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On average, how many hours do you sleep each night? For most healthy adults, guidelines suggest at least seven hours of slumber.

But these are general recommendations and not strict rules. “Some people need less than seven hours, while others might need more,” says Eric Zhou with the Division of Sleep Medicine at Harvard Medical School.

Do you need more or less sleep time?

We get it: you know people who swear they only need five hours of sleep per night, yet you feel foggy unless you log in eight to nine hours. The major reason for individual differences is that we often look at sleep the wrong way.

“Instead of focusing exclusively on the number of hours we sleep per night, we should also consider our sleep quality,” says Zhou.

Sleep quality means how well you sleep during the night. Did you sleep straight through? Or did you have periods where you woke up? If so, did it take you a long time to fall asleep? How did you feel when you woke up?

“If you awaken refreshed and feel like you have the energy to get through your day, then I would worry less about the exact number of hours you’re sleeping,” says Zhou.

How does sleep quality affect your health?

Sleep quality is vital for our overall health. Research has shown that people with poor sleep quality are at a higher risk for diabetes, heart disease, stroke, and mental health issues like anxiety and depression.

And that’s not all. “Poor sleep also can increase daytime fatigue and make it more difficult to enjoy life,” says Zhou.

Yet it’s normal for people’s sleep patterns to change over time. “Many people are not going to sleep in their 50s and 60s exactly like they did in their 20s,” says Zhou.

Many of these changes are age-related. For instance, your circadian rhythm — which regulates many bodily functions, including our sleep-wake cycle — can naturally get disrupted over time. This means people spend less time each night in restorative slow-wave sleep.

Production of melatonin, the sleep hormone, also gradually declines with age. “As a result of these changes, when we get older we may start to wake up earlier than we did when we were younger, or wake up more frequently during the night,” says Zhou.

How can you track sleep quality?

How can you better understand the factors likely contributing to your sleep quality? One way is to keep a sleep diary where you track and record your sleep.

Every day, record the time you went to bed, how long it took you to fall asleep, whether you had any nighttime awakenings (and if so, how long you were awake), and at what time you woke up. Also, keep track of how you feel upon awakening and at the end of the day.

“After a week or two, review the information to see if you can identify certain patterns that may be affecting your sleep quality, then make adjustments,” says Zhou.

For example, if you have trouble falling asleep, go to bed half an hour later than usual but maintain the same wake-up time. “It is common for people struggling with their sleep to try to get more sleep by staying in bed longer, but this disrupts their sleep patterns and diminishes their sleep quality,” says Zhou.

Three key strategies to support the quality of your sleep

Other strategies that can help support good sleep quality include:

• maintaining a consistent wake time, especially on weekends
• limiting daytime naps to 20 to 30 minutes, and at least six hours before the desired bedtime
• being physically active.

When it comes to sleep quality, consistency is vital. “People with good sleep quality often have a predictable sleep window where their sleep occurs,” says Zhou. “Good sleepers are likely to sleep around the same number of hours and stay asleep through the night.”

The bottom line on getting restful sleep

It’s unrealistic to expect perfect sleep every night. “If you have trouble sleeping one or two nights during the week, that can be related to the natural ebbs and flows of life,” says Zhou. “You may have eaten a big meal that day, drank too much alcohol while watching football, or had a stressful argument with someone. When tracking sleep quality, look at your overall sleep health week-to-week, not how you slept this Tuesday compared to last Tuesday.”

If you are doing all the right things for your sleep but still do not feel rested upon waking, talk to your doctor. This can help you rule out a sleep disorder like sleep apnea, or another health issue that can interfere with sleep such as acid reflux or high blood pressure. Other factors that can affect the quality of your sleep include taking multiple medicines, depression, anxiety, loneliness, and environmental changes like temperature, noise, and light exposure.

About the Author

Matthew Solan, Executive Editor, Harvard Men's Health Watch

Matthew Solan is the executive editor of Harvard Men’s Health Watch. He previously served as executive editor for UCLA Health’s Healthy Years and as a contributor to Duke Medicine’s Health News and Weill Cornell Medical College’s … See Full Bio View all posts by Matthew Solan

About the Reviewer

Howard E. LeWine, MD, Chief Medical Editor, Harvard Health Publishing

Dr. Howard LeWine is a practicing internist at Brigham and Women’s Hospital in Boston, Chief Medical Editor at Harvard Health Publishing, and editor in chief of Harvard Men’s Health Watch. See Full Bio View all posts by Howard E. LeWine, MD

Blood circulation is vital to our health. Our arteries deliver oxygen, energy-rich nutrients, hormones, immune cells, and other essentials throughout the body. When deliveries are cut off, organs and tissue can be irreversibly damaged within minutes.

But a second part of blood circulation is also vitally important: the return trip. After our arteries deliver the goods, our blood must return to the lungs to pick up more oxygen, stock up on nutrients, get rid of carbon dioxide, and head back to the heart to be pumped out again. In this way, blood is in continuous motion, ensuring organs and tissues get what they need while waste products are removed.

The vessels designed for the return trip are your veins. Read on for answers to questions about how veins work, what can interfere with their ability to work smoothly, and five ways to keep thousands of miles of these blood vessels healthy.

What are veins and what do they do?

Perhaps you haven't thought much about your veins. Or if you have, maybe you focused on varicose veins, those swollen, unsightly purplish vessels that may be visible just beneath the skin of the legs. Or perhaps you had a blood test and the person taking the blood had a hard time finding a "good vein." But these are just a small part of vein world.

