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Archive for the ‘Hormone Clinic’ Category

The article I wish I’d had: Diagnosed with POTS and still anchoring the news – WJAC Johnstown

The article I wish I'd had: Diagnosed with POTS and still anchoring the news  WJAC Johnstown

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The article I wish I'd had: Diagnosed with POTS and still anchoring the news - WJAC Johnstown

Factors that influence your skin – CelebMix

The skin is in many ways the largest organ of the human body. It provides the first line of defense in the immune system since it helps to prevent many pathogenic organisms from gaining entry into our body. Our skin also contains many sensory receptors that allow us to sense our environment. We can sense pressure, touch, temperature changes, and pain, all through special structures in our skin which are attached to nerve fibers.

There are three main layers making up the skin. The outermost layer is the epidermis which consists of stratified squamous epithelial cells which are designed to be sloughed off. These are close-fitting cells which have no blood supply. This layer of cells provides a waterproof barrier and protection for the underlying tissue layers. There are cells present in the epidermis that make the protein keratin, these are cells called keratinocytes. The dermis is the layer of skin that occurs below the epidermis of the skin.

The dermis is the layer where you find blood vessels, nerves and also where the hair follicles grow from. Sweat and sebaceous glands are also found in the dermis of the skin.

Beneath the dermis is the hypodermis which contains areolar connective tissue and adipose tissue. The areolar connective tissue contains various cells including macrophages and fibroblasts, which are scattered in a matrix of collagen and elastin fibers. Macrophages are immune system cells and fibroblasts make fibrous proteins such as collagen. The adipose tissue consists of the fat cells, which are important in helping to protect our internal organs and as a source of stored energy for times when we may be starving.

The condition of our skin is influenced by a combination of many internal and environmental factors, including exposure to toxins in the environment. If you have fair skin you also have a greater risk of damage from the sun.

This is because people with darker skin have more melanin pigment which helps protect against the harmful effects of UV radiation. Excess UV radiation can cause genetic changes in skin cells that can lead to skin cancer, but some sunlight is important for vitamin D synthesis. In fact, vitamin D may help to prevent some illnesses such as heart disease, and thus some sunlight exposure is necessary for good health. Internal factors also influence the health of our skin, including our genetics and hormone levels, and allergies can often manifest as skin rashes or hives.

Over time, as we age, our skin tends to become thinner and may sag and droop. This can lead to aging of the face and, in the case of women, sagging of the breasts. There are cosmetic surgeries that can deal with many of the problems associated with sagging skin. You can consult with a specialist at a clinic such as the Vera Clinic to find out what procedures can be done to tighten up skin and regain a more youthful appearance to the body.

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Factors that influence your skin - CelebMix

KFDM Investigates: The hiring of a Lamar University instructor who has now resigned – KBTV Fox 4 Beaumont

KFDM Investigates: The hiring of a Lamar University instructor who has now resigned  KBTV Fox 4 Beaumont

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KFDM Investigates: The hiring of a Lamar University instructor who has now resigned - KBTV Fox 4 Beaumont

The article I wish I’d had: Diagnosed with POTS and still anchoring the news – wpde.com

The article I wish I'd had: Diagnosed with POTS and still anchoring the news  wpde.com

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The article I wish I'd had: Diagnosed with POTS and still anchoring the news - wpde.com

Scientists discover change in cell logistics that helps cancer become resistant – The Institute of Cancer Research

Image: Proliferating cells in a tumour organoid of triple-negative breast cancer. Credit: Dr Rebecca Marlow

Researchers have uncovered a potential cause of sustained resistance to hormone therapy in the most common form of breast cancer.

The majority of breast cancersare hormone receptor positive these are cancers which have an oestrogen receptor on the surface of the cells. Hormone therapy is an effective treatment, but roughly 40 per cent of women relapse with a form of the disease which proves resistant to available treatments.

Scientists found that breast cancers which had become resistant to hormone therapy have a molecular advantage that helps their cells successfully evade hormone therapies, which are the best treatment option currently available for patients with hormone receptor positive (or ER+) cancers.

The study, led by researchers at Department of Experimental and Clinical Biomedical Sciences at the University of Florence, Italy, in collaboration with colleagues at The Institute of Cancer Research, London, has shown that breast cancer cells which are resistant to hormone therapy have more of a microRNA molecule called miR-23b-3p.

MicroRNA is involved in gene expression controlling whether a gene has an effect or not, and how much and the researchers found that miR-23b-3p causes a decrease in a type of protein for transporting amino acids which are either alkaline or neutral in pH.

In resistant breast cancer cells, a rise is seen in a different type of transporter which deals with the acidic amino acids glutamate and aspartate. Cells which are reliant on these acidic amino acids are able to continue to successfully resist hormone therapy treatment.

Scientists in our Division of Breast Cancer Research have been involved in some of the most famous discoveries in the history of breast cancer research. Learn how the ICR is tackling the most common type of cancer among women, which affects around one in eight women in their lifetime.

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In this study, which was published in Cell Reportsand funded by Associazione Italiana per la Ricerca sul Cancro (AIRC)and Fondazione Umberto Veronesi, researchers used multiple models of cancer including the so-called patient-derived xenografts, which originate from a patient but are then implanted into a mouse model to aid their study and monitoring.

This allowed for careful and thorough experimentation on naturally growing cancers and provides data which is relevant for the original patient.

By looking at the expression of all of the genes in the cancer cells, scientists could point out which substances were being made in excess, and which substances were made in shorter supply.

Analysis of these results led to researchers painting a picture of which molecules the cancer cells were reliant on as fuel sources, and which substances cells were not able to make use of.

Cells unable to transport neutral and basic amino acids become forced to rely on their acidic counterparts.

The scientists then showed that increasing the levels of aspartate and glutamate in ER+ breast cancer cells was related to the development of resistance to endocrine therapy.

Whats more, shutting down the cells ability to move aspartate and glutamate inside the cell reduced the ability of endocrine therapy resistant cells to spread, proving that there is a robust relationship between these molecules and the cancer cells ability to survive and thrive.

Dr Andrea Morandi, an Assistant Professor of Biochemistry and Group Leader at the University of Florence, who led the research and was previously a postdoctoral fellow in the Division of Breast Cancer Researchat the ICR, said:

It was great to collaborate with colleagues at the ICR on this paper to examine the factors that drive resistance in breast cancer in the experimental setting.

We know that 40 per cent of patients with this cancer who respond to treatment will go on to relapse with a form of the disease that is resistant to all available treatment options. Uncovering the molecular basis of this is a critical step in towards understanding what helps drive cancers resistance to treatment.

In the future we hope this research will provide valuable information to help predict the likelihood of relapse in patients with hormone therapy-resistant cancers, as well as providing insight into a potential new way to treat these cancers.

Dr Lesley-Ann Martin, former Group Leader in Endocrinologyand the lead ICR researcher on the study, said:

This analysis gives information about the key molecular players involved in ER+ cancers which are resistant to the current front-line treatments in our experimental settings.

Further work will determine whether the findings presented in this work have significance in the clinic for predicting the best treatment courses for patients, and the potential for the development of resistance in some patients.

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Scientists discover change in cell logistics that helps cancer become resistant - The Institute of Cancer Research

Meet the ‘detransitioners’: the women who became men – and now want to go back – Telegraph.co.uk

How could I remove my healthy breasts when Id seen my mother lose one of hers to cancer? asks Charlie Evans. Until recently, the science writer from Margate identified as transgender, convinced, along with increasing numbers of young women, that she had been born in the wrong body.

After undergoing a social transition, for which she changed her name from Charlotte, as well as her pronouns, her passport and driving licence, in order to live as her chosen sex, she refused to go through with the gender reassignment operation that would give her the sexual characteristics she thought she wanted.

But earlier this year, at 28, she faced coming out for a third time in her life: having announced...

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Meet the 'detransitioners': the women who became men - and now want to go back - Telegraph.co.uk

The Jason Hahn Files: The Pains Of Having A Hunky Yoga Instructor Named Javier – TODAYonline

The Jason Hahn Files: The Pains Of Having A Hunky Yoga Instructor Named Javier  TODAYonline

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The Jason Hahn Files: The Pains Of Having A Hunky Yoga Instructor Named Javier - TODAYonline

Chronic Pain Eased With Meditation And Lower Doses Of Opioids : Shots – Health News – NPR

To deal with chronic pain, Pamela Bobb's morning routine now includes stretching and meditation at home in Fairfield Glade, Tenn. Bobb says this mind-body awareness intervention has greatly reduced the amount of painkiller she needs. Jessica Tezak for NPR hide caption

To deal with chronic pain, Pamela Bobb's morning routine now includes stretching and meditation at home in Fairfield Glade, Tenn. Bobb says this mind-body awareness intervention has greatly reduced the amount of painkiller she needs.

There's new evidence that mind-body interventions can help reduce pain in people who have been taking prescription opioids and lead to reductions in the drug's dose.

In a study published this month in JAMA Internal Medicine, researchers reviewed evidence from 60 studies that included about 6,400 participants. They evaluated a range of strategies, including meditation, guided imagery, hypnosis and cognitive behavioral therapy.

"Mindfulness, cognitive behavioral therapy and clinical hypnosis appear to be the most useful for reducing pain," says study author Eric Garland, a professor at the University of Utah. The reductions in dose were modest overall, he says, but the study is a signal that this approach is beneficial.

And Pamela Bobb, who lives in Fairfield Glade, Tenn., can attest to the benefits. She's 56 and has endured decades of pain. "Oh, I had been suffering terribly for years," Bobb tells us.

Bobb was born with a malformation in her pelvis that led to pain. Over the span of two decades, she underwent more than a dozen major surgeries, yet none offered relief. "When you get to that point, you can't see beyond the pain," Bobb says. "You're just surviving." Jessica Tezak for NPR hide caption

Bobb was born with a malformation in her pelvis that led to pain. Over the span of two decades, she underwent more than a dozen major surgeries, yet none offered relief. "When you get to that point, you can't see beyond the pain," Bobb says. "You're just surviving."

She was born with a malformation in her pelvis that led to pain. Over the span of two decades, she underwent more than a dozen major surgeries, yet none of them gave her relief; each procedure left more scar tissue and nerve damage.

"I felt desperate, " Bobb says. "I didn't feel like I had any control."

She couldn't do basic things such as cook or take care of her family.

"I was completely debilitated," Bobb says. "And when you get to that point, you can't see beyond the pain you're just surviving."

She was put on high doses of opioids to ease the constant pain, but then a few years ago she thought, "There just has to be a better way." Ultimately, she found help at a clinic that specializes in complementary and alternative medicine.

"We offer a variety of things, explains Wayne Jonas, a physician who treated Bobb at the Fort Belvoir Community Hospital Pain Clinic in Fairfax County, Va.

"We offer physical therapy, behavioral medicine, acupuncture, yoga and mind body practices," Jonas says. None of these is a cure-all, he adds, but the idea is that there are lots of tools in the toolkit for people to try.

Jonas is a longtime proponent of an integrated, mind-body approach to treating pain and the author of How Healing Works, a book that describes the science behind these approaches.

He says that when someone is in severe pain, their body's normal defenses are down.

Pamela Bobb harvests some mint from her indoor herb and lemon garden at her home in Fairfield Glade, Tenn. Changes in her diet lots more greens, fruits, vegetables and herbs and spices that reduce inflammation are also part of her pain-reduction routine. Jessica Tezak for NPR hide caption

Pamela Bobb harvests some mint from her indoor herb and lemon garden at her home in Fairfield Glade, Tenn. Changes in her diet lots more greens, fruits, vegetables and herbs and spices that reduce inflammation are also part of her pain-reduction routine.

"It bumps up a variety of dysfunctions," Jonas says. Pain increases levels of the stress hormone cortisol and increases inflammatory processes in the body, too. "This starts a continual negative feedback loop that produces more pain," Jonas explains.

It's not a surprise, he says, that techniques such as meditation or yoga can be helpful. "If you engage in a deep mindfulness and relaxation it will counter those stress responses," Jonas says.

Think of meditation as a form of mental exercise.

"It's almost like weightlifting for your brain," says Garland. Just as curling a dumbbell strengthens the bicep, he says, "meditation is almost a way of, sort of curling the dumbbell of the mind to strengthen the mind's self control."

And this can change the way the brain perceives the input from the body. "If you can change the way the brain perceives signals from the body you can actually change the experience of pain," Garland says.

But there's a trick here: Learning to meditate takes time, effort and some training. It's more complicated than swallowing a pill. Pamela Bobb has stuck with it. She has tried a bunch of these alternative mind-body strategies, including acupuncture and biofeedback, and now starts every morning with a meditation practice.

"It's 4:45 in the morning and I've just awakened," she says in a recording she made of her practice, so I could listen in. She sounds centered, and calm. "I'm allowing my body to feel as relaxed as it possibly can."

After several surgeries were unable to alleviate her pain, Bobb couldn't do basic things such as cook or take care of her family, she says. "I was completely debilitated." Incorporating mind-body techniques have completely changed that, she says. Jessica Tezak for NPR hide caption

After several surgeries were unable to alleviate her pain, Bobb couldn't do basic things such as cook or take care of her family, she says. "I was completely debilitated." Incorporating mind-body techniques have completely changed that, she says.

Bobb has also overhauled her diet, now eating a lot more greens, fruits and vegetables and herbs and spices with anti-inflammatory properties. On the day we talk, she's making a spinach saute with ginger, mint and rosemary.

"I swear you can smell each of those spices. They smell so good!" she says.

Bobb is so at ease now that, just hanging out with her, you'd never guess all that she has endured. And she feels so much better, she says.

"It's empowering to [have] come all this way," Bobb says. She says she's made a fundamental transition in her mind: Instead of waiting for doctors to heal her with surgeries or injections, she now realizes that many of these alternative therapies have empowered her to help herself.

Pamela Bobb still takes medicine to help manage her pain and other health issues, but she cites meditation as key to helping her reduce the opioid dose to 25% of the amount she once took. Jessica Tezak for NPR hide caption

Pamela Bobb still takes medicine to help manage her pain and other health issues, but she cites meditation as key to helping her reduce the opioid dose to 25% of the amount she once took.

"So much of it does lie within me," she says.

Bobb accepts that she may never be completely pain-free, but now feels she has control over the discomfort.

She has reduced her opioid dose by 75%. She says she still benefits from a small maintenance dose of the medication. And her doctors say that for her, the benefits of the medicine outweigh potential harms.

In the midst of an opioid epidemic, Bobb's story may seem unlikely. But many people who have taken opioids for a prolonged period have similar stories. And last month, the Department of Health and Human Services released new guidelines urging doctors to take a deliberate approach to lowering doses of opioids for chronic pain patients.

The guidelines point to the potential harms of forcing patients off the medications.

"The goal is not necessarily to get off of all opioids but to reduce it to a dose [that is] safe," Adm. Brett P. Giroir, a physician and assistant secretary for health at HHS, told NPR. We asked him about Bobb's case. He is not her doctor, but after hearing her story he said, "The fact that she's been able to reduce her opioids substantially is a success story."

Giroir says this kind of comprehensive approach that includes alternative therapies "could be a model for what we want to do nationwide." He points out that earlier this year, the Centers for Medicare & Medicaid Services proposed covering acupuncture for Medicare patients who have chronic lower back pain.

Bobb massages her feet with sweet-smelling lavender oil another part of her morning routine. Successfully mitigating long-term pain, she finds, takes all of the tools in the toolkit. Jessica Tezak for NPR hide caption

Bobb massages her feet with sweet-smelling lavender oil another part of her morning routine. Successfully mitigating long-term pain, she finds, takes all of the tools in the toolkit.

