Nordstrom Has Beauty Products on Sale for Up to 50 Percent Off

I’m never one to resist a good sale, especially when it’s regarding some of my favorite beauty brands. Right now, Nordstrom is offering awesome discounts on hair tools, beauty palettes, brush sets, and more from brands like MAC, Stila, Benefit Cosmetics, and T3 for up to half off their original price. While I probably don’t need to add any more beauty products to my arsenal, I hate to ignore a bargain (which is why I’m already adding some goodies to my shopping cart.)

If you’re looking to test out new beauty products or want to restock your tried-and-true favorites, read on for a few skin-care and makeup items that are worthy of making it into your daily rotation. These products are almost too good to pass up—so get them before they’re gone.

Drinking contexts associated with early onset of alcohol intoxication among adolescents

Early onset drinking, drinking and intoxication at an early age among adolescents, has been identified as a primary risk for later heavy drinking, alcohol problems, and alcohol dependence among youth and young adults. To prevent or delay early onset drinking, we must know more about the modifiable circumstances that enable these behaviors.

New research by scientists at the Prevention Research Center (PRC) of the Pacific Institute for Research and Evaluation has begun to identify these circumstances by examining relationships between early age of first intoxication (less than 15 years), drinking in different contexts such as one’s own home, at friends’ homes, or outdoor settings, and problems that arise in those contexts.

The scientists looked at data from 405 adolescent drinkers (15-18 years old) from 24 midsized California cities in 2013 and 2014. They focused upon measures of age of first intoxication, frequencies of drinking at restaurants, bars/nightclubs, outdoor places, and homes, and problems occurred during or after drinking in these places. They assessed whether there were certain contexts associated with early age of intoxication and greater numbers of problems.

The authors found that, about 1/3 of adolescent drinkers experienced first intoxication by age 15, about 1/3 experienced it after age 15 years, and about 1/3 had used alcohol but never to intoxication. Drinkers reported drinking most frequently in homes, followed by outdoor settings, and then restaurants, and bars or nightclubs.

More specifically, early age of first intoxication was:

  • Highly associated with drinking at outdoor settings, but not at other contexts including in homes.
  • Associated with increased numbers of problems related to drinking in restaurants, outdoor settings, and homes (e.g., getting into a verbal argument or a physical fight, risky sex, driving after drinking alcohol).

Knowing the contexts most closely associated with early onset drinking allows us to develop effective prevention efforts toward those aspects of youth drinking environments.

As co-author, Dr. Lipperman-Kreda, says, the results of the current study clearly suggest the importance of considering the contribution of contexts to alcohol early initiation and problems to inform the development of preventive interventions specific to contexts.

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Materials provided by Pacific Institute for Research and Evaluation. Note: Content may be edited for style and length.

Abdominal Pain: How to Know If Yours Is Physical or Mental

If your stomach hurts, you might think the culprit is some misbehaving organ in your abdomen. That’s a definite possibility, but the offender could actually be your brain. Yup, just like chest pain, abdominal pain can be physical or mental.

Here’s a fascinating fact that might help you win at trivia night: Your mind is connected to your gut by way of the vagus nerve, the longest cranial nerve in your body. (That means this nerve originates from your brain, not your spinal cord). You can think of this nerve as a bidirectional conduit that is constantly communicating back and forth between your brain and your gastrointestinal tract, Emeran A. Mayer, M.D., a professor of medicine, physiology, and psychiatry at the David Geffen School of Medicine at UCLA and author of The Mind-Gut Connection, tells SELF.

In fact, the majority of your body’s production of serotonin, a neurotransmitter that plays a role in mood, takes place in the digestive tract, Jacqueline Sperling, Ph.D., a clinical psychologist and director of training and research the McLean Anxiety Mastery Program, tells SELF. “When you’re experiencing something going on in your brain, it can communicate to the gut and vice versa,” she says.

So, how are you supposed to know if your abdominal pain is actually coming from that area or if your mental health might be behind your discomfort? Here, doctors explain the signs of each.

Here are six signs your abdominal pain could be physical.

1. You recently ate food that might have been contaminated.

Many triggers of abdominal pain are situational, James Marion, M.D., a gastroenterologist and professor of medicine at the Icahn School of Medicine at Mount Sinai in New York, tells SELF. Unfortunately, sometimes the situation in question is a nasty bout of foodborne illness.

Something as seemingly harmless as trying a new dish at a restaurant could leave your stomach feeling wonky. So can making these food safety mistakes when you’re cooking at home.

Foodborne illness can set in hours to days after eating something contaminated, though sometimes it might even take weeks, according to the Mayo Clinic. In any case, food poisoning can cause symptoms such as abdominal pain and cramping, nausea, vomiting, watery or bloody diarrhea, and a fever.

2. You’re burping and/or farting.

While it can seem like gas is only about burping and farting, pain is also a common symptom.

Gas often happens when your body is struggling to break down certain carbohydrates, leading to excess air in your system. For example, about 65 percent of people in the world have some amount of lactose intolerance, meaning they have a hard time processing a kind of sugar that’s present in dairy, according to the U.S. National Library of Medicine. If you’re one of them, going to town on cheese, milk, ice cream, and other products that contain lactose can result in abdominal pain, bloating, gas, nausea, and diarrhea. For many people, lactose intolerance develops in adulthood, so it can take time to pinpoint dairy as the source of your stomach troubles.

You can also burp, fart, have abdominal pain, and experience other gas symptoms due to things like swallowing too much air as you chew or drinking a lot of carbonated beverages. And sometimes gas is a symptom of a condition like irritable bowel syndrome or inflammatory bowel disease, in which case you’ll experience other signs that something is physically wrong, like bloody diarrhea and constant exhaustion. (Here’s how to tell the difference between IBS and IBD.)

If you routinely have stomach pain that you think is due to something you ate but you’re not sure what, talk with your doctor. They may recommend keeping a food journal to pick up on any patterns you haven’t noticed. This could give them a good idea of what kind of tests to run to land on a diagnosis, too.

3. Your stomach is swollen and you can’t poop or are having a hard time keeping food down.

These can be signs of intestinal obstruction, which happens when some sort of blockage is keeping food or fluids from passing through your digestive system, says Dr. Marion. In addition to crampy, irregular abdominal pain, it can cause symptoms like a loss of appetite, constipation, and vomiting, according to the Mayo Clinic. If you notice these issues, Dr. Marion recommends seeing your doctor ASAP for a diagnosis and treatment.

4. You can point to exactly where in your abdomen hurts.

While it’s not always true that specific abdominal issues come with specific kinds of pain, certain conditions do tend to have characteristic types of discomfort that potentially make them easier to identify.

For example, appendicitis often causes pain that starts around the belly button then moves below and to the right of it, according to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Gallstones usually lead to stabbing pain in the upper right portion of your abdomen.

Point is, if your pain is localized to one part of your abdomen, that could hint at something going on with a certain organ in there.

5. You just took nonsteroidal anti-inflammatory drugs (NSAIDs) without eating enough.

Using nonsteroidal anti-inflammatory drugs (NSAIDs)—pain relievers such as naproxen and ibuprofen—too frequently, and especially without eating, could cause inflammation in the lining of your stomach and intestines that leads to abdominal pain, says Dr. Marion. The pain is usually heartburn-like or confined to your upper abdominal area, he adds.

Make sure to follow the dosage instructions for any medication you’re taking, including eating adequately or drinking enough fluids. This is a big way to prevent GI symptoms that might occur with NSAIDs, according to the Cleveland Clinic.

