaculation (not FDA approved)
Injecting Botox into the penis might relax the muscle and delay ejaculation; Allergan is currently testing Botox for this issue. The company also holds a patent for the treatment of erectile dysfunction, which is currently being tested in a third-party clinical trial.

Abnormal heartbeat (not FDA approved)
Allergan is exploring Botox as a therapy to prevent abnormal heartbeat patterns after open-heart surgery (called postoperative atrial fibrillation). “After having a drug on the market for 27 years, and having a good understanding of the safety profile, we’ve made the decision to take it to an area of significant unmet need,” says Dr. Mitchell Brin, senior vice president of Drug Development at Allergan and Chief Scientific Officer for Botox about the potential use.

Severely cold hands (not FDA approved)
At the Cold Hand Clinic at the University of Chicago, doctors use Botox off-label to treat people with very cold hands. Botox is injected into a person’s hand in order to relax muscles that surround constricted blood vessels, the course of poor circulation. When the vessels relax and enlarge, blood flows through the hand and into the fingertips, providing symptom relief. Doctors say the treatment can last up to three months.

Cleft lip scars in babies (not FDA approved)
Every year, about 2,650 babies are born with a cleft palate and 4,440 are born with a cleft lip. Many undergo surgery. Some doctors—like Dr. Roberto Flores, director of the Cleft Lip and Palate Program at NYU—will inject the infants’ scars with Botox in order to hold the muscles still and allow it to heal. This can greatly improve the appearance of the scars. “[We are] giving Botox to infants, but there is science behind it,” says Flores. “It’s a relatively new and innovative offering.”

Painful sex (not FDA approved)
Some women experience muscle spasms on their pelvic floor or contractions of the vagina that can make sex painful. Botox injections can ease pain by making the muscles stop contracting. Doctors at the Cleveland Clinic who offer Botox injections for painful sex say some women may need injections every six months, while others may only need them every couple years.

Severe neck spasms (FDA approved)
Even before Botox was approved for frown lines between the eyebrows in 2002, Allergan got approval for the drug in 2000 for its use in treating a disorder called cervical dystonia, which is characterized by abnormal head position and severe neck pain.

Read more about the weird and wild science behind Botox, here.

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Here’s Why the Cancer Death Rate Has Plummeted

This article originally appeared on Time.com.

Death rates from cancer, the second-biggest killer in the United States, have dropped 25% since 1991, according to a new report from the American Cancer Society. That statistic translates into a lot of lives saved; had the cancer death rate remained steady from its peak in 1991, about two million more people would have died from cancer in the years until 2014, the report finds.

The drop is fueled by decreasing death rates from the four largest types of cancer: lung, breast, prostate and colorectal. “It’s pretty exciting for us that the cancer death rate continues to decline,” says Rebecca Siegel, strategic director of surveillance information services at the American Cancer Society and lead author of the annual report, which was published in CA: A Cancer Journal for Clinicians. “We’re making a lot of progress.”

The authors credit the drop to reductions in smoking—shown last year to be responsible for about 30% of all cancer deaths—as well as advances in treatment and earlier detection.

The report also finds that cancer incidence is 20% higher in men than in women, and the cancer death rate is 40% higher in men. “There’s a different mix of cancers in men and women, and a lot of it has to do with differences in exposure to cancer risk factors,” Siegel says. Though the gender difference isn’t fully understood, men are more likely than women to smoke and drink excessively, both risk factors for several kinds of cancers. Hormone and even height differences may also make men more susceptible, though it’s not yet clear how.

Racial disparities also affect who dies from cancer, but those differences are shrinking, the report shows. In 1990, black men were almost 50% more likely to die from cancer than white men, but in 2014, that difference dropped to 21%. The gap is also narrowing in women. These drops are largely due to declines in smoking by black youth in the 1970s and early 1980s, Siegel says.

Minorities also have better access to healthcare and insurance, and the proportion of uninsured Blacks and Hispanics halved from 2010 to 2015. Those changes are too recent to make much of a dent in the present data, Siegel says, but they do suggest a way to drive cancer death disparities down even more. “The potential for an acceleration in closing that gap is there with this increased access to healthcare,” Siegel says. “Hopefully it will be sustained.”

While good news overall, the report doesn’t guarantee a continuous downward trend of death rates from cancer. Recent evidence shows that death rates from other leading causes of death—like heart disease, closely related to obesity—are on the rise. Obesity, a risk factor for cancer, probably has yet to show its full effect on the death rates of cancer, Siegel says. “We don’t know when we’re going to see the effects of the tripling of the obesity rate in the past several decades,” she says, adding that excess body weight, unhealthy diet and a lack of physical activity account for about 20% of cancer diagnoses in the U.S. Some statistics hint that obesity may already be taking a toll. Rates of colorectal cancer, which is linked to obesity, are declining overall, Siegel says, but they’re rising in people younger than 50.

