6 Things Everyone Gets Wrong About Laser Tattoo Removal

Rethinking that ink? If you’re not as in love with your tattoo as you once were, laser tattoo removal is a generally safe (albeit expensive) way to get the job done.

Between our increased access to laser removal and the candidness with which celebrities showcase their use of it on social media (Khloé Kardashian, I’m talking to you), a permanent tattoo feels like less of a commitment. But “they’re not like magic erasers,” as dermatologist Amy Wechsler, M.D., previously told SELF—there’s more to it than you may think.

Though lasers are helpful, efficient, and effective when it comes to tattoo removal, there are a bunch of misconceptions about what they can (and can’t) do. Before you willingly get that questionable song lyric etched into your forearm—or take the plunge to have something old removed—here’s what you should know about the laser process first.

Myth #1: It’s safe to get laser removal done anywhere it’s offered.

Though laser centers and spas are popping up everywhere, it’s important to make sure laser removal is done by a dermatologist. “[Dermatologists] know what to recognize, how to look for a complication, and who not to treat,” Robert Anolik, M.D., a board-certified celebrity dermatologist, tells SELF. With laser tattoo removal, there’s a risk of bleeding, infection, and scarring, all of which can be successfully treated, but only under the proper care of a dermatologist. It’s up to you to check the qualifications of your practitioner. New Jersey is the only state that requires licensed physicians to operate a laser, meaning that in most places, the path to offering laser removal has fewer roadblocks than it should.

Myth #2: Laser removal is a simple, quick, reliable, and easy solution to a bad tattoo.

“The big misconception with tattoo removal is that it’s an eraser,” Sherrif F. Ibrahim, M.D., Ph.D., an associate professor in the department of dermatology at the University of Rochester, tells SELF. But it’s not that simple. “It’s a process,” he says. Sometimes, complete removal of a tattoo can take one or two years, with treatments occurring every six, eight, or 12 weeks. Plus, it’s not like getting your eyebrows waxed—it’s an invasive procedure that costs hundreds of dollars a session. Lasers remove tattoos by blowing up pigment molecules into tiny pieces, which are then cleared away by an immune system response. Healing from laser treatment isn’t always a walk in the park, either. “The laser breaks the skin’s surface, so you have bleeding, you have swelling, and you have pain after the treatment,” says Dr. Ibrahim.

Myth #3: It isn’t painful to have a tattoo removed.

Laser tattoo removal can be painless, but that’s usually because practitioners can give you a numbing agent first. For larger tattoos where the removal process takes longer, a doctor can give you a lidocaine injection to numb the area, whereas a non-medical professional might not. Smaller tattoos are technically just as painful to remove, as the laser settings reflect the color of the tattoo rather than its size. However, the pain you’d endure removing a small tattoo is less ongoing than that which you’d feel while removing a large tattoo, making it more bearable for some.

Myth #4: Laser removal is safe for everyone.

Not everyone is an ideal candidate for laser removal. “Removal is always going to be more difficult in patients who have a darker skin tone based on laser physics and the way the laser works,” says Susan Bard, M.D., a board-certified dermatologist and a fellow of the American College of Mohs Surgery. “The laser targets pigment that’s in the dye, but at the same time, it can also target melanin in your skin. So, the darker your skin, the more complicated it will be to utilize a laser to remove the tattoo.” Laser removal can cause burns and hyperpigmentation in darker skin tones.

Myth #5: All tattoos are equally easy to remove.

Not all tattoos are created equal. “Black tattoos are easier to remove than brightly colored tattoos. Green and blue tend to be a little more challenging, and things like yellow, white, and purple are almost impossible to remove completely,” says Dr. Ibrahim. “Different wavelengths of laser target different colors in the skin,” says Dr. Bard. This is why multiple lasers are required for the successful removal of a multicolor tattoo—another reason to see a well-versed doctor for treatment. If you have laser removal done properly, you should see about 90 percent clearance on a tattoo, says Dr. Anolik. “You can’t be sure that you’re going to get 100 percent clearance on a tattoo, and that’s for a variety of reasons, including the type of ink and if [the tattoo] was done by a professional tattoo parlor,” he says. “Professional tattoos tend to incorporate more colors and deposit more deeply into the dermis, making them more challenging.” Amateur tattoos tend to be easier to remove, as they are often carbon-based, single-color, and placed more superficially. Dr. Ibrahim says the same goes for older tattoos, where the ink diffuses upward over time, making it easier to break up with a laser.

Myth #6: If you had no reaction to getting a tattoo, you’ll have no reaction to getting it removed.

It’s possible to have a smooth healing process after getting your tattoo, but still a poor reaction to laser removal. For one, lasers can cause scarring and permanent skin discoloration that tattoos might not (aside from doing so in the obvious ways, of course).

Alternatively, you may have had a bad reaction to the tattoo and want it taken off. In this case, says Dr. Bard, “the worst thing you can do is laser tattoo removal. [Laser removal will] to break up the pigment and bring it into the lymph nodes, which will cause a systemic reaction everywhere.” A systemic reaction puts a patient at risk for anaphylaxis, which is life threatening. Alternative removal methods for people with allergies include surgically cutting the tattoo out or removing it with an abrasive laser, which removes the top layer of skin.