6. Your pain is severe and comes with a fever, rectal bleeding, nausea, and/or vomiting.

These are signs of a potentially serious GI infection, Dr. Marion says, like appendicitis or an extreme case of viral gastroenteritis (stomach flu). Don’t brush off severe abdominal pain, especially when it comes with other physical signs that something’s wrong. If you’re dealing with extreme abdominal pain and accompanying GI symptoms, you should seek emergency medical treatment.

Here are two signs your abdominal pain could be mental.

1. It flares up when you’re anxious.

Whether your stomach cramps strike every time you have to take a flight or before big work presentations, it could be a sign that you’re so stressed it’s affecting your gut.

“There’s a clear connection between the brain and our emotions and how our body feels,” says Sperling. Realizing that your abdominal pain always crops up around moments of fear, stress, or anxiety can help you figure out that your emotions are behind the discomfort.

If you already know you have anxiety but are having a hard time managing this symptom, talk to your doctor or therapist to see if any tweaks in your treatment may help. If you’re not sure your abdominal pain is connected with changes in your emotions, consider keeping a journal for a few weeks to chart how you feel and how your pain comes and goes in response.

In the event that your GI issues do seem tied with mental health concerns like anxiety, a mental health professional may be able to help you through methods like cognitive behavioral therapy (CBT). This form of therapy aims to help people identify and change unhelpful thoughts and behaviors to live healthier, happier lives. If you’re interested in trying it, here’s a guide on how to find an affordable therapist.

2. Your pain comes with a sense of overwhelming panic.

Panic attacks are harrowing episodes of uncontrollable fear. As with anxiety, panic attacks can cause physical symptoms such as abdominal pain and GI issues like diarrhea. They can also cause symptoms like chest pain, heart palpitations, sweating, shaking, and feeling like you’re going to die.

While undeniably horrible in the moment, panic attacks are highly treatable with medication, therapy such as CBT, and coping mechanisms like deep breathing, according to the Mayo Clinic. See your doctor or therapist for help if you think you’re having panic attacks.

Sometimes abdominal pain is physical and mental.

If you have a gastrointestinal condition such as IBS, Crohn’s disease, or ulcerative colitis, stress or anxiety can exacerbate your symptoms. This can make your physical and mental health even more inextricably linked.

This relationship can be cyclical, Sperling says: Stress or anxiety can prompt gut inflammation and intestinal spasms, leading to more GI symptoms, which can just translate to more stress or anxiety. It’s pretty unfair. If you have a GI condition and feel like you’re stuck in this rhythm, talk to your doctor to see if there’s a way to make your gut and your brain get along a little better so that you don’t have to suffer.

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Learn How to Ski: 8 Great Ski Spots for Beginners to Start

Even if your typical cold-weather routine involves avoiding the outdoors at all costs, there’s no denying that winter takes on a picturesque vibe on a ski trip. Think hot tubs, après ski drinks, and of course, hitting the slopes. But if you’ve never been, having to actually learn how to ski can be a daunting detail.

Trying any new activity as an adult can feel intimidating, especially when those little ski school tykes seem like they’re picking it up so much quicker. Listen, I’ve been skiing since I was eight years old, and I still have plenty of challenging days on the mountain that force me to get back to those basics. It’s part of the thrill, and whether you’ve been skiing for a while or you’re a true beginner, improving your skills is a rewarding feeling.

Aside from being a fun athletic challenge, Skiing is also an excellent way to get outside in the winter, and it’s also a great workout for your legs, butt, and core. Plus, it challenges your balance and stability. (Psst, here’s a 10-minute workout to get your muscles ready for ski season.)

It’s also worth noting that skiing isn’t exactly a low-barrier-to-entry sport. Depending on where you live and your skiing needs, it requires travel, gear rentals, lift tickets, and lessons, so it can get costly, both money- and time-wise. But if skiing is a sport you’re interested in trying and you’re in a position to invest in learning, it’s totally possible to pick up the winter hobby as an adult.

When you’re deciding on a destination, it’s important to remember that some ski resorts are better to start at than others—even as an experienced skier, there are some mountains that I feel iffy at and wouldn’t recommend to beginners. (For example, Jackson Hole, Wyoming is a popular ski spot, but it isn’t for the faint of heart.) Some ski resorts are just known for having mainly challenging, steep terrain—think ungroomed runs, lots of moguls (bumps), and all-around limited options for beginners to enjoy safely.

The good news? There are plenty of mountains that are practically primed for learning, and being in a place that sets you up for success will make it way more fun.

Here, we rounded up eight of the best places to learn how to ski (or snowboard!) in North America, according to common knowledge among experienced skiers (including me!) and general info provided by each mountain. These destinations all have reputations for being beginner-friendly, with plenty of easy terrain, deals on lessons and rentals packages, fun villages to hang out in, plus, options for more advanced skiers you might be traveling with, too.

1. Steamboat Springs, Colorado

Steamboat‘s trademark “Champagne powder” (which basically refers to light, dry snow) draws in skiers from around the world, including beginners. While most of the beginner terrain is located at the base of the mountain (as is the case with many ski resorts), after gaining some confidence, newbie skiers can take a gondola up to the Why Not trail. At over three miles long, it’s Steamboat’s longest beginner trail. Whether it’s easy or advanced, long trails like these are fun because you can swish down ‘em for a while without constantly stopping to take another lift up. No one wants to feel like most of their ski day is spent on a lift or in line, so this kind of long run, which is sometimes called a “cruiser,” is good news for beginner skiers.

And with a pretty incredible ski-slope backdrop, Steamboat is also known for being a charmingly classic mountain town. Plus, the nearby natural hot springs is a perfect place to soothe sore muscles after a ski day.

2. Sugarloaf, Maine

Sugarloaf is one of the most popular ski destinations on the East Coast, but don’t worry about overwhelming crowds—it’s the largest ski area east of the Rockies, so there’s space for days. Sugarloaf also has a hard-to-beat beginner’s package, so it’s a cost-effective choice for newbies: You can snag rental equipment, a 90-minute lesson, and a single day lift ticket for $99, which is an exceptionally good deal.

Another benefit of East Coast skiing is the lower elevation. The summit of the mountain tops out at 4,237 feet—less than, say, Breckenridge, Colorado’s 9,600 feet. (Breckenridge can also be a great ski trip choice for beginners thanks to its ski area and fun town, but the elevation can be a challenge for out-of-towners.) A lower elevation makes it easier to acclimate, so your chances of altitude sickness are lower.

3. Big Sky, Montana

Big Sky is an aptly named ski area. Aside from its expansive views, the resort is known for its big, wide runs, which is good news for beginners. When you’re learning skills like turning and stopping, the more space and width you have to work with, the better. Narrow runs can feel a little claustrophobic when you’re first learning, and as someone who’s been skiing for years and still feels nervous on narrow runs when the terrain is above my comfort level, I know how helpful this extra room can be. And as a bonus, Big Sky is also known for being an uncrowded ski area, which adds to your space even more.

Plus, in the Moonlight Basin area of the mountain, the bottom left section is almost entirely made up of green (easy) runs. This is great for your peace of mind, since you don’t have to worry much about accidentally skiing into an area you didn’t mean to be in.

4. Park City, Utah

Park City Mountain Resort is the largest ski resort in the U.S., so there’s no shortage of options for skiers of all levels. It merged with next-door Canyons Resort in 2015, which is good news for newbies: In 2018, they opened the High Meadow Park on the Canyons side, a big learning area exclusively for beginners, so you’ll avoid reckless skiers and boarders zooming by and throwing you off. Since the beginner’s park is on the Canyons side, staying in that area is your best bet for easy access—the Grand Summit Hotel is right by the Red Pine Gondola, which takes you straight to that amateur’s playground. (I was recently given a complementary first-hand look at the beginner’s park as a member of the press.)

