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Archive for the ‘Hormone Physician’ Category

ASH Physician-Scientist Career Development Award

The application cycle is now open.

The Physician-Scientist Career Development Award provides an opportunity for first-, second-, and third-year medical students to gain experience in hematology research under the mentorship of an ASH member and to learn more about the specialty. Awardees must agree to spend more than 80 percent of their time, during the immersive, year-long project, conducting laboratory, translational, or clinical hematology research.

The award provides recipients with $42,000 of funding for a one-year period. This includes $32,000 to support the trainee, $4,000 for research supplies, $4,000 for insurance and educational expenses (including one course), and $2,000 for meeting attendance (including the ASH annual meeting).

Award recipients attend the ASH annual meeting in December following their research experience. During an orientation breakfast, members of the ASH Committee on Training and Trainee Council are available to discuss specific areas of research and to provide recommendations on annual meeting sessions, events, abstracts, and/or posters related to the awardees areas of interest. Awardees are also invited to attend the Career Development Reception on Monday evening.

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SelectTimelineEligibility RequirementsApplication ProcessEvaluation, Selection, and NotificationTerms and Conditions Questions

At the time of application, the applicant must:

The following individuals are not eligible to apply:

Physician-Scientist Career Development Award mentors must be ASH members who will assume the responsibilities of overseeing the award recipients work and progress. Mentors assist in completing the program application, aid the recipient in his/her research, and ensure that the recipient meets all deadlines, including those for award reports.

ASH believes that a multiple mentorship model is important for researchers regardless of their career stage. Therefore, the applicant may include a second mentor in his/her application to provide advice and career development support as well as additional guidance on research questions. If the study section believes additional mentorship may be beneficial to the applicant, members of the study section will be responsible for identifying an appropriate mentor and facilitating contact. The additional mentor will coordinate with the research mentor to the extent that is feasible and desirable.

The Physician-Scientist Career Development Award application, as well as all supporting documents outlined below, must be submitted through the ASH online awards system.

Required Documents

For more information about the required materials, please see the Required Documents PDF.

Applications submitted by the deadline will be reviewed by the Physician-Scientist Career Development Award study section. Applicants will be evaluated on the following criteria:

There is no limit to the number of applications that an institution and its affiliates can submit. However, no more than one award will be granted for any given institution. For this purpose, ASHs definition of medical school encompasses all affiliate institutions (e.g., University of Washington would include the Fred Hutchinson Cancer Research Center, Seattle Children’s Hospital, etc.).

All awards will be activated on July 1 of the award year and will conclude on June 30 of the following year (off-cycle exceptions may be allowed with explanation). Payment will be made in two equal installments (on July 1 and on January 1) to the institution at which the recipient will conduct his/her research. Research award funds are non-transferable.

As a condition of acceptance of the Physician-Scientist Career Development Award, it is required that:

After the award period, recipients are required to submit a final written report (not to exceed four pages). The report will include a summary of research, manuscript submissions during the award period related to the funded research, presentations (locally and nationally) of the funded research during the award period, educational goals met, and a summary of the usage of funds. This report must be emailed to awards@hematology.org. Members of the Oversight Committee will evaluate final reports.

Please note: Failure to submit the final report or an interim progress report will render the applicant ineligible for future ASH funding.

Students making significant progress may submit a written request to reapply for one additional year of funding. Award renewal requests should be submitted by the award deadline. As part of the request, a joint letter must be submitted by the awardee and his/her mentor addressing the following:

No-cost extensions may be requested if needed. To request an extension, the awardees mentor should submit a letter to ASH by emailing the Awards Department at awards@hematology.org.

Any funding not spent by the end of the award term must be returned to the Society when submitting the final report. A check made out to American Society of Hematology must be sent to the address listed below:

Allie SamisAwards Programs SpecialistAmerican Society Hematology2021 L Street NW, Suite 900Washington, DC 20036

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ASH Physician-Scientist Career Development Award

DMG Health – About Us

Martin Nwosu MD is the founder and medical director of Doctors Medical Group (DMG) Health and wellness center. Founded in 2010, DMG is the leading Anti-Aging and Functional Medicine specialty practices in Middle Tennessee and surrounding states. The practice reflects his passion to bring an integrative approach to patient care that combines the latest in scientifically validated treatment protocols with the best of conventional medical therapies.

Dr. Nwosu specializes in treating men and women with bio-identical hormone replacement, weight management, a functional approach to treating and preventing chronic disease, and therapies to reverse the symptoms of aging and enhance overall wellness and longevity. Dr. Nwosu is a diplomat in Geriatric medicine, a board-certified internal medicine, a member of the American Academy of Anti-Aging Medicine and a member of the American Association of Pain Management. His practice emphasizes a thorough competency in the areas of nutrition, fitness, stress reduction, bio-identical hormone replacement and spirituality as a necessary basis for optimal health

By utilizing bio-identical hormone products that restore hormones to optimal levels, strengthen the immune system, and increase energy levels, we are able to help you regain and prolong your quality of life. Our Center has many years of experience in treating hypothyroidism, adrenal fatigue and hormone imbalances using bioidentical hormones, desiccated thyroid supplementation and Dr. Nwosus 8-Point Treatment Regimen. Given our years of experience, level of expertise, and renowned treatment using bio-identical hormones, the DMG Health & Wellness Center is considered the Hormone center of choice.

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DMG Health – About Us

What Is a Hormone Doctor? | Career Trend

A hormone doctor, or an endocrinologist, is a physician who treats diseases related to the endocrine system. While primary care physicians (family practitioners and internal medicine physicians) can treat many hormonal disorders without a need for specialized training, a physician may also receive advanced training and specialize in endocrinology. A primary care physician can determine whether he or she can treat a patient or whether the patient should be referred to a specialist treating only disorders of the endocrine system.

The endocrine system is composed of many glands, including the pituitary, thyroid, parathyroids, adrenals, hypothalamus, pineal body, ovaries and testicles. The islet cells of the pancreas are also part of the endocrine system. These glands secrete hormones (chemical messengers) that regulate the bodys metabolism, growth, sexual development and sexual function, by complex feedback systems comparable to a thermostat regulating room temperature.

A hormone doctor can specialize in diseases of one or two glands or treat patients in all areas of endocrinology. A large part of a typical practice could involve treating diabetes and related complications. The physician may also treat thyroid disorders, inborn metabolic disorders, over- and underproduction of hormones, osteoporosis, menopause, cholesterol disorders, hypertension, and short or tall stature. Patients with endocrine cancer are usually referred to an oncologist.

To treat non-reproductive hormonal disorders, a physician generally completes four years of medical or osteopath school and a three-year residency in either family medicine or internal medicine. He or she must pass a board examination to become board certified in family or internal medicine. To become board certified as an endocrine specialist, the physician completes a three-year endocrinology fellowship program and passes a board certification examination.

Reproductive endocrinologists complete four years of residency training in obstetrics and gynecology, rather than training in family medicine or internal medicine. They must complete two or three years of fellowship training in reproductive endocrinology and infertility and pass the board certification examination. These specialists treat infertility by using in vitro fertilization, embryo and sperm freezing, assisted embryo hatching, pre-implantation genetic diagnosis and other emerging technologies. Reproductive endocrinologists also treat a wide range of reproductive disorders, including endometriosis, polycystic ovary syndrome, gonadal dysgenesis, galactorrhea, repeat pregnancy loss, ectopic pregnancy and excess hair in women, to name just a few.

A hormone doctor may work in academic medical centers, community hospitals, private group practices or private solo practices. Each situation can involve different work hours, a different patient base, and different lifestyles. Unlike surgical specialties, hormone doctors generally do not take call hours, but they may be called on an emergency basis to see a patient in a hospital when the physician on staff cannot appropriately treat the patient.

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What Is a Hormone Doctor? | Career Trend

Beware of Social Media Celebrity Doctors – Scientific American (blog)

The celebrity doctor phenomenon is not new to Americans. With the release of his first baby-care book in the 1940s, Benjamin Spock became a household name by helping mothers across America feel more confident in their child-rearing skills, long before the age of social media and daytime television. Now, decades later, some of the most prominent players in the game of celebrity doctoring are integrative medicine expert Andrew Weil, cardiothoracic surgeon turned daytime television health guru Mehmet Oz, and televisions go-to-psychologist, Phil McGraw.

All of these men have come under fire in the past, usually due to questions regarding the medical safety and efficacy of their recommendations. But the controversies surrounding them have hardly made a dent in the profitability of their longstanding empires or in the dedication of their fans. Doctors and researchers have been so riled up by the lack of medical evidence for the recommendations handed down by medical television shows that a 2014 study looked specifically at this issue. Not too surprisingly, only 54 percent of the recommendations studied had even one piece of medical evidence to back them up. And less than 1 percent were accompanied by disclosures of potential conflicts of interest.

But now, in the era of social media influencers, celebrity doctoring is no longer exclusively available through the handful of physicians writing books or starring in television shows; it can be found across just about every social media platform. Medical bloggers, doctor instagrammers, and physician twitterati are all reaching out to the American public, and this is a slippery slope to disaster.

