Archive for the ‘Hormone Physician’ Category

Having a normal blood pressure level is necessary for overall well-being.Blood pressure is essential because it helps the flow of blood from the heart to other areas of the body like organs, tissues and arteries and having high blood pressure can cause serious long-term health issues. But the good news is there's several ways to get blood pressure under control. Eat This, Not That! Health spoke with Dr. Bayo Curry-Winchell, Urgent Care Medical Director and Physician, Carbon Health and Saint Mary's Hospital who shares causes of high blood pressure and how to help prevent it. Read onand to ensure your health and the health of others, don't miss these Sure Signs You've Already Had COVID.

Dr. Curry-Winchell says, "Your blood pressure is the (normal) pressure created by blood flowing in your arteries. This pressure might change throughout the day based on multiple things such as exposure or response to mental or physical stressors. It's important to remember having high blood pressure is considered a silent disease. Therefore, there is no guarantee you will experience any symptoms or warning signs that you have high blood pressure (defined as a number greater than 120/80). The only way to know is to get your blood pressure checked."

Dr. Curry-Winchell tells us, "A blood pressure greater than 120/80 can increase your risks of having a stroke, heart attack or developing heart disease. A higher-than-normal blood pressure can cause damage to the arteries affecting the amount of blood flow to organs such as your eyes, brain, heart, and kidneys."

"You can't always tell! Not everyone gets a warning sign they have elevated blood pressure," says Dr. Curry-Winchell. "Because high blood pressure is a silent disease some of my patients discover they have high blood pressure after a heart attack or stroke. The only way to know is to get it checked. I recommend purchasing a blood pressure cuff that you can use at home that records your readings."

According to Dr. Curry-Winchell, "You are at increased risk if you have a family history of hypertension, getting older (aging), diagnoses with chronic health conditions such as diabetes, eat a high salt diet, are considered overweight, drink large amounts of alcohol, and use tobacco."6254a4d1642c605c54bf1cab17d50f1e

Dr. Curry-Winchell explains, "There are several causes that increase your risk for developing high blood pressure including family history, age, lifestyle choices, etc. It is often socialized that elevated blood pressure is more common amongst African Americans. The reason is multi-faceted and not due to race/ethnicity; it is due to access to quality care, medical racially based algorithms, distrust of healthcare, and social, economic, and environmental determinants of health to name a few."

Dr. Curry-Winchell shares the following ways to have a normal blood pressure level.

"Stay Active

Participating in low or high impact exercising for approximately 5 days a week for approximately 30 minutes a day can lower your risks.

Lower Stress

I encourage my patients to find ways to lower their stress each day. Take the time to invest in yourself and find ways to bring a sense of joy or relaxation to your day. It can be as simple as closing your eyes and thinking about absolutely nothing, listening to music, singing in the shower, or reading one page in the book you have been wanting to read.

Eating Heart Healthy Foods

A balanced diet of fruits, vegetables, carbohydrates, and protein that includes low sodium (salt) options can help decrease your risks.

Quit Smoking

Smoking (nicotine) cigarettes causes your heart rate and blood pressure to increase. When this happens over an extended period and multiples times a day you increase your risks of developing hypertension.

Drink Less or Refrain from Alcohol

Alcohol increases several hormones such as renin, vasopressin (antidiuretic) and cortisol (stress hormone) which helps regulate blood pressure. Why does this matter? An increase in these hormones such as renin causes blood vessels to narrow, decreasing the amount of blood flowing to organs. Vasopressin, an antidiuretic hormone, allows your body to hold on to more fluid. Alcohol quells this function which in turn increases urination and risks for dehydration."

Heather Newgen

More:
The #1 Cause of High Blood Pressure According to Science Eat This Not That - Eat This, Not That

To the Editor:

Re Why Is the Right Forcing Women Who Miscarry to Suffer?, by Michelle Goldberg (column, July 19):

They dont tell you this in medical school, but to be an OB-GYN physician is to know heartache up close and personal, over and over again. I have been a practicing physician in Portland, Ore., for the last 37 years. My colleagues span the political spectrum, but almost everyone I have known has put the interest of the mothers life before that of the embryo or fetus. And if for reasons of conscience they could not, they would find another provider who could.

With the Dobbs decision, my specialty has been thrown into disarray. Miscarriage is one of the most common conditions we treat, as it occurs in about 10 to 20 percent of known pregnancies.

These new laws in anti-choice states just ban termination of pregnancy, some immediately after fertilization. They have no subtlety, they have no algorithms to guide practice.

Now providers are in an extremely precarious situation, risking prosecution. When the only exception for pregnancy termination is the mothers risk of death, how close must she be for them to act? Most pregnant people are young and healthy, and they cope well with blood loss and infection, until suddenly they do not, and by then it may be too late to save them.

America will now see what happens when politicians exploit the care of women for their political gain. It is brutal. Anyone who thought it would take a long time to see the consequence of banning a common medical procedure will soon see the tears, blood and death that we told them was coming. It is inevitable, and it will continue.

Marguerite P. CohenPortland, Ore.The writer is a fellow of the American College of Obstetricians and Gynecologists.

To the Editor:

Re Risks to Patients as Doctors Deal With Abortion Exceptions (news article, July 21):

As a Missouri resident living under a new abortion ban, I am enraged and disgusted. Advocates warned of the dangers of bans for years, unheeded. Even now, as doctors describe how pregnant women will die from substandard care as a result of this ban, our leaders shrug.

Days after Missouri enacted an abortion ban except in medical emergencies, I called the attorney generals office for clarification. I shared that I had experienced two life-threatening conditions in my last pregnancy, and I was concerned that my obstetrician might be constrained if a similar complication arose today.

The staff attorney told me that he was unable to offer guidance, as giving legal advice could jeopardize his law license. I replied that this ban could jeopardize my life. His response? That I could leave the state.

Unfortunately, I worry that many Missouri families like mine will take him up on his suggestion. I worry that our womens health providers will choose to practice elsewhere. I worry that Missouris elected officials will be shortsighted enough to celebrate these losses. The state deserves better.

Katy NimmonsSt. Louis

To the Editor:

Re Im Terrified for My Patients, by David N. Hackney (Opinion guest essay, July 10):

Dr. Hackney describes the pain experienced by a pregnant woman who learns that her child has a lethal condition yet has no option but to carry to term. While accurate, the potential pain of learning your fetus has a serious abnormality goes well beyond this.

A variety of severe, life-altering birth defects and genetic syndromes can be diagnosed prenatally, and many of these conditions are not lethal or not lethal immediately but serious enough that the affected child faces a lifetime of severe disability and, in many cases, pain.

Being told in the middle of a much wanted pregnancy that your child will have severe neurological or physical disabilities, that she will never walk, or talk or even be able to roll over by herself, and yet will survive, is as devastating as being told your child will die at birth, but with far different consequences.

Despite Justice Amy Coney Barretts assertion, these children are unlikely to be adopted. It is unethical to diagnose a medical condition and not provide the patient with reasonable and safe therapeutic options, but the laws of many states now make it impossible to do the ethical thing. More pain for everyone.

Katharine WenstromProvidence, R.I.The writer is a professor at the Alpert Medical School of Brown University and past president of the Society for Maternal Fetal Medicine.

To the Editor:

Dr. David Hackney joins so many doctors highlighting the serious life and health risks pregnant women now face. President Biden and Congress cannot restore comprehensive abortion rights in any manner that will survive future elections.

So congressional Democrats should immediately legislate a strong national right to abortion if continued pregnancy would risk the life, physical health or mental health of the mother, or if the fetus will not survive.

Further, there should be reasonable protection for medical providers who perform these medically necessary procedures. Otherwise, physician hesitation may cost womens lives.

I would hope there might be bipartisan support for this.

Without these protections, hikes to doctors liability insurance could render obstetrics care grossly overpriced and take already scarce funding away from all medical care.

Mary Jo NapoliColumbus, Ohio

To the Editor:

Re Abortion Bans Will Affect Both Rich and Poor Americans (Opinion guest essay, July 7):

Elizabeth Spiers describes the impact of abortion restrictions as a crisis for all American women, with delays in therapeutic abortions resulting in fatal consequences. As an emergency physician who routinely cares for women with pregnancy-related complications, I echo Ms. Spierss concerns.

I frequently treat obstetric emergencies. In recent weeks I cared for pregnant women with the following complications: ectopic pregnancy, undetectable fetal heartbeat with decreasing pregnancy hormone levels, and copious vaginal bleeding with an open cervix.

My patients were not asked their political affiliation or religious persuasion. I didnt need to know whether their pregnancies were planned or desired. My focus was on the timely care of three vulnerable patients, with pain and bleeding, who looked to our medical team for compassionate treatment and emotional support. All three patients had therapeutic abortions.

As abortion bans proliferate throughout our country, I feel fortunate to practice in New York Citys public hospital system, where the law supports sound medical decision making combined with a womans choice. No time for complacency, however. The lives and well-being of millions of women will depend on it.

Bonny J. BaronBrooklyn

Read this article:
Opinion | New Risks Facing Doctors and Their Pregnant Patients - The New York Times

Study participants

We evaluated data from 70 consecutive patients with PAI on conventional steroid treatment in a real-life study. Patients were consecutively referred to the Division of Endocrinology of Palermo University from January 2012 to December 2020. Patients were on conventional steroid treatment (cortisone acetate and HC), administered twice or three times a day. Thirty-five patients, 15 males and 20 females, maintained conventional steroid therapy (17 cortisone acetate and 18 HC) (group A) while the other 35, (16 who were on cortisone acetate and 19 who were on HC), 11 males and 24 females, were switched from conventional steroid treatment to DR-HC (group B) administered orally in the morning in a fasting state. Patients had a 60-month follow-up. In group A there were 5 women in menopause, while in group B there were 6 women in menopause. Exclusion criteria were the following: age18years, secondary AI (SAI), treatment with other steroids (prednisone), pregnancy, breastfeeding, premature ovarian failure, hypoparathyroidism, hyperparathyroidism, treatment with estrogens and underweight (BMI<18.5kg/m2). The switch to DR-HC was judged to be appropriate on clinical grounds in those patients who complained of fatigue and weakness, presented hyponatraemia (<134mmol/L) or hypoglycaemia (2.78mmol/L) or showed more than two comorbidities such as diabetes, osteoporosis/osteopenia, arterial hypertension and central obesity. The switch from HC to DR-HC was made with an equivalent dose, while the dose was reduced from cortisone acetate to DR-HC taking into consideration the minor steroid activity of cortisone acetate compared to HC and patients clinical characteristics.

PAI was diagnosed as recommended by international guidelines9.

In detail, among the total of 70 patients, 42 had autoimmune polyglandular syndrome (APS), while 28 had isolated autoimmune AI. Among patients with APS, 26 had combined Addisons disease and autoimmune thyroid disease, 6 had combined Addisons disease, type 1 diabetes mellitus and autoimmune hypothyroidism and 10 had combined Addisons disease, autoimmune hypothyroidism and celiac disease. Patients with celiac disease were on a stable gluten-free diet. All patients with PAI were also on stable treatment with fludrocortisone (0.050.1mg/day, once). Patients with hypothyroidism were treated with levo-thyroxine at the average dose of 1.21.5 mcg/kg. Patients with type 1 diabetes were on basal-bolus treatment on flash blood glucose monitoring. Five postmenopausal women had been treated with DHEA for a ranging period of 618months, before being included in the study.

During the 60-month treatment period, the conventional steroid and the DR-HC doses were changed based on the physicians judgement of a patients need in both groups of patients (Table 1). Each patient received instructions for treatment in special or emergency situations. Patients treated with DR-HC were instructed to add a rescue dose of HC during an intercurrent illness or stress (5 or 10mg according to severity of stress and symptoms). Overall, 8 patients had to take a rescue dose of HC, 5 of them less than 10 times and 3 of them from 20 to 30 times during the 60-month period.

The current study was carried out in accordance with the recommendations of the Paolo Giaccone Policlinico ethics committee, with written informed consent from all subjects. All subjects gave written informed consent in accordance with the Declaration of Helsinki. The protocol was approved by the Paolo Giaccone Policlinico ethics committee (protocol 06/2021).

At baseline and after 18, 36 and 60months of conventional steroid and DR-HC treatment, clinical and bone metabolic parameters were evaluated.

Anthropometric parameters such as BMI and waist circumference (WC), measured at the midpoint between the lower rib and the iliac crest, were evaluated. In addition, sodium, potassium, serum 25hydroxyvitamin-D (vitaminD), parathyroid hormone, calcium, phosphorus, creatinine, osteocalcin and bone alkaline phosphatase were assayed.

The blood sample was taken about 2h after steroid administration (patients took the dose in the morning on waking) to avoid patients experiencing fatigue or other symptoms due to delayed intake of the drug.

In both groups, hypovitaminosis D was observed at baseline and a pharmacological supplementation was started in 26 patients of group A and 25 of group B, at the mean dose of 800 UI/day and maintained during the follow-up. Hypovitaminosis D was defined as a serum 25-hydroxy vitamin D level below the normal range (<30ng/ml). All patients supplemented with vitamin D reached the threshold of 30ng/ml.

BMD was measured by DXA at lumbar spine and femoral neck (Hologic Horizon Inc., QDR-4500W Waltham, MA) at baseline and after 18, 36 and 60months of follow-up.

In patients aged 50 or more, BMD was expressed as the T-score, comparing the results with those obtained in a sex-matched Caucasian population at the peak of bone mass. A T-score less than or equal to 2.5 SD at the neck or spine was defined as osteoporosis, whereas osteopenia was defined as a T-score between 1 and 2.5 SD. In patients younger than 50years, the results were expressed as a/the Z-score, comparing the results with those obtained in an age and sex-matched Caucasian population. A Z-score of 2.0 SD or lower was used to define a BMD below the expected range for age10. The coefficients of variation in the DXA measurements for BMD, bone mineral content (BMC) and area were 0.61%, 2.98% and 2.89%, respectively.

We also evaluated rib, femoral neck and hip fractures rate during the follow-up in both groups.