Plus, Park City is only a 30- to 40-minute drive from the Salt Lake City airport, so Utah skiing is known for being easy to access when you’re coming from out of state. Pro tip: If you manage to nab accommodations during Sundance Film Festival, that’s known as the best time to ski—the slopes usually aren’t crowded since the old mining town itself is buzzing with activity. (And you just might spot some celebrities at après ski drinks, too.)

5. Beaver Creek, Colorado

Beaver Creek is a unique ski destination in that most of its beginner terrain is toward the top of the mountain, so you can experience Insta-worthy views in an area that’s often reserved for more advanced terrain. Beaver Creek debuted its Red Buffalo Park in 2017, which has 12 fun beginner-friendly trails at 11,440 feet (which is really high; don’t forget to stay hydrated and make sure you adjust to the altitude before skiing). In 2018 it opened another beginner area called Haymeadow Park, so Beaver Creek officially has the most dedicated learning terrain in Colorado. Plus, Haymeadow is also at a slightly lower elevation (8,400 feet), so if you’ve got a couple days to ski, it might be a good idea to start there while your body adjusts to the altitude.

And as far as lessons go, Beaver Creek is also known for its fantastic ski school and world-class instructors (they’re said to be in the “Ivy League of ski schools“). In fact, it’s one of the mountains I first learned to ski on, and I think it served me well.

Beaver Creek itself is a luxury destination, so it’s not always inexpensive to stay there. But it’s located in Summit County along with other popular ski destinations like Breckenridge and Vail, so it’s definitely accessible for a day if you’re staying in another ski town.

6. Whistler, British Columbia

Whistler Blackcomb ski resort is a bucket-list destination for skiers from across the globe, and for a good reason: The scenery is spectacular, the village area itself has plenty to do, and with over 8,000 skiable acres, it’s the largest ski resort in North America. Over 1,600 of those acres are designated for beginners, and they’re spread across the entire mountain, so you’re not confined to one area. In fact, only a handful of the lifts don’t have access to green runs at the top.

Bonus: Since Whistler was home to several events during the 2010 Winter Olympics, you can also visit the Olympic rings at the Olympic Plaza in Whistler Village. Plus, you’ll likely fly in and out of Vancouver, which is worth spending an extra day exploring if you have time.

7. Northstar, California

Lake Tahoe is known for its skiing, but that actually doesn’t refer to just one resort. There are about 13 ski resorts around Lake Tahoe, and Northstar is one of the best picks for first-timers. While Tahoe in general isn’t a super easy place to ski, Northstar is known for being less steep than some of the other Tahoe options, so it’s a good choice if you’re in Northern California, Nevada, or another nearby state, since it’s relatively accessible.

There are plenty of groomed green runs and blue runs (intermediate) to choose from, and when you’re not skiing, Northstar is also known for its fun non-ski scene off the mountain. Think: great restaurants and an ice skating rink.

8. Okemo, Vermont

Okemo Mountain Resort in Southern Vermont is another East Coast favorite for those new to skiing. According to the resort, 32 percent of the terrain is beginner friendly, which is a big percentage for most resorts. They also have a great deal for beginners: The First Tracks packages include full rentals, a two-hour group lesson, and access to the lower mountain lifts for $98.

And, like many ski schools, they focus on working your way up as you build on skills and on having a good time, even when you’re learning.

And ultimately, that’s the point of skiing: Sliding on snow is supposed to be fun. So wherever you learn, the most important thing is to ski safe and enjoy the process.

Urgent Care vs. ER: 5 Signs to Go to Urgent Care and 5 to Go to the ER

Choosing where to turn for care in a scary and sudden medical situation can be confusing. You might not know if you should head to urgent care or go straight to the emergency room (or, in some cases, call 911).

Are your fever and cough due to the flu, or do you have pneumonia, which could require hospitalization? Is that chest pain from a muscle you pulled at a high-intensity interval training class, or could it be something more serious? Here, experts explain the purpose of urgent care, plus when to go there vs. the emergency room.

Urgent care is for minor—not major—medical issues.

The difference between urgent and emergency care boils down to what constitutes a medical emergency. “Urgent care is a form of medical care that focuses on conditions that are not potentially life- or limb-threatening emergencies, but still require prompt care within 24 hours or less,” Timothy Tan, M.D., M.P.H., an assistant professor at the Icahn School of Medicine at Mount Sinai and an attending physician at Mount Sinai Urgent Care, tells SELF.

At urgent care centers, you’ll typically find both doctors and physician assistants who usually have training in emergency or family medicine, Dr. Tan explains. “They have a broad range of medical knowledge and skills that allow them to diagnose and treat a wide variety of illnesses in patients of all ages,” Dr. Tan says. “[They can] also identify when a specialist is needed or when there is a potential emergency medical condition requiring an emergency room visit.”

Urgent care centers usually have X-ray machines, basic lab testing (think: throat or nasal swabs for strep throat or flu), and equipment for minor procedures such as splinting a broken bone, stitching a wound, or draining an abscess, Dr. Tan explains. If what you’re dealing with requires a more intense level of care, going to an emergency room (or calling 911) makes more sense.

“Emergency departments will have more in-depth diagnostic testing, a wide range of medications, and access to specialists such as cardiologists for heart attacks, or orthopedic surgeons for complex fractures,” Dr. Tan says.

A doctor will usually see you more quickly at urgent care.

Since emergency rooms prioritize life-threatening health problems, urgent care can get you in and out more quickly if you have a minor medical concern. “[At] the ER, patients often wait hours to be seen for their potentially non-life-threatening concern,” Alexis Halpern, M.D., an emergency medicine physician at NewYork-Presbyterian/Weill Cornell Medical Center, tells SELF.

There are even some technology-based urgent care services where you can see a provider ASAP, such as NYU Langone’s Virtual Urgent Care center. For $126 (plus any additional fees based on treatments), people in New York, New Jersey, Connecticut, and Pennsylvania can book appointments to see an NYU Langone doctor virtually for non-emergency concerns.

We’re going to go ahead and emphasize that “non-emergency” bit. If you need care for a concern that feels like a serious threat to your health, the emergency room is a better option than virtual or even IRL urgent care. Also, emergency rooms are open 24/7, whereas many urgent care centers are closed late at night, Dr. Tan says. They do typically stay open later than doctors’ offices, though.

Urgent care centers generally cost less than emergency rooms.

Of course, what you’ll pay will depend on your insurance, but urgent care is often much cheaper.

“Because most urgent care clinics don’t have as much equipment or specialist availability as an emergency department, the cost to provide care is less, and many insurance companies will require a lower co-payment for evaluation,” Paul L. Nadler, M.D., medical director of adult urgent care and a clinical professor of medicine at the University of California at San Francisco, tells SELF.

Here are five signs you should consider going to urgent care.

Remember, though, that you should always follow your gut. If something about your health feels so off that you’re tempted to seek emergency care, don’t let anything on the following list stop you.

With that in mind, here are five general signs that urgent care may be able to help you.

1. Your medical issue is not threatening your life or a body part.

Let’s say you were slicing an avocado and cut your hand badly enough that an adhesive bandage won’t quite stanch the flow, but the wound isn’t spurting blood, you don’t see bone or anything else that’s super worrisome. Urgent care is likely your best option here. Lacerations should be cleaned and potentially stitched within hours to minimize the risk of infection and scarring, says Dr. Tan.

