Archive for the ‘Hormone Clinic’ Category

While she has been given the green light to start treatment, not everyone has been so lucky.

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Associate Professor Peter Illingworth, medical director of IVF Australia, wrote to patients warning that while the fertility provider was "aiming to accommodate everyone who contacts us ... we will not compromise the care IVF Australia can offer you, by taking on too many patients at once".

Those patients whose had already had a cycle postponed due to the COVID-19 epidemic, were "short of time by being aged 40 or above, had a low ovarian egg number or had already completed three full cycles with IVF Australia" would be prioritised, the email said.

Dr Anne Clark, medical director of Sydney IVF clinic Fertility First, Sydney, said it would not be a simple case of booking a procedure when the ban lifts on Tuesday, as many clinics were operating on a skeleton staff and some patients had stopped their hormone treatment.

"Many women and couples have had to delay treatment when their time to have a child is already very limited," Dr Clark said.

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"For many women, their cycles will be out of synchronisation."

Professor Luk Rombauts, vice president of the Fertility Society of Australia, said families seeking IVF treatment had "often been trying for two or three years with lots of mishaps along the way" before seeking treatment.

"They don't rock up on our doorstop with a new problem ... By the time we see them, they're new to us, but they've already had a significant journey behind them, including a couple of miscarriages, perhaps," he said.

"So for them to be told ... they would have to postpone or delay their treatment for an indefinite period of time because no one knew whether this was going to be six months or a year that was understandably very devastating and very hard for us to communicate to our patients."

Professor Rombauts said it made sense to restore IVF services early in the elective surgery restart, as patients with fertility problems were "otherwise generally healthy, and they're quite young".

"So, if some of them were to accidentally somehow get infected, the implications of that is probably less than for older people who need a colonoscopy," he said.

Fertility industry guidelines were being distributed, outlining best practice for the use of personal protective equipment and COVID-19 testing of patients deemed at risk.

"Testing patients when they come in is probably one of the best ways we can minimise the risk of infection," Professor Rombauts said.

Dana is health and industrial relations reporter for The Sydney Morning Herald and The Age.

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Fertility patients eager to restart IVF treatment when ban lifts - Sydney Morning Herald

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Weekly Update: Global Coronavirus Impact and Implications on Endometriosis Treatment Market Projection By Top key Players, Share, Size, Demand,...

Our hands are at the frontline of our personal battle against Covid-19.

Weve all learnt to wash them regularly, for extended periods of time, and to slather them in hand sanitiser when needed. But for many, the flip side of all this attention is flaky or dry skin, exacerbated by the fact that we are spending more time indoors, with the air conditioning on.

We are seeing more dermatitis of the hands than usual, as the alcohol in hand sanitisers as well as the act of washing hands more frequently are both drying out the skin

Dr Mariam Khalfan Al Suwaidi

With Covid-19 requiring frequent handwashing and sanitising, and with most people staying at home, as well the onset of summer and Ramadan, we should be taking more care of our skin, says Dr Mariam Khalfan Al Suwaidi, consultant dermatologist and head of Healthpoints department of dermatology.

"At Healthpoint, we are seeing more dermatitis of the hands than usual, as the alcohol in hand sanitisers as well as the act of washing hands more frequently are both drying out the skin. Some sanitisers and soaps contain chemicals and perfumes that irritate the skin, and cause contact dermatitis, she adds.

After washing your hands for the prescribed minimum of 20 seconds, ensure they are completely dry and then make a habit of applying some moisturiser. Al Suwaidi recommends a skincare, rather than cosmetics, range with as few perfumes, chemicals and potential irritants possible.

Using moisturiser will not neutralise your handwashing efforts, or leave you more vulnerable to infections, notes Dr Rutsnei Schmitz Junior, a dermatologist at Medcare Women and Children Hospital. He also recommends that you moisturise immediately after washing your hands, using a pea-sized amount of lotion that you rub into both hands.

Use moisturisers with mineral oil or petrolatum they are the ones that you squeeze out of a tube, not the ones that you pump out of a bottle. Choose fragrance-free and dye-free moisturisers, as these are less irritating to your skin.

If you suspect that you are suffering from more than your run-of-the-mill dryness, Al Suwaidi recommends consulting with a dermatologist; she is currently seeing patients through video calls to maintain social distancing. If you have a flare-up indicating dermatitis, with symptoms such as red, cracked, itchy or burning skin, it should be evaluated by a dermatologist to ensure it is not accompanied by a bacterial infection.

Heightened anxiety and stress levels, as well as disrupted sleeping patterns, may also be having an adverse affect on your skin, suggests Dr Fiona Cowie, an aesthetician at Dermalase Clinic in Dubai.

It is important for our skin that we stick to a regular sleep pattern otherwise our bodies release more cortisol which is the stress hormone. Cortisol can cause flare ups of acne, eczema and psoriasis. Exercising regularly at home will help to reduce cortisol as well as reducing stress and anxiety, leading to clearer skin.

If you are suffering from perpetually itchy skin, Cowie suggests acquiring a humidifier. Also, avoid long hot showers, which can further dehydrate your skin and take shorter, lukewarm showers instead. And do not become over-reliant on the hand sanitiser. Its alcohol content is far more likely to dry out your skin, so rely on good old fashioned soap and water instead.

Avoid washing in excessively hot water, as this can strip the natural protective oils from your skin. Make sure you use a moisturising soap, soaps that have glycerin and lanolin in them are excellent moisturisers, suggests Cowie. Try to avoid bar soaps, and use liquid soaps instead as these have a lower pH and are less drying to skin. And try to pat hands dry rather than using rough towels to avoid disrupting the natural skin barrier.

A good tip is to leave a moisturiser next to every sink and get into the habit of applying it after every hand wash. Using gloves as much as possible for household chores will also help to protect your hands. Finally, if you suffer with a skin condition that has become worse during lockdown, try to avoid foods with a high glycemic index, such as cereals, rice and white bread, and replace them with foods that are rich in antioxidants to boost your overall health.

As the weather heats up, you should also be doing your best to stay hydrated, especially if you are fasting, as this will have an impact on the skin all over your body.

As a special treat, why not try a DIY hand mask, says Galina Antoniuk, director of Anantara Dubai Spa. Hand masks are a skin conditioning, nourishing treatment, improving the appearance of the skin and are usually used after exfoliation, which removes dead skin and improves circulation.

"Note that hand masks can be prepared at home. Add 2/3 cup of sugar to a jar or container of your choice (whatever sugar you have in the pantry is fine). Add 1/4 cup of either coconut oil or olive oil. Apply to hands and rub together. Rinse and apply hand cream.

Updated: April 27, 2020 08:39 AM

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Dry hands from constant washing? Here are some tips on how to counter the flaky problem - The National

According to some of the more dramatic pandemic predictions, as many as 150 million Americans will come down with COVID-19 before a vaccine becomes widely available. While avoiding it altogether is the ideal scenario, as the virus continues to spread, for many, infection is inevitable.

Given that unfortunate reality, building up a personal defense system against an invisible enemy is paramount, according to the experts.

In March, Banner Health published a blog post: How You Can Boost Your Immune System, with the message: A strong immune system is the ultimate defense against illness, whether its COVID-19, seasonal flu, or something else. The posts advice is largely mundane: Get eight hours of sleep, eat nutritious foods, exercise, hydrate, and do what you can to reduce stress in an incredibly stressful time.

Most people understand that adopting healthier habits is a good idea, but can these habits really boost your immune system so that a coronavirus infection looks more like, say, a common cold? Jessica Lancaster, an immunologist researcher at the Mayo Clinic, thinks its a distinct possibility.

If you had two people with the same virus exposure and very similar genetic makeup, Lancaster said, and if one had been better overall sleeping, eating well, and exercising that person would most likely be much better off than the person who is not caring for themselves as well.

The microscopic novel coronavirus typically enters the body through the nose, she said. From there, it begins a deliberate and dangerous process of multiplying and penetrating deeper down the respiratory tract and into the bloodstream. A spry immune system bolstered by exercise, healthy food, and plenty of sleep will harass the virus before it wreaks the kind of havoc that requires hospitalization, ICU admission, or a ventilator.

Essentially, the immune system is a collection of cells, surveilling our body for unwelcome visitors: viruses, bacteria, various toxins, and cancer. When something isnt right, alarm bells go off and the immune system springs into action to make things right.

Jessica Lancaster, immunologist at the Mayo Clinic

YouTube/Mayo Clinic

Our immune systems ability to react to alarm bells and fight off foreign intruders depends on a multitude of factors. Among them are our age, where we live, what we do for work, and three biggies: good sleep, low stress, and healthy eating. These things have a profound effect on two major contributors to our immune systems sharpness: chronic inflammation and cortisol levels.

In the case of COVID-19, the virus hijacks lung cells and eventually damages them to where they become inflamed. But when there is chronic inflammation in people, such as those with preexisting conditions like heart disease or lung disease, the immune cells are worn out or lulled to sleep.

In these cases, Lancaster said, [immune cells] are kind of used to hearing these signals over and over again. When they have to actually respond to something, they're already exhausted.

For example, if you are regularly exposed to toxic chemicals that cause inflammation, like cigarette smoke, you can have a boy that cried wolf situation, where the body gets jaded to these constant warning signs of trouble and is slower to respond.

For someone with COVID-19, any kind of delayed immune response can be catastrophic.

When you have something that is quite aggressive like coronavirus, which can strike really quickly if you have a lagging immune response, that can be devastating because by the time everything is mobilized, its too late. There's too much damage to the lungs, Lancaster said.

One simple way to avoid inflammation is to avoid overeating. If you eat too many calories, it can be hard for your body to regulate its blood sugar. And that leads to inflammation, Lancaster said, adding that this kind of blood sugar-induced inflammation tends to affect the kidneys, liver, and pancreas.

When it comes to supplements, Lancaster is ambivalent. But she admitted that when she gets sick herself, she takes zinc lozenges. She cited some inconclusive evidence that Vitamin C may have some antiviral properties or may be simply reducing inflammation across the body.

Cortisol is another of the bodys loud alarm bells. It is our primary stress hormone, and according to Lancaster, it can cause drastic changes to the way that your cells can function on a genetic level. A burst of cortisol here or there can help you spring into action to avoid a threat, but too much, too often can leave your body stuck in an uncomfortable, unhealthy kind of overdrive.

Lab research shows that immune cells can't fight viruses as well when they are injected with cortisol. In 2018, researchers at the University of Kent found cortisol levels to be a critical factor at play in leukemia cases, showing that the stress hormone hinders the immune systems ability to incapacitate intruders before they really get destructive.

Reading, meditating, and especially exercising may lower cortisol levels in people.

Exercising has the added benefit of helping you get your eight hours of sleep, all of which helps reduce inflammation and regulate stress hormones.Last week, a cardiovascular researcher at the University of Virginia released findings suggesting that an antioxidant that is naturally released during exercise can significantly reduce the risk of suffering fromacute respiratory distress syndrome, a severe problem that occurs in 20 to 42 percent of hospitalized COVID-19 patients. Exercise, the research found, boosts production of an antioxidant known as extracellular superoxide dismutase, or EcSOD, which "hunts" atomic free radicals that can harm the body's cells.