As the evidence accumulates, Giroir says, there will be more attention placed on covering alternative therapies.

A 2017 Gallup Poll found that 78% of people would prefer to try other ways to address their physical pain before they take pain medication.

And doctors groups such as the American College of Physicians recommend that doctors offer more nonpharmacological treatments to pain patients, such as those who have chronic lower back pain.

Yet, a paper published last year finds that most insurers have not adopted policies that are consistent with these guidelines, and many don't pay for coverage of these services. An accompanying editorial argues that it's time for that to change.

It's clear that when it comes to tackling pain, it takes all of the tools in the toolkit. And when it comes to opioids, the approach needn't be all or nothing. Bobb says she has learned that, for her, the combination of medicine plus mind-body therapies works best.

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Chronic Pain Eased With Meditation And Lower Doses Of Opioids : Shots - Health News - NPR

Genome research gave life back to West Van cancer survivor – Vancouver Courier

Candy Woodworth knows shes won the lottery.

In the past five years, shes seen a daughter get married and celebrate the births of two grandchildren.

But for a while, whether the West Vancouver grandmother would be around to mark those milestones was far from certain.

Six years ago, Woodworth was a busy 65-year-old, looking after her first grandchild while her daughters took care of the family business.

It was during a Pilates class when she was lying on her stomach that she first noticed something odd an uncomfortable feeling in her lower abdomen. Woodworth didnt think much of it, but when she felt it again at next weeks class, she made an appointment to see her doctor, who sent her for an ultrasound.

When she got back home, the phone was ringing before she even had her coat off, telling her to come to her doctors office right away.

There she got the news that she had ovarian cancer.

According to the BC Cancer Agency, over 300 women in B.C. will be diagnosed with ovarian cancer this year. Its not nearly as common as breast cancer women have about a one in 70 lifetime chance of getting ovarian cancer but the prognosis can be far more serious.

You just dont feel anything, said Woodworth. Thats the difficult thing with ovarian cancer.

Because there is no way to screen for ovarian cancer, and the disease is usually without symptoms until at an advanced stage, effective treatment is often a challenge.

We have treatments that are very likely to cause the cancer to regress and improve but theres a very high risk of recurrence, said Dr. Anna Tinker, a medical oncologist at BC Cancer who is one of the leading experts in gynecological cancers and who worked on Woodworths case.

Woodworth knew she was facing a serious diagnosis. So she did some research and was referred to the expert team that specializes in gynecological cancer at Vancouver General Hospital, headed by Dr. Dianne Miller.

Woodworth had surgery to remove the tumour from her abdomen, which was confirmed as a high-grade Stage 3 aggressive cancer.

But her journey was only just beginning.

For the next four and a half months, Woodworth had 18 rounds of chemotherapy. After my third week I literally crawled on my hands and knees into the chemo clinic, she said. I was literally throwing up as I was sitting in the chair.

She credits her support team of her husband and three daughters for getting her through it. And the chemotherapy worked at first.

But 18 months later, the cancer was back, with a tumour on her colon. She had another surgery.

Throughout the process, My attitude was always Lets get in there. Lets get the job done, she said.

When the tumour returned again in the same place, six months later, Woodworths doctors signed her up for an experimental research program, the Personalized Onco-Genomics program, run by a team of doctors and researchers at the BC Cancer Agency.

The program which is usually only open to patients after standard treatments have been tried takes a novel approach to cancer, looking for genetic mutations in a patients tumour for clues to whats causing the cancer to grow, and with that, a possible treatment.

In Woodworths case, the analysis showed her tumour had a signature similar to that seen when a BCRA gene mutation is present more usually associated with some types of breast cancer, said Tinker.

In early 2017 Woodworths results were matched with an experimental drug, Olaprib Lynparza.

In Woodworths case, the drug worked. Shes now been on it for two and a half years with no side effects and no recurrence in her cancer.

The 12 capsules she takes every day down from the number she started on have literally saved her life.

Im so grateful for every day, said Woodworth. I dont think the public realizes the scientists we have here in Vancouver.

Woodworth is among the more dramatic success stories to come out of the personalized genomic research project, falling into a small group of super responder patients.

Others include a Langley woman whose metastatic breast cancer was beaten back by a drug commonly used to treat diabetes, in addition to hormone treatment.

Another Metro Vancouver woman was saved when scientists discovered her advanced colon cancer had a protein that responded to blood pressure medication.

Since the program started in 2012, 1,136 patients, including 123 children, have been enrolled in the program.

Patients who take part need to understand the process is experimental, said Tinker. While helpful new information is gleaned in about 80 per cent of cases, the result is not always as dramatic as it was in Woodworths case and not all cancer patients are helped by the genome analysis.

In some patients, no helpful mutations are discovered that can be used as clues to treatment and in some cases, no drugs are a match.

Cancer patients start new treatments as a result of their genome results about 40 per cent of the time.

Ideally, patients who are matched with treatments can be enrolled in clinical trials that make expensive drugs available to them free of charge, said Tinker.

But thats not the always the case.

Woodworth knows shes lucky. I knew what I was up against, she said, but she remained stubbornly optimistic, describing herself as a glass half full kind of person.

These days, Woodworth who recently celebrated her 70th birthday takes delight in spending time with her grandkids.

I cant let a day go by without stopping by for a quick hug, she said. I dont stay around and clean my house. I get out there.

I dont take anything for granted. Thats the one thing you take away when you feel that mortality. You have to live every day the best that you can.

She hopes stories like hers will lead to money for research that will benefit other cancer patients.

The research at the Personalized Onco-Genome program is funded by approximately $22.7 million from the BC Cancer Foundation, largely raised through philanthropic donations, as well as by research grants, particularly through the Canada Foundation for Innovation.

Hopefully theyll find more [information on how cancers behave], and more people will survive, said Woodworth. Thats what I want for everyone. There is hope out there.

To find out how to donate to the research funded by the BC Cancer Foundation, including the Personalized Onco-Genomics program, click here.

To find out how to donate to the VGH/UBC Hospital Foundation, which benefits programs including the Ovcare research team examining gynecological cancers, click here

To view a CBC Nature of Things documentary on the Personalized Onco-Genomics program, which aired on the network in February 2017, click here

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Genome research gave life back to West Van cancer survivor - Vancouver Courier

How Does the Abortion Pill Work? Heres Everything to Know About a Medical Abortion – PEOPLE Great Ideas

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How Does the Abortion Pill Work? Heres Everything to Know About a Medical Abortion

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How Does the Abortion Pill Work? Heres Everything to Know About a Medical Abortion - PEOPLE Great Ideas

The Price of Life: Battling medical debt in the Midlands – WIS10

The kind of costs were talking about here, unless youre very rich, will basically knock your savings out, Olatosi said. So you see families that are easily ruined when this occurs. Theres no way to prepare for it. It has to be a systemic way to deal with the issue yet, and weve not done that yet. Weve focused a lot on access, and increasing access to care, but weve not talked about the coverage the access providers.

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The Price of Life: Battling medical debt in the Midlands - WIS10

Many hands needed to help LCAC prepare, deliver 300 Thanksgiving meals to the needy: A Place in the Sun – cleveland.com

LAKEWOOD, Ohio -- Thanksgiving is just two weeks away, and in Lakewood that signals the annual effort by the Lakewood Charitable Assistance Corp. to ensure that those in need have a hearty meal for the holiday.

About 300 people receive food packages for Thanksgiving from LCAC, a nonprofit, all-volunteer organization dedicated to improving the quality of life of Lakewoods families in need. The organization has offered this program for more than three decades.

Collections of non-perishable food items -- including canned goods, gravy mix, pie filling, stuffing and biscuit mixes, cereal, peanut butter and more -- are taking place in schools and churches throughout the city to help provide a foundation for the holiday meal and to help families even beyond Thanksgiving.

Cash donations also are welcome to help with costs associated with the LCAC programs.

LCAC purchases perishable items, including turkeys, potatoes, butter and pumpkin pies, just before the food distribution day, which this year will be Nov. 23.

Volunteers are needed to help sort, prepare and bag the non-perishable items, as well as to help load the food into vehicles for delivery.

Non-perishable food donations will be collected and sorted from 9 a.m. to 1 p.m. Nov. 22 on the lower level of the Lakewood Masonic Temple, 15300 Detroit Ave., Lakewood.

Additional volunteers are needed from about 6 to 7:30 p.m. Nov. 22 to form an assembly line to pack the food bags.

Then, beginning at 9 a.m. Nov. 23, volunteers are needed to bag the perishable food items, load the meals into cars and help deliver the food to those on the distribution list for Thanksgiving.

Celia Dorsch, LCAC president, said the entire organization consists of volunteers. They also deliver meals for Christmas and provide cleaning supplies in the spring.

For more information on LCAC and its programs, visit lcac.info.

Junior Womens Club meets: North Olmsted Junior Womens Club will meet at 7:30 p.m. Thursday (Nov. 14) at North Olmsted Senior Center, 28114 Lorain Road, North Olmsted.

There will be a program on pain management following the meeting. The program begins with a social time from 7 to 7:30 p.m.

The club is a diverse group of women of all ages -- 21 and older -- who want to return something to the community.

For more information, visit northolmsted.wixsite.com/nojwc.

Pride Clinic: The MetroHealth System began offering Pride Clinic services this week at the LGBT Community Center of Greater Cleveland, 6705 Detroit Ave., Cleveland. MetroHealth and the LGBT Center are working together to provide safe and supportive medical care to the Cleveland LGBTQ community in the Gordon Square neighborhood. Community members can receive many health services at the clinic.

MetroHealth primary care physician Dr. Douglas Van Auken will provide care from 12:30 to 4:30 p.m. Tuesdays.

Services include primary adult care (age 13 and older), hormone therapy, family planning, smoking cessation, cholesterol control, blood pressure control, immunizations, HIV prevention and STI testing and treatment.

In addition to primary care services being offered at the LGBT Center, MetroHealths Pride Network also offers primary care services at MetroHealths Brecksville, Cleveland Heights, Middleburg Heights, Rocky River and Thomas F. McCafferty locations.

Specialty services also include plastic surgery, gynecology, ENT, behavioral health, and physical medicine and rehabilitation.

To schedule an appointment at the LGBT Center or any of the Pride Network locations, call 216-957-4905. To learn more about MetroHealths Pride Network, visit metrohealth.org/pride.

Free produce: Cleveland residents are invited to stop by Cudell Recreation Center from 11 a.m. to 1 p.m. the third Thursday of every month (Nov. 21 this month) for free, fresh produce. Cudell is at 1910 West Blvd., Cleveland.

Produce is distributed on a first-come, first-served basis, rain or shine. Those coming for produce should bring an ID and bags to carry the items home.

On display: The North Olmsted Arts Commission displays artwork from local artists on a temporary basis at City Hall. The featured artist for November is Dennis Nelson, a North Olmsted resident.

Nelsons work includes poured acrylic, also called fluid art. He uses vibrant colors and bold patterns in his work.

Stop in during business hours at North Olmsted City Hall, 5200 Dover Center Road, North Olmsted, to see Nelsons exhibit.

The rotating displays at City Hall provide an opportunity for art groups to introduce or expand the visibility of their work. For more information or for North Olmsted artists interested in applying for exhibit space, call 440-716-4134.

Welcoming a legacy: Fairview Park Mayor Eileen Patton swore in new police officer Erik Joyce recently. He is the son of James Joyce, a retired Fairview Park police officer who served the city for 34 years, from 1984 to 2014.

The proud papa pinned his old badge onto his sons shirt after he took the oath of office.

Erik Joyce started his law enforcement career in Fairview Park when he joined the auxiliary police unit at age 19. A few years later, he served briefly with the Cuyahoga Metropolitan Housing Authority as a police officer. After that, he spent six years with the Cuyahoga County Sheriffs Office as a deputy sheriff.

Friendsgiving luncheon: Area residents ages 55 and older are invited to a free Friendsgiving luncheon on Nov. 20, provided by ONeill Healthcare North Olmsted. Attendees need not live in North Olmsted.

Lunch includes turkey, mashed potatoes and gravy, vegetables, a roll and pumpkin pie. Registration is required by Nov. 15.

For more information or to register, call 440-777-8100 or stop by the North Olmsted Senior Center, 28114 Lorain Road, North Olmsted.

We Do Care awards: Fairview Park Womens Club will host the We Do Care God & Country letter-writing contest winners at 6:30 p.m. Nov. 18, prior to the Fairview Park City Council meeting in council chambers at City Hall, 20777 Lorain Road, Fairview Park.

A small reception will follow the ceremony.

The We Do Care Committee was created in 1976 by Fairview Park resident Harriet Beekman in response to diminishing patriotism during the Vietnam War era. Beekman generated community support for local military personnel and sent care packages to them. The group continues to send boxes to troops.

Seventh- and eighth-graders at Lewis F. Mayer Middle, St. Angela Merici and Messiah Lutheran schools are invited to participate in the God & Country letter-writing contest each year to express gratitude for the sacrifices made by members of the armed forces serving overseas.

The letter-writing project began in 1976, also.

Student letters are submitted to the We Do Care Committee and judged by volunteers. Winners are selected from each school and read aloud at a City Council meeting. The winning students receive a certificate.

Information, please: Readers are invited to share information about themselves, their families and friends, organizations, church events, etc. in Fairview Park, Lakewood, North Olmsted and West Park for the A Place in the Sun column, which I write on a freelance basis. Awards, honors, milestone birthdays or anniversaries and other items are welcome. Submit information at least 10 days before the requested publication date to carolkovach@hotmail.com.

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Many hands needed to help LCAC prepare, deliver 300 Thanksgiving meals to the needy: A Place in the Sun - cleveland.com

Secret Shopper: What supplements are best to boost immunity? – New Hope Network

NFM Secret Shopper: Im confused about whats best to boost my immunity. Is it zinc, vitamin C, vitamin D, elderberry or something else?

Retailer: Any of those can help with immunity, but it depends on when you take them. Vitamin C is good for when you already have a cold, but if you eat your fruits and veggies, you probably dont need to take a vitamin C supplement all the time. Same with zinc and elderberry. But vitamin D is a supplement you might need every day, depending on your levels.

NFM: That makes sense. Any other supplements youd recommend, especially for cold and flu season?

Retailer: Garlic is popular and seems to work pretty well for immunity.

Our expert educator: Yufang Lin, M.D., of the Cleveland Clinics Center for Integrative and Lifestyle Medicine

Immunity is very complex. As an integrative practitioner, I look at the whole picture, so the first things I suggest are getting enough sleep, hydrating well and eating healthy. As for specific foods that boost immunity, garlic and ginger are both antimicrobial, antifungal and antiviral. You can use them in your day-to-day cooking, but if you are getting sick, definitely step up your intake, whether through food or supplements. Ginger, which is also anti-inflammatory, can also be made into tea.

There is data showing that both vitamin C and zinc support the immune system when you are sick. They are particularly useful in the first few days of illness, as they can reduce the duration and severity. But use these supplements only as needed, not on a long-term basis.

Elderberry is a diuretic, so if you are running a fever, it can help you sweat it out. Another supplement, echinacea, revs up the immune system, so it is great for fighting off a cold or even for the early stages of the flu. The problem with echinacea is it can stimulate the immune system too much, which is bad if you have an autoimmune disease. But for most people, it can be very helpful, but take it only for three to five days.