Veins make up a network of connecting tubes throughout the human body, ranging in size from 1 mm (about the size of a pencil point) to 2 cm (about the size of a quarter), that bring blood low in oxygen back to the lungs to reload with oxygen. Then four pulmonary veins carry oxygen-rich blood from the lungs to the heart. (Fun fact: some people have three or five pulmonary veins, but most of us have four.)

Often, major veins are found alongside similarly named arteries, like a highway with cars moving in opposite directions: in the upper arm, for example, the axillary vein lies next to the axillary artery; in the kidney, the renal vein runs alongside the renal artery.

How do veins help keep blood flowing?

Let's start by picturing tiny red blood cells loaded up with oxygen. Now imagine you're a red blood cell that has just traveled from the heart through the arteries to a calf muscle of someone who is jogging. After you drop off the much-needed oxygen and pick up waste products like carbon dioxide, you need to get back to the heart — fast! — because exercising muscles need extra oxygen.

But wait. As you head back to the lungs to load up on more oxygen and release carbon dioxide, there's a steep climb straight up. How can you make it back to the lungs without help?

Fortunately, veins have tiny valves within them that allow blood to flow in only one direction. When muscles contract near larger veins, they pump blood toward the lungs. In addition, taking in a breath creates a sort of suction that pulls blood toward the lungs. Without these forces encouraging blood to flow in the right direction through the veins, blood flowing into the legs would pool there, causing dangerously high pressure and swelling.

Why are veins blue?

Actually, they aren't. People think they're blue because that's often how they appear in diagrams and illustrations. But that's just to set them apart from the bright red arteries.

The veins on the back of your hand may appear blue if you have light-colored skin. That's an illusion due to the way light is absorbed by the skin. In people with darker skin tones, veins tend to blend in more.

If you could look at veins directly, without any skin in the way, they'd appear pale because they are naturally colorless, or dark red due to the blood inside them.

What sort of problems can occur in veins?

Blood clots, varicose veins, and venous insufficiency are some of the most common health conditions affecting the veins:

• Deep vein thrombosis (DVT) occurs when a blood clot forms in a deep vein, blocking blood flow. This condition is potentially serious because clots in deep veins can travel to the lungs, causing a life-threatening pulmonary embolism by blocking an artery that delivers blood to part of the lungs.
• Superficial thrombophlebitis is a blood clot in a small vein just under the skin. This causes inflammation and pain.
• Varicose veins are small veins under the skin that swell and twist. While these may be harmless, they can cause pain and are occasionally complicated by blood clots.
• Venous insufficiency occurs when the valves in veins are damaged — due to aging or prior blood clots, for example. The blood flow through the veins may be impaired, leading to leg swelling, increased pressure, inflamed skin, and poor healing.

One far more rare condition goes by the impressive name of phlegmasia cerulea dolens. It is a serious complication of DVT in which the obstruction of blood flow through a deep vein leads to blocked blood flow through nearby arteries. That can cause gangrene and the need for amputation.

All of these conditions can affect circulation temporarily or in a lasting way. Treatments are aimed at restoring circulation, if possible.

Top 5 ways to improve vein health

Healthy veins help the heart, brain, and every other part of your body. Here are five ways to improve vein health, even if you already have vein disease:

• Be active. Exercise regularly and avoid prolonged standing or sitting.
• Choose healthy foods, such as those in a plant-based, heart-healthy diet.
• Maintain a healthy weight.
• Don't smoke.
• Wear compression stockings if you already have vein disease such as venous insufficiency.

And of course, seek medical care for unexplained swelling, inflammation, or ulcers on your legs, ankles, or feet.

The bottom line

Our veins are busy around the clock, shuttling blood from distant sites back to the lungs and heart, which pumps enriched blood out again. Without veins, blood circulation could not happen. They're a good example of how many parts of your amazing body are easy to overlook until something goes wrong.

About the Author

Robert H. Shmerling, MD, Senior Faculty Editor, Harvard Health Publishing; Editorial Advisory Board Member, Harvard Health Publishing

Dr. Robert H. Shmerling is the former clinical chief of the division of rheumatology at Beth Israel Deaconess Medical Center (BIDMC), and is a current member of the corresponding faculty in medicine at Harvard Medical School. … See Full Bio View all posts by Robert H. Shmerling, MD

One of the many underappreciated things about the human body is that it has a lot of excess capacity. That is, our organs have more reserve than most of us will ever need.

It’s as if our bodies were designed with the idea that we might need backups in case of illness or injury. And voila: when all goes well, we arrive at birth with two kidneys, not just one!

Of course, the kidneys are not the only example. So, why are we built with natural redundancy? And which of your body parts can safely fail or be removed without impairing your health?

Why do our organs have so much reserve?

The likely answer is evolution: early humans with a genetic makeup that produced organs with functional space to spare were better able to survive, thrive, and reproduce than others without such a genetic makeup. As a result, genes associated with excess organ capacity — remember: two kidneys, not one — were more likely to be passed down to future generations.

Meanwhile, evolutionary ancestors without as much reserve may not have survived long enough to reproduce, and so weren’t as successful at passing their genes along. Over thousands of years, this power of natural selection has led to modern-day humans having organs with plenty of reserve.