19 People Share the Powerful Stories Behind Their Tattoos

I don’t have a tattoo, but I’ve always been curious about getting one. I’ve gone through phases where I use a Sharpie to draw a shape that feels meaningful to me at any given time—an infinity symbol, a safety pin, the letter of someone’s first name—on the inside of my index finger or below the edge of my palm. Is this what it would feel like? I stare down at my hands habitually and ask myself. Is this where it should go? Is this what it should be?

Whenever I see someone’s tattoo—whether it be big or small, and whether or not I know that person—I wonder why they got it. To put something on your body permanently, enduring what I imagine must be quite a bit of pain, and often paying a lot of money, takes a level of passion and dedication that I find fascinating. I always want to ask, What motivated you?

So, I asked.

Here, 19 SELF readers (of over 200 submissions) share photos of their tattoos and the stories behind them. The stories—like the tattoos themselves—are all different and beautiful.

Widely used mosquito repellent proves lethal to larval salamanders

Insect repellents containing picaridin can be lethal to salamanders. So reports a new study published today in Biology Letters that investigated how exposure to two common insect repellents influenced the survival of aquatic salamander and mosquito larvae.

Insect repellents are a defense against mosquito bites and mosquito-borne diseases like dengue, chikungunya, Zika, and West Nile virus. Salamanders provide natural mosquito control. During their aquatic juvenile phase, they forage on mosquito larvae, keeping populations of these nuisance insects in check.

Emma Rosi, a freshwater ecologist at Cary Institute of Ecosystem Studies and a co-author on the paper explains, “Use of insect repellents is on the rise globally. Chemicals in repellents enter aquatic ecosystems through sewage effluent and are now common in surface waters. We set out to understand the impact of repellent pollution on both larval mosquitoes and the larval salamanders that prey on them.”

The paper is the first to suggest that environmentally realistic concentrations of picaridin-containing repellents in surface waters may increase the abundance of adult mosquitoes due to a decrease in predation pressure on mosquitoes at the larval stages.

Testing the two most popular repellents

The research team tested the effects of two of the most widely used insect repellents — DEET (Repel 100 Insect Repellent) and picaridin (Sawyer Premium Insect Repellent) — on larval salamanders and mosquitoes. In a lab, they exposed mosquito larvae and just-hatched spotted salamander larvae to three environmentally relevant concentrations of these chemicals, as well as a control treatment.

Rosi notes, “The concentrations in our experiments are conservative; we prepared them based on unadulterated commercial formulations, not concentrations of pure active compounds.”

Mosquito larvae were not impacted by any of the treatments and matured unhindered. After four days of exposure to repellent with picaridin, salamanders in all of the treatment groups began to display signs of impaired development such as tail deformities. By day 25, 45-65% of picaridin-exposed salamander larvae died.

Co-author Barbara Han, a disease ecologist at Cary Institute explains, “Our findings demonstrate that larval salamanders suffer severe mortality and developmental deformities when exposed to environmentally relevant concentrations of commercially available repellent containing the active ingredient picaridin.”

Adding, “The expediency of salamander mortality was disconcerting. When studying the effects of a chemical on an amphibian, we usually look for a suite of abnormalities. We couldn’t collect these data because the salamanders died so quickly.”

How toxic is toxic?

LC50 tests are used to define a chemical’s environmental toxicity. These standard tests, based on one life stage of a single species, measure how long it takes for 50% of a test population to die with increasing exposure to a chemical in a lab over a four-day period.

Co-author Alexander Reisinger, an Assistant Professor at University of Florida, Gainesville says, “We observed heavy salamander mortality with picaridin, but not until after the fourth day of exposure. By the LC50 measure, picaridin would be deemed ‘safe’, but clearly, this is not the case. If a substance doesn’t kill organisms within the first few days of exposure, it can still be toxic and have ecological impacts.”

Results may underestimate the problem

Lethal in a controlled setting, picaridin may cause greater mortality in a natural context, where organisms are exposed to numerous stressors. Rosi notes, “Animals don’t exist in isolation. In nature, competition, predation, resource limitation, and social interactions make it difficult for an organism to tolerate the added stress of exposure to a harmful substance, even in small amounts.”

Timing — of both repellent use and amphibian reproduction — is also key. Many amphibians breed in a single seasonal pulse, putting all their eggs in one basket, so to speak. Mosquitoes have an extended breeding season, and reproduce multiple times.

Lead author Rafael Almeida, a postdoctoral researcher at Cornell University, conducted the research as a visiting PhD student at the Cary Institute. He explains, “The amount of repellents entering waterways peaks seasonally. If amphibians are exposed during a sensitive life stage, entire cohorts could perish. The population would not have a chance to recover until the following year. Meanwhile, mosquitoes would continue to reproduce. It suggests a negative feedback loop.”

Additional study

Future work is needed to explore the relationship among mosquito repellents, amphibians, and other ecological factors, and to better assess the severity of repellents’ impact in the wild.