Vitamin D is a hormone so it generally has many benefitsfor mood, bone health and immune support. But it is more for day-to-day care, not to start taking once you get sick.

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Secret Shopper: What supplements are best to boost immunity? - New Hope Network

Mallinckrodt Announces New Clinical Data Evaluating Acthar Gel (Repository Corticotropin Injection) in Rheumatoid Arthritis (RA) at the 2019 American…

STAINES-UPON-THAMES, United Kingdom, Nov. 12, 2019 /PRNewswire/ -- Mallinckrodt Pharmaceuticals plc (NYSE: MNK), a global biopharmaceutical company, today announced data on patient-reported outcomes (PROs) showing Acthar Gel (repository corticotropin injection) improved disease measures that impact rheumatoid arthritis (RA) patients with persistently active disease, as well as new data from an exploratory analysis.The data originate from new analyses from Mallinckrodt's Phase 4 study of Acthar Gelin RA patients with persistently active disease and was recently presented at the 2019 American College of Rheumatology/Association of Rheumatology Professionals (ACR/ARP) Annual Meeting, held Nov. 8-13 in Atlanta.

The study posters can be accessedhereon the company's website.

Acthar Gel is a naturally sourced complex mixture of adrenocorticotropic hormone analogs and other pituitary peptides. ActharGel is approved by theU.S. Food and Drug Administration(FDA) as adjunctive therapy for short-term administration (to tide the patient over an acute episode or exacerbation) in RA, including juvenile RA (selected cases may require low-dose maintenance therapy).1 Please see Important Safety Information for Acthar Gel below.

"Patient-reported outcomes, like fatigue, pain, and physical functioning, are an important part of any trial assessing clinical treatment outcomes. These additional data shed light on managing this challenging patient population whose symptoms persist after use of first-line therapies and suggest Acthar Gel treatment improved PROs in patients with persistently active RA," said Dr. Nancy E. Lane, Distinguished Professor of Medicine, Rheumatology and Aging, and Director of the UC Davis Center for Musculoskeletal Health. "The data exploring the effect of Acthar Gel treatment on patient-reported outcomes may help clinicians better understand Acthar Gel's use for patients with difficult-to-manage RA, those who have continued symptoms following standard therapies. The need for additional treatment options in this patient population is critical."

Patient-Reported Outcomes and Impact of Treatment (Abstract #439)

New data from the company's two-part Phase 4 multicenter, placebo-controlled study assessing the efficacy and safety of Acthar Gel in patients with persistently active RA who were previously treated with disease-modifying anti-rheumatic drugs (DMARDs) and corticosteroids showed that Acthar Gel treatment significantly improved patient-reported pain, fatigue, physical functioning and work-related impairment as early as Week 4, and resulted in clinically meaningful improvements in PROs.

The analysis examined PRO measures as a secondary endpoint from Part 1 of the study, the 12-week open-label period, and assessed mean changes at baseline and at Weeks 4, 8 and 12.

Patient-Reported Outcomes From the 12-Week Open-label RCI Treatment Perioda,2

PRO Assessment

Baseline, Mean(SD)

Week 4

Week 8

Week 12

Mean Change From Baseline (SD)

FACIT-F

22.8 (8.4)

5.0 (8.2)*

6.5 (8.4)*

8.7 (8.4)*

HAQ-DI

1.7 (0.6)

0.5 (0.5)*

0.6 (0.6)*

0.84 (0.6)*

Patient global assessment of disease activityb,3

63.4 (20.0)

17.8 (23.6)*

25.7 (25.2)*

35.0 (27.3)*

WPAI-RA

Percent work time missed due to RAc

24.9 (27.6)

7.0 (26.6)

5.2 (28.0)

10.8 (26.5)**

Percent impairment while working due to RAc

50.3 (27.1)

18.7 (24.4)*

18.0 (23.9)*

25.2 (25.3)*

Percent overall work impairment due to RAc

58.1 (28.6)

17.6 (27.0)*

17.6 (27.5)*

25.5 (29.2)*

Percent activity impairment due to RAc

63.2 (24.2)

18.1 (24.3)*

22.5 (25.3)*

32.8 (27.4)*

Patient global assessment of paind

64.9 (20.4)3

20.8 (23.3)*

27.6 (25.3)*

37.4 (27.4)*

*p<0.001 vs baseline. **p=0.003 vs baseline.

amITT population (all patients who received study drug and had any post-treatment efficacy assessment).

bMCID = 15% absolute/20% relative improvement.

cMCID = 7% absolute change.

dMCID = 11.

Abbreviations and MCID references: FACIT-F; Functional Assessment of Chronic Illness Therapy Fatigue (MCID = 3-41); HAQ-DI, Health Assessment Questionnaire Disability Index (MCID = 0.2); MCID, minimum clinically important difference; mITT, modified intent-to-treat; PRO, patient-reported outcome; RCI, repository corticotropin injection; SD, standard deviation; WPAI-RA, Work Productivity and Activity Impairment Questionnaire Rheumatoid Arthritis.

AEs observed in the Phase 4 study were consistent with those in previous trials of Acthar Gel.

Study Limitations

"Mallinckrodt remains committed to the rheumatology community and to improving the lives of patients with autoimmune-mediated diseases like RA who continue to have debilitating symptoms and disease exacerbations despite standard treatments," saidSteven Romano, M.D., Chief Scientific Officer and Executive Vice President atMallinckrodt. "We are pleased to be at this year's ACR Annual Meeting to present new data on Acthar Gel that will broaden our understanding of its utility in rheumatology clinical practice for patients with difficult-to-manage RA and areas of high unmet need."

Assessment of Bone and Cartilage Turnover Markers (Abstract #528)

A new exploratory analysis from the Phase 4 RA study assessed bone markers associated with bone loss to evaluate the impact of Acthar Gel treatment on bone turnover in patients with persistently active RA. Bone and cartilage biomarker levels were evaluated throughout the study, at baseline and Weeks 12 and 24 and included: C-terminal cross-linking telopeptide (CTX), C-terminal cross-linking telopeptide of type I collagen (CTX-I), osteoprotegrin (OPG), N-terminal propeptide of type I collagen (PINP), and soluble receptor activator of nuclear factor kappa- ligand (sRANKL) and cartilage degradation biomarkers (C-terminal cross-linking telopeptide of type II collagen (CTX-II) and CTX-II creatinine (CRT).

At Week 12, the open-label period, significant decreases in mean levels of the bone turnover biomarker PINP (P<0.01) and mean levels of cartilage degradation biomarkers CTX-II (P<0.01) and CTX-II CRT (P<0.001) were observed. At Week 24, the end of the study's double-blind period, there was a significant increase from baseline in mean sRANKL levels at both Week 12 and Week 24 (P<0.05) compared to placebo, suggesting a potential increase in osteoclast differentiation. Mean levels of all other bone and cartilage biomarkers remained stable at all time points and markers of bone degeneration remained stable.5

Results from the full RA study were presented earlier this year at the Annual European League Against Rheumatism (EULAR 2019) in Madrid in June. More information on the Phase 4 RA study can be found here on ClinicalTrials.gov.

About Rheumatoid ArthritisRA is an autoimmune disease. It is a chronic condition that causes pain, stiffness, and swelling of the jointsall symptoms caused by inflammation.6 An estimated 1.5 million U.S. adults are living with RA.7 Treatment is aimed at stopping inflammation to put the disease in remission and relieve symptoms.8 Nonsteroidal anti-inflammatory drugs are used to ease symptoms whereas corticosteroids, disease-modifying anti-rheumatic drugs and biologics are used to slow down the disease activity.8

Acthar Gel (repository corticotropin injection)IndicationsActhar Gel is an injectable drug approved by theFDAfor the treatment of 19 indications. Of these, today the majority of Acthar use is in these indications:

IMPORTANT SAFETY INFORMATION

Contraindications

Warnings and Precautions

Adverse Reactions

Other adverse events reported are included in the full Prescribing Information.

Please see fullPrescribing Information.

ABOUTMALLINCKRODTMallinckrodt is a global business consisting of multiple wholly owned subsidiaries that develop, manufacture, market and distribute specialty pharmaceutical products and therapies. The company's Specialty Brands reportable segment's areas of focus include autoimmune and rare diseases in specialty areas like neurology, rheumatology, nephrology, pulmonology and ophthalmology; immunotherapy and neonatal respiratory critical care therapies; analgesics and gastrointestinal products. Its Specialty Generics reportable segment includes specialty generic drugs and active pharmaceutical ingredients. To learn more about Mallinckrodt, visit http://www.mallinckrodt.com.

Mallinckrodtuses its website as a channel of distribution of important company information, such as press releases, investor presentations and other financial information. It also uses its website to expedite public access to time-critical information regarding the company in advance of or in lieu of distributing a press release or a filing with theU.S. Securities and Exchange Commission(SEC) disclosing the same information. Therefore, investors should look to the Investor Relations page of the website for important and time-critical information. Visitors to the website can also register to receive automatic e-mail and other notifications alerting them when new information is made available on the Investor Relations page of the website.

CAUTIONARY STATEMENTS RELATED TO FORWARD-LOOKING STATEMENTSThis release includes forward-looking statements concerning Acthar Gel including expectations regarding its potential impact on patients and anticipated benefits associated with its use. The statements are based on assumptions about many important factors, including the following, which could cause actual results to differ materially from those in the forward-looking statements: satisfaction of regulatory and other requirements; actions of regulatory bodies and other governmental authorities; changes in laws and regulations; issues with product quality, manufacturing or supply, or patient safety issues; and other risks identified and described in more detail in the "Risk Factors" section ofMallinckrodt'smost recent Annual Report on Form 10-K and other filings with theSEC, all of which are available on its website. The forward-looking statements made herein speak only as of the date hereof andMallinckrodtdoes not assume any obligation to update or revise any forward-looking statement, whether as a result of new information, future events and developments or otherwise, except as required by law.

CONTACTSFor Trade Media InquiriesCaren BegunGreen Room Communications201-396-8551caren@greenroompr.com

For Financial/Dailies Media InquiriesDaniel YungerKekst CNC212-521-4879mallinckrodt@kekstcnc.com

Investor RelationsDaniel J. Speciale, CPAVice President, Investor Relations and IRO314-654-3638daniel.speciale@mnk.com

Mallinckrodt, the "M" brand mark and theMallinckrodt Pharmaceuticalslogo are trademarks of aMallinckrodtcompany. Other brands are trademarks of aMallinckrodtcompany or their respective owners.2019Mallinckrodt.US-1901844 11/19

References

1ActharGel (repository corticotropin injection) [prescribing information].Mallinckrodt ARD LLC.

2Data on File, Mallinckrodt, 2019. Furst D, Wan G, Liu J, Zhu J, Bartels-Peculis L, Panaccio M, Fleischmann R. Improved Patient-Reported Outcomes in Patients with Persistently Active Rheumatoid Arthritis Following Treatment with Repository Corticotropin Injection. Poster presented at: 2019 American College of Rheumatology/Association of Rheumatology Professionals (ACR/ARP) Annual Meeting November 8-13, Atlanta, GA.

3Data on File, Mallinckrodt, 2019. Furst D, Wan G, Liu J, Zhu J, Bartels-Peculis L, Panaccio M, Fleischmann R. Improved Patient-Reported Outcomes in Patients with Persistently Active Rheumatoid Arthritis Following Treatment with Repository Corticotropin Injection [abstract]. Arthritis Rheumatol. 2019; 71 (suppl 10). https://acrabstracts.org/abstract/improved-patient-reported-outcomes-in-patients-with-persistently-active-rheumatoid-arthritis-following-treatment-with-repository-corticotropin-injection/. Accessed November 8, 2019.

4Fleischmann R, Furst DE, Brasington R, Connolly-Strong E, Liu J, Barton ME. A multicenter study assessing the efficacy and safety of repository corticotropin injection in patients with rheumatoid arthritis: preliminary interim data from the open-label treatment period. Poster presented at: American College of Rheumatology and Association of Rheumatology Health Professionals (ACR/ARHP) Annual Meeting; October 19-24, 2018; Chicago, IL.

5 Data on File, Mallinckrodt, 2019. Fleischmann R, Furst DE, Connolly-Strong E, Liu J, Zhu J, Brasington R. Assessment of Bone and Cartilage Turnover Markers Following Treatment With Repository Corticotropin Injection in Patients With Persistently Active Rheumatoid Arthritis. Poster presented at: 2019 American College of Rheumatology/Association of Rheumatology Professionals (ACR/ARP) Annual Meeting November 8-13, Atlanta, GA.

6 Mayo Clinicwebsite. Rheumatoid Arthritis. Overview. Available at:https://www.mayoclinic.org/diseases-conditions/rheumatoid-arthritis/symptoms-causes/syc-20353648. AccessedNovember 5, 2019.

7 What is Rheumatoid Arthritis?Arthritis Foundation. Available at:http://www.arthritis.org/about-arthritis/types/rheumatoid-arthritis/what-is-rheumatoid-arthritis.php. AccessedNovember 5, 2019.

8 Arthritis Foundation. Rheumatoid Arthritis Treatment. Available at:http://www.arthritis.org/about-arthritis/types/rheumatoid-arthritis/treatment.php. AccessedNovember 5, 2019.

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Call for greater inclusion of kids with Type 1 diabetes – Gulf News

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Dubai: As Dubai marks World Diabetes Day on November 14, parents of children diagnosed with Type I diabetes called for greater inclusion of these young patients in schools across the UAE.

Discussing the challenges they face in helping their children manage the disease, they said lack of awareness about the condition among the general public is the main reason why children with Type 1 Diabetes feel isolated.

What is Type I diabetes?

It is an auto immune disorder affecting young children whose body makes little or no insulin. Insulin is a hormone that helps the body use sugar for energy. It is produced by the pancreas, which is an organ located behind the stomach. In Type 1 diabetes, the childs immune system becomes faulty and destroys the cells in the pancreas that makes insulin (beta cells ). As a result, children with Type 1 diabetes need to take insulin to stay healthy. The condition can be life-threatening if it is not diagnosed early. It is different from Type II diabetes which is triggered by poor nutrition, sedentary lifestyles and obesity, resulting in insulin resistance.

Individual challenges

Pained by the lack of awareness surrounding Type 1 diabetes, Dubai-based Pamela Durant, whose son was diagnosed with diabetes at 20 months, gave up her highly successful career in health care management to start her own diabetes awareness company Diapoint to educate the community. Bringing up her son, now 11, she has been a hands on mother volunteering to accompany the school on field trips to keep an eye on her child, but she says not all kids are fortunate enough to get this inclusion.

Children with Type I diabetes require to have their blood sugar monitored regularly to avoid high or low blood sugar episodes. Sometimes, a school understands the severity of what could happen, or the care required, it may be frightening for them, or may seem like too much of a liability. There are cases of children who have been turned away from schools or left out of school activities for this reason - which is heart-breaking. In other cases, some schools have asked parents if they could provide a private nurse for their child at school. Not only is this a financial burden for the family, but it affects the child socially. It adds to the social stigma of having diabetes.

In another case, Nathalie, who arrived in the UAE with her husband last year, was heartbroken when her four-and-a-half-year-old daughter was given admission to a prestigious school in Abu Dhabi only to be declined when she disclosed her condition. My daughter was diagnosed with Type 1 diabetes when she was three-and-a-half. No kid should be treated differently because of their medical condition. They are already going through a lot each and every day and do not deserve to be treated that way, especially in a place where they are supposed to learn values, respect and equality, she remarked.