Sodium, potassium, serum 25hydroxyvitamin-D (vitamin-D), parathyroid hormone, calcium, phosphorus, creatinine, osteocalcin and bone alkaline phosphatase were measured with standard methods (Modular P800, Roche, Milan) at our hospital centralized laboratory. The intra- and interassay coefficients of variation were the following: Sodium 0.5% to 1.2% and 1.28% to 1.44%, respectively; potassium 1% to 2.1% and 2.2% to 3.08%, respectively; vitaminD 0.9% to 1.6% and 1.7% to 2.56%, respectively, parathyroid hormone 1.2% to 2.6% and 2.8% to 3.9%, respectively; calcium 1.8% to 3.5% and 3.75% to 4.23%, respectively; phosphorus 1.6% to 3.3% and 3.5% to 4.2%, respectively; creatinine 1.7% to 2.9% and 3.3% to 4.6%, respectively; osteocalcin 1.9% to 3.3% and 3.6% to 4.9%, respectively; bone alkaline phosphatase 2.7% to 3.6% and 3.8% to 5.2%, respectively.

The Statistical Packages for Social Science SPSS version 19 (SPSS, Inc., IBM, New York, USA) were used for data analysis. The normality of quantitative variables was tested with the Shapiro-Wilk test. The baseline characteristics of the groups were presented as meanSD for continuous variables, while the rates and proportions were calculated for categorical data. The differences between groups were performed using ANOVA for quantitative variables and the 2-test for categorical variables. A comparison between numerical variables at baseline, 18-, 36- and 60-month follow-up was performed with the Friedman analysis. In addition, multiple linear regression analysis was performed to identify independent predictors of the dependent variables lumbar spine and femoral neck T and Z scores and of dependent variable fracture. A p value<0.05 was considered statistically significant.

Read more:
Long-term outcomes of conventional and novel steroid replacement therapy on bone health in primary adrenal insufficiency | Scientific Reports -...

Emily Daniels, who lives with her husband and their young son in Golden, CO, was 32 years old, and in the 33rd week of her pregnancy, she began feeling tightness in her chest.

She wisely had it checked out, and a CT scan found two blood clots in her lungs. The scan also discovered a mass, which a biopsy confirmed was stage IV lung cancer.

Daniels, who has never smoked, was shocked to hear the diagnosis.

Her doctors arent sure how she got cancer. But they told her it was best to induce labor for the sake of the babys health and the mothers.

I had undergone a year and a half of fertility treatment, and if I had to guess, my body wasnt strong enough in that stress mode because of fertility and the hormones. It made things go crazy in my body, she told Healthline.

My doctor thinks this is valid. But we dont know.

Daniels is still living with lung cancer. Shes been through chemotherapy and several other treatments and procedures. Its been difficult, and her life has changed dramatically.

But shes taking it all in stride because shes still alive. And her baby boy, Brady, is now four and a half. Daniels will soon celebrate her 37th birthday.

Lung cancer has given me a perspective on what is important and how you want to live your life, she told Healthline. I want to live every day with no regrets.

Today is World Lung Cancer Day, and the American Lung Association released the Lung Health Barometer, a new survey revealing critical lung cancer awareness statistics.

The good news is that lung cancer overall is down.

The bad news is that it remains the leading cause of cancer death in the U.S.

Smoking is still the most common cause of lung cancer, but an increasing percentage of lung cancer patients like Daniels who have never smoked and are under age 40 are being diagnosed with the disease.

While rates of lung cancer have fallen in the last 15 years because tobacco control is better and there are more preventive measures, theres a higher percentage now of never smokers who are getting lung cancer, David Tom Cooke, MD, F.A.C.S. chief division of general thoracic surgery at UC Davis, told Healthline.

Cooke said there are multiple reasons why people who have never smoked get lung cancer.

They include exposure to second-hand smoke, radon, asbestos fibers, air pollution, toxins from increasing wildfires worldwide, and genetic factors.

Its important to look at the big picture. The death rate from lung cancer has been falling in our country for 10 years, Cooke said.

Thats because of tobacco recovery and prevention, advances in surgery for early stage, immunotherapy, and precision medicine.

The adoption of precision medicine includes the deployment of liquid biopsies, which are simple blood tests that look at circulating tumor DNA in the blood, Cooke said.

These assays can detect cancer and find driver mutations. Its a promising technology, and its most effective in patients with advanced lung cancer, Cooke said.

It makes sense that the more cancer you have in [your] body, the more you will have circulating tumor DNA in [the] blood.

He said that its not as effective with early-stage lung cancer when the tumor is very small and may not be shedding DNA into the bloodstream.

According to the American Lung Association survey, lung cancer is the leading cause of cancer deaths in the U.S., but the disease often remains in the shadows.

Its estimated that more than 235,000 Americans will be diagnosed this year with lung cancer.

But only 29% of Americans know that lung cancer is the leading cause of cancer deaths in the U.S.

Only about one in four respondents (26%) knew that the lung cancer survival rate increased by over 30% in the past ten years.

Seventy-three percent of adults have not spoken with their doctor about their risk for lung cancer, and only 40% are concerned they might get the disease.

And nearly 70% of respondents were unfamiliar with the availability of lung cancer screening for early detection of the disease.

The American Lung Association is working to defeat lung cancer.

To do so, the organization is engaging a variety of tactics and stakeholders to address the disease.

This low awareness is due in part to an undeserved stigma that has followed lung cancer for decades. The fact is that anyone can get lung cancer, and no one deserves it, Harold Wimmer, national president and CEO of the American Lung Association, said in a press statement.

The good news is that the lung cancer survival rate has risen substantially, and awareness of this deadly disease has steadily increased, he stated.

Greater awareness of lung cancer is key to securing research funding, encouraging lung cancer screening, reducing stigma around this disease, and ultimately, saving lives, Wimmer said.

Read the rest here:
Lung Cancer Remains the Leading Cause of Cancer Deaths in the U.S. - Healthline

For anyone who doesnt have a thyroid condition, it might be easy to forget about the gland in the front of their neck that controls hormone production. But behind the scenes, the thyroid does a lot of work to help metabolize and maintain blood pressure, body temperature and heart rate.

Thyroid disease affects approximately 20 million people in the US and about one in eight women. The two most common types of thyroid disorders are hyperthyroidism and hypothyroidism.

Hyperthyroidism produces too much thyroxine hormone (an overactive thyroid) and hypothyroidism does not produce enough (an underactive thyroid). Although the two conditions have different signs and symptoms, there can be some overlap.

There is no replacement for getting the proper diagnosis and starting medication when necessary, said Vatche Zohrabian, DO, primary care physician with the Hartford HealthCare Medical Group, but there are some lifestyle modifications that can help augment conventional treatment and help keep your thyroid on track.

Here are the five things Dr. Zohrabian recommends you do to upkeep a healthy thyroid:

Dr. Zohrabian encourages anyone who experiences the following symptoms to have their thyroid function checked by their primary care provider:

Continue reading here:
Five Easy Steps to Keep Your Thyroid Healthy - Health News Hub

Mark Purcell: Welcome to Thoughts on the Market. I'm Mark Purcell, Head of Morgan Stanley's European Pharmaceuticals Team.

Terence Flynn: And I'm Terence Flynn, Head of the U.S. Pharmaceuticals Team.

Mark Purcell: And on this special episode of Thoughts on the Market, we'll be talking about the global obesity challenge and our outlook for the next decade. It's Tuesday, August the 2nd, and it's 1 p.m. in London.

Terence Flynn: And 8 a.m. in New York.

Terence Flynn: So Mark, more than 650 million people worldwide are living with obesity as we speak. The personal, social and economic costs from obesity are huge. The World Health Organization estimates that obesity is responsible for 5% of all global deaths, which impacts global GDP by around 3%. Obesity is linked to over 200 health complications from osteoarthritis, to kidney disease, to early loss of vision. So tackling the obesity epidemic would impact directly or indirectly multiple sectors of the economy. Lots to talk about today, but let's start with one of the key questions here: why are we talking about all this now? Are we at an inflection point? And is the obesity narrative changing?

Mark Purcell: Yeah Terence look, there's a category of medicine called GLP-1's which have been used to treat diabetes for over a decade. GLP-1 is an appetite suppressing hormone. It works on GLP-1 receptors, you could think of these as hunger receptors, and it helps to regulate how much food our bodies feel they need to consume. Therefore, these GLP-1 medicines could become an important weapon in the fight against obesity. The latest GLP-1 medicines can help individuals who are obese lose 15 to 20% of their body weight. That is equivalent to 45 to 60% of the excess weight these individuals carry in the form of fat which accumulates around the waist and important organs in our bodies such as the liver. There is a landmark obesity study called SELECT, which has been designed to answer the following key question: does weight management save lives? An interim analysis of this SELECT study is anticipated in the next two months, and our work suggests that GLP-1 medicines could deliver a 27% reduction in the risk of heart attacks, strokes and cardiovascular deaths. We believe that governments and insurance companies will broaden the reimbursement of GLP-1 medicines in obesity if they are proven to save lives. This comes at a time when new GLP-1 medicines are becoming available with increasing levels of effectiveness. It's an exciting time in the war against obesity, and we wanted to understand the implications of the SELECT study before it reads out.

Terence Flynn: So, our collaborative work suggests that obesity may be the new hypertension. What exactly do we mean by that, Mark? How do we size the global opportunity and what's the timeline here?

Mark Purcell: Back in the 1960s and 1970s, hypertension was seen as a lifestyle disease caused by stress and old age. Over time, it was shown that high blood pressure could be treated, and in doing so, doctors could prevent heart attacks and save lives. A new wave of medicines were introduced to the market in the mid 1980s to treat individuals with high blood pressure and doctors found the most effective way to treat high blood pressure was to use combinations of these medicines. By the end of the 1990's, the hypertension market reached $30 billion in sales, that's equivalent to over $15 billion today adjusting for inflation. Obesity is seen by many as a lifestyle disease caused by a lack of self-control when it comes to eating too much. However, obesity is now classified as a preventable chronic disease by medical associations, just like hypertension. Specialists in the obesity field now recognize that our bodies have evolved over hundreds of thousands of years to put on weight, to survive times where there is a lack of food available and a key way to fight obesity is to reset the balance of how much food our bodies think they need. With the availability of new, effective obesity medicines, we believe that obesity is on the cusp of moving into mainstream primary care management. And the obesity market is where the treatment of high blood pressure was in the mid to late 1980s. We built a detailed obesity model focusing on the key bottlenecks, patient activation, physicians engagement and payer recognition. And we believe that the obesity global sales could exceed $50 billion by the end of this decade.

Terence Flynn: So Mark, what are the catalysts aligning to unlock the potential of this $50 billion obesity opportunity?

Mark Purcell: We believe there are full catalysts which should begin to unlock this opportunity over the next six months. Firstly, the SELECT study, which we talked about. It could be stopped early in the next two months if GOP P1 medicines are shown overwhelmingly to save lives by reducing excess weight. Secondly, the demand for GLP-1 medicines to treat obesity was underappreciated by the pharmaceutical industry. But through the second half of this year, GLP-1 medicines, supply constraints will be addressed and we'll be able to appreciate the underlying patient demand for these important medicines. Thirdly, analysis shows that social media is already creating a recursive cycle of education, word of mouth and heightened demand for these weight loss medicines. Lastly, diabetes treatment guidelines are actively evolving to recognize important comorbidities, and we expect a greater emphasis on weight treatment goals by the end of this year.

Terence Flynn: Mark, you mentioned some bottlenecks with respect to the obesity challenge. One of those was patient activation. What's the story there and how does social media play into it?

Mark Purcell: Yes, great question Terence, look it's estimated that less than 10% of individuals suffering from obesity are diagnosed and actively managed by doctors. And that compares to 80 to 90% of individuals who suffer from high blood pressure, or diabetes, or high levels of cholesterol. Once patients come forward to see their doctors, 40% of them are treated with an anti-obesity medicine. And as more effective medicines become available, we just think this percentage is going to rise. Lastly, studies designed to answer the question, what benefit does 15 to 20% weight loss deliver in terms of reducing the risk of high blood pressure, diabetes, kidney disease and cardiovascular disease? Will help activate governments and insurance companies to reimburse obesity medicines. But it all starts with individuals suffering from obesity coming forward and seeking help, and this is where we expect social media to play a really important key role.

Terence Flynn: To a layperson, there's significant overlap between diabetes and obesity. How do we conceptualize the obesity challenge vis a vis diabetes, Mark?

Mark Purcell: Terence, you're absolutely right. There is significant overlap between diabetes and obesity and it makes it difficult and complicated to model. It's estimated that between 80 to 85% of diabetics are overweight. It's estimated that 35% of diabetics are obese and around 10% of diabetics are severely obese. GLP-1 medicines have been used to treat diabetes for over a decade, not only being extremely effective in lowering blood sugar, but also in reducing the risk of cardiovascular events like heart attacks and removing excess body weight, which is being recognized as increasingly important. This triple whammy of benefit means that the use of GLP-1 medicines is increasing rapidly, and sales in diabetes are expected to reach over $20 billion this year, compared to just over $2 billion in obesity. By the end of the decade our work suggests that the use of GLP-1 based medicines in obesity could exceed the use in diabetes by up to 50%.

Terence Flynn: Mark, thanks for taking the time to talk.

Mark Purcell: Great speaking with you again, Terrence.

Terence Flynn: And thanks for listening. If you enjoy Thoughts on the Market, please leave us a review on Apple Podcasts and share the podcast with a friend or colleague today.

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Pharmaceuticals: Thoughts on the Market - Morgan Stanley

ADAPT Triad minimal residual disease analysis study intended to evaluate the association between circulating tumor DNA (ctDNA) positivity and recurrence intervals

MADISON, Wis., Aug. 2, 2022 /PRNewswire/ -- Exact Sciences Corp. (NASDAQ: EXAS), a global leader in cancer diagnostics, announced today that it has entered a collaboration agreement with the West German Study Group (WSG), an international research institution that focuses on practice-changing clinical studies in breast cancer. Together, Exact Sciences and WSG plan to conduct a prospective, multicenter validation study in hormone receptor (HR)-positive, HER2-negative early breast cancer patients. The study is intended to demonstrate the ability of Exact Sciences' tumor-informed ctDNA liquid biopsy test to detect minimal residual disease (MRD) and to collect important long-term follow-up and outcome data.

