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Lara K. Butler, M.D. is a Harvard trained, board-certified Dermatologist and Mohs Micrographic Surgeon. She also specializes in reconstructive and cosmetic surgery. She is a diplomate of the American Academy of Dermatology, and a fellow of the American College of Mohs Surgery and American Society of Dermatological Surgery. Following her Dermatology residency, she completed a fellowship in cutaneous oncology, Mohs micrographic, and reconstructive surgery with the Harvard Medical School Department of Dermatology at the Lahey Medical Center. She has been a researcher at the Johns Hopkins and Mount Sinai Hospitals and has published numerous articles and chapters on skin cancer, scar revision and cosmetic surgery in leading medical journals. She has taught at the Harvard Medical School Department of Dermatology, and is a lecturer on complex reconstruction techniques after Mohs surgery.

Mallika Marshall, MD, is an Emmy-winning journalist and physician. She is Medical Director at WBZ-TV in Boston, and a practicing physician at MGH's Chelsea Urgent Care Clinic and MGH Revere Health Center. Marshall is a Contributing Editor for Harvard Health Publishing and host of HHP's e-learning courses. She has nearly 15 years of media experience. She graduated cum laude from Harvard College and received her medical degree with honors from UCSF. She is a member of the Alpha Omega Alpha Honors Society and various medical associations. She has served on the Board of Trustees for the Urgent Care Foundation and the Board of Directors for Dress for Success Boston. She was an Associate Editor of the Harvard Medical School Family Health Guide.

Katie Morganti Stewart, CNP, MS, is a nurse practitioner in the Cardiovascular Performance Program (CPP) at Massachusetts General Hospital, specializing in the cardiovascular care of athletes and highly active individuals. Katie works closely with patients along the continuum of their care, from initial screening to longitudinal follow-up, and is a program coordinator for the Athletes with Arrhythmias Clinic. Katie completed her Bachelor of Science in Nursing at Boston College and then earned her Master of Science degree at the University of California San Francisco. She is nationally board-certified by the American Nurses Credentialing Center (ANCC) as an acute care nurse practitioner. Katie is dedicated to health and wellness, both personally and professionally, with a passion for yoga and cycling. When she is not engaging with patients in the CPP, she delights in spending time with her husband and three young children. 

Dr. Dean Xerras is from the greater Boston area and attended Tufts University, where he majored in Spanish and received his medical degree. He completed his residency at Beth Israel Deaconess Medical Center and currently practices general internal medicine at MGH Chelsea Healthcare Center, where he has been the medical director since 2009. He is also an assistant professor of medicine at Harvard Medical School and is active in various committees, including the Partners HealthCare Engagement and Communications team of the NIH's All of Us Research Program. Awarded a National Health Service Corps Scholarship, he is committed to reducing disparities in healthcare delivery, evidenced by his 15 years of service on the Board of Health in Chelsea, MA, where he helped develop stricter tobacco and trans fat regulations.

Infectious Disease Physician, Brigham & Women’s Hospital  

Dr. Cindy Chang is a specialist in primary care sports medicine with almost 3 decades of experience. She has served as head team physician at UC Berkeley, chief medical officer for Team USA in 2008 & 2012 Olympics, and assisted in the WNBA COVID "Wubble." Chang takes an individualized approach to care, seeing athletes of all ages. She is Program Director of UCSF's Primary Care Sports Medicine Fellowship, board of trustees for the American College of Sports Medicine, chairs the Sports Medicine Advisory Committee for the California Interscholastic Federation & National Federation of State High School Associations, and past president of the American Medical Society for Sports Medicine. She earned her medical degree from Ohio State Univ. College of Medicine, followed by a residency in family medicine at UCLA Medical Center & a fellowship in sports medicine at Ohio State Univ. Medical Center.