Almeida concludes, “The effects of repellents containing DEET and picaridin need to be studied further to determine the extent to which these chemicals disrupt aquatic ecosystems and potentially increase mosquito-borne disease risk worldwide.”

Three percent of children hit daily activity target

Only one in 30 children does the recommended amount of daily physical activity, new research suggests.

Guidelines from the Chief Medical Officer say people aged five to 18 should do at least 60 minutes of “moderate-to-vigorous intensity physical activity,” every day.

Previous research has often used less than seven days of data on children’s activity and created an average based on that.

But a study by the universities of Exeter and Plymouth of Year Five children (aged nine or ten) found that although almost a third (30.6%) achieved an average of 60 minutes per day, just 3.2% did so every day.

Activity levels among girls were even lower, with just 1.2% hitting the 60-minute daily target — compared to 5.5% of boys.

“Previous studies based on average activity are likely to have overestimated the percentage of children meeting the recommendations,” said Dr Lisa Price, of the University of Exeter.

“Our findings suggest that just under a third of children are achieving an average of 60 minutes per day, but only 3.2% meet the 60-minute target every day.

“We were surprised to find such a big difference.

“We don’t know whether averaging 60 minutes a day will be different in terms of health outcomes compared to 60 minutes daily — more research is needed to look into this.

“We do know that most children aren’t doing enough physical activity, and that this has consequences not just in childhood but in adulthood too.”

The data was gathered from 807 Year Five children from 32 schools in Devon, with a full seven days of data gathered on each child using an activity tracker watch.

Previous studies collecting activity data have been limited by the ability to obtain a full seven days of data, so this study has some of the most robust data on nine and ten year olds’ activity.

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Babies born at home have more diverse, beneficial bacteria, study finds

Infants born at home have more diverse bacteria in their guts and feces, which may affect their developing immunity and metabolism, according to a study in Scientific Reports.

Understanding why babies born at home have more diverse microbiota for at least a month after birth, compared with those born in a hospital, could help prevent disease later in life. The human microbiome consists of trillions of bacteria, fungi and viruses that live on and in our bodies, many of which benefit our health and prevent chronic conditions such as obesity, diabetes, asthma and gut inflammatory disorders. Microbes transmitted from mother to baby help prevent chronic disease.

“The reasons for the differences between infants born at home versus in hospitals are not known, but we speculate that common hospital interventions like early infant bathing and antibiotic eye prophylaxis or environmental factors — like the aseptic environment of the hospital — may be involved,” said senior author Maria Gloria Dominguez-Bello, a professor in Rutgers University-New Brunswick’s Department of Biochemistry and Microbiology and Department of Anthropology.

In the study, researchers followed 35 infants and their mothers for a month after birth. Fourteen infants were born at home (four of them in water) and 21 in the hospital. All 35 infants were delivered vaginally without interventions (including no maternal antibiotic treatment) and were exclusively breastfed. All infants were delivered by midwives who supported mothers, and they all had skin-to-skin contact with their babies, and began breastfeeding shortly after birth.

In a related analysis, fecal samples of month-old infants born in a hospital showed greater inflammatory gene expression in a human epithelial cell model, compared with infants born at home. Epithelial cells cover organ linings, skin and mouths.

While more research is needed, the study suggests that revamping the hospital environment for non-high risk births, so it more closely approximates home conditions, may be beneficial.

The study included researchers from Rutgers, New York University, Sejong University in Seoul, South Korea, and the University of California San Francisco.

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Benefits of Being Bilingual: Delay Alzheimer’s?

I’ve heard that learning a second language can help delay the onset of Alzheimer’s disease. Is this true?

Answer From Jonathan Graff-Radford, M.D.

Possibly. Studies on the connection between bilingualism and a lower risk of Alzheimer’s disease have had conflicting results.

Some studies have shown that if you know two or more languages—and you have risk factors for Alzheimer’s—you may experience a delay in the onset of Alzheimer’s symptoms. Some researchers believe being bilingual or multilingual helps develop your brain’s cognitive reserve in the same way that engaging in other mentally and socially stimulating activities does.

However, other studies have not found a clear connection between being bilingual and having a lower risk of Alzheimer’s disease. More research is needed before it’s completely understood how cognitive reserve works to delay the onset of Alzheimer’s disease and other dementias.

It’s thought that activities that develop cognitive reserve work because they increase the robustness of your brain’s architecture—enriching blood flow, enhancing the activity of neurons, and putting more of your brain to use. This may make up for the loss of diseased parts of the brain.

Engaging in a variety of activities, especially those promoting mental and social stimulation, may help people at risk of developing Alzheimer’s disease or dementia slow or delay its onset.

And if you’re interested in learning another language, go for it. However, more research is needed before it’s known whether learning a second language later in life has the same protective effect as might a lifetime of speaking a second language.

Updated: 2017-11-03

Publication Date: 2017-11-03

Childhood antibiotics and antacids may be linked to heightened obesity risk

Young children prescribed antibiotics and, to a lesser extent, drugs to curb excess stomach acid, may be at heightened risk of obesity, suggests research published online in the journal Gut.

These drugs, particularly if taken for lengthy periods, may alter gut microbes that have been associated with weight gain, explain the researchers.