Exact Sciences Corporation Logo (PRNewsfoto/EXACT SCIENCES CORP)

The combined analysis, called ADAPT Triad, is expected to include data from approximately 3,000 German patients enrolled in two ongoing WSG ADAPT trials and one WSG registry study. All patients included in the analysis are stratified using the Oncotype DX Breast Recurrence Score test. The study is part of Exact Sciences' global initiative to generate clinical validation data for its tumor-informed ctDNA MRD liquid biopsy test, currently in development.

"This ADAPT Triad project with WSG offers a tremendous opportunity to help inform treatment decisions and recurrence monitoring, and ultimately improve future outcomes for breast cancer patients," said Rick Baehner, MD, chief medical officer of Precision Oncology for Exact Sciences."In addition to helping validate our MRD assay, we're also eager to better understand the potential synergies involving the predictive and prognostic information provided by our Oncotype DX Breast Recurrence Score test. WSG's expertise in breast cancer research makes them ideal collaborators to conduct these important MRD studies in HR positive, HER2-negative early breast cancer."

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The ADAPT Triad MRD analysis study in breast cancer builds on Exact Sciences and the National Surgical Adjuvant Breast and Bowel Project's (NSABP) CORRECT-MRD II clinical validation studyto detect MRD in colorectal cancer patients. These studies will help create a solid evidence foundation for Exact Sciences' MRD program in two core cancer types where the company has established leadership.

"The WSG's ADAPT study program examines ways to achieve patient-specific decision-making for the treatment of early breast cancer based on biological markers," said Professor Nadia Harbeck, Scientific Director of the WSG and Head of the Breast Centre at LMU Klinikum Munich, Germany. "Partnering with our long-time collaborators at Exact Sciences to evaluate the association of post-initial therapy, pre-recurrence ctDNA with distant recurrence-free interval is a worthy addition to our program and will help change the treatment and monitoring program for solid tumors."

About Minimal Residual DiseaseMinimal residual disease (MRD) refers to the presence of tumor-specific DNA in the body after cancer treatment. These fragments of genetic information, known as circulating tumor DNA (ctDNA), are shed into the blood by solid tumors as part of the tumor growth cycle. Their presence may indicate that a tumor is likely to return. Solid tumors are typically undetected until they are advanced enough to be picked up by a radiologic image or physician examination. The detection of ctDNA at extremely low levels has the potential to provide crucial insights that may help discover cancer recurrence earlier and inform treatment decisions.

About Exact Sciences' MRD ProgramThe Exact Sciences' MRD program is powered by our in-house capabilities to advance a tumor-informed or a tumor-nave solution, with an initial focus on tumor-informed (bespoke) with whole exome or whole genome sequencing.This approach identifies somatic genomic alterations in DNA extracted from the patient's tumor tissue and detects a subset of these mutations in ctDNA present in the patient's blood. The MRD test that Exact Sciences is developing is intended for patients diagnosed with solid tumor malignancies to detect ctDNA before, during, and after cancer treatment. Such information may be used for guidance of adjuvant therapy decisions and/or for monitoring of cancer recurrence, in conjunction with other clinicopathological findings, providing more than 12 million testing opportunities in the United States alone.1

About Exact Sciences Corp.A leading provider of cancer screening and diagnostic tests, Exact Sciences relentlessly pursues smarter solutions providing the clarity to take life-changing action, earlier. Building on the success of Cologuard and Oncotype tests, Exact Sciences is investing in its product pipeline to support patients before and throughout their cancer diagnosis and treatment. Exact Sciences unites visionary collaborators to help advance the fight against cancer. For more information, please visit the company's website at http://www.exactsciences.com, follow Exact Sciences on Twitter @ExactSciences, or find Exact Sciences on Facebook.

About the West German Study Group and ADAPTThe West German Study Group (WSG) is a collaborative academic research group that focuses on the design, organization, and implementation of clinical studies in the field of breast cancer. Its ADAPT studies aim to develop new therapeutic strategies that significantly improve efficacy and tolerability in comparison with existing standard therapies. Its scientific work focusses on the individualization of breast cancer treatment and the development of de-escalated therapeutic strategies with the aim of finding the best possible treatment for each patient. More than 12,000 patients have already participated in WSG studies.

NOTE: Oncotype, Oncotype DX, and Oncotype DX Breast Recurrence Score are trademarks or registered trademarks of Genomic Health, Inc. Exact Sciences and Cologuard are trademarks or registered trademarks of Exact Sciences Corporation. All other trademarks and service marks are the property of their respective owners.

Forward-Looking StatementsThis news release contains forward-looking statements concerning our expectations, anticipations, intentions, beliefs or strategies regarding the future.These forward-looking statements are based on assumptions that we have made as of the date hereof and are subject to known and unknown risks and uncertainties that could cause actual results, conditions and events to differ materially from those anticipated. There can be no assurance as that the WSG ADAPT MRD analysis study will successfully validate Exact Sciences' MRD test or that Exact Sciences will be able to successfully develop or market any MRD or recurrence monitoring tests. Therefore, you should not place undue reliance on forward-looking statements. Risks and uncertainties that may affect our forward-looking statements are described in the Risk Factors sections of Exact Sciences' most recent Annual Report on Form 10-K and any subsequent Quarterly Reports on Form 10-Q, and in Exact Sciences' other reports filed with the Securities and Exchange Commission. Exact Sciences undertakes no obligation to publicly update any forward-looking statement, whether written or oral, that may be made from time to time, whether as a result of new information, future developments or otherwise.

Exact SciencesU.S. Media Contact:Steph Spanos, sspanos@exactsciences.com, 608-556-4380Int'l Media Contact:Federico Maiardi, fmaiardi@exactsciences.com, +41 79-138-1326Investor Contact:Megan Jones, meganjones@exactsciences.com, 608-535-8815

WSG Media Contact: Michael Stdele, Michael.Staedele@wsg-online.com, +49 216156623 10

1 Source: U.S. Census data, Exact Sciences estimates; includes U.S. markets only

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Figure:

antidote, EM best practice, antidote derangement syndrome, toxicology

I love the Oxford English dictionary definition of antidotea medicine given to counteract the influence of poison or an attack of diseasebecause it is subtly correct. It suggests that an antidote is given with the belief that it will successfully treat a poisoning.

It does not imply that the antidote will treat the poison, reverse toxic effects, or be necessary to improve clinical outcome. Taken literally, it implies that the concept of antidote is, like Santa Claus or the Tooth Fairy, a matter of belief, not necessarily fact.

I'd propose a second definition of antidote from the Gussow Dictionary of Rational Toxicology: something that stops all critical thinking and provides clinicians with a false sense of security in medical toxicology cases.

Not infrequently, we at the poison center find that a physician, having learned that drug B is the antidote to poisoning from substance A, becomes stubbornly fixated on administering antidote B, even before asking some critical questions:

Too often, it's easy for the physician to feel that his job is done and the patient is out of danger once an antidote is given. This misconception can lead the medical team to lessen its attention to basic supportive care and careful monitoring. An antidote is not magic; it is just one more thing in the medical toxicologist's toolbox that may or may not be helpful in a specific situation.

Take glucagon, a counterregulatory hormone moderating the effects of insulin by increasing blood glucose. It is synthetized in pancreatic a-cells, and has long been considered an antidote to beta-blocker poisoning because it increases myocardial cAMP though the actions of specific glucagon receptors that are separate from the adrenergic b pathway.

But does the use of glucagon in beta-blocker poisoning actually improve clinical outcomes? This has not been well studied. Early animal research and case reports suggested that it might improve some hemodynamic parameters such as heart rate. But this has never been evaluated in controlled clinical trials. It is also important to realize that most of that research was done prior to 1998 and used glucagon derived from cow or pig pancreas. These preparations contained insulin. It is not clear to what extent that insulin affected the results and case outcomes.

Aside from the lack of convincing evidence of clinical efficacy, additional potential problems arise with administering glucagon. First, bolus doses frequently cause significant nausea and vomiting, not a good development in patients who may be bradycardic or have decreased mental status.

Second, glucagon has a very short duration of action10 to 20 minutesmeaning that a post-bolus infusion will be necessary to maintain its effect. Third, glucagon is surprisingly expensive. The acquisition cost of a 1 mg IV dose is $180 to $280, so administering a 10 mg bolus followed by an infusion of 10 mg per hour quickly adds up to real money. Many hospitals do not stock enough of the drug to treat even a single patient effectively because of the expense.

A recent systematic review on beta-blocker poisoning concluded that glucagon appears to have a minimal effect on improving hemodynamics, and proposed a management scheme that did not include glucagon at all, focusing instead on supportive care with fluids, atropine, and pressors. (Clin Toxicol [Phila]. 2020;58[10]:943.) An even more recent survey of cardiotoxic medication poisoning noted, Although glucagon has been touted as the traditional antidote to beta-blocker poisoning, evidence supporting its use is limited. The authors suggested, however, that it may be useful in treating small accidental overdoses of beta-blockers, or as a transient therapy to bridge patients to more definitive therapies. (Emerg Med Clin North Am. 2022;40[2]:395.)

The bottom line: Glucagon has several significant adverse effects but has not been proven to improve clinical outcomes in beta-blocker poisoning. It seems to be more effective at increasing heart rate than optimizing hemodynamics. It is not mandatory in all cases of beta-blocker overdose and is never definitive treatment. Considering it an antidote can lead to faulty clinical decision-making.

I have discussed other examples of antidote derangement syndrome in previous columns, noting that some online medical databases list cyproheptadine (Periactin) as an antidote for serotonin syndrome, and some clinicians fixate on using it in all such cases. Its clinical efficacy has not been demonstrated, however, and it has no established dose regimen. (No Evidence Supports Using Cyproheptadine for Treating Serotonin Syndrome. EMN. 2020;42[10]:18; https://bityl.co/Cmuk.)

High-dose insulin was introduced as an antidote to calcium channel blocker toxicity, and most cases of significant overdose back then involved verapamil and diltiazem, both of which are predominantly myocardial depressants. Today, the majority of overdoses at our poison center involve amlodipine, which is primarily a vasodilator. High-dose insulin is an inotrope but not a vasopressor, and it dilates blood vessels. (The Truth about High-Dose Insulin. EMN. 2021;43[12]:5; https://bityl.co/Cmul.) The use of the term antidote covers over this nuance.

We should abandon the term antidote. It often leads to muddy thinking. These drugs may or may not be indicated in specific circumstances. It's our job to think this through and determine optimal treatment for the patient in front of us.

One more definition: Antidote derangement syndrome refers to clinical decision-making induced by the delusion that the term antidote is synonymous with panacea.

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Access the links in EMN by reading this on our website: http://www.EM-News.com.

Comments? Write to us at [emailprotected].

Dr. Gussowis a voluntary attending physician at the John H. Stroger Hospital of Cook County in Chicago, an assistant professor of emergency medicine at Rush Medical College, a consultant to the Illinois Poison Center, and a lecturer in emergency medicine at the University of Illinois Medical Center in Chicago. Read his blog atwww.thepoisonreview.com, follow him on Twitter@poisonreview, and read his past columns athttp://bit.ly/EMN-ToxRounds.

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Toxicology Rounds: Abandon the Term 'Antidote' and Its... : Emergency Medicine News - LWW Journals

-- Top-line readout of data expected in October 2022 --

-- U.S. regulatory submission planned for the first half of 2023 --

-- Phexxi may become the first-ever woman-controlled prophylactic for the prevention of chlamydia and gonorrhea --

SAN DIEGO, Aug. 1, 2022 /PRNewswire/ --Evofem Biosciences, Inc., (Nasdaq: EVFM) today announced that the last subject has completed her last visit in EVOGUARD, the Company'sregistrational Phase 3 trial evaluating the efficacy and safety of Phexxi (lactic acid, citric acid, potassium bitartrate) for the prevention of chlamydia and gonorrhea infection in women. There are no prescription pharmaceuticals approved to prevent these sexually transmitted infections (STIs).

Evofem Biosciences (Nasdaq: EVFM) (PRNewsfoto/Evofem Biosciences, Inc.)

Top-line data fromEVOGUARDis expected in October 2022. Evofem expects positive outcomes would enable the Company to submit regulatory applications in the first half of 2023 to the U.S. Food and Drug Administration (FDA) to expand Phexxi's approved indications to include prevention of urogenital chlamydia and gonorrhea in women. Phexxi is currently approved in the U.S. for the prevention of pregnancy.

"This is a major milestone for Evofem and brings us closer to our goal of providing women a safe and effective, woman-controlled prophylactic measure against chlamydia and gonorrhea, the two most commonly reported sexually transmitted infections in the U.S.," said Saundra Pelletier, Chief Executive Officer of Evofem. "We believe these potential new indications represent significant upside for shareholders, above and beyond the multi-billion-dollar birth control market which we continue to increasingly penetrate with Phexxi for hormone-free contraception."

20% of people in the U.S. had an STI on any given day in 2018,according to a 2021 study in the journal Sexually Transmitted Diseases. The CDC estimates that 4.0 million and 1.6 million new cases of chlamydia and gonorrhea, respectively, occurred that year.1Infected people are often unaware of, and do not seek treatment for their infections. Almost 60% of women infected with chlamydia have no symptoms.2

Story continues

Chlamydiais the most frequently reported bacterial infection in the U.S. and can infect both men and women. It can cause serious, permanent damage to a woman's reproductive system and make it difficult or impossible for a woman to become pregnant later in life.

Chlamydia and gonorrhea have been reported to be responsible for one-third to half of pelvic inflammatory disease (PID) cases. PID can cause serious, long-term problems including infertility, ectopic pregnancy, and chronic pelvic pain.

EVOGUARDbuilds on the positive, statistically significant outcomes of AMPREVENCE, the randomized, double-blind placebo-controlled Phase 2b/3 study evaluating Phexxi for the prevention of chlamydia and gonorrhea. AMPREVENCE met its primary and secondary endpoints and showed that the product was generally safe and well-tolerated.