Hi there. Dr. Lara Butler, board-certified dermatologist here to answer the question, how can you tell if you are fully hydrated? Well, when your skin loses moisture and becomes dehydrated, you'll be able to see noticeable changes in the skin. Your skin tone will be a little dull. You'll notice more fine lines and wrinkles. Even the dark circles under the eyes will be more pronounced. So you can also experience things like headache, fatigue, decreased urination. But in terms of skin symptoms, that's what we're going to be talking about today. You can tell if your skin is dehydrated by trying to do a pinch test where you pinch the skin on the cheek or on the chest. And it should retract and not leave a wrinkle. If it does leave a wrinkle or take a while to retract, usually, that means that the skin is dehydrated, and you need to start rehydrating. So how can we do that? Well, we do it from the outside in and the inside out. From the outside, we can start hydrating by drinking a ton of water, 8 to 12 cups a day. And if you can super boost that by adding in a lemon wedge, that just adds some vitamin C, which is an antioxidant that's going to help with collagen synthesis. And that's just going to help to boost and plump the skin even more. In terms of sports drinks, we kind of recommend steering clear of those because they can have a high amount of sugar in them and that can counteract what you're trying to do with hydrating the skin since the sugar can then dehydrate the skin more. In terms of outside in, putting on a topical moisturizer or something with a ceramide, that's the key ingredient you want to look for. Ceramides are lipids, which are basically fat molecules that are going to help to lock in that moisturizer or that moisture. For extra hydration, you can add a serum like a hyaluronic acid. The serum should go in first and then the moisturizer on second. Hyaluronic acid serums are going to help the water bind collagen for that extra plumping. Otherwise, eating a ton of fruits and vegetables that can help to plump the skin with hydration are always a good option. So we get about 20% of our hydration from what we consume. So just be aware of what you're putting in your body, drink a ton of water, use some great moisturizers, and hopefully that will help plump the skin. Take care.

You can tell if your skin is dehydrated by doing a pinch test where you pinch the skin on the cheek or on the chest. To rehydrate, drink 8-12 cups of water per day and add in a lemon wedge for vitamin C. Use topical moisturizers with ceramides and hyaluronic acid serums to help lock in moisture. Eat plenty of fruits and vegetables for added hydration.

How can you tell if you are fully hydrated?

Stay Hydrated: Signs of Dehydration Revealed

To determine if you are fully hydrated, pay attention to your skin. When your skin lacks moisture and becomes dehydrated, you may notice visible changes such as dull skin tone, increased fine lines and wrinkles, and more pronounced dark circles under the eyes. Other symptoms of dehydration can include headaches, fatigue, and decreased urination.

To assess skin hydration, you can perform a pinch test. Pinch the skin on your cheek or chest and observe how it retracts. If it quickly returns to its original state without leaving a wrinkle, your skin is likely well-hydrated. However, if it takes longer to retract or leaves a wrinkle, it indicates dehydration and the need to rehydrate.

Hydration can be achieved both from the outside and inside. Drinking an adequate amount of water, around 8 to 12 cups per day, is essential. Adding a lemon wedge to your water can provide a boost of vitamin C, an antioxidant that aids in collagen synthesis and promotes plump skin. It is advisable to avoid sports drinks due to their high sugar content, which can further dehydrate the skin.

From the outside, use a moisturizer containing ceramides, which are lipids that help lock in moisture. Additionally, consider incorporating a hyaluronic acid serum before applying moisturizer. Hyaluronic acid helps bind water to collagen, providing extra hydration and plumping effects.

Eating a diet rich in fruits and vegetables can also contribute to skin hydration, as approximately 20% of our hydration comes from what we consume.

By staying mindful of your water intake, using effective moisturizers, and nourishing your body with hydrating foods, you can help maintain well-hydrated skin.

So when I think of foods that can potentially help with sleep, I think about carbohydrates because carbohydrates can increase serotonin levels. Serotonin is known to help increase the onset of sleep. It also helps with mood and improving calmness. And so serotonin and again, carbohydrates help do that. And so a carbohydrate type food, not a large meal, a couple of hours before bed can help do that. And then melatonin, a lot of people supplement with melatonin, which can be helpful at times and maybe not always a great choice to supplement with melatonin. But cherry juice and cherries, in general, are high and-- or have a good source of melatonin, which can, again, help increase the onset of sleep. And so those are the two things that I would think about a couple of hours before bedtime to help improve sleep.

Eating carbohydrates, such as a small snack a few hours before bed, can help promote sleep by increasing serotonin levels. Cherry juice or cherries can also be a good source of melatonin, which has been known to help with the onset of sleep.

What are some good foods to help improve sleep?

Carbs and Cherries: Sleep-Boosting Foods to Try!

When it comes to foods that can potentially improve sleep, carbohydrates are worth considering. Carbohydrates can increase serotonin levels, which aid in the onset of sleep and promote mood improvement and calmness. Consuming a carbohydrate-rich food, in a moderate portion, a few hours before bedtime can be beneficial.

Another option is melatonin, a hormone often used as a supplement for sleep. While supplementing with melatonin may not always be the best choice, cherry juice and cherries themselves are natural sources of melatonin. Including these in your diet can help increase the onset of sleep.

So, when looking to improve sleep, consider incorporating carbohydrates and melatonin-rich foods a few hours before bedtime.