What started as a way to improve professional development for physicians and help disseminate credible information for patients has slowly started to devolve into a world of glamour shots, with physicians often exaggerating their credentials at the expense of a gullible social media audience. As a result, social media has created microcosms of celebrity doctoring that have started to expand unchecked and unfettered, usually at the expense of their target audience.

Todays self-promoting physicians have strayed far from the no advertising rule in the original American Medical Association (AMA) Code of Ethics that was in place from 1847 to 1975mainly to prevent the practice of medicine from turning into a practice of solicitation. And while the rule ended to allow hospitals and medical practices to work on public relations efforts for the betterment of healthcare, we have to wonder about the significant potential for harm that stems from often misleading and misrepresentative healthcare information coming from these physician social media accounts.

With 2.5 million Instagram followers, Dr. Mike Varshavski is one of the most popular young physicians on the social media playing field. His account can often be entertaining, albeit misleading: many of his followers likely do not realize that Dr. Mikes experience is very different from the experiences of the average American physician-in-training, based on previous studies looking at resident quality of life. This is fairly harmless, but he also ventures into some dangerous territory, where the line between physician and social media maven begins to blur. Recently, Dr. Mikes Instagram account has been a collection of promotional photo shoots for companies ranging from Charmin to Kenneth Cole to Braun, raising the question of how appropriate is it for a physician to be profiting from Instagram views of posts on the same platform that provides medical commentary? Unfortunately, my requests for comments from Varshavski went unanswered.

Pop-star status for physicians has the potential for harm, simply because of the power wielded by physicians who have such wide access to the American public. Thankfully, in many instances, the Food and Drug Administration has cracked down on misinformation and false claims from such celebrity physicians as Oz and Weil. Ozs claims regarding potentially unsafe arsenic levels in apple juice caused unnecessary hysteria, while Weils claims for his immune boosting supplements came with zero evidence that they could in fact ward off swine flu.

When the practice of clinical medicine begins to be trumped by individual physician brand-building, patient safety and well being can become endangered. And while many of the mega-media physicians often do face scrutiny for their practices, physicians who are merely social media celebrities attract less, even though they might have just as large an audience.

I am not advocating for a witch hunt, but physicians should be held to high clinical standards across every platform in which they practicefrom their clinics to their Instagrams. Unfortunately, clinical standards seem to disappear in the realm of social media, where private practice physicians tout affiliations with academic institutions that they truly have no day-to-day dealings with; pediatric physicians branding themselves as integrative medicine experts for adults; internal medicine physicians branding themselves as skincare experts; and even non-endocrinologists branding themselves as thyroid and adrenal gland experts and pioneering hormone revolutions. The list goes on ad nauseam. Maybe we should have kept some form of the AMAs original no advertising rule around.

Ultimately, there is an almost complete lack of evidence about the long-term effects of social media on the practice of medicine, and right now, there are several accounts that could potentially be deceiving their followers. So what can be done in the meantime? Take everything you see, read, and hear from social media physicians with a grain of salt. Google their credentialsbecause for nearly all physicians with legitimate training, this information is readily available online. Lastly, take some time to scrutinize those credentials to understand if their current area of medical practice is consistent with their training.

It’s wise to remember thatnot everything natural is safe, and not all expert advice is sound.

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Beware of Social Media Celebrity Doctors – Scientific American (blog)

Depression: The Taboo Topic in Church – Beliefnet

Awhile back, I posted on my Facebook page a question, Is it easy to talk about depression in the church? The overwhelming response to the question was, No. In fact, the church was the last place most people felt they could discuss the subject that affects 1 out of 10 people in our country. We need to do better. We need to understand what depression is all about.

Most people are unaware of the many causes of depression. It is a complicated disorder that requires on-going attention and treatment.

Depression can be a result of medical conditions such as hypothyroidism, Cushings, heart disease, sleep apnea, strokes, Parkinsons, Alzheimers, hormonal imbalances, HIV and AIDS, cancer, autoimmune disorders, seizure disorders and chronic pain.

Depression is also associated with substance abuse and withdrawal from long-term use of many drugs such as cocaine, sedatives, narcotics and steroids.

It is more common in people with a family history of mental illness, suggesting genetic involvement and heritable traits. And people with depression experience biological changes in their brains. Brain chemicals go out of balance and hormone changes can create depressive symptoms.

Traumatic life events such as childhood trauma, death, loss, financial pressures and stress that strains a persons ability to cope all play a role as well.

Certain personality traits make a person more susceptible to depression. Medication side-effects can cause depression. For example, a common medication such as Accutane, used to treat acne, has a side effect of depression in some people.

While the causes of depression are complicated, treatment is available and effective. We know the signs: difficulty concentrating, fatigue, feelings of hopelessness, guilt, worthlessness, helplessness, insomnia or excessive sleeping, loss of pleasure, overeating or appetite changes, sad, anxious or empty feelings, and thoughts of suicide.

If you struggle, dont do so in silence. Tell your physician or a mental health professional and get the help you need. Lets all be a part of making the church aware that people in our congregations struggle in this area and need to discuss depression without the stigma attached or some accusation of having little faith. Based on all the possible ways people can experience depression, dont judge, rather love and encourage people to get help.

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Depression: The Taboo Topic in Church – Beliefnet

Physician Experts Highlight Research Ahead of Otolaryngology’s Annual Meeting – Sleep Review

The latest research on patient preferences, quality-of-life, ear health, thyroidectomy, and other topics related to the specialty of otolaryngology will be presented in Chicago Sept 10-13, during the AAO-HNSF 2017 Annual Meeting & OTO Experience.

The 2017 Annual Meeting includes hundreds of research presentations. All abstracts to be presented are now available online as a PDF.

Nineteen studies have been selected to be presented during the Best of Orals session on Sunday, Sept 10, at 10 am, CDT, in room E450A of the McCormick Place Convention Center. These studies, identified by the Annual Meeting Program Committee, comprised of physician members, are recognized for outstanding scientific merit and innovation.

What role does the Internet and social media play in patient perception of physicians? This study looks at the physicians age and online/social media presence in relation to positive ratings and comments from patients.

What drives patients decisions, and what are their preferences of care? Where do factors like cost, timely appointments, experience, and thorough physical exam fall in a patients list of priorities?

This study reviewed 906 patient charts to identify significant factors predicting hypocalcemia after total thyroidectomy. After extensive analysis of patient demographics and surgical characteristics, only parathyroid hormone (PTH) was found to have significantly predicted hypocalcemia postoperatively. Further findings suggest that early, standardized supplementation can significantly reduce hypocalcemia-related extended stays and associated costs.

This is the first population-level analysis focusing on quality metrics for parathyroidectomy. The study identified independent, potentially modifiable perioperative factors that may assist in appropriate risk stratification for patients susceptible for readmission and reoperation.

What are the outcomes and complications after rhinoplasty with either autologous rib graft (ARG) or cadaveric rib graft (CRG)? This meta-analysis demonstrates that further research is needed to determine the complication rates and outcomes of ARG versus CRG in rhinoplasty.

Is advanced age an independent risk factor for complications following free flap surgery of the head and neck? Are such patients likely to have a longer hospital stay or be discharged to a skilled nursing facility? This study analyzes the effects of increasing age on outcomes of microvascular reconstructive surgery of the head and neck.

This study assesses the sustainability of clinical benefit with balloon dilation of the Eustachian tube (BDET) using the Eustachian tube balloon catheter (ETBC) in conjunction with medical management at 12 months follow-up in adult patients aged 22 years and older with drug-refractory Eustachian tube dilatory dysfunction (ETDD).

Do ototopical quinolones delay tympanic membrane healing in a drug-specific manner? This study compared the effect of both ciprofloxacin + dexamethasone and ofloxacin on tympanic membrane perforation healing in rats, with reported results.

The study population consisted of 8,281 individuals diagnosed with HNSCC, with 537 (6.4%) surviving to 5 years with the purpose to estimate the prevalence of comorbidity in HNSCC survivors at diagnosis and evaluate changes in prevalence of comorbidity over time.

This review analyzed the effect of adjuvant radiation on survival in pathologic N1 oropharyngeal squamous cell carcinoma (OPSCC) and if these findings apply to HPV+ tumors.

Laryngotracheal stenosis (LTS) is a fibroinflammatory disorder that causes narrowing of the airway. This study analyzed the effects of macrophage polarization on LTS-derived and normal airway fibroblasts (FBs) in vitro.

This study assessed patient decision making in subglottic stenosis treatment with findings that predict that most patients will prefer voice-sparing, low-risk procedures, consistent with an endoscopic approach, even if they require multiple procedures.

Is there a significant difference in postoperative complications in tympanoplasty with or without concurrent therapeutic mastoidectomy? This study addressed this question in the management of chronic ear disease alone.

Is the human middle ear inhabited by more diverse microbial communities than was previously thought? The aim of this prospective multicenter cohort study was to profile and compare the middle ear microbiomes of human individuals with and without chronic otitis media.

Does gender, age, nasal trauma, prior nasal surgery, allergic rhinitis, or additional surgeries (at the time of procedure) affect postoperative Nasal Obstruction Symptom Evaluation (NOSE) scores? This study analyzed disease specific quality-of-life in patients undergoing septoplasty and functional septorhinoplasty.