Other issues that urgent care facilities typically handle include pink eye, rashes, hives, ear pain, a twisted ankle, other musculoskeletal pains, and gynecologic issues such as urinary tract infections.

2. You have cold- or flu-like symptoms that aren’t responding to treatment.

You can usually treat a cold or flu at home. But urgent care can be helpful when you’re not sure if you have a minor respiratory infection or something more intense, like pneumonia. “If you’re experiencing a fever, body and muscle aches, chills and sweating, feel really tired, and have a dry cough that has persisted one to two days, it’s best to get checked out,” Dr. Halpern says. “The same goes for chest congestion, headache, stuffy nose, and rashes.”

3. You have chest pain, are under 55, and think it could be due to something like a strenuous workout.

“Chest pain is a tough one,” Dr. Nadler says. After all, even otherwise healthy people can have unexpected heart attacks. But if you’re under 55 (the age at which risk goes up for women), have no history of heart disease, and think you can pinpoint a minor cause behind your chest pain, you may want to consider urgent care over the emergency room.

For instance, if you recently lifted too much at the gym and think you pulled a muscle, or if you’re thinking your chest pain could be heartburn, urgent care should be able to help you out. Here are some more tips for demystifying your chest pain.

4. You have what seems like a minor bone fracture.

Many urgent care clinics can diagnose and splint fractures, says Dr. Nadler, but not every break should be treated at urgent care. “Fractures commonly treated in urgent care include elbow, wrist, hand, finger, ankle, foot, toe, and ribs,” says Dr. Nadler. It’s best to have anything more serious or complex, like long bone fractures in the arm or leg, hip, and back treated in an emergency department, he says.

5. You’d normally see a primary care doctor but don’t want to wait.

If you can’t get to your primary care doctor in time for something like diagnosing a yeast infection, urgent care can be a good option, Dr. Tan says.

However, don’t rely on urgent care as a replacement for preventive care. You shouldn’t put off routine screenings and check-ups with the thought that you can just go to urgent care if something comes up. It should be a complement to your normal preventive care when necessary, not a substitute.

Here are five signs you should head for the emergency room instead.

Again, these are general. If you think you need emergency care for something that isn’t on this list, seek it.

1. You’re having a hard time breathing.

For instance, an allergic reaction involving swelling in your tongue and mouth can impact your breathing, which deserves emergency attention. Severe shortness of breath can also be a sign of a cardiovascular issue such as a heart attack. No matter the cause, always seek emergency care if your ability to breathe is compromised in an alarming way.

2. You have chest pain (especially on the left side) and are at an increased risk for heart disease.

Chest discomfort on the left side, which could signal a heart attack, generally deserves prompt medical attention. This could present as straight-up pain, but it might also feel like pressure, squeezing, or as though that area is strangely full, according to the National Heart, Blood, and Lung Institute. This discomfort can be mild or intense, persistent or intermittent.

With that said, women are more likely to experience lesser known symptoms of a heart attack, like shortness of breath, nausea, vomiting, fatigue, and pain that radiates into the back, shoulders, and jaw. If you’re experiencing any of these, go to the emergency room or call 911.

This is especially important if you’re more prone to heart attacks due to being over 55 or having other heart attack risk factors, such as high blood pressure, high cholesterol, diabetes, and a family history of this health issue.

3. You’re experiencing sudden paralysis, trouble speaking, confusion, and other strange symptoms.

These are all signs of a stroke, in which case you’ll need emergency care and should call 911. Emergency rooms are guaranteed to have access to CT and MRI machines that can diagnose issues such as strokes, says Dr. Tan, but that’s not always true for urgent care.

You can think of the stroke symptoms to watch for with the acronym FAST, the Mayo Clinic says:

Face: Does one side of your face droop when you try to smile?
Arms: Can you raise both arms and keep them up, or does one refuse to lift or start to lower?
Speech: Is yours slurred?
Time: If you answer yes to any of these questions, you need to call 911 because time is of the essence.

4. You have a fever and severe abdominal pain along with issues like nausea, fatigue, stomach swelling, and lethargy.

A mix of these kinds of symptoms could signal a lot of gastrointestinal conditions that need emergency care, like appendicitis, a serious gallbladder attack, and pancreatitis (an inflamed pancreas), Dr. Nadler says. These issues require immediate attention because they can lead to complications if left untreated. Since it’s really hard to ID the cause of these symptoms on your own, it’s important to get yourself to the hospital ASAP, the experts say.

5. You’re dealing with any illness or injury that is limb- or life-threatening.

If you have a deep wound that won’t stop bleeding, think you’ve broken a major bone, or are generally experiencing severe symptoms of illness at a level you never have before, you should consider choosing an emergency room over an urgent care center.

Don’t put off going to urgent care or the emergency room because you’re worried about the costs. Health care can be exorbitantly expensive in this country, so that concern is absolutely valid. But there are ways to negotiate high medical bills and make it easier to pay them off. If you’re worried about your health—and especially if you think your life depends on it—seek the care.

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Graphene-based wearables for health monitoring, food inspection and night vision

The first of ICFO’s devices on display will allow customers to monitor their level of exposure to sunlight through a UV sensor. Designed as a flexible, transparent and disposable patch, it connects to a mobile device and alerts the user once he or she has reached a defined threshold of sun exposure.

Using the same core technology as the UV patch, ICFO’s fitness band is being developed to measure heart rate, hydration, oxygen saturation, breathing rate and temperature, while monitoring the user when he or she is exercising, for example. However, the fitness band does more than simply measure physical activity.

Consider the following scenario. A person is trekking in the remote amazon jungle with limited access to water. By measuring the skin hydration of their body with ICFO’s fitness band, the user can optimize water intake, preventing any sort of dehydration. Similarly, an explorer hiking to the peak of mount Everest could use the band to accurately monitor oxygen saturation in blood. The high altitude can severely effect oxygen saturation in the body. Using the band, the hiker could monitor these levels and emit a warning if oxygen saturation in the blood decreases drastically below a certain level.

In addition to these prototypes being exhibited at MWC 2019, ICFO will also showcase two other light-based graphene technologies. These include the world’s smallest single pixel spectrometer and a graphene-enabled hyperspectral image sensor, both with broadband capabilities, beyond to what was once perceived possible without the use of costly and bulky photodetection systems.

By enabling spectroscopy in such small dimensions, consumers could now be equipped with tools that previously were only available to highly specialised laboratories. From the detection of counterfeit drugs to the identification of harmful substances within a product that we use or food that we eat, compact, low-cost spectrometers could become an indispensable accessory of our everyday life.

“Built into a smart phone camera, the graphene-based camera sensor allows phones to see more than what’s visible to the human eye,” comments Frank Koppens, group leader at Graphene Flagship partner ICFO, and Chair of the Graphene Flagship MWC Committee. “Made up of hundreds of thousands of photodetectors, this incredibly small sensor is highly sensitive to UV and infrared light.”

“This technology would allow users in the supermarket to hold the camera to fruit and infer which is the freshest piece. Or, in a more extreme example, the camera could be used for driving in dangerously dense fog by providing augmented outlines of surrounding vehicles on the windscreen.”

To find out more about these technologies and to meet the team of experts that have developed these applications, visit the Graphene Pavilion at MWC in NEXTech Hall 8.0 Stand 8.0K31 on February 25-28.

