motion-fix

By midwinter, our urge to hibernate can start to feel constricting instead of cozy. What better antidote to being cooped up indoors than a bracing hike in the crisp air outdoors?

Winter backdrops are stark, serene, and often stunning. With fewer people on the trail, you may spot more creatures out and about. And it’s a prime opportunity to engage with the seasons and our living planet around us, says Dr. Stuart Harris, chief of the Division of Wilderness Medicine at Massachusetts General Hospital. But a multi-mile trek through rough, frosty terrain is far different than warm-weather hiking, requiring consideration of health and safety, he notes. Here’s what to know before you go.

Winter hiking: Safety first

“The challenge of hiking when environmental conditions are a little more demanding requires a very different approach on a winter’s day as opposed to a summer’s day,” Dr. Harris says. “But it gives us a chance to be immersed in the living world around us. It’s our ancient heritage.”

A safety-first attitude is especially important if you’re hiking with others of different ages and abilities — say, with older relatives or small children. It’s crucial to have both the right gear and the right mindset to make it enjoyable and safe for all involved.

Planning and preparation for winter hikes

Prepare well beforehand, especially if you’re mixing participants with vastly different fitness levels. Plan your route carefully, rather than just winging it.

People at the extremes of age — the very old or very young — are most vulnerable to frigid temperatures, and cold-weather hiking can be more taxing on the body. “Winter conditions can be more demanding on the heart than a perfectly-temperatured day,” Harris says. “Be mindful of the physical capabilities of everyone in your group, letting this define where you go. It’s supposed to be fun, not a punishing activity.”

Before setting out:

• Know how far, high, and remote you’re going to go, Dr. Harris advises, and check the forecast for the area where you’ll be hiking, taking wind chill and speed into account. Particularly at higher altitudes, weather can change from hour to hour, so keep abreast of expectations for temperature levels and any precipitation.
• Know if you’ll have access to emergency cell coverage if anything goes wrong.
• Always share plans with someone not on your hike, including expected route and time you’ll return. Fill out trailhead registers so park rangers will also know you’re on the trail in case of emergency.

What to wear for winter hikes

Prepare for extremes of cold, wind, snow, and even rain to avoid frostbite or hypothermia, when body temperature drops dangerously low.

• Dress in layers. Several thin layers of clothing are better than one thick one. Peel off a layer when you’re feeling warm in high sun and add it back when in shadow. Ideally, wear a base layer made from wicking fabric that can draw sweat away from the skin, followed by layers that insulate and protect from wind and moisture. “As they say, there’s no bad weather, just inappropriate clothing,” Dr. Harris says. “Take a day pack or rucksack and throw a couple of extra thermal layers in. I never head out for any hike without some ability to change as the weather changes.”
• Protect head, hands, and feet. Wear a wool hat, a thick pair of gloves or mittens, and two pairs of socks. Bring dry spares. Your boots should be waterproof and have a rugged, grippy sole.
• Wear sunscreen. You can still get a sunburn in winter, especially in places where the sun’s glare reflects off the snow.

Carry essentials to help ensure safety

• Extra food and water. Hiking in the cold takes serious energy, burning many more calories than the same activity done in summer temperatures. Pack nutrient-dense snacks such as trail mix and granola bars, which often combine nuts, dried fruit, and oats to provide needed protein, fat, and calories. It’s also key to stay hydrated to keep your core temperature normal. Bonus points for bringing a warm drink in a thermos to warm your core if you’re chilled.
• First aid kit. Bandages for slips or scrapes on the trail and heat-reflecting blankets to cover someone showing signs of hypothermia are wise. Even in above-freezing temperatures, hypothermia is possible. Watch for signs such as shivering, confusion, exhaustion, or slurring words, and seek immediate help.
• Light source. Time your hike so you’re not on the trail in darkness. But bring a light source in case you get stuck. “A flashlight or headlamp is pretty darn useful if you’re hiking anywhere near the edges of daylight,” Harris says.
• Phone, map, compass, or GPS device plus extra batteries. Don’t rely on your phone for GPS tracking, but fully charge it in case you need to reach someone quickly. “Make sure that you have the technology and skill set to be able to navigate on- or off-trail,” Harris says, “and that you have a means of outside communication, especially if you’re in a large, mixed group.”

About the Author

Maureen Salamon, Executive Editor, Harvard Women's Health Watch

Maureen Salamon is executive editor of Harvard Women’s Health Watch. She began her career as a newspaper reporter and later covered health and medicine for a wide variety of websites, magazines, and hospitals. Her work has … See Full Bio View all posts by Maureen Salamon

Roughly one in six men will be diagnosed with prostate cancer at some point in their lives, but these cancers usually aren’t life-threatening. Most newly diagnosed men have Grade Group 1 (GG1) prostate cancer, which can linger for years without causing significant harms.

