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An operation called a radical prostatectomy has long been a mainstay of prostate cancer treatment. Offered most often to men whose cancer has not yet begun to spread, it involves removing the entire prostate gland, and can be performed in different ways. With the traditional "open" method, surgeons remove the prostate through an 8-to-10-inch incision just below the belly button. Alternatively, surgeons can perform a robot-assisted radical prostatectomy. With this approach, miniaturized robotic instruments are passed through several much smaller incisions in the patient's abdomen. Surgeons control these instruments remotely while sitting at a console.

At least 85% of all radical prostatectomies in the United States today are performed robotically. But how do those high-tech surgeries compare with the traditional open method?

Most studies show no major differences between the procedures in terms of patient survival or their ability to control prostate cancer over the long term. Robotic prostatectomies ostensibly offer quality-of-life advantages for urinary function and sexual health. However, the supporting evidence comes mostly from doctors' reports, insurance claims-based data, or studies too small to generate definitive conclusions.

Now, results from a much larger comparative study provide needed clarity.

During the study, researchers from Harvard-affiliated hospitals and other academic medical centers in the United States followed 1,094 men who were treated with radical prostatectomy between 2003 and 2013. All the men had newly-diagnosed cancer that was confined to the prostate gland. Among them, 545 men had an open radical prostatectomy, while the remaining 549 men had a robot-assisted operation. Then at two-, six-, 12-, and 24-month intervals, the men responded to questions about their urinary and bowel functioning, ability to engage in sexual activity, energy levels, and emotional state.

What the study found

According to the results, both methods were equally effective at removing cancer from the body, and post-surgical complications between them occurred relatively infrequently. However, there were some short-term differences between the two approaches. For instance, the robotically-treated men had shorter lengths of hospital stay (1.6 days versus 2.1 days on average), and they also reported lower pain scores after surgery. Men who underwent robotically-assisted surgery also reported fewer complications such as blood clots (10 men versus three men), urinary tract infections (33 men versus 23 men), and bladder neck contracture, which is a treatable condition that occurs when scarring in the bladder outflow makes it hard to urinate. In all, 45 men experienced a bladder neck contracture after open surgery, compared to nine men treated with the robotic method.

"With regard to urinary and sexual health, there were no appreciable average long-term differences between the two approaches," said Dr. Peter Chang, a urologist at Harvard-affiliated Beth Israel Deaconess Medical Center in Boston, and the study's lead author, in an email. "This suggests that with high-volume providers in academic centers, quality-of-life outcomes between open and robotic prostatectomy are similar."

Dr. Marc Garnick, the Gorman Brothers Professor of Medicine at Harvard Medical School and Beth Israel Deaconess Medical Center, and editor of Harvard Health Publishing Annual Report on Prostate Diseases, agreed with Dr. Chang's conclusions. "This important study adds clarity to ongoing debates over the superiority of open versus robotic prostatectomy, and confirms little differences between the two methodologies, both in terms of patient satisfaction/outcomes and efficacy of cancer treatment," he said. "The skill and familiarity of the surgeon in performing either method of prostate removal by open or robotic approaches should guide the specific treatment choice."

Let’s face it: inflammation has a bad reputation. Much of it is well-deserved. After all, long-term inflammation contributes to chronic illnesses and deaths. If you just relied on headlines for health information, you might think that stamping out inflammation would eliminate cardiovascular disease, cancer, dementia, and perhaps aging itself. Unfortunately, that’s not true.

Still, our understanding of how chronic inflammation can impair health has expanded dramatically in recent years. And with this understanding come three common questions: Could I have inflammation without knowing it? How can I find out if I do? Are there tests for inflammation? Indeed, there are.

Testing for inflammation

A number of well-established tests to detect inflammation are commonly used in medical care. But it’s important to note these tests can’t distinguish between acute inflammation, which might develop with a cold, pneumonia, or an injury, and the more damaging chronic inflammation that may accompany diabetes, obesity, or an autoimmune disease, among other conditions. Understanding the difference between acute and chronic inflammation is important.