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Medical Bills: 8 Ways to Negotiate and Pay Off Expensive Medical Bills

There is perhaps no scarier field to navigate as a consumer than the health insurance industry. Grappling with medical bills can be especially stressful. You might already be feeling vulnerable after putting your health and safety into a doctor’s hands. Maybe you’re even still recovering from a procedure. Trying to sort through medical bills that seem like they’re written in a foreign language just makes the situation worse.

In a nationally representative Pew Research Center survey of 2,537 U.S. adults, 83 percent of respondents considered high treatment costs that made quality medical care unaffordable “a big problem.” This can lead people to delay seeking care because they fear the financial impact. But sometimes you need expensive preventive care or wind up in an emergency situation, leaving you with medical bills that can cause frustration and anxiety.

Before we dive into expert advice on navigating big medical bills, it’s important to acknowledge that even being able to do so is, in many ways, a privilege. It typically requires a lot of time and energy (often during regular business hours), and is generally easier if you have health insurance. If you’re LGBTQ+, a woman, a person of color, have a disability, or have another (or many) marginalized identities, it can be even harder to get people to listen when you try to advocate for yourself. While many of the tips here are broad, some of them do speak to these concerns specifically.

With that in mind, read on for advice from health equity advocates and health insurance experts on how to avoid big medical bills or, if necessary, deal with them after the fact.

1. Try to estimate your costs ahead of time.

If you know you have some kind of medical procedure coming up and you have insurance, have a conversation with your doctors, hospital, and your insurance company to get a ballpark of what you’ll owe.

First, ask your providers and hospital if they are in-network. Them being in-network means they accept your insurance, which likely translates to a much lower bill. Double-check what they say with your insurance provider, if you have one, and make sure you’re getting information for all of the major care providers involved in your procedure (like your surgeon, anesthesiologist, etc.), since some of them may have different insurance policies. (It may be easier to first ask the hospital if they can verify that all providers involved are in-network for you.)

Then ask your primary care provider and hospital for as much detail as possible about the procedure you’re having and what it might cost. If you have insurance, call them and ask them to help you break down possible out-of-pocket costs based on what your doctor and hospital told you.

If English isn’t your first language, you have the right to speak to someone who can communicate clearly in your primary language. While the patient’s bill of rights can vary from hospital to hospital, one of the overarching requirements is that people have access to health services in a language they are comfortable with, which may require an interpreter.

Beyond that, there are pricing tools online that can help you assess the standard rate for your procedure. FAIR Health is one national option, and you can Google for more local options, too.

However, don’t take any of this information as a guarantee of what you’ll pay. “Often, the doctor, the hospital, and the insurance company don’t know what the [others] are doing,” Jane Kaye, a former chief financial officer at two New Jersey hospitals, tells SELF. This can lead to different estimates from different sources. Plus, your providers might adjust aspects of your care as it happens.

“You could have a bad reaction to a particular medication [or] need an additional treatment, which would add to your bill,” says Kaye, who is also a consultant for hospital billing departments at HealthCare Finance Advisors.

However, Kaye says even confirming that your hospital and doctors accept your insurance and getting a ballpark idea of what your procedure costs can give you a better idea of what to expect.

2. If you’re uninsured, try to sign up for a plan.

This is another step you might try if you have some time to prepare before a procedure. Having health insurance is often a worthwhile investment, but it’s a particularly good idea if you know you’ll be going in and out of a doctor’s office in the near-future.

If you can’t afford insurance, check to see if you qualify for Medicaid, which provides insurance for many people and families with low incomes. Many people qualify for Medicaid and don’t realize it, Elisabeth Ryden-Benjamin, vice president of health initiatives at the Community Service Society of New York, an anti-poverty advocacy organization serving New Yorkers, tells SELF. Qualification is based on your income and family size; here’s how to see if you’re eligible.

Qualifying for Medicaid can drastically reduce the amount you’ll owe, as federal regulations prohibit out-of-pocket costs for Medicaid beneficiaries from being more than 5 percent of a family’s income.

If you’re not eligible for Medicaid but have recently had what’s known as a qualifying life event (divorce, marriage, had a baby, lost your job, etc.), you can try to enroll in your state’s health insurance marketplace. Normally you can only enroll in marketplace plans during open enrollment (usually November and December, though it may be longer depending on what state you live in), but these situations grant you an exception.

If enrolling in a health insurance plan just isn’t an option right now, see if you can go to a low-cost or free health center to get the care you need. Federally-funded health centers provide care for underserved populations, often on a sliding scale. Find one close to you here.

3. Call the hospital billing department to confirm your insurance information.

So, you did your research, maybe even signed up for health insurance if you didn’t have it before, and you’re still staring at a bill that doesn’t seem quite right. You’re not alone: According to a nationally representative 2018 Kaiser Family Foundation poll of 1,201 people aged 18 and older, 39 percent of insured adults had a higher-than-expected medical bill in the past year.

Receiving the bill might feel catastrophic, but experts agree that you shouldn’t immediately panic—or pay it. “The biggest mistake people make is they’ll see the bill and automatically pay,” Claire McAndrew, director of campaigns and partnerships at Families USA, a health care advocacy organization, tells SELF. “Consumers are so worn down that they think they don’t have any recourse. But there are often solutions.”

Calling the hospital billing department to confirm they have the right insurance on file is a good first step. Health care technology is notoriously antiquated, so it’s plausible that the high number you see is an error. “There are many places where things could have gone wrong,” Kaye says. “When you showed them your insurance card, they could have keyed in one wrong thing. That very first misstep can cause problems down the road.”

4. Call your insurer to better understand your bill.

Unless you’ve opted out, health insurance companies will email or mail you an explanation of benefits (EOB) after you’ve visited a doctor or hospital to explain what exactly they will and won’t cover. Parsing through your bill and EOB can be overwhelming. “I teach health care finance at Rutgers, and I bring in real-life bills to show students how complicated it is,” Kaye says.

To make it easier, have someone at your insurance company walk you through what the numbers and codes on your bill and EOB mean. This can help ensure that they’re covering everything they’re supposed to and that you weren’t accidentally billed for a service you didn’t receive.

If you’re on Medicaid, you should be shielded from sticker shock because of those federal protections we mentioned above. So, if any out-of-pocket costs seem exorbitant, call your state’s Medicaid office to see if your bill is accurate.

5. Ask the hospital for a prompt pay discount or payment plan.

If a medical bill seems accurate but is still too expensive for you to pay, ask the hospital for a prompt pay discount, which is when they reduce your fee if you pay the charges in full right away. Not all providers offer this, but most do, Kaye says, adding that the discount is often 10 to 20 percent.

If you’re not in a position to pay your bill in full, ask the hospital’s billing department about a payment plan. This can be a multi-year plan, and the experts note that sometimes you can pay as little as $5 a month. Hospitals would rather have someone be willing to pay a little bit at a time instead of ignore the bill altogether, Kaye says, so they are typically willing to work with you on a plan you can manage.

Even if you agree on a set amount per month, it’s always worth asking if you qualify for any additional discounts on your bill, Ryden-Benjamin says. This is especially important if you’re uninsured, as many hospitals have charity care programs that can greatly reduce (or even eliminate) your bill if your income is low enough or your situation is extreme enough.

6. File an appeal with your insurance company.

If you can’t come to an agreement with the hospital on a payment plan or you still feel your insurance should cover more, you may want to file an appeal with your insurer. Every insurance provider handles appeals differently, but you can often find steps for the appeal process on the company’s website, like Aetna’s guide here.