The composition of gut bacteria (the microbiome) has been linked to various aspects of human health, including obesity. And certain drugs, such as antibiotics and acid suppressants-histamine 2 receptor antagonists (H2RA) and proton pump inhibitors (PPIs)-can alter the type and volume of bacteria in the gut.

To try and find out if exposure to these drugs in early childhood might increase the risk of obesity, the researchers looked at the medicines prescribed to 333,353 infants, whose medical records had been input into the US Military Health System database between 2006 and 2013, in the first two years of their lives.

In all, 241, 502 (72.5%) had been prescribed an antibiotic; 39,488 (just under 12%) an H2RA; and 11,089 (just over 3%) a PPI during this period. Some 5868 children were prescribed all three types of drug.

Some 46,993 (just over 14%) children became obese, of whom 9628 (11%) had not been prescribed any antibiotics or acid suppressants.

Boys, those born after a caesarean section, and those whose parents were below officer rank were more likely to become obese.

But after taking account of potentially influential factors, a prescription for antibiotics or acid suppressants was associated with a heightened risk of obesity by the age of 3 — the average age at which obesity was first identified in these children.

A prescription for antibiotics was associated with a 26 per cent heightened risk of obesity. This association persisted, irrespective of antibiotic type, and strengthened with each additional class of antibiotic prescribed.

Acid suppressants were also associated with a heightened obesity risk, although to a lesser extent, and this association strengthened for each 30-day supply prescribed.

Although the largest study of its kind, it is nevertheless observational, and as such, can’t establish cause. And potentially influential information on how much the children’s mothers weighed, and whether they smoked or had other underlying conditions wasn’t available.

And the researchers emphasise that the links between the individual, the environment, and obesity are complex, highlighting the “current difficulty of drawing clear conclusions about the interplay between exposure history, gut microbiota and propensity to develop obesity.”

They add: “There is an important therapeutic role for microbiota-altering medications. The long term risks to health must be weighed against the short-term benefits.”

But they also point out that over prescription of both antibiotics and acid suppressants, including in young children, is “a significant problem.”

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Why Doing a Hollow Body Hold Like Blake Lively’s Trainer Is So Challenging—Plus, How to Work Up to It

You know an exercise is extremely challenging when one of Hollywood’s top trainers struggles to do it.

Don Saladino, celebrity trainer and co-founder of Drive495 gym whose clients have included Blake Lively, Ryan Reynolds, and Hugh Jackman, among others, posted an Instagram video last week of himself demoing a core move—the hollow body hold—and a progression called the hollow body rock.

Take one look at Saladino’s facial expression—or simply listen to his groans—and you’ll get the gist: This move is tremendously tough.

You can check out the video, via @donsaladino, here:

The hollow body hold originated in gymnastics and is “entry level for the sport,” Tony Vidal, NYC-based certified strength and conditioning specialist and master trainer with fitness app POPiN, tells SELF. But for the general population? “It’s very difficult,” he says.

This move is so damn difficult because it requires an immense amount of core strength.

With the hollow body hold, think of your body like a teeter totter, Stephanie Mansour, Chicago-based certified personal trainer, tells SELF. Your core is the fulcrum and your arms and legs are the levers.

The primary challenge comes in keeping your lumbar spine (lower back) pressed flat against the ground, explains Vidal. This positioning in and of itself can be difficult to achieve based on the level of core strength it requires, and it becomes more difficult the more that you lengthen your levers, or extend your arms and legs farther from your core.

As your body works to support the weight of your arms and legs, your back naturally wants to arch to alleviate the tension. Yet the whole point of the hollow body is to maintain a flat, or neutral, spine. “That’s the reason it’s so hard,” says Mansour.

If you’re up for the challenge, you’ll work several major muscles in your core—plus others in your upper and lower half.

If you do the hollow body hold as Saladino demos, with your arms raised overhead and your legs extended straight out and parallel to the ground, you’ll work essentially “the whole front surface of the body from toes up to the fingertips,” says Vidal.

The major workhorses will be in the core, specifically the transverse abdominis (the deepest core muscle that wraps around your spine and sides) and rectus abdominis (what you think when you think abs), says Vidal. You’ll also challenge your quads, hip flexors, inner hip muscles, and lats, he adds, as well as your glutes, inner thighs, and erector spinae (the muscle that wraps around the spine), says Mansour.

Doing this move on the reg can help your core muscles work together more efficiently. Bonus: It can also help you nail a handstand.

The hollow body hold “teaches you how to train your abs,” says Mansour. Many basic exercises, like squats, lunges and planks, are properly performed with a neutral spine. “You have to pull your abs in in order to achieve that,” says Mansour. Other core-centric moves, like sit-ups and crunches, teach you how to engage your abs while moving, while the hollow body hold focuses on stabilizing your midsection without moving, explains Mansour. “This teaches you how to connect multiple core muscles together,” she says, which will help your core be more powerful and efficient as a unit.

On top of that, hollow body holds can train your body to better execute inversion movements, says Vidal, like handstands. That’s because a handstand requires overhead hand positioning, intense core strength and a straight, stacked spine in order to stay still—which is the exact body positioning that the hollow boy hold demands. Both moves require many muscles to be working synergistically, says Vidal.