The FDA has granted Fast Track designation and "Qualified Infectious Disease Product" (QIDP) designation to Evofem's product candidatefor the prevention of both chlamydia and gonorrhea in women.

TheFast Track program facilitates the expedited development and review of new drugs or biologics that are intended to treat serious or life-threatening conditions and demonstrate the potential to address unmet medical needs. The purpose is to get important new drugs to the patient earlier.

QIDP designation is intended to encourage development of new products for the treatment of serious or life-threatening infections. A drug or product in development that receives this designationqualifies for an additional five years of marketing exclusivity following FDA approval for that indication.

Evofem is grateful to the study investigators and coordinators at the more than 100 participating study centers across the U.S., as well as the 1,903 women who participated in this landmark study.

About Evofem BiosciencesEvofem Biosciences, Inc., (Nasdaq: EVFM) is developing and commercializing innovative products to address unmet needs in women's sexual and reproductive health, including hormone-free, woman-controlled contraception and protection from chlamydia and gonorrhea. The Company's first FDA-approved product,Phexxi(lactic acid, citric acid and potassium bitartrate), is ahormone-free, on-demand prescription contraceptive vaginal gel. It comes in a box of 12 pre-filled applicators and is applied 0-60 minutes before each act of sex. The Company expects to report top-line data this fall from its registrational Phase 3 EVOGUARDclinical trial evaluating Phexxi for two potential new indications prevention of chlamydia and prevention of gonorrhea in women. Learn more atphexxi.comandevofem.com.

Phexxiis a registered trademark of Evofem Biosciences, Inc.

About PhexxiPhexxi is an on-demand method of birth control used to prevent pregnancy. Phexxi is not effective when used after sex.

Important Safety Information

Rare cases (0.36%) of bladder and kidney infections have been reported. If you have a history of urinary tract problems that keep coming back, you should not use Phexxi.

Contact your healthcare provider if you are experiencing genitourinary side effects such as vaginal burning, itching, discharge, genital discomfort (including in male partners), yeast infection, urinary tract infection, or bacterial vaginosis.

Phexxi does not protect against sexually transmitted infections, including HIV.

For more information about Phexxi, talk to your healthcare provider and see full Product Information atwww.phexxi.com. Please report side effects by contacting Evofem Biosciences toll-free at 1-833-EVFMBIO or contact FDA at 1-800-FDA-1088 or http://www.fda.gov/medwatch.

Intended forUnited Statesresidents only.

Forward-Looking StatementsThis press release includes "forward-looking statements," within the meaning of the safe harbor for forward-looking statements provided by Section 21E of the Securities Exchange Act of 1934, as amended, and the Private Securities Litigation Reform Act of 1995, including, without limitation, the expansion of Phexxi's label, any FDA approvals of new indications and the resulting effect on stockholder value, evaluations and judgments regarding Evofem, its products, its product candidates and their development, and demand for Evofem's products and product candidates. Various factors could cause actual results to differ materially from those discussed or implied in the forward-looking statements, and you are cautioned not to place undue reliance on these forward-looking statements, which are current only as of the date of this press release. Each of these forward- looking statements involves risks and uncertainties.Important factors that could cause actual results to differ materially from those discussed or implied in the forward-looking statements, or that could impair the value of Evofem Biosciences' assets and business are disclosed in the Company's SEC filings, including its Annual Report on Form 10-K for the year endedDecember 31, 2021, filed with the SEC onMarch 10, 2022 and its Quarterly Report on Form 10-Q filed with the SEC on May 10, 2022. All forward-looking statements are expressly qualified in their entirety by such factors. The Company does not undertake any duty to update any forward-looking statement except as required by law.

Sources:

https://www.cdc.gov/std/infertility/default.htm#infnote1

Patel, Chirag G et al. "The Proportion of Young Women Tested for Chlamydia Who Had Urogenital Symptoms in Physician Offices." Sexually Transmitted Diseases vol. 45,9 (2018)

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Evofem Announces Completion of Last Subject Last Visit (LSLV) in Registrational Phase 3 "EVOGUARD" Trial Evaluating Phexxi for the...

For some women, menopausal symptoms such as hot flashes and vaginal changes can be severe and debilitating, greatly affecting their quality of life. In search of relief, some consider hormone replacement therapy (HRT), which is proven to help these symptoms. But HRT also can mean risks that arent completely understood yet. Our understanding of HRT is still evolving as the medical community pieces together the findings of different studies and continues its research.

Knowledge about HRTs impact on breast cancer risk is also developing. But still, there is great concern about women with a history of breast cancer taking HRT, because we know that hormones can fuel breast cancer growth. There are similar concerns about HRT for women who are at high risk of breast cancer because of a strong family history or a positive genetic test result.

What we do know is that the issue of HRT is complex and controversial. In making decisions about HRT, each woman has to work closely with her doctor to weigh the risks and potential benefits in her particular situation. The information we present here can get you started:

Read this article:
Hormone replacement therapy - Breastcancer.org

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I looked at the clock glowing on the nightstand in my bedroom and it read 1:23, one-two-three, a neat set of numbers. I tossed and turned and writhed and looked again, and it read 1:17. Had I misread the clock? Maybe I was dreaming about the time. Maybe I was just confused.

I slept, I woke up, I slept, I woke up. I hobbled into the bathroom, feeling shooting pain each time I moved my left side. The veins in the stone on the vanity writhed and breathed. Everything smelled metallic. I was hallucinating. I itched, and so I scratched, clawing at the damp back of my knees, my soft belly, my ribs. I broke open the scabs on my legs, watching my blood bead on my irritated skin. Back in the bedroom, a strange pair of eyes, slate-blue with yellow sclera, stared at me in the mirror. I had given birth to my second child a week before, and nothing made sense.

The hallucinations that arrived post-delivery were far from my worst symptoms. I experienced debilitating nerve pain during the second pregnancylike having a tattoo gun alight on my skin, over and over. I itched unceasingly and uncontrollably during both: For 136 days the first time and 167 days the second, I was itchy every single moment of every single day. The sensation ranged between the tight skin of a sunburn and the agony of poison ivy. The itching intensified after sundown, causing sleeplessness and exhaustion. I was itchy in my dreams. I sometimes wonder whether my son, sharing my body, might have been itchy too.

For me, pregnancy was obscene, in the phrasing of one of my doctors. And mysterious. Over the course of my two pregnancies, more than 40 physicians and midwives, by my count, failed to explain why my blood work kept coming back with so many anomalies, why so many debilitating complications kept piling up in an otherwise healthy woman.

Though my experience was unusual, I did have something in common with countless other pregnant people: Despite recent medical advances, bearing a child remains startlingly dangerous, a fact that Americas lawmakers on the bench have chosen to ignore. One in five pregnant people experiences a significant complication. And one in 4,000 dies during pregnancy, in childbirth, or shortly after delivering, including one in 1,800 Black mothers. Yet Justice Samuel Alitos opinion in Dobbs v. Jackson Womens Health Organization takes the interests of the unborn human being into account while dismissing those of the person forced to carry a pregnancy to term.

Gone are Roe v. Wade and Planned Parenthood v. Casey, which protected the constitutional right to termination. Eight states and counting have banned abortions, with no or minimal exemptions for medical reasons. But there is no standard for what preserving the health or the life of the mother means.

Read: The Roe baby

What actually counts as the life of the mother? asks the physician Jennifer Jury McIntosh, a spokesperson for the Society of Maternal-Fetal Medicine, an organization for obstetricians who handle high-risk pregnancies. Is that her life today? Is that her life during this pregnancy? How close to losing her life does she have to be for us to decide to terminate? That feels really weighty, because my interpretation of what I feel is lifesavingdoes that align with a particular prosecutors interpretation? She told me that she feared situations in which not ending a pregnancy might constitute medical malpractice, but doing so might open her up to criminal prosecution. (She practices in Wisconsin, where nearly all abortions are now banned under a law passed in 1849.)

Worst-of-the-worst stories are beginning to surface in the press, an appalling countdown clock tick-tocking until Americans learn of the first woman who dies after being denied a termination since Roe was overturned. Media attention focuses rightly on those worst-of-the-worst cases, in which abortion is obviously lifesaving. In countless other cases, the circumstances will be murkier and stranger, but the elimination of the option of abortion will nevertheless do grievous harm.

As it would for me. My two pregnancies left me disabled, a word I am still struggling to come to terms with. They put my life at significant risk. Some of my doctors have made clear that they do not think I should bear a child again. Still, if I got pregnant, I would likely be forced to carry to term in much of the country, despite how sick I was, despite all the damage and pain I endured.

The 2018 midterms were looming, and my husband and I were planning to relocate from Washington, D.C., to California, when I learned that I was pregnant the first time. At our first ultrasound, we sat besotted, looking at the gummy-bear contour on the screen as a wub-wub-wub sound filled the room. The first jump scare came minutes later. The technician went silent, moving the wand over my pelvis again and again. In time, a doctor came in to tell me there was a mass the size of a softballroughly the size my babys head would be at 40 weeks, she notedsitting on the left side of my pelvis. She was not worried about it affecting the pregnancy. But she was worried about it twisting and cutting off the blood supply to one of my ovaries. That would be a nine or 10 out of 10 on the pain scale, the doctor said, as flatly as if she were letting me know the time.

Duly noted, I guess. She expected the baby to arrive at the end of March or early April, and with that deadline set, my husband and I hastened our move across the country. Toward the end of my first trimester, as we were packing boxes and giving away books, the itching showed up, as I noted in my diary at the time. I first noticed it in the morning. Lots of people stretch and then scratch themselves when they wake up, right? Next, I noticed it in the evening, a reaction to our laundry detergent, perhaps? Soon there was no noticing necessary. I could not not notice it. Especially in warm weather and at night, I felt centipedes scuttling over my feet and hot needles poking my shoulder blades.

From the May 1997 issue: Abortion in American history

Things I tried to make it stop: hypoallergenic detergents and soaps; pine-tar soap; eczema wash; calamine lotion and capsaicin lotion; oatmeal baths; shea butter and dozens of other emollients; antihistamine cream; a variety of over-the-counter and prescription oral antihistamines; topical steroids; showering with cold water; holding bags of frozen corn against my body; wearing loose clothing; acupuncture (not fun when you are itchy); screaming. Only three things helped: ice, a cream called Sarna that made me smell like an unsmoked Newport, and scratching. So I iced, applied lotion, and scratched. I tore the webbing between my toes and the thin skin around my belly button. I clawed out clumps of hair. I fantasized about being able to scratch my wet bones or the jelly in my eyeballs.

My West Coast providers were sympathetic, if not overly concerned. Itching was not unusual during gestation, my new obstetrician noted. She suspected I had intrahepatic cholestasis of pregnancy, a dangerous condition that affects roughly one in 1,000 pregnancies. She ordered weekly blood tests to look for a telltale increase in bile acids. In the meantime, she told me to use cold compresses.

Aside from the pruritusthe medical term for itchingI felt joyous as my belly swelled and we got used to our new home, hiking on the beach with our dogs and trying out baby names. My husband and I took the cult low-intervention birthing class everybody we knew took, called, ahem, Yes to Birth! I read book after book about how I was built for this.

As the weeks dragged on, though, the itching kept getting worse, and the blood work showed nothing. By the middle of my second trimester, struggling to function, I called my providers, sobbing and begging for help. The nurse on call asked me if I had taken antihistamines. Of course I had. If you felt like you had poison ivy for months, I snapped, did you think you would have taken a fucking Benadryl? She had me leave an escalatory message on some voicemail. Nobody called me back. So we moved on to our third set of medical providers, a team of crunchy, evidence-based midwives in Oakland.

At our first meeting, my new lead midwife took one look at my skinwhich, from all my scratching, had undergone a process called lichenification, becoming thick and leathery and covered in weltsand referred me to a dermatologist, who guessed I had either scabies or cholestasis and prescribed a strong topical steroid. (Alas, I did not have scabies.) The new drug would work, I promised myself. I lurked at home, talking to my baby, who we had learned was a boy, telling him I could not wait to meet him.

That happened sooner than Id imagined. Early in my third trimester, my midwife kept muttering Fuck as she took my blood pressure. It had spiked to 170 over 90, a level suggesting that I had preeclampsia. She called in an obstetrician who deals with high-risk cases to take over my care, as I had risked out of her scope of practice.

That new doctor, No. 4, confirmed that I had preeclampsia, with anomalies in my liver and kidney labs. She admitted me to the hospital at 31 weeks so she could monitor my organ function and asked me to stay there until I gave birth, which was likely to be at least a month early. Well deliver you at 36 weeks, she told me. But youre not going to make it that long.

I raged. How dare she! I would delivernot uswhen my body and my baby were ready. I was healthy. I was built for this. (I was in denial.) Her face softened. She had a feeling about some pregnancies, she told me. Mine was one of them. Then she told me about two patients who had had severe pruritus during pregnancy. The first gave herself frostbite during a blizzard, ripping her clothes off and letting the snow numb her. The second threw herself out a window.

Doctor No. 4 agreed to discharge me if I would come back for monitoring in the hospital every third day, so we did that, and I would cry listening to my sons heartbeat in the dark of the sonogram room. Two long weeks later, I went in and got a 220 over 100 blood-pressure reading, then 180 over 110. Then time sped up: The chatty sonogram technician going silentthats not good. Itching. Machines beeping, cuffs squeezing, panicked phone calls. Itching. A meeting with a gray-faced neonatologist, the decision to induce. IV poles. Itching. It was Valentines Day, I realizedred hearts, blood-soaked linens. A dozen people rushing into the room. No time to induce, time to move to surgery. Sign this form. Stay still. Your husband has to wait outside. Cutting, tugging, pulling on my insides, as if I were a prey animal being eaten alive. The discovery that my placenta was shearing away from my uterus, a complication that could have killed me and the baby.

I am not sure exactly when I became a mother. He was quiet at birth, and the neonatal team whisked him away before I could see him. We met hours later, my tiny valentine in his glowing plastic box, covered in wires, fed by a tube.

I was eating soft pretzels with my siblings in a mall food court a year later when my younger sister tried to discourage me from having another child. Dont do it, she told me. You could have died. The baby could have died. Dont do it.