Is the modified Swallowing Quality of Life instrument a valid measure of dysphagia-specific QOL in children? Does it demonstrate a significant association with videofluoroscopic swallow studies and moderate-to-strong correlations with multiple domains of generic QOL measure?

Is balloon catheter dilation (BCD) an effective treatment for sinus pressure headaches? In this study, participants were recruited who reported sinus pressure headaches, localizing to either unilateral or bilateral maxillary and/or frontal sinuses, and were blinded and randomized to receive either BCD of the affected sinus ostia or a sham procedure.

This study explored whether single-nucleotide polymorphisms (SNPs) in the Thymic Stromal Lymphopoietin gene are associated with chronic rhinosinusitis and can predict TSLP activity.

This study analyzed cranial nerve XII (CNXII) stimulation 5-year outcomes and assessed effects of stimulation and body mass index (BMI). The study found that cranial nerve stimulation demonstrates significant clinical improvements at one year, but was it maintained at 5years?

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Physician Experts Highlight Research Ahead of Otolaryngology’s Annual Meeting – Sleep Review

Pneumonia ventolin inhaler – Albuterol aerosol inhaler – Laughlin Entertainer

When an experiment turns into a tradition in Laughlin, it means there was a show worth taking a chance on at one timethen consistently that same show proved itself time after time to be one audiences didnt want to miss. The Memorial Day Comedy Festival at the Riverside Resort was that show. Experiencing comedy served up as a variety show with veteran comedian Gabe Lopez as the shows producer, performer and emcee was like discovering a hidden gem on the entertainment landscapemore along the lines of one of those underground clubs in Vegas, known only to a lucky few. But now the word is out and the Comedy Festival is coming back to the Riverside Resort over the Labor Day weekend this time.

If you are a local, or a regular visitor to Laughlinespecially if your visits are on holiday weekendsyou are aware that the Avi Resort & Casino doesnt simply wait for the Fourth of July to set off a major fireworks display. Nope. Beginning in 1996, and continuing every year since, they have been filling the skies above the Colorado River with the amped-up creations of Zambelli Internationale Fireworks on Memorial Day weekend, the Fourth of July and Labor Day weekend.

The Colorado Belle is home to a multitude of outdoor festivals that embrace particular themes and for the Labor Day Riverwalk Festival, its a celebration of the end of summer and the cooler temperatures just starting to take hold of the Colorado River regionthink of it as one big neighborhood block party.

Theres a lot to be said for being in the right place at the right time, but could Air Supplys long-time success be the result or a chance meeting or was the cosmos working overtime on a little something called destiny? Maybe, but one thing is for surenone of it would have been possible at all without their hard work and tenacity to make it happen.The two Russells, Graham Russell and Russell Hitchcock, happened to be cast in the same Sydney, Australian production of Jesus Christ Superstar in 1975, and everything changed after that.

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Pneumonia ventolin inhaler – Albuterol aerosol inhaler – Laughlin Entertainer

Military ban will risk the health and well-being of transgender Americans – The Hill (blog)

As physicians who collectively care for thousands of transgender children, adolescents and adults in Philadelphia, we are deeply troubled by the presidents new policy that bans transgender Americans from joining the military and immediately stops gender-affirming medical care for those in active duty.

The reasoning for such a policy outlined earlier by the president that the military cannot be burdened with the tremendous medical costs and disruption that transgender in the military would entail is not supported by scientific evidence or by our experiences with transgender patients.

This reasoning implies that care to support transgender individuals medical transition is necessarily invasive and expensive. In fact, for our patients, the most common interventions include supporting social transition and prescribing hormones, like estrogen or testosterone, which cost less than $50 per month.

Despite higher costs for procedures like gender reassignment surgery, which only a minority of transgender individuals undergo, a report by the RAND corporation and a recent study published in the New England Journal of Medicine confirm that the overall cost to the military to care for transgender soldiers would be negligible.

Actually, most gender-affirming treatment for transgender individuals will in the end save the health care system money. A report by PolicyLab at Childrens Hospital of Philadelphia (CHOP) details how treatments like puberty blockers and mental health support services for transgender children and adolescents can actually prevent the need for some expensive procedures later in life.

These treatments also lead to better health outcomes as adults by shielding patients from the high costs of mental health conditions or substance abuse that might result from untreated gender dysphoria. Further restricting such treatments as the ban proposes could have unintended consequences.

As stated in our recent qualitative studies published in Journal of Adolescent Health and Transgender Health, we found that many young transgender women described lack of access to gender-affirming hormone therapy as a barrier to receiving other essential preventive and cost-saving care, such as mental health support or HIV Pre-exposure Prophylaxis,a daily pill to prevent HIV infection.

Transgender women are at nearly 50 times the risk for HIV infection compared to the average person.

Beyond this flawed over estimation of health care costs, and underestimation of potential savings, any message of you are not welcome here can cause major harm to the mental and physical well-being of transgender individuals, which make up one percent of the U.S. population. Transgender people have high rates of depression and anxiety, and as many of 40 percent have attempted suicide. These and other physical health problems are not due to their identity, but rather a result of shame, stigma and isolation when ones identity is not affirmed.

When caring for transgender children and adolescents, we talk to them about what they want to be when they grow up. They have the same hopes and dreams as other kids.

Take, for example, one 18-year-old patient who during his first visit to the CHOP Gender and Sexuality Development Clinic disclosed that despite being born assigned female sex at birth, he knew he was a boy since age four. At that young age, he had begun walking around with his shirt off because he felt he was a boy like his dad and couldnt understand why he was being told to put it back on. He also said that he has always wanted to serve our country in the military, just like his father.

But, we cant only be concerned for those who have hopes of serving their country; if enacted, this directive could have particularly grave consequences for the thousands of transgender individuals already serving in the military.

The current U.S. Department of Defense policy states that transgender individuals can serve openly and cannot be discharged solely on the basis of being transgender.

This policy helped a patient, who we are calling Sarah, at Philadelphias Mazzoni Center transition socially and medically while continuing to serve in the military. She was able to start hormones safely under medical supervision, and she had the full support of her fellow service members and her commanding officer. Without this policy, Sarah would have been forced to decide between her duty to her country and hiding her true self.

The policy also allowed a patient, here referred to as Michelle, at the University of Pennsylvania Health System begin to affirm her female gender via hormone therapy while actively serving her country. Michelle was able to seek civilian medical care for gender affirmation in collaboration with her base physicians and supervising officers. Though she enlisted as male, Michelle said that the reception to her transgender identity on the base was overwhelmingly positive, especially among her peers. She considers her status as a member of the U.S. military as integral to her identity as her gender, and has always hoped it would be her lifelong career.

Clearly this policy does not align with the real stories that we, as physicians, confront every day when we talk to patients for whom this is a deeply personal matter. Even if you disregard stories like our patients, there is no evidence to support the idea that allowing transgender individuals to serve in our military would burden us with medical costs, and there could be major negative effects to health and well-being of those currently serving if gender-affirming medical care is restricted. Our patients, and any transgender individuals, who wish to bravely serve their country should continue to be able to do so.

Nadia Dowshen, MD, MSHP is a pediatrician and adolescent medicine specialist who is co-founder of the Childrens Hospital of Philadelphia Gender (CHOP) and Sexuality Development Clinic, a faculty member at PolicyLab at CHOP and assistant professor of Pediatrics at the Perelman School of Medicine at the University of Pennsylvania.

Allison Myers, MD, MPH is a family medicine physician and clinical assistant professor of family medicine and community health at the University of Pennsylvania where she specializes in the care of LGBTQ patients.

Lin-Fan Wang, MD, MPH is a family medicine physician at Mazzoni Center Family & Community Medicine, which provides comprehensive health care with a primary focus on the needs of lesbian, gay, bisexual, and transgender individuals.

The views expressed by contributors are their own and are not the views of The Hill.

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Military ban will risk the health and well-being of transgender Americans – The Hill (blog)

EHormonesMD Hormone Doctors – Ehormones

What Makes Ehormones Different?

Each person is biologically unique, therefore, EHormones s Physicians design a comprehensive Hormone Replacement Therapy (or HRT) protocol to match each persons individual needs. At EHormones, individuals undergo comprehensive lab work as well as a physical examination. Additionally, each individual receives a thorough consultation with his or her physician to discuss and interpret the comprehensive lab results. Thereafter, every EHormones managed physician will use your medical history, symptoms, and labs to develop an individualized and comprehensive Hormone Replacement Therapy protocol.

Testosterone Replacement Therapy (or TRT) is typically administered in the form of once weekly Testosterone injections. There may be ancillary medications which allow the testes to continue its natural production of testosterone while on therapy, and an Aromatase Inhibitor, an estrogen suppressing pill typically taken once to several times weekly.

HGH Therapy prescribed by an EHormones managed physician is also administered by injection, typically in the form of Sermorelin and/or Growth Hormone Releasing Peptides.

Female Bio-identical Hormone Replacement Therapy is generally administered in the form of transdermal creams, typically applied daily to the skin.

We offer comprehensive Hormone Programs for nearly all budgets.

Our affiliates have offices in many US cities and we continue to grow. Getting started is as easy as setting you up for lab work.