Here’s how to progress up to the hollow body hold:

  • Lie face up with your legs raised, knees bent in tabletop position, and arms extended along your sides, hovering several inches above the ground.
  • Contract your abs to press your low back into the ground. Squeeze your thighs together and squeeze your glutes.
  • Lift your shoulders off the ground (making sure they are pulled down from your ears and not hunched up) like you’re doing a crunch, and keep your head in a neutral position so that you’re not straining your neck. Your legs and mid-back should both be off the ground.
  • Try to hold this position for 30 seconds, keeping your low back continually pressed against the floor.

Once you can hold the position correctly for one minute, try progressively extending and then eventually lowering your legs until they are parallel to the ground and hovering just several inches above, keeping all of the form cues mentioned above. Place your hands under each hip for extra support if you need it.

Once you can correctly hold this position for one minute, progressively extend your arms over your head and down until they are parallel to the ground and hovering just several inches above. You should be in the shape of a banana with just your low back and hips on the ground. This is the full hollow body hold.

When—and only when—you can hold both your arms and legs out straight for at least a minute, you can up the ante by attempting Saladino’s rocking progression, keeping your low back pressed down into the ground as you totter back and forth. The momentum should come from your core, says Mansour. Your arms and legs aren’t instigating the motion and should remain as still as possible as just your torso moves, she adds.

No matter where you are in the progression, remember the most important element: keeping your back flat and pressed into the ground. Think about pulling your low ribs down and knitting them together “like a corset,” says Mansour. “The second your back starts arching, stop,” says Mansour. You should also stop if you experience any pain, especially in your low back, adds Vidal.

The one thing you should feel? Intense activation in your core. “If you do it correctly, you should be shaking like [Saladino] is,” says Mansour.

14 Experienced New York City Marathoners Share Their Best Tips for First-Timers

If you’re reading this, there’s a good chance you’ll be at the starting line of the TCS New York City Marathon on Sunday, November 4. Or maybe you hope to be one day!

I called New York City home for six years, and eventually left after my love-hate with the city turned more into a strong dislike for all things urban. That said, my experience running this marathon in 2015 was the moment I fell back in love with New York. The opportunity to cover ground in every single borough and be constantly surrounded by a roar—whether crowds cheering or the foot strikes of runners nearby—turned New York City into something magical that day. It’s an experience I’ll never forget.

With this year’s race just days away, I reached out to a handful of other New York City Marathon veterans to collect their best pieces of advice. From resting on pool floaties beforehand to navigating the more challenging parts of the course, here are the best tips from athletes who know the New York City Marathon experience by heart, lung, and foot.

1. Throw away any expectations and just get out there.

“I know a lot of people get intimidated by NYC Marathon being a notoriously difficult course, but I think that makes it a great first marathon if you have no idea what to compare it to. I always say my first marathon (New York in 2009) was my easiest because I didn’t know what to expect and nothing hurt until it was over.”
Carla Benton, a three-time NYC Marathon finisher (2009, 2013, and 2015), book copy editor, and former Brooklynite now based in Chicago

My thoughts: I’ll vouch for that! Familiarize yourself with the course, but don’t dissect it to the nth degree. Your adrenaline, training, and poise will carry you through the difficult sections—the crowd cheering you on will help, too.

2. Wait at the Staten Island ferry for as long as possible.

“The runners’ village at the start line is overrated. Wait in that Staten Island ferry terminal as long as possible until race officials make you get on the bus. That way you can take advantage of the heat, being indoors, being able to sit down, and indoor plumbing while you still have it.”
Maria Reinstein, a two-time New York City marathoner, NYC-based film critic, and celebrity journalist who loves to run (slowly) in her spare time

My thoughts: Unless you’re a pro runner who gets your own tent, I pretty much agree. However, I took a bus to Staten Island from Prospect Heights in Brooklyn, so didn’t have the opportunity to wait at the ferry terminal. Make sure you figure out how you’re getting to Staten Island, and perhaps just give yourself enough time (but not too much!) to get near the start before it’s time to take off.

3. Stay off your feet as much as you can the day before.

“The day before the marathon I always stay off my feet, sit on my butt, and plan out the places I’m going to eat after the marathon. This is also very helpful for all the people who are coming to watch you because you will have a meeting place post-finish line! And hopefully, it involves pizza and a drink. I highly recommend going to the Kips Bay AMC Movie theater the day before the marathon, too. They have recliner seats!”
Jocelyn Bonneau, a three-time NYC marathon finisher, and apparel designer based in New York

My thoughts: Wise words. Staying off your feet the day before is a great idea. Maybe treat yourself to taking a cab or Lyft, and hydrate while you’re at the movies!

4. Bring a pool float to the start.

“I saw a group sitting on pool toys the first year I ran NYC and now I always bring one for myself. You sit around for 2-3 hours before starting, and having something squishy to prop up against a tree and sit on is a game changer. But you can only get them on Amazon this time of year so you have to think ahead. This is what I bought last year.”
Kelly Roberts, a three-time New York City marathoner, Brooklyn based storyteller, and creator of the #SportsBraSquad

My thoughts: All I can say is I would sign up for the New York City Marathon again only to be able to do this. And P.S.: Kelly will be running this year, so look out for her and her lime green inflatable!

