Hodgkin survivors face risk of serious heart problems


People who survive a type of blood cancer known as Hodgkin lymphoma early in life may be twice as likely to develop heart problems in adulthood as peers without a history of these tumors, a U.S. study suggests.

By age 50, Hodgkin survivors were almost five times as likely to have severe cardiovascular health conditions that can be life threatening, the study found.

While the study didn’t look at why these cancer survivors might have heart problems, both chemotherapy and radiation typically used to treat these tumors can cause permanent heart damage, said lead study author Dr. Nickhill Bhakta of St. Jude Children’s Research Hospital in Memphis, Tennessee.

“The most obvious and simple option is to just give less medicine and/or radiation,” Bhakta said by email. “This is difficult because we want to cure cancer and when we know something works, it’s hard to give less of it for fear that we may not cure patients.”

To assess the lasting effects of treatment on heart health, Bhakta and colleagues examined data on about 350 adults who survived at least a decade after their Hodgkin diagnosis, as well as about 270 people without a cancer history who were similar in gender and age.

Researchers started following patients in 1971 and continued to monitor them through 2014.

More than 90 percent of the participants with Hodgkin disease received radiation during their treatment, and 36 percent of them took drugs known as anthracyclines, a type of chemotherapy that can damage the heart.

Researchers looked at a wide range of cardiovascular conditions, from abnormal heart rhythm to high blood pressure and elevated cholesterol, as well as heart attacks, valve disorders and clots that impede blood flow.

They assessed both the number of heart-related problems, and the severity of each one.

At age 50, about 46 percent of the cancer survivors had experienced at least one serious heart problem, compared with about 16 percent in the control group of individuals without a cancer history, researchers report in The Lancet Oncology.

Cancer survivors were also more likely to experience severe complications like heart attacks and structural defects such as valve disorders or damage to the aorta, the vessel that carries blood from the heart to the rest of the body.

Higher radiation doses were associated with higher odds that patients would have severe complications, though higher doses of anthracyclines didn’t appear to influence this risk.

One limitation of the study is that it may have underestimated the mortality risk associated with cancer treatment because not enough people died to calculate this, the authors note.

It’s also possible that the results could look different for patients who joined the study more recently, when doctors treating them might have been more aware of the heart risks of radiation and chemotherapy and more closely monitored people for heart problems, the authors point out.

Targeted radiation techniques as well as new types of cancer drugs may cause less damage to the heart in the future, but it’s too soon to say which of these experimental approaches might pan out, Bhakta said.

“If any of these treatment options mean we can dial down the effect to the heart, substitution could play a role in reducing the burden of heart disease in this population,” Bhakta added.

Even without new treatments, there are some things patients can do to help prevent heart problems, noted Marianne Aznar an oncology researcher at Rigshospitalet and the University of Copenhagen in Denmark who wrote an editorial accompanying the study.

“Patients can reduce their risk of heart disease by adopting a healthy lifestyle – giving up smoking, avoiding becoming overweight, and eating a healthy diet with plenty of fruit and vegetables and cutting down on saturated fat and sugar,” Aznar said by email.

“Patients could also talk to their general practitioner about monitoring for hypertension and high cholesterol, which can also affect the risk of heart disease,” Aznar added.

The dangers of a prolonged erection


John* had an erection that hurt worse than anything he could recall in his life—and it just wouldn’t go away.

At first, the 55-year-old Florida resident figured his alprostadil, an injectable medication for erectile dysfunction (ED), was simply taking longer than usual to wear off.

So he popped some Tylenol to fight the pain while he waited for his erection to go away.

And he waited…and waited.

Seven hours later, the throbbing in his mid-shaft was only getting worse—and his erection still remained. Still, he figured the erection and the pain would eventually go away on their own.

But after 7 more hours, panicked by the severity of the pain—and the persistence of the erection—he headed to the emergency room.


There, doctors diagnosed him with priapism, the official term for a prolonged erection that lasts longer than 4 hours.

And while it may sound like a punch line, John’s 14-hour experience with priapism confirms that it’s no joke.

In fact, priapism can cause serious damage to your penis if it’s not treated properly.