These are four of the most common tests for inflammation:

• Erythrocyte sedimentation rate (sed rate or ESR). This test measures how fast red blood cells settle to the bottom of a vertical tube of blood. When inflammation is present the red blood cells fall faster, as higher amounts of proteins in the blood make those cells clump together. While ranges vary by lab, a normal result is typically 20 mm/hr or less, while a value over 100 mm/hr is quite high.
• C-reactive protein (CRP). This protein made in the liver tends to rise when inflammation is present. A normal value is less than 3 mg/L. A value over 3 mg/L is often used to identify an increased risk of cardiovascular disease, but bodywide inflammation can make CRP rise to 100 mg/L or more.
• Ferritin. This is a blood protein that reflects the amount of iron stored in the body. It’s most often ordered to evaluate whether an anemic person is iron-deficient, in which case ferritin levels are low. Or, if there is too much iron in the body, ferritin levels may be high. But ferritin levels also rise when inflammation is present. Normal results vary by lab and tend to be a bit higher in men, but a typical normal range is 20 to 200 mcg/L.
• Fibrinogen. While this protein is most commonly measured to evaluate the status of the blood clotting system, its levels tend to rise when inflammation is present. A normal fibrinogen level is 200 to 400 mg/dL.

Are tests for inflammation useful?

In certain situations, tests to measure inflammation can be quite helpful.

• Diagnosing an inflammatory condition. One example of this is a rare condition called giant cell arteritis, in which the ESR is nearly always elevated. If symptoms such as new, severe headache and jaw pain suggest that a person may have this disease, an elevated ESR can increase the suspicion that the disease is present, while a normal ESR argues against this diagnosis.
• Monitoring an inflammatory condition. When someone has rheumatoid arthritis, for example, ESR or CRP (or both tests) help determine how active the disease is and how well treatment is working.

None of these tests is perfect. Sometimes false negative results occur when inflammation actually is present. False positive results may occur when abnormal test results suggest inflammation even when none is present.

Should you be routinely tested for inflammation?

Currently, tests of inflammation are not a part of routine medical care for all adults, and expert guidelines do not recommend them.

CRP testing to assess cardiac risk is encouraged to help decide whether preventive treatment is appropriate for some people (such as those with a risk of a heart attack that is intermediate — that is, neither high nor low). However, evidence suggests that CRP testing adds relatively little to assessment using standard risk factors, such as a history of hypertension, diabetes, smoking, high cholesterol, and positive family history of heart disease.

So far, only one group I know of recommends routine testing for inflammation for all without a specific reason: companies selling inflammation tests directly to consumers.

Inflammation may be silent — so why not test?

It’s true that chronic inflammation may not cause specific symptoms. But looking for evidence of inflammation through a blood test without any sense of why it might be there is much less helpful than having routine healthcare that screens for common causes of silent inflammation, including

• excess weight
• diabetes
• cardiovascular disease (including heart attacks and stroke)
• hepatitis C and other chronic infections
• autoimmune disease.

Standard medical evaluation for most of these conditions does not require testing for inflammation. And your medical team can recommend the right treatments if you do have one of these conditions.

The bottom line

Testing for inflammation has its place in medical evaluation and in monitoring certain health conditions, such as rheumatoid arthritis. But it’s not clearly helpful as a routine test for everyone. A better approach is to adopt healthy habits and get routine medical care that can identify and treat the conditions that contribute to harmful inflammation.

We all experience moments of indulgence that lead to overeating. If it happens once in a while, it’s nothing to worry about. If it happens frequently, you may wonder if you have an overeating problem or “food addiction.” Before you worry, know that neither of those is considered an official medical diagnosis. In fact, the existence of food addiction is hotly debated.

“If it exists, food addiction would be caused by an actual physiological process, and you’d experience withdrawal symptoms if you didn’t have certain foods, such as those with sugar. But that’s a lot different than saying you love sugar and it’s hard not to eat it,” notes Helen Burton Murray, a psychologist and director of the Gastrointestinal Behavioral Health Program in the Center for Neurointestinal Health at Harvard-affiliated Massachusetts General Hospital.

Many people unconsciously overeat and don’t realize it until after they finish a meal. That’s where mindfulness exercises can help you stick to reasonable portion sizes.

But she urges you to seek professional help if your thoughts about eating are interfering with your ability to function each day. Your primary care doctor is a good place to start.

What is mindful eating?

Mindfulness is the practice of being present in the moment, and observing the inputs flooding your senses. At meal time: “Think about how the food looks, how it tastes and smells. What’s the texture? What memories does it bring up? How does it make you feel?” Burton Murray asks.