5. Wear an extra layer that you can throw in the donation bins once you start.

“The weather in New York will always be a little bit unpredictable, but it will most likely be on the cool side. Head to an inexpensive clothing store (like Kmart or a drug store) and buy something warm like a coat and gloves that you can wear and throw in a donation box before the gun goes off. There will be plenty right next to your corral!”
Laura Schwecherl, one-time New York finisher, marketing consultant, and writer based in Denver, Colorado

Yes, this is me! I wanted to include a bit of my own advice, too—especially since I’m someone who gets anxious about being cold at the starting line of races. I also have to include this advice from Jocelyn, who says she typically gets an XL kids snowsuit at Kmart. In her words: “They are pretty cheap and they look super cool!” You can also just wear something warm that you’ve been meaning to donate.

6. Follow the instructions from New York Road Runners.

“Follow the arrival directions sent to you by NYRR. They are spot on, and since they have done this before, they’ve got your arrival time and corral times figured out. This prevents you from standing around too long at the start. Oh, and at the end, hug Peter Ciaccia, if you can. Celebrate his last NYC Marathon with him. [Writer’s note: He’s the TCS New York City Marathon race director and is retiring this year.] He is a gem of a human.”
Mirna Valerio, one-time NYC Marathon finisher (10-time marathoner), ultra runner, writer, and speaker based in New York

My thoughts: NYRR does a fantastic job making this race a success year after year. They know their stuff, so take their advice seriously. There are amazing volunteers the day of, too, so use them as a resource and remember to thank them!

7. Start slow so your body can warm up.

“Start the race slow. Give your body time to warm up. This, unfortunately, wasn’t something I did in 2015. I started way too fast and while I set a good pace for the first 16 miles, I really struggled with the last 10. I finished in a lot of pain and needed to take some time to recover.”
Dom Goodrum, one-time NYC Marathon finisher and director of product at Let’s Do This in London

My thoughts: Read this one again and again…and again. My first mile when I ran New York was a minute faster than it should have been (oops). And I ended up running out of gas by mile 20. It’s hard but so important to start conservatively on this course!

8. Save as much energy as you can for the second half.

“It’s easy to run fast out the gate and get fired up in Williamsburg, but when you’re in the Bronx and the crowds die down, you’ll be happy having aimed to run the first 13.1 slower and save some energy.”
Kevin Carpenter, a 4-hour NYC Marathon finisher and consultant based in New York

My thoughts: Kevin brings up a great point here. While the crowds in New York are amazing, there are a few sections where the amount of people does die down. After mile 20 (usually when you start getting really tired) you’re in the Bronx; the crowds up there don’t compare to the wall of cheerers lining up along First Avenue in Manhattan. Be prepared to save some gas for when you’re up in the Bronx and don’t have as much energy to pull from the sidelines.

9. Be extra careful about pacing on the first bridge.

“As you’re wondering what to expect within this life-changing experience, I would tell you to watch out for the first 2 miles, also known as the Verrazano-Narrows Bridge. The bridge, spanning almost 14,000 feet across, also stands almost 700 feet high! This bridge will be the toughest you face throughout the course. As your adrenaline is running and your heart is pumping, remember to pace yourself throughout this lengthy and steep bridge as you have quite a trek throughout the rest of the race! Another notable bridge is the Queensboro at mile 15. Remember: Trust your training, pace yourself, keep pushing forward, and smile through the pain. Welcome to NYC!”
Jenna Fesemyer, youngest athlete in the pro wheelchair women’s field and full-time undergraduate student at the University of Illinois, looking to finish her second NYC Marathon this year

My thoughts: This advice came up time and time again, so it’s worth mentioning repeatedly. Pacing yourself for the first 2 miles is key. You still have 24 miles remaining once they’re over! Also, soak in your surroundings when you’re on each bridge. The sights are pretty magnificent.

10. Take advantage of the quiet stretches to check in on yourself.

“The race itself is lively, exciting, energetic, and fun! So first and foremost I would tell a first-timer to simply ENJOY the experience of the crowds and everything in between on race day. The difficulty might start around the Queensboro bridge as there are no crowds to cheer you on. Use that quiet time to do a self-check-in and keep your head in the game but also anticipate the roar of cheers when you come off the bridge. The rest of the race ( Mile 16+) is rolling hills, so take each mile one at a time. Let the energy of the crowd carry you home. Look out for the cheer zones at Mile 10 and Mile 21, with music and confetti and all the high fives you can manage!”
Danni McNeilly, two-time NYC Marathon finisher and administrative professional based in Brooklyn, New York

My thoughts: Queensboro is definitely tough and is indeed very quiet. To stay present, try to listen to everyone’s footsteps or use it as an opportunity to encourage someone running next to you.