With 100% confidentiality, our doctors and staff are available by phone for any questions you may have while you are under our care.

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EHormonesMD Hormone Doctors – Ehormones

Husband on clomid for low sperm count – The doctors who pioneered the ivf procedure in australia – Laughlin Entertainer

When an experiment turns into a tradition in Laughlin, it means there was a show worth taking a chance on at one timethen consistently that same show proved itself time after time to be one audiences didnt want to miss. The Memorial Day Comedy Festival at the Riverside Resort was that show. Experiencing comedy served up as a variety show with veteran comedian Gabe Lopez as the shows producer, performer and emcee was like discovering a hidden gem on the entertainment landscapemore along the lines of one of those underground clubs in Vegas, known only to a lucky few. But now the word is out and the Comedy Festival is coming back to the Riverside Resort over the Labor Day weekend this time.

If you are a local, or a regular visitor to Laughlinespecially if your visits are on holiday weekendsyou are aware that the Avi Resort & Casino doesnt simply wait for the Fourth of July to set off a major fireworks display. Nope. Beginning in 1996, and continuing every year since, they have been filling the skies above the Colorado River with the amped-up creations of Zambelli Internationale Fireworks on Memorial Day weekend, the Fourth of July and Labor Day weekend.

The Colorado Belle is home to a multitude of outdoor festivals that embrace particular themes and for the Labor Day Riverwalk Festival, its a celebration of the end of summer and the cooler temperatures just starting to take hold of the Colorado River regionthink of it as one big neighborhood block party.

Theres a lot to be said for being in the right place at the right time, but could Air Supplys long-time success be the result or a chance meeting or was the cosmos working overtime on a little something called destiny? Maybe, but one thing is for surenone of it would have been possible at all without their hard work and tenacity to make it happen.The two Russells, Graham Russell and Russell Hitchcock, happened to be cast in the same Sydney, Australian production of Jesus Christ Superstar in 1975, and everything changed after that.

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Husband on clomid for low sperm count – The doctors who pioneered the ivf procedure in australia – Laughlin Entertainer

Brand cialis – Difference generic brand cialis – Laughlin Entertainer

Theres a lot to be said for being in the right place at the right time, but could Air Supplys long-time success be the result or a chance meeting or was the cosmos working overtime on a little something called destiny? Maybe, but one thing is for surenone of it would have been possible at all without their hard work and tenacity to make it happen.The two Russells, Graham Russell and Russell Hitchcock, happened to be cast in the same Sydney, Australian production of Jesus Christ Superstar in 1975, and everything changed after that.

Many an audience member has probably asked himself if a fine looking group of ladies about to take the stage could possibly do justice to one of the most popular rock bands in the world. Its a legitimate question considering its not easy music to play, so a person cant help but wonder if the music will be taken as seriously as the people in the audience do. However, once the guitars are plugged in and the girls dig into those first few chords, the obvious answer to that question is, oh, hell, yes.

Many a cook tries their hand at duplicating foods they love in restaurants and specialty shops, telling themselves, it cant be that difficult. Often times, theyre right. It can be doneand its pretty simple. However, sometimes, its not as easy as it looks.Mexican food for example looks easy because ingredients are simple, sauces are often slow-cooked and meat is marinated, making this comfort food one of Americas favorite. Recipes are often handed down and each time theyre prepared, a spice might be tweaked or flavor added, depending on taste and preference.

Its been 40 years since Elvis Presley died (August 16, 1977) and millions of people still have the date circled in red on their calendars. People still remember and they still mourn. Some internet sites have gone to the extent of estimating what he would look like now, if he were still here in the physical.This time of year Memphis fills up with more people than usual as crowds in large numbers make their pilgrimages to Graceland for visits to his home while tribute shows pop up all around the country to remember the huge icon that he was.

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Brand cialis – Difference generic brand cialis – Laughlin Entertainer

Breaking the mold: A doctor’s illness journey changes her practice – Peninsula Press

Ten years ago, a young woman came to Dr. Cynthia Li, seeking treatment for fungal overgrowth causing chronic fatigue and digestive disorders. Drawing on years of internal medicine training, Li dismissed the patients self-diagnosis. I thought it was probably some quackery she found on the internet, she recalled. Little did Li realize that she, too, would soon turn to alternative solutions for her own mysterious medical condition, in a development that would change her approach to life and to medicine.

(Photo courtesy of Cynthia Li)

Up until her thirties, Li was living every well-intentioned doctors dream. She worked at the San Francisco General Hospital and taught UCSF medical residents, volunteered with Doctors Without Borders at an HIV/AIDS clinic in rural China, lived in a classic Victorian-style house in San Francisco, exercised regularly and ate a mostly vegetarian, organic low-fat diet.

Not until the spring of 2007 as she was being rushed to the hospital, heart rate over 200, delirious and slipping out of consciousness, did she realize she was spiraling into an inexplicable chronic health crisis.

Li had experienced severe fatigue and dizziness after her first pregnancy, but brushed it off because she felt well enough. This time in 2007, while visiting her family in Beijing, she experienced the perfect storm pollution exposure, stomach flu, unusual foods and a second pregnancy left her bedbound for six months after the emergency room visit and another two years housebound. Having endured 36-hour shifts, Li was no stranger to fatigue, but what she felt now was a completely different animal. I couldnt move my muscles and didnt feel like I had the energy to draw my next breath, she said.

Her primary care doctor, endocrinologist and psychiatrist shuffled her around in a referral merry-go-round. Screening tests including the thyroid-stimulating hormone, TSH, were normal. No sign of depression or mental health disorders. She had become one of the invalids those with a medical case that went unrecognized and deemed incurable.

Growing up, Li was not one to deviate much from the norm. Her parents emigrated from Taiwan and held a high regard for authority. She lived her life by the book went to church on Sundays and always turned in her schoolwork on time. In her third year of medical school, she shoved a nasogastric tube down the nose of an unwilling patient because a resident told her to. She attributed repeated instances like this to unknowingly stifling her curiosity and will to question what happens in medicine and why.

It came as a shock, then, when she violated medical norm and became the difficult patient. Desperate but still skeptical of alternative treatments, she began with acupuncture, and then slowly integrated other paradigms like environmental health (how pollutants and chemicals disrupt hormone function) and ancestral health (how an evolutionary perspective helps define diet and lifestyle) into her personal healing routine.

She understood diets had to be personalized there is no one-size-fits-all perfect diet and ditched vegetarianism for more nutrient-dense foods like bone broth soup, learned to rewire her brain and dampen inflammatory stress responses through a technique called neural retraining, took up Qigong practice, and supplemented with things ranging from amino acids like L-glutamine for repairing the gut lining to vitamin B-complex with active folate and B12 for healthy detoxification support.

Li, 46, eventually diagnosed and slowly healed herself from autoimmune thyroiditis, multiple food sensitivities and chronic fatigue syndrome. Her personal health journey profoundly changed the way she now practices medicine. In 2012, she opened her own practice in Berkeley, based on an approach known as functional medicine, which seeks to find root causes and mechanisms for chronic disease instead of ruling out and reducing problems.

Cynthia Li (Photo courtesy of Cynthia Li)

Matthew Sades son was one patient who walked through Lis door last year. When the 8-year-old boys eyebrows and eyelashes began to fall out, their pediatric dermatologist diagnosed him with alopecia areata, an autoimmune disease that causes excessive hair loss. Treatment included monthly injections of steroids in his scalp and daily topical creams. It was labor intensive and after three to four months of very minimal progress, Sade decided to take his son to see Li.

Li ordered a battery of stool, urine and blood tests and found that his sons gut flora the microorganisms that resided in his gut was out of balance. She prescribed a cocktail of probiotics and prebiotics to restore the dysbiosis, and vitamins and minerals to support his immune function. In addition, his celiac panel testing for gluten sensitivity turned up positive, and Li provided articles citing an increased incidence of alopecia in celiac patients. Sades son remains gluten-free today.

Sade, CEO of natural food company Kite Hill, admits that conclusions can never be definitive, but says that for his son, the results were significant. Four weeks into the new regimen and boom, it was just like night and day. His hair grew back like it had never happened, Sade said.

Hes a big believer in Lis work and has referred a half a dozen people to her this past year whom he felt, much like his son, were not getting the answers and relief they needed from their conventional Western medicine practitioners.

Not everyone is enamored by Lis less-than-standard method of care. When Sade shared the good news of his son with a physician at UCSF Benioff Childrens Hospital Oakland, she replied that this was a new body of medicine with insufficient research to speak to it.

It was a little bit disappointing because it felt there was this undertone of adversity to the possibility that there are other practices that could be yielding different and potentially better outcomes, Sade said.

Cynthia Li traveling with her husband in South Africa, while still in her prime. Her life would soon change as her health took a turn for the worst. (Photo courtesy of Cynthia Li)

Christopher Gardner, professor of medicine and director of nutrition studies at the Stanford Prevention Research Center, said what functional medicine practitioners do is plausible and makes sense and may work well for some. (EDITORS NOTE: Peninsula Press is a project of the Stanford Journalism Program and not affiliated with Stanford Medicine.) However, his impression is that they believe in a lot of non-standard diagnostic tests, many of which are related to the gastrointestinal tract and system, which have limited scientific evidence to either support or refute their claims.