Elsewhere, Louis Kiernander, a mother of two, recently faced a terrible dilemma when her 11-year-old son had to go on a school trip in a new secondary school he had recently shifted to. Kiernander said: In the primary school my son attended, he was well supported by the school staff and nurses and was never excluded from school trips or sports or treated differently. However, in the new school, there are 11 diabetics in the secondary section and my son is the youngest. While the school tries to be supportive, challenges remain. As per law, only a certified nurse is allowed to give a life-saving injection in case of hypoglycaemia. So my son was asked not to go on the regular school trip and instead go on another where the nurse could accompany him. He was segregated and felt ostracised. All they had to do is send the nurse on the regular trip and I do pay a handsome amount as school fees. I was asked to sign a form saying that if my son faced an emergency in those three days, no one would be giving him a life-saving injection. It was a horrible situation and felt like signing a death warrant.

Right to a normal life

Dr Amani Osman, paediatric endocrinologist with Imperial College of London Diabetes Centre at Al Ain, who handles several cases remarked that every child had a right to be treated well in school. This is a psychosocial element and I constantly advise parents and schools that one must not set boundaries for a child because of his diabetes. No child should be denied the right to live a normal life, play sports and go on field trips or be treated any differently because of their condition.

Dr Osman added: Children with Type I diabetes spend a considerable number of their active hours at school and it is important to have a proper diabetes management plan in place. This can be possible with proper awareness, education and communication between parents, school nurses and the childs private physician.

Diabetes Management: What parents and schools can do

Parents should be honest and not conceal a childs condition from the school and friends so that he can get help in time. Children are afraid to be different, but in this case full disclosure can be life-saving.

Once the condition is known, parents need to supply glucose testing kits, insulin vials, syringes to the school. Usually, children have automatic glucose pumps attached and only a test in presence of the nurse is required to determine the bolus (unit quantity of insulin ) required to delivered mechanically. In other cases, a certified nurse can administer an insulin shot at the school clinic.

A child with diabetes requires insulin three times a day with three major meals. Children usually have breakfast at home and have their first insulin shot at home, the second one is in school during lunch hour and the child needs to go to the nurse and check his blood sugar levels before the meal to decide on the dose he needs two hours after the meal. Usually this is the only meal a child has at school. Any snack that has less than 50 gms of carbohydrates does not require the child to take insulin.

Hypoglycaemia: Anything below 70 milligrammes per deca litre (mgdl) is low blood sugar and once detected, parents usually pack orange juice as an emergency meal. The rule is 15 gms of carbohydrates which amounts to half a glass of orange juice or a glucose gel tablet that can be given orally and 15 minutes later blood needs to be tested.

There are cases where the blood sugar could get low enough for the child to lose consciousness. Sometimes, children take insulin and in their excitement to participate in some event, say a sport, overlook eating a proper meal. In such cases, the sugar could get very low. Nurses are trained to administer an intra muscular glucagon injection to reverse the action of insulin.

Hyperglycaemia: This is blood sugar above 200 mgdl two hours after a meal. Diabetic children must check their blood sugar in school before meals and two hours after meal and have their insulin dose adjusted as per the reading, something which the school nurse can help them with. A child who has high blood sugar must not be allowed to do a sport activity as he can easily go into diabetes ketoacidosis which is a stage where the body has not enough insulin and begins to produce blood acids and burn fat as fuel. In both cases of high or low blood sugar, the nurse can intervene and advise the child. Nowadays most children carry continuous glucose monitoring devices and it is not difficult to know what a childs blood sugar levels are.

Children with Type I diabetes usually must maintain higher levels of hygiene. In case of diabetic children, it is absolutely necessary to keep them at home as their blood sugar levels can dangerously fluctuate when they are ill.

It is also advisable that Type I diabetics get seasonal flu vaccines to keep any infections at bay as more complications would mean difficulty in managing their condition.

Mothers must pay attention to meal qualities providing nutritionally balanced meals with dense carbohydrates and whole foods and discourage any processed and sugary foods that could spike blood sugar.

It is important for schools to have regular physical activity and sports and encourage every child to be active. Obesity and over-weight issues are resulting in occurrence of Type II diabetes in children as young as six.

In case of adolescent children with Type I diabetes, the school must be sensitive to not discriminate against them as these can have long term impact on their self esteem and trigger depression.

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Stanford’s new, innovative tools to address chronic pain – Climate Online

In a world of hurt. Its a figure of speech not meant to be taken literally. But its a real place to those who inhabit the world of persistent pain, one whose moment-by-moment ramifications can upend and redefine life.

Theres a continuum in this world of hurt: Pain is variable and many manage it themselves without going to the doctor. They can hold jobs and function, albeit through varying levels of pain. For others, severe chronic pain can mean an inability to sit comfortably, or far worse, to fall off to sleep at night, day in and day out. For some, pain brings an inability to work, to get out and see friends, to travel or to take in a movie. And, with those compounding, cascading inabilities, an ever-shrinking solitary world because of hurt.

The threat of even more hurt must be defended against. When you have chronic pain, says 27-year-old Erika Delgado of South San Francisco, who has suffered with it her whole life, its like constantly being in flight mode. You constantly feel that youre in danger.

Often patients are reluctant to talk about pain that may send them to one doctor or therapist after another. Or pain that doesnt have a clear diagnosis, or pain that doesnt look obvious. They go stoic. You adapt, says David, a 68-year-old former executive who has been dealing with the after-effects of a sports injury and two back surgeries for two decades. At some point, youve got to say that what youve got is what youve got.

Despite the constant burning sensation in his back, the healthy appearing Redwood City resident tries to cope with his chronic pain quietly and, as much as possible, anonymously. Nobody wants to acknowledge their disability, says David, who nonetheless manages two contradictory things: an active schedule as a community volunteer and usually only two hours of sleep a night.

Except for those born with a rare congenital insensitivity which makes them literally feel no pain, everyone experiences it. A 2018 report for the U.S. Centers for Disease Control and Prevention estimated that 50 million Americans suffer from some form of chronic pain, and of that number, 19.6 million have pain severe enough that it frequently limits life or work activities. The economic toll is an estimated $560 billion in medical care, lost productivity and disability programs. The prevalence of pain, not surprisingly, goes up with age.

Pain, however, is actually beneficial, warning of danger so people can respond, for example, by pulling a hand away from a hot surface. Episodes of acute pain go with the territory for stubbed toes and broken bones, but the symptoms usually resolve as the tissue heals or bones mend. Persistent, or chronic pain, on the other hand, can become a disease in its own right, as the nervous system over time becomes rewired, even spreading pain beyond the original area. Thats one of the reasons why it can be so challenging to treat and so frustrating to those who live with it.

If theres good news in all of this for Peninsula residents, its that advances are being made in better understanding the causes and effective treatments for pain, and with that the ability to offer more personalized approaches for targeting individual patients. Whether high-technology brain imaging, or no-tech therapies like breathing exercises and yoga, there are more alternatives available than just going home with a prescription for pain pills something the nations opioid crisis has elevated as an urgent concern.

Dr. Sean Mackey is chief of the division of pain medicine and director of neuroscience and the pain lab at Stanford University. He leads a multidisciplinary team which brings academic research findings into a clinical setting to help patients alleviate longstanding pain and even to prevent pain, notably following surgery, from transitioning from acute to chronic. Our message, Mackey says, is that you dont have to suffer in silence, that there are approaches that can help.

Stanford Health Cares Pain Management Center at 500 Broadway in Redwood City is one of the largest, most comprehensive pain centers in the United States, if not the world, according to Mackey, and has twice been designated a Center of Excellence by the American Pain Society. Physicians from multiple disciplines including psychiatrists, physical therapists, nutritionists and others get involved treating patients.

One of the things that I think is unique to the Stanford program is that we integrate our research and clinical missions very tightly, he adds. Clinical knowledge can feed researchers with questions to go after, and research discoveries are translated into safe, effective therapies. One example of something that is being tested is transcranial magnetic stimulation brain zapping using something like a coil placed on top of the patients head. It doesnt hurt, Mackey says. Theres no pain and you can induce a current through it that generates a magnetic field that can activate different brain centers, and we can turn on and off the brain systems that are associated with pain. And weve had some really good results with it.

Stanford has been recruiting volunteers for further study of the efficacy of TMS for two kinds of pain, one of several studies that are planned. Another one is seeking evidence of the benefits of acupuncture for low back pain.

The Stanford scientists also study novel applications for medications, according to Mackey, as an example, repurposing naltrexone, which was originally used to treat drug and alcohol addiction. But at much lower doses, like one tenth of the usual dose, it has a completely different action, he says. It blocks nerve inflammation so its been very useful with fibromyalgia, which predominately affects women in their 30s, 40s and 50s, as well as some other chronic painful conditions.

Among the other new alternatives, Stanford is also using implanted devices that can override pain signals to a specific nerve and provide relief.

If the body had only a single pain center, obviously treating pain would be much simpler, but many parts of the brain and neural pathways are involved in the pain experience. One of the problems when pain becomes chronic is that it can alter both the peripheral nervous systems and the brain and spinal cord so that it amplifies the experience of pain and that magnifies it, according to Mackey. When that occurs, someone who has come through an injury or surgery may no longer need the original signals to keep on feeling pain.

What is experienced as pain relies on many sensory cues, among them emotions, beliefs, thoughts and expectations, and one of the factors that can feed into chronic pain is known as catastrophizing. The big word can apply to anything. Bills. The job. The country. But with pain, rumination, hopelessness and a feeling that the condition will never get better can trap the brain in an endless loop that is very difficult to break out of.

But the pain is still real. Unfortunately, in part because its invisible, patients commonly report feeling they are being blamed for their pain, according to Stanford associate professor Dr. BethDarnall, who has a doctorate in clinical psychology and is a pain scientist. (Its) a misperception that somehow people are saying pain is all in your head. Youre making it up. Its not real. Theres not a medical basis for your pain, therefore there must be something wrong with you (But) all pain is real. I always say that at the outset. All pain is real.

One of her primary interests is in developing low-cost, accessible treatments that empower patients so they can begin participating in managing their symptoms rather than feeling at the mercy of them among them cycles of poor sleep, persistent worry and feeling helpless.Darnall, who teaches a class on this at Stanfords Redwood City clinic four times a year, says studies demonstrate that in two months or so of cognitive behavioral therapy, improvement can be shown. They have evidenced substantial volumetric increases in the regions of the brain associated with brain control so literally increasing the brain matter in those regions that associate better regulation of pain.

Its long been established that cognitive and behavioral therapies are important in addressing chronic pain. Whats different is that were now focusing more and getting people better access to what works, she says. Rapid access to relief is kind of where the rubber hits the road.

Pain physician and professor Dr. Ming-Chih Kao is chief of Stanfords network of pain clinics (including the one in Redwood City), which is expanding geographically: Patients who are already in pain benefit because they dont have to drive so far for treatments and can come in more often.

Kao started his career in internal medicine, intending to focus on cancer as his specialty, but decided to switch to pain management in part because of how common pain complaints are, headaches and back pain topping the list. In the primary clinic that I saw about 20 to 30 percent of my patients could benefit from a pain specialist, he says. But the diagnosis and treatment of pain, he also saw, is very complicated and requires a team approach.

When he started at Stanford as a fellow, patients routinely were coming in who had been prescribed very high dosages of opiates. Primary care doctors, he says, were trying to do the right thing to reduce pain but the nature of opiate medications is that patients get used to it very quickly. They develop tolerance. They had to escalate the dose again and again and again. And pretty soon, some patients are finding themselves taking astronomical doses. And still not getting pain relief.

The issue has taken on new urgency as a result of the nations opioid crisis, which is commanding more public and regulatory attention. From a period when the drugs were overpromoted and the risks minimized, the pendulum has swung the other way, and in 2016 the Centers for Disease Control and Prevention recommended against opioids as a first-line treatment for chronic pain. There has been pushback from patients and physicians alike that things have gone too far the other way. (Both Mackey andDarnallhave spoken out against forced tapering of opioids.)

Fortunately, Kao notes, there are new medications available that can be used safely to treat chronic pain, and many patients on large-dose opiates have been switching over successfully. There are 200-plus medications for pain management; 20 are opioids.

With most patients who develop chronic pain, Kao observes, usually theres not just one cause. It may start out with a herniated disk, nerve impingement, joint inflammation or a muscle or tendon issue. If pain persists and reaches a high level, secondary injuries from disuse or being bedbound can set in too.

Sofor us, a patient coming in with back pain or a headache, weve got to figure out what parts of the pain cycle are important contributors to the chronic pain and then we try to tackle them one by one, Kao says, not just with the doctors but with the rest of our team.

Lifestyle changes can make a big difference. Oftentimes patients find themselves essentially in a feedback loop where they become less and less active to avoid pain, Kao says, but unfortunately inactivity over long periods of time weakens muscles and that can cause secondarily more pain. So thats actually the cycle were trying to break for a lot of patients. The therapeutic prescription might include swimming, yoga, Nordic walking using poles, biofeedback and meditation and psychological counseling to improve coping skills and the ability to commit to a treatment program.

San Mateo Medical Center the countys safety net hospital offers a multidisciplinary pain clinic that includes similar therapies including meditation, physical therapy, yoga and art, as well as classes to help patients understand the physiology of pain. The program draws heavily on the work of Australian neuroscientist Dr. Lorimer Moseley, whose poplar and entertaining talks on You Tube help as the title of one of his books puts it Explain Pain.

Clinic patient Douglas has the autoimmune disease fibromyalgia, which makes people hypersensitive to pain. Since she enrolled in the hospitals program early this year, she feels better and has gained a new perspective about how the mind and the body are linked. This class reminds us were not crazy, she says. Our pain is real.

It would be hard to find a more enthusiastic graduate than San Bruno resident JohnAcayan, aback painsufferer who says the pain clinic has helped him get past being depressed about things he can no longer do and instead look forward to what he can do. One of the things the pain management clinic has done for me is help me to realize that (if) youre injured, perhaps youre not going to be 100 percent the same, youre not going to be able to do everything that you used to. But you can be happy. You can do other things.

He even tried acupuncture, and despite a fear of needles, It was fantastic. I couldnt believe it. It made everything go away. Ill say literally the rest of that day was so tranquil. Absolutely no pain. Zero. That night, I slept fantastic. The next morning was great, but after a few days the pain came back. He tries not to think about pain so much. At one time, in fact, he thought his medication needed to be stronger. He was taking 600 milligrams of tramadol a day and is now down to 50. The clinic team guided him to the realization that he didnt need that much. I could take a pill and be happy and lightheaded, he says, but that isnt the way I want to feel. I want to feel normal. I dont want to feel loopy.

This summer,Acayangot to try out something fairly new in the hospitals treatment toolbox virtual reality. Patients put on goggles and operate controls to throw things at friendly sea otters on a video screen and become completely engrossed. Another version has a biofeedback component that gives viewers some control as their heart rate changes.

Chief Medical Information Officer Dr. MichaelAratowsays virtual reality can calm people down in high-anxiety areas like emergency rooms. He brought the idea to Dr. MelissaFledderjohann, a licensed clinical psychologist who directs the pain management clinic, and she readily agreed to offer it in her program. Most patients get a reduced pain sensation while theyre using VR, according toFledderjohann. We know that during and right after it, they definitely feel a decrease,Aratowsays. The question is does that decrease persist until next time? The jurys still out on that one.