This is a big question, and my answer might surprise some people. But the best way to stop "sugar addiction" is to eat sugar, and/or carbohydrates, they go hand-in-hand. Our body breaks down carbohydrates to simple sugars. And oftentimes, people who feel like they are addicted to sugar or can't control themselves around sugar are people who are restricting carbohydrate pretty severely. There's a lot of misinformation out in the media about this premise of addiction to sugar, and there's really not research to show that we can be addicted to sugar like we can a narcotic, or other drug, or alcohol even. What we can be though we can have the physiological drive or need for carbohydrate, because it fuels much of what we do, our brain prefers glucose, a simple sugar as its primary fuel source. So absolutely when we restrict sugar, our bodies nature is to say I need that. It wants that, it craves that, and that's what sometimes gets skewed as addiction. That whole idea of that kind of lack of control when we restrict really heavily can then lead to this compulsive overeating and this gets a little bit deeper, but then you start to get into maybe some binge eating type behavior. Because again, it's that physiological drive to make up for restriction. I want to stress, if you're struggling with this to an extent of feeling like you're bingeing or truly out of control, one of the best steps you can take is to work with a psychologist, and dietician to help work through that. But from a more basic standpoint, if you're someone who just feels like, man, I just am craving sugar a lot and I can't control myself. Again, it might surprise you but the best thing to do would include those foods. And break down that stigma of that those foods are bad, and you'll find oftentimes that if you just include them in moderation and take away that stigma, that craving, that addiction kind of goes away.

Eating sugar and/or carbohydrates in moderation can help reduce cravings and "sugar addiction." If someone feels like they are truly out of control and binge eating, they should work with a psychologist and dietician to help them.

How do you stop sugar addiction and compulsive overeating?

Surprising Solution: Include Sugar to Beat Addiction

To address sugar addiction and compulsive overeating, it's important to understand that the best approach might be different from what some people expect. Contrary to popular belief, the most effective way to stop sugar addiction is to actually eat sugar and carbohydrates. Carbohydrates are broken down into simple sugars by our bodies, and often, individuals who feel addicted to sugar or struggle with self-control around it are those who severely restrict their carbohydrate intake.

There is a lot of misinformation in the media about sugar addiction, and research does not support the idea that we can be addicted to sugar in the same way as drugs or alcohol. However, we can experience a physiological drive or need for carbohydrates because they fuel many of our bodily functions. When we heavily restrict sugar, our bodies naturally crave it and desire it, which can be misconstrued as addiction. This can lead to compulsive overeating and potentially binge eating as a way to compensate for the restriction.

If you find yourself struggling with binge eating or feeling truly out of control around food, it is highly recommended to seek support from a psychologist and a registered dietitian who can help you work through these challenges. On a more basic level, if you simply feel a strong craving for sugar and struggle to control yourself, it may surprise you to learn that the best approach is to include those foods in moderation and remove the stigma that labels them as bad. By normalizing and incorporating these foods in a balanced way, you may find that the cravings and perceived addiction diminish over time.

OK, good question. What should I do if I think I'm bipolar? A couple of things. First of all, I know that we all have lots of insight sometimes into some of our behaviors and our mannerisms. But it's also really important that we aren't diagnosing ourselves. So you can have a guess or a hypothesis, but what I think you should do is actually really go schedule an appointment with a qualified mental health professional or someone who can truly diagnose. And then come up with a treatment plan. And I will say that there are some amazing medications for bipolar disorder that can really help stabilize your mood. And then just getting lined up with a good mental health professional. So I guess that's my answer. We all have insights and hypotheses and also family history of mental health issues and also physical health issues. But it's really important to seek a diagnosis and treatment from a qualified provider. So that is my insight.

It is important to seek a diagnosis and treatment from a qualified mental health professional if you think you are bipolar. There are great medications that can help stabilize your mood and it is important to get lined up with a good provider.

Seek professional help for suspected bipolar disorder.

If you suspect that you may be bipolar, it's important to take certain steps. While we may have insights into our behaviors and mannerisms, self-diagnosis is not recommended. Instead, I suggest scheduling an appointment with a qualified mental health professional who can provide an accurate diagnosis and create a treatment plan.

There are effective medications available for bipolar disorder that can help stabilize mood. It's also crucial to establish a relationship with a good mental health professional who can provide ongoing support and guidance.

While personal insights and family history of mental health issues can be valuable, seeking a diagnosis and treatment from a qualified provider is essential. Remember, they are equipped to provide the necessary expertise and support for your specific situation.