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What You Should Do Today If You Have Obamacare

This article originally appeared on Money.com.

As Republicans move to eliminate Obamacare, you might be worried about the future of your health insurance plan—and rightfully so.

Here’s what’s happening: Republicans are meeting to try to figure out how to speedily repeal major parts of Obamacare through an obscure process called budget reconciliation. The reality is that it’s very likely that major portions of Obamacare—like premium tax credits and the individual and employer mandate—could be axed in the near future.

What’s more, getting rid of the health care law in its entirety might not be all that difficult. As MONEY’s Alicia Adamczyk noted in the aftermath of the presidential election, a clause in the contract between insurers and the government would allow insurers to discontinue their policies if subsidies were to end.

In order to keep insurers on board with a government-run health care plan, “it’s going to take more than ‘stay tuned’ if they repeal without a replacement plan,” said Tim Jost, a health care law expert at Washington and Lee University.

Unfortunately, if you depend on Obamacare for health insurance, there’s not much you can do except sit tight and keep your current plan as long as you can. If you haven’t signed up for Obamacare via open enrollment and would like to, the deadline for 2017 coverage is Jan. 31 and you can sign up at Healthcare.gov.

“People should sign up and continue to be covered as long as the Republicans let them,” Jost said. “People should think about if there’s anything I can get now, that might not last past repeal.”

One such policy that has people worried is birth control. Under Obamacare, it falls under preventative care, which must be provided to you for free. MONEY has previously reported that it’s not likely that this policy could be axed through budget reconciliation.

However, a full repeal could leave women without coverage for gender-specific services like birth control and breast pumps. Even worse, insurers could charge women more than men for insurance, as was the practice before the ACA was passed.

The bright side for worried Obamacare subscribers is that repealing Obamacare would be disastrous for Republicans if they aren’t able to present an alternative plan. Without a replacement plan, more than 20 million people with diseases like cancer or diabetes would be left without health insurance—a political catastrophe for the GOP.

“Responsible Republicans will do everything they can to make sure people are covered,” Jost said. “There will be a high political price to pay if people aren’t covered through 2018.”

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A Month-by-Month Guide to the Best Places to Travel in 2017

How to Get Rid of Earwax

This article originally appeared on RealSimple.com.

Mom always told you not to put anything in your ear that's smaller than your elbow. Well, she was right. Not only is that good advice; it’s now an official guideline for the diagnosis and treatment of earwax, published Tuesday by the American Academy of Otolaryngology—Head and Neck Surgery Foundation.

This update to the Foundation’s existing earwax guidelines, originally published in 2008, takes a new, consumer-focused approach, says Seth R. Schwartz, M.D., chair of the guideline update group and medical director at The Listen for Life Center at Virginia Mason Hospital in Seattle. That includes a list of do’s and don’ts for doctors to pass on to their patients.

“We tried to include information that was directly applicable to what people are experiencing at home,” Dr. Schwartz told RealSimple.com. “And the most important thing we want to get across to patients is that earwax is not unhealthy.”

In fact, earwax is normally quite good for our ears: Dirt and dust particles stick to the gunky deposits, which keep them from traveling farther down into the ear canal. And when our bodies work the way they should, old earwax moves outward naturally over time, and flakes off—or is washed off during bathing—as new earwax is formed.

But there are times this self-cleaning mechanism gets stuck, and earwax can build up and block the ear canal—a condition called cerumen impaction. It’s estimated that about 1 in 10 children and 1 in 20 adults has impacted or excessive cerumen (a.k.a. earwax), which can cause symptoms like hearing loss, ringing in the ears, a foul odor, or ears that feel clogged, painful, or itchy. In geriatric and developmentally delayed groups, the percentage may be as high as one third.

And that’s where the guidelines come in. In addition to the commonly cited elbow advice, the new list of “don’ts” warns against over-cleaning the ears (which may irritate the ear canal, cause infection, or even increase earwax levels) and using ear candles (which have no established benefit, but can cause serious and permanent damage).

What they do recommend, on the other hand, is seeking medical attention if you have symptoms of hearing loss, ear pain, or ear fullness. You should also see a doctor if you experience drainage or bleeding from your ears, they add, which are likely not caused by earwax and need further evaluation.

Patients should also ask their doctors about ways they can treat their earwax at home, the guidelines state. That may include using wax-softening eardrops or even rinsing your ears with water, says Dr. Schwartz. Your doctor might also recommend a home irrigator designed for ear cleaning, or may refer you to a specialist (like an otolaryngologist or an audiologist) for in-office cleanings or wax removal.