Prostate cancer is categorized according to how far it has spread and how aggressive it looks under the microscope. Pure GG1 prostate cancer is the least risky form of the disease. It occurs frequently with age, will not metastasize to other parts of the body, and it doesn’t require any immediate treatment.

So, should we even call it cancer? Many experts say no.

Dr. Matthew Cooperberg, who chairs the department of urology at the University of California, San Francisco, says men wouldn’t suffer as much anxiety — and would be less inclined to pursue unneeded therapies — if their doctors stopped referring to low-grade changes in the prostate as cancer. He recently co-chaired a symposium where experts from around the world gathered to discuss the pros and cons of giving GG1 cancer another name.

Treatment discrepancies

GG1 cancer is typically revealed by PSA screening. The goal with screening is to find more aggressive prostate cancer while it’s still curable, yet these efforts often detect GG1 cancer incidentally. Attendees at the symposium agreed that GG1 disease should be managed with active surveillance. With this standard practice, doctors monitor the disease with periodic PSA checks, biopsies, and imaging, and treat the disease only if it shows signs of progression.

But even as medical groups work to promote active surveillance, 40% of men with low-risk prostate cancer in the United States are treated immediately. According to Dr. Cooperberg, that’s in part because the word “cancer” has such a strong emotional impact. “It resonates with people as something that spreads and kills,” he says. “No matter how much we try to get the message out there that GG1 cancer is not an immediate concern, there’s a lot of anxiety associated with a ‘C-word’ diagnosis.”

A consequence is widespread overtreatment, with tens of thousands of men needlessly suffering side effects from surgery or radiation every year. A cancer diagnosis has other harmful consequences: studies reveal negative effects on relationships and employment as well as “someone’s ability to get life insurance,” Dr. Cooperberg says. “It can affect health insurance rates.”

Debate about renaming

Experts at the symposium proposed that GG1 cancer could be referred to instead as acinar neoplasm, which is an abnormal but nonlethal growth in tissue. Skeptics expressed a concern that patients might not stick with active surveillance if they aren’t told they have cancer. But should men be scared into complying with appropriate monitoring? Dr. Cooperberg argues that patients with pure GG1 “should not be burdened with a cancer diagnosis that has zero capacity to harm them.”

Dr. Cooperberg does caution that since biopsies can potentially miss higher-grade cancer elsewhere in the prostate, monitoring the condition with active surveillance is crucial. Moreover, men with a strong family history of cancer, or genetic mutations such as BRCA1 and BRCA2 that put them at a higher risk of aggressive disease, should be followed more closely, he says.

Dr. Marc Garnick, the Gorman Brothers Professor of Medicine at Harvard Medical School and Beth Israel Deaconess Medical Center, and editor in chief of the Harvard Medical School Guide to Prostate Diseases, agrees. Dr. Garnick emphasized that a name change for GG1 cancer needs to consider a wide spectrum of additional testing. “This decision can’t simply be based on pathology,” he says. “Biopsies only sample a miniscule portion of the prostate gland. Genetic and genomic tests can help us identify some low-risk cancers that might behave in a more aggressive fashion down the road.”

Meanwhile, support for a name change is gaining momentum. “Younger pathologists and urologists are especially likely to think this is a good idea,” Dr. Cooperberg says. “I think the name change is just a matter of time — in my view, we’ll get there eventually.”

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

Most men over 50 will develop an enlarged prostate. Also called benign prostatic hyperplasia (BPH), this bothersome condition makes it hard to urinate and can eventually lead to other problems, such as infections, kidney stones, and bladder damage, if left untreated. Many different BPH therapies are available, including medications and various types of surgery.

One of the newer surgical options, called aquablation, trims excess prostate tissues with highly pressurized jets of saline. Doctors perform aquablation in the operating room while looking at the prostate gland on an ultrasound machine. Patients are put under general anesthesia, so they don’t feel any pain during the procedure.

Men typically have to urinate through a catheter for about 24 hours after surgery until swelling of the urethra (the tube through which urine flows out of the bladder) subsides. Aquablation is gaining in popularity — in part because, unlike other more traditional BPH treatments, it can preserve normal ejaculation.

In September, researchers published a study showing that improvements in urinary function from aquablation were still holding up after five years.