By being mindful at meals, you’ll slow the eating process, pay more attention to your body’s hunger and fullness cues, and perhaps avoid overeating.

“It makes you take a step back and make decisions about what you’re eating, rather than just going through the automatic process of see food, take food, eat food,” Burton Murray says.

Set yourself up for success in being mindful when you eat by:

• Removing distractions. Turn off phones, TVs, and computers. Eat in a peaceful, uncluttered space.
• Pacing yourself for a 20-minute meal. Chew your food slowly and put your fork down between bites.

More mindfulness exercises to try

Practicing mindfulness when you’re not eating sharpens your mindfulness “muscles.” Here are exercises to do that.

• Focused breathing. “Breathe in and breathe out slowly. With each in breath, allow your belly to go out. With each out breath, allow your belly to go in,” Burton Murray explains. “This engages the diaphragm, which is connected to the nerves between the brain and gut and promotes relaxation.”
• Progressive muscle relaxation. In this exercise, you tighten and release one major muscle group at a time for 20 seconds. As you release a contraction, notice how it feels for the muscles to relax.
• Take a mindful walk, even if it’s just for five minutes. “Use your senses to take in your surroundings,” Burton Murray suggests. “What colors are the leaves on trees? Are there cracks on the ground, and where are they? What does the air smell like? Do you feel a breeze on your skin?”
• Practice yoga or tai chi. Both of these ancient martial arts practices include deep breathing and a focus on body sensations.
• Keep a journal. Write down the details of your day. Try to include what your senses took in — the sights, sounds, and smells you experienced, and the textures you touched.

Don’t worry about trying to be mindful all day long. Start with a moment here and there and build gradually. The more mindful you become throughout your day, the more mindful you’ll become when you eat. And you may find that you’re better able to make decisions about the food you consume.

Who are you today? Who were you a decade ago?  For many of us, shifts in our lives — relationships, jobs, friendships, where we live, what we believe — are the only constant. Yet it’s a common misconception that sexual orientation develops at an early age and then remains stable throughout one’s life.

Rather, changes in sexual orientation are a common thread in many people’s lives. People may experience changes in who they are attracted to, who they have sex with, and which labels they use to describe their sexual orientation. Such changes in sexual orientation are called sexual fluidity.

Attraction, identity, and behavior

While anyone can experience changes in their sexual orientation, sexually fluidity is more common in younger people and among people who are LGBTQ+ (lesbian, gay, bisexual, transgender, queer, and additional identities).

Sexual fluidity might include

• changes in attractions: Someone may be attracted to one gender at one time point and attracted to a different gender or more than one gender at another time point.
• changes in identity labels: Someone may identify as lesbian at one time point and as bisexual at another time point.
• changes in sexual behavior: Someone may have a sexual partner at one time point who is a cisgender woman and then have another sexual partner at a different time point who is nonbinary. (A cisgender woman is a person assigned as a female at birth and who identifies as a woman. Someone who is nonbinary was assigned either female or male at birth and identifies as neither a woman nor a man.)

Sexual fluidity happens for many different reasons. For some people, sexual fluidity occurs when they meet people and discover new attractions. For other people, sexual fluidity may occur when they learn a new identity label that better fits their experience.

Misconceptions and stigma about sexual fluidity

Many people may have questions and biases about sexual fluidity. Let’s explore a few.

Are people who identify as bisexual sexually fluid? Some are and others are not. Sexual fluidity is distinct from bisexuality. Sexual fluidity may be experienced by people with any sexual orientation identity, including people who identify as bisexual, lesbian, gay, or heterosexual.

Stigma directed at sexual fluidity (and similar stigma surrounding bisexuality) may stem from misconceptions about changes in sexual orientation. Consciously or unconsciously, some people may believe that anyone who experiences changes in their sexual orientation is promiscuous or incapable of being monogamous. However, such beliefs are untrue.

Misconceptions and stigma can hurt. Growing evidence links different forms of stigma experienced by people who are sexually fluid with more depression and poor mental health. Yet it’s not the change in sexual orientation that raises this risk, nor is it automatic, genetic, or otherwise predestined. The higher risk of mental health concerns among people who experience sexual fluidity is more likely to be related to minority stress — that is, because sexual fluidity is stigmatized, people who experience that stigma may also experience stress that negatively affects their mental health.