More outspoken critics include Wallace Sampson, the late oncologist and emeritus professor of clinical medicine at Stanford University, who wrote that functional medicine is nothing more than a treatment of phantom diseases and a non-scientific, ineffective, jingoistic, cultic approach to dysfunctional somatoform, non-disease conditions.

Li is undeterred by the naysayers. She said that functional medicine does not replace her medical training but instead enhances it. In addition, in randomized controlled trials, people become statistics. The idea that this gold standard of research always produces the best evidence-based medicine is limiting, she claims. Standard practice has been proven ineffective time and time again and off-label uses of drugs are often prescribed. Conversely, functional medicine is not without the more out there practitioners. Integrative medicine people can be equally dogmatic, Li said, chuckling.

While sitting at a bustling Berkeley brunch spot picking at her fruit salad, Li articulated a keen awareness and respect for the complexity of the human body, while remaining pragmatic and skeptical throughout the conversation. Of course, she would research each of her patients cases thoroughly, scouring PubMed articles and natural supplement databases, but her humility stood out the most. The most valuable thing that I learned in my health journey was to come to the place of not knowing, she said.

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Breaking the mold: A doctor’s illness journey changes her practice – Peninsula Press

Haqqani: Cardiovascular health in women Part two – Midland Daily News

Dr. Omar P. Haqqanifor the Daily News

Dr. Omar P. Haqqani

Dr. Omar P. Haqqani

Haqqani:Cardiovascular health in women Part two

In part 1 of our series addressing cardiovascular health in women, we discussed the three most significant risk factors in developing cardiovascular disease. This week, we focus on the two deadliest cardiovascular events that can result from CVD, which are heart attacks and strokes.

Heart Attacks

Heart attacks are often viewed as something that primarily strike men; however, nearly a quarter million women a year die from them. That is 5 times higher than the number of deaths resulting from breast cancer.

In order to reduce occurrences of this cardiac event, women should be aware that a heart attack does not always feel the same in females as it does in men. The typical heart attack signs — severe chest pain radiating down one arm or extreme shortness of breath — can certainly occur in women, but many times, their symptoms are much more subtle.

They include:

Chest pain or discomfort that feels more like a fullness or squeezing throughout the chest rather than sharp, severe pain on the left side.

Pain in your back, neck or jaw that can build gradually and that can come and go.

Stomach pain and abdominal pressure that may be mistaken for heartburn.

Shortness of breath, nausea or lightheadedness for no apparent reason.

Sweating suddenly even though you have not exerted yourself.

Fatigue after engaging in activities as simple as walking up the stairs.

If you have any of these symptoms, do not ignore them. Get medical attention immediately and, rather than driving yourself to the hospital or asking a friend or family member to do so, call 911 so first responders can manage the event. Acting quickly can save your life and decrease the damage done to your heart.

To reduce your overall risk of a heart attack, make heart-smart lifestyle choices including getting regular exercise, not smoking, maintaining a healthy weight and eating a healthy diet. It is also very important to keep your blood pressure under control and manage your blood sugar if you are diabetic.

Strokes

Stroke is another cardiovascular event that is a leading cause of death in women. In addition, because women live longer than men, the long-term effects of a stroke can have a much more negative impact on their lives. Once again, there are risk factors, warning signs and symptoms that are unique to women.

The typical risk factors for stroke — being overweight, high blood pressure, an inactive lifestyle, smoking and diabetes — apply equally to both sexes. But there are others that occur only in women such as pregnancy, using birth control pills or taking hormone replacement medications. Women who are in their child-bearing years or who are post-menopausal must be alert to the increased chances of having a stroke and be vigilant about monitoring symptoms.

Women will experience different symptoms than men when having a stroke. These include fainting, dizziness, hallucinations, nausea or vomiting, and frequent hiccups. Women may also feel numbness over their entire body rather than in a localized area. If you experience any of these symptoms, call 911 immediately, particularly if you have difficulty speaking or see drooping in your face. Just like with heart attacks, it is imperative you act quickly to minimize stroke damage.

To reduce your risk of a stroke, stop smoking immediately and work toward reaching and maintaining a healthy body weight. If you are pregnant, monitor your blood pressure carefully throughout your pregnancy. Monitor it closely as well if you are on birth control pills or hormone replacement therapy drugs and see your physician immediately if it rises.

While heart attacks and strokes are real dangers for women because the signs and symptoms are very different than those experienced by men, you can reduce your chances of having either by making important lifestyle changes, being alert to the signs and reacting quickly if symptoms appear.

Next week, part three of our series on cardiovascular health in women will specifically address how ethnicity plays a role in cardiovascular disease and cardiovascular events.

Dr. Omar P. Haqqani is the chief of Vascular and Endovascular Surgery at Vascular Health Clinics in Midland.

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Haqqani: Cardiovascular health in women Part two – Midland Daily News

Blacks with prostate cancer less likely to get ideal treatment – Reuters

(Reuters Health) – Black men with riskier prostate cancers may be less likely than their white counterparts to get aggressive treatment that can give them the best survival odds, a recent U.S. study suggests.

Researchers focused on men with medium- and high-risk localized prostate tumors likely to benefit from aggressive treatment like surgery or radiation, rather than the conservative approaches of watchful waiting or hormone therapy often used for men with low-risk tumors.

While 83% of white men received aggressive treatment, just 74% of black men did, the study found.

Given the evidence suggesting a benefit for treatment in men diagnosed with intermediate- and high-risk prostate cancer, our findings may explain, to some degree, the differences in survival odds between black and white men diagnosed with prostate cancer,” said lead study author Dr. Quoc-Dien Trinh, co-director of the Dana-Farber/Brigham and Women’s Prostate Cancer Center in Boston.

Black men are more likely to develop prostate cancer and to die from it than white men, the researchers note in European Urology, online August 2. Black patients are also more likely to be diagnosed when tumors are more advanced and more difficult to treat.

For the current study, researchers examined national cancer registry data on 223,873 white men and 59,262 black men aged 40 or older diagnosed with prostate tumors in the U.S. between 2004 and 2013.

Half of the white men in the study were at least 65 years old, while half of the black men were at least 63.

Black men were more likely to be low-income and uninsured or covered by Medicaid, the U.S. health program for the poor.

During the study period, the proportion of white men receiving aggressive treatment rose from 81% to 83%, while for black men it increased from 73% to 75%.

Overall, 39% of the 356 facilities in the study were significantly more likely to give aggressive therapy to white men than to black men with similar tumors. Only 1% of facilities were more likely to give aggressive treatment to black men.

Geography also played a role. For example, in the southeastern U.S., white men were 69% more likely to receive aggressive treatment than black men, the study found.

From a system-level perspective, we need to do a better job to (standardize) prostate cancer counseling and recommendations, Trinh said by email. There is no reason why there would be such a variation in how black men are treated from one institution to another.

One limitation of the study is that researchers lacked data on patient preferences that may have driven treatment decisions. Researchers also lacked data on patients treated at smaller facilities and places that treated fewer than 50 men a year for prostate cancer.

Its also hard to say how many patients may have opted against aggressive treatment because they didnt trust their physician or worried about side effects like urinary incontinence or erectile dysfunction, said Dr. Simpa Salami, a urologist at the University of Michigan in Ann Arbor who wasnt involved in the study.

We do not know if black men were offered definitive therapy at the same rate as white men but chose other options instead, or if black men were simply not offered the same treatment options as white men, Salami said by email.

Differences in income and insurance may also help explain the disparities in how men were treated, said Dr. Brian Chapin of the University of Texas MD Anderson Cancer Center in Houston.

I would expect that if a comparison was made between whites and blacks within the same income bracket and equivalent insurances, the findings may not have been as significantly different, Chapin, who wasnt involved in the study, said by email.

Even so, the findings suggest that men should speak to more than one doctor before deciding how to proceed, Chapin said.

I would encourage any newly diagnosed prostate cancer patient to obtain a second opinion regarding their cancer care, and meet with both a radiation oncologist and a urologist to be presented with all available options and make sure they are fully informed before making a treatment decision, Chapin advised.

SOURCE: bit.ly/2voWkvq

Eur Urol 2017.

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Blacks with prostate cancer less likely to get ideal treatment – Reuters

How to manage the symptoms of menopause – The Oakland Press

Menopause is often associated with troublesome symptoms like hot flashes and mood swings, yet even more serious health issues may be part of this life stage, such as heart disease.

The North American Menopause Society estimates that 2 million 6,U.S. women reach menopause every year.

Women experience a number of changes during menopause due to shifting hormones and lower levels of estrogen, said nationally renowned natural health physician and author, Dr. Fred Pescatore. Hot flashes, night sweats and fatigue can interfere with everyday activities. These symptoms can be severe and can occur for several years as the body adjusts to the reduced level of estrogen. We know that fluctuating hormones can also contribute to increased risk of heart disease and its important to take steps to manage that risk during menopause.

There are several ways for women to manage menopause symptoms and heart health risks, Pescatore said.

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A healthy life starts with a nutritious diet, and this becomes even more important during menopause. For women experiencing menopause symptoms, I recommend adopting a diet filled with more vegetables, lean protein, nuts and seeds to support a healthier lifestyle and a healthier heart, he said.