Results of data analysis

The study assessed long-term data from two clinical trials. The first, called the WATER trial (for Waterjet Ablation Therapy for Endoscopic Resection of Prostate Tissue) launched in 2015 and enrolled 116 men with prostates ranging up to 80 cubic centimeters. The second trial, WATER II, launched in 2017 and enrolled 101 men with prostates ranging between 80 and 150 cubic centimeters. (Normal prostates range from 25 to 30 cubic centimeters in size.) Enrolled patients had a median age of 66 in the WATER study and 68 in WATER II. In addition, 92% of men in the WATER trial were sexually active, as were 75% of the men in WATER II.

Both clinical trials used the so-called International Prostate Symptom Score (IPSS) to measure treatment-related improvements in urinary functioning and quality of life. Calculated based on how patients rate their symptoms on a standardized questionnaire, IPSS scores fall into three categories: mild symptom scores range from 1 to 7; intermediate symptom scores range from 8 to 18; and scores greater than 19 indicate severe symptoms.

When they first enrolled in the trials, men in the WATER and WATER II studies reported average IPSS scores of 22.9 and 23.3 respectively. Five years later, the average respective scores were much lower: 7.0 and 6.8. The average length of hospital stay was 1.4 days in the WATER group and 1.6 days for the WATER II group. Only 1% of men were taking BPH medications after five years, and fewer than 5% had been surgically re-treated.

Another randomized control trial, WATER III, is currently underway in Europe. That trial compares aquablation with a more established type of BPH surgery, prostate enucleation, which uses a laser to remove obstructing tissues. Six-month data reported in 2023 showed that men in either group had comparable symptom improvements.

However, 98% of men in the prostate enucleation group had ejaculatory dysfunction. That side effect is caused by damage to delicate tissues around the bladder neck that propel semen out of the body. Semen therefore flows back into the bladder, a condition called retrograde ejaculation. None of the men in the aquablation group reported ejaculatory problems.

A word of caution

Aquablation can result in extended bleeding, cautions Dr. Heidi Rayala, an assistant professor of urology at Harvard Medical School and a member of the Harvard Medical School Guide to Prostate Diseases advisory board. That’s because unlike other types of surgery for BPH, including prostate enucleation, aquablation doesn’t cauterize tissues with heat. “I tell my patients to expect some blood in the urine for about four to six weeks after the procedure,” Dr. Rayala said.

Moreover, aquablation may be unsuitable for some men who take blood thinners to prevent blood from clotting, according to Dr. Rayala. Appropriate candidates for the surgery must be able to “safely discontinue anticoagulant medications during post-operative healing, given the bleeding risk,” Dr. Rayala said. Still, aquablation is an excellent option for most men, Dr. Rayala said, especially those with medium to large prostates “who want a durable solution with a lower risk of sexual side effects.”

“These early results are encouraging, but limited by a relatively small number of patients,” said Dr. Marc Garnick, the Gorman Brothers Professor of Medicine at Harvard Medical School and Beth Israel Deaconess Medical Center, and editor in chief of the Harvard Medical School Guide to Prostate Diseases. “Further evidence with a significantly larger number of patients and longer follow-up will help to support this new method of reducing prostate tissue as an important treatment option.”

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

Chocolates and flowers are great gifts for Valentine’s Day. But what if the gifts we give then or throughout the year could be truly life-changing? A gift that could save a life or free someone from dialysis?

You can do this. For people in need of an organ, tissue, or blood donation, a donor can give them a gift that exceeds the value of anything that you can buy. Fittingly, Valentine’s Day is also known as National Donor Day, a time for blood drives and sign-ups for organ and tissue donation. Have you ever wondered what can be donated? Had reservations about donating after death or concerns about risks for live donors? Read on.

The enormous impact of organ, tissue, or cell donation

Imagine you have kidney failure requiring dialysis 12 or more hours each week just to stay alive. Even with this, you know you’re still likely to die a premature death. Or, if your liver is failing, you may experience severe nausea, itching, and confusion; death may only be a matter of weeks or months away. For those with cancer in need of a bone marrow transplant, or someone who’s lost their vision due to corneal disease, finding a donor may be their only good option.

Organ or tissue donation can turn these problems around, giving recipients a chance at a long life, a better quality of life, or both. And yet, the number of people who need organ donation far exceeds compatible donors. While national surveys have found about 90% of Americans support organ donation, only 40% have signed up. More than 103,000 women, men, and children are awaiting an organ transplant in the US. About 6,200 die each year, still waiting.

What can you donate?

The list of ways to help has grown dramatically. Some organs, tissues, or cells can be donated while you’re alive; other donations are only possible after death. A single donor can help more than 80 people!