Changing misconceptions and stigma about sexual fluidity

We can help normalize sexual fluidity in several ways. First, we can introduce the possibility of changes in sexual orientation as part of sex education in schools and in the doctor’s office. Second, we can work toward responding to sexual fluidity with openness and curiosity rather than making assumptions and viewing these changes as negative. Third, we can move beyond preconceived notions of sexual orientation as stable to expecting change in sexual orientation for some people.

As people experience the world and learn more about themselves, their views, beliefs, and feelings may change. Sexual fluidity reflects one possible change over time, a change that fits into the greater diversity of sexuality. We can all hold space for this diversity by letting go of misconceptions about the stability of sexual orientation over a lifespan and staying open instead to the possibility of change.

Concussions are very common — in fact, they are the most common kind of traumatic brain injury (TBI). While most people recover completely, concussions sometimes lead to lifelong problems, as we’ve learned from the experiences of former National Football League players.

That’s why it’s important that we do everything we can to not just prevent concussions in children and teens, but to give them the right treatment when a concussion happens.

The problem for doctors, parents, and coaches has been that while we want to do the right thing when a child gets a concussion, it’s not always easy to know what the right thing is. To help, the Centers for Disease Control and Prevention (CDC) reviews all the research and makes recommendations to help guide us as we care for children with concussions.

Every child is different, and concussion care should reflect that

The recommendations reflect the fact that every child who has a concussion is different. Every injury is different, obviously, but it’s more than that. Some children are more likely to have trouble, such as those who have had prior concussions or have learning problems, mental health problems, or neurological problems.

Interestingly, children whose families are stressed for reasons such as poverty can take a longer time to recover from concussions. And there is a bit of a wild-card factor too: sometimes children unexpectedly take a long time to recover — or, conversely, recover very quickly.

What are the concussion care recommendations?

Practice guidelines developed by the CDC for health providers include these points:

• Most children with concussions don’t need CT or MRI scans. If there was a severe injury or the child is having severe or unusual symptoms, then it’s worth doing to be sure there isn’t internal bleeding, a fracture, or some other injury. Most of the time with concussions, there is nothing to see — and it’s not worth the risk or expense involved in these imaging studies.
• Use the right tool to make the diagnosis. There are some symptoms we associate with concussion, like bad headache, dizziness, loss of memory of the accident. But because it isn’t always clear, it’s helpful to use a checklist or questionnaire that is validated, meaning that it’s been shown to accurately pick out those with a concussion from those who simply have a bad clunk to the head and not a concussion.
• When a child has a concussion, assess for risk factors for a prolonged recovery. As I said above, some children take longer to get better — and while we can never predict for sure, it’s important to think about that at the time of the injury.

What should parents know about concussions?

• Most children and teens with concussions get completely better within one to three months. But it’s important that children, families, and coaches know what all the symptoms are after a concussion, and understand what’s normal and what is a sign of a problem. For example, trouble sleeping, dizziness, and moodiness can be normal, but if any of those symptoms are getting worse, it’s important to call the doctor.
• Parents can help children return to normal activities after a concussion. Rest — of not just the body, but the mind too — is important for the first two to three days after a concussion, but after that it’s important to start getting back to normal. When people rest completely for longer than that, it actually takes them longer to get better.

Getting back to normal after a concussion

We used to think that total rest of the brain and body after a concussion was the best treatment. Increasingly, research shows that resuming normal activities is the better treatment. For example, recent research analyzing many studies showed that exercise can help speed recovery from concussion. The tricky part is figuring out how best to resume normal activities, because it is different for each child.

The basic idea is to start slow and see how the child does. If they do okay, they can do a bit more schoolwork or exercise. If they don’t do okay — meaning they have more symptoms — they should do less and go more slowly.

The process of getting back to normal life can take a few days, or a few months. It has to be tailored to each child and each situation, which is why collaboration with your pediatrician is so important. It’s also really important not to rush the process, especially when it comes to returning to a sport where concussions are common, such as football, hockey, or soccer. If a child gets another concussion while they are still recovering, it will take them much longer to get better, and put them at risk of permanent disabilities.

To learn more, visit the CDC’s Heads Up page.

Follow me on Twitter @drClaire