What you shouldn’t do is use a Q-tip—or any other tiny tool—to try to clean out your ear canal. “Even something as soft as a cotton swab can traumatize that delicate skin, which can cause pain and infection,” says Dr. Schwartz. “And a lot of people end up pushing the wax deeper into the eardrum. That makes it harder for it to make its way out naturally, and can cause even more symptoms.”

And finally, if you’re not experiencing any earwax-related symptoms, simply leave your ears alone. “For most people, wiping the outer edges of your ears with a washcloth or a tissue is all you need to do,” says Dr. Schwartz. “Don’t go any deeper than that.”

The updated guidelines were published in the journal Otolaryngology-Head and Neck Surgery, and are endorsed by several large medical groups, including the American Academy of Family Physicians, the American Academy of Pediatrics, and the American Geriatric Society.

The guidelines should serve as a “strong reminder to patients that ear health starts with them,” says Dr. Schwartz, and should help doctors better communicate the importance of healthy habits—and, in this case, a healthy respect for earwax.

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The Case for Taking a 7-Day Facebook Detox

This article originally appeared on RealSimple.com.

It’s no secret that sometimes, spending time on Facebook can be a real downer. Maybe you’ve considered deleting your account for the sake of your sanity. But you don’t have to quit the social network altogether to feel better, suggests a new study. Researchers say that simply changing your behavior on the site—or taking an occasional break—may be just the mood-booster you need.

To be fair, the research on Facebook, and on social media in general, has been all over the map when it comes to mental health. Several studies have linked heavy use of these sites to loneliness and depression, while others have found that social networking can actually improve mood and satisfaction with life.

One problem, says Morten Tromholt, a sociology researcher at the University of Copenhagen, is that most of these studies have been observational; they’re only able to track people over time and find associations, not cause-and-effect relationships. So Tromhold wanted to conduct a true experiment that could suggest whether Facebook use actually leads to negative emotions (and not the other way around)—and whether changing one’s behavior could help.

To do that, he recruited more than 1,000 Danish Facebook users in late 2015, and tested them on several measures of social-media use, well-being, and life satisfaction. Then he asked half of them to continue Facebook use as normal, and half to take a one-week break.

Those on a break were encouraged to delete the Facebook app from their mobile devices. Most users complied with the digital detox rules, although—as a testament to the site’s pervasiveness (and addictiveness!)—some admitted to briefly checking in once or twice, either as a habit or because they needed information about an event.

After that week, Tromhold again assessed the mental health of all participants. He found that those in the no-Facebook group showed significant improvement in well-being, while those in the normal-use group showed no change.

Those gains varied depending on how, and how much, people normally used Facebook. People who were heavy users (as measured by the Facebook Intensity Scale), those who reported having a lot of envy while on Facebook, and those who tended to use Facebook passively rather than actively (reading and viewing, rather than posting and commenting) saw the most mental-health benefits from taking time off.

Tromhold’s final results were published in the journal Cyberpsychology, Behavior, and Social Networking. (His preliminary findings were published in 2015.) The experiment “provides causal evidence that Facebook use affects our well-being negatively,” he wrote, and also that “taking a break from Facebook has positive effects on the two dimensions of well-being: our life satisfaction increases and our emotions become more positive.”

Brenda K. Wiederhold, Ph.D., editor-in-chief of the journal and executive director of Virtual Reality Medical Institute in Brussels, Belgium, said in a press release that this study supports previous research that has found that “lurking” on Facebook may cause negative emotions.

“However, on the bright side, as previous studies have shown, actively connecting with close friends, whether in real life or on Facebook, may actually increase one’s sense of well-being,” she added.

Tromhold notes that his findings are only averages, and that studies are almost never able to determine whether one variable truly causes another. And more research is needed to see if quitting Facebook (or other social networks) for longer periods of time have the same impact—or perhaps even better impacts—on mental health, he says.

But he believes the study does provide some real lessons for Facebook users. “These findings indicate that it might not be necessary to quit Facebook for good to increase one’s well-being,” Tromhold wrote. He suggests that if you’re a heavy user, try scaling back. If you tend to feel envy when on Facebook, avoid browsing the sections (or the specific friends) that cause this feeling. And if you often use it passively, try participating a little bit more.

Of course, Tromhold added, old habits die hard, and these things may be too difficult to change. “If this is the case,” he wrote, “one should consider quitting Facebook for good.”

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28 New Year's Resolutions to Look and Feel Better

Can’t shake the stress eating? Always fall into a Facebook hole at bedtime? We’ll show you how to clean up your routine once and for all and get into a healthier groove.

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