Read on to find out what’s causing these endless erections, and what you can do if yours won’t quit.

How common is priapism?

Despite what watching commercials for Viagra or Cialis may have you think, priapism is not as common as it may seem, even in guys who take those drugs for ED.

In fact, over a 4-year period, only about 8,700 guys went to the emergency room for the condition nationwide, a study published in the Journal of Sexual Medicinefound.

Even though these prolonged erections are rare, they can have serious consequences to your penis—and your sex life—if you let them go untreated.

Why do you get a prolonged erection?

An erection occurs when you’re aroused, and the blood vessels in your penis relax and open up so more blood can flow in.

The pressure of the increased blood flow constricts the deep dorsal vein at the bottom of your penis so the blood can’t flow out, making your penis hard and erect.

After you ejaculate, your blood vessels in your penis should go back to their normal size, and the extra blood will flow out, says Daniel Williams, IV, M.D., an associate professor of urology, obstetrics, and gynecology at the University of Wisconsin School of Medicine and Public Health.

Sometimes, though, your blood vessels will stay relaxed, even though you’re no longer aroused.

But since the dorsal vein is still constricted, the extra blood flow stays in your penis instead of flowing back out.

This gives you a prolonged erection, says Dr. Williams.

When that happens, all of that pent up blood will make you penis feel unusually hard, swollen, and painful.

How do ED drugs increase your risk of a prolonged erection?

While ED meds can increase your risk of priapism, the chances are still really, really low, Dr. Williams says. (It’s difficult for experts to give an actual number, since some men may be too embarrassed to seek treatment.)

In many cases in men with ED, their blood flow is compromised, so the blood flow into their penis is impeded, too. As a result, they have difficulty growing hard.


Oral drugs like Viagra and Cialis, or injectable meds like alprostadil, help the blood vessels in the penis relax and open, so you can get and maintain an erection, Dr. Williams says.

But in rare cases, the meds cause the blood vessels to stay relaxed even after ejaculating, leading to a prolonged erection.

Injectable medications—where you give yourself a shot of blood-flow boosting meds into your penis’s shaft—come with a slightly higher risk than oral meds. That’s because they’re more powerful than oral meds, Dr. Williams says.

But the real problem comes from using the medications incorrectly, like taking too-high doses or using the drugs if you don’t need them.


“With too much ED medication, the blood keeps flowing in, the blood gets trapped, and the erection doesn’t go away,” says Dr. Williams.

That’s exactly what happened in John’s case. After he experienced the 14-hour erection, his doctor felt the dosage of his injectable medication was too strong, so he tried lowering it.

But he experienced another prolonged erection even after lowering the dosage—this time lasting 7 hours total.

His doctor decided to take him off injectable meds and put him on Cialis instead. He hasn’t experienced any problems since making the switch.

What else can raise your risk of priapism?

But ED meds aren’t the only factors associated with priapism: Certain blood disorders like sickle cell anemia or leukemia can make it harder for blood to flow out of the penis.

In fact, according to the study published in the Journal of Sexual Medicine, 20 percent of guys who went to the ER for priapism had sickle cell anemia.

Some meds for conditions other than ED—like some antidepressants, antianxiety meds, and blood thinners—can also increase your risk, too.

How can a prolonged erection hurt your penis?

Priapism isn’t just uncomfortable and embarrassing. It can also put your penis at risk for tissue damage that can make erectile dysfunction worse, says Dr. Williams.

When blood stays trapped in your penis for too long, it can start to clot, blocking the flow of fresh, oxygen-rich blood.

“When the penile tissue isn’t receiving oxygen from the blood, tissue starts to die,” says Dr. Williams. “That leads to the development of permanent scar tissue that doesn’t function normally anymore.”

As a result, you can find it more difficult to get and maintain an erection in the future.

What should you do if you experience a prolonged erection?

If your erection isn’t going away after sex or is uncomfortable, it’s okay to wait at home for a little while to see if it goes away on its own, says Dr. Williams.

But 4 hours is your max: At that point, you need to head to the emergency room as soon as possible.

The longer you wait to get treatment, the more likely you are to sustain lasting tissue damage, Dr. Williams says.