One of the best things you can do to help your body and mind adjust to shifting hormone levels during menopause is to maintain an active lifestyle. Just 30 minutes of cardio each day can really make a difference. Get moving. Try taking a brisk walk or a bike ride. You can even do things in your own home, like jumping jacks, Pescatore said.

A new peer-reviewed clinical study shows that daily supplements of the anti-oxident found in pine bark oligomeric proanthocyanidin compounds, also found in grapeseeds, peanut skin and witch hazel bark (trademarked as Pycnogenol) can help reduce the symptoms of menopause and related heart disease risk factors. This study shows the effectiveness of Pycnogenol in alleviating perimenopause symptoms like hot flashes and night sweats and reducing key cardiovascular risk factors like high blood pressure, Pescatore said.

This new study further expands on previous research conducted on hundreds of patients that shows the benefits of Pycnogenol for minimizing common, disruptive symptoms of menopause including night sweats, hot flashes, depression, anxiety and memory problems by supporting vascular relaxation, which allows the body to rid itself of excess heat. For more information, visit pycnogenol.com.

Herbal extracts that contain natural phytoestrogen compounds that mimic estrogen are also readily available and work for many women. Isoflavones such as those found in soy products and red clover may help, DHEA supplements are another hormone replacement option,and other popular supplements include flax seed oil, black cohosh, dong quai.

Check with your doctor before trying a supplement to be sure its safe for you.

StatePoint

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How to manage the symptoms of menopause – The Oakland Press

7 IBS Symptoms Every Woman Should Know About – Women’s Health

To state the obvious, poop problems are the worst. Whilecramping, constipation, and diarrhea are a drag for everyone, those who suffer from irritable bowel syndrome (IBS) have to live with those symptoms on a daily basis. IBS is a gastrointestinal syndrome characterized by chronic abdominal pain and altered bowel habits in the absence of any organic cause, says Niket Sonpal, M.D. It is the most commonly diagnosed gastrointestinal condition. The prevalence of IBS in the United States is estimated from population-based studies to be approximately 10 to 15 percent but, in my experience, I feel the prevalence is much higher.

Unfortunately, women are twice as likely as men to have IBS, according to theU.S. Department of Health and Human Services. Women can attribute their likelihood of getting IBS to the fact thathormonescontribute to flare-ups and estrogen and progesterone both rise and fall during the monthly menstrual cycle, says Sonpal. Because these hormone receptors are found in the G.I. tract, their fluctuations manifest symptoms. Furthermore, womens symptoms can differentiate from one another because, in addition to hormonal fluctuations, IBS flare-ups can be influenced by emotional health and the guts microbiome as well.

IBS is what Sonpal calls a diagnosis of exclusion, meaning a physician should rule out all other possible causes of symptoms first. Because of that and the way women uniquely experience IBS, it can be difficult to diagnose. After all, how do you tell if its IBS or intense period cramps or anxiety?

Here are some classic symptoms that can help you tell whats what:

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7 IBS Symptoms Every Woman Should Know About – Women’s Health

Physicians with increased stress make more mistakes in patient care – WSYM-TV

Not surprisingly, physicians working in a big city hospital emergency room are under plenty of stress.

A Michigan State University physician has now shown how this stress affects the care of their patients.

The more stress an emergency room physician experienced, the more likely he or she was to make a minor mistake, also known as a near miss among hospital staff, according to a new study led by Arnetz and published today in BMJ Open, an online British medical journal.

Researchers took blood and saliva samples from 28 emergency room resident physicians before and after their shifts to check for biological stress markers, Arnetz said, who is chair of the MSU College of Human Medicines Department of Family Medicine. After their shifts, the doctors were questioned about the number of critically ill patients and trauma victims they treated and how many near misses they made.

The result: the physicians who reported the most near misses had the highest biomarkers for stress.

Stress among physicians is not just perception, Arnetz said. It has a biological affect and that biological affect might impact the wellbeing of patients.

The study was conducted in the emergency department of the Detroit Medical Center, which defines near misses as any process variation that did not reach the patient, employee or visitor, but for which a recurrence carries a significant chance of a serious adverse event in other words, a mistake that, if repeated, could harm a patient.

Arnetz has been investigating psychophysiology the relationship between the brain and the body since 1983 when a hospital in his native Sweden hired him to look into the health of its medical providers. He has done previous studies on how workplace stress affects workers productivity.

The more stress in general in an organization, the less efficiently it is run, Arnetz said.

His latest study is the first that associates near misses with biomarkers of stress, including cortisol, a stress hormone found in saliva. The researchers also took blood samples, looking for markers of inflammation in the brain, which increases in stressful situations.

In addition to contributing to errors in patient care, stress can negatively affect the cardiovascular health of physicians, Arnetz said.

Very few emergency physicians work past 50, he said. They burn out.

Those in the current study were young physicians in their second and third years of residency, a continuation of their education after graduating from medical school. Some stress might be self-induced by the residents unsure of their own medical skills and afraid to ask a supervising physician for help, Arnetz said.

Thats a dangerous combination, he said. Were trying to move the whole thing from being punitive.

Arnetz hopes to conduct a follow-up study of whether the near misses caused by stress are associated with poor outcomes for patients. Further research also could look for ways to help emergency physicians reduce stress, he said.

The study was funded by the Blue Cross Blue Shield of Michigan Foundation and conducted by researchers from Michigan State University and Wayne State University.

SOURCE: MSU Today

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Physicians with increased stress make more mistakes in patient care – WSYM-TV

Ageless Forever – Bio-identical Hormone Replacement

The first office visit includes an hour and a half with Dr. Pierce, and an hour and a half with a nutrition consultant. In that time we develop a unique treatment and nutrition plan based on each patient’s individual needs, their symptoms and lab results, as well as personal preferences.. We emphasize a more holistic approach and use dietary modification, nutritional supplementation and hormone balancing when indicated, as opposed to going straight to patented pharmaceutical drugs.

We do not take medical health care insurance. We are a fee-for-service medical wellness clinic. You may however use your health care insurance for your lab work. Remember, you have a contract between yourself and your insurance provider. We are not a part of that contract. Your insurance provider also has a contract between itself and their preferred laboratory. Our staff will help you figure out what is your insurance’s preferred laboratory and submit your requisition and/or blood work to that laboratory. We will also provide you with the proper CPT codes and submit them to your insurance carrier to give you the best chance of having your tests covered.

There are some tests, such as a cortisol saliva test, that are not covered by any insurance to our knowledge. This is because the performing laboratory is not contracted by any insurance provider to perform the test and they are a fee-for-service company as well.

You may take your lab requisition directly to the lab and have your blood drawn there, or we can provide the blood draw service for you at our clinic at a scheduled convenient time for you. This avoids waiting in line at the laboratory for an unknown amount of time, while fasting, to get your blood drawn.

Is important to know that when you submit a request for your insurance company to cover your lab work, they will have access to you labresults. They can use this information to increase your insurance premiums in the future.

However, if you pay out-of-pocket directly to Ageless Forever for your lab work the information stays between Ageless Forever and you, the patient. Your insurance company does not have the right to obtain your lab and health information at that juncture.

Read more…

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Ageless Forever – Bio-identical Hormone Replacement

Jenny Van Winkle, MD, OB/GYN joins Haywood Regional and Haywood Women’s Medical Center – Mountain Xpress (blog)

Haywood Regional Medical Center (HRMC) is announcing that obstetrician Dr. Jenny Van Winkle joined the medical staff on August 1, 2017.

We are very pleased with the addition of an experienced physician and surgeon like Dr. Van Winkle, said Rod Harkleroad, CEO of Haywood Regional Medical Center. With Dr. Van Winkle on board, we plan to expand upon the services for womens care to meet the needs of Western North Carolina so more patients can get quality and personalized care closer to home.

Van Winkle is board certified in Obstetrics & Gynecology. She received her medical degree from Texas A&M Health Science Center College of Medicine and completed her residency at The Methodist Hospital Houston Obstetrics & Gynecology in Houston, TX. Her special interests and training include prenatal care, contraception, infertility, laparoscopic and vaginal surgery, colposcopy and LEEP (Loop Electrosurgical Excision Procedure) procedures, PCOS, heavy menstrual bleeding, fibroids, incontinence, pelvic organ prolapse and menopause. Van Winkle is also fluent in Spanish.

Dr. Van Winkle, with her husband and children, decided to move to the mountains of Western North Carolina from Houston for a better quality of life. I love that obstetrics and gynecology provides me the opportunity to form long-term relationships with women, managing all stages of their life. My philosophy is to provide high quality patient centered care. I believe in listening and spending as much time with patients to offer individualized care, and Im looking forward to becoming part of the community. Shes also excited about working with the team as the practice service line pursues designation as a center for excellence for minimally invasive gynecological surgery.

Womens care providers at Haywood Regional Medical Center also include Robin Matthews, MD, and David Kirk, MD both board certified physicians. Also the hospital recently welcomed the addition of a certified nurse-midwife, Jody Schmit.