11. Make sure you have a fueling strategy.

“I consider NYC to be one of the most challenging courses on the [marathon] circuit. Athletes have to empty their energy tank repeatedly, from the first climb up the Verrazano, through the Queensboro Bridge, and finally through Central Park (and all the climbs connecting those points). This makes a strategic refueling plan all the more important, ensuring optimal hydration and replenishing glycogen stores. Ideally, each athlete races with a personalized refueling strategy developed by a sports nutritionist that addresses their specific needs. But, understandably, that’s not reasonable for everyone, in which case doing a little research on general guidelines is time well spent.”
—Adam Bleakney, eight-time NYC Marathon finisher and head coach of the University of Illinois Wheelchair Track team

My thoughts: I couldn’t agree more. Every runner should have his or her own fueling plan that mirrors long runs and hard workouts. While there are plenty of aid stations on the course, not all of them have food, so make sure you carry the food you are used to eating and don’t solely rely on the fluid tables!

12. Don’t forget to actually take a look around you.

“There are emotional support dogs in the pens before the marathon [specifically for runners to pet]. I grabbed a bagel and some coffee and went to pet a dog, which helped relieve some pre-race nerves. Also, keep an eye out not just for race supporters but other runners. I was blown away by how many Achilles International teams there were with blind/differently abled runners. Don’t miss all of your amazing fellow marathoners!”
Aisha Washington, one-time NYC Marathon finisher and news marketer based in New York

My thoughts: This one is worth writing down. The New York City Marathon is a chance to celebrate everything around you. Also, make sure to look at the signs! People have some pretty witty sayings that have made me laugh out loud when I needed it most.

13. Be mindful about how much energy you’re using.

“Stay focused on the finish line in your mind; you’re gonna need every ounce of effort to get there so be mindful of how much energy you’re leaving out there on the course. Cheering, chit-chat, hugs, and high fives are often tremendously motivating but in some sense, they’re a drain on the finite reserves you have stored for the race. Use your energy wisely—with intention!”
Knox Robinson, 10-time NYC Marathon finisher, writer, founding coach of Nike+ Run Club, and captain of Black Roses NYC crew

My thoughts: This logic is really helpful. The end of this course is pretty difficult, so make sure to soak it all in while dialing into your body, paying close attention to how it’s feeling and what it needs.

14. Have a meeting place set up post-race.

“If you have people meeting you after the race, make sure that you pick a place far enough away from the course, but close enough that it’s easy for you to get to. I made the mistake of not having that location in place and wound up having some frustrating, tired phone calls with my family as my phone was dying and I was trying to get out of the crowd with weak legs!”
Courtney Spiller, a one-time NYC Marathon finisher, writer, and actor from New York

My thoughts: I wish someone had given me this advice. The finish line of the marathon can be quite chaotic, and you might find yourself walking more than you’d like just to get your drop bag and figure out how to exit the park. I remember walking for nearly 30 minutes to find my family since we never decided on an exact place to meet. Don’t be shy about leaving the finish area altogether, too. Once you’ve soaked it all in, the 1, A, C, and D subway lines are near the finish, which can take you straight to your brunch reservations.

At the end of the day, remember to be kind to yourself, especially when things get challenging.

Not to pick favorites, but one of most encouraging pieces of advice, which is fitting for all marathons, also comes from Robinson. He reminds us that in the moments when things get tough, we have to remember to love ourselves. “When the marathon gets hard—and it does get hard—it helps to remember that you are loved. The people who loved you before you set out on this whole crazy journey are still gonna love you when it’s over. You’re YOU and that’s enough—that’s all you need to be in the marathon…and in life.”

So go out there and remember that. You’re a rockstar for even making it to the starting line, and I can guarantee that no matter what happens on Sunday, you’ll cross the finish line feeling exhilarated—and yeah, probably pretty exhausted. It’ll be worth it, I promise.

Lena Dunham Says She’s 6 Months Sober After Years of ‘Misusing’ Her Anti-Anxiety Medication

Lena Dunham revealed recently that she’s been sober for six months after treating a substance abuse problem that began in a doctor’s office.

In Monday’s episode of Dax Shepard’s podcast Armchair Expert, Dunham said she had been misusing the anti-anxiety medication she was prescribed for anxiety, panic attacks, and PTSD.

“I’ve been sober for six months,” she told Shepard. “My particular passion was Klonopin,” which is a type of benzodiazepine (also called benzos). “If I look back, there were a solid three years where I was, to put it lightly, misusing benzos, even though it was all quote unquote doctor prescribed,” she said.

Dunham says that over the years, she started increasingly turning to the medication to manage the anxiety that would otherwise make it difficult to keep up her daily obligations.

She felt like she was required to show up for things she “didn’t feel equipped” for. “But I know I need to do it, and when I take a Klonopin, I can do it,” she explained.

Klonopin made Dunham “feel like the person I was supposed to be,” she continued. “It was like suddenly I felt like the part of me that I knew was there was freed up to do her thing.” Her doctor’s (or doctors’) willingness to prescribe the medication enabled Dunham to keep her worsening habit going, she says. “I didn’t have any trouble getting a doctor to tell me, ‘No you have serious anxiety issues, you should be taking this. This is how you should be existing.'”