Once you get the to ER, the doctors will usually start by giving you a penile injection of a drug called phenylephrine, which tightens up your blood vessels to reduce blood flow to the penis.


“If blood in the penis has already clotted, they may also need to use a needle to flush out the blood clot and get normal, healthy blood flowing back into the tissue,” says Dr. Williams.

John admits having a giant needle injected into his penis was painful and more than a little intimidating.

Still, it’s better than the second-line option: an operation to remove the blood clot, which must be done if doctors can’t flush the blood clot out.

And while he was sore for a few days after, John didn’t experience any lasting problems related to his priapism.

In fact, with fast treatment, many guys will still be able to get an erection with no problem in the future.

“But the best treatment for priapism is to avoid getting it in the first place by taking your ED medications as instructed,” says Dr. Williams.


Letting Go of Attachments Through Yoga


Addiction, greed, resistance, fear, suspicion—much of the inner and outer conflict we experience in life is rooted in attachment. The yogic concept of attachment or raga, however, is often misunderstood. According to the Yoga Sutras (2.3), raga is one of five kleshas or afflictions that cause suffering. But releasing attachments doesn’t require withdrawing from the world andbecoming a sannyasin. As a yoga student, you have the tools that will help you identify and go beyond attachments that limit your potential.

Think of the kleshas as counterproductive mindsets—all too often, we don’t even realize when they’ve boxed us in. This is because the source of all attachment, the ego, is like a blind spot that keeps us from recognizing our true nature. One of the aims of yoga is to lead us away from this false ego identity, a process of detaching (vairagya) that grants us healthy perspective. Here’s how some yoga practices help us break out of the box:

Self-inquiry. Svadhyaya, often translated as self-study, is one of yoga’s observances or niyamas, and helps us recognize the variety of ways raga plays out in our lives. The Indian saint Ramana Maharshi recommended that his students ask “who am I?” until, layer by layer, they release ego attachments to their identity (“I am a teacher” or “I am an American” or “I am a good person”) and see beyond to the true self. Svadhyaya also includes studying philosophy and texts such as the Sutras or Bhagavad Gita that illustrate the yogic path toward freedom.

Meditation. Through patience and trial and error, meditation trains us to detach from the mind’s busy-ness. We do this through dharana, working to concentrate on a single thing, such as thebreath or a mantra. Dharana shifts naturally into dhyana (total meditative absorption) when the boundaries between the object and the self dissolve. The mind becomes quiet, and we become observers. By patiently returning again and again to the process of meditation, we strengthen our ability to practice vairagya in daily life, recognizing what pushes our buttons instead of reacting out of ego or attachment.

Pranayama. Even something as simple and natural as the breath can be a teacher. Before every inhalation, there must be an exhalation—a letting go. If you don’t fully release the old breath, there isn’t enough room for the new, the in-spiration. Slowing or extending the exhalation enhances the body’s parasympathetic responses, making it more easeful to stay longer in that place of letting go.

Asana. During asana, we become curious to our attachments to our physical bodies and play with our attachment to the earth, stretching against the limitations of gravity. Through inversions, backbends and other poses, we find more freedom in the spine. Even gentle or seated practices foster inner-contemplation that lead us toward self-inquiry, concentration, pranayama andsamyama. Through asana, we detach from our daily routines and habitual thoughts about our bodies by moving in and out of postures with presence, curiosity and impartial investigation.

Abhyasa. Sutra 1.12 tells us that we need to combine vairagya (non-attachment) with abhyasa (dedicated practice) to go beyond the egoic mind and recognize true self. This sutra is the key everything we do in yoga, from a single pose to the process of meditation. When we practice with dedication and detachment, we even let go of expected results. It reminds me a little of the quote that’s been attributed to everyone from Thomas Jefferson to Vince Lombardi: “The harder I work, the luckier I get.”

Yoga isn’t a quick fix—the true magic of yoga is that it isn’t magical at all. Consistent and dedicated practice, joined with non-attachment, leads to freedom. And as we free ourselves from the attachments that make our lives smaller, everyone will benefit.