Eyes, liver, lungs, and more

Here’s just a partial list of body parts with plenty of reserve:

• Eyes: You can be perfectly healthy with one eye, although you may miss the depth perception and larger field of vision provided by having two. Even losing both eyes does not directly lead to poor health, though obviously blindness can pose challenges and impact quality of life. Additionally, studies suggest that significant vision impairment may raise the risk of Alzheimer’s disease.
• Ears: Although having two ears allows us to locate sounds from all directions, losing hearing in one or both ears doesn’t immediately impact overall health. But as with vision loss, quality of life can be diminished by hearing loss. And as with vision loss, recent studies suggest that people with hearing impairment are at an increased risk of developing cognitive problems.
• Gut: Relatively large portions of the small and large intestines can be removed without having a major impact on your health. In fact, the entire colon can be removed (an operation called pancolectomy) without shortening a person's life, although diarrhea or other digestive symptoms may follow. Removing a section of bowel is a relatively common operation (for colon cancer, for example), but the removal of part of the bowel doesn’t itself impair health or shorten lifespan.
• Kidneys: Most people can live perfectly well with only one kidney. That's why people can donate a kidney to someone in need. However, the remaining kidney must work harder, and the risk of future kidney failure does increase somewhat. In addition, an injury, infection, or other disease affecting the remaining kidney can lead to kidney failure more quickly than usual.
• Lungs: When necessary, an entire lung can be removed, and you can rely on the other lung and function quite well. A lung may be removed due to a tumor, but occasionally it's done because of infection or emphysema.
• Liver: A relatively large portion of the liver can be removed (assuming the rest of the liver is healthy) because there is so much “reserve” liver tissue, and because the liver has an ability to regenerate.

Does this mean many parts of our bodies are truly expendable?

Maybe. If you’re only considering survival, you could view many of our body parts as expendable. Indeed, you could survive without your spleen, much of your liver, your eyes, your ears, a lung, a kidney, and other parts.

But clearly, there are factors to consider other than survival, especially quality of life. So, no one would suggest parting with even the least useful organs without a good reason.

The bottom line

It’s fortunate that our organs have so much reserve: millions of people worldwide owe their very survival to the fact that our organs have so much redundancy. And living organ donors can give up a kidney or a portion of another organ to help others live well and still be healthy.

So, even if some parts aren’t absolutely necessary, it’s good to know there’s so much reserve available. You never know when it might come in handy.

About the Author

Robert H. Shmerling, MD, Senior Faculty Editor, Harvard Health Publishing; Editorial Advisory Board Member, Harvard Health Publishing

Dr. Robert H. Shmerling is the former clinical chief of the division of rheumatology at Beth Israel Deaconess Medical Center (BIDMC), and is a current member of the corresponding faculty in medicine at Harvard Medical School. … See Full Bio View all posts by Robert H. Shmerling, MD

The holidays, as painted by idealists, are hardly the time for disagreements. They’re supposed to be filled with love, laughter, good cheer, and those tiny sparkly lights that make the mood feel festive. Unfortunately, joyous celebration often deteriorates into epic discord when family and friends gather during the season. But you don’t have to get drawn into arguments if you plan ahead and stay alert for potential triggers.

Why do we fight at the holidays?

In many ways, we are primed for holiday arguments. “It’s a stressful time. Buying gifts can lead to financial worries. The weather is colder. Days are darker. We’re trying to juggle work and get time off,” says Justin Gillis, a clinical therapist at Harvard-affiliated McLean Hospital. “The holidays can also elicit painful memories or make us face unfortunate realities in our lives, such as a lack of family or close support.”

As a result, we are often emotionally vulnerable during the holidays, Gillis says. It’s hard to manage intense feelings, express ourselves accurately, or be open and nonjudgmental.

“When we increase emotional arousal, it impacts our reasoning and subsequent behaviors. So we may be more defensive, or express ourselves in ways that result in conflict,” Gillis says.

Drinking alcohol at holiday gatherings can also fuel arguments, since alcohol lowers inhibitions and makes it harder to remain calm or maintain composure. In a 2021 survey from the American Addiction Centers, 57% of 3,400 respondents said they had at least one family member who becomes argumentative at holiday gatherings after imbibing too much.

Plan ahead to help defuse emotions and arguments

It’s challenging to control emotions in a heated moment. A bit of planning can help you avoid potential arguments or take appropriate action if angry words start flying. Here are some helpful tips.

Set a time limit. If you’re hosting the event, let your guests know in advance what time the festivities will end. If you’re attending the event, tell the host in advance when you’ll have to leave. “Stick to the plan, even if things are going well, so you can end on a high note,” Gillis says.

Ask for help. To help you rein in reactivity, ask someone you trust to give you a sign if a conversation appears to be risky or escalating. “They can chime in and ask you to do something, which is code for, ‘Back out or take a break.’ Doing that will ensure that you separate from the discussion,” Gillis says.

Schedule breaks. Think about when and how you’ll be able to take breaks during a gathering. This gives you an opportunity to check in with your emotions. “You might go into another room and take a moment to breathe deeply, volunteer to help set the table or clean up, or excuse yourself to make a phone call, even if nothing is wrong,” Gillis suggests. “These can be welcome distractions that limit the chance for conflict.”

Prepare words of deflection. If you know loved ones might ask questions that will lead to conflict, have a prepared answer and practice it. “Make a statement acknowledging the person’s feelings and letting them know it’s best for the topic to change,” Gillis says. He suggests using a version of the following statements.

• “I appreciate your thoughts, but let’s talk about something we agree on or share.”
• “I care about you, but I’m starting to feel sad and I don’t want to continue a negative conversation.”
• “I appreciate and respect your passion about this, but I don’t think I can talk about this anymore.”