We did not die, though. My three-pound newborn had grown into a thriving toddler, all wacky smiles and fistfuls of spaghetti. As for me, at four days post-delivery, I was so itchy that I demanded a surgeon amputate my legs. (Well take that under advisement.) The next day, the itch disappeared, leaving my doctors and me never really knowing what it was. Months of intensive trauma therapy, started when my son was in the NICU, had restored my mental health in a way I did not think possible at first.

In the end, it was my kid, in all his chaotic wonder, who convinced me to try again. Wasnt it worth it? What wouldnt I sacrifice for him? I prayed that the complications would not come back and that the baby would be safe in my body until we reached full term. But if they did, I knew I had the right to a termination for medical reasons.

When I got pregnant the second time, my providers considered me high-risk from the start. A team of clinicians scrutinized my body and blood, anticipating problems rather than reacting to them. The irregularities started to show up in the first trimester, againproblems with my liver labs, then itching, then nerve pain and insomnia.

My providers could do little to manage my symptoms. As the pregnancy wore on, the aperture of my life drew smaller and smaller. I struggled to think. My hair fell out. I developed gestational diabetes, snatching away the routine of a sandwich, the delight of a good banana. Injecting insulin into the tight drum of my abdomen made me itch every time I did it; I took to stabbing my thighs with my finger-stick lancet after I was done, because pain inhibits itching. I became so foggy-headed that I drove the family car into a concrete pylon. From time to time, I felt so overwhelmed with love that I could not imagine not being pregnant. From time to time, I felt a yen not so much to die as to not exist at all.

Early on, my high-risk-pregnancy obstetrician had called in a hepatologist, a genial older guy with a cravat and an indeterminate European accent. He initially told me I did have intrahepatic cholestasis, both in my first pregnancy and in this one. But well into my second trimester, he left me a voicemail: I would like to discuss your disease. My disease? He had added some tests to my blood work, he explained. My body was teeming with an antibody indicating that my immune system was attacking my bile ducts. I had a disease called primary biliary cholangitisslow-moving, rare, degenerative, and incurable. The hormone load of pregnancy was exacerbating its symptoms.

Hot astonishment, cold relief. I was sick. I had been sick for years. I would be on medication for the rest of my life. I would likely be diagnosed with other autoimmune conditions in time, and was now more susceptible to developing a host of diseases, including liver cancer. My pregnancies had unmasked this reality, as my hepatologist put it. And in creating life for my children, I caught a glimpse of how my own might end: brain-fogged, fatigued, vitamin-deficient, dry-eyed, and, yes, itchy.

But such symptoms might not emerge for years, if at all. After I delivered my son, I hoped, I would again be delivered from the miseries of my own body. The day finally came, and I decided to opt for an induction instead of a C-section, given how much I had hated the latter experience the first time. I labored, feeling the itching subside with the pain of every contraction, breathing myself closer and closer to relief.

Of course, we were in for a few final scares. During one cervical check, my midwife said my son was emerging hand-first. She would have to push him back up to reposition him. (This, well, hurts.) And she worried about his heart rate, which kept dropping, indicating that my contractions might be compressing the umbilical cord and he might have to come out via C-section after all.

From the August 1965 issue: One womans abortion

A doctor placed an epidural. Beeping, people crowding the room. Pushing. I thought I was supposed to feel pressure but not pain. The need to get him out, now. The decision to try forceps. My husband blanching as he stared at the monitor. A request from the doctor for more anesthesia, a warning that it would take a few minutes to kick in. Searing pain, leading me to scream at the doctor to stop. The doctor with the forceps not stopping. Nurses pinning my legs down in the stirrups. The sense of being eviscerated, the room going Technicolor. I did not know I could feel so much pain.

At least it was over quickly. The baby emerged quiet, floppy, purplish. My first reaction was to laugh. I went through all of that to have a baby who was dead? But soon he started to breathe, letting out a raspy cry. The extra anesthesia kicked in, so I keeled over in the bed as the doctor explained that hed performed an episiotomy while wresting the baby out. I was insufficiently anesthetized at the time. Im sorry, he said softly.

My experience of pregnancy was over, and I slammed the door shut. I thanked my clinicians and meant it. I ate three adult portions of spaghetti, ignoring the admonishments of the nurse who had to come in to give me more insulin. I washed away the blood the nurses had missed between my toes and ministered to my stitches and scratch marks. I declined to go back to trauma therapy, though I knew I needed it. I had a beautiful newborn, a beautiful toddler, a beautiful husband. I took my torn-up body home.

Some heartbroken part of me wants to have another kid. I am a middle child, my parents are both middle children, and I am married to a middle child; I have a deep-seated intuition that families are most fun when they are big. Plus, I did heal postpartum. The hallucinations went away when the itching stopped and I started sleeping again. My doctors found a cocktail of medications that have ameliorated many of my symptoms. But I know I cannot give birth againnot least because I need to be a parent to the children I already have and love. And I cannot imagine being forced to.

A majority of Supreme Court justices and a number of state legislators not only can imagine that scenario, but would make it a reality. They would let states force childbirth on victims of rape, incest, and intimate-partner violence; on people without the means or desire to raise a child; even on literal children. The decision is about life, supposedlythe anticipated lives of the embryos and fetuses people will be required to gestate against their will, like brood mares. The lives of those pregnant people do not matter. My experience does not matter. What matter are the opinions of judges and politicians, most of them men with no medical expertise and no experience of being pregnant, no visceral understanding of how messy and hard it can be, even in the best of circumstances.

Even those best of circumstances can be obscenely dangerous, and Dobbs has made them more so. The ruling will absolutely lead to an increase in maternal morbidity and mortality, McIntosh told me. Physicians are now waiting for women with prematurely ruptured membranes to decompensate before providing an abortion. They are reconsidering how to care for pregnant people with cancer, among other ailments. There are reports of people being denied drugs that could be used as abortifacients, even if those drugs are being prescribed for a different purpose.

Read: How the end of Roe would change prenatal care

The judiciary is forcing pregnant people and their doctors to justify care that was once allowed by constitutional right. What if I had had to plead my own case? Would I have been denied a termination if I had never gotten my proper diagnosis, and had only a history of extreme symptoms and abnormal test results? Would I have qualified on the basis of my liver disease and diabetes, both now diagnosed as permanent? How about my chronic fatigue, or my history of pregnancy-related mental-health troubles? Would a physician have been able to end my pregnancy if Id had another placental abruption or another bout of dangerously high blood pressure? Would the state have required me to itch for months on end as my body and my mind deteriorated?

These queries are personal, but Dobbs has raised more metaphysical ones too. What does the life and health of mothers mean? How could it possibly mean so little? What are we supposed to do?

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What Counts as the Life of the Mother? - The Atlantic

It happens more often than you might think: A middle-aged woman schedules an annual physical with her primary care physician, dutifully answers all of her doctors questions, and completes the appropriate bloodwork. Then, a few months later, shes struggling with a recurring issue that never came up in a routine exam. As a result, she may have to undergo more extensive medical treatment that could have been avoided if addressed earlier.

Its important for all women and especially those who are in their middle years (50-70) to establish a relationship with their primary care provider, says Melanie Santos, MD, FACOG, FPMRS, medical director of pelvic health for St. Jude Medical Center in Fullerton, California. Santos is a urogynecologist who specializes in treating women with incontinence and other pelvic floor disorders. I see most patients more often than an annual exam, so sometimes they feel more comfortable with me than they do with their primary care doctor, she said. I often find myself recommending that they see their primary care doctor about certain medical conditions that they have been keeping private.

In some cases, women are too embarrassed to bring up personal concerns with their doctor, such as urine leakage or other pelvic issues. For others, they simply dont feel they have the time to seek treatment. Women tend to take care of everyone else in their lives before they manage their own health, Dr. Santos said. They wait until the dust settles with everything else, when in reality, their problem may have a simple and quick solution.

For women who are past their childbearing years, it is especially important to be honest with their primary care doctor, because they may be experiencing treatable conditions related to menopause, heart health, bone health, or pelvic health.

During menopause (when a womans sex hormone levels decrease, which results in her menstrual cycle stopping) and perimenopause (the time leading up to that point), the body undergoes several hormonal changes that can cause a variety of unpleasant symptoms. While some women believe its just a part of aging and something they have to go through, there are plenty of ways in which a primary care doctor can help.

Hormone replacement therapy is considered a safe and effective choice for women whose hot flashes and night sweats are intolerable. However, its not the only option. Other medications that treat hot flashes and night sweats include gabapentin, an anti-seizure medication, and antidepressants. Doctors also recommend that women avoid hot-flash triggers, including alcohol, caffeine, stress, tobacco, and spicy foods. Additionally, there are other natural ways to manage symptoms that doctors can help recommend and manage.

The key is for a woman to talk about it in detail and describe what is happening so that the doctor can determine the best way to help her. So many people suffer when they dont need to, said Dr. Santos. That, in turn, can affect mental health, and create a cascade of other problems.

Heart disease is the leading cause of death for women in America, and it leads to almost as many deaths in women as it does in men. Symptoms of heart disease in women are different than in men and can include (but are not limited to):

Dr. Santos said women shouldnt feel shy about reporting any new or unusual symptoms to their doctor. Even if a patient suspects her symptoms are probably just acid reflux, she should still talk to her primary care provider. Telemedicine has become a big part of what some providers offer, Dr. Santos said. It is very easy to have a quick virtual appointment with your doctor to discuss your concerns.

The Centers for Disease Control and Prevention recommends that women ages 65 and older should undergo a bone density test to learn if they suffer from osteoporosis. If a woman has a parent who has broken a hip or other risk factors for osteoporosis, however, she should undergo her first bone density test between the ages 50 and 64.

Brittle bones can be especially risky for women as they grow older because they are at a high risk of experiencing a debilitating fracture. Early symptoms can include:

There are three main types of pelvic floor disorders: urinary dysfunction or incontinence, or lack of bladder control; bowel dysfunction or fecal incontinence, or lack of bowel control; and pelvic organ prolapse, a condition in which the uterus, bladder, and bowel may drop within the vagina. According to Dr. Santos, women who have these issues, such as urinary incontinence, often wait an average of seven years before seeking treatment. Thats living with discomfort for a long time!!

Incontinence can be a difficult topic to broach with a primary care doctor, but its an important one. Some women think that leaking urine or fecal matter is just a part of aging they will have to live with, but thats not true. There are many treatment options, and some are very easy fixes. If a problem causes you concern, it doesnt matter if its a part of aging, Dr. Santos said. You shouldnt have to just live with it.

Dr. Santos suggests compiling a list of questions before an appointment to avoid forgetting anything. When you go to the grocery store, you dont just wing it, she said. You make a list and use that to guide your shopping trip. Its the same with a doctor appointment.

A strong relationship with a primary care doctor can lead to overall better health and better quality of life. There is nothing that they havent already heard and no issue is cause for embarrassment. Communication is key to treatment.

If you are looking for a primary care doctor, you can search for one whos right for you in our provider directory.

Were with you, wherever you are. Make Providences app your personalized connection to your health. Schedule appointments, conduct virtual visits, message your doctor, view your health records, and more. Learn more and download the app.

Womens health resources

How heart disease affects women

Pelvic floor therapy

This information is not intended as a substitute for professional medical care. Always follow your health care professional's instruction

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Women's healthcare from top to bottom - Providence

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LGBTQ patients are at higher risk for sexually transmitted infections, HIV and certain cancers. Community Health Network primary care physician Dr. Mike Giffen said LGBTQ friendly health providers are crucial in reducing these health disparities.

LGBTQ patients are at higher risk for sexually transmitted infections, HIV and certain cancers. Community Health Network primary care physician Dr. Mike Giffen said LGBTQ-friendly health providers are crucial in reducing these health disparities.

If the provider is not open, if the patient's not comfortable and not open, we kind of gloss over a lot of stuff, Giffen said. And that's where a lot of this stuff is missed.

Giffen said trust is key in developing patient-provider relationships that are open and honest, especially if the patient is a member of the LGBTQ community. He said if trust is not built, health disparities in the community will continue.

So that's why this is super important, is to try to kind of break down those disparities and kind of actually level the playing field and get patients the care they deserve, he said.

Giffen said the LGBTQ community also faces higher rates of anxiety, depression and other mental health disparities. As a primary care physician, he helps those in need of hormone replacement therapy, surgery or other gender-affirming medical care. He said he has created a tight-knit community with other LGBTQ-friendly providers across the state.

I've built a nice network of connections of different surgeons and differenttherapists and counselors kind of across the board, Giffen said. Anything of a person who really needs their care.

Giffen said he understands many people are hesitant to get medical care. He said he wants to make sure patients feel comfortable.

People always think they come to a doctor and they need to have a lot of issues and a lot of stuff has to be up front, he said. Meeting with a patient can be literally just a conversation. Hey, it's good to meet you. Let's make sure this is a good, you know, interaction. And if you feel comfortable, we can move forward.

Contact reporter Darian Benson at dbenson@wfyi.org. Follow on Twitter: @helloimdarian.

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Open, honest conversations key in reducing LGBTQ health disparities - WFYI

Trans kids seek safety and freedom on Transgender Day of Visibility

States are passing anti-LGBTQ laws across the country, but that can't erase the past, present or future of the transgender community.

Scott L. Hall and Cody Godwin, USA TODAY

After starting hormone replacement therapy, Elliot Wade noticed a difference in his body.

It wasn't that he hated his body before he started to transition. But there was something comforting about being in a body that looked like he felt a man.

"Immediately, when I started to see the effects of testosterone, then I was much more happy with myself," he said. "I can say that my overall mental health just improved significantly."

When Wade sought hormone replacement therapy about four years ago, he was seen quickly and could start with informed consent, meaning he wouldn't have to go through months of therapy and other counseling before receiving treatment.

But others in Lafayette and Acadiana aren't always as lucky, often being told an office isn't taking new patients or being placed on a waitlist for about six months before being seen by a medical provider for hormone replacement therapy, said Louisiana Trans Advocates Board Secretary Peyton Rose Michelle.