Beth Jacobs

University of Arizona

"We cannot live in isolation forever, said Zhen Yan of the University of Virginia School of Medicine in an April 15 University of Virginia news release. "Regular exercise has far more health benefits than we know. The protection against this severe respiratory disease condition is just one of the many examples.

Beth Jacobs, a nutritional epidemiologist at the University of Arizona, is wary about making any promises about how any type of immune boosting can influence ones chances of coming down with a bad case of the virus.

"We know essentially nothing about COVID19 yet," she said in a recent interview.

In lieu of more specific knowledge about the virus, she echoes Lancasters sentiments about the importance of healthy habits. When it comes to immunity, she said, it is all about the three interlocked concepts, which are diet, physical activity, and sleep.

Essentially, [sleep] is the time when you're repairing what's happened during the day, Jacobs said. It allows you to heal up to take on the next day.

While science has yet to uncover the inner workings of sleep, Jacob says we can infer its value from its incredible cost. Our ancient ancestors risked being eaten while they laid motionless for hours a day for it, she pointed out.

She urges persistence and patience in developing new, healthy habits, stressing that we are still at the very beginning of the pandemic. Try new recipes and get outside, Jacobs urged.

Use the time to go outside and walk," she said. "And if you've never walked before, just take a 10-minute walk, and then a 15-minute walk next week. Just keep going."

See original here:
Boosting the Immune System Really Does Help With COVID-19, Experts Say - Phoenix New Times

In the United States, across the countries various medical clinics are actively involved in the advertising activities for hormone treatment. Many people believe that hormonal treatment as a source of youth. Medical clinics marketing and selling hormonal treatment as an alternative therapy to make individuals feel and look younger. Though, the further research and investigation of CBS News found that the particular claim regarding hormonal treatment is not right and may be harmful to the patient life.

In 2018, Cindy Kinder-Binge, a woman of 60 years had admitted to a hospital-based in New Albany, Indiana, for the high blood pressure and excess heart rate related issues. She had registered with the four times heart rates, which are very high as compared to the normal one. Prior to this incidence, she had undergone an emergency situation with the palpitations. Cindy Kinder-Binge was treated by a nurse practitioner at 25 Again clinic. In this clinic, she had been prescribed hormone of thyroid for the menopausal symptoms such as hot flashes, irregular periods, night sweats, mood changes, and weight gain and slowed metabolism despite having normal thyroid blood levels. CBS News found that there are many more clinics throughout the country which are prescribing testosterone and thyroid hormones to individuals with standard levels.

According to the Cardiologist, hormonal therapy was the major cause of abnormal heart rates in the case of Cindy Kinder-Binge. Doctor Leighann Decker, who is currently working as an ultrasound technician and previously employed with OB-GYN in Owensboro, Kentucky stated that she had also given prescription of testosteroneto the many patients who had normal level testosterone. She also stated that many medical practitioners are involved in hormonal therapy as there is a huge profit in practice. Some research studies suggest that the adoption of hormonal therapy, such as thyroid and testosterone, may lead to an increased risk of stroke or heart attack.

Related

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Hormone Therapy May Lead To The Heart Rates Abnormalities And Possibilities Of Stroke - TheLoop21

Accessing NHS fertility treatment involves a tremendous amount of patience at a period in your life when you have least time to spare. It was 14 months after my first tearful appointment with my GP that I lay on an operating table at Manchesters Saint Marys hospital last year, squeezing the anaesthetists hand as he put me under heavy sedation so that a doctor could stick a needle up my vagina to hoover out my eggs. I was 38 and had been told there was a 20% chance IVF would result in me finally becoming a mother.

My clinical commissioning group started a consultation on cutting all funding for fertility treatment

I felt miserable, a failure. Id failed to meet the right man until I was 35 and now my ovaries were failing me too. Coming round from the egg collection, I started blabbering deliriously about a school friend who fell pregnant at 16. We all thought she was nuts to keep the baby. But maybe she had the right idea, I wailed at the nurse, as she handed me a cup of tea and a biscuit.

All of the resulting embryos were frozen so that my body, battered after the hormone injections, could go back to normal. Christmas approached and the clinic began its annual shutdown. More waiting. It wasnt until early March that the doctors allowed me to finally prepare for an embryo transfer and I started taking HRT to override my natural menstrual cycle. It seemed particularly cruel that in order to outsmart my ageing reproductive organs I had to take menopause pills. Still, I thought, it would all be worth it if it worked.

I was supposed to have the transfer the week beginning 23 March. You know what happened next. All fertility treatment was suspended. My embryos would stay in the freezer. For how long? Nobody knows. Ive had a lot of time to brood during lockdown. Sure, being pregnant during a global pandemic wouldnt be much fun, but what if coronavirus takes away my one-in-five shot at motherhood? Where I live, women under 40 are entitled to two NHS-funded IVF cycles (one fewer than recommended by Nice, the national body that advises clinicians). It is not clear whether I will get my second if the clinic does not reopen before I turn 40 next year.

Now I hear Saint Marys the first ever NHS IVF clinic and my local centre may close for ever in April 2021 after hospital bosses said they could not afford a 10m refurbishment. Reproductive medicine is not, it seems, a priority, even when it comes with world-class research in tow. I knew the hospital had seen better days. The day I went for egg collection it had been raining and there were buckets and what looked like incontinence pads catching the drips from the ceiling. Im glad the lift was working that day: I discovered later that for a while staff had had to practise carrying a loaded stretcher downstairs in case they had to evacuate a patient who fell ill under sedation in the weeks before the lift engineer arrived.

It now feels inevitable that IVF will be rationed even further, particularly at a time when the NHS is under so much pressure. Can it afford to help create new life as well as sustain those already in existence? Last year my local clinical commissioning group started a consultation on cutting all funding for fertility treatment, which it said would save almost 700,000 a year. Five other CCGs have already stopped paying for any IVF cycles, according to the Fertility Network. Its a classic postcode lottery: if our house were half a mile away we would get three cycles on the NHS.

The NHS is currently buckling under the strain of coronavirus, and I know Im part of a long line of patients waiting for deferred operations or specialist appointments, many far more urgent than mine. When the worst of the pandemic has passed, a huge backlog awaits not to mention an almighty budgetary black hole, which will surely exacerbate the decline in publicly funded fertility treatment.

I also know that some people may have no sympathy for people like me. We should have procreated at least a decade earlier, maybe even two, like my high-school chum. Having a child is not a human right, particularly on our overpopulated planet.

Perhaps you have your own children, conceived the traditional way. But what if you, like me, were infertile? Would you have sought out NHS treatment to have your precious offspring? Should fertility assistance be yet another luxury available only for the rich? I dont have the answers. I just feel sad.

Continue reading here:
Coronavirus has slashed my chances of IVF treatment - The Guardian

CNA Staff, Apr 24, 2020 / 12:17 pm MT (CNA).- The president of the Scottish bishops' conference wrote Friday to the Scottish health secretary, saying the permission for women to self-administer both stages of a medical abortion at home during coronavirus is born of ideology rather than true concern for women.

I believe it is profoundly depressing that in the midst of this unprecedented global pandemic when the resources of almost every government on earth are being diverted towards the preservation of life, especially the lives of the weak and vulnerable, the Scottish Government continues to act to end the lives of the weakest and most vulnerable members of society, the unborn, Bishop Hugh Gilbert of Aberdeen wrote April 24 to Jeane Freeman, Scotland's Cabinet Secretary for Health and Sport and a member of the Scottish National Party.

It is more than disheartening that the Scottish Government should see fit to promote abortion at home as though this were a trivial matter equivalent to taking any other medication at home. A position like this appears to be more a matter of ideology than of genuine and dispassionate concern for womens wellbeing, the bishop, a Benedictine, wrote.

The Scottish government has lifted restrictions on at-home medical abortions during coronavirus.

A medical abortion is a two-step process that involves the ingestion of mifepristone and misoprostol. Mifepristone blocks the effects of the progesterone hormone, inducing a miscarriage. Misoprostol is taken up to two days later, and induces labor.

Women in Scotland have been able to self-administer misoprostol in their homes since 2018. However, until recently, they had to take mifepristone at a clinic.

The medications will be delivered by mail.

Because of coronavirus-related lockdowns, the Scottish government has allowed at-home self-administration of mifepristone as well, following a phone or video consultation with a doctor.

A similar permission was made in England last month, and Sinn Fin's leader in Northern Ireland has pressed for a similar change in that region.

Bishop Gilbert said he found the Scottish government's decision deeply troubling.

He said that while mifepristone and misoprostol not only end the life of an unborn child, they are also a risk to the health of its mother, noting that even in the best of circumstances administration at a clinic with several hours of clinical observation there is a real risk of severe bleeding and sepsis in a small number, and a need for further surgery in a larger proportion, depending on the stage of the pregnancy.

The bishop added that vulnerable women in unsatisfactory domestic circumstances are particularly at risk.

He asked whether, under the new policy, women are receiving information on all available options including details of organisations which can offer support to both the mother and the baby, if enough time is given to counselling during the consultation, and is it appropriate for drugs which end the life of a human being to be sent by post, trivialising what is an extremely serious and life-changing procedure.

Aside from the Scottish Bishops Conferences absolute opposition to abortion, there are also serious practical concerns involved here, he said. The decision to allow women to take potent abortifacient medications in a largely unsupervised manner at home is not only fatal for the innocent human beings in the womb but also constitutes a real risk to womens present and longer term health and wellbeing.

Bishop Gilbert added that it is of particular concern that there is no way of establishing that a woman is not being coerced into an abortion in the context of a poorly safeguarded online consultation.

In the current situation, there is already an increase in complaints about domestic abuse since the Coronavirus restrictions were put in place. It is far from clear how the Scottish Government proposes to set in place the prudent support procedures which permit all the relevant factors in each individual case privately and without coercion.

See the rest here:
Scottish bishop: Permission for wholly at-home medical abortion is ideological - Catholic News Agency

NewsHealthHuman Fertilisation and Embryology Authority has stopped all fertility treatment at NHS and private clinics due to lockdown measures

Thursday, 23rd April 2020, 4:46 pm

Thousands of women are increasingly fearful they will miss their last chance of becoming a mother due to the ongoing shutdown of fertility services across the UK amid the pandemic.

Last week, the Human Fertilisation and Embryology Authority (HFEA) decided to stop NHS and private clinics providing treatment and leaving patients with no idea when their IVF treatment is likely to resume. Women who had already begun a cycle of treatment, which includes being injected with a fertility hormone which increases the number of eggs your ovaries produce, were also told they could not continue.

Those affected say they have been left in limbo. One woman, Sian, who was about to start her second cycle of IVF before it was halted said: "My clinic, although I'm NHS funded, is a private clinic, and they do have the resources and the staff to be able to afford treatments in some cases.

"I do worry if this goes on for longer that it will be too late for me. We have been trying for a baby for a long, long time, and the effect it's having on my mental health, as well as my husband's, is enormous at times. While you do try to keep positive, ultimately I've sacrificed much of my 30s trying to achieve a pregnancy that just hasn't happened.

"I feel especially sorry for those women who have already had their injections because unless you've been through this process, you don't understand the toll fertility treatment has on you."

Unable to guarantee safe service

Sally Cheshire, chair of the HFEA, said one of the reasons why clinics closed was because they could not guarantee a safe service due to NHS staff being moved elsewhere to help with the coronavirus outbreak.

