Month: November 2022

Summer is an ideal time to take a hike, especially if you have the opportunity to explore one of our country’s many state and national parks. But if you venture far from home, it’s essential to make sure you’re prepared for the local climate and other conditions you may encounter on the trail, especially if you’re not an experienced hiker. Higher temperatures than you’re accustomed to or other extreme weather can be deadly.

“If you’re taking a hike in mid-July in the Arizona desert, there’s a very different list of considerations than if you’re in the mountains of Montana or the forests of North Carolina,” says Dr. N. Stuart Harris, chief of the Division of Wilderness Medicine at Harvard-affiliated Massachusetts General Hospital. Here’s a run-down of what to consider before you hit the trail.

Traveling companions, safety notifications, and orientation

First, it’s safer to travel in pairs or a group of people. But always tell someone not on your hike where you’re going, your anticipated route, and when you expect to return. National parks often require reservations or permits for overnight stays or treks to certain locales, and keep a record of day-hikers, so sign up as requested. If you end up getting injured or lost, the information can make a huge difference in locating you more quickly.

Remember to bring a map and know how to orient yourself. In many wilderness areas, cell service may be spotty or nonexistent, so don’t count on using your phone’s GPS.

In the desert, you may be able to see for 50 miles in the distance. But if you’re in a steep, wooded area, you might not be able to see 100 yards ahead and it’s much easier to become disoriented, says Dr. Harris.

Be ready for heat, humidity, and other weather hazards

Check forecasts first. Always check the forecast so you can be prepared for weather changes. Temperatures may drop and wind may increase as you climb higher. If you’re in an area prone to thunderstorms, lightning injury should definitely be on your radar, says Dr. Harris. Learn these lightning safety tips from the Centers for Disease Control and Prevention. Because these storms usually strike in the afternoon, you can minimize your risk by hiking in the earlier part of the day.

Hydrate well. During any type of exercise — especially hiking, which often demands a fair bit of exertion — be sure to drink extra water to replace the fluid you lose from sweating. On a warm day, you might not notice you’re sweating if it’s breezy. Pay attention to any signs or alerts advising hikers on how much water is best to carry.

Consider humidity. Temperature isn’t the only consideration, however. “If you’re in Arizona and the temperature is over 100° F, your body may be better able to release heat by sweating than if you’re in a very humid area,” says Dr. Harris. In the Great Smoky Mountains, for example, the temperature in July may be only in the high 80s. But humidity levels usually hover around 75% or higher. That means your sweat will evaporate more slowly, so your body’s natural cooling mechanism doesn’t work as efficiently. Be sure to rest and hydrate if you start feeling overheated.

What to wear and bring

Many park websites offer detailed safety tips specific to the terrain and weather you may encounter on a hike, so check before you go. Five basics to consider are as follows:

• If your hike involves rocky or uneven terrain, hiking boots will offer more support than tennis shoes.
• You’ll be more comfortable in lightweight, moisture-wicking clothing, but bring extra layers and rain gear, if the weather forecast suggests this is appropriate. Temperature drops can be surprising in some places when the sun wanes, so be prepared to layer up as needed if you’re out longer than expected.
• Wear a wide-brimmed hat and sunglasses to shield you from the sun’s glare — and don’t forget to apply sunscreen to all exposed skin before you set off.
• Along with plenty of fluids, bring high-energy snacks. If you get off course or encounter a problem, you’ll be glad you did.

Additionally, depending on where you’re hiking, you may need to dodge rash-inducing plants, including stinging nettles, poison oak, or poison ivy. Bring insect repellent to fend off biting insects and follow prevention strategies for ticks, which may harbor bacteria responsible for Lyme disease and other illnesses. Finally, carry a first aid kit with bandages for cuts and scrapes and moleskin for blisters.

About the Author

Julie Corliss, Executive Editor, Harvard Heart Letter

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

About the Reviewer

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

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

Think of prostate cancer surgery and what likely comes to mind is a radical prostatectomy, which is an operation to remove the entire prostate gland along with the seminal vesicles that produce semen. However, men with localized prostate cancer — meaning cancer that is still confined to the prostate — have another surgical option.

Called focal therapy, this alternative procedure treats only the cancerous part of the prostate and leaves the rest of the gland intact. The aim is to remove “clinically significant” tumor tissue, cancer that would spread further if it wasn’t treated at all. While there is a small risk that some cancer may be left behind after treatment, focal therapy also has the benefit of minimizing risks for erectile dysfunction and urinary incontinence, which are both potential side effects of radical prostatectomy. And growing evidence shows it can be an effective strategy.

Last year, researchers reported that 1,379 men treated with focal therapy or radical prostatectomy had similar cancer outcomes after five years of follow-up. The men were 66 years old on average, and doctors treated them with a technique called high-intensity focused ultrasound, or HIFU. This approach destroys cancer by subjecting it to high-energy ultrasound waves that heat tumors to high temperatures.

Now, findings from the same research team show that focal therapy is also an effective option for older men with prostate cancer. During this newer study, researchers assessed outcomes for 649 men ages 70 and above who were treated at 11 sites in the United Kingdom. Two-thirds of the men had cancer with an intermediate risk of further spread, and the remaining third had more aggressive, high-risk prostate tumors that are more dangerous.

All the men were treated with HIFU or a different type of focal therapy, cryotherapy, that destroys cancer by freezing it. The primary goal of the study was to assess “failure-free survival,” whereby treated men avoid a prostate cancer death, or worsening disease leading to further interventions.

What the data reveals

After follow-up durations ranging up to five years, 96% of the men were still alive, and the overall failure-free survival rate was 82%. No differences in outcomes between HIFU- and cryotherapy-treated men were reported. The men with high-risk cancer had worse outcomes: their failure-free survival rate was 75%, compared to 86% among men with intermediate-risk disease.

But 88% of the high-risk men and 90% of the intermediate-risk men also avoided hormonal therapy, a treatment that — because of its side effects — most men don’t want. The authors concluded that focal therapy may be an acceptable treatment that controls prostate cancer in older men as well as radical prostatectomy does.

It’s important to note that complications from focal therapy are possible. For instance, a small percentage of men in the new study developed urinary tract infections, and some also wound up with urinary retention, a treatable condition that occurs when the bladder can’t empty completely. The authors didn’t assess functional outcomes after surgery, such as erectile dysfunction or urinary incontinence. But mounting evidence from other studies shows that long-term urinary incontinence after focal therapy is very rare.

The findings are encouraging, but Harvard experts emphasize that more evidence with focal therapy is still needed. “Despite promising results such as those reported in this and other studies, long-term outcomes (e.g., 10 to 15 years or more) following focal therapy must still be assessed to fully determine how this treatment option compares to radical prostatectomy or radiation therapy,” says Dr. Boris Gershman, aurologist at Beth Israel Deaconess Medical Center and an assistant professor at Harvard Medical School focusing on prostate and bladder cancer. “Additional studies can also help us refine the types of prostate cancer that focal therapy is most appropriate for, and which types should be given therapies that treat the entire prostate gland.”

About the Author

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

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

About the Reviewer

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

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