How to de-escalate arguments

If you find that heated debates or arguments are brewing — or boiling over — you can still take a few steps to defuse the situation. Use the deflection statements you practiced, or excuse yourself from the conversation to go do another activity.

Other tips to keep in mind:

Don’t take the bait. Don’t answer nosy questions if you don’t want to. “Change the subject. Move the focus back onto the other person and ask how they’re doing,” Gillis says. And if someone asks a loaded question (such as, “I suppose you voted for that candidate?”), use humor if appropriate (“Let’s talk about the Bruins instead”) and change the subject or the activity.

Adjust your mindset. “We have to accept that there are perspectives we don’t like and that engaging in conflict isn’t likely to change anyone’s perspective,” Gillis says. “You can choose not to participate in an unhealthy conversation.”

Respond with kindness. “If someone is angry with you, that suggests they really care what you think. Remember that and try to maintain a compassionate stance and response,” Gillis advises.

Remember why you’re there. The goal of the gathering is celebrating, not solving painful or controversial issues. “It’s the holiday. It doesn’t have to be the day when everyone puts their cards on the table to work out problems,” Gillis says. “Make it festive and enjoyable so you can feel that you created a pleasant holiday memory together.”

About the Author

Heidi Godman, Executive Editor, Harvard Health Letter

Heidi Godman is the executive editor of the Harvard Health Letter. Before coming to the Health Letter, she was an award-winning television news anchor and medical reporter for 25 years. Heidi was named a journalism fellow … See Full Bio View all posts by Heidi Godman

About the Reviewer

Howard E. LeWine, MD, Chief Medical Editor, Harvard Health Publishing

Dr. Howard LeWine is a practicing internist at Brigham and Women’s Hospital in Boston, Chief Medical Editor at Harvard Health Publishing, and editor in chief of Harvard Men’s Health Watch. See Full Bio View all posts by Howard E. LeWine, MD

Nearly a century ago, surgeons developed what is still considered the gold-standard treatment for benign prostatic hyperplasia (BPH), an age-related affliction that occurs when an enlarged prostate obstructs the flow of urine.

Offered to men who don't respond to BPH medication, this procedure, called a transurethral resection of the prostate, or TURP, involves trimming excess prostate tissue with an electric loop. Roughly 90% of treated men achieve long-lasting relief, but they typically also have to spend a night recovering in the hospital, and many are left unable to ejaculate.

Newer, minimally-invasive BPH procedures offer faster recovery times and fewer risks of complications. Where a TURP cuts directly into the prostate, these alternate procedures treat BPH in other ways — for instance, by using steam, microwaves, or lasers to treat the obstructing tissues.

Minimally-invasive procedures are gaining in popularity, and earlier this year another won the FDA's approval. Called the Optilume BPH catheter system, it provided sustained relief from BPH symptoms that continued holding up after four years, according to study results presented at the 2023 Annual Meeting of the American Urological Association, in April.

The procedure and the study

During an Optilume procedure, doctors thread an inflatable catheter toward the prostate through the urethra, which is the tube that carries urine out of the bladder. The catheter splits the two halves of the prostate (which are called lobes), creating a V-shaped channel in the top of the gland that reduces pressure on the urethra, improving urinary flow rates. Importantly, the catheter is coated with a chemotherapy drug, paclitaxel, that helps to limit treatment-related inflammatory responses. After the catheter is removed, the channel in the prostate remains.

Dr. Steven Kaplan, professor of urology at the Icahn School of Medicine at Mount Sinai in New York, led the studies leading to the FDA's approval. He says symptom improvements with the new system rival those achieved with TURP. "We're pretty excited about it," he says. "This is a potential game changer."

During the research, Dr. Kaplan's team measured changes in the International Prostate Symptom Score (IPSS), which ranges from 0 to 35 and classifies BPH as either mild, moderate, or severe. According to results from the first clinical trial, called the PINNACLE study and limited to men with prostates ranging from 20 to 80 grams in size, Optilume treatment produced immediate benefits. At one year, IPSS scores among treated men were 11.5 points lower on average than those reported at baseline.

Follow-up and commentary

Follow-up evaluations for men enrolled in the second clinical trial, called the EVEREST study, are still ongoing. But results available so far — again for prostates no larger than 80 grams — show IPSS scores dropping from 22.5 at baseline to 11.5 four years after treatment, with no significant changes in ejaculatory functioning.

"Numerous innovative treatment alternatives for BPH have emerged over the years," says Dr. Heidi Rayala, a urologist affiliated with Beth Israel Deaconess Medical Center, an assistant professor at Harvard Medical School, and a member of the editorial board of the Harvard Medical School Annual Report on Prostate Diseases. "TURP still stands as the benchmark, given that many initially promising technologies have faltered due to loss of efficacy over time. Nonetheless, recent advancements like Optilume offer exciting prospects for enhanced durability with reduced side effects.

"It's essential to note that Optilume's efficacy varies based on prostate size and patient symptoms. Matching the appropriate surgical approach to the individual patient will remain crucial as patients and their urologists evaluate the optimal choice within the spectrum of minimally-invasive therapies."