Outside of finding providers who offer hormone replacement therapy, Michelle said it can be difficult and frustrating to find physicians and medical providers in the area who offer gender-affirming care, which treats individuals in a way that aligns their outward traits with their gender identity.

Wade socially transitioned, coming out to loved ones and telling them about his preferred pronouns and new name when he was 17. It wasn't until he was 20 that he sought hormone replacement therapy.

At first he thought he would have to move outside Louisiana to seek the care he wanted without having to jump through hoops like being diagnosed with gender dysphoria. But he found treatment at a clinic in Lafayette.

"I didn't hate myself. It didn't hurt to look at myself," the 24-year-old Black man said. "I've heard of experiences where it's horrific for (people) to look in the mirror or get out of bed in the morning.

"While I was able to go two years, that two years for somebody else? It could be torturous."

Pride in Acadiana: From Drag Queen Storytime to a celebration with a parade

But even finding basic medical care can be challenging.

"I still haven't found a general practitioner that I feel is receptive or understands or takes me seriously," Wade said. "It's also really frustrating to have to go in and educate somebody about your body or to feel like they aren't believing you."

"There aren't enough doctors that are trained to help trans people," he added. There are a lot of doctors, nurses, medical professionals that are sympathetic and want to help, but they don't really know where to start."

A 2015 U.S. Transgender Survey, the most recent survey, found about 23% of more than 27,000 respondents reported they didn't seek needed health care for fear of being mistreated as a transgender person.

Even after a trans person finds a health care provider who isn't outright transphobic, they can still be misgendered or have a provider who doesn't know the best treatment.

"There's so many barriers to access," Michelle said. "Some doctors are less educated on working with trans people. It's very common for trans people to have to educate their own providers about how to even treat them."

"Even doctor's offices that provide affirming care sometimes slip in their affirming care," she added.

Gender-affirming care involves a range of social, psychological, behavioral and medical interventions that affirm a persons gender identity when it conflicts with the gender they were assigned at birth, according to the World Health Organization.

It can include everything from hormone replacement therapy, counseling, voice coaching to physically altering surgery or any combination of care. There are no one-size-fits-all treatments for trans men, trans women, non-binary and gender-fluid people.

LGBTQ discrimination: Most LGBTQ Americans face discrimination amid wave of anti-LGBTQ bills, study says

For subscribers: Gender-affirming care helps save lives, cuts depression risk in transgender and nonbinary youth, study finds

And while Wade has found providers who offer gender-affirming care, it isnt always seamless. Wade wanted an intrauterine device, which is used as a long-term contraceptive. His gynecologist, who Wade said is receptive, wasnt sure whether the IUD would work for Wade because of his hormone treatment.

The treatment was successful but his doctor never informed him that muscle spasms that mimic contractions could be a side effect. It was something theyd never seen before.

Everything was fine except that I was suffering, Wade said. Just having that nuance in that background makes a lot of difference.

Gender-affirming health care improves mental health and the overall well-being of gender-diverse people, according to the U.S. Department of Health and Human Services.

"It can make it or break it for a lot of my clients," said Monet David, a licensed professional counselor in Lafayette.

It's important to David as someone who treats mental health that clients felt like they weren't being judged or like she was going to make assumptions about them.

"People don't want to have to justify who they are in a session," David said. "I don't want you to have to explain what it means to be trans. As a mental health professional, I should know about that.

"There's too many texts, too many podcasts, too many books, all this content out there that people are willingly writing. You shouldn't have to perform additional emotional labor to catch me up to speed."

Health and wellness: How doctors' assumptions about LGBTQ patients can be harmful to their health

When she first started practicing, she didn't have as much autonomy to offer affirming care. Now she does that through her paperwork, asking for pronouns and allowing people to not indicate their gender.

She advertises herself as a practitioner who offers gender-affirming care and as someone who's trained in serving the LGBTQ+ community, she said.

"In Lafayette, there's still a pretty big make up of people who are uncomfortable by that," she said. "So by choosing to be affirming, I think I'm excluding myself from a big population that is turned off by that, but it's worth it.

"That's what matters the most."

Wade has sought out health care providers who offer gender-affirming care and said it makes a difference.

"For me, it's made accessing medical care not as scary," he said.

Until that care is widespread, Wade, who also sits on the Louisiana Tras Advocates board,said people will need to advocate for themselves and do the best they can with the resources they have.

Michelle has a wishlist of things she would change about health care for gender-diverse people.

It includes intake forms that separately ask about gender and sex assigned at birth. It asks about a preferred name, pronouns and honorifics. She wants people to be able to go to their longtime primary care physicians and receive treatment and be referred to other specialties without hesitation.

"In a perfect world, you just tell your doctor what you want. and they say, 'OK, here's what you can do about it' instead of being like, 'I have no clue what that is,'" she said.

"I could go on a very long list about other things that I wish doctor's offices did to make trans people more comfortable and provide services. But they first have to provide services."

For resources about finding gender-affirming care in Louisiana, visit http://www.latransadvocates.org.

Contact Ashley White at adwhite@theadvertiser.com or on Twitter @AshleyyDi.

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Trans health care options in Louisiana exist, but are hard to come by - Daily Advertiser

Breast cancer affects millions of women around the world. In the United States alone, it is estimated that one in eight women will develop breast cancer in their lifetime. While there are many factors that can contribute to the development of this disease, some lifestyle choices and habits can play a significant role. Read on to find out moreand to ensure your health and the health of others, don't miss these Sure Signs You've Already Had COVID.

One of the best ways to catch breast cancer early is to perform regular self-examinations. This allows you to become familiar with how your breasts look and feel so that you can more easily spot any changes.

Screening mammograms are an important tool in the early detection of breast cancer. These tests can often find tumors that are too small to be felt by hand.

Women who don't get regular mammograms are at a higher risk of developing this disease. If you're over the age of 50, it's important to get a mammogram every two years. You may need to get them more frequently if you have a family history of breast cancer.

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One of the most important things you can do to reduce your risk of breast cancer is to avoid smoking. Tobacco use is linked to a variety of health problems, including cancer. Smoking cigarettes or using other tobacco products increases your risk of developing breast cancer. In fact, studies have shown that women who smoke have a 20 to 30 percent higher risk of developing this disease.

If you currently smoke, quitting is one of the best things you can do for your health.

Another bad habit that can lead to breast cancer is excessive drinking. Alcohol consumption can increase your risk of developing this disease. If you drink alcohol, it's important to do so in moderation. Women who drink more than three alcoholic beverages per week have a higher risk of developing breast cancer than those who don't drink.

A poor diet can also contribute to the development of breast cancer. Eating a diet high in processed and red meats has been linked to an increased risk of this disease. Conversely, eating a diet rich in fruits and vegetables may reduce your risk. It's also important to maintain a healthy weight and avoid excessive weight gain. Being overweight or obese is a major risk factor for breast cancer since excess fat tissue can produce hormones that can promote the growth of cancer cells.

Getting regular exercise is another important way to reduce your risk of breast cancer. Studies have shown that women who are physically active have a lower risk of developing this disease. Women who exercise for at least 30 minutes per day have a significantly lower risk than those who don't get any exercise.

Certain birth control methods have also been linked to an increased risk of breast cancer. Oral contraceptives that contain estrogen and progestin can slightly increase your risk. This is especially true if you use them for 10 or more years. If you're concerned about the risks associated with birth control, talk to your doctor about other options.

Hormone replacement therapy (HRT) is another factor that can contribute to the development of breast cancer. HRT is often used to relieve symptoms of menopause, such as hot flashes and night sweats. This treatment can also help prevent osteoporosis. However, HRT has been linked to an increased risk of breast cancer. If you're considering HRT, talk to your doctor about the risks and benefits.

While there are many factors that can contribute to the development of breast cancer, some lifestyle choices and habits can play a significant role. Smoking, drinking alcohol, and eating a poor diet are all bad habits that can increase your risk. Getting regular exercise and maintaining a healthy weight are good ways to reduce your risk. Certain birth control methods and hormone replacement therapies can also contribute to the development of this disease. If you have any of these risk factors, it's important to talk to your doctor about them. And to protect your life and the lives of others, don't visit any of these 35 Places You're Most Likely to Catch COVID.

Gethin Williams MD Ph.D. is the Medical Director of Imaging & Interventional Specialists.

Gethin Williams, MD, Ph.D

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8 Bad Habits Leading to Breast Cancer Eat This Not That - Eat This, Not That

In recent years, transgender people and particularly, transgender kids have become pawns in a broader political struggle.

Florida officials in June proposed a rule preventing the states Medicaid program from reimbursing providers for a series of therapies meant to treat gender dysphoria. Florida joined other red states that have moved to restrict access to those medical treatments.

Gender dysphoria is defined as strong, persistent feelings of identification with another gender coupled with significant discomfort and distress with ones own assigned gender and sex.

Floridas efforts follow years of litigation and lawmaking driven by conservatives about whether transgender girls can compete in womens sports, how the existence of transgender people is explained in schools and which bathroom is appropriate for them to use.

Essentially, those in favor of treating the condition with hormonal therapy care and those against the practice are accusing each other of the same thing: distorting the scientific evidence in order to politicize the well-being of children.

Lets delve into some of the most important questions on the subject.

Want to suggest more questions that could appear in a future story? Email kwilson@tampabay.com or codonnell@tampabay.com.

An estimated 16,200 Florida teenagers roughly 1.32% of children aged 13 through 17 identify as transgender, according to a June report by The Williams Institute, a think tank at UCLAs School of Law. The report uses data from Floridas 2019 Youth Risk Behavior Survey. Across the U.S., as many as 300,000 teens identify as transgender, the report found.

That does not mean they meet the psychological criteria to be diagnosed with gender dysphoria. Based on the number of people who seek treatment, up to 0.014% of those assigned male at birth and 0.003% of those assigned female at birth are later diagnosed with gender dysphoria, according to the American Psychiatric Association.

To be diagnosed, the condition must persist for six months, and children must be able to verbalize their discomfort, according to the definition of gender dysphoria offered by the American Psychiatric Association.

Its not clear. However, the number of children needing services to treat gender dysphoria or related mental health issues is on the rise in some western countries such as the United Kingdom. Some attribute this to decreasing social stigma to being transgender, or the increased availability of services. Others, including conservative policymakers, have hypothesized the condition is socially influenced.

For Nikole Parker, gender identity was a matter of life and death.

I would not be alive if I did not transition, said Parker, whos now the director of transgender equality at the LGBTQ advocacy group Equality Florida.

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Many transgender people experience gender dysphoria so acutely it has negative consequences for their mental health. Parker says when she began her transition journey at 19, she wanted to align her body with her gender identity so much that she acquired hormones off the black market.

At least one in four kids diagnosed with gender dysphoria report having attempted suicide, according to three studies cited by a peer-reviewed case report.

The medical therapies, which experts say should be administered gradually along with extensive consultation from mental health professionals, fall under three categories.

First, if a child has not already gone through adolescence, they can be put on puberty blockers. This can alleviate distress from body changes that dont align with identity. Puberty blockers can also buy children time to figure out how or whether they want to proceed with their transition.

Next, they can be prescribed hormones: typically estrogen for transgender girls and testosterone for transgender boys. Like puberty blockers, these hormones treat a number of other medical conditions. The Endocrine Society, which advises doctors on hormone science, notes that for most kids, 16 is the youngest age that they can consent to treatment.

Finally, people can pursue gender confirmation surgeries that involve reconstructing reproductive organs. However, medical societies do not generally recommend these irreversible surgeries for children.

In a recent report, Floridas Agency for Health Care Administration explored whether insurance should cover these therapies and whether they fall under the states professional medical standards, or whether they were experimental or investigational.

The state decided the scientific community had not demonstrated enough evidence to show whether the treatments were safe or effective in easing the mental health burden associated with gender dysphoria. More traditional mental health counseling is appropriate for transgender kids, but not hormonal therapies, Florida officials have said.

Major medical societies such as the Endocrine Society and American Academy of Pediatrics and the World Professional Association for Transgender Health disagree with the states assessment. They recommend the treatments be available for kids and adults.

A team of Yale researchers wrote a policy paper in April criticizing conservative-run states for restricting access to puberty-blocking drugs, arguing that the therapies are safe, effective, and fully reversible.

The drugs have been prescribed by doctors since the 1980s to treat kids suffering from a phenomenon called precocious puberty, in which some children begin the process of puberty at an inappropriately early age. Once a child is of the proper age to go through puberty, they are taken off the drugs.

Some other academics, including many cited by Florida officials, argue the effects of puberty blockers arent fully reversible. They say theres not enough evidence to demonstrate whether puberty blockers alleviate the mental health symptoms of gender dysphoria nor is there enough evidence on the long-term effects of the drugs prescribed to kids to treat gender dysphoria.

Hormonal therapies present more significant long-term effects for children, some of which can be irreversible, such as a reduction in fertility.

Michael Haller, the chief of pediatric endocrinology at the University of Florida, works at a clinic in Florida that treats children with gender dysphoria. He says his patients benefit from hormonal therapies, and that the families know the potential downsides.

The majority of the bodies that have looked at the available data and who take care of these patients have argued in favor of these treatments, Haller said.

Some who have undergone hormonal therapies say they regret the process. Experts on both sides of the debate around hormonal therapies agree more study is needed. Haller said in his experience, the number of children who regret transitioning is exceedingly low.

State officials are questioning the authority of three medical societies: the Endocrine Society, the American Academy of Pediatrics and the World Professional Association for Transgender Health.

Those three groups have endorsed hormonal therapies care based on studies that rely on survey results; doctors shouldnt heed their advice, Florida officials say.

Physicians who recommend sex reassignment treatment are not adhering to an evidence-based medicine approach and are following an eminence-based model, the June report from the state reads. Florida officials argued the guidance recommending puberty blockers to treat childhood gender dysphoria is based on studies that involved small sample sizes and subjective methods.

In response, the World Professional Association for Transgender Health, a nonprofit dedicated to advancing the health of transgender people, called the states report misleading and dangerous. The Endocrine Society stands by its guidance, which was primarily crafted by nine experts according to the groups standards for evidence-based guidelines. The American Academy of Pediatrics also backs its guidance, which was created with the help of more than a dozen expert members.