SaysFledderjohann: It helps reinforce the concepts in our classes, saying There are tools you can do to manage your pain, reduce your pain. Its not just an external thing thats coming at you. You yourself can do your own pain management. And this would be a good example. By going though VR, you saw your pain reduced.

SimonKoytiger, a physical therapist who manages Vibrant Care Rehabilitation in San Carlos, is also a proponent of a comprehensive and holistic approach to treating pain, which he views a symptom, not the root of the problem. Especially in the fast-paced Bay Area, lifestyle issues including lack of exercise, working long hours, stress, poor diet and anxiety can show up as back or knee problems, andKoytigertries to help patients develop healthier habits. We have this chronic pain issue, he says. Lifestyle is never going to show up on an MRI.

Exercise, he points out, helps reduce pain many ways, first by making people stronger and less fragile and improving the capacity of all tissues in the body. Exercise also has endocrine effects, releasing the happy hormones serotonin and dopamine and reducing the production of the stress hormone cortisol.

I talk to patients about these three pillars very frequently: Its physical exercise, its diet and nutrition and its mental health,Koytigeradds. AndactuallyIm a bit of a believer, even though Im a physical therapist, that the primary pillar is mental health. Because who is the one whos choosing to eat well? Who is the one whos deciding to exercise that day or not? We make those decisions and if we are at ease and we have more peace and calmness in our minds, we are going to naturally do those things that are right for our body. If we are suffering with depression and anxiety and stress, its going to be much more challenging to balance those two domains.

Coming back from chronic pain can be a long haul.

Woodside resident Brad Dary, 65, counts himself fortunate that he came out the other side of years of chronic pain, which began in 1995 with a laminectomy followed by fusion surgery for a vertebra five years later.

For the first year after the surgery, I felt like I was cut in half, he says. I moved home with my parents. I was literally in bed for a year after that operation. It would take me about a half an hour to get from the bed to the bathroom. You cant do anything without your back being involved. I used a walker. He had to take morphine for the pain but hated having a foggy brain and couldnt wait to get off of it.

He tried acupuncture once but thought it was silly. But Dary, who is a videographer, says through a slow progression of pushing himself to do exercise and the healing process, he finally recovered. You just fight it out, he says. My biggest thing was doing exercise and trying to build my muscles as best I could Everyones situation is different. I had a lot of time to heal. It was 10 years. Today he jogs three times a weekand works out with weights. He thinks having to work so hard to get where he is challenges him to be more alive.

Rose who did not want to be identified by her real name for this story has made a remarkable comeback too from barely being able to get out of a hospital bed using a walker. The southern San Mateo County resident disciplines herself to walk two miles, three times a week and has worked up to doing 15 minutes on an exercise bike at the gym. Shes arrived at this point 15 years after a series of back surgeries over four years, the first to address stenosis and then two more that turned out to be needed because of damaged disks.

When it all began, she had a job, but she had to give up working long ago.

Patients tend not to do their physical therapy if its too painful, and she was prescribed fentanyl and vicodin to help her be better able to do the therapy she would need, which it did. They put me on heavy opioids because they knew to get through years of it would be so painful because all of these core muscles were, waist to pelvis front and back, cut three times through three surgeries, Rose explains. So that is a huge amount of healing.

Fifteen years ago, her first pain management doctor assured her that it would easy to get off the opioids when the time came. Its no problem, Rose clearly recalls him saying. Literally, he told me No problem. You just gradually step off the opioids.

But when she had been on them for six years and was ready to start declining, she learned otherwise. It took three years of tapering to get off opioids, drugs so powerful that she had to cut back milligram by milligram, for a month perhaps and then wait two months to cut back again. Each time, she had to deal anew with increased pain, plus the jittery withdrawal symptoms. Her skin felt like it was crawling and she had no idea what it was until someone she knows who works with people in addiction explained it to her.

Id never done drugs, she says. I didnt know. Im such an innocent Girl Scout.

She methodically tracked her dosage on an Excel spreadsheet. With such a plodding pace, it helped to be able to look back and confirm that she really was taking less. Rose says her current pain specialist is a Kaiser Permanente doctor who has been with her every step of the way and is her cheerleader. He emphasizes the importance to her of pacing activities, not overdoing and causing more pain that will trigger a desire for more opioids. Though she was already slender, when one of Roses physicians told her that losing five pounds would reduce the pain, she lost ten. In my case, she says, it makes a huge difference.

More than anything, what has really gotten her through it all, says Rose, is her support system of her husband and friends and her Christian faith. A Bible study group from church met in her house when she could not get out, and it helped to know that they were praying for her. Prayer is meditation, she observes, and the Bible study group was group therapy.

Roses advice to others with chronic pain? From my experience, really slow is what does it, she responds with a laugh, like the old Aesops fable, the tortoise always wins.

This story was originally published in the November print edition of Climate Magazine.

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Stanford's new, innovative tools to address chronic pain - Climate Online

Is Endometriosis Therapies Market Trapped Between Growth Expectations and Uncertainty? – Industry News Stock

AMA recently published a detailed study of over 180+ pages in its repository on Endometriosis Therapies market covering interesting aspects of market with supporting development scenario till 2025. The study provides market size break-up by revenue and volume* for emerging countries and important business segments along with commentary on trending factors, growth drivers. Profiled players in study from the coverage used under bottom-up approach are AbbVie Inc. (United States),Eli Lilly and Company (United States),AstraZeneca (United Kingdom),Bayer AG (Germany),Astellas Pharma, Inc. (Japan),Pfizer, Inc. (United States),Takeda Pharmaceutical Company Limited (Japan),Myovant Sciences (United Kingdom)

According to the endometriosis.org, the disorder, Endometriosis affects approximately one in 10 women during their reproductive years, estimating around 176 million women in the world. Endometriosis is a painful disorder in which the layer of tissue that normally surfaces inside the uterus, starts growing outside the uterus. This mainly occurs on the fallopian tubes, ovaries, and tissue around the uterus; however, in exceptional cases, it may occur in other parts of the body. Hormone therapies may be used as a treatment for mild endometriosis or as combined therapy, either before, or after surgery, for moderate to severe endometriosis. Further, High investment made by the Government in the R&D of endometriosis disorder and increasing female population of reproductive age is driving the Global Endometriosis Therapies market

Request a sample report @ https://www.advancemarketanalytics.com/sample-report/62980-global-endometriosis-therapies-market

Market Segmentation:by Type (Hormonal Therapy (Oral Contraceptive Pills, Progestins), Hormone Replacement Therapy (GnRH Agonists, Luteinizing-hormone-releasing hormone receptor antagonist, etc.), AromataseInhibitors, Thermal Endometrial Ablation Devices), Application (Hospital, Clinic, Other), Drug Type (Oral Contraceptives, Progestins, NSAIDs, GnRH Analogues, LNR-IUDs, Others), Synthetic Hormone (Danazol, Gestrinone), Distribution Channel (Hospital Pharmacies, Retail Pharmacies, Drug Stores, E-commerce), Surgery (Laparoscopy, Hysterectomy, Laparotomy), Treatment Type (Pain Management, Hormone Therapy)

Make an enquiry before buying this Report @ https://www.advancemarketanalytics.com/enquiry-before-buy/62980-global-endometriosis-therapies-market

Whats Trending in Market: Availability of a Large Number of Branded as Well As Generic Products

Major Players in the Market Involved In Clinical Trials

Growth Drivers:

Increasing Female Population of the Reproductive Age

Availability of Various Treatment Options

Rising Prevalence of Endometriosis in Young Adults

Restraints:

High Cost of Advanced Therapeutic Drugs

Less Number of Studies On the Disease

View Detailed Table of Content @ https://www.advancemarketanalytics.com/reports/62980-global-endometriosis-therapies-market

Country level Break-up includes:North America (United States, Canada and Mexico)Europe (Germany, France, United Kingdom, Spain, Italy, Netherlands, Switzerland, Nordic, Others)Asia-Pacific (Japan, China, Australia, India, Taiwan, South Korea, Middle East & Africa, Others)

* Customized Section/Chapter wise Reports or Regional or Country wise Chapters are also available.

Strategic Points Covered in Table of Content of Global Endometriosis Therapies Market:

Chapter 1: Introduction, market driving force product Objective of Study and Research Scope the Endometriosis Therapies market

Chapter 2: Exclusive Summary the basic information of the Endometriosis Therapies Market.

Chapter 3: Displaying the Market Dynamics- Drivers, Trends and Challenges of the Comptroller Software

Chapter 4: Presenting the Endometriosis Therapies Market Factor Analysis Porters Five Forces, Supply/Value Chain, PESTEL analysis, Market Entropy, Patent/Trademark Analysis.

Chapter 5: Displaying the by Type, End User and Region 2013-2018

Chapter 6: Evaluating the leading manufacturers of the Endometriosis Therapies market which consists of its Competitive Landscape, Peer Group Analysis, BCG Matrix & Company Profile

Chapter 7: To evaluate the market by segments, by countries and by manufacturers with revenue share and sales by key countries in these various regions.

Chapter 8 & 9: Displaying the Appendix, Methodology and Data Source

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Is Endometriosis Therapies Market Trapped Between Growth Expectations and Uncertainty? - Industry News Stock

"When they told me I had breast cancer at 23 I started to laugh" – Manchester Evening News

It was like an out of body experience when Charlotte Evans was told she had breast cancer at the age of 23.

In a state of shock, the young woman started laughing uncontrollably as doctors explained the devastating news.

Charlotte, now 25, had been aware of breast cancer ever since her mum was diagnosed with the disease 12 years ago.

When she found a lump in her own breast in April 2017, Charlotte initially assumed it was hormone related and felt reassured when her doctor turned her away because of how young she was.

But when she noticed changes to the lump, she booked another appointment with her GP and took her mum along.

Shortly afterwards, Charlotte set off on a romantic break with her boyfriend Adam, and when they returned Charlotte went to the clinic for her test results.

They sat me down and said you have breast cancer and because of the shock I just started laughing uncontrollably," says Charlotte.

"It was an out of body experience and I dont think I took any of what they were saying in.

"I just remember my mum grabbing my leg and letting out a horrified gasp.

"It didnt register with me for months to be honest. I just said I cannot lose my hair.

In the months that followed Charlotte underwent chemotherapy, a double mastectomy, breast reconstruction and a course of radiotherapy.

She opted for 'cold cap' treatment so she didn't lose her hair.

Charlotte's treatment also forced a discussion about her fertility much sooner than she and Adam had planned.

"I started IVF just before my chemotherapy began and I remember going to the hospital with Adam thinking it was a joke that we had to think about this at our age," she explains.

"It felt as though we were in a parallel universe. I knew one day I wanted to have a family but going through IVF treatment at 23 felt so premature.

"Adam was 24 and he hadnt signed up for this; fertility treatment, hospital appointments, bathing me when I didnt have the energy.

"But he took it all in his stride and I cant thank him and our families enough for all that they have done for me.

"Now I can see how important it was for me to take those precautionary steps for our future together.

Charlotte, who works as cabin crew for easyJet, is sharing her story as part of the Life-saving Journeys partnership, which sees charities Breast Cancer Now and Prostate Cancer UK join forces with her employer.

She says being diagnosed with cancer at such a young age forced her to grow up quickly.

She finished radiotherapy a year ago and is now back at work after 16 months off.

There are no words, youll never think it will happen to you," she explains.

"I had to grow up so quickly and it was hard but I always tried to stay positive.

"I would go to my chemo appointments wearing the clothes and make-up that made me feel good, and I would just deal with it.

"A diagnosis of breast cancer is life-changing, but it makes you appreciate everything so much more. As a teenager, it was really tough seeing my mum go through breast cancer, but it made our family closer.

"When I turned 22 I had a thought one day, just out of the blue, about whether or not I would be diagnosed at some stage in my life. I didnt think it would be at 23, but youre never too young."

Charlotte is sharing her story as part of the Life-saving Journeys partnership, which sees charities Breast Cancer Now and Prostate Cancer UK join forces with her employer.

The six-week collaboration, which last year raised more than 430,000 for cutting-edge research, hopes to raise even more money through its on-board collections this Autumn.

Charlotte says: "It feels really special knowing that money raised by easyJet passengers and crew during this campaign will be supporting Breast Cancer Now and Prostate Cancer UK.

"As well my own diagnosis of breast cancer, and my mums, my grandad was diagnosed with prostate cancer in2014 and has since made a full recovery, so both organisations are close to my heart."

She added: "Going back to work after 16 months off was tough, but easyJet were hugely understanding and supportive and Im so pleased to be back at work in a job I love. I want to thank all of our passengers for their donations, this money will provide hope for so many by helping to fund vital research into these horrible diseases.

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"When they told me I had breast cancer at 23 I started to laugh" - Manchester Evening News

‘Women know nothing about menopause, then it hits them over the head like a ton of bricks’ – Belfast Telegraph

'Women know nothing about menopause, then it hits them over the head like a ton of bricks'

BelfastTelegraph.co.uk

Not only do we not talk nearly enough about menopause - something that affects half the people on the planet, with menopausal women the fastest growing demographic section in the world - but most of the conversations we do have, are misplaced. We spend too much time talking about HRT versus no HRT, about breast cancer risks, even debating whether or not menopause is a 'thing'.

https://www.belfasttelegraph.co.uk/life/health/women-know-nothing-about-menopause-then-it-hits-them-over-the-head-like-a-ton-of-bricks-38682571.html

https://www.belfasttelegraph.co.uk/life/features/article38682570.ece/6fd38/AUTOCROP/h342/2019-11-12_lif_54832131_I5.JPG

Not only do we not talk nearly enough about menopause - something that affects half the people on the planet, with menopausal women the fastest growing demographic section in the world - but most of the conversations we do have, are misplaced. We spend too much time talking about HRT versus no HRT, about breast cancer risks, even debating whether or not menopause is a 'thing'.

In fact, we should be talking about heart health, osteoporosis, and Alzheimer's. We should be talking, at a most fundamental level, about what is a significant health occurrence, one that now, because of rising life-expectancy, comes roughly midway through a woman's life, and that will have a considerable impact on physical and mental wellbeing.

The conversation we need to be having isn't the slightly judgemental one around women's 'choices', it is around the health impact of the menopause and what to do about it.

At its simplest, menopause marks the end of a woman's reproductive phase. The ovaries no longer release an egg every month and menstruation stops. Production of oestrogen diminishes gradually in the years before menopause, accelerating in the last year or two.

This is the point at which women will generally begin to notice symptoms - there is a check-list of over 40 possible, from the well-known (hot flushes, night sweats, insomnia), to the less recognised: panic attacks, painful joints, dry eyes. Some are life-threatening, and some are life-limiting.

Obviously the different reactions of women are dictated by the severity of symptoms - and every woman is different, every woman will have a different menopause, just as we all had different experiences of puberty and hormonal cycles.

However, symptomatic responses aside, the fundamental reality of menopause is that depleted oestrogen has consequences for the whole of a woman's health, no matter how well she is managing her symptoms, and it is this that needs to be talked about, and understood.

"The problem is, women know nothing," says Barbara Taylor MD (menopausetaylor.me), who was an obstetrician and gynaecologist at the Texas Medical Centre, before she retired due to severe arthritis and threw herself into educating women about menopause.

"They don't know what menopause is, when it hits them over the head like a ton of bricks. They go through years of seeing doctors for all these different things. They see one person for their joint pain, someone else for their insomnia, they don't realise it's all one thing, that losing your oestrogen involves a whole list symptoms that make you miserable.

"It's not even about the symptoms, it's about the fact that when you lose your oestrogen, you are at higher risk of heart attack, osteoporosis and Alzheimer's, simply by virtue of losing something your body needed to function.