Dr. Van Winkle is accepting new patients. Appointments may be made by calling 828.452.5042. Services include obstetrics, well-women gynecological exams, adolescent gynecological care, ultrasounds, minimally invasive hysterectomy, abnormal pap smear treatments, endometrial ablation, infertility evaluation, breast and cervical cancer screenings, contraceptive management including IUDs, hormone replacement, incontinence, pelvic pain, pelvic prolapse, perimenopausal symptoms, laparoscopic surgery, and treatment of menstrual disorders.

As a part ofDuke LifePoint Healthcare, Haywood Regional Medical Center is supported by Duke University Health Systems world-renowned leadership in clinical excellence and quality care andLifePoint Healths extensive resources, knowledge and experience in operating community hospitals.Visit us at HaywoodWomensCare.

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Jenny Van Winkle, MD, OB/GYN joins Haywood Regional and Haywood Women’s Medical Center – Mountain Xpress (blog)

Parents and Doctors, Hold Off on This ‘Devastating’ Surgery – Newser

(Newser) When Kimberly Mascott Zieselman was 15, she had surgery she now says caused “irreversible harm” due to others’ “discomfort with difference.” In her op-ed for USA Today, Zieselman explains how, as a young teen, she didn’t get her period like other girls, and when her parents took her to get examined, doctors made a surprising discovery: She was intersex, meaning a person born with both male and female characteristics. In Zieselman’s case, that meant that even though on the outside she appeared female, she had male XY chromosomes and testes (instead of ovaries and a uterus) inside her body. She had androgen insensitivity syndrome, so that her body resisted male sex hormones called androgens and led to an external appearance of being female.

She says her parents agreed, per physician advice, to have her “healthy gonads” taken out, “without my knowledge or consent.” She was also placed on a lifelong hormone replacement therapy, as her natural hormones had halted. She says these types of “non-consensual and medically unnecessary procedures” on intersex kids have been common since the ’60s, with “often catastrophic” results and “largely unproven” benefits. “We are erased before we can even tell our doctors who we are,” she writes. Zieselman believes most doctors and parents think they’re doing the right thingbut she notes the “devastating impact” on patients and says “every human rights organization that has considered this practice has condemned it.” “The right thing is to wait until an intersex person can participate in these life-altering decisions,” she writes. Read the full piece.

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Parents and Doctors, Hold Off on This ‘Devastating’ Surgery – Newser

Transgender clinic for kids and teens opens in St. Louis – WENY-TV

Marielle Mohs

St. Louis, MO — St. Louis is now home to a first-of-its-kind clinic for transgender teens and kids. It’s being administered by Washington University physicians based out of St. Louis Children’s hospital.

The clinic aims to provide transgender children and teens with comprehensive health care including mental health resources, hormonal therapy, voice therapy, and reconstructive surgery. Washington University physicians have been taking care of transgender children and teens since 2009 and noticed the growing demand which sparked the push to establish a fully operating clinic.

In 2016, Washington University physicians had 74 transgender patients. From just January to May 2017, they’ve already seen 71 patients.

This clinic is a huge milestone for the Seay family this month, especially for 15-year-old Leslie.

“Sometimes I identify as a girl, sometimes a boy, sometimes neither,” said Leslie Seay.

She started exploring gender identity at 13-years-old, ultimately assigning to being gender fluid, which means she will always feel a mix of identifying between a boy and a girl.

“I would really like to go on hormone blockers so that my voice doesn’t get any more feminine and [no] more feminine features show up,” said Seay.

Leslie’s identity is simple to her, so she needs a pediatrician who understands transgender health simply too.

“Having support and acceptance is extremely important for this patient population,” said Dr. Christopher Lewis, founder and physician of the Transgender clinic. “Transgender patients already deal with harassment and discrimination within the medical community and that is a barrier to them accessing care.”

Leslie’s dad, Peter Seay, is thrilled to know his child is in safe, supportive care with an expertise in transgender health.

“To find out that the gender center was opening this month was something we’ve been celebrating for a little while. We’ve been very excited about this,” said Peter Seay. “There could not be a greater value, the gratitude will not stop.”

The Transgender Center of Excellence opened the first week of August. They are already booked through mid-September with new patient appointments. It’s the only clinic of its kind within a 250-mile radius.

KMOV

TM & 2017 Cable News Network, Inc., a Time Warner Company. All rights reserved.

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Transgender clinic for kids and teens opens in St. Louis – WENY-TV

Health Matters: Answering Questions about Menopause – NBC2 News

Any health change can bring questions and concerns. One of the most common issues patients ask OB/GYN Dr. Lesley Furman about is menopause. A lot of women come into the office with either questions about menopause or symptoms of menopause and want to know whats going on? Is what Im going through normal?

Dr. Furman says while the symptoms are normal, they can be uncomfortable. Hot flashes are the biggest one. Hot flashes, night sweats, sleeplessness, decrease in libido, vaginal dryness, those are the main ones, said Dr. Furman.

The average age of menopause is 51, but doctors say symptoms can start when women are in their 40s and can last a few years. Its important for them to know that it is a natural process. Its not going to last forever but there are treatment options, said Dr. Furman.

Treatment options, like medications, lifestyle changes, even hormone therapy can help. Each treatment option should be tailored for each patient, not just one size fits all. They should be aware that there are certain factors in their lifestyle that they can alter to help. There can be medications that we can offer that will help, said Dr. Furman.

Doctors may recommend different treatments to help with different symptoms. Patients often have a lot of symptoms; in fact most of the symptoms start way before that last menstrual period occurs, said Dr. Furman.

Women may even experience anxiety or depression during menopause. Whatever the symptoms are, doctors say they are normal and its important to explain them to your physician so treatment can be started.

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Health Matters: Answering Questions about Menopause – NBC2 News

NFP is a Low-Profile But Best-For-You Method – National Catholic Register (blog)

Blogs | Aug. 6, 2017

Why dont doctors tell women about NFP? Often the doctors have no idea themselves.

At a localpregnancy center, the young women I talk to are constantly stunned to learn that there’s a scientifically proven way to planor postpone children. When I mention that natural family planning is far better for their bodies, can even help detect various medicalconditions early on (such as endometriosis), and is effective and completely risk- and expense-free, I get a blank look. They’ve simply never heard of it.

Most of them are casuallyusing birth control pills or similar hormonal based contraceptives that have all sorts of health and psychological risks they know nothing about. Why didn’t their doctors tell them? Often the doctors have no idea themselves.

Sadly plenty of doctors themselves prescribe birth control pills or other hormonal-based contraceptives without having read the research themselves.For the most part, that research isn’t new; it’s been known since the 1970s and only replicated around the world since then, with only worse reports since then. For example, a recent extensive study of Danish women found a correlation with hormonal contraceptives and depression.

One supporter of NFP is theFertilityAppreciationCollaborative toTeach theScience (www.FactsAboutFertility.org), a group of physicians and other health care professionals and educators workingto educate the medical community as well as the public onnatural or fertility awareness based methods (FABMs) of family planning.

A big reason a lot of child bearing aged women are completely unfamiliar with NFP is simply that no one is profiting from it. The birth control industry is a $6 billion a year business with a hugemarketing campaign. Television, magazine, social media ads, brightly colored posters and brochures on college campuses, health centers, even high schools and middle school’s bulletin boards and health offices, and doctors offices promotethe birth control pill, patch, IUD, etc., with no mention of the risks. With no money to be made promoting NFP, it’s remained low-profile.

The young women I speak to are exasperatedwhen I tell them that the World Health Organization, not exactly a bastion of conservative or Catholic thought, classifies the birth control pill as a Class A carcinogen. They feel betrayed by a medical community and pharmaceutical companies that are suppressing the full truth about the ramifications of hormonal birth control.

Dr. Marguerite Duane, a family physician and director of FACTS, said in a Relevant Radio interviewthat part of the lack of awareness is that only about 6% of medical doctors are aware of the scientific researchconfirming the effectiveness and benefits of NFP, particularly the latest research. She highlights theCenters for Disease Control website which continues to have extremely outdated information on NFP that doesn’t mention the newest most compelling and most accurate reports. For example, the CDC says that NFP has a 24% failure rate which iscompletely false; based on the most up-to-date and highest quality published medical research,the effectiveness rates of Fertility Awareness Based Methods (FABMs) with correct use are between 95% and 99.5%. In fact, her organization is promoting a petition to the CDC which can be read here:http://petition.naturalwomanhood.org/cdc/script/.

The Pill is the most widely used drug given to healthy people to suppress a normal physiologic function. [Yet]it exposes women to a myriad of side effects including blood clots, bleeding irregularities, breast tenderness, mood changes, and many others, said Dr. Duane in an interview with Verily magazine. She pointed out that hormonal contraception introduces synthetic hormones, which modulates hormone production already occurring in the body. As noted in a recentJournal of the American Medical Associationarticle,External progestins, probably more than natural progesterone, increase levels of monoamine oxidase, which degrades serotonin concentrations and thus potentially produces depression and irritability.Serotonin is a major neurotransmitterinvolved in the control of pain perception, the sleep cycle, and mood. It should come as no surprise, then, that hormonal contraceptives impact aspects of the body beyondthe reproductive cycle.