Paul Hruz, an associate professor of pediatrics at the Washington University School of Medicine in St. Louis, was one researcher cited in the Florida report. He said Florida officials did a good job highlighting what he describes as gaps in the science that call into question the efficacy of hormonal treatments for kids.

I think it would be erroneous to say we know the answer and that were going to limit our investigation, Hruz said.

Haller said the bulk of the scientific evidence, along with the clinical benefits hes seen, justify prescribing hormonal therapies.

The benefits far outweigh the risk, Haller said.

Another researcher cited by the Florida Agency for Health Care Administration, James Cantor, testified in favor of a law that blocks the use of puberty blockers and hormone therapies for children during a recent federal court case in Alabama.

The judge wrote that he gave Cantors testimony very little weight as it emerged in cross-examination that Cantor had never treated a transgender child under the age of 16 or diagnosed a child with gender dysphoria.

The Florida Department of Health issued guidance in April recommending against gender-affirming care for kids. It also recommended against social transitioning, in which a child takes on a different outward presentation. That can include assuming a new name or wearing new clothes.

Critics of the states guidance, including DeSantis former surgeon general, signed a letter in April noting that Floridas stance on social transitioning is not in line with the countries cited by the state that are skeptical of hormonal therapies.

Surgeon General Joseph Ladapo, who leads the state health department, asked a few weeks later that the Florida Board of Medicine create rules that could restrict access to certain gender dysphoria treatments.

The Agency for Health Care Administration has now proposed a rule that would block Medicaid from covering procedures that alter primary or secondary sexual characteristics.

A hearing is set for July 8 on that rule, which LGBTQ advocates have harshly criticized. They argue the DeSantis administration is interfering with a personal medical choice for political gain.

Read this article:
As DeSantis focuses on Florida transgender kids, heres what you need to know - Tampa Bay Times

The days of safe and legal abortion are limited in Tennessee.

Our state has a trigger ban on abortion, scheduled to go into effect when the Supreme Court ruling on Dobbs v. Jackson becomes final and Roe v. Wade is overturned. When this happens, it means that emgergency physicians like me will no longer be able to refer my patients who need an abortion to a facility where they can obtain one safely within our state.

The only exception for the new abortion ban in Tennessee would be for the life of the mother, a term deliberately vague enough to give many doctors and healthcare workers pause. What does the life of the mother exception really mean? How threatened must someones life be before we can intervene and help them medically?

Take ectopic pregnancies. In an ectopic pregnancy, a fertilized egg implants itself outside the uterus, typically in the fallopian tubes or an ovary, but occasionally into other sites in the abdominal cavity. Ive seen a case report of an ectopic pregnancy in someones liver.

These pregnancies are not viable. Contrary to the belief of some politicians, there is no medical way to salvage them or reimplant them into the uterus. Eventually, an ectopic pregnancy will grow large enough to rupture the organ in which it is growing and cause the patient to hemorrhage.

In current practice, if I diagnose an ectopic pregnancy in my emergency department, I call my obstetric/gynecology colleague and we discuss the case. If the patient is not too far along in the pregnancy and there are no signs of rupture, we treat the patient with a medical abortion. The patient takes a pill called methotrexate and follows up in the clinic for a repeat ultrasound and check of her hormone levels. If there is cardiac activity on ultrasound, hormone levels are high, the ectopic pregnancy is large or there are any signs of rupture, the Ob/Gyn physician takes the patient for an operation to remove the ectopic pregnancy, thus aborting the nonviable fetus.

In countries with laws preventing abortions for any reason, patients with non-viable fetuses have become septic from uterine infections and died. Is that what lies in store for patients in a post-Roe v. Wade Tennessee?

In a post-Roe state where abortion is illegal from the moment of conception with only life of the mother exceptions, a physician may hesitate to act until the patient is hemorrhaging and their life is at risk. But we know from years of scientific study that treating ectopic pregnancies prior to rupture leads to better outcomes and fewer deaths. I worry that the vaguely-worded abortion laws about to take effect in Tennessee will cause women to suffer and die as a result.

Another case would be that of a pregnant patient who goes into labor before the fetus is viable, or before 24 weeks.The first step is an ultrasound, done in the emergency department, before the patient is admitted to the labor and delivery ward and my OB colleague takes over treatment. The treatment involves trying to stop the labor with medications. If that is unsuccessful and the patients water breaks, then an abortion is necessary to save the mothers life.

There have been several cases around the world where patients have not been given abortions when theyve gone into preterm labor with nonviable fetuses because of anti-abortion laws. These patients have become septic from severe infections allowed to fester in their wombs and spread throughout their bodies until they go into multi-system organ failure and die.

I know other emergency and OB/Gyn physicians who are incredibly concerned about these two scenarios and countless others. What will the OB physicians who specialize in high risk pregnancies do when their high risk patients suffer? How will in-vitro fertilization be affected by the new laws?

And where is that line where a patients life is so at risk that doctors are allowed to do their jobs?

If I, an emergency physician, dont know the answer to these questions, you can bet most other doctors in our state dont either. What I do know is our patients will suffer and some will die.

Original post:
A post-Roe Tennessee threatens patients and hamstrings physicians Tennessee Lookout - Tennessee Lookout

DAVINA McCALL could not believe it when two US neuroscientists told her hormone replacement therapy might reduce the risk of dementia and she was not the only one.

In the presenters Channel 4 documentary Sex, Mind And The Menopause, Dr Lisa Mosconi and Dr Roberta Diaz Brinton from Arizona University said oestrogen could have huge potential in lowering womens chances of developing Alzheimers.

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Speaking exclusively to Sun Health, Dr Brinton revealed that women are twice as likely to get dementia because of the way their brain changes during menopause, when oestrogen levels drop and affect brain function.

She said: On average, women live four and a half years longer than men, but that doesnt account for a two-fold greater lifetime risk of developing Alzheimers disease.

Our research shows its not because women live longer than men. Its because they begin the disease earlier, in mid-life.

Due to oestrogen loss during menopause, the brain can suffer a 20 to 25 per cent drop in glucose metabolism, the process that provides the brain with fuel.

That drop can trigger a starvation response in the brain.

It can lead to a decline in white brain matter (which helps different parts of your brain communicate) and an increase in a sticky plaque, called amyloid beta deposition, which, according to Dr Brinton, is found in greater quantities in people with dementia.

In theory, prescribing oestrogen to women who are in perimenopause which starts several years before menopause could reduce their risk of these problems and dementia.

But HRT is not suitable if, for instance, you have had breast, ovarian or womb cancer.

Most read in Womens Health

And oestrogen treatment is no good post-menopause, either. Dr Brinton said: Using oestrogen as a treatment doesnt work, as the brain has already changed. Its needed when women have symptoms.

She adds there is no data on whether intervening before symptoms would work, and little research has been carried out on HRT and the brain in the UK.

That is not good enough, says Dr Louise Newson, who supports our Fabulous Menopause Matters campaign, especially when 600,000 British women have dementia and it is the leading cause of death in UK women.

The HRT shortages have also forced some women to take drastic action and buy the drugs they need on the black market.

Sam Youngz, 49, a wellness adviser from Telford, Shrops, said: My nan had dementia and my mum suffers. Ive been diagnosed with Ehlers-Danlos syndrome, a connective tissue disorder that affects the whole body including the brain. My risk is high.

Sam went through early menopause at 37 and was shocked by the revelations in Davinas show. She said: I was finally diagnosed as menopausal at 44, so the news is too late for me. I dont know if it would have helped, but I wish Id had the chance to try.

Fabulous Menopause Matters

An estimated one in five of the UKs population are currently experiencing it.

Yet the menopause is still whispered in hush tones like its something to be embarrassed about.

The stigma attached to the transition means women have been suffering in silence for centuries.

The Sun are determined to change that, launching the Fabulous Menopause Matters campaign to give the taboo a long-awaited kick, and get women the support they need.

The campaign has three aims:

The campaign has been backed by a host of influential figures including Baroness Karren Brady CBE, celebrities Lisa Snowdon, Jane Moore, Michelle Heaton, Zoe Hardman, Saira Khan, Trisha Goddard, as well as Dr Louise Newson, Carolyn Harris MP, Jess Phillips MP, Caroline Nokes MP and Rachel Maclean MP.

Exclusive research commissioned by Fabulous, which surveyed 2,000 British women aged 45-65 who are going through or have been through the menopause, found that 49% of women suffered feelings of depression, while 7% felt suicidal while going through the menopause.

50% of respondents said there is not enough support out there for menopausal women, which is simply not good enough. Its time to change that.

Dr Newson said research looking at both women who do and women who do not take HRT could be a game-changer.

She added: Is it because men have more testosterone in the brain that they are less likely to develop dementia?

We need answers. We know if women have their ovaries removed, their cognitive function declines faster than women who havent had them removed.

Women who go through early menopause are also more likely to experience dementia. But does giving these hormones back to women help reduce the risk?

Its logical to assume putting something back in the brain that helps it function would help. The logic is there. Nothing is proved.

After four years of low mood, brain fog and insomnia, Katie Taylor, 53, is reaping the benefits of HRT.

The Latte Lounge founder a website that supports women in mid-life lives in London with her husband and children, and at 47 was diagnosed as perimenopausal.

She began using oestrogen and progesterone patches and said: In a few weeks, all my symptoms disappeared. I had energy again.

She was sleeping better and her brain clarity returned. Katie added: I can see the difference HRT has made.

Dr Newson, who had brain fog before starting HRT, said: Many women think they have dementia. We know brain fog improves with HRT. If it helps reduce dementia risk too, then thats incredible.

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Read more from the original source:
Im a GP heres the truth behind Davina McCalls claims about HRT and dementia... - The Irish Sun

Magnesium bisglycinate, the leading mineral ingredient in the formula, is a combination of magnesium and the amino acid glycine. Glycine has been found in research to enhance sleep quality and neurological function, while magnesium, an essential macromineral, supports our circadian rhythm and is clinically shown to soothe the mind and body to promote relaxation and sleep.*

And along with magnesium bisglycinate, sleep support+ also includes jujube seed extract, a fruit that has long been used in traditional Chinese medicine, as well as PharmaGABA, a natural form of an amino acid neurotransmitter. Both of which have been found to help people fall asleep fasterand stay asleep longermaking this special blend a no-brainer.*

If you need more convincing, take it from double board-certified integrative medicine doctor Amy Shah, M.D., who told mbg that sleep support+ is her go-to when it comes to quality sleep: "[I] used to take melatonin at night but found that it often did not work. mindbodygreen's natural, gentle sleep support+ formula has effectively solved my sleep issues. The unique combination of magnesium bisglycinate, jujube, and PharmaGABA induces relaxation and calm, and helps maximize my sleep quality,"* she says.

Excerpt from:
Want To Stay Asleep Through The Night? Stop Taking This Supplement - mindbodygreen.com

The grant is being used to fund a first-of-its-kind clinical trial that will recruit healthy individuals through a genome-first approach and perform deep metabolic phenotyping to understand the underlying mechanisms responsible for the regulation of the human bodys metabolism through natriuretic peptide hormones.

The grant is being used to fund a first-of-its-kind clinical trial that will recruit healthy individuals through a genome-first approach and perform deep metabolic phenotyping to understand the underlying mechanisms responsible for the regulation of the human bodys metabolism through natriuretic peptide hormones.Researchers from the University of Alabama at Birmingham Division of Cardiovascular Disease have been awarded a $3.7 million grant from the National Heart Lung and Blood Institute to study how genetically determined differences in natriuretic peptide levels (heart hormones) regulate the handling of glucose metabolism and use of energy while resting and while exercising.

The grant is being used to fund a first-of-its-kind clinical trial that will recruit healthy individuals through a genome-first approach and perform deep metabolic phenotyping to understand the underlying mechanisms responsible for the regulation of the bodys metabolism through NPs.

NPs are hormones produced by the heart that regulate cardiometabolic health. These hormones are released in response to changes in pressure inside the heart. These hormones are also responsible for regulating how the body responds to glucose and how it utilizes energy at rest and while working out.

Pankaj Arora, M.D., associate professor of medicine and the director of the $11 million NIH-funded Cardiovascular Clinical and Translational Research Program and the UAB Cardiogenomics Clinic, received the grant.

An estimated 37 million adults in the United States have diabetes, and an additional 96 million adults have pre-diabetes, which predisposes them to a higher risk of potentially fatal cardiovascular events such as heart attack, stroke and heart failure.

Researchers believe that genetically determined low NP levels may contribute to some individuals having a poor glucose metabolism and a low amount of any exercise. Individuals with lower circulating NP levels are predisposed to a higher risk of cardiometabolic diseases such as diabetes, high blood pressure, heart attacks, stroke and heart failure.

Pankaj Arora, M.D., associate professor of medicine and the director of the $11 million NIH-funded Cardiovascular Clinical and Translational Research Program and the UAB Cardiogenomics Clinic, received the grant.The study is employing an innovative genome-first strategy to assess the role of NPs in regulating the cardiovascular and metabolic health of an individual, Arora said. We will be enrolling individuals with and without a common genetic variant that predisposes them to have low NP levels. The study participants will then undergo a comprehensive metabolic assessment to understand the influence of genetically determined low NP levels.

The study is the result of decades of interdisciplinary research conducted by UAB scientists in collaboration with investigators across the country. Through past research, Arora and colleagues have shown that certain RNA-based regulators control the production of NPs and serve as potential therapeutic targets. Arora and his colleagues are studying how these regulators can be targeted for a precision medicine approach to the treatment of common cardiometabolic diseases.

There are certain RNA-based regulators that control the production of these good heart hormones that were discovered by our group of researchers, Arora said. These regulators reduce the production of NPs in individuals with a low NP genotype and may serve as potential therapeutic targets for the treatment of high blood pressure, diabetes, pre-diabetes and heart failure.

In addition to an innovative genome-first approach, the study by Arora and colleagues may also unravel a potentially new line of personalized therapeutics that follow the same genome-first precision medicine approach.

