Ask the Doctors

Dear Doctors: My husband and I usually make a few resolutions for the new year. This year, I skipped it because I never follow through, and I wind up feeling bad about myself. My husband did OK for about a month, but now he’s also quit trying. Why are resolutions so hard to keep?

Dear Reader: As the launch pad for a fresh start, New Year’s Day is pretty irresistible. It’s the crescendo to a month (or two, if you’ve started at Halloween) of celebratory eating, drinking and socializing. By the time we crack open that brand-new calendar, we’re ready to tackle some changes in our lives. Although we think of those changes as resolutions -- lose weight, exercise more, save money, quit sugar, quit smoking, spend less time on social media -- what they really boil down to are plans to form a new habit. And that’s where things get tricky.

Research tells us that forming a new habit involves the creation of new neural pathways. You are basically rewiring your brain. This takes a lot of repetition, often over a significant period of time. An added complication is that to successfully form a new habit, there is usually at least one old habit you will have to break. You not only have to be willing to take the time and energy to adopt a new behavior, but you also have to put in the work to let go of an old one. This often means being willing to endure a certain amount of mental and physical discomfort.

Force of will can get you through a few days, or even a few weeks, of a new habit. But to successfully integrate a new behavior into the bedrock of daily life takes strategic planning. One interesting study found that how you state your goal plays a role. People whose desired habits were of the “I will” variety were more successful than those who approached their resolutions with “I won’t.”

Also important in goal-setting is to be as precise as possible. Rather than the vague “exercise more,” choose a specific target. Then break that into realistic increments. Maybe the wish is to run a 10k race. To get there, the first step may involve a 15- or 20-minute walk/run three or four days a week. Once that becomes a habit, you can gradually begin to increase the time and distance.

As many people who have successfully modified their behavior can attest, slip-ups are often part of the process. You wind up skipping a day, or perhaps even a week, of working toward your new goal. It can be tempting to view these lapses as a failure. But the good news is that the new neural pathways you have been building still exist. It means returning to the new behaviors will be easier than launching them had been.

It can be even easier, and more fun, with someone to support you. You might also consider goal-sharing with a friend, a family member or co-worker. Having support in the ups and downs of a transformational journey can make a big difference to its ultimate success.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10960 Wilshire Blvd., Suite 1955, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)

Dear Doctors: Has there been any progress in figuring out how to treat long COVID? I have been dealing with the symptoms for two years, and my doctor seems to have given up. Is anyone even doing research anymore? I feel as though we are being forgotten.

Dear Reader: It has been five years since the start of the COVID-19 pandemic. The disease that once dominated headlines now rarely makes a blip in the news, but that doesn’t mean it is no longer with us. SARS-CoV-2, the virus that causes COVID-19, continues to circulate throughout the world. The United States saw more than 1.25 million cases of the disease in January alone, and more than 3,600 deaths. And for at least 10% of those who recover, developing a debilitating condition known as long COVID remains a threat.

It is estimated that at least 20 million Americans are now living with long COVID, with more developing the disease each day. This makes the condition a significant threat to public health. People with long COVID not only miss work, but sometimes have to stop working altogether. The disease often limits their ability to participate in normal activities, and it has an effect on their families and those around them.

For those who are not familiar, long COVID is the name for a group of physical, neurological and psychological symptoms that persist for months, and sometimes years, after someone has recovered from the initial infection. Among the most common are exhaustion, brain fog, headache, loss of the sense of smell and/or taste, muscle pain, heart arrhythmias, respiratory problems, depression and disordered sleep. The cause of the condition is not yet understood.

When it comes to research into helping people living with long COVID, we are glad we can report that it continues to be robust. At this time, more than 450 clinical trials are either in progress or are actively recruiting participants. Researchers are looking at drugs, treatments, medical devices, behavioral therapies and other interventions. One study will examine the use of taurine, an amino acid, to help people who have developed cardiac issues as a result of COVID-19.

Another study is exploring if a specific amino acid can reduce the number of viral particles circulating in the body and, thus, limit the scope of the disease. Several studies are exploring the use of stem cells collected from the patient’s own body to help ease symptoms. One intriguing study is looking at sauna as a potential treatment.

People with long COVID develop different combinations of symptoms that vary in severity. As a result, treatment is on a case-by-case basis. It often involves not only a primary care doctor, but also multiple specialists. These can include a cardiologist, pulmonologist, neurologist, physical therapist and mental health professionals. If your own doctor appears unable to manage your care, we urge you to seek a referral to someone who has developed a specialty in long COVID. They can assess your specific case, guide you to the appropriate specialists and treatments, and help coordinate your ongoing care.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10960 Wilshire Blvd., Suite 1955, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)

Dear Doctors: What do you know about a study that says aerobics might be good for slowing down the progression of Alzheimer’s disease? I’ve read that being active helps your memory, but how would it affect an actual disease?

Dear Reader: You are referring to a study conducted by researchers in Great Britain that appeared in the journal Brain Research. And you are correct that it investigates the idea that regular physical activity can have a positive effect on the progression of Alzheimer’s disease. The study is part of a growing body of research into the role of physical activity in bolstering and preserving cognition. What makes it notable is that the findings offer clues to the question that you have posed, which is what causes the protective effect.

Although the word Alzheimer’s has become shorthand for dementia, it is actually a specific form of the brain disorder. Alzheimer’s disease is caused by the buildup in the brain of a sticky substance known as beta-amyloid protein. This protein collects into clumps known as plaques, which damage the neurons and disrupt neural pathways. An erosion of the myelin sheath, the fatty membrane that surrounds and protects neurons, may also play a role in the formation of toxic proteins. The first area to be affected is the hippocampus, which is the part of the brain that allows us to form memories. As the disease progresses, it gradually begins to affect the areas of the cerebral cortex that are associated with reasoning, logic, language and behavior.

Previous studies conducted in rodents have found that exercise can have a protective effect on the hippocampus. In this new study, researchers wanted to learn why. Their test subjects were 10 geriatric rats who were old enough for their brains to have begun the physical changes associated with Alzheimer’s disease. Half of the rats were put on an eight-week exercise program. This consisted of 30 minutes on an exercise wheel, five times per week. The other five, who served as the control group, remained sedentary.

When the researchers examined the rat brains at the end of the study, they found measurable differences in the two groups. The exercise group not only had a higher volume of normal neurons, but it also had lower amounts of the toxic proteins associated with Alzheimer’s disease. The exercise group also had lower amounts of a type of immune cell, which, when it malfunctions, is associated with age-related inflammation. The researchers concluded that regular physical activity may lead to beneficial changes in brain chemistry that reduce inflammation, slow the accumulation of toxic proteins and, thus, improve the survival of neurons. This has consequences not only for people living with Alzheimer’s disease, but also for all adults as they reach older age.

Although this was just one small study, the results are promising. The researchers are planning a human clinical trial. With an estimated 6.9 million people in the U.S. over the age of 65 now living with Alzheimer's disease, any advances toward managing the disease are very good news.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10960 Wilshire Blvd., Suite 1955, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)