If your appeal is rejected, Ryden-Benjamin recommends trying again. “It’s a pain in the neck for [hospitals and insurers] to keep dealing with you,” Ryden-Benjamin says, meaning that sometimes being persistent will be enough for them to grant your appeal and lower your costs.

Be sure to let the hospital know as soon as you’ve filed an appeal with your insurance company, Kaye says. Some hospitals will put your bill on hold, so they won’t expect payments at that time. Not all will, Kaye says, but the three main U.S. credit agencies allow a grace period of 180 days before an unpaid medical bill impacts your credit report. That’s around six months, giving you a bit of wiggle room to fight for a fairer bill.

Here’s more information on how to appeal an insurance claim.

7. Find advocates to fight or even pay on your behalf.

Hospitals have patient advocates to help you make your way through the complex world of health care. Ask to speak with one, explain your situation, and see if they are able to offer financial guidance.

There are also external advocacy organizations that can help you figure out if your charges are fair, work with you on appeals, or even help cover your costs.

For instance, Community Health Advocates, a free service that operates under the Community Service Society of New York, works with the privately insured, publicly insured, and uninsured to navigate the minefield of health care bills. This can include filing an appeal on a consumer’s behalf, and their free helpline (888-614-5400) offers guidance in over 170 languages.

Research similar consumer assistance programs nationally and in your area. If you live in a state or region with limited resources, this is where your state department of insurance can come in handy. “They can contact the hospital and your insurance to serve as an advocate,” McAndrew says.

There are also countrywide organizations like the National Patient Advocate Foundation, which has no-cost case managers to help advocate on behalf of patients. They are associated with the Patient Advocate Foundation’s co-pay relief program and financial aid fund, which both offer financial assistance to people who meet certain income-based and health-related criteria.

Going the advocate route can be a particularly good option for non-English speakers or people with marginalized identities who are more vulnerable to poor treatment within the health care system. It could be easier to have an advocate working on your behalf than to take on all this labor yourself.

8. Call your elected officials.

Two Senators and one House representative have filed legislation against surprise medical billing in the past year, and President Trump expressed desire in January to make sure people know exactly how much a procedure might cost before getting anything done. It’s unclear how that would work because, as Kaye says, hospital care tends to have many variables. However, McAndrew notes that this is seen as one of the only bipartisan health issues in government.

If you get a surprisingly high bill, call your elected officials and let them know, McAndrew says. Although it likely won’t affect your current bill, making your voice heard may compel your elected officials to act. If everyone who got a surprise bill made that phone call, it could get us closer to a future with more transparent health care billing.

Related:

Find a Therapist: 7 Ways to Find an Actually Affordable Therapist

Therapy can be incredible. Trying to find a therapist you connect with and can afford? Not so much. “There’s a lot of legwork on behalf of the patient-consumer [trying] to find the right care for themselves, and that can be discouraging,” C. Vaile Wright, Ph.D., director of research and special projects in Practice Research and Policy at the American Psychological Association (APA), tells SELF.

If you’re seeking therapy while managing a condition like depression or anxiety, the mental labor involved can be especially overwhelming, Vaile Wright says. Then there’s the money issue. Working with a limited budget presents an additional challenge.

Despite these obstacles, therapy doesn’t have to be as prohibitively expensive and exclusive as it may seem, Vaile Wright says. It is increasingly accessible and affordable if you know how to go about your search. Here are seven tips for finding affordable therapy.

1. Start by asking your insurance provider what they will cover.

Mental health services are among the 10 essential health benefits that the Affordable Care Act requires insurance plans in the individual and small group marketplace to cover, according to the U.S. Department of Health and Human Services (HHS). All Medicaid plans and the vast majority of large employers cover at least a portion of mental health care, too, according to the APA. We recognize, of course, that you may not have access to insurance. Don’t worry—there are still options available to you, which we’ll get to in a bit.

Thanks to federal and state parity laws, most insurance plans can’t charge a much higher co-pay to see a therapist than to see a doctor like a primary care physician or ob/gyn, the HHS explains. But beyond that, the specifics of coverage can vary from plan to plan.

Coverage details should be included in the plan information you received when you first enrolled, but those documents can be nearly impossible to understand. To make things easier, call your insurance’s member services number (you can find it on the back of your insurance card or on the website) and ask questions like:

  • What is my co-pay for therapy visits?
  • Do I need a referral or pre-approval from the insurer?
  • Is there any coverage for out-of-network therapists?
  • If so, how much, and what’s the process for getting reimbursed?
  • Do you cover some kinds of mental health professionals and not others?

Here are more questions you might want to consider asking.

2. Look at your insurer’s online directory or ask them to send you a list of in-network therapists.

If you have health insurance, staying in-network is a clear way to save money.

You can try looking through your insurance provider’s online directory as a start. But if you’d like to bypass a difficult-to-navigate website, call your insurance company and ask them to send you a list of in-network therapists in your area.

“Tell them exactly what you need,” Ken Duckworth, M.D., medical director for the National Alliance on Mental Illness (NAMI) and assistant clinical professor at Harvard University Medical School, tells SELF. “You’re paying them, and [helping you find someone] is part of their obligation.”

Unfortunately, your options might be limited. “It can be really hard to find somebody in-network,” Vaile Wright says. And some of the in-network providers you do find may not be accepting new patients.

If you’re lucky enough to have some out-of-network coverage, you’ve got more flexibility, but it might cost you. You may have to meet a deductible before coverage kicks in, and even then, some plans will only offer minimal help. Plus, as Vaile Wright points out, you often have to pay the session price upfront for reimbursement at a later date, which isn’t always feasible. Then there’s the headache of submitting claims to insurance. (Make sure any out-of-network therapist you want to see is willing to provide the necessary reimbursement paperwork.)

3. Ask therapists if they use sliding scales.

If you feel like you’ve exhausted your insurance options or you don’t have health insurance, then it’s time to explore other options like sliding scales.

Typically, an out-of-pocket therapy session will cost $100 to $250 depending on the provider and where you live, Vaile Wright says. Fortunately, some providers operate on a sliding scale with some or all of their clients. This means that the amount they charge varies based on factors like a person’s income, although how much of a discount they offer is totally up to them, Dr. Duckworth says.

Treatment locators like those provided by the Substance Abuse and Mental Health Services Administration (SAMHSA) often include whether a provider accepts sliding scale fees. Some resources, like Thero.org, allow you to only search for providers with sliding scales.

While many therapists will indicate on their online profiles or websites that they operate on a sliding scale, others will not. When you first speak with a therapist, it’s perfectly appropriate to ask, “What is your rate?” and “Do you have a sliding scale?” Dr. Duckworth recommends being prepared to tell them how much you make and how much you are able to pay per session. Theresa Nguyen, L.C.S.W., vice president of policy and programs at Mental Health America (MHA), suggests being ready to make a case for why you want to see this person in particular.

4. Look into community- and federally-funded health centers.

These facilities offer low-fee, sliding scale, or even completely free care to people in lower income brackets. Sometimes they provide both physical and mental health services, Vaile Wright says, which could make receiving care overall more seamless.

To find this kind of center, try Googling your city or county’s mental health authority or department of behavioral health, Nguyen says. These sites will typically provide information about these kinds of centers or contact information for someone who can offer details. You can also search the Health Resources & Services Administration database of health centers.

If you’re not sure you qualify to see a provider at one of these centers, Nguyen says to call and say something like, “I’m interested in accessing services. Can you tell me what the criteria are?”