What yoga practices have helped you identify and release attachments? How has letting go of self-limiting attachments improved your relationships with friends and family?


Yoga of Social Media: Navigating with Integrity


If ever we were tempted to forget the world’s pain, these days it’s undeniable. From Africa’s Ebola outbreak to deep unrest and bloodshed in the Middle East, to ongoing racial tension in the USfollowing the deaths of black Americans by whites, the world is crying. Yet rather than tears, an outpouring of opinions and colliding perspectives propagate mainstream media and permeate our social media personas.

Though many of us harbor a love-hate relationship with social media, the medium is ethically neutral. The content of our newsfeeds and our relationship thereto reflects our relationship to life at large. How can we engage with our social media in a way that consciously aligns us with our values? Put another way, how can we turn our engagement with social media into a laboratory for practicing yoga “off of the mat?”

When you log on and scroll past bigoted, racist, sexist, violent or otherwise offensive content, how do you respond? Do you engage with the poster, speaking your truth but risking the connection? Do you ignore the post or sanitize and clean your feed, hiding or unfriending the offender?  Next time a triggering post shows up for you, take a moment to notice what arises for you mentally, physically, emotionally and spiritually. Can you honor, respect and hold your own experience in kindness—as well as the reality of the person who has posted?

Sometimes, hiding provocative content posted by repeat offenders is necessary. Yet learning to be exposed to conflicting views, while extending compassion to the person expressing them with the understanding that some views are borne of ignorance and conditioning (while not elevating yourself above them), can be a powerful practice. Can you love the person, while maintaining equanimity? Can you cultivate compassion despite your own anger, anxiety or outrage, knowing that their expression of prejudice, racism or injustice reflects alienation from their own hearts?

Although it may feel most comfortable to us, when we consistently block or hide reminders of pain or injustice on our feeds, we turn our hearts and eyes away from the world’s suffering. In so doing, we become more comfortable in our insular existence, yet we also maintain the internal and external status quo. We perpetuate the problem, even as our hearts long to be part of the solution. In the moment, turning “off” or ignoring a particular story may make us feel better. Yet every time another uncomfortable story pops up we may also be reminded of our unwillingness to speak our truth in the face of injustice, reminding us of the discrepancy between our gut values and the face we present to the world.

Are you willing to sacrifice your personal comfort and likeability for collective well-being? In yoga’s seminal text, the Bhagavad Gita, the warrior Arjuna was asked into battle by Krishna against his family and beloved peers, in the pursuit of truth and self-realization. Each of us on the path of yoga is called to the same. When we read articles we do not agree with, or hear convictions that conflict with our heart, do we keep scrolling, silently recoiling inside as we silence ourselves? Do we retreat from the battlefield to preserve the peace, to keep being liked, to avoid making waves? Or, like Martin Luther King and Mahatma Gandhi, do we sacrifice our personal comfort—in the service of truth, justice and the inner and outer liberation of all beings?

There are no right or wrong answers here. One person’s truth is not the same as another’s. Yet attuning to the wisdom of the heart-mind (bodhicitta) facilitates a conscience and truth that transcends the petty defenses, preferences and opinions of the conditioned, egoic mind.

Notice how you show up on social media. Do you post content that feels safe and comfortable for your friend group, and prefer friends that do the same? Or do you post provocative content? If a post doesn’t receive any likes, do you delete it, or feel secure enough to leave it intact, knowing that it was reflective of something needing expressed, even if those around you didn’t necessarily validate it? How does this reflect your behavior in life, when exposed to views or actions you don’t agree with?

The path of Arjuna is not an easy one. It requires taking up the sword and engaging in battle with those you love most to honor the wisdom of your own heart and humanity’s collective liberation. It requires sacrificing the parts of you that feed on social desirability and likeability, although the fruits of this sacrifice facilitate liberation.

“Blessed are warriors who are given
the chance of a battle like this,
which calls them to do what is right
and opens the gates of heaven …

… But if you refuse the call
to a righteous war, and shrink from
what duty and honor dictate,
you will bring down ruin on your head

… If you are killed, you gain heaven;
triumph, and you gain the earth.
therefore stand up, Arjuna;
steady your mind to fight.”