About the Author

Charlie Schmidt, Editor, Harvard Medical School Annual Report on Prostate Diseases

Charlie Schmidt is an award-winning freelance science writer based in Portland, Maine. In addition to writing for Harvard Health Publishing, Charlie has written for Science magazine, the Journal of the National Cancer Institute, Environmental Health Perspectives, … See Full Bio View all posts by Charlie Schmidt

About the Reviewer

Marc B. Garnick, MD, Editor in Chief, Harvard Medical School Annual Report on Prostate Diseases; Editorial Advisory Board Member, Harvard Health Publishing

Dr. Marc B. Garnick is an internationally renowned expert in medical oncology and urologic cancer. A clinical professor of medicine at Harvard Medical School, he also maintains an active clinical practice at Beth Israel Deaconess Medical … See Full Bio View all posts by Marc B. Garnick, MD

Small animals like turtles, iguanas, and frogs are often chosen as first-time pets for children because they are easy to interact with and low maintenance for busy households. While they can be fun, it may be best to avoid them.

The reason? “Reptiles and amphibians can carry germs that make people sick, the most common of which is the Salmonella bacteria,” says Dr. Elizabeth Hohmann, an infectious disease expert with Harvard-affiliated Massachusetts General Hospital. “These animals live in warm and wet environments where Salmonella thrives.”

Outbreaks of illness across the US

Reptiles and amphibians often carry Salmonella in their digestive tracts, although the bacteria doesn’t affect them. The risk of illness from these pets became so severe this year that the CDC warned about adopting tiny pet turtles after reported outbreaks of Salmonella illnesses and hospitalizations in 24 states. (Other small pets such as mice or hamsters, and farm animals like chickens, may also carry and spread the bacteria.)

How is the bacteria transferred from pets to children and adults?

People become exposed to Salmonella through physical contact with the animals, their droppings, food, items like toys or food dishes, and habitats such as cages, tanks, aquariums, and water.

“They get the bacteria on their hands and then inadvertently touch their mouths or nose,” says Dr. Hohmann. This is especially likely in younger children.

Once exposed to the bacteria, people can get an infection called salmonellosis.

Who is more likely to get sick?

Anyone can get salmonellosis, but children younger than age 5, adults 65 and older, and people with chronic conditions are at higher risk for severe illness and even hospitalization.

“Kids that are very young don’t always follow proper personal hygiene or understand safety protocol when handling these animals,” says Dr. Hohmann. “Older adults and people with chronic conditions like diabetes can have weakened immune systems that make them more susceptible to illnesses.” In the most serious cases, the bacteria can reach the bloodstream and from there infect other places within the body.

What are the symptoms of this infection?

The hallmarks are diarrhea, fever, and abdominal cramps. These symptoms usually appear within six hours to four days after infection and last about four to seven days.

Call your pediatrician or primary care team for advice if you have a pet that potentially carries Salmonella.

When should you seek immediate medical care?

Seek medical care immediately if you or your child have any of these severe symptoms:

• diarrhea and a fever higher than 102° F
• diarrhea for more than three days that is not improving
• bloody diarrhea
• so much vomiting that you cannot keep liquids down
• signs of dehydration such as not urinating much, dry mouth and throat, or feeling dizzy when standing up.

What if you already have a pet turtle?

If you already have a pet turtle or similar high-risk pet, make sure everyone follows these safety steps from the CDC. Children may need frequent reminders about washing hands and playing safely.

Wash hands. Always wash hands for at least 20 seconds with plenty of soap and warm water right after touching or feeding your pet, and after handling or cleaning the area where it lives and roams. “Adults should make sure to teach young children how to wash their hands properly,” says Dr. Hohmann.

Play safely. Don’t kiss or snuggle the pet, and don’t eat or drink around it. Keep it out of the kitchen and other areas where you eat, store, or prepare food.

Properly clean. Use cleaning materials like a wash tub, sponge, and scrub that are reserved only for your pet. Always clean cages, tanks, and other pet items outdoors. Avoid using a kitchen sink, as this can increase the risk of spreading germs to your food.

But perhaps the best safety advice is to simply avoid these animals as pets — or at least wait until your kids are much older, says Dr. Hohmann. “It’s probably safer to stick with dogs and cats.”

About the Author

Matthew Solan, Executive Editor, Harvard Men's Health Watch

Matthew Solan is the executive editor of Harvard Men’s Health Watch. He previously served as executive editor for UCLA Health’s Healthy Years and as a contributor to Duke Medicine’s Health News and Weill Cornell Medical College’s … See Full Bio View all posts by Matthew Solan

About the Reviewer

Howard E. LeWine, MD, Chief Medical Editor, Harvard Health Publishing

Dr. Howard LeWine is a practicing internist at Brigham and Women’s Hospital in Boston, Chief Medical Editor at Harvard Health Publishing, and editor in chief of Harvard Men’s Health Watch. See Full Bio View all posts by Howard E. LeWine, MD

Cellulitis is an infection of the deep layers of the skin. It develops when bacteria enter through a cut, bite, or wound — including tiny breaks in cracked, dry skin. Common skin-dwelling bacteria, Staphylococcus or Streptococcus, are the usual culprits. Although cellulitis can occur anywhere on the body, the most common location is the lower leg.

Dr. Arash Mostaghimi, a dermatologist at Brigham and Women’s Hospital and associate professor of medicine at Harvard Medical School, weighs in on new research that explores important questions about how long it takes to fully heal.

What are the symptoms of cellulitis?

The body’s natural immune response to this bacterial invasion triggers a painful rash that appears red on lighter skin and dark purple on darker skin. The affected area also may be swollen and feel warm.

How is cellulitis treated?

The typical treatment is five to 10 days of antibiotic pills. More serious cases may require intravenous antibiotics.

How quickly can antibiotics help cellulitis resolve?

After starting antibiotic treatment, people usually notice improvement within a few days. However, the area may remain swollen, warm, and painful even after 10 days.