Dr. Duane asksthe commonsense question, Why would we want to expose healthy women to serious or a substantial number of side effects under the guise of preventing pregnancy when there are other effective options available that pose no health risk?

Fertility Awareness-Based Methods, or FABMs, for instance, area very effective method of family planning and are comparable to most artificial methods of birth control when it comes to avoiding pregnancy,Dr. Duane says. AndFABMs arenatural, hormone-free, and free of side effects.

FABMs are notgrandmas rhythm method. Rather, they arebased on decades of solid scientific research of a womans reproductive physiology. Dr. Duane shares that FABMsallow a woman to work with her body rather than suppress her normal physiology.In fact, Dr. Duane calls FABMsthe only true methods of family planning because couples can use them to both avoid and achieve pregnancy.

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NFP is a Low-Profile But Best-For-You Method – National Catholic Register (blog)

Summertime, and the sleeping is not easy: 7 tips for putting insomnia to rest – Loma Linda University Health

As if the heat werent enough, late sunsets, dehydration and pollen allergies can all make sleeping difficult in the summer months.

Keeping ones bedroom cool and dark, showering to cool down and wash off pollen, and drinking plenty of water can help.

But people can be their own worst enemy when it comes to a good nights rest, according to Cameron Johnson, MD, a psychiatrist at Loma Linda University Health. The single biggest return on effort for better sleep, Johnson said, is to avoid all electronic screens starting an hour before bedtime.

Johnson delivered a presentation on sleep to a standing-room-only crowd at Loma Linda University Healths recent 2017 Womens Conference. Here are seven of his other top tips:

Power down. TVs, computers, smartphones, tablets and e-readers should be turned off and banished from the bedroom. The blue light waves emitted by these devices interfere with the bodys production of melatonin, a natural hormone that helps regulate circadian rhythm. To avoid this, put down your devices an hour prior to your desired sleep time.

Know when to exercise. Staying fit is one of the best things people can do for their well-being, but for the sake of a healthy sleep cycle, the timing is important. Exercising 20 minutes in the early-morning sun helps set your body clock to the right schedule. In the evening, dont exercise within at least one hour of bedtime; this is the time when you should be winding down.

Prepare your body and your bedroom for rest. They dont call it body clock for nothing; schedule is everything when it comes to getting adequate rest. To signal your body that it will soon be time to fall asleep, create a relaxing bedtime ritual. To complement this, the bedroom should be like a tomb: cold and dark, Johnson said. Cooling caps or blankets can help aid sleep, along with white noise.

BedTIME matters. Bedtime shouldnt change daily. Hit the pillow within the same half-hour timeframe each night. What time should that be? Johnson recommends getting to sleep by about 10 p.m. Doing so takes advantage of an important window for the delta portion of sleep, which helps the brain lock in the days memories, clear toxins, increase energy stores and release growth hormone to repair the body, he said. A 10 p.m. bedtime also protects REM sleep. REM promotes a healthy immune system, improves memory, prevents mood problems and protects nerve cells.

Avoid napping and night shifts. If at all possible, Johnson recommends avoiding overnight shiftwork. To a lesser degree, napping can also wreak havoc on a healthy sleep cycle. Try not to nap, but if you must, do so before 2 p.m. and only sleep 15-20 minutes, he said.

Weigh the benefits and risks of chemical help. Johnson recommends trying to avoid sleep medications that interfere with REM and/or delta sleep which is most of them, he said. Additionally, taking melatonin can help people fall asleep, but this risks lowering the bodys own natural production of this hormone. Discuss options with a qualified physician. When daytime comes, dont be fooled by caffeine it gives a false sense of well-being, Johnsons said. Sufficient sleep is vital for the health of ones mind and body.

Get tested for a sleep disorder. Sleep apnea, Johnson said, is a huge cause of mental health problems. A sleep study is in order, he noted, for people who have symptoms such as morning headache, fuzzy mind and irritability, as well as family members who snore.

Dont be too hard on yourself if you cant do all of these, Johnson cautioned.

The best approach to improving sleep habits, he said, is to choose one of these tips and practice it for three months, by which point it will become an unconscious habit. Then repeat with a second change for three months, and so on.

Don’t push yourself too hard, Johnson said. Get early wins.

A pleasant way to start? Get a weekly massage for six weeks, which can improve sleep and cause a cascade of other health benefits, Johnson said.

Approximately 40 million Americans suffer from sleep disorders. The Sleep Disorders Center at Loma Linda University Medical Center can help. Opened in 1982, the center is accredited by the American Academy of Sleep Medicine and treats both adults and children. Call 909-558-6344 to learn more.

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Summertime, and the sleeping is not easy: 7 tips for putting insomnia to rest – Loma Linda University Health

Aggressive Breast Cancers May Contribute to Racial Survival Disparities – Newswise (press release)

Newswise CHAPEL HILL A higher proportion of aggressive breast cancer subtypes are seen in black women, University of North Carolina Lineberger Comprehensive Cancer Center researchers have found. The study findings help to explain a gap in mortality that exists between black and white women with breast cancer, and could lead to improved treatment approaches to help close it.

In the Journal of the National Cancer Institute, researchers published results of an analysis of approximately 1,000 invasive breast tumors. The study confirmed that young black women are more likely to have triple negative, or basal-like, breast cancers, a subtype that does not express any of the receptors for targeted biologic therapies. The study also identified variation by race within a clinical breast cancer type that has the greatest mortality disparity. Researchers found that younger black women with hormone-receptor positive, HER2-negative breast cancer were more likely to have a high risk of recurrence score.

When we look at a more clinically homogeneous group, such as women who have hormone-responsive, HER2-negative disease, we see pretty significant and biologically important differences between black and white women, said the studys lead author Melissa Troester, PhD, UNC Lineberger member and professor of epidemiology in the UNC Gillings School of Global Public Health. With genomic information, were better able to say which patients are likely to have indolent or slow-growing disease. And right now, we might mistake some people as having indolent disease, when actually they have a more aggressive tumor.

The study was part of the third phase of the seminal Carolina Breast Cancer Study, a population-based study launched at UNC-Chapel Hill in 1993. A driving motivation for the study has been to understand why African-American women disproportionately die from breast cancer. Since 1993, the study has gathered data on more than 8,000 women from 44 counties in North Carolina.

In the new study, researchers compared the findings of commonly used immunohistochemical tests, which classify breast cancer according to tumor markers, with the findings of the PAM50 gene expression assay, which classifies tumors into different risk groups as well as different molecular subtypes based upon each tumors genomic characteristics.

Confirming previous findings, researchers found that black women were less frequently diagnosed with luminal A breast cancer, a subtype of breast cancer that has a better prognosis overall. Black women had significantly higher odds of all three non-luminal A breast cancer subtypes: Their odds of basal-like breast cancer, a particularly aggressive subtype, were three times higher for black women compared to white women; odds were 45 percent higher for luminal B breast cancer or black women, and odds were twice that of white women for HER2-enriched breast cancer.

If you look at the group of basal-like breast cancers, the burden of this disease is much higher if youre young and black, said UNC Linebergers Lisa A. Carey, MD, physician-in-chief of the N.C. Cancer Hospital. We believe this is playing a role in racial disparities in outcomes between young and old, and black and white women with breast cancer.

They also found variation within a clinically defined subtype the hormone-receptor positive, HER2-negative subtype in particular. Hormone receptor-positive, HER2-negative breast cancer has the best prognosis overall, but the researchers report mortality disparities are also greatest within this group. In both black and white women, hormone receptor positive, HER2-negative breast cancer tumors were sometimes classified into the more aggressive genomic subtypes, including as basal-like breast cancer. In addition, on average, black womens tumors were more often classified into aggressive subtypes and had higher risk of recurrence scores within this group.

The findings underscore the role for genomic testing to drive precision medicine approaches to treatment, and may help explain a disparity in survival for black women with this type of breast cancer. In addition, the findings could have important clinical implications: Black patients with higher risk of recurrence scores could be candidates for chemotherapy or new treatment approaches since high-risk scores are an indication for chemotherapy.

If you really have a luminal A, low-risk tumor, and you were hormone receptor-positive and HER2-negative, you could be treated less aggressively, and have different surgical options, Troester said. But if you had these other tumor genomic subtypes, your doctor might consider a more aggressive treatment plan. We can do better to distinguish aggressive and indolent cancers if we use the genomic data that is becoming available.

In addition to Troester and Carey, other authors include Charles Perou, Xuezheng Sun, Emma H. Allott, Joseph Geradts, Stephanie M. Cohen, Chiu-Kit Tse, Erin L. Kirk, Leigh Thorne, Michelle Matthews, Yan Li, Zhiyuan Hu, Whitney R. Robinson, Katherine A. Hoadley, Olufunmilayo I. Olopade, Katherine E. Reeder-Hayes, H. Shelton Earp, and Andrew F. Olshan.

The study was supported by the National Institutes of Health and the National Cancer Institute.

Perou is listed as an inventor on a patent application on the PAM50 assay, which is licensed to BioClassifier LLC, Perou is an equity stock holder and board of director member of BioClassifier.

SEE ORIGINAL STUDY

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Aggressive Breast Cancers May Contribute to Racial Survival Disparities – Newswise (press release)

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