"It's a deficiency state. If you lose your insulin, you have 20 symptoms that make you miserable, and if you don't do something about it, you die. If you lose your thyroid hormones, ditto. So why do we not respond when we lose our oestrogen? Your body is trying to tell you something. And if you don't listen to it, it's going to get worse."

Barbara's mission is education. "I help women manage their menopause whatever way they want. I have no agenda, no product. This is a purely educational resource for women, on all of their options - diet, lifestyle, vitamins, minerals, herbs, hormonal medications, non-hormonal medications, acupuncture... All I do is teach."

Barbara emphasises the importance of understanding personal risk factors. "For example, one glass of red wine is good for reducing your risk of heart attack. But that same glass of red wine increases your risk of breast cancer. So you need to understand - what are your personal risk factors? Are you more at risk of breast cancer? Of stroke? Of heart attack? And act accordingly."

She emphasises that "one in every two deaths of post-menopausal women in America is from heart disease" - low levels of oestrogen pose a significant risk of developing disease in smaller blood vessels - "compared with 1 in 29 from breast cancer. And yet we talk far more about the breast cancer risk. We're looking the wrong way."

Women, she says, consult with her from all over the world, and the two biggest complaints are: "One, their vaginas are on fire - vaginal irritation is the biggest, most bothersome symptom - and they won't talk about it. They will talk about hot flushes, but not vaginal discomfort. Two, is insomnia, because when you don't get sleep, everything else is off track and awful. Those are the two biggest and most obvious complaints. But, once they get some information, what they want to know is, 'How can we be at such huge risk of heart attack, Alzheimer's and osteoporosis, and not know it'?"

Many women come to Barbara determined against HRT, and many of those reconsider in the light of the information.

"I see more converting to HRT than anything," she says. But the endgame is not conversion - to anything - it's education.

"Each woman has a journey, finding what works best for her. When they do find it, they are so shocked at how different their lives can be."

Most women who come to see Nigel Denby, dietitian and nutritionist at the Hormone Health clinic, come because of the weight.

Nigel explains: "They find this extra stone, stone-and-a-half, all in the mid-section. Often, they aren't eating more, they haven't stopped exercising, so why is this happening? Oestrogen levels are falling and the way your body lays down its fat changes. This is a symptom of menopause." Here, Nigel gives some advice to women going through 'the change'.

Diet won't "give you a 'natural HRT'. It just won't. Let's lay that to rest".

In terms of diet and lifestyle, you need to "take care of your bones, look after your heart, and sort out this menopausal midriff weight gain".

"The second your oestrogen starts falling, your risk of a heart attack goes up to the same as a man's. You've had protection all your life, until now. This is the biggest killer in the UK and the second biggest in Ireland, and nobody talks about that."

Essentially, you may need to learn to eat and exercise differently.

"What you're trying to do is wind back time," he says. "Your body is ageing. You're losing muscle tissue, laying fat down in a different way. You need to reverse that. And you're not going to do it by a couple of gym classes a week. It has to be every single day. It's hard work.

"First, get yourself active. Look at your day-to-day stuff. Are you getting your 10,000 steps in? If not, nothing you do in the gym is going to make a difference. Combine it with resistance exercise, focusing on thighs, gluts, abs, upper body and arms. wDo squats, abdominal curls, box press-ups, 4x10 reps every day. Work until your muscles are tired. That's going to generate muscle tissue that is going to speed up your metabolic rate."

As for diet: "If you are going to lose weight, you've got to cut out about 300-500 calories a day. Start with a food and activity diary.

"For most people, the extra calories come from booze and large portion sizes; most of us are eating way too much."

But, he emphasises: "All of that needs to happen while taking care of your bones and your heart health. You need two to three servings of dairy and consider supplementing with vitamin D. Try and eat more fruit and veg, more oily fish and soluble fibre."

Remember that: "You have another four decades in front of you, and the quality of those decades is down to you.

"If a woman focuses on the facts and not the hype, she can give herself the best years of health ahead of her."

And, he adds: "I love this work, because women at this phase of their lives are the most motivated women I work with."

The bad news is that there is no one test you can do to show you where you are in your fertility lifespan. GPs will do a blood test to establish your levels of follicle-stimulating hormone (FSH) and to rule out other possible causes, such as thyroid issues or vitamin deficiencies.

If your FSH blood levels are 30 mIU/mL or higher, together with absence of periods for 12 months, that suggests you have reached menopause.

However, testing during the years before menopause (known as peri-menopause), when FSH may be within normal range but oestrogen is dwindling, is more a question of symptom-checking, as blood tests are unreliable: hormone levels fluctuate constantly, so a blood test is a snapshot of a particular moment, rather than an overall picture.

Instead, it's a question of a balanced assessment of a woman's age, her symptoms, including changes to the menstrual cycle, and how she feels, after having ruled out other possible causes.

Belfast Telegraph

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'Women know nothing about menopause, then it hits them over the head like a ton of bricks' - Belfast Telegraph

Development and internal validation of a Nomogram for preoperative prediction of surgical treatment effect on cesarean section diverticulum – BMC…

Patients

Between Jun 11, 2012, and May 272,016, 228 Chinese women underwent vaginal repair for CSD at Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine. These women all had prolonged postmenstrual spotting and underwent treatment in our hospital. The research protocol was approved by the relevant Institutional Review Board before the study began. This study was approved by the Ethics Committee of Shanghai First Maternity and Infant Hospital, affiliated with Tongji University (KS1512), and was conducted in accordance with the Declaration of Helsinki.

We reviewed and collected the patients medical records and follow-up data after they provided informed consent. All participants gave written informed consent before the study began. The author(s) agreed to provide copies of the appropriate documentation if requested. Baseline clinicopathologic data, including delivery times, menstrual cycle, age, gravidity, parity, age at first C-section, number of C-sections, hemoglobin (Hb) and data from MRI imaging, were also recorded before surgery. Laboratory analysis of Hb was conducted via a regular blood test within 3days of surgery.

Patients treated by vaginal surgery were included in the study with the following criteria: 1) clinical features, such as longer menstruation after C-section and no significant change in the menstrual cycle; 2) history of C-section; and 3) CSD detected by MRI. Exclusion criteria included uterine pathologies, such as adenomyosis, leiomyoma and other conditions [21].

Each patient received continuous epidural anesthesia while in the lithotomy position. At a distance of 0.5cm below the site of the reflexed vesicocervical area,an anterior incision was made from the 3 oclock position to the 9 oclock position using an electric knife. The bladder was carefully dissected away from the uterus with sharp dissection scissors toward the abdominal cavity until the peritoneum was reached. Once the abdominal cavity was entered and the cervical and lower uterine segments were exposed. The CSD tissue was cut to the normal healthy muscle. The incision was closed with a double layer of 10 absorbable interrupted sutures. After adequate hemostasis, the peritoneum and bilateral bladder column were sutured, followed by the incision in the cervical vaginal area.

Patients included in the study had follow-up clinic visits to record their menstruation at 1, 3 and more than 6months after the procedure and measure the CSD scar site by MRI at more than 6months after the procedure. According to the previous study, patients menstruation would likely plateau at follow-up visits more than 3months after surgery [21]. The data from MRI were evaluated at the same center by an experienced radiologist. The data after surgery mainly included the number of menstruation days and the depth, length, width, and thickness of the remaining muscular layer (TRM) as well as the depth/ TRM ratio based on contrast-enhanced MRI [21](Fig. 1). Primary outcomes were the number of postmenstrual spotting days and depth/ TRM ratio. All events and any modifications that occurred during follow-up were recorded.

We defined the Class-A healing group as CSD patients who had menstruation duration of no more than 7days and a thickness of the remaining muscular layer of no less than 5.8mm after vaginal repair, and all other patients were included in the non-class-A healing group [28].

Patient characteristics and preoperative factors were analyzed using students t test and chi-square tests. Ages are given as the medians with ranges, others variables are expressed as meanSD. Multivariate logistic regression models were used to assess risk factors associated with non-class-A healing of CSD. Regression coefficients were used to generate prognostic nomograms. Model discrimination was measured quantitatively with the concordance index. Internal validation was performed using 1000 bootstrap resampling to quantify the overfitting of our modeling strategy and predict future performance of the model.

We incorporated both the depth/TRM ratio measured by MRI and clinical factors into a personalized nomogram for facilitating preoperative prediction of non-class-A healing in CSD patients. Multimarker analyses have been used in recent years for incorporating individual factors into marker panels [29].

All statistical analyses were performed by R software (version 3.3.2). The statistical significance levels were two-sided, with a P value of .05 or less.

Multivariable logistic regression analysis was used to assess the individualized prediction model with the following clinical candidate factors taken before surgery: the depth/ TRM ratio via MRI, number of menstruation days after C-section, WBC and fibrinogen. We built the final nomogram based on logistic regression analysis in the training cohort.

A calibration curve was plotted to evaluate the calibration of the nomogram using the Hosmer-Lemeshow test. A significant test statistic indicated that the prediction model did not calibrate perfectly [30]. Harrells C-index was computed to quantify the performance of the nomogram.

Internal validation was carried out using data from 167 patients.

Decision curve analysis was performed to determine the clinical usefulness of the nomogram by quantifying the net benefits at different threshold probabilities.

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Development and internal validation of a Nomogram for preoperative prediction of surgical treatment effect on cesarean section diverticulum - BMC...

Chinese Medical Tourists visiting Thailand set to exceed 1 million by 2020 – The Thaiger

For those who want to match their physical gender with what they feel is their true gender, Thailand is the place for Sex Reassignment Surgery (SRS) also known as Gender Reassignment Surgery, Sex Change Operation, and MtF Surgery, to name a few. So, what makes Thailand such an attractive destination for this type of procedure? In short, its because patients can get the most out of such surgeries in Thailand thanks to the number of highly trained surgeons, low-cost and quality health care, and decades of knowledge and experience in perfecting this procedure.

If youre considering SRS in Thailand, or you have a family member, a partner, or a friend who is wondering what is involved in the procedure, this guide should help to paint a clearer picture.

To undergo SRS is a huge, life-changing decision that should not be made lightly. It is a lengthy process that requires a lot of resilience and patience. Before the actual surgery, you will first need to live as a woman for at least a year and undertake hormone treatment to help reshape your body contour and stimulate the growth of a labia majora.

Heres a list of the required prerequisites that all surgeons will insist upon before considering your case:

The actual process usually involves a few procedures:

You may also choose other surgical procedures, such as a Tracheal Shave to remove your Adams apple, or a Buttock Augmentation to increase the volume of the buttocks. Since every patient is unique, the procedures involved in SRS can be performed based on your needs and budget.

The most important part of male-to-female surgery is the creation of the vagina. There are numerous surgical techniques to do this based on your preference. You can discuss with your surgeon which one is best for you. The other popular techniques are as follows:

1. SRS without vaginal depth

2. SRS with Penile Skin Inversion

3. SRS with Scrotal Skin Graft

4. SRS with Sigmoid Colon by Laparoscopic Technique

Caitlyn Jenner, Possibly the Most Famous Transgender Person Ever

Recovery after surgery will be a long and painful process. It will also require several follow up procedures as well as constant monitoring so you will have to stay a little bit longer at the hospital until you are fully ready to be discharged. Generally, allow for a minimum of 3 weeks stay in Thailand or the country of your choice area after your surgery. Most people are able to return to work in about 4-6 weeks after a sex change operation. Furthermore, you can resume strenuous work and exercise in about 6-8 weeks. It is vital that you strictly follow all medication instructions during your recovery period.

Social support is very important before and after the surgery, especially the support that comes from your family and loved ones. You have to be socially and emotionally stable before you undergo the operation. This is why it is required that you have proper counseling to help you with your emotional wellbeing. You have to prepare yourself mentally, before, during and after transition because it can be quite overwhelming and stressful.

It is also important that you maintain regular check-ups with your local Doctor to monitor the progress of your healing and avoid such complications.

The success rate for a sex change is very high, given our technological advancements. Gender reassignment surgery from male to female has a higher success rate than female to male; this is why more male transgender opts for a sex change.

However, given the nature and complexities of this type of surgery, you also have to be aware of its complications:

Possible side effects may also include:

SRS can be very expensive, especially since it is difficult to get this type of surgery in many countries. One reason why Thailand is popular with those who want to change their sexual identity is that the country offers more affordable fees. Many patients come from the United States because the US has the most expensive male-to-female SRS prices in the world.

The prices range from $25,000 to $30,000 for just the reconstruction of the genitals alone. If you want to add breast augmentation and voice feminisation surgery, you can expect to pay more than $50,000. Additionally, some clinics in the US dont include consultation fees in their prices, so you need to pay at least $50-100 for every consultation.

In general, SRS in Thailand costs around a third to half of what it can cost in the United States. For the reconstruction of the genitals in Thailand, you can expect to pay between $8,400 to $13,700 depending on which technique you choose.

Breast augmentation costs approximately $4,100 to $6,170 and Voice Feminisation Surgery costs between $3,590 to $7,180. In total, you will need to pay around $16,090 to $27,050 in Thailand for the complete procedure. These prices can also include packages, such as hospitalization accommodation, post-operative care, consultation fee, post-operative care, medications, and transportation.

The low-cost healthcare in Thailand does not mean low-quality treatment. In fact, Thailand is extremely popular among medical tourists because the country is known to have high-quality healthcare. Numerous medical centers in Thailand are accredited by prestigious international organizations, such as the Joint Commission International (JCI). The country has come a long way since its first Sex Reassignment Surgery in 1975, with many surgeons specialising in SRS for years, some even have over 20 years of experience. With their skills and experience, the surgeons and clinics can give patients the proper care they need and guarantee the best possible result.

Since there are many medical centres in the country that offer Male to Female SRS, it is understandable that some will better than others. To avoid disappointment, do your research, read reviews, find out about the clinics accreditation, and ask for your surgeons certifications. Better still, seek out the services of a dedicated Medical Tourism Facilitator like MyMediTravel who will guide you through the whole process and find you the best possible surgeon/clinic/hospital available and within your budget.

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Chinese Medical Tourists visiting Thailand set to exceed 1 million by 2020 - The Thaiger

Global Addison Disease Testing Market: What it got next? Find out with the latest research available at ‘The Market Reports’ – Market Research…

Addison disease occurs due to the injury of the adrenal cortex which causes insufficient generation of the hormone aldosterone and cortisol.Indications of Addisons disease are known as primary adrenal insufficiency, resulting from insufficient production of two hormones cortisol and aldosterone.

Treatment options for Addisons disease include many medications, usually in the form of tablets, depending on the specific hormones that the body is missing.

The drugs required to effectively treat Addisons depends on the hormones that are no longer being effectively produced in the adrenal glands.

Access Report Details at: https://www.themarketreports.com/report/global-addison-disease-testing-market-research-report

The global Addison Disease Testing market is valued at xx million US$ in 2018 is expected to reach xx million US$ by the end of 2025, growing at a CAGR of xx% during 2019-2025.

This report focuses on Addison Disease Testing volume and value at global level, regional level and company level. From a global perspective, this report represents overall Addison Disease Testing market size by analyzing historical data and future prospect. Regionally, this report focuses on several key regions: North America, Europe, China and Japan.