Does that mean the antibiotic treatment was ineffective? Not necessarily, according to a recent study of people with cellulitis in the lower leg that described the natural history of the healing stages following antibiotics.

“The healing process has two parts, which is why a full recovery takes longer than you might think,” says Dr. Mostaghimi.

First, the antibiotics and your white blood cells work together to kill the bacteria. But your body’s immune response against the bacteria may take a while to shut down. As a result, this second stage of the healing process may include some residual symptoms, he explains.

What did the study find?

The study included 247 people with mild to moderate cellulitis of the lower leg who received antibiotics for seven to 10 days. By day 10:

• Their swelling had lessened by 50%, and the size of the affected area had shrunk by about 55%.
• A blood marker of inflammation, C-reactive protein, dropped during treatment and reached near-normal levels in all the participants.
• Still, more than half continued to report discomfort in the affected leg, with 14% ranking their pain as 5 or greater on a scale of 1 to 10.

This pattern of discomfort isn’t unusual, especially with leg infections, says Dr. Mostaghimi. As people are recovering from leg cellulitis, they’re often advised to elevate the leg, which helps to ease the swelling. (Putting a warm, moist washcloth on the area may also help.)

But after they feel better and start walking more, fluid shifts back down into the legs. So it’s not surprising that the area might feel a little swollen and uncomfortable again once they’re back on their feet, he says.

Who is at greatest risk for cellulitis?

Remember, cellulitis typically occurs when bacteria normally present on our skin manage to breach that shield to enter the body.

Some people who develop cellulitis have no obvious injury or skin damage to explain the infection, which can occur in people who are generally healthy. However, people with certain health problems are more prone to cellulitis. This includes people who are overweight or have diabetes, a weakened immune system, poor circulation, or chronic edema (swollen limbs).

Additionally, skin conditions such as eczema and athlete’s foot can create small cracks in the skin that make it easier for bacteria to penetrate deeper into the skin, Dr. Mostaghimi says. Scratching a bug bite until it bleeds is another possible entry point for bacteria.

What happens if cellulitis goes untreated?

Untreated cellulitis can be very serious. The rash may spread, be surrounded with blisters, and become increasingly painful. Nearby lymph nodes may become tender and swollen, followed by fever and chills. Seek medical care right away if you experience these symptoms.

The bottom line

“It’s important for people with leg cellulitis to realize that it may take a bit longer after finishing your antibiotics for all of your symptoms to completely resolve,” says Dr. Mostaghimi. You’ll probably start to feel better within a few days, but always finish all the pills in your antibiotic prescription. However, having residual symptoms once you’re done does not mean you need another course of antibiotics or a different antibiotic, he says.

About the Author

Julie Corliss, Executive Editor, Harvard Heart Letter

Julie Corliss is the executive editor of the Harvard Heart Letter. Before working at Harvard, she was a medical writer and editor at HealthNews, a consumer newsletter affiliated with The New England Journal of Medicine. She … See Full Bio View all posts by Julie Corliss

About the Reviewer

Howard E. LeWine, MD, Chief Medical Editor, Harvard Health Publishing

Dr. Howard LeWine is a practicing internist at Brigham and Women’s Hospital in Boston, Chief Medical Editor at Harvard Health Publishing, and editor in chief of Harvard Men’s Health Watch. See Full Bio View all posts by Howard E. LeWine, MD

You may have heard recent news reports about a company that knowingly sold defective lead testing machines that tested tens of thousands of children between 2013 and 2017. Or wondered about lead in tap water after the widely reported problems with lead-contaminated water in Flint, Michigan. Reports like these are reminders that parents need to be aware of lead — and do everything they can to keep their children safe.

How is lead a danger to health?

Lead is poisonous to the brain and nervous system, even in small amounts. There really is no safe level of lead in the blood. We particularly worry about children under the age of 6. Not only are their brains actively developing, but young children commonly touch lots of things — and put their hands in their mouths. Children who are exposed to lead can have problems with learning, understanding, and behavior that may be permanent.

How do children get exposed to lead?

In the US, lead used to be far more ubiquitous than it is now, particularly in paint and gas. Yet children can be exposed to lead in many ways.

• Lead paint. In houses built before 1978, lead paint can sometimes be under other paint, and is most commonly found on windowsills or around doors. If there is peeling paint, children can sometimes ingest it. Dust from old paint can land on the floor or other surfaces that children touch with their hands (and then put their hands in their mouths). If there was ever lead paint on the outside of a house, it can sometimes be in the dirt around a house.
• Leaded gas. While leaded gas was outlawed in 1996, its use is still allowed in aircraft, farm equipment, racing cars, and marine engines.
• Water passing through lead pipes. Lead can be found in the water of older houses that have lead pipes.
• Other sources. Lead can also be found in some imported toys, candles, jewelry, and traditional medicines. Some parents may have exposure at work or through hobbies and bring it home on their hands or clothing. Examples include working in demolition of older houses, making things using lead solder, or having exposure to lead bullets at a firing range.

What can parents do to protect children from lead?

First, know about possible exposures.

• If you have an older home, get it inspected for lead if you haven’t done so already. (If you rent, federal law requires landlords to disclose known lead-based paint hazards when you sign a lease.) Inspection is particularly important if you are planning renovations, which often create dust and debris that increase the risk of exposure. Your local health department can give you information about how to do this testing. If there is lead in your home, don’t try to remove it yourself! It needs to be done carefully, by a qualified professional, to be safe.
• Talk to your local health department about getting the water in your house tested. Even if your house is new, there can sometimes be older pipes in the water system. Using a water filter and taking other steps can reduce or eliminate lead in tap water.
• If you have an older home and live in an urban area, there can be lead in the soil. You may want to have the soil around your house tested for lead. Don’t let your child play in bare soil, and be sure they take off their shoes before coming in the house and wash their hands after being outside.
• Learn about lead in foods, cosmetics, and traditional medications.
• Learn about lead in toys, jewelry, and plastics (yet another reason to limit your child’s exposure to plastic).