After death, people can donate:

• bone, cartilage, and tendons
• corneas
• face and hands (though uncommon, they are among the newest additions to this list)
• kidneys
• liver
• lungs
• heart and heart valves
• stomach and intestine
• nerves
• pancreas
• skin
• arteries and veins.

Live donations may include:

• birth tissue, such as the placenta, umbilical cord, and amniotic fluid, which can be used to help heal skin wounds or ulcers and prevent infection
• blood cells, serum, or bone marrow
• a kidney
• part of a lung
• part of the intestine, liver, or pancreas.

To learn more about different types of organ donations, visit Donate Life America.

Becoming a donor after death: Questions and misconceptions

Common misconceptions about becoming an organ donor limit the number of people who are willing to sign up. For example, many people mistakenly believe that

• doctors won’t work as hard to save your life if you’re known to be an organ donor — or worse, doctors will harvest organs before death
• their religion forbids organ donation
• you cannot have an open-casket funeral if you donate your organs.

None of these is true, and none should discourage you from becoming an organ donor. Legitimate medical professionals always keep the patient’s interests front and center. Care would never be jeopardized due to a person’s choices around organ donation. Most major religions allow and support organ donation. If organ donation occurs after death, the clothed body will show no outward signs of organ donation, so an open-casket funeral is an option for organ donors.

Live donors: Blood, bone marrow, and organs

Have you ever donated blood? Congratulations, you’re a live donor! The risk for live donors varies depending on the intended donation, such as:

• Blood, platelets, or plasma: If you’re donating blood or blood products, there is little or no risk involved.
• Bone marrow: Donating bone marrow requires a minor surgical procedure. If general anesthesia is used, there is a chance of a reaction to the anesthesia. Bone marrow is removed through needles inserted into the back of the pelvis bones on each side. Back or hip pain is common, but can be controlled with pain relievers. The body quickly replaces the bone marrow removed, so no long-term problems are expected.
• Stem cells: Stem cells are found in bone marrow or umbilical cord blood. They also appear in small numbers in our blood and can be donated through a process similar to blood donation. This takes about seven or eight hours. Filgrastim, a medication that increases stem cell production, is given for a number of days beforehand. It can cause side effects such as flulike symptoms, bone pain, and fatigue, but these tend to resolve soon after the procedure.
• Kidney, lung, or liver: Surgery to donate a kidney or a portion of a lung or liver comes with a risk of complications, reactions to anesthesia, and significant recovery time. It’s no small matter to give a kidney, or part of a lung or liver.

The vast number of live organ donations occur without complications, and donors typically feel quite positive about the experience.

Who can donate?

Almost anyone can donate blood cells –– including stem cells –– or be a bone marrow, tissue, or organ donor. Exceptions include anyone with active cancer, widespread infection, or organs that aren’t healthy.

What about age? By itself, your age does not disqualify you from organ donation. In 2023, two out of five people donating organs were over 50. People in their 90s have donated organs upon their deaths and saved the lives of others.

However, bone marrow transplants may fail more often when the donor is older, so bone marrow donations by people over age 55 or 60 are usually avoided.

Finding a good match: Immune compatibility

For many transplants, the best results occur when there is immune compatibility between the donor and recipient. Compatibility is based largely on HLA typing, which analyzes genetically-determined proteins on the surface of most cells. These proteins help the immune system identify which cells qualify as foreign or self. Foreign cells trigger an immune attack; cells identified as self should not.

HLA typing can be done by a blood test or cheek swab. Close relatives tend to have the best HLA matches, but complete strangers may be a good match as well.

Fewer donors among people with certain HLA types make finding a match more challenging. Already existing health disparities, such as higher rates of kidney disease among Black Americans and communities of color, are worsened by lower numbers of donors from these communities, an inequity partly driven by a lack of trust in the medical system.

The bottom line

You can make an enormous impact by becoming a donor during your life or after death. In the US, you must opt in to be a donor after death. (Research suggests the opt-out approach many other countries use could significantly increase rates of organ donation in this country.)

I’m hopeful that organ donation in the US and throughout the world will increase over time. While you can still go with chocolates for Valentine’s Day, maybe this year you can also go bigger and become a donor.

About the Author

Robert H. Shmerling, MD, Senior Faculty Editor, Harvard Health Publishing; Editorial Advisory Board Member, Harvard Health Publishing

Dr. Robert H. Shmerling is the former clinical chief of the division of rheumatology at Beth Israel Deaconess Medical Center (BIDMC), and is a current member of the corresponding faculty in medicine at Harvard Medical School. … See Full Bio View all posts by Robert H. Shmerling, MD