5. Ask nearby colleges and universities to see a clinician-in-training.

If you want to see someone who has years of experience working with clients, this may not be for you. Otherwise, consider seeing someone who’s in the process of getting their mental health practitioner degree. They typically charge reduced rates but are under the close supervision of a licensed professional, so you’re still receiving quality care.

“A clinician-in-training is a really nice option if you know you want someone who has more flexibility in their time, because sometimes [they] can spend more than 50 minutes with you,” Nguyen says. Also, trainees might be motivated to approach each case with a little extra energy, given their eagerness to learn and newness to the field. “They’re training to be the best at their job that they can be,” Vaile Wright says.

If you live near a college or university, call and ask if they have a training clinic open to the public. You can also check out the Association of Psychology Training Clinics’ list here.

6. Consider teletherapy.

“Telehealth options are generally less expensive than traditional face-to-face therapy,” Nguyen says.

You might be wondering if teletherapy is as good as classic therapy. The answer can be yes, as long as you are working with a licensed individual, Dr. Duckworth says. For instance, a 2015 review published in the Cochrane Database of Systematic Reviews analyzed 30 studies of 2,181 patients, ultimately suggesting that internet-based cognitive behavioral therapy (ICBT) was about as effective as in-office CBT for treating anxiety. (More research is necessary to reach any conclusions about how telehealth compares with traditional therapy, though.)

But the field is still relatively new, rapidly growing, and generally unregulated, Dr. Duckworth explains. It is key to make sure that you’re getting good care, even if it’s virtual. The National Institute of Mental Health (NIMH) has some suggestions for finding the most trustworthy teletherapy service possible, and here’s advice on how to have successful teletherapy appointments.

Instead of looking for telehealth apps and services, then selecting a therapist, you could start by looking for a therapist who uses teletherapy. Thero.org has a filter option to search for providers that offer teletherapy, Psychology Today can show you practitioners who do video counseling, and the Anxiety and Depression Association of America has a directory of members who provide telehealth services.

7. Try group therapy and support groups.

There is no substitute for individual counseling, and not everyone is a group person. But group-based mental health treatment can be tremendously helpful and cost-effective, if not free.

Large practices, training clinics, and community health centers sometimes offer group therapy facilitated by a licensed therapist at a very low cost, Vaile Wright says. These can happen in conjunction with individual therapy or potentially as a standalone.

Then there are peer-led groups, which are meant to be supportive, judgment-free environments where you can share your experiences with people who can relate to you.

In both scenarios, you also get to listen to other people process what’s going on with them, which can be helpful, Nguyen says. And the built-in social support network can be really valuable to people who feel isolated.

The National Alliance on Mental Illness, the Anxiety and Depression Association of America, Mental Health America, Psychology Today, and the Depression and Bipolar Support Alliance all have tools for finding a wide variety of local (and online) support groups based on where you live and what you’re seeking.

You deserve a qualified therapist you connect with no matter your budget.

Scoring a therapist at a good price is just the first step. It’s essential that you trust your therapist enough to open up and work together toward your goals, Nguyen says.

To help you figure out if you’re on the same page as soon as possible, Dr. Duckworth recommends interviewing your new therapist during your initial consult or first session.

If you’ve given it an honest go for a few sessions but aren’t feeling it, Vaile Wright encourages you to bring up your reservations with your clinician. Have a discussion about what to do differently or if it might be time to try someone else, Vaile Wright says: “You shouldn’t ever settle.”

Related:

Pregnancy After Miscarriage: Why I Can’t Shake the Fear of Another Pregnancy Loss

I’m eight months pregnant, and it can be a terrifying thing for me to speak openly about.

I find it therapeutic to write about it, oddly, but talking it about it casually with loved ones still isn’t easy. I even have family members and friends who I don’t see regularly who still don’t know, even though I’m due to give birth in just a few weeks.

The reason behind this is simple—at least, to me: During my last pregnancy, I miscarried twin boys and it was devastating. The miscarriage happened with no warning at 14 weeks, a time when I thought the pregnancy was considered “safe.” In reality, there is no such thing.

Before our loss, my husband and I had already told our sons that they would be having not one, but two little brothers, and we loved telling everyone about our news. We also started talking about childcare and learning about all the twin gear that’s out there. Suddenly, none of that mattered anymore.

It took six long, agonizing months to get pregnant again, and I’m so incredibly grateful that this pregnancy has been going well. But I’m still scared to allow myself to believe it actually will work out. I know it’s unreasonable, but I carry the fear that, if I allow myself to think everything will be OK, something will definitely go wrong.

As a result, I’ve struggled with making plans for the new baby. It took me two weeks to psych myself up to ask my children’s daycare to hold a slot for the new baby in the future, and I cried the whole way home, worried that I had somehow jinxed things.

Friends who I see regularly in person (from whom I clearly can’t hide the fact that I’m pregnant) have passed on hand-me-downs that sat for weeks untouched before I managed last week to bring myself to go through them. I only just recently filled out hospital paperwork and told work that I’m expecting. And, when well-meaning friends wanted to throw me a baby shower, I asked if we could just have a regular brunch with no baby theme instead.

Doctor’s visits are also scary. In my ob/gyn’s office, I’m reminded that we learned our twin babies no longer had heartbeats during a routine ultrasound. Every time I have an appointment (which is now weekly), I have to take deep breaths to try to stay calm. I have trouble celebrating the positives in these appointments; instead, I find myself searching for little clues that aren’t there, pressing for more information from my doctor that something may be off. Up until this baby started kicking regularly, I cried during every visit after getting confirmation that the pregnancy was still viable.

It’s a very real emotion to fear that history will repeat itself.

I realize that thinking so negatively is unhelpful. I also acknowledge that not all people react with grief after a miscarriage, or react the way that I have if they get pregnant again—but many people do. The rational part of my brain knows that believing in and getting excited about this pregnancy won’t somehow wish it gone. But I was and probably always will be scarred emotionally by the loss of those babies.

The fear associated with pregnancy after a miscarriage may differ from that of other traumatic events in that you can’t avoid it if you want to carry another baby, Tamar Gur, M.D., Ph.D., a women’s health expert and reproductive psychiatrist at The Ohio State University Wexner Medical Center, tells SELF. When people have been in a serious car accident, for instance, they may want to avoid driving for a while or try to steer clear of the scene as much as possible—but that type of avoidance and distance is impossible with pregnancy, she points out. “You’re performing the act of ‘driving’ at the scene of the accident on a constant basis,” Dr. Gur says.

Pregnancy is a constant, often-triggering reminder of the loss that you experienced, Dr. Gur goes on. “That can be very stressful in the sense that it reminds you repeatedly and acutely of your loss,” she says, adding that she hears worries about another pregnancy loss from patients who are pregnant after a miscarriage “more times than I don’t.”

Being pregnant again after a miscarriage can lead to a person feeling a range of emotional symptoms, including anxiety, preoccupying thoughts, and even post-traumatic stress disorder (PTSD) or panic attacks, Jessica Zucker, Ph.D., a psychologist specializing in women’s reproductive and maternal mental health and creator of the #IHadAMiscarriage campaign, tells SELF. It’s also not uncommon for a person to search for symptoms that will give them a clue of another loss, like inspecting their toilet paper after they wipe to look for blood or analyzing any change in their pregnancy symptoms, she says.

The negative emotions someone feels may also come in waves. For some, they may peak around the time of the previous loss, but for others it may spike every time they have an appointment, Dr. Gur notes.

“Before miscarriage affects you personally, you don’t really think it’ll happen to you,” Zucker says. “Once it does, it can become hard to trust that it won’t happen again.”