After being diagnosed with an additional mental health condition and undergoing stressful medical ordeals to treat her endometriosis (including a total hysterectomy earlier this year), Dunham’s anxiety only grew. “I was diagnosed with pretty serious PTSD. I have a few sexual traumas in my past and then I had all these surgeries and then I had my hysterectomy after a period of really extreme pain,” she told Shepard.

Eventually, she began experiencing symptoms of anxiety, including panic attacks, much more frequently. And as her anxiety ramped up, so did her prescribed dosage and the severity of her Klonopin misuse. “It stopped being, ‘I take one when I fly,’ to ‘I take one when I’m awake,'” she said.

Benzodiazepines are a class of sedatives that are the most commonly prescribed anti-anxiety medications in the U.S.—and they can definitely be habit-forming.

“They help people relax, and they’re good for immediately relieving anxiety,” as well as anxiety-related insomnia, Steven Siegel, M.D., Ph.D., professor and chair of psychiatry and the behavioral sciences at the Keck School of Medicine of USC, tells SELF.

Clonazepam (Klonopin), diazepam (Valium), and alprazolam (Xanax) are all benzodiazepines and induce their calming or sedating effect by increasing the levels of a neurotransmitter called GABA, according to the National Institute on Drug Abuse (NIDA). They may be prescribed as a first-line treatment for generalized anxiety disorder and a second-line treatment for panic disorder and social anxiety disorder, according to the National Institute of Mental Health (NIMH). Side effects may include drowsiness, lightheadedness, headache, irritability, constipation, and nausea. And when mixed with other drugs, particularly opioids or alcohol, the sedative effects can be dangerous and even life-threatening.

But they’re really meant to be taken on a short-term or occasional basis. “They were designed to be taken as needed [or] used for days or weeks—not months, and definitely not years,” Timothy Brennan, M.D., director of the Addiction Institute at Mount Sinai West and Mount Sinai St. Luke’s Hospitals and director of the Fellowship in Addiction Medicine Program at the Icahn School of Medicine Mount Sinai, tells SELF.

When used this way, they can be an extremely effective component of an anxiety treatment plan, Dr. Siegel says. For instance, he says, a psychiatrist might give a patient suffering from severe PTSD-related panic attacks a prescription for 10 pills a month to be taken as needed. Or they might prescribe a few days’ worth to somebody who just had a death in the family and is experiencing severe insomnia, or to a person with a severe fear of flying.

The risk for misuse and abuse emerges when people start to use these drugs regularly for a long period of time.

Even though experts know these drugs should only be used in the short term, “people are staying on them for months or even years,” Dr. Brennan says. People may become accustomed to immediately mitigating any feelings and symptoms of anxiety with a pill, he explains. And for somebody suffering from severe anxiety or panic attacks, the attraction of rapidly and reliably alleviating these symptoms is obvious. “It’s understandable someone would want immediate relief,” Dr. Brennan says. “If you take something that works in 15 minutes, like a benzo, you can imagine how challenging it [would be] for somebody to decide that a different drug like an SSRI”— which can take weeks or months to be noticeably effective—”might be better.”

In addition to this psychological reliance, people can develop a tolerance to and chemical dependence on benzodiazepines. That means that your brain becomes accustomed to having the drug in your system and you gradually require more and more to experience the same effects, Dr. Siegel explains. “If you’re using them a lot and often, then you develop a brain chemistry where you cannot function without them,” he says. “And when the substance wears off, you undergo a very recognizable withdrawal syndrome,” Dr. Brennan adds. That might include symptoms like anxiety, insomnia, restlessness, agitation, and, most dangerously, seizures, he explains.

Treatment for benzodiazepine addiction involves gradually tapering off of the drug—and creating a treatment plan to more effectively manage the underlying anxiety issue.

“If you pull the drug away rapidly, you are instantly out of balance in a very dangerous way,” Dr. Siegel says. In order to avoid those intense withdrawal symptoms, it’s crucial to quit benzos under the supervision of a psychiatrist who can help you taper down the dosage very slowly over a span of weeks or months, he adds. A psychiatrist can also help you “cross-taper,” Dr. Brennan says, meaning they will slowly introduce a new drug, like an SSRI (selective serotonin reuptake inhibitors, which are commonly used to treat depression and anxiety disorders), while decreasing the dose of the benzo. And a therapist can help you developing coping skills to use to manage anxiety in the short term as well as over time.

It’s also important to have supervision because long-term use of benzodiazepines use can actually increase a patient’s baseline level of anxiety, sometimes referred to as “rebound” anxiety. “[The drugs] reset the barometer, so to speak, such that people’s anxiety somewhat worsens over the long term,” Dr. Brennan says.

That makes treating the underlying anxiety with tools other than benzos all the more important. That might include different forms of therapy, different medications, or a combination of the two. Developing a benzo dependence can be a sign that the rest of a person’s treatment plan is not working well enough, Dr. Brennan explains. “Many patients who abuse benzos do it because they feel their anxiety is not controlled.”

The bottom line is that, if you feel your anxiety is still overwhelming even under the current set of tools you have to manage it, talk to your doctor, therapist, or psychiatrist—you have plenty of other options.