"A lot of equipment in embryology labs is now being used for coronavirus testing as well, so it's a mix of factors," she said. "We have huge sympathy for the thousands of patients who are not able to continue their treatment. In our 30 years of existence this is the most difficult decision the HFEA has had to take."

Exit strategy

The HFEA said in a statement: "We understand what a difficult and emotional time this is for fertility patients with fertility treatment ceasing from 15 April 2020 in line with other NHS and private healthcare.

"Any decision to allow fertility clinics to re-open will consider the views of the UK professional fertility societies and the impact that resuming treatment would have on NHS services. We also need to be assured that clinics are able to provide a safe service to patients and a safe working environment for clinic staff.

"We recognise the distress this closure is causing any patients awaiting fertility treatment and hope that those relying on NHS funding will be allowed to continue their treatment as they expected. We want to reassure patients and clinics that we are actively working on an exit strategy to enable fertility treatment to resume when Government restrictions on social contact and travel are lifted."

Dr Marta Jansa Perez, director of embryology at the British Pregnancy Advisory Service, said: We would advise that patients to contact their local Clinical Commissioning Groups as soon as possible to ask for written confirmation that funding will be maintained for treatment in the future, as we know this is a huge cause of concern for many. Individual IVF services should be able to provide their patients with up-to-date information about their current position, and also professional counselling."

See original here:
Coronavirus: IVF services shutdown in UK leaves thousands of women fearing they will be unable have children - inews

This article originally appeared on VICE Spain.

When I mentioned on Instagram that I've been having the weirdest dreams during quarantine, dozens of people replied telling me about their own dreams. I won't recount them here, because it's a universal truth that it's extremely boring to hear about other people's dreams.

But the fact is, my unscientific research revealed I'm certainly not alone in having more intense dreams during the pandemic or at least remembering them more. People said their dreams had been more disturbing, and often with highly unsubtle coronavirus symbolism: if we're not dreaming of empty supermarket shelves, we're fighting in the trenches. It appears our subconscious doesn't agree that war is a bad analogy for the pandemic.

Symbolism or not, the best thing about dreams is that they can't be completely explained. "Scientifically, dreams have always had, and still have, a certain essence of mystery surrounding them," said psychologist and private practitioner Francisco Lpez Cnovas, explaining that psychologists approach dreams like "detectives approach a crime".

"Doctors are interested in whether or not a patient has nightmares, because it can indicate that someone has suffered an experience that was difficult to take in psychologically," he said. "Sleep tends to be an activity that 'compensates' or reflects our psyche throughout the day."

A simple example would be that if we go to bed hungry, we could dream we're in a restaurant waiting for a great meal. During a pandemic we might dream of the various fears our subconscious is busy suppressing during the day.

Clinical psychologist Juan Antonio Membrive, who recently published a Twitter thread about why we've been having weird dreams during the pandemic, argued there is only so much we can know about what's happening in our subconscious but he did have a few theories.

Depressingly, Membrive basically said we're remembering more of our dreams because they're all we've got at the moment. "Throughout the day, when we have experiences that are meaningful or out of the ordinary, they function as 'markers' in our memory," he wrote. "We pay more attention to these events. During confinement, we have fewer experiences throughout the day, so it's easy for our dreams to stand out."

His second hypothesis concerned our attention and mood. "Dysphoric mood (or discomfort) and low stimulation are two conditions that increase your self-focus (focus on yourself and your own psychological reactions)," he said. "So we know that an altered mood can cause us to have more dreams and, above all, dreams with a greater emotional charge. Among them, nightmares."

Lpez Cnovas said the subject of our dreams was less to do with external events that happen to us, and more to do with our internal thoughts during the day. "To make dreams, the brain can start with events and real people, but we also find that it can create unknown images. Therefore, both children and adults can end up having a dream about something that they have never seen or lived through."

But how to interpret them? "In The Interpretation of Dreams, Freud explained that in his experience a dream is usually a hallucinatory realisation of more or less conscious wishes of the dreamer," said Lpez Cnovas.

As for dreams about conflict, threats and war, Membrive said, "The content of our dreams usually refers to aspects related to survival, such as threats to our integrity and our own health or other related themes such as aggression." He thinks our memories are more likely to grab onto these subjects in the current climate.

So if we can understand the mechanisms behind our dreams to some extent, can we control them? The simple answer is no. "There are people who naturally experience the ability of 'choosing' what to dream about or what to do within a dream. But even for these people, sleep is a largely autonomous process," explained Membrive. "You can train yourself in lucid dreaming. It's been used to treat chronic nightmares, with good results in some cases."

One technique is known as systematic desensitisation. "Basically, we repeat the problematic dream in our imagination while we are awake, but with a different ending or while trying to relax, as an alternative behaviour to the anxiety-inducing, threatening nature of the dream," Membrive explained. This technique is often used when a patient's nightmares get so bad they interfere with everyday life.

What we can do to try to prevent quarantine nightmares is keep our sleep patterns healthy, said clinical neurophysiologist Javier Albares, a specialist in sleep medicine from the Teknon Clinic of Barcelona. Our sleep patterns work to a circadian rhythm, which self-isolation can mess with. "Our internal clocks need three external synchronisers: light and dark, food and physical activity. Three factors that are very easy to lose in quarantine." He cited social relations as a fourth factor something that's currently especially hard to maintain.

But there are small things we can do. "Opening the curtains and blinds as soon as we get up tells our body that it's daytime, and gets us activated," said Albares. "The sooner you get some light, the sooner you'll be tired. The same goes for darkness: two or three hours before sleeping, we should start telling our bodies that it's night, so that we secrete the sleep hormone melatonin."

Maintaining some semblance of an eating routine, even if that means routinely eating cereal in bed, will help to "mark the rest of the routines in our day", he explained, while physical activity also aids sleep. Lastly, he recommended we put ourselves on an "information diet" regulating the time we spend scrolling constant news updates and trying some meditation or mindfulness instead.

But if none of the above works and your dreams still feel like a Tarantino remake of Apocalypse Now, maybe it's time to start a dream journal. Just remember: the excitement you feel when retelling a dream is directly proportional to the torture experienced by the person forced to listen.

Read the original here:
This Is Why You're Having Such Wild Quarantine Dreams - VICE

If your motivation to exercise and eat right has flatlined, youre not alone.

Falling out of routine is a normal reaction to change at the best of times, and were certainly in unique times. Having more time to forage through the pantry or refrigerator while binge-watching the news is wreaking havoc on fitness plans and waistlines everywhere.

Hey, if youve got time right now, use it to do productive things such as exercise. If youre trying to survive financially, balance work with taking care of kids and keep the house in order, its OK to cut yourself some slack.

You decide what you can commit to. If fitness helps maintain your sanity, like it does for me, keep making it a priority, but dont stress if you cant. Fitness is not a race and your goals can wait. Trust me, most of us, even fitness professionals, are sucking wind right now. Theres been a lot of change, added stress, and uncertainty.

However, if youre eating recklessly and not getting any form of exercise in, youre probably making things worse. Try to do your best to create an environment that minimizes the damage, and thats what this article is all about.

First off, its awfully tough to gain pounds of actual body fat over the span of a couple weeks.

What your body cannot process for storage, it tries to burn (your temperature rises) and excrete (you end going to the bathroom a bit more in the following 12 to 24 hours).

The only way you couldve gained an actual pound of fat overnight is if you ate something like five fast food burgers in excess of your BMR (the baseline calories needed to maintain your weight).

So you probably didnt eat 5,000-plus calories in one sitting, am I right? Yes, your scale weight will be up a lot. The excess stomach content and water weight will drastically skew the number for a day or two. Its temporary if you cut yourself some slack and use the tips in this article to help guide you forward.

Junk Food Cravings Explained

First, though, what is it about chocolate, pizza and sweets that make it so hard to stop at "just one"? You know these foods arent good for you in excess, so why do you indulge? Is it the forbidden fruit mentality? You want what you cant have?

For starters, your brain loves junk food. They are energy-dense (i.e. high in calories). Good news if youre a hunter-gatherer and nutrients are scarce, but bad news nowadays with endless food at your fingertips.

Your brain releases dopamine when your mouth and small intestine detect the base materials in sugar, fat, and protein. The more concentrated the nutrients, as in junk food, the greater the surge in dopamine and the more immediate your craving. Essentially, your brain is doing its job by encouraging you to pursue calorie-dense foods, but your brain chemistry simply wasnt built for the world you live in today.

You need simply take a passing glance at that timely pizza promotion in your mail and crave it because the sensory cues are so innate. Then, with a few clicks on your smartphone, that cheesy delight arrives at your doorstep.

Other factors that exasperate cravings can be brought on by high stress and poor sleep.

Inadequate sleep decreases levels of leptin, the hormone that signals satiation, and increases levels of the hunger-signalling hormone ghrelin. A joint study by the National Institutes of Health, the Minnesota Obesity Center, and the Mayo Clinic showed that when the test subjects were sleep-deprived, they ate an extra 549 calories per day.

Similar problems are encountered when the stress hormone, cortisol, is chronically elevated.

Tiredness, of course, also affects motivation and leads to missed workouts, lower activity levels overall and poor food choices.

Overcoming Social Norms

Our society associates eating with leisure, however you may be spending more time on the couch. Which leads to watching more Netflix, which can lead to more grazing.

These are powerful social cues to overcome, but itll take replacing old habits with new, healthy ones to buck those trends. Start by eating a filling, healthy dinner so you arent so tempted to snack at night. Try to do some form of exercise before settling into your TV routine. Keep it simple and short to start with and build up from there.

Set up Your Environment

Now, heres a quick checklist to survive the remaining time in isolation with your health and waistline intact.

If its not immediately in your environment, youre probably not going to eat it: So keep it out. Yes, you may need to stock up on snacks for the kids, but limit exposure to your kryptonite foods.

If it has to be in the house, put up "walls" in front of it. Keep the junk food in less visible and less convenient locations. For example, if you need it in the house for your kids, keep ice cream in the downstairs freezer and hide it under a stash of frozen vegetables if necessary.

On the opposite end of the spectrum, take down the "walls" in front of making healthy food choices. For example, keep a fruit bowl out on the counter, not a bowl of candies. Keep refrigerated vegetables on the front and middle shelves of your refrigerator, and keep more "off plan" refrigerated items near the back (or perhaps in the drawers).

Keep to a schedule of planned dinners you prepare and food prep some lunch essentials ahead of time, particularly proteins and starchy carbs, which cant really be figured out on the fly.

Dont buy super-sized portions you might binge on only indulge in controlled amounts.

If you live with others who bring junk food home, get their support by at least getting them to agree to hide it in a place only they will know to find it.

Prepare your meals as you normally would for your job and have them ready in the fridge, eating meals on the same schedule.

Eat more whole, fresh, minimally processed foods with a balance of macronutrients, protein, carbs and fats so you arent "shortchanging" your brain from much-needed nutrients (i.e. limit cravings)

Eat slowly and mindfully. No matter what you eat, slowing down will help your digestive system do its job and also help your brain get the signal from your gut that its full.

The best kept secret is not to depend on willpower but to have an alternative option at the ready that meets your goals. Find your go-to healthy meal or snack options and make sure theyre staring at you when you open the fridge or pantry or are offered something youre trying to avoid. Hey, if you slip up, dont see fitness so black and white. A few slices of pizza arent going to ruin your progress if you see it that way.