Second, talk to your pediatrician about whether your child should have a blood test to check for lead poisoning. The American Academy of Pediatrics recommends:

• Assessing young children for risk of exposure at all checkups between 6 months and 6 years of age, and
• Testing children if a risk is identified, particularly at 12 and 24 months. Living in an old home, or in a community with lots of older homes, counts as a risk. Given that low levels of lead exposure that can lead to lifelong problems do not cause symptoms, it’s always better to be safe than sorry. If there is any chance that your child might have an exposure, get them tested.

How is childhood lead exposure treated?

If your child is found to have lead in their blood, the most important next step is to figure out the exposure — and get rid of it. Once the child is no longer exposed, the lead level will go down, although it does so slowly.

Iron deficiency makes the body more vulnerable to lead poisoning. If your child has an iron deficiency it should be treated, but usually medications aren’t used unless lead levels are very high. In those cases, special medications called chelators are used to help pull the lead out of the blood.

For more information, visit the Centers for Disease Control and Prevention website on lead poisoning prevention.

About the Author

Claire McCarthy, MD, Senior Faculty Editor, Harvard Health Publishing

Claire McCarthy, MD, is a primary care pediatrician at Boston Children’s Hospital, and an assistant professor of pediatrics at Harvard Medical School. In addition to being a senior faculty editor for Harvard Health Publishing, Dr. McCarthy … See Full Bio View all posts by Claire McCarthy, MD

Once babies are a year old, those who have been drinking infant formula don’t need it anymore. By that age, they can and should get most of their nutritional needs met by solid foods. Drinking cow’s milk, or a fortified plant milk such as soy milk, is perfectly fine. And honestly, they don’t even need that much of it.

A 2023 report from the American Academy of Pediatrics (AAP) looked closely at what toddlers actually need for healthy growth and development — and toddler milks didn’t make the cut. Here are a few key takeaways for parents.

Is toddler formula more nutritious than milk?

No. But for some parents, it feels odd and uncomfortable to stop formula and give cow’s milk. They feel like formula is more nutritious and maybe even more easily digested. That may not be surprising: a lot of marketing money has encouraged people to think this way.

So it’s understandable that some parents turn to formulas marketed for toddlers. It’s especially understandable given the claims that formula companies make about the nutritional advantages of toddler formula. You may have seen — or bought — these products marketed purely as “follow-up formulas,” “transition formulas,” or “growing-up milks.” These formulas do not have a medical purpose. They simply help companies keep the customers they would otherwise lose once babies turn a year old.

Not only are toddler formulas unnecessary, some of them are actually worse than cow’s milk. That’s the main message shared by the AAP, which hopes to help parents understand what older infants and toddlers actually need — and see through the marketing claims.

Do some toddlers need specialized formulas?

Yes. Just to be clear, I am not talking about specialized formulas for children over 12 months who have digestive, metabolic, or other medical problems.

Are toddler formulas regulated in any way?

No. Because infant formulas must meet all the nutritional requirements of babies less than 12 months of age, they are regulated by the FDA. The FDA has requirements about what they must and must not contain, and it makes sure that the facilities where infant formulas are made are regularly inspected.

This is not true of toddler formulas. They are not regulated, and not required to prove any of the claims they make about their nutritional benefits.

What might make a toddler formula unhealthy?

Given the lack of regulation, it’s not surprising that there is wide variation in the composition of toddler formulas. But what is particularly worrisome, says the AAP, is that some of these products are actually unhealthy. They may have too little or too much protein, or have added sweeteners. These added sweeteners can build a child’s “sweet tooth” and set them on the path to obesity.

Additionally, toddler formulas are more expensive than cow’s milk, creating a financial burden for families — one that is definitely not worth it.

Is your toddler’s diet healthy?

Instead of reaching for a toddler formula, try to take a broader look at your child’s diet. Toddlers should eat from the same healthy food groups we all need. This includes

• fruits and vegetables
• whole grains
• protein (such as meat, fish, beans, and nut butters)
• dairy or dairy substitutes fortified with calcium and vitamin D.

Limit added sugars, and after age 2 try to limit less-healthy fats in the child’s diet as well. The best way to build healthy lifetime habits is to start early, and this is particularly true of nutrition.

About the Author

Claire McCarthy, MD, Senior Faculty Editor, Harvard Health Publishing

Claire McCarthy, MD, is a primary care pediatrician at Boston Children’s Hospital, and an assistant professor of pediatrics at Harvard Medical School. In addition to being a senior faculty editor for Harvard Health Publishing, Dr. McCarthy … See Full Bio View all posts by Claire McCarthy, MD

Looking for gifts to give or donate this year? Climate-conscious gifts come in many guises. They may directly support our environment, for example, or aim to reduce fossil fuel use and electronic, textile, and food waste. Or they might offer enjoyable, creative ways to connect, reuse, and recycle — and possibly even regift.

"Our purchases and choices impact our climate and planet," notes Dr. Wynne Armand, a physician and associate director of the Massachusetts General Hospital Center for the Environment and Health. Small steps like these do help, she says, even when the complex issues of climate change leading to health-compromising pollution, extreme weather, and a stressed planet feel so large and overwhelming.