Key companies profiled in Addison Disease Testing Market report are Nhs.Uk, Mayo Clinic, Vca Animal Hospital, Niddk, Cleveland Clinic, Webmd, Bmj Best Practice, National Organization For Rare Disorders, Core Diagnostics Private Limited, Laboratory Corporation Of America Holdings, Sonora Quest Laboratoriesand more in term of company basic information, Product Introduction, Application, Specification, Production, Revenue, Price and Gross Margin (2014-2019), etc.

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Table of Content

1 Addison Disease Testing Market Overview

2 Global Addison Disease Testing Market Competition by Manufacturers

3 Global Addison Disease Testing Production Market Share by Regions

4 Global Addison Disease Testing Consumption by Regions

5 Global Addison Disease Testing Production, Revenue, Price Trend by Type

6 Global Addison Disease Testing Market Analysis by Applications

7 Company Profiles and Key Figures in Addison Disease Testing Business

8 Addison Disease Testing Manufacturing Cost Analysis

9 Marketing Channel, Distributors and Customers

10 Market Dynamics

11 Global Addison Disease Testing Market Forecast

12 Research Findings and Conclusion

13 Methodology and Data Source

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Global Addison Disease Testing Market: What it got next? Find out with the latest research available at 'The Market Reports' - Market Research...

MetroHealth, LGBT Center of Greater Cleveland Partner On New Clinic Opening Tuesday – WKSU News

MetroHealth is opening a permanent clinic Tuesday at the LGBT Community Center of Greater Cleveland specifically to treat LGBTQ patients.

Greater Cleveland LGBT center, MetroHealth partner on clinic

MetroHealths Pride Network has operated clinics -- geared to LGBTQ patients -- within its existing facilities since 2007. Now, the hospital system is opening a clinic inside the community center for both well visits and specialized care, such as hormone therapy and HIV prevention. Daniel Hamilton is the community centers operations manager.

Its not just about testing. Its about preventative medication that will help people to make better health choices and reduce the risk of HIV when engaging in safer sex practices.

Hamilton also says he hopes having the clinic inside of the center will make getting care more convenient -- and less stigmatized -- for people who might otherwise delay treatment or ignore lingering illnesses.

The endorsement from the LGBT center, having the clinic here, and being able to make direct referral to a place thats already a place theyve come to feeling its a safe outreach: its a great way to get someone directly into service that may or may not make the call.

The new clinic at the community center will be open on Tuesdays.

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MetroHealth, LGBT Center of Greater Cleveland Partner On New Clinic Opening Tuesday - WKSU News

Meditation Reduced The Opioid Dose She Needs To Ease Chronic Pain By 75% | Morning Edition – KCRW

Written by Allison Aubrey Nov. 11, 2019

There's new evidence that mind-body interventions can help reduce pain in people who have been taking prescription opioids and lead to reductions in the drug's dose.

In a study published this month in JAMA Internal Medicine, researchers reviewed evidence from 60 studies that included about 6,400 participants. They evaluated a range of strategies, including meditation, guided imagery, hypnosis and cognitive behavioral therapy.

"Mindfulness, cognitive behavioral therapy and clinical hypnosis appear to be the most useful for reducing pain," says study author Eric Garland, a professor at the University of Utah. The reductions in dose were modest overall, he says, but the study is a signal that this approach is beneficial.

And Pamela Bobb, who lives in Fairfield Glade, Tenn., can attest to the benefits. She's 56 and has endured decades of pain. "Oh, I had been suffering terribly for years," Bobb tells us.

She was born with a malformation in her pelvis that led to pain. Over the span of two decades, she underwent more than a dozen major surgeries, yet none of them gave her relief; each procedure left more scar tissue and nerve damage.

"I felt desperate, " Bobb says. "I didn't feel like I had any control."

She couldn't do basic things such as cook or take care of her family.

"I was completely debilitated," Bobb says. "And when you get to that point, you can't see beyond the pain you're just surviving."

She was put on high doses of opioids to ease the constant pain, but then a few years ago she thought, "There just has to be a better way." Ultimately, she found help at a clinic that specializes in complementary and alternative medicine.

"We offer a variety of things, explains Wayne Jonas, a physician who treated Bobb at the Fort Belvoir Community Hospital Pain Clinic in Fairfax County, Va.

"We offer physical therapy, behavioral medicine, acupuncture, yoga and mind body practices," Jonas says. None of these is a cure-all, he adds, but the idea is that there are lots of tools in the toolkit for people to try.

Jonas is a longtime proponent of an integrated, mind-body approach to treating pain and the author of How Healing Works, a book that describes the science behind these approaches.

He says that when someone is in severe pain, their body's normal defenses are down.

"It bumps up a variety of dysfunctions," Jonas says. Pain increases levels of the stress hormone cortisol and increases inflammatory processes in the body, too. "This starts a continual negative feedback loop that produces more pain," Jonas explains.

It's not a surprise, he says, that techniques such as meditation or yoga can be helpful. "If you engage in a deep mindfulness and relaxation it will counter those stress responses," Jonas says.

Think of meditation as a form of mental exercise.

"It's almost like weightlifting for your brain," says Garland. Just as curling a dumbbell strengthens the bicep, he says, "meditation is almost a way of, sort of curling the dumbbell of the mind to strengthen the mind's self control."

And this can change the way the brain perceives the input from the body. "If you can change the way the brain perceives signals from the body you can actually change the experience of pain," Garland says.

But there's a trick here: Learning to meditate takes time, effort and some training. It's more complicated than swallowing a pill. Pamela Bobb has stuck with it. She has tried a bunch of these alternative mind-body strategies, including acupuncture and biofeedback, and now starts every morning with a meditation practice.

"It's 4:45 in the morning and I've just awakened," she says in a recording she made of her practice, so I could listen in. She sounds centered, and calm. "I'm allowing my body to feel as relaxed as it possibly can."

Bobb has also overhauled her diet, now eating a lot more greens, fruits and vegetables and herbs and spices with anti-inflammatory properties. On the day we talk, she's making a spinach saute with ginger, mint and rosemary.

"I swear you can smell each of those spices. They smell so good!" she says.

Bobb is so at ease now that, just hanging out with her, you'd never guess all that she has endured. And she feels so much better, she says.

"It's empowering to [have] come all this way," Bobb says. She says she's made a fundamental transition in her mind: Instead of waiting for doctors to heal her with surgeries or injections, she now realizes that many of these alternative therapies have empowered her to help herself.

"So much of it does lie within me," she says.

Bobb accepts that she may never be completely pain-free, but now feels she has control over the discomfort.

She has reduced her opioid dose by 75%. She says she still benefits from a small maintenance dose of the medication. And her doctors say that for her, the benefits of the medicine outweigh potential harms.

In the midst of an opioid epidemic, Bobb's story may seem unlikely. But many people who have taken opioids for a prolonged period have similar stories. And last month, the Department of Health and Human Services released new guidelines urging doctors to take a deliberate approach to lowering doses of opioids for chronic pain patients.

The guidelines point to the potential harms of forcing patients off the medications.

"The goal is not necessarily to get off of all opioids but to reduce it to a dose [that is] safe," Adm. Brett P. Giroir, a physician and assistant secretary for health at HHS, told NPR. We asked him about Bobb's case. He is not her doctor, but after hearing her story he said, "The fact that she's been able to reduce her opioids substantially is a success story."

Giroir says this kind of comprehensive approach that includes alternative therapies "could be a model for what we want to do nationwide." He points out that earlier this year, the Centers for Medicare & Medicaid Services proposed covering acupuncture for Medicare patients who have chronic lower back pain.

As the evidence accumulates, Giroir says, there will be more attention placed on covering alternative therapies.

A 2017 Gallup Poll found that 78% of people would prefer to try other ways to address their physical pain before they take pain medication.

And doctors groups such as the American College of Physicians recommend that doctors offer more nonpharmacological treatments to pain patients, such as those who have chronic lower back pain.

Yet, a paper published last year finds that most insurers have not adopted policies that are consistent with these guidelines, and many don't pay for coverage of these services. An accompanying editorial argues that it's time for that to change.

It's clear that when it comes to tackling pain, it takes all of the tools in the toolkit. And when it comes to opioids, the approach needn't be all or nothing. Bobb says she has learned that, for her, the combination of medicine plus mind-body therapies works best.

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Meditation Reduced The Opioid Dose She Needs To Ease Chronic Pain By 75% | Morning Edition - KCRW

The battle over Luna Younger, a 7-year-old trans girl in Texas, explained – Vox.com

Around age 3, Luna Younger started asking to wear dresses. Since the age of 5, she has insisted she is a girl. Now Luna is 7, and during court hearings, physicians, school staff, and family members have all testified that Luna has consistently, persistently identified as a girl.

While Lunas mother respects her daughters gender identity letting her wear what she chooses, whether its nail polish, dresses, or longer hair Lunas father does not. He insists Luna is not transgender. These polarizing differences over how to raise and treat a child are why trans families and advocates, as well as conservatives, have been closely watching the custody battle over the Coppell, Texas, trans girl.

After 15 months in court, on October 22, the jury awarded Lunas mother, Anne Georgulas, full conservatorship of her daughter. It was a decision that brought relief to the trans community and outraged conservatives who believe supporting a trans childs gender identity is tantamount to child abuse.

People were so riled up online, some sent threats to Georgulas; she was viciously attacked and threatened by complete strangers, her attorneys told the Daily Caller. Several prominent Texas officials even added to the fray, including Republican Gov. Greg Abbott, who promised to order the states child protective services to investigate Georgulas. State Rep. Steve Toth said he would propose a bill to add Transitioning of a Minor as Child Abuse.

Two days after the debate boiled over online, Judge Kim Cooks decided to vacate the jury decision. Instead, she granted the parents joint managing conservatorship, which is the equivalent of joint custody in Texas. (Cooks has maintained that she did not make her decision based on any government officials opinion; she has not responded to Voxs request for comment.) While Georgulas, a pediatrician, had requested that the court order Lunas father, Jeffrey Younger, to respect their daughters gender identity, Cooks said that the Court finds that the State of Texas has no compelling interest to justify such interference.

The ruling has brought more questions than answers: When one parent honors her childs gender identity and the other does not, what does that mean for the child? More specifically, what will it mean for her socialization, her mental well-being, and who shes allowed to be?

Trans advocates say Cookss decision is a dangerous misstep. Transgender children are among the most vulnerable members of the next generation, Gillian Branstetter, media relations manager at the National Center for Transgender Equality, told Vox. We know they experience any variety of godawful barriers to their own success, including bullying and harassment, including psychological distress, often resulting from such harassment, [and] family rejection. It does a serious disservice to those kids to give any incentive for a parent to reject their child for who they are.

On Tuesday, Georgulas filed to appeal the judges ruling, according to a press release from a family representative. The mother is asking Cooks to recuse herself after allegedly posting about the case on her personal Facebook while deliberations were ongoing. This is after the judge had placed a gag order on Georgulas and Younger from commenting about the case, acknowledging that the publicity from it was affecting Lunas and her twin brothers privacy and well-being. (Georgulas and Younger are still currently under gag order; Youngers attorney did not return Voxs request for comment.)

Since the verdict, a representative for Georgulas, Karen Hirsch, said that a rock was thrown through a window at Georgulass house while the children were sleeping and that Georgulas has been forced to close her pediatric practice after dead animals and graffiti were left outside the door. Meanwhile, parents in Lunas neighborhood are afraid to send their children to class after Younger had named the school online they feel their children could be in danger from those trying to attack Luna.

The case has hit a boiling point where lives feel threatened and trans families inside and outside of Texas feel unsafe all over whether a child should be allowed to wear a dress and be called she and her.

The legal battle over Luna and, ultimately, how she is allowed to identify reached a tipping point in August 2018 when Georgulas filed for a restraining order against Younger, specifically seeking to prevent him from entering Lunas school and telling people that the gender of Luna is different than a girl named Luna.

In response, Younger petitioned for full conservatorship that same month. Up until this point, he had been allowed to see his kids once a week for two hours and on the first, third, and fifth weekends of each month since 2017, though court testimony indicates he frequently skipped his visitation days. He also launched a social media campaign to save his child from the supposed harm of transitioning. For a child of Lunas age, this is solely social and consists of keeping her hair long, choosing her own clothing, and using a feminine name and pronouns.

However, the conservative campaign spread incorrect fears that Georgulas was seeking to immediately chemically castrate the child a misinformed, scary-sounding reference to hormone medications that would suppress Lunas testosterone production and replace it with estrogen, which would typically be years in Lunas future, according to standard medical guidelines. The only plans Georgulas had, according to court transcripts, was to take Luna to a Childrens Health clinic for transgender kids in Dallas. There, they would discuss a plan for potentially starting her on puberty blockers, which are reversible, in the next few years if Lunas gender dysphoria persists. (The clinic did not return Voxs requests for comment.)

Seizing on Youngers narrative of Georgulas manipulating her child, right-wing media outlets like LifeSiteNews and the Daily Wire also accused Georgulas of forcing Luna to be transgender because she wanted a girl. But that claim seems rather flimsy because Georgulas has two older daughters from a prior marriage.

In court testimony, Georgulas said that she would prefer if Luna were not transgender, but she supports her childs gender identity regardless of her own feelings. From my knowledge as a pediatrician and also from the research Ive done, it is better to affirm for the psychological well-being of the child [doctors recommended] that we affirm the childs choices, whatever those choices are, she said.

Meanwhile, Younger made the conservative media circuit rounds, insisting it was Georgulas who was forcing Luna to present as a girl. Luna presents as a boy with me and [she] presents as a girl with his mom, Younger told LifeSiteNews, a conservative Christian website, in September. [She] gets dressed as a boy at [her] mothers home and [she] comes out to me as a boy. That means that [shes] comfortable as a boy at [her] mothers home. Georgulas and others who have testified have disputed this latter part, saying it was Younger forcing Luna to present as a boy.

Maternal blame appears to be common when it comes to trans children of estranged couples. While data on the number of trans children involved in custody disputes doesnt yet exist, a Family Court Review study released earlier this year examined the cases of 10 divorced mothers who affirm their childs trans- and gender non-conforming identities. In each of the 10 cases, the childs father blamed the affirming mother for causing the child to be trans, and courts gave a favorable ruling to the father in four of those cases. However, parents probably have little or no influence on the childs core feelings that define him or her as gender typical or gender variant, the study said.

Overall, conservative media has used the custody case to not only bash transgender people (When they come for your kid blared a headline in the American Conservative, which was followed by a roundup of disinformation), but to demonize a mother and small child. It has resulted in threats, harassment, and even vandalism of my clients property, attorneys for Georgulas told the Daily Caller in a statement.

Despite how the far right has painted Georgulas, it is Youngers character that has come under legal scrutiny. According to court documents of the annulment of his and Georgulass marriage, the court found that Younger lied about multiple aspects of his life: his career, his previous marriages, his income, his education, and even his military service. It was enough for a Texas court to annul their six-year marriage because it was entered into under fraudulent terms.

Judge Cooks also called out Younger for profiting off a violation of his familys privacy. The father finds comfort in public controversy and attention surrounded by his use of unfounded facts and is thus motivated by financial gain of approximately $139,000 which he has received at the cost of the protection and privacy of his children, she wrote in her judgment, referring to a crowdfunding and merchandising scheme launched last year by Younger.

Even conservative pundit Glenn Beck expressed concern over Youngers past. On his radio show, he read the courts findings of fact showing that Younger acted aggressively toward Georgulass older daughters, withholding their possessions, locking them in their rooms, and forcing them to do plank push-ups until they agreed to follow house rules.

