Health (USA)

OUR DOC WILL SEE YOU NOW

Loss of smell, nighttime awakenings, a leaky bladder—Dr. Raj has fixes for these problems and more.

- Health’s medical editor, ROSHINI RAJAPAKSA, MD, is an associate professor of medicine at the NYU School of Medicine and a cofounder of Tula Skincare.

Dr. Raj has advice on regaining your sense of smell, dealing with insomnia, and more.

When I had COVID earlier this year, I lost my sense of smell. Can smell training really help me get it back?

A loss of smell, or anosmia, is one of the most common symptoms of COVID-19. About 80 percent of people infected experience some kind of disturbanc­e of the sense. We don’t fully understand why, but it’s likely that the virus disrupts or destroys the tiny, hairlike cells in the nasal passages that detect odors and send signals to the olfactory bulbs in the brain, where those odors are interprete­d.

While many people regain the ability to smell soon after they recover from COVID, some have more persistent anosmia. And another small group regains their sense of smell but in a distorted way, called parosmia; for these folks, scents may register differentl­y from how they remembered them. (For example, freshly baked cookies might smell rancid instead of sweet.)

Smell training may be worth trying. Research that was conducted before the pandemic suggested that it can benefit people with smell disorders. The training involves sniffing four different scents—say, chocolate, lemon, honey, and coffee beans—multiple times a day. The idea is to really concentrat­e on each individual scent, to help your brain regenerate pathways for accurate smell perception. (There are resources online that can walk you through the process, such as abscent.org.) The good news is that, eventually, most people with anosmia due to COVID will naturally recover their former sense of smell. It’s just a matter of time.

I fall asleep as soon as my head hits the pillow. But I often wake up at 3 a.m., and my thoughts start racing. Why does this happen?

When you are anxious or stressed about something, it can pop into your mind at the worst possible times—including the middle of the night. And once your brain gets revved up, it can take a while to wind down again.

This type of insomnia is often fueled by unresolved problems you’re too busy to think about during the daytime. So it may help to devote a few minutes at bedtime to journaling about whatever is bugging you.

Write down at least one small step you can take to address each

issue. Then finish off your entry by listing three things (or more) for which you are grateful. That way, you’ll doze off on a positive and reassuring note.

If you still wake up in the wee hours, concentrat­e on your breath. Use the 4-7-8 technique to slow your heart rate: Inhale for 4 seconds through your nose, hold for 7 seconds, then exhale for 8 seconds through your mouth.

Another self-soothing trick: As your brain turns toward a problem, visualize a stop sign. This helps redirect your thoughts so you can regain your calm.

Some people struggle to fall back asleep because they’re so worried that they’re not sleeping. If that’s you, try to remember that what you’re doing isn’t nothing: Breathing deeply while lying in bed is also restful and restorativ­e.

My brother occasional­ly throws out his back and is virtually incapacita­ted. What’s going on in his body, and is there a way to prevent it?

When someone says they threw out their back, they usually mean they’ve injured their lower back after lifting a heavy object or twisting in an awkward way. It could be a muscle spasm, or a torn muscle or ligament. Sometimes the pain is so severe the person can’t walk for several days.

The best way to avoid this injury is to take up Pilates or yoga. These workouts stretch and strengthen your core, the group of muscles that support your lower back. (Check out the sidebar for some of my favorite yoga gear.)

It’s also important to learn how to lift heavy things properly: by bending at the knees (not the waist), with your elbows at your sides, and using a slow, smooth motion—no jerking or twisting. Practicing good posture is a preventive measure, too.

If the injury ever strikes, rest and take anti-inflammato­ries. Icing regularly can also ease pain and swelling as you recover. But don’t stay immobile for too long, or the stiffness may worsen. After a few days, do a little light movement and some stretching.

People who repeatedly throw out their back should talk to a doctor. She may prescribe a muscle relaxant to take when these episodes occur. Wearing a brace or belt can provide extra support to avoid future strains. And working with a physical therapist can help build up resilience in your lower back.

If you experience any other symptoms alongside the pain from the injury—such as incontinen­ce (urinary or bowel), or tingling, numbness, or weakness in your legs—your doc may order imaging of your spine. Those symptoms could indicate a herniated disc, or a tumor pressing on the spine.

I’ve read that Botox can help with a leaky bladder. How does that work?

Botox is a paralyzing toxin derived from bacteria that temporaril­y stops a muscle from moving. When people get Botox to smooth out their wrinkles, it paralyzes the tiny facial muscles that cause those creases in the skin. But Botox can treat medical conditions as well, including urinary incontinen­ce.

It is used for a specific type called urge incontinen­ce, which is when the bladder muscles squeeze involuntar­ily, forcing urine out. Botox is also used to treat overactive bladder, a condition in which the bladder muscles spasm, causing a frequent, sudden urge to pee.

In these cases, Botox works by reducing the contractio­ns of the bladder—allowing women more time to get to the bathroom when they feel the need to go. The injections are administer­ed by a urologist under local anesthesia (it’s an in-office procedure), and the effects usually last 6 to 12 months.

Botox can be quite helpful as a treatment, but there are less invasive options to try first, such as antispasmo­dic medication­s, and pelvic floor therapy to strengthen the muscles under the bladder that help control the flow of urine.

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