"Unquestionably, we need bold, strong leaders to seek policy changes that address these problems at a systems level. But, as individuals we can make a difference through small steps," says Dr. Armand. "Our choices help drive cultural and market shifts that hopefully push our neighbors, businesses, and policy leaders in the right direction."

Four climate-conscious principles for gifting

• Channel the 5 Rs. Refuse, reduce, reuse, repurpose, and only then recycle. Say no to excess. Comic sections from print newspapers or beautiful images from last year's calendars or magazines make great envelopes and gift wrap. If you're choosing clothes, consider buying upcycled clothing or at resale shops, as appropriate.
• Beware of greenwashing. Eco-consciousness is big business, and the benefits of what you buy may be questionable. If you have a small lawn that needs infrequent maintenance, says Dr. Armand, keeping a trusty (albeit gas-fueled) mower could be a better choice for the planet than buying an electric mower, when factoring in upstream costs of natural resources and the carbon footprint required to manufacture and ship the new — and toss out the not-so-old. (Alternatively, maybe it's time to replant that lawn with wildflowers and vegetables?)
• Skip what's not needed. A new backpack crafted from water bottles? Another sweater to add to a closetful? If there's no apparent need, think twice about purchases.
• Double down on experiences and connection. Think concert tickets, museum passes, or energetic options like rock-climbing gym passes and outdoor skills classes. "Gifts of experience are great, especially for people who already have all they need. If you buy for two or try a skills swap you also get to enjoy that time together," says Dr. Armand.

25 climate-conscious gifts

Below are 25 suggestions for climate-conscious giving intended to work with many budgets.

Small but mighty climate-conscious gifts

1. Soft, warm sweaters, thick socks, or puffer vests can help people turn down the heat, saving energy resources and money.

2. Rechargeable batteries reduce materials and packaging waste.

3. An electric kettle, induction hot plate, or toaster oven can help limit indoor pollutants from gas stoves.

4. Perfectly Good Food: A Totally Achievable Zero Waste Approach to Home Cooking aims to pare back food waste and is available online.

5. Shop local artisans and craft fairs rather than buying online.

6. Plants brighten any room and help scrub the air: choose easy-care varieties, such as succulents, colorful coleus, and some herbs.

7. Protect the natural world: birds, bees, and other insects could use your help. Consider a small bird feeder that attaches to a window, a bee house, gardening tools, or seeds for a pollinator garden of colorful flowers.

8. Donate to national or worldwide climate or environmental organizations, local green spaces, and local conservation groups.

9. Gift green bonds for companies that support renewable energy — do your research, though, because greenwashing can be an issue.

10. Secret gifter-giftee swaps with large groups save sanity and throttle back waste.

Bigger splurges on climate-conscious gifts

11. When appliances reach the end of useful life, consider replacing gas stoves, water heaters, washers, dryers, and similar items with electric versions.

12. Plan a week of nearby tours and events with friends or family instead of flights and faraway travel.

13. Gift clothes and tools to enjoy the natural world: for example, warm, waterproof clothing and hiking boots, cross-country skis or skates, good binoculars for bird-watching.

14. Composters (or a weekly composting service subscription) recycle food scraps and organic waste into soil-enriching "black gold."

15. Electric bikes may be a boon if they reduce reliance on vehicles using fossil fuels.

16. Help fund energy-efficient heat pumps or renewable solar energy.

17. Substantial donations and sustaining donor gifts to climate-conscious organizations can help in many ways.

No-cost climate-conscious gifts

18. Offer to gather information on big-ticket items in the big splurges section, including state and federal rebates and 0% loans for heat pumps, energy-efficient furnaces, solar panels, and energy-efficient appliances.

19. Teach a skill one-on-one, such as home repair, skating, chess, training for a mud run, knitting, cooking, orienteering, or gardening, or organize skills swaps with friends.

20. Gift the human power needed to replant portions of a lawn with vegetables or pollinator plants, or make a rain garden (note: automatic download) to help divert storm water.

21. Combine a no-cost reminder of the environmental benefits of no-mow May and leave the leaves campaigns with an offer to help peel back these layers come spring.

22. Friends often want to gift one another — costly generosity that can prompt last-minute candle-buying. As an alternative, gather a small group of friends for a clothing, accessories, and candle swap of new, never-took-the-price-tag-off, nearly new, and well-loved items.

23. Offer a DIY nature or bird walk for two. Try the free Pl@ntnet and Merlin apps if you can't tell a pin oak from a petunia or a robin from a California condor.

24. If you buy for a ton of people, buy in bulk and figure out how to parcel it out in more sustainable packaging.

25. Make dinner, fudge, or another treat with friends — not completely free, but always a great way to gather your community.

About the Author

Francesca Coltrera, Editor, Harvard Health Blog

Francesca Coltrera is editor of the Harvard Health Blog, and a senior content writer and editor for Harvard Health Publishing. She is an award-winning medical writer and co-author of Living Through Breast Cancer and The Breast … See Full Bio View all posts by Francesca Coltrera

About the Reviewer

Howard E. LeWine, MD, Chief Medical Editor, Harvard Health Publishing

Dr. Howard LeWine is a practicing internist at Brigham and Women’s Hospital in Boston, Chief Medical Editor at Harvard Health Publishing, and editor in chief of Harvard Men’s Health Watch. See Full Bio View all posts by Howard E. LeWine, MD