Mitch Calvert is a Winnipeg-based weight loss coach who regularly contributes to Mens Health and has helped over 1,100 people realize their fitness goals. Visit mitchcalvert.com to grab yourself a free diet secrets checklist to get started.

More:
Food, fitness and the virus - Winnipeg Free Press

This week, reports emerged that former baseball player Alex Rodriguez and his fiance Jennifer Lopez are eyeing a bid to buy the Major Leagues Baseball (MLB) team, New York Mets. However, with Rodriguez's extensive history with using performance-enhancing drugs, should such a sale be allowed?

In an earlier report, we had written that Rodriguez had opened up to 'The Tonight Show' host Jimmy Fallon about his inclination towards launching a future bid for the Mets and also confessed how he grew up a Mets fan before winning a world series with the Yankees. "I will say this, if the opportunity came up (to buy the Mets), I would certainly look at it," he told Fallon. He also went on to say how the 1986 championship-clinching game was one the best nights of his life after the birth of his daughters.

While Rodriguez now has a thriving career as a baseball analyst, commentator and host and enjoys the limelight coming from being engaged to actor, dancer and singer Jennifer Lopez it is difficult to erase his baseball career. Even though he was once dubbed the greatest baseball player of his generation, his achievements were marred by cheating scandals.

His playing career had resulted in one World Series title, three MVP awards, 14 All-Star appearances, 696 home runs and earnings of $452M the most in the history of Major League Baseball.

The Biogenesis scandal, which resulted in Rodriguez's suspension, broke out in 2013 and was the biggest baseball performance-enhancing drugs (PED) scandal, but Rodriguez had been caught using performance-enhancing drugs much before that.

In July 2007, former outfielder and steroid-user Jose Canseco called Rodriguez a "hypocrite" and alleged that the latter was using steroids something Rodriguez vehemently denied.

In 2009, Sports Illustrated reported that Rodriguez had tested positive for two anabolic steroids, testosterone and Primobolan, during his 2003 season playing for the Texas Rangers. This was the same season in which he captured his first American League Most Valuable Player award, broke 300 career home runs (hitting 47 that year) and earned one of his 10 Silver Slugger Awards.

The same year, Rodriguez told ESPN that he had used PEDs when he first started out, stating, "When I arrived in Texas in 2001, I felt an enormous amount of pressure. I felt like I had all the weight of the world on top of me and I needed to perform, and perform at a high level every day."

In 2003, as the result of a collectively bargained union agreement, there was no penalty or punishment for a positive test during an anonymous drug survey and mandatory drug testing only began in 2004 after more than 5% of the samples taken from players in 2003 came back positive. In 2013, the New York Times alleged that Rodriguez tested positive for a banned stimulant in 2006.

It was the Biogenesis scandal that broke out the same year that catapulted the MLB, Rodriguez and other players of note to infamy. A disgruntled former employee of Biogenesis in America a health clinic briefly operating in Coral Gables, Florida, specializing in weight loss and hormone replacement therapy released records of the clinic's real business. These records showed that players such as Rodriguez, Melky Cabrera, Bartolo Coln, Ryan Braun and Nelson Cruz were getting access to PEDs, thanks to an unlicensed doctor.

Over the next two months, MLB suspended 14 players. Meanwhile, penalties for getting caught increased. First-time offenses went from 50 to 80 games, while second-time offenses went from 100 games to an entire season. Any offender caught doping is now ineligible for that year's playoffs, no matter when the infraction occurs.

For a long time, Rodriguez insisted he was innocent and even alleged that the MLB engaged in a "witch hunt" to get him out of baseball when he sued the league in 2013. Rodriguez and his team voluntarily dropped the suit in February 2014.

In 2019, Billy Corben's documentary on the scandal titled 'Screwball' released and oddly, news of Rodriguez's engagement to Lopez broke a day after the trailer for the documentary released. In an interview with Rolling Stone, Corben described the scandal as Florida f**kery distilled like freebasing Florida f**kery and crony capitalism".

Although Rodriguez has since apologized for his role in the Biogenesis scandal, Corben was suspicious of Rodriguez's image rehab. Corben told Rolling Stone, "This is the guy who was never beloved. He was booed by his own fans, for crying out loud. Without so much as a mea culpa tour, he hasnt rehabilitated his image, hes created an entirely new one that never existed before."

In August 2013, Rodriguez was suspended through the 2014 season (211 games at the time of the decision), but was allowed to play in 2013 pending his appeal of that decision. His suspension was upheld in January 2014 after being allowed to play in the 49 games between the decision and the hearing, technically reducing the suspension to 162 games. In July 2014, Rodriguez was sued by his lawyers for $380,000 in unpaid legal fees.

In November that year, it was revealed that Rodriguez had admitted to the Drug Enforcement Administration that he had used performance-enhancing drugs as early as January of the same year and Rodriguez got immunity from prosecution.

Many have also called into question MLB's handling of the Biogenesis scandal, suggesting that the MLB's actions were motivated to save face rather than to take serious action on the use of PEDs among players.

Given Rodriguez's lengthy history of association with PEDs, it stands to question whether the one-time-great baseball player ought to be given the power of owning an entire baseball team and whether the MLB would even allow it.

However, with Rodriguez's new image and with Lopez's name included in the deal, it stands to reason that the MLB would be okay with Rodriguez being one of the owners of the New York Mets, even if that may leave baseball lovers with a sour taste in their mouths.

As 'Screwball' filmmaker Corben said on the Biogenesis scandal, "When Alex was useful as a heel, he was the villain. When Bud Selig needed to salvage his own reputation as the steroid commissioner and was trying some kind of redemption and legacy-saving measures, Alex was the villain. And now that Bud Seligs gone, (current commissioner) Rob Manfred, who was responsible for this entirely botched, potentially illegal investigation of Biogenesis, ascends (within MLB) into a position of power and decides, "Oh, Alex is an ally." They let bygones be bygones now? Like after the s**tshow that they put each other through? It certainly goes to show how not legitimate MLBs concerns are about steroids and shooting up in baseball, because its obviously good for business."

Link:
Given Alex Rodriguez's history with doping scandals, should he be allowed to own New York Mets? - MEAWW

Following the announcement of the UK lockdown in March, we have all had no choice but to quickly adapt to a different way of living in order to ensure the safety of ourselves and others.

Our daily routines have been completely altered, many of our plans postponed or cancelled, and we have been unable to meet relatives and friends who we may ordinarily have seen on a regular basis. It has been tough for everyone. Unfortunately, the situation is especially difficult for the younger members of our community who are in lockdown with unsupportive families.

Research by LGBTQ youth charity, Just Like Us, suggests that LGBTQ young people may struggle more at home than cis straight young people, as they are more likely to initially confide in friends rather than a family member; the reverse is true for their non LGBTQ peers.

For so many closeted young people including some Just Like Us volunteer ambassadors moving out of home for college, university or work is an opportunity to come out and build a support network. Meeting other LGBTQ young people and moving away from home has been a life-changing experience for many of us, who kept our identities hidden from our families for many years.

The closure of universities, colleges and workplaces means that many LGBTQ young people are now separated from their chosen friends and family, and are having to re-enter unsupportive households. My co-ambassador Nicole said, Having to go from being out and living on my own, then back to being closeted in a homophobic household, has hit hard.

Anna, another ambassador, whose family is Catholic, says, I came out to my family last year after I began my second year at uni and started dating a girl. I knew they wouldnt take it well initially, but thought they would at least be able to process what Id told them by the time I came home. Now Im back home [early] they barely speak to me and when they do, they criticise me for my sinful lifestyle Being back at home with my family has definitely taken its toll on my mental health.

Our trans ambassadors face additional problems. Joel says, Im really lucky to be isolating with people who are very trans friendly and affirming, but its medical stuff thats my concern. Its causing a lot of worries around my transition. Ive recently changed from getting my Hormone Replacement Therapy (HRT) injections to gel. Im due a blood test in two weeks, but my GP isnt doing any face to face appointments so I cant have one, and if I cant have my bloods okayed at safe levels on the new HRT, my endocrinologist will probably stop it until we can prove my liver is coping.

There are other trans folk who are in similar boats. My friend has missed one injection, as he has a condition meaning he cant self-inject, and the nurse wont make an appointment to inject him at this time. Others have had their gender affirming surgeries cancelled. Theres also the fact that Gender Identity Clinics are all closed right now, so the already ridiculous wait times (currently around 26 months from referral to first appointment and 20 months between appointments for the Newcastle clinic) are only going to be longer when all this is over.

At Just Like Us, we work with LGBTQ young people in schools, many of whom are not yet out to their friends and relatives. Now that schools are closed, these kids are with their families 24/7, and if they have not yet had the chance to build a support network, this could be incredibly isolating. Many will be suppressing their identities due to the fear of being rejected by their families, and with most currently entirely dependent on their families, akt (Albert Kennedy Trust), the LGBTQ youth homelessness charity, has advised LGBTQ young people not to come out to family during the lockdown, because of the consequences of a potential negative response. In addition, the possibility that university and college courses may commence online in September will come as a huge disappointment for those who are hoping to move away from unsupportive households.

But despite this, were coming together to support one another during these difficult times, and our LGBTQ young adults are finding great ways to support themselves and one another. As an example, the Just Like Us ambassadors have set up a WhatsApp group aimed at sharing (both LGBTQ related and more general) quarantine tips, including recipes, craft ideas and self-care advice. I think we may have also broken the world record for the number of pet photos shared in one group chat, and I am completely living for it. Ive learned so much from hearing about how other ambassadors are looking after themselves during this time.

Im looking after myself by trying new hobbies, connecting with friends and not beating myself up about everything, says Sophie. Ive found that making lists with friends of stuff you guys want to do once were out of lockdown has really given me some perspective on whats important.

Just Like Us have also launched a new social media campaign, #JLUatHome, in order to support young LGBTQ people during lockdown. The campaign has consisted of a range of content so far, including messages of support to isolated LGBTQ young people, film and book recommendations, as well as the opportunity to ask Just Like Us ambassadors questions. Through this period, we are really seeing the benefits of being part of an LGBTQ community that is still connected from afar.

If you are a LGBTQ young person, we would love you to join us by listening to our latest podcast episode, which you can listen to here. This month, ambassadors Isaac, Elly and Arber will discuss more in depth what its like being LGBTQ at home. If youre an LGBTQ teenager in the UK, we also want to welcome you into our digital ambassador team which is another way to be part of this incredible community.

Finally, if youre reading this article and want to help us to help LGBTQ young people during this difficult time, you can also make a donation to Just Like Us, but only if you are in a position to do so. You can make a gift here. Thank you!

Related: Volunteering for Just Like Us gave me confidence in my identity as a young, gay, mixed race Muslim.

Related: The invisible have voices too listen to trans youth.

Read the rest here:
School is out. Many young people are not - the impact of lockdown on LGBTQ youth - Gay Times Magazine

According to a national study conducted by The Williams Institute in Jan. 2017, West Virginia had the highest population of teens, ages 13 to 17, who identified as transgender, but according to data recently collected by Fairness West Virginia, 70 percent of transgender West Virginians said they have delayed accessing healthcare due to fear of discrimination. Following the collection of this data, Fairness West Virginia sought out to improve the livelihood of trans West Virginians by improving LGBTQ+ education in the states healthcare system.