Arora believes that innovative studies like these build upon the advances in genomic medicine and bring the knowledge of decades of research back to the benefit of the patients at their bedside. UAB has been supporting such bench-to-bedside initiatives that translate scientific evidence accumulated from large-scale population genomic studies and bench research to the patient bedside. UAB physician-scientists are leading several such initiatives to enhance clinical and translational research in the domains of cardiometabolic disease.

Read the original:
Arora receives $3.7 million grant to assess a genome-first approach to improving cardiometabolic health through heart hormo - University of Alabama at...

As of May 24, 2022, 18 states have placed laws and regulations that either ban or limit transgender athletes from participating in sports. Many conservative policymakers aim to restrict athletes to only participating in sports under their assigned birth gender. Their main reasoning for doing so is that trans athletes have a "biological advantage" over cisgender athletes, particularly within women's sports. While there are some biological differences, many activists argue that these policymakers are more concerned with excluding trans athletes than ensuring fairness.

There are certain biological and anatomical differences between sexes, the main ones relating to overall strength, endurance and lean body mass. For example, according tohealthshots.com, biologically male individuals have higher testosterone levels than biologically female individuals. This hormone makes it easier for them to burn away fat and gain muscle. On the other hand, biologically female people have higher estrogen levels, making losing fat and gaining muscle more challenging.

However, there are many other factors to consider, which involve training and practice more so than biological traits. All athletes undergo some level of physical training that requires effort to build their physique and technique. Skills such as hand-eye coordination and sports-specific techniques must be learned and repeatedly practiced.

Joanna Harper is a medical physicist at Loughborough University, as well as being a trans athlete herself. In her March 2021 study, she says that while there are some biological differences for trans athletes, it isn't unfair for them to compete since there are so many other factors to consider besides biology. Her study, published in the British Journal of Sports Medicine, on trans athletes in women's sports found that testosterone suppressants reduced hemoglobin levels in trans women to the same levels as cisgender women, negating the advantage.

"After four months of hormone therapy, trans women have [hemoglobin and hematocrit] levels equivalent to those of cisgender women," according to Harper's study. "After 12 months of hormone therapy, significant decreases in measures of strength, [lean body mass] and muscle area are observed."

Additionally, many activists argue that conservative policymakers want to restrict trans athletes because they are transphobic, not because they actually want to keep women's sports fair. Many believe that these authority figures express little to no interest in women's sports most of the time, except when trans rights come into play. Women's sports are not as popular as men's sports and generally do not receive as much attention or funding. For example, the U.S. Soccer Federation only established a deal to pay both the Men's and Women's National Teams an equal amount this past May.

Moreover, "biological advantages" only seem to be a problem when the athlete is transgender. There are plenty of athletes with unique biological factors, but they are not excluded from sports. For instance, basketball player Shaquille O'Neal is 7 feet 1 inch tall, giving him an advantage against opposing players. Another example is Michael Phelps, whose wingspan is longer than his height, which provides him with an edge in swimming. He is also hyper-jointed and double-jointed, which helps him bend his ankles and kick from his chest.

Even though athletes like Phelps and O'Neal have clear and distinct biological advantages, they are not banned from competing. In contrast, trans athletes' rights are constantly being debated for more minuscule advantages.

The transgender flag shown in front of UNC Charlotte's Jerry Richardson Stadium.

Here at Charlotte, the University has some trans athletes' participation policies. There are different recommendations for trans athletes, depending on whether they are undergoing hormone treatment and which type of treatment they receive. It is important to note that not all trans individuals undergo hormone therapy or gender-affirming surgery.

In summary, with hormone treatment, male-to-female athletes may participate on women's teams after one year, while female-to-male athletes may compete on men's teams if they are on medically prescribed testosterone. The University's policies seem to aim for equity and inclusivity, using the NCAA's Inclusion of Transgender Handbook guidelines. Additionally, any athlete undergoing hormone treatment must be monitored by a physician and give regular reports to demonstrate the athlete's eligibility.

"In any case where a student-athlete is taking hormone treatment related to gender transition, that treatment must be monitored by a physician, and the NGB must receive regular reports about the athlete's eligibility according to these guidelines," said the Trans Resources section on Charlotte'swebsite.

Many activists are advocating for the exclusion of trans athletes. "It's important that transgender people continue to experience the social, physical, and cultural benefits of athletics," said the Gender Justice organization in theirtrans equity campaign. "Sports institutions must respect the dignity and humanity of transgender people by ensuring their ability to participate."

Ultimately, while there are some biological advantages that transgender women have over cisgender women, the policymakers who complain about trans athletes are primarily doing so out of transphobianot out of genuine concern for women's sports. Many more factors contribute to an athlete's abilities than what they are born with, like learned skills. Inclusivity is essential, and trans athletes deserve to be able to see themselves represented in sports.

Go here to see the original:
The excuses for the exclusion of trans athletes - Niner Times

Transgender kids have become the latest target of the far rights moral ire. Last year, Arkansas became the first state to make it a felony for doctors to provide gender-affirming carewhich can include puberty blockers, hormone therapy, and surgeryfor transgender children. Alabama followed suit in April, and at least 13 states are considering similar bills. While most bills go after doctors, others would penalize parents for seeking care for their children.

Introduced last year during the 87th Texas legislative session, Senate Bill 1646 would have categorized providing such care to minors as child abuse, but the measure failed to become law. Nevertheless, in February, Attorney General Ken Paxton wrote an opinion categorizing all gender-affirming care for minors as child abuse. Texas Governor Greg Abbott then ordered the Texas Department of Family and Protective Services to investigate parents seeking gender-affirming care for their children, prompting several employees to resign in protest. Now, the Texas Supreme Court is considering whether Abbott had the authority to call for the investigations after three district courts issued injunctions.

Proponents of the investigations claim that gender-affirming treatments are harmful to children. But major medical associations, like the American Medical Association, the American Psychiatric Association, the American Academy of Pediatricians, and the American Academy of Child and Adolescent Psychiatry assert that gender-affirming care is a necessary treatment for dysphoria. These are among the dozens of medical groups that have signed on to amicus briefs supporting lawsuits filed to combat these bills, including the Texas case pending against Abbott. The Texas Observer spoke with licensed physician Colton St. Amand, a gender therapy specialist who identifies as transgender, and psychologist Cesar A. Gonzalez of the Mayo Clinic about the necessity of gender-affirming care for transgender minors and the potential mental health consequences of depriving them of it.

Their responses have been edited for length and clarity.

Why is Gender-Affirming care crucial for minors? Why not wait?

Dr. St. Amand: Gender-affirming care is critical for transgender patients of all ages. We know now from decades of clinical practice, and now over the last couple of decades of research, that the earlier that we affirm someone, the better outcomes they have in terms of mental health and physical health. We found that people generally do really well with treatment. Gender-affirming care is life-saving. This is a population that has high rates of risk for self-harm, suicidal ideation, and suicide attempts, as well as other disparities due to negative responses by the environmentdiscrimination at school, and rejection from family. All of these variables put this population at risk.

Gonzalez: Not everyones going to need some of the biomedical interventions. Psychological and social and even legal interventions may just be as important as biomedical interventions.

For example, we know that name change and gender marker changes are associated with better health outcomes longitudinally. We also know that, psychologically, home environments that are gender-affirming are critical to preventing and actually protecting against suicidal ideation. We know that gender-affirming care not only impacts mental health but also impacts physical health. I think thats really why gender-affirming care is crucial for trans youth, because it sets them up to have a healthy and quality life in adulthood.

How does receiving gender-affirming care affect the lives of trans kids?

Dr. St. Amand: Ive seen kids whose parents would tell me [before treatment] that theyve been depressed for years, not engaging in their life, only kind of on the computer, in their room most of the time, not engaging in school, not making friends. Parents tell me, I havent seen my kids smile in years.

And when they come [back to] see us, and theyre affirmed in whichever ways are appropriate for the patientwhether thats a name change, whether thats pubertal suppression and hormone therapy, whether thats getting connected with other transgender people to feel more acceptedthey smile and they do well. We see improvements academically; we see improvements in mood; we see improvements in anxiety; we see improvements in self-esteemall very critical for adolescents as they are developing. We see some more engagement with friends and family as well. They just shine. Its a tribute to when somebody is able to live as their full authentic self.

If the state were to outlaw gender-affirming care, what are the risk factors of completely stopping treatment?

Dr. St. Amand: I think not only are there clear mental-health risks associated with stopping medically necessary treatment but of course, also physical health risks. If they have a puberty blocker in their arm, we generally dont keep those for more than two years because theyll need hormones in order for their bone health to be protected. But if theyre not able to access hormone therapy, and they still have puberty-suppressing treatment in them, theyre at risk for early osteoporosis.

Or lets say that they were taking estrogen and their body is trying to increase their testosterone and the estrogen is suddenly taken away. They can start getting a deeper voice, hair on the face, and other pubertal changes you would associate with male puberty. This can be life-threatening for the young person. All of the changes that we talked about can go away: less family engagement, less school engagement, increased issues with mood anxiety, low self-esteem, and medical distrust, distrust of systems that are supposed to be there to take care of you.

I think all of that is already happening.

Gonzalez: People arent going to flourish because theyre going to feel that no one else understands them, or that their identity isnt really being supported. Its going to lead to more concealment, and essentially, more minority stress. Minority stress is a really big component of what the individuals deal with but also families deal with. Its this reinforcement of any experiences of prejudice, discrimination, and violence.

And then, of course, there are other stressors that are these internal feelings or belief systems: Other people are going to reject me, or Other people arent going to like me, because if the government or these policymakers, you know, dont support me, so what does that mean for me?

We have to think about this in terms of disenfranchisement. Who is most disenfranchised here? Its going to be people who are of lower socioeconomic status, who cant afford to move to another state. Its going to be individuals who already experience day-to-day stress. This additional stress puts an additional burden on their health, leading ultimately to increased risk for a variety of different conditions through inflammation, stress responses, and non-engagement in the healthcare system.

The cascade of consequences isnt solely on the individual, but on family, communities, and ultimately, populations.

What are the families you are consulting with feeling at this moment?

Dr. St. Amand: In 2019, they started to use some political rhetoric saying child abuse and associating that somehow with gender-affirming care, which is the furthest thing from the truth. Its medically necessary care. Not doing it is actually neglect. Im currently getting emails now from families that I saw several years ago, before I started my residency, asking, What should I do? Should we leave the state? You know, very big, big questions. Is my child going to be safe? Can they take my child away? I know this was the right thing for my child. But, what do I do? There are high levels of anxiety and political distrust and worries for the safety of the young person.

How are you advising them to deal with whats happening now?

Gonzalez: I work with our adolescents and their families to focus on what is actionable, what is controllable, and that is going to be reducing some of the checking of media or websites to see if there are any updates, really trying to create as much sense of stability for the individual. In some ways, thats helping them live in the moment, giving them the skills to emotionally regulate so that they can fall asleep and not activate stress responses, which then perpetuate distress and anxiety and also physical harms. And so thats a lot of skill-building and coping.

More:
Healthcare for Trans Kids Is Not Abuse - The Texas Observer

The Brainy insight analyzes the offers sectors present situation & important drivers in its insightful study Global Hormone Replacement Therapy Market. The global Hormone Replacement Therapy market report aids in evaluating statistics related to the industry progress in terms of value (US$ Bn/Mn). Moreover, the research has provided the most up-to-date competitive industry information and valuable advice for other businesses and consumers interested in entering the worldwide Hormone Replacement Therapy market or any regional market. Further, the analysis provides insights on the COVID-19 outbreak considering the alteration in customer demand & behavior, purchasing patterns, re-routing of the supply chain, significant interventions of governments, and the dynamics of current market forces. The in-house database includes market data for various industries & domains.

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Global Hormone Replacement Therapy Market 2022 Industry Share, Trends, Consumption, Growth, Top Manufacturers, Type and Forecast to 2028 Designer...

Hormone Replacement Therapy Market to 2022 Updated with Impact of COVID-19 is latest research study released by Adroit Market Research evaluating the market, highlighting opportunities, risk side analysis, and leveraged with strategic and tactical decision-making support. The study provides information on market trends and development, drivers, capacities, technologies, and on the changing investment structure of the Hormone Replacement Therapy Market to 2030 Updated with Impact of COVID-19 Market.

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Hormone Replacement Therapy Market to 2030 Updated with Impact of COVID-19 Industry Overview:

The Brainy Insights Hormone Replacement Therapy Market to 2030 Updated with Impact of COVID-19 provides a comprehensive coverage on Hormone Replacement Therapy industry. It provides historical and forecast data on the countrys coal production, consumption, and imports. The production section provides an extensive analysis over the trend of production, impact of the COVID-19 and information on production by company, by type, by grade and by state. The report also provides detail for reserves by state and country. The trade section briefs about major partners involve in this market. An extensive demand drivers section provides information on factors that are affecting the countrys coal demand such as domestic demand from power and steel industry. It further includes profiles of producers, information on the major active, planned and exploration projects.

Important years considered in the study are: Historical year 2015-2022; Base year 2022; Forecast period** 2022 to 2030 [** unless otherwise stated]

Market segments and sub-segments:

Type such as

Application such as

Hormone Replacement Therapy Market Scope:

The report contains an overview of Hormone Replacement Therapy industry and the impact of COVID-19 on the countrys Hormone Replacement Therapy market. It also includes key driving factors that affects global demand such as demand from the application industry.

It provides detailed information on reserves by country, production, production by state, company, type and grade. Along with this, major operating, exploration and development projects, competitive landscape and major importers are also included in the report.

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Reasons to Buy:

Key Answers Captured in Study are

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About The Brainy Insights:

The Brainy Insights is a market research company, aimed at providing actionable insights through data analytics to companies to improve their business acumen. We have a robust forecasting and estimation model to meet the clients objectives of high-quality output within a short span of time. We provide both customized (clients specific) and syndicate reports. Our repository of syndicate reports is diverse across all the categories and sub-categories across domains. Our customized solutions are tailored to meet the clients requirement whether they are looking to expand or planning to launch a new product in the global market.

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Top 10 Hormone Replacement Therapy Industry to Look Out for in 2022 by Abbott Laboratories, Novartis, Pfizer, Inc., Mylan Laboratories - Digital...