While you may have to learn to live with your fear on some level, there are a few things you can do to lessen it.

First, it’s important to make sure that you’ve dealt with the loss appropriately, Catherine Birndorf, M.D., founder of the Motherhood Center in New York and an associate professor of psychiatry and obstetrics & gynecology at the New York-Presbyterian Hospital Weill Cornell Medical Center, tells SELF. “It’s hard to push past something if you haven’t dealt with it,” she says. “You can’t pretend it didn’t happen and have to acknowledge to yourself what the loss was like and how it affected your life.”

Everyone handles a miscarriage differently. Some people may choose to mourn the loss, or possibly even commemorate it in some way. Some may find it helpful to lean on and open up about how they are feeling to trusted loved ones or perhaps someone who has been through it before. You also may benefit from professional therapy or counseling.

To handle fear in the moment, one tactic worth trying is to mentally bring yourself to the present when your concerns start to take over, Zucker suggests. That can mean doing something as simple as reciting a mantra to yourself, such as, “In this moment, I am pregnant. This much I know,” or, “As far as I know, everything is going smoothly.” Anxiety often manifests as “what if” questions, Zucker says, and this type of mantra can help ground you if you feel yourself start to go down a bad mental path.

Keep in mind, too, that if you feel like going to the same doctor that you saw during your miscarriage is triggering you and only making you feel anxious during every visit, it’s okay to look for a new one, Dr. Birndorf says. But overall, Dr. Gur recommends taking it one day at a time and feeling grateful for every day of your pregnancy. “Allow yourself to enjoy things like a positive ultrasound or big kicks,” she says. “This isn’t like a light switch flipping—this is a daily practice.”

And, of course, if you feel like you can’t handle the stress on your own or by talking through it with your support network, it’s a good idea to seek out counseling. Your doctor or midwife should be able to recommend a good mental health counselor, Zucker says.

It may also be comforting to consider the fact that most people who have a miscarriage go on to have a healthy future pregnancy. The American College of Obstetricians and Gynecologists (ACOG) specifically calls repeated pregnancy losses “rare.” But, even though statistics say otherwise, it can still be hard to believe that things will be OK after you’ve lived through a pregnancy that wasn’t, so numbers alone may not give you peace of mind, and that’s OK.

And if you feel like you just can’t feel at ease until your pregnancy is over, don’t beat yourself up.

“Oftentimes I find that, until you are able to bring home a healthy baby, there is sort of a difficulty believing that it could happen,” Dr. Gur says. “There’s nothing wrong with that.” While carrying fear through a new pregnancy after a miscarriage can make it tough to prepare for a baby the way you might have otherwise, it’s not a known risk factor for postpartum depression or something that will interfere with your ability to bond with the baby once it arrives, she notes.

As for me, I’m still taking it one day at a time. I’m grateful to be pregnant and that everything has gone well so far. And, while I still haven’t allowed myself to get excited for the day that this baby will be born, I hope with every fiber of my being that it’s coming.

Related:

Bone Health: Tips To Keep Your Bones Healthy

Bones play many roles in the body—providing structure, protecting organs, anchoring muscles, and storing calcium. While it’s important to build strong and healthy bones during childhood and adolescence, you can take steps during adulthood to protect bone health, too.

Why is bone health important?

Your bones are continuously changing—new bone is made and old bone is broken down. When you’re young, your body makes new bone faster than it breaks down old bone, and your bone mass increases. Most people reach their peak bone mass around age 30. After that, bone remodeling continues, but you lose slightly more bone mass than you gain.

How likely you are to develop osteoporosis—a condition that causes bones to become weak and brittle—depends on how much bone mass you attain by the time you reach age 30 and how rapidly you lose it after that. The higher your peak bone mass, the more bone you have “in the bank” and the less likely you are to develop osteoporosis as you age.

What affects bone health?

A number of factors can affect bone health. For example:

  • The amount of calcium in your diet. A diet low in calcium contributes to diminished bone density, early bone loss, and an increased risk of fractures.
  • Physical activity. People who are physically inactive have a higher risk of osteoporosis than do their more-active counterparts.
  • Tobacco and alcohol use. Research suggests that tobacco use contributes to weak bones. Similarly, regularly having more than two alcoholic drinks a day increases the risk of osteoporosis, possibly because alcohol can interfere with the body’s ability to absorb calcium.
  • Gender. You’re at greater risk of osteoporosis if you’re a woman, because women have less bone tissue than do men.
  • Size. You’re also at risk if you’re extremely thin (with a body mass index of 19 or less) or have a small body frame because you might have less bone mass to draw from as you age.
  • Age. Your bones become thinner and weaker as you age.
  • Race and family history. You’re at greatest risk of osteoporosis if you’re white or of Asian descent. In addition, having a parent or sibling who has osteoporosis puts you at greater risk—especially if you also have a family history of fractures.
  • Hormone levels. Too much thyroid hormone can cause bone loss. In women, bone loss increases dramatically at menopause due to dropping estrogen levels. Prolonged absence of menstruation (amenorrhea) before menopause also increases the risk of osteoporosis. In men, low testosterone levels can cause a loss of bone mass.
  • Eating disorders and other conditions. People who have anorexia or bulimia are at risk of bone loss. In addition, stomach surgery (gastrectomy), weight-loss surgery, and conditions such as Crohn’s disease, celiac disease, and Cushing’s disease can affect your body’s ability to absorb calcium.
  • Certain medications. Long-term use of corticosteroid medications, such as prednisone, cortisone, prednisolone, and dexamethasone, are damaging to bone. Other drugs that might increase the risk of osteoporosis include aromatase inhibitors to treat breast cancer, selective serotonin reuptake inhibitors, methotrexate, some anti-seizure medications, such as phenytoin (Dilantin) and phenobarbital, and proton pump inhibitors.

What can I do to keep my bones healthy?

You can take a few simple steps to prevent or slow bone loss. For example:

  • Include plenty of calcium in your diet. For adults ages 19 to 50 and men ages 51 to 70, the recommended dietary allowance (RDA) is 1,000 milligrams (mg) of calcium a day. The recommendation increases to 1,200 mg a day for women after age 50 and for men after age 70.

    Good sources of calcium include dairy products, almonds, broccoli, kale, canned salmon with bones, sardines, and soy products, such as tofu. If you find it difficult to get enough calcium from your diet, ask your doctor about supplements.

  • Pay attention to vitamin D. Your body needs vitamin D to absorb calcium. For adults ages 19 to 70, the RDA of vitamin D is 600 international units (IUs) a day. The recommendation increases to 800 IUs a day for adults age 71 and older.

    Good sources of vitamin D include oily fish, such as tuna and sardines, egg yolks, and fortified milk. Sunlight also contributes to the body’s production of vitamin D. If you’re worried about getting enough vitamin D, ask your doctor about supplements.

  • Include physical activity in your daily routine. Weight-bearing exercises, such as walking, jogging, tennis, and climbing stairs, can help you build strong bones and slow bone loss.

  • Avoid substance abuse. Don’t smoke. Avoid drinking more than two alcoholic drinks a day.

Enlist your doctor’s help.

If you’re concerned about your bone health or your risk factors for osteoporosis, including a recent bone fracture, consult your doctor. He or she might recommend a bone density test. The results will help your doctor gauge your bone density and determine your rate of bone loss. By evaluating this information and your risk factors, your doctor can assess whether you might be a candidate for medication to help slow bone loss.

Updated: 2016-01-15

Publication Date: 2010-12-07