Hemorrhoids, who wants to talk about that? Well, it's a super common search term on the internet. And a lot of patients are looking for information about their anorectal complaints. Typically, hemorrhoids will bleed with bowel movements or they'll prolapse, meaning they pop out when you go to the bathroom or strain. And they will either go back in on their own or you have to push them back in over time. And it tends to be relatively progressive. We're not exactly sure why hemorrhoids form. But it's probably related to straining and excess pressure. And that's why we always recommend that patients maintain soft regular bowel movements, and that they supplement with fiber products to keep things regular. Fortunately, there are a lot of good treatments available-- treatment options available. And many of these are actually performed in the office, such as rubber band ligation. Others require a trip to the operating room for hemorrhoidectomy. There are a lot of myths out there about recovery. There are a lot of new technologies available. And to be perfectly honest, most hemorrhoids and their symptoms are totally fixable and curable. In addition, there can be other conditions that mimic hemorrhoid symptoms, whether it be an anal fissure or a fistula or skin conditions or even tumors or masses. And so it's really important that if you have persistent symptoms, you bring it to the attention of your primary care doctor, get in for an evaluation. They'll make the proper referral. And then a surgeon like a colorectal surgeon will see you, perform a full assessment, and talk to you about options.

Hemorrhoids are a common anorectal complaint that can cause bleeding and prolapse. We're not sure why they form, but straining and excess pressure probably contributes to it. Fortunately, there are many treatments available, from rubber band ligation to hemorrhoidectomy, and most cases are curable. It's important to get an evaluation from a doctor if you have persistent symptoms, as other conditions can mimic hemorrhoidal symptoms.

What causes hemorrhoids and how are they best treated?

Hemorrhoids: Causes, treatments, and debunking myths

Hemorrhoids, although not a pleasant topic, are a common concern for many individuals. They often cause bleeding during bowel movements or prolapse, where they protrude during straining and may need to be manually pushed back in. The exact cause of hemorrhoids is not fully understood, but it is likely related to straining and increased pressure.

To treat hemorrhoids, it is important to maintain soft and regular bowel movements. This can be achieved by incorporating fiber products into your diet. There are various treatment options available, with many procedures being performed in the doctor's office. Rubber band ligation is a common procedure, while more severe cases may require a hemorrhoidectomy in the operating room.

It is essential to dispel myths about recovery, as most hemorrhoids and their symptoms can be effectively treated and cured. It's worth noting that other conditions, such as anal fissures, fistulas, skin conditions, tumors, or masses, can mimic hemorrhoid symptoms. If you experience persistent symptoms, it is crucial to consult your primary care doctor for evaluation and appropriate referral. A colorectal surgeon can then assess your condition fully and discuss treatment options.

So would you recommend someone train of sick? At what point should you rest? Excellent question. And I know that there's been certainly a lot of debate about this especially when we've seen risks of more serious illness from patients after recovering from COVID and all of that. And so generally speaking, you should let your body be your guide. And so if you're feeling a little bit unwell but you don't have a fever, you don't have any GI upset, you feel like you could do something, I certainly wouldn't push myself. But it might be reasonable to do something very gentle, like maybe a little bit of recovery resting. Definite no nose for exercise would be fever. So fever is a temperature greater than 100.4. If you're really have deep chest congestion, something like pneumonia, you've been diagnosed with or if you have lower GI symptoms. And so a good rule of thumb is that if it's generally relatively mild and above the head, then it would be fine to do some gentle activity. If it's below the diaphragm, then I would definitely stay away from that. Nobody wants to work out when their stomach is really bothering them. And then when you get back into exercise just as importantly, when you start to feel well, you don't want to go immediately back into full activity. And so making sure that you're gradually-- just listening to your body and gradually increasing your intensity.

When you are feeling unwell, listen to your body and if it's relatively mild and above the head then doing some gentle activity like rest may be fine. If it's below the diaphragm, then stay away from any exercise. When you start to feel well, don't go back into full activity immediately, but gradually increase intensity.

How do you know when to train though illness or when to rest?

Listen to Your Body: Training Through Illness or Resting?

Knowing when to train through illness or when to rest is an important consideration. Generally, it's best to let your body be your guide. If you're feeling slightly unwell without a fever or gastrointestinal issues, you might consider engaging in gentle activity like recovery resting. However, it's crucial to avoid exercise if you have a fever (temperature greater than 100.4), deep chest congestion, diagnosed pneumonia, or lower gastrointestinal symptoms.

A good rule of thumb is that if the symptoms are relatively mild and above the head, gentle activity may be acceptable. But if the symptoms are below the diaphragm, it's best to refrain from exercise, as no one wants to work out with a bothersome stomach.

When you start to feel better and decide to resume exercise, it's important to do so gradually. Listen to your body and gradually increase the intensity rather than immediately jumping back into full activity.