That aggressiveness was also directed at Luna, according to Georgulass attorney Kim Meaders. [Luna] has said to CPS that she is afraid of her father, she said in her opening statement. Her brother has said that she is sad and her father makes her sad. By making her dress in boys clothes, that makes Luna sad.

Perhaps the greatest falsehood of all, according to official court records, is that Luna hasnt been clear about how she identifies.

According to a transcript of a July 10, 2018, hearing in the case, Lunas twin brother, a CPS worker, a therapist, and a pediatrician all attest to Lunas gender identity as a girl. The medical professionals who have seen Luna have recommended she be affirmed and treated as a girl, and its Younger who refuses to accept his childs gender identity.

In April 2017, Luna asked to be referred to by the name Luna. At age 5, Luna was diagnosed by a qualified professional therapist as having gender dysphoria, distress stemming from a mismatch between her birth sex and her gender identity. Her pediatrician noted that at both her 5-year and 6-year checkups, Luna presented as a girl and has been persistent in her gender identity throughout her childhood.

The father doesnt follow the recommendations of the counselor or the pediatrician, and he shames her to try to make her feel bad for wanting to dress as a girl, Meaders, Georgulass attorney, told the court. Even though the father knows she wants super-long hair, he shaves her head when he has the opportunity and leaves the other twin boys hair long, referring to her twin brother Jude.

It is the hair-shaving detail that stands out as especially cruel to trans people and advocates. Lunas father has been very insistent on cutting her hair extremely short, and that is like one of my daughters biggest dysphoric points, Jane, a Dallas-area mother of a trans kid who knows Luna (and whose name has been changed for this story) told Vox. For her, all of this is about the fact that Luna is being forced to have short hair. She doesnt understand all the other ramifications.

Lunas hair figures so prominently in this case because at age 7, hair is often the only differentiating physical indicator of a childs gender. Clothed, boys and girls bodies at that age are essentially the same, having not yet undergone any effects from puberty. A trans child at age 7 does not make permanent changes to their body, despite what Younger claims Georgulas wants to do.

Ultimately, the dispute at this current stage and several years into the future is over Lunas social transition: how she wears her hair, what clothes she wears, her name, and pronouns.

There is no medical intervention of any sort prior to someone hitting puberty, Dr. Joshua Safer, executive director at the Center for Transgender Medicine and Surgery at Mount Sinai and president of the United States Professional Association for Transgender Health, told Vox. So small children do not get medicines and small children do not get surgeries, for sure.

The standard approach when kids are gender expansive when they say theyre transgender, when they think theyre transgender, whatever that might happen, to get a clue that this might be going on is pretty much to listen to the kid and to kind of follow their guidance in terms of what they want to do, what the child wants to do, he added.

Safer says its important to develop an individualized plan for mental and physical health for gender dysphoric kids and adolescents. Varying degrees of family support for transition means coexisting mental health issues are important to examine for any trans child; theres no one-size-fits-all solution for all kids. Most of all, the child must feel comfortable with the plan.

Genecis, the Childrens Health clinic where Georgulas wanted to Luna to receive care, makes it clear on its website that it does not perform gender-related surgeries. In providing comprehensive, age-appropriate mental health and hormonal care for trans youth and adolescents, it follows established guidelines from major medical associations in its treatment. The jurys decision, before it was overruled by the judge, would have allowed her to Luna to receive care at the clinic without Youngers approval. Now she wont be able to.

According to court transcripts, Younger had missed several appointments with medical professionals who have worked with Luna, claiming to want opinions from other providers. However, at the time, he hadnt followed through on those requests.

Boiling under the surface of the custody battle is a medical dispute over how best to treat and support children with gender dysphoria. Younger claimed in court that he supports the watchful waiting approach to dysphoric youth. Watchful waiting wasnt given its name until 2012, but its based on an older approach developed by Dutch and Canadian clinicians in the mid-to-late aughts that suggests that parents must ensure their children perform the role of their assigned sex at birth.

Under watchful waiting, a prepubescent trans girl like Luna would be forced to maintain short hair, wear stereotypical boy clothes, form friendships with boys her age, maintain her birth name and pronouns under the belief that its statistically likely that her dysphoria will desist by the time puberty begins. If Lunas dysphoria does persist, only then would she be given puberty blockers, so she can mature before making a more permanent decision on hormone treatment.

Political forces opposed to social transitions for children are fond of saying let kids be kids but watchful waiting seems counterintuitive to that goal.

Watchful waiting is a deceptive term, said Kelley Winters, a writer and consultant on issues of gender diversity in medical and public policy, told Vox. Theres nothing neutral. Its meant to sound effectively neutral, and theres nothing neutral about forcing trans kids to spend their childhoods in the closet and grow up with absolutely no memories of being authentically present in their entire childhood.

The approach is based on older statistics that as many as 80 percent of children with gender dysphoria will eventually desist and grow into cisgender adults. But those numbers, according to Safer, are flawed.

In terms of that desistance 80 percent comment, thats an old Dutch study where they didnt ask the blunt question about your gender identity to these kids, he said. They kind of danced around the topic with a bunch of other questions and kind of assumed they knew the gender identities, but I dont know that it shows much of anything. It just shows that 80 percent of kids who answer questions in a stereotypical way, that you think might be associated with gender identity, end up not being transgender. But theres a lot of bias in the questions.

At issue is the fact that when the Dutch and Canadian studies were conducted, the official diagnosis for gender-variant kids was gender identity disorder. In order to be diagnosed with GID, a child merely had to display cross-gender dress or behavior, regardless of whether they declared themselves to actually be a member of the opposite sex. The effect of this diagnosis is that cisgender gay and lesbian children, who also frequently display cross-gender preferences without declaring themselves to be the opposite gender before puberty, were caught up in the clinicians studies and so of course they would desist later on.

Even Thomas Steensma, a researcher and clinician at the Center of Expertise on Gender Dysphoria in Amsterdam and a proponent for watchful waiting, has noted the earlier samples may have included milder cases that are hard to compare with the clinical samples we see now in our clinics, in an interview with KQED last year. But he still urged caution with social transitioning of prepubescent children. With certain steps like a name change or a pronoun change, with a result that maybe others will only perceive you as a girl thats somewhere where we say, Okay, maybe you should explore things without taking steps that are hard to reverse. (Steensma hasnt returned Voxs request for comment.)

In 2012, gender identity disorder was changed to the less stigmatizing term gender dysphoria, distress resulting from a mismatch between the childs natal gender and their internal sense of their gender identity. Nowadays, in order to qualify for a gender dysphoria diagnosis, the child must be persistent, insistent, and consistent in their gender identity over a long period of time, criteria that didnt exist under the older diagnosis.

Similarly, watchful waiting as a concept has been pushed to the fringes in American medicine as of late, as it is seen as needlessly punitive to the child. Instead, whats more commonly recommended is the affirming method, which allows gender-expansive children to more freely experiment with their gender expression, trying on new names or pronouns as needed. Its an individualized approach without permanent outcomes. Rather than attempting to fix a prepubescent childs perceived gender-related disorder, the affirming approach, which recommends social transitioning if the child wants it, seeks to lessen the actual dysphoria experienced by the child without medical treatment.

The affirming model has been recommended by nearly every major American medical association, including the American Academy of Pediatrics, the American Medical Association, the American Psychological Association, the Endocrine Society, the World Professional Association for Transgender Health, the American College of Obstetricians and Gynecologists, and many others. What is most important is for a parent to listen, respect and support their childs self-expressed identity. This encourages open conversations that may be difficult but key to the childs mental health and the familys resilience and wellbeing, wrote Jason Rafferty, a doctor at Hasbro Childrens Hospital in Providence, Rhode Island, and a professor at Brown University, in a key AAP statement on affirming the gender identities of trans youth released last October.

The kid isnt going to brainwash him or herself into being transgender [if their gender identity is affirmed], Safer said. Theyre going to say how they feel and you can pretty much be respectful and they wont be railroaded into anything, which I think is the anxiety that people still have, and there was some anxiety in the past in the medical establishment, but I think the medical establishment is getting more and more comfortable that that does not seem like a likely event.

Critics of the affirming model fret that cisgender kids may unknowingly get caught up in a gender transition that they will later come to regret, but according to Safer, the key is to be cautious and keep communication open with kids. The ones who are sure of themselves will continuously tell you so.

Safer has said that within his previous practice in Boston and his current one in New York City, hes seen less than 1 percent of his own patients, among several hundred cases, end up desisting. We certainly dont want to be taking transgender kids and not treating them because we know were not perfect in our understanding, he said. There are opportunities, again, to go slow and theres a real range. The kids who are certain of their gender identity, those are not the kids who come back 10 years later and say that it was wrong to do the treatment.

According to a 2016 University of Washington study of 73 children with gender dysphoria, trans kids who are affirmed in their gender identity showed typical rates of depression and only slightly elevated rates of anxiety compared to their non-transgender peer groups. These findings suggest that familial support in general, or specifically via the decision to allow their children to socially transition, may be associated with better mental health outcomes among transgender children, the study said.

Meanwhile, a 2018 study shows that using a trans childs chosen name and pronouns significantly reduces suicide risk.

By the time Luna persists to the stage where her family would need to consider puberty blockers, which according to Georgulass testimony is sometime between the ages of 9 and 11, she would have been persistent, insistent, and consistent in her gender identity for at least six years, with another two or so years to go before having to make a decision about whether to pursue puberty as a girl through the use of cross-sex hormones.

While puberty blockers merely act as a pause on an adolescents natal puberty, cross-sex hormones would be used to initiate the puberty of the opposite sex if the teens dysphoria still persists. Blockers are a tool to keep permanent changes from natal puberty from taking place so that adolescents age 9 to 14 can be more mentally mature before deciding on the course of their permanent treatment when the time comes, according to Safer. Cross-sex hormones would mean testosterone injections for trans boys and a combination of a testosterone blocker in addition to estrogen for trans girls. Safer says its a careful and cautious system that also respects the autonomy young trans people should have over their own lives and bodies.

However, ultra-conservatives and trans-exclusionary radical feminists, along with some extreme sexologists, have other ideas for those childrens futures, lobbying to ban puberty blockers and cross-sex hormones for all minors. While theyve tried to appropriate the watchful waiting description, their approach is more traditionally known as the reparative method, a form of conversion therapy. They appeal to the fallacy that natal puberty is natural and therefore necessary for all kids.

But this approach would force trans girls into male puberty and trans boys into female puberty without their consent, and brings along its own permanent changes, which could only partially be reversed through painful and expensive medical treatments in adulthood. Trans women forced through male puberty would then have to undergo painful and expensive electrolysis to remove facial hair and may be left with a body frame (shoulder and hip width) that would be unchangeable by any surgeries. Trans men would have to have surgery to remove their breasts and, like their trans female counterparts, be forced to live in an unwanted body frame for their entire lives.

Then there are the repercussions of depriving adolescents of social transitioning. Forcing trans people to wait until adulthood deprives them of a childhood where they can be their full selves. Gendered socialization is also missed, dumping adult trans people into a new gender role without the experience to handle delicate gendered social situations such as dating or employment. Trans women are often perceived as too aggressive after transitioning in the workplace, thanks to sexist gender expectations. Allowing for an earlier social transition would let trans adolescents learn how to handle these situations on the same time scale as their cisgender peers.

However, those most invested in maintaining a strict gender dichotomy are the same crowd thats ardently opposed to the existence of trans people, especially trans kids.

Beyond the larger questions over how to treat gender expansive and dysphoric children, the Luna Younger case serves as yet another battleground in the conservative war against the transgender community at large. What concerns Jane, the Dallas-area parent of a trans child, though, is how powerful state and federal officials have taken aim at individual trans children in order to push their political agenda.

Im really concerned about what this looks like moving forward in politics that our politicians here in Texas, our legislators that are supposed to be protecting all children, are explicitly targeting a 7-year-old for their own political gain, she said. Thats really frightening that theyre stooping to those levels.

In addition to Governor Abbott, Texas Sen. Ted Cruz and the presidents son, Donald Trump Jr., a frequent commenter on trans issues, also chimed in on the case, both calling Lunas transition child abuse.

Riding the wave of conservative outrage, Texas legislator Matt Krause has floated the idea of banning the use of puberty blockers in gender dysphoric children in the state, a move which, if replicated in other states, could rip thousands of adolescents off of gender-affirming treatment and force trans girls like Luna to develop facial and body hair in addition to stereotypically male secondary sex characteristics without her consent. Or it could force her to travel hundreds of miles out of state to seek the same treatment.

Fellow Republican legislator Steve Toth promised on Twitter that the first bill in the next legislative session in 2021 would aim at designating affirming a trans childs gender identity as child abuse under state law. This would mean the state would legislate the clothes, name, and hair of a child.

The movement against trans kids has also spread beyond Texas state lines. Early last week, Georgia Republican state Rep. Ginny Ehrhart proposed the Vulnerable Child Protection Act, which would make it illegal for medical providers to consider any treatment which would result in sterilization, mastectomy, vasectomy, castration and other forms of genital mutilation, many of which are not treatments considered for trans adolescents. However, Ehrharts bill would also ban puberty blockers and cross-sex hormones for every individual under the age of 18. A similar bill has also been floated by a Kentucky state lawmaker following the Younger case.

Among the disinformation tossed around by conservative media recently was a report that the puberty-blocking drug Lupron was responsible for the death of thousands of people. However, an NBC News report on the controversy found that the drugs primary usage is to treat hormone-dependent cancers such as terminal prostate cancer and the drug was used as part of treatment and was not the cause of death in those cases.

Branstetter said that the Younger case in particular is dangerous because its so personal for one family. This has been a constant disinformation war amongst a legion of conservative media sites that has sought to disparage transgender people and to fear-monger about our health care, she said. To play into those hands, as the governor has done in this case, its exploitative. It is using a family and a child as a means to score political points and youre doing so without their consent.

Jane said the attention to the case has given her serious doubts about her public advocacy as a parent of a trans child in Texas. She has hired IT professionals to monitor her familys tech and installed additional security cameras around her house. Its been really, really stressful, intense, she said. And lots of tears, lots of sleepless nights. And lots of phone calls from other people figuring out how they can support this family.

Already, the attention from state and national conservative politicians has had a chilling effect on trans-supportive parents. Several Texas-based parents of trans kids declined to speak with Vox for this story because they were specifically afraid of the governor calling CPS on them. Branstetter notes that many parents of trans kids keep whats called a safe book, which documents every instance of observable gender dysphoria and every medical and psychological appointment because strangers who disagree with allowing children to socially transition often call CPS with accusations of child abuse. One clinician who was approached for an interview for this story had been told by their institution not to comment for a piece that mentioned ongoing litigation.

While Texas families with trans kids fear official government retaliation for supporting their childrens transitions, the family at the center of the case is left to deal with the fallout. Lost in the media frenzy and the court dispute has been Lunas own voice on the matter. In her young mind, what this boils down to is she thinks that all of this court stuff is so she doesnt have to cut her hair anymore, Karen Hirsch, a family friend of Georgulas who is acting as a media contact, told Vox. Thats what it comes down to for her. She just wants to be a girl. She doesnt want all of [this] conflict.

As of last week, Judge Cooks granted Younger an extra school day of custody a week. Hirsch said that Younger dressed Luna as a boy and sent her off to class on Tuesday. When she arrived, the teacher had extra clothes and said that if you want to change, you may change, Hirsch said.

And when mom and dad werent around and couldnt influence Luna one way or the other, what did she choose to do?

Hirsch said Luna chose to wear the dress.

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The battle over Luna Younger, a 7-year-old trans girl in Texas, explained - Vox.com

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