Despite facing obstacles during the beginning of her transition, Natasha Stone, the transgender visibility coordinator for Fairness West Virginia, a statewide civil rights advocacy organization dedicated to the equal treatment of LGBTQ West Virginians, was able to find her way to medical resources, even if it meant chipping in while creating those resources.

As discussions related to transgender individuals begin to grow throughout the state, providing the community an attempt to become normalized, resources related to trans care are also beginning to grow throughout the nation. In West Virginia this process has been slow, providing limited opportunities for trans care.

While the state historically has been bombarded with various health issues over the past decades, the condition of West Virginias transgender health care system, or the lack thereof, may be one of the next issues the state must face.

Before I came on, Fairness West Virginia put a call out for information about the state of healthcare for trans people in the state of West Virginia and heard a lot of horror stories, Stone said.

The collected data set a baseline of insight centered around the experiences that trans West Virginians may face when navigating the states health care system. Stone said that among the topics researched were experiences of discrimination, necessary travel to receive care and the impact of medical costs.

According to Rebecca Denning, a board-certified child and adolescent psychologist, instances of transgender discrimination may be connected to a general misunderstanding of gender-nonconforming individuals.

Historically, training in culturally competent care has not been a standard in many healthcare programs, Denning said. We know this adversely impacts care for people of diverse backgrounds.

For Evan Wiseman, a 21-year-old trans man from Parkersburg, West Virginia, the journey to transition brought on many of those obstacles due to a lack of resources and general understanding about transgender individuals.

Starting in 2014, my parents, eldest sister and I searched all throughout the state looking for hormone therapy before I eventually started, Wiseman said. We looked everywhere but eventually accepted the fact that I would have to travel to Cleveland Clinic. All of the primary physicians in Parkersburg werent interested in helping me.

Due to the lack of resources in the state, trans individuals such as Wiseman are often times left to travel out of state in order to receive the care they need. In its surveying, Fairness West Virginia found that 36% of transgender West Virginians traveled out of state to receive care while 46% of transgender West Virginians had to travel more than one hour to receive care.

In addition to a lack of resources, Wiseman said trans West Virginians may also travel extended distances in order to receive educated, understanding care from medical professionals who are knowledgeable on how to interact with transgender individuals.

In Wisemans experience, he said any time hes received care from an emergency room, he has been treated extremely poorly.

(Doctors) in the ER will use she/her pronouns because my gender is not legally changed and theyll ask for my dead name even though I list my preferred name, Wiseman said. Often times male doctors wont even look me in the eyes and will say the bare minimum to me.

While recently receiving care for kidney stones at Ruby Memorial Hospital in Morgantown, West Virginia, Wiseman said he felt violated and not cared for after receiving care from one of the physicians.

I had a doctor who was using a scope for a vaginal procedure and, before telling me what was going on, he started the procedure, Wiseman said. When I made a sound because of the pain, he told his nurses to restrain me and told me to be quiet because its not that bad.

While medical professionals may not understand how their actions can be harmful, Denning said unfavorable medical experiences can have traumatizing effects of trans patients.

We know that when transgender patients encounter messages that their identity and gender expression are a problem, they are at a significantly increased risk for a range of poor health outcomes, Denning said. These experiences actively cause harm.

Regarding mistreatment in a medical setting, data collected by Fairness West Virginia found that 60% of transgender West Virginians said a healthcare provider intentionally misgendered them. 20% of transgender West Virginians said they had been refused care due to their gender identity and 25% of transgender West Virginians said that unrelated health issues were blamed on their gender identity.

Even still, outside of obstacles created by a lack of cultural differences and a general lack of understanding, trans individuals may still come into contact with barriers that prevent them from receiving the care that Wiseman deems life threatening.

Once Wiseman decided to look into top surgery, a medical procedure which removes breast tissue to produce a masculine appearance, he said that finding the one and only trans educated surgeon in the state was not hard, but trying to get the procedure covered by insurance was difficult.

I was supposed to get surgery heading into my senior year of high school in 2018 but my insurance said they wouldnt pay for it until I turned 18, Wiseman said. Come November 2018, I turned 18 but the insurance said they wouldnt pay for it because it was elective, despite receiving numerous letters from my therapists about how the surgery could save my life.

In order for Wiseman to eventually receive the procedure, he and his family had to pay $7,000 out of pocket.

According to Stone, in contrast to Wiseman, the cost of medical care can be debilitating to West Virginians, but can be particularly troublesome for LGBTQ citizens who historically have been shown to live in poverty.

Overall, Denning said in order to truly understand the condition of West Virginias transgender health, its important to take a look at the states overall health system.

In West Virginia we have challenges with healthcare overall, with many West Virginians struggling with access to healthcare, Denning said. When you consider that some portion of that workforce is not able to provide gender affirming care, its easy to see that accessibility is a significant barrier to care.

Joelle Gates can be contacted at [emailprotected]

See the article here:
Lost in Transition: Understanding West Virginia's transgender health care system - MU The Parthenon

CUH has avoided the planned-for surge in Covid-19 cases, for now at least, but doctors concern for non-Covid patients has never diminished, writes Catherine Shanahan.

Ward staff, Cork University Hospital. Photo: Daragh Mc Sweeney/Provision

With the daily slew of statistics around the level of coronavirus infection almost relentlessly grim, some cheering news is emerging from Cork University Hospital (CUH) where just 33 staff have tested positive for Covid-19.

The number of confirmed cases among in-patients is stable at around 30, and the number in intensive care on any given day is staying constant at five or six. The hospital had planned for upwards of 100 in the ICU.

A number of outpatient clinics are resuming off-site this week, albeit on a reduced scale, among them Care of the Elderly, Rheumatology, Gastroenterology, and Respiratory Medicine.

Cancer surgery and cancer treatment is continuing, although some patients due to undergo chemotherapy are unable to do so because it weakens the immune system, which puts them at risk of Covid-19.

There are also concerns that patients who suffer minor strokes are not coming to hospital the number of stroke attendances halved in the first few weeks of the pandemic, but these figures have now begun to improve.

Mary Horgan, consultant physician in infectious disease at CUH and president of The Royal College of Physicians of Ireland (RCPI), says good planning and fantastic public compliance with Government restrictions designed to limit the spread of the virus have fed into the hospitals success.

Ive been on the last two weekends and it was so nice to see the number of positive tests markedly reduced for those people coming into the hospital.

At the weekend, there was just one positive case of someone who presented to the hospital, and in actual fact, they were known positive, so we were just re-swabbing them to see if they had cleared it.

Dr Horgan, who has more than 30 years experience in acute medicine and infectious disease, says she has never seen anything like Covid-19.

I suppose why it is different is it doesnt affect children, yet it affects everybody else.

And while most people have no symptoms, or mild symptoms, others will get a lot sicker.

If I looked at two [ostensibly healthy] 50-year-olds, I wouldnt be able to say: You are going to do really well and you are not going to do so well.

Dr Horgan doesnt like what she has seen: Im doing this for 30 years and I can tell you after looking after patients - I would not like to get this infection.

CUH has devised two separate patient pathways for Covid and non-Covid patients.

If theres an index of suspicion, they go into the Covid pathway, where they are swabbed and isolated, and staff put on their PPE (no shortages at the moment).

Oxygen levels are monitored and once the test is back, they are treated accordingly.

Dr Horgan says most of those who are admitted require some level of breathing assistance. They usually have viral pneumonia.

Its a lack of oxygen that results from the viral pneumonia that gets a patient into trouble. The virus is gone down into their lungs.

Some patients have ended up on ventilators, including some in their 30s. Some people recover quickly, others dont.

As of the end of March, about one-third of those admitted had been discharged, Dr Horgan says.

"About 50% of those admitted are under the age of 60 and otherwise healthy.

The big question now, she said, was what the impact on the hospital system will be as restrictions are gradually lifted.

I think what we are going to be looking at in the health system is cranking up non-Covid activity again, so that we are giving care in the way we always have, as well as having a parallel life of Covid care delivery.

We have to start planning for us to increase outpatient numbers, to ensure people come into hospitals when they are getting sick, Dr Horgan says.

Her sentiments are echoed by CUH clinical lead for stroke services, Liam Healy and clinical lead for cancer services, Richard Bambury.

Dr Bambury, a consultant medical oncologist, says as of last weekend, there were 146 empty beds in the hospital.

Pre-Covid CUH was pretty much running at max capacity, so in a way this [empty beds] is welcome, but this is an unusual situation.

CUH has not made much use of private hospitals in the region some acute medical patients have been transferred to the Mater Private, but no-one so far to the Bon Secours. Dr Bambury says there are ongoing discussions.

At CUH, they have worked to make the hospital as safe as possible for cancer patients, creating a separate entrance and triage area, swabbing any suspected cases, and if they test positive we dont recommend chemotherapy.

This is because chemotherapy suppresses the immune system, which heightens the risk to cancer patients in the event of Covid-19.

The risk:benefit ratio in some situations has changed. For some, the risk might outweigh the benefits so if alternative therapy is available we are looking at that.

"Its a case-by-case decision.

Alternative treatments include the use of hormone therapy in treating prostate cancer.

Postponing treatment where it is safe to do so is another. For those on annual check-ups or who are in remission, their appointments can be postponed for a month or two until the Covid situation stabilises, Dr Bambury says.

Theres been some decrease in non-urgent activity to reduce the footfall and help with social distancing, Dr Bambury says but in saying that, in the past six weeks they have 200 new patients on radiotherapy and 50 on chemotherapy.

Rapid assessment clinics for anyone with a high suspicion of cancer are continuing.

On Ward 3B, Dr Healy, consultant geriatrician, is happy to see they are nearly back to the normal cohort of around 25-30 stroke patients, after seeing figures halve, dropping back to 10 or 15, in the early days of the pandemic.

I suppose the general message has been one should not come to hospital unless one absolutely needs to - but there are some conditions, like stroke, whereby if someones having symptoms, the only right thing to do is come in as quickly as you possibly can.

Theres a worry, he says, that people with a minor stroke may have stayed away, but theres plenty we can do for them in terms of optimising their treatment, or seeing if its something we can reverse," Dr Healy says.

Theyve had no Covid-19 staffing issues on his ward and very few patients affected by Covid-19, even though some of the early indications in this outbreak were that a higher percentage of people with the virus would have strokes.

Theres not a case that I can think of whereby weve had a stroke patient whos been disenfranchised by it or has had any kind of problems because of Covid-19, he says.

Consultant geriatrician at CUH, Paul Gallagher, is playing a role in the care of Covid patients in residential care facilities.

They have set up four teams to cover Cork and Kerry, each with senior nurses, and led by a geriatrician.

They are taking calls from care homes in the community - of which there are c100 in the region - and giving expert advice and guidance.

In some cases there are site visits to assist with care on the ground, for example at Clonakilty Community Hospital where there has been an outbreak and, tragically, a number of deaths.

Dr Gallagher says some elderly people have typical Covid symptoms, but others have atypical symptoms, such as a tummy upset, as well as fever and shortness of breath.

Within CUH itself, the number of Covid patients he sees remains stable, which has allowed us to manage it in a more planned way.

We had planned for upwards of 100 in ICU, that hasnt happened at all.

Dr Gallagher resumed his outpatient clinic for Care of the Elderly this week, albeit a scaled-down version.

The clinic is being run off-site on Model Farm Road.

At the moment, we are seeing urgent new referrals.

"Hopefully it will ramp up, but we have to be very cautious. Appointments will be staggered and time allowed between appointments to clean the rooms, for protection of patients and staff.

As CUH looks to returning to a more normal service, the medics do have certain concerns.

As Dr Gallagher points out, the fear now is of a non-Covid surge.

If people who need it dont seek treatment now, the risk is that we will be overwhelmed down the line.

The latest restrictions in operation since Friday, March 27 mandate that everyone should stay at home, only leaving to:

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Catherine Shanahan: Cautious optimism is order of the day at Cork University Hospital - Irish Examiner

At the moment, it feels like life has been put on pause... Literally. The government has advised us to stay at home to help control the spread of coronavirus. So what does this mean for women who are struggling to fall pregnant and embarking on IVF?

IVF is already a daunting, stressful and emotionally-draining process. But now, there are a whole new cohort of people with the added layer of uncertainty of whether they will ever get pregnant because treatment has been postponed indefinitely.

On 24 March, the official regulator for fertility clinics, Human Fertilisation and Embryology Authority (HFEA) announced no new treatment can begin. It means patients whod already started an IVF cycle can finish it, but all treatment after 15 April has been stopped.

On the face of it, HFEAs measures are simply complying with government social distancing advice to flatten the curve and ease the burden on the NHS which is already under huge pressure. Sounds reasonable. But that doesnt change how upsetting this is for so many who now feel helpless in their pursuit of parenthood.

We have had many calls from patients who are upset and distressed by the indefinite delay, said Dr Geeta Nargund, Medical Director at CREATE Fertility and abc IVF. Not knowing when they're able to start treatment brings with it a potentially serious mental health impact, particularly when patients know that time is of the essence and that it may impact upon their chance to become biological mothers.

Dr Nargund says that once a patient is given medication to stimulate ovaries, it can take up to two weeks to mature the eggs and prepare them for egg collection. First, she is given stimulation medication and monitored with ultrasound scans and blood tests, before an egg-collection procedure is booked in. Next, the eggs are fertilised with sperm in a lab to create embryos. Embryo/s are either transferred as fresh embryos three or five days later or frozen for later use.

Nargund says the treatment suspension has been particularly hard for women who have waited a long time for IVF or those diagnosed with a very low egg reserve, for whom time is of the essence.

Matilda*, 37, from Cheshire has a low Anti-Mullerian hormone level for her age, indicating a decreased egg reserve. Shes had two unsuccessful rounds of NHS-funded IVF, in August 2019 and January 2020. She and partner Eric*, 41, scraped together savings and borrowed from family and friends for private treatment, costing around 7,000.

At first, I was reluctant, Matilda says. If you have another round of heartbreak, you lose all that money. But you also feel, if I dont do it, will I live the rest of my life in regret?

We decided, finding all the funds, going into debt, using our life-savings, its such a huge risk. Sometimes I feel physically sick about spending that amount on a small chance and potentially ending up with nothing at all, she explains.

The clinic put Matilda on the pill and scheduled her egg collection for 17 April. But her treatment was cancelled as it had surpassed HEFAs deadline by two days. As Matildas turning 38 in a couple of months, shes concerned the delay for someone her age could mean not having a biological child.

Your chances diminish every month. This could have been my month, this could have been my cycle. Im losing that chance and its getting less likely it will ever work. If this lasts six or twelve months, Ive spent all that money and its going to be pointless, she says. Ive lived from appointment-to-appointment for close to a year, trying to keep healthy, not drinking alcohol, doing things to prepare and now theres no appointments, theres nothing. I dont know how to carry on. Im depressed and angry at just how hopeless you are as a woman in this situation.

Matilda says she will try again once the suspension lifts, but knows her chances will be slimmer.

Leanne Jones, 31, from Hampshire is having pre-implantation genetic diagnosis (PGD) IVF because her husband Kyle, 30, has a genetic disorder called PKD1 which affects life-expectancy and has a 50% chance of being hereditary..

During five years of treatment, Leannes had two cycles resulting in early miscarriages in September 2019 and February 2020. When you have a positive pregnancy test, a door opens. Youre planning the next 35 years of your life and your emotions run away with you. Then someone goes nope and shuts the door. Its grief. My emotions were like someone had died. I felt like someone had taken my right to breathe and I couldnt catch my breath at all, she explains.

As a midwife, Leanne sympathises for NHS staff, both in the face of COVID-19 and the suspension: It must be horrendous. Its hard but its the right thing.

What can you do if youre in a similar situation?

Dr Nargund suggests:

1. Use this time to make sure your body is ready for treatment. Make sure you're maintaining a healthy weight, getting regular exercise and following a balanced diet. While it may be difficult during this time, trying to stay relaxed and giving up vices such as smoking will all help to optimise your fertility status.

2. Do your research. There are multiple discussion groups and webinars being hosted that will allow you to better understand the treatment suspension and what it means for you, as well as ask questions of experts and decide on what treatment is right for you.

3. Explore getting treatment started online. Some clinics are offering virtual consultations that can be conducted over video call and using hormonal blood tests conducted at home. This will allow you to get the process moving and ensure that once the lockdown is lifted treatment can be started as soon as possible.

Help:

HFEA are updating patient guidance on their website.

The Fertility Network UK support line (0121 323 5025) is open Monday, Wednesday and Friday between 10am-4pm.

Professional Infertility Counselling Association(BICA) have a Find A Counsellor section on their website.

Professor Dr Geeta Nargund at CREATE Fertility is hosting webinars twice a week to provide information and guidance for all those considering starting treatment after the suspension.

*Matilda and Eric are fictional names

Read this article:
The Impact of Suspended IVF Treatment On Women - GLAMOUR UK

DENVER, April 18, 2020 /PRNewswire/ -- In response to current media stories regarding Low T Center's commitment to meeting the needs of Colorado patients during this COVID-19 Emergency, Low T Center provides the following for immediate release.

On April 9, the Colorado Department of Public Health & Environment released its 4th Updated Public Health Order (PHO) 20-24, encouraging Critical Businesses to remain open: "Critical Businesses, as defined below, are exempt, subject to certain limitations, from this PHO and are encouraged to remain open." Part C of PHO 20-24 states, "Any business . . . engaged primarily in any of the service activities listed below, may continue to operate as normal." PHO 20-24 defines a Critical Business as "Healthcare Operations, Including: . . . clinics, and walk-in health facilities . . . Medical . . . care, including ambulatory providers . . . [and] laboratory services." On April 6, 2020, Governor Polis issued Executive Order 2020 024 stating, "I direct all Coloradans to stay at home, unless necessary to provide, support, perform, or operate Necessary Activities . . . Necessary Travel or Critical Businesses as such terms are defined in PHO 20-24 . . . " The Order provides that "Necessary Activities" include . . . "Engaging in activities . . . including, but not limited to . . . without limitation, obtaining medical supplies . . . obtaining durable medical equipment, obtaining medication, [and] visiting a healthcare professional . . . " On that same day, the Governor issued an amended Executive Order D 2020 027, prohibiting voluntary or elective surgical procedures, if same could be safely postponed for at least three months.

Low T Center is a multi-specialty medical clinic with forty-six clinic locations spanning eleven states. Low T Center is not a hospital or outpatient surgery or procedure provider. It is not a gym or supplement store. Each clinic operates a certified and licensed moderately complex CLIA/COLA medical laboratory facility, which can accommodate a variety of important medical diagnostic tests. Pursuant to recently issued Department of Homeland Security regulations, Low T Center's facilities and its healthcare team members are classified as part of the Essential Critical Infrastructure Workforce.

Low T Center physicians treat chronic health diseases and conditions, as well as acute medical issues, ranging from low testosterone, to obstructive sleep apnea (a respiratory condition), to hypertension, high cholesterol, thyroid disorders, severe allergies, cardiometabolic issues, and other conditions that make men feel bad, and if left untreated, can be life-threatening. These conditions are often correlated with a serious medical condition known as hypogonadism. Hypogonadism is a clinical syndrome that results from the body's failure to produce physiologic concentrations of the hormone Testosterone.Hypogondal men require medically necessary hormone therapy to restore normal body functions. Failure to adequately treat and monitor these conditions can lead to serious problems such as heart disease, diabetes, obesity and cancer as well as adversely effecting overall well-being and quality of life. Treatment for hypogonadism is recognized as "medically necessary" by every major insurance carrier in Colorado.

Proper treatment of chronic hypogonadism requires office visits, labs, and continued therapy.For the individuals that require this therapy, interrupting, deferring or otherwise discontinuing therapy for a period of three months would lead to severe adverse effects, and place these patients at risk. Similarly, failing to provide treatment for diabetic patients, patients suffering from respiratory disorders, and serious cardiologic issues, is simply not acceptable, and would be contrary to the treatment guidelines employed at Low T Center.Remote treatment protocols are enabled for patients whose medical conditions do not require an in-person visit to the clinic.

For many of our patients, Low T Center is the sole provider of their preventive and primary care services. As noted above, in addition to having extensive clinical and research experience in diagnosing and treating hypogonadism, Low T Center also provides vital and continuous life-saving evaluation, diagnosis, treatment, and control of a variety of chronic, serious, and potentially life-threading disorders including cardiometabolic health, obstructive sleep apnea, hypertension, cholesterol disorders, metabolic syndrome, diabetes, and other chronic men's health issues including cardiovascular risk assessment and prevention. Because of the nature of the practice, many patients require close follow-up including appropriate physical exams as well as critical laboratory services, that if delayed "for a minimum of three months" would place these patients at "undue risk to both the current [and] future health of the patient." The treatment programs for these chronic, progressive and potentially fatal conditions (if not appropriately diagnosed, managed, and treated) are evidence- and guideline-based using the most recent literature and approaches and have been developed by a protocol committee comprised of medical school faculty and Harvard-trained distinguished leaders in their respective fields.

Consistent with Executive Order D 2020 027, these important primary care assessments and treatments cannot be delayed (as with any primary care office) as there would be 1) "a threat to the patient's life," 2) "a threat of permanent dysfunction of an extremity or organ system," (e.g., chronic limb ischemia risking amputations or progression of chronic kidney disease or heart failure.) These conditions require close physical and laboratory follow-up and monitoring of both the disease as well as the response to therapy. Furthermore, there is 3) "risk of . . . progression" particularly of the target organs of hypertension, cholesterol disorders, and diabetes manifesting as preventable strokes, heart attacks, limb damage, blindness, kidney failure, and heart failure - all of which require close medical management and adjustment of medical therapy to prevent.

Executive Order D 2020 027 rightly lets "the doctor make the decision," by granting the "treating medical facility" the exclusive discretion to determine whether a three month delay or interruption in treatment would risk the health of the patient. It would be unfortunate indeed that a hypertensive Coloradan would die, because the access to the care he needed, was postponed for three months. The Governor's Order expressly recognizes this principle, by leaving the classification of "voluntary" to the patient's medical professionals.

Low T Center does not believe Governor Polis' Order prohibits Coloradans from obtaining medically necessary treatment for diabetes, hypogonadism, hypertension, hypercholesterolemia, receiving allergy antigens, obtaining medical laboratory testing, receiving treatment for thyroid disorders, obtaining continuous positive airway pressure devices for the treatment of respiratory conditions, or any of the other medically necessary services provided to patients at Low T Center healthcare facilities. The Order uses the words "without limitation" which means Low T Center's patients should have the right to visit their healthcare provider - without limitation, for these important continuing care services.By signing the Order, Governor Polis assured Coloradans that they would be able to continue to receive their medical care during this time, by expressly classifying these activities as "Necessary Activities." Low T Center physicians, nurse practitioners, and medical staff are persons involved in operating a Critical Business which are necessary to help patients with these Necessary Activities.

Also, very relevant to the current COVID-19 crisis, outpatient centers like Low T Center significantly reduce the likelihood of requiring care in both Emergency Departments and acute care hospitals - where patients may have enhanced risk of both contracting SARS-CoV-2 and developing a potentially life-threatening and/or fatal complication of COVID-19.

Finally, Low T Center's protocol committee has mandated a series of workplace safety initiatives designed to implement social distancing guidelines. The clinic operational teams continue to adhere to enhanced cleaning and sterilization protocols. Sick persons or those exhibiting any COVID-19 like symptoms are prohibited from coming to work, but may work from home in some situations. Consistent with good medical practice, all team members are required to wash hands and use hand sanitizer between each patient visit in increasing frequency throughout the day. Patients are educated about covering coughs and sneezes, and recognizing signs or symptoms associated with COVID-19.

Low T Center's healthcare team members recognize their role as healers, and status as members of critical infrastructure, and are committed to remaining available to protect patients' rights, while adhering to all public health orders and directives issued in this state.

Media contact:David J. Moraine, J.D., M.A., LL.M. Chief Legal Officer, david@mailproglobal.com 469-990-3626

Continued here:
Low T Center Is Committed To Meeting The Needs Of Colorado Patients During The COVID-19 Emergency - The Grand Junction Daily Sentinel

Even if youve been staying mostly inside during the COVID-19 outbreak and laying off heavy makeup, your skin may be acting out.

Reports of increased acne and dry skin are not uncommon, even for people who previously had their skin under control.

For many people, stress can be a trigger for acne and we are certainly living in stressful times, said Dr. Julia Carroll, a Toronto-based dermatologist at Compass Dermatology.

But stress is only one culprit.

Here are some reasons why you may be experiencing acne or overly dry skin during coronavirus isolation.

Stress

Like Carroll said, the outbreak of the novel coronavirus is understandably causing a lot of people stress. From job loss to health concerns, many Canadians are experiencing a pique in anxiety.

Unfortunately, stress can wreak havoc on our skin and the stress hormone, cortisol, can lead to acne flare-ups. Theres also stress-related habits that we develop.

With so many people working from home all day in isolation, Ive had a lot of my patients confess to touching and picking at their face, Carroll said.

Its a common habit when people are stressed, bored or procrastinating.

Carroll said people should try to keep their hands off their face, which is not only important for acne, but for preventing the transmission of COVID-19.

To help lower stress levels, try to find ways to relax, like exercising, deep breathing, meditation or doing something creative.

New skincare routines

With more free time on our hands, some people are experimenting with their skincare routine, Carroll said. This can include using different and new products, like cleansers and leave-on face masks.

Many of the patients I have been seeing virtually are trying new routines while isolating and this has caused some breakouts, she said.

Others are abandoning their routine all together, which is also causing changes in the skin.

Carroll suggests people take a look at their skincare routine and make modifications accordingly. If you tend to have breakouts, she said to add products with either salicylic or glycolic acid.

This could be in the form of a cleanser or a medicated cream, she added.

For people who are wearing masks, their skin may also see a change.

Carroll said shes seeing a lot of acne-like breakouts due to the humidity in closed-off masks, like the N95 model.

Stress may also be a factor here, she said.

Others are reacting to the mask material with contact dermatitis. This could be a true allergy or just an irritation. The mask marks are another common complaint.

To treat mask irritation, Carroll suggests people use a gentle cleanser before putting on the mask and after they remove it.

Moisturizer can also be used, but she cautions against over-applying as it can affect the masks material, she said.

Lifestyle and environment

Because health officials urge people to stay at home to help curb the spread of COVID-19, many of us are not getting the same amount of fresh air we are used to.

Im seeing a lot of patients with dry skin, Carroll said. This comes from low humidity in some of our dwellings.

Theres also lifestyle changes, including diet and exercise, that many of us are experiencing.

Research shows exercise can help reduce inflammation, which can be a culprit of acne. Exercise also helps reduce stress, and might even lead to younger-looking skin, according to research out of McMaster University.

Our eating patterns may also be out of whack, and what we eat might affect our complexion.

While this varies from person to person, Carroll said, some people do have specific triggers to certain foods.

According to the Canadian Dermatology Association, if a certain kind of food seems to aggravate your acne, its best to avoid it.

There is evidence that avoiding dairy products or having a diet with a low glycemic index may reduce symptoms for some people, the association said on its website.

Treatment

If you have dry skin, Carroll suggests adding a hydrating wash to your routine, as well as moisturizers or serums with ceramides and hyaluronic acid.

If your acne does not get better with a consistent skincare routine and lifestyle changes, you might want to see a dermatologist, Carroll said.

Whatever you do, do not pop your pimples or pick at your skin. Squeezing pimples only leaves behind holes, or worse, acne scars.

Once scars are on your face, you cant do anything, Dr. Faisal Al-Mohammadi, a Mississauga, Ont.-based dermatologist and pathologist at Dermcare clinic, previously told Global News.

He said that for for some adults, laser scar removal treatments only improve scars by 40 to 50 per cent.

We will not be able to bring your skin back, he said.

Questions about COVID-19? Here are some things you need to know:

Health officials caution against all international travel. Returning travellers are legally obligated to self-isolate for 14 days, beginning March 26, in case they develop symptoms and to prevent spreading the virus to others. Some provinces and territories have also implemented additional recommendations or enforcement measures to ensure those returning to the area self-isolate.

Symptoms can include fever, cough and difficulty breathing very similar to a cold or flu. Some people can develop a more severe illness. People most at risk of this include older adults and people with severe chronic medical conditions like heart, lung or kidney disease. If you develop symptoms, contact public health authorities.

To prevent the virus from spreading, experts recommend frequent handwashing and coughing into your sleeve. They also recommend minimizing contact with others, staying home as much as possible and maintaining a distance of two metres from other people if you go out.

For full COVID-19 coverage from Global News, click here.

Laura.Hensley@globalnews.ca

- Global News

View post:
COVID-19: Here's how isolation might be impacting your skin - TimminsToday

When Dr Phil McGraw was 29, he had a vasectomy. At the time his wife was pregnant and he had made up his mind that he didnt want more children. Six years later, he would walk back into the clinic and demand for a reversal. Six months later, his wife was expectant.Having the procedure at such a young age was the biggest mistake I ever made.It is for this reason that doctors advice that when going for some long term family planning measures, you need to be absolutely sure. Vasectomy offers 99 per cent effectiveness and is suitable for men who are certain that they do not want any more children. According to Marie Stopes Kenya, this male sterilisation surgical procedure takes approximately 15 minutes and its failure rate is about 1 in 2,000 men. The Kenya Obstetrical and Gynecological Society reports that only one per cent of Kenyan men have undergone vasectomy despite its high effectiveness and surgical simplicity. However, since most vasectomies are performed in private facilities rather than in the public health system, the statistics could be an underestimation.It is estimated that 40 per cent of pregnancies globally are unplanned. In addition, most women are shunning hormonal contraceptives due to associated side effects. The modern man has grown more aware of the struggles their female partners go through and is more willing to take up family planning options. The options are nevertheless limited for men. Condoms, withdrawal (coitus interruptus and vasectomies are the most readily available artificial methods men can use. A man produces over 1,500 sperms per second which makes it challenging to come up with the most suitable reversible family planning method for men. But not to worry, there are options in the pipeline that will give the man more options and power over how many children he can have.WATCH OUT FOR:1. The Contraceptive gel

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Birth control options for the man who wants to take charge - The Standard

Potbelly.Beer belly. Muffin top. Spare tire. Regardless of what you call it, excessbelly fat is frustrating.

Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services.Policy

For most people, the appearance of excess weight around the midsection is their biggest concern. But obesity medicine specialist W. Scott Butsch, MD, says the bigger issue is the increased health risks that come with belly fat.

Abdominalfat is visceral fat, stubborn fat that surrounds the organs deep within theabdomen. Researchers have proved that excess visceral fat increases a personsrisk of metabolic diseases, including:

Dr.Butsch says belly fat affects men and women differently: Men are more likelyto havemore belly fat (orvisceral fat) than premenopausal women. But aftermenopause, women begin to gain more weight in their abdominal area.

An easy wayto gauge abdominal weight gain is to just pay attention to how your pants fitor the notch on your belt, says Dr. Butsch. If things are tight, then thatmay be an early warning sign of potential health problems.

Waistcircumference correlates to visceral fat. For men, a waist circumferenceapproaching 40 inches indicates increased risk. For women, 35 inches raises ared flag.

Patientswant to know why they cant just do sit-ups to melt away the fat, says Dr.Butsch. When you do sit-ups, youre increasing muscles in the abdomen, butthat doesnt specificallytarget the visceral fat that is around the organsdeeper in the body. Instead, Dr. Butsch recommends these strategies to trim thebelly fat:

Weight lossalone can effectively reduce visceral fat, says Dr. Butsch. By losing 10% ofyour body weight, you may lose up to 30% of your body fat.

Talk to your doctor about a weight-loss method that is right for you. While there are lots of options to choose from, Dr. Butsch recommends you avoid fasting for long periods. Prolonged fasts cause the body to hold onto the visceral fat, making it tougher to lose. If fasting is your jam, an intermittent or time-restricted fasting approach may be more effective for losing belly fat.

Exercises that increase the heart rate and make you sweat help you lose weight in general both visceral fat and the subcutaneous fat under the skin. Aerobic exercise burns overall calories and helps you reduce total body fat.

Dr. Butsch says the key to losing abdominal visceral fat seems to lie in a combination approach. He suggests trying 20 minutes of whole-body strength training plus a cardio routine to strengthen muscle cells and increase fat burn.

Fructose, or sugar, causes fat cells to mature faster, specifically in the visceral fat. A diet filled with fructose-containing sodas or drinks not only increases your calorie intake, but it impacts how the belly fat develops.

If youre feeling stressed out, especially right now that were in the middle of a pandemic, your body is likely releasing the stress hormone, cortisol, into the bloodstream. This can not only lead to weight gain, but theres also a strong link between an increase in cortisol and higher amounts of visceral fat.

Do your best tode-stress if you want to whittle your middle. Dr. Butsch states yoga,meditation, therapy and physical activity as ways to dial down your stresslevel.

Follow this link:
Want to Lose the Belly Fat? - Health Essentials from Cleveland Clinic

From weird dreams and nightmares to increased insomnia, the coronavirus pandemic has stimulated some unusual sleep issues for many people.

As a behavioral sleep researcher at theUniversity of Alabama at Birmingham, a number of patients have been asking: "Why is this happening, and what can I do to stop it?"

We do most of our dreaming during a stage of sleep called "rapid eye movement." This is when the brain grows more active and revs up the amygdala and hippocampus (regions of the brain that deal with emotions and memories).

In this time of heightened fear and distress, the brain has even more emotional demands to process. And because our brain likes order, the frontal lobes attempt to process, organize and integrate our thoughts to make sense of the chaos of REM neural signals (which is what produces those dreams).

In other words, our colorful yet strange dreams may be a reflection of the negative emotions invited by Covid-19.

Like so many others, I've also had my fair share of weird and memorable dreams since the pandemic.

In one dream, I boarded a cruise ship, dressed head to toe in bubble wrap and carrying nothing but a roll of toilet paper. In another, I slept through my shift at the telemedicine clinic and missed all my patients.

Luckily, I've been able to get those unwanted dreams under control. Here's what I've been doing to sleep better at night:

1. I wake up at the same time every day.

We tend to keep a consistent sleep schedule mostly during the weekdays. But I'm now waking up at 5:30 a.m., seven days a week.

This helps because the body rewards regularity: People who wake up at the same time experience more metabolic health, improved cognition and enhanced emotion regulation.

To keep myself accountable, I place my alarm clock across the room so that I have to get out of bed to turn it off. I've also created an enjoyable morning routine that involves coffee and gratitude journaling outside, where I can bask in the morning light.

Having something pleasant to look forward to makes waking up easier, while the natural light helps entrain my circadian rhythm.

2.I do everything I can to stay active during the day.

This can be a difficult task during a time of social distancing and quarantining. It now feels nearly impossible to get in as much physical movement as I did before the pandemic.

But it's still important to try.Vigorous, moderate or even mild cardiovascular exercise (i.e., walking or doing household chores) stimulates adenosine, which helps build sleep pressure or the body's "hunger" for sleep. And an increased sleep pressure means less likelihood of anxiety or insomnia.

However, I avoid exercising too much in the evenings.Research has shown that intense physical activity within one hour of bedtime can reduce sleep time, while also making it harder to wake up.

3. I use my bed for three things: Sleep,sex and rest (if I'm sick).

Everything else watching, reading or anxiously scrolling through my phone for news about Covid-19 happens out of the bed.

With more time spent inside, people may start adopting the habit of eating, working or binge-watching Netflix in bed. This can be disruptive to our sleep, because it trains the brain to associate the bed with daytime activities, rather than a place for resting.

Even on nights when I find myself unable to sleep, I'll get out of bed and go to another room. Keeping a dim light on, I'll do something relaxing, like guided meditation or fold the laundry. When I'm finally sleepy again, I'll return to bed.

4.I take a bath before bedtime and avoid devices.

Darkness facilitates healthy production of melatonin, a hormone that promotes drowsiness; whereas light interrupts it. So at least one hour before bedtime, I try to reduce my exposure to light-emitting devices, such as my phone, laptop and TV.

Instead, I take hot bath or shower.According to studies, our core body temperature needs to drop by about2 to 3 degrees Fahrenheit to maintain deep sleep and soaking yourself in warm water can help.

Most people think it's easier to fall asleep after a bath because your body is nice and toasty.But the opposite happens: It actually brings the heat from the core of your body to the surface, thus naturally cooling the body andpromoting a more peaceful sleep.

Christina Pierpaoli Parker is a behavioral sleep researcher and clinical psychology resident at the University of Alabama at Birmingham. She writes about sleep forPsychology Today and HealthDay, and her work has been published in the Journals of Aging & Health, Geriatric Psychiatryand The Clinical Gerontologist.

Don't miss:

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Continue reading here:
This sleep expert also had 'weird dreams and nightmares' since Covid-19. Here's what she does now to sleep better - CNBC

Connectus Health is donating nonperishable food items, hygiene products and diapers at two of its Middle Tennessee clinics for those dealing with hardships brought about by the coronavirus pandemic. (Courtesy Connectus Health)

At Connectus, we strive to serve as a healthcare home for every single Nashvillian in need, and Second Harvests mission aligns perfectly with ours, Connectus Health Co-CEO Suzanne Hurley said in a release. We feel so lucky to have this partnership with them and do our part in alleviating food insecurity in our community.

The clinics pantries are stocked with food items, such as soup, rice, cereal and pasta, along with hygiene products, such as toothpaste, soap and deodorant.

For those wishing to pick up supplies or visit the clinics, Connectus asks that they call ahead at 615-292-9770 to ensure that a staff member is able to meet them.

Supplies are available for pick up Mon.-Thu. 8 a.m.- 5 p.m. and Friday from 8 a.m.-2 p.m. at the Vine Hill clinic, located at 601 Benton Ave., Nashville, or the clinic at Priest Lake, located at 2637 Murfreesboro Pike, Nashville.

In addition to food and hygienic products, Connectus Health is also accepting new patients for pediatrics, midwifery, primary care, behavioral health services, hormone replacement therapy and transgender care, with financial counselors available to assist with securing health insurance coverage.

More:
Connectus Health providing food, supplies to Middle Tennessee during coronavirus pandemic - Community Impact Newspaper

Even if youve been staying mostly inside during the COVID-19 outbreak and laying off heavy makeup, your skin may be acting out.

Reports of increased acne and dry skin are not uncommon, even for people who previously had their skin under control.

For many people, stress can be a trigger for acne and we are certainly living in stressful times, said Dr. Julia Carroll, a Toronto-based dermatologist at Compass Dermatology.

But stress is only one culprit.

Here are some reasons why you may be experiencing acne or overly dry skin during coronavirus isolation.

Stress

Like Carroll said, the outbreak of the novel coronavirus is understandably causing a lot of people stress. From job loss to health concerns, many Canadians are experiencing a pique in anxiety.

Unfortunately, stress can wreak havoc on our skin and the stress hormone, cortisol, can lead to acne flare-ups. Theres also stress-related habits that we develop.

With so many people working from home all day in isolation, Ive had a lot of my patients confess to touching and picking at their face, Carroll said.

Its a common habit when people are stressed, bored or procrastinating.

Carroll said people should try to keep their hands off their face, which is not only important for acne, but for preventing the transmission of COVID-19.

To help lower stress levels, try to find ways to relax, like exercising, deep breathing, meditation or doing something creative.

New skincare routines

With more free time on our hands, some people are experimenting with their skincare routine, Carroll said. This can include using different and new products, like cleansers and leave-on face masks.

Many of the patients I have been seeing virtually are trying new routines while isolating and this has caused some breakouts, she said.

Others are abandoning their routine all together, which is also causing changes in the skin.

Carroll suggests people take a look at their skincare routine and make modifications accordingly. If you tend to have breakouts, she said to add products with either salicylic or glycolic acid.

This could be in the form of a cleanser or a medicated cream, she added.

For people who are wearing masks, their skin may also see a change.

Carroll said shes seeing a lot of acne-like breakouts due to the humidity in closed-off masks, like the N95 model.

Stress may also be a factor here, she said.

Others are reacting to the mask material with contact dermatitis. This could be a true allergy or just an irritation. The mask marks are another common complaint.

To treat mask irritation, Carroll suggests people use a gentle cleanser before putting on the mask and after they remove it.

Moisturizer can also be used, but she cautions against over-applying as it can affect the masks material, she said.

Lifestyle and environment

Because health officials urge people to stay at home to help curb the spread of COVID-19, many of us are not getting the same amount of fresh air we are used to.

Im seeing a lot of patients with dry skin, Carroll said. This comes from low humidity in some of our dwellings.

Theres also lifestyle changes, including diet and exercise, that many of us are experiencing.

Research shows exercise can help reduce inflammation, which can be a culprit of acne. Exercise also helps reduce stress, and might even lead to younger-looking skin, according to research out of McMaster University.

Our eating patterns may also be out of whack, and what we eat might affect our complexion.

While this varies from person to person, Carroll said, some people do have specific triggers to certain foods.

According to the Canadian Dermatology Association, if a certain kind of food seems to aggravate your acne, its best to avoid it.

There is evidence that avoiding dairy products or having a diet with a low glycemic index may reduce symptoms for some people, the association said on its website.

Treatment

If you have dry skin, Carroll suggests adding a hydrating wash to your routine, as well as moisturizers or serums with ceramides and hyaluronic acid.

If your acne does not get better with a consistent skincare routine and lifestyle changes, you might want to see a dermatologist, Carroll said.

Whatever you do, do not pop your pimples or pick at your skin. Squeezing pimples only leaves behind holes, or worse, acne scars.

Once scars are on your face, you cant do anything, Dr. Faisal Al-Mohammadi, a Mississauga, Ont.-based dermatologist and pathologist at Dermcare clinic, previously told Global News.

He said that for for some adults, laser scar removal treatments only improve scars by 40 to 50 per cent.

We will not be able to bring your skin back, he said.

Questions about COVID-19? Here are some things you need to know:

Health officials caution against all international travel. Returning travellers are legally obligated to self-isolate for 14 days, beginning March 26, in case they develop symptoms and to prevent spreading the virus to others. Some provinces and territories have also implemented additional recommendations or enforcement measures to ensure those returning to the area self-isolate.

Symptoms can include fever, cough and difficulty breathing very similar to a cold or flu. Some people can develop a more severe illness. People most at risk of this include older adults and people with severe chronic medical conditions like heart, lung or kidney disease. If you develop symptoms, contact public health authorities.

To prevent the virus from spreading, experts recommend frequent handwashing and coughing into your sleeve. They also recommend minimizing contact with others, staying home as much as possible and maintaining a distance of two metres from other people if you go out.

For full COVID-19 coverage from Global News, click here.

Laura.Hensley@globalnews.ca

- Global News

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COVID-19: Here's how isolation might be impacting your skin - ThoroldNews.com

Its not unusual to crave a cold glass of water on a hot summer day or after youve eaten something particularly spicy. But there are multiple reasons why you may suddenly find yourself thirsty and some are more serious than others.

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One of the most common reasons youre probably thirsty is dehydration. Overheating is one of the biggest causes of dehydration. Whether youve been rigorously exercising or just resting in the sun at the beach, your body needs water to keep from overheating.

When you exercise, your muscles generate heat. To keep from burning up, your body needs to get rid of that heat. The main way the body discards heat in warm weather is through sweat. As sweat evaporates, it cools the tissues beneath. Lots of sweating reduces the bodys water level, and this loss of fluid affects normal bodily functions.

According to the American College of Sports Medicine, to avoid dehydration, active people should drink at least 16 to 20 ounces of fluid one to two hours before an outdoor activity. After that, you should consume 6 to 12 ounces of fluid every 10 to 15 minutes that you are outside. When you are finished with the activity, you should drink more. How much more? To replace what you have lost: at least another 16 to 24 ounces (2 to 3 cups).

One way to make sure you are properly hydrated is to check your urine. Matthew Goldman, MD, says, The goal is to keep the urine clear. If it starts to become yellow, then youre getting dehydrated.

Certain foods are also great at helping you stay hydrated thanks to being heavy on water content. And many have added benefits of including other essential nutrients your body needs. Vegetables such as cucumbers and celery arent just high in water content, theyre also low in calories, making for a perfect snack.

If youre looking for fruits, both watermelon and strawberries are excellent choices with 91% water content and make for great, sweet treats, especially in hot weather.

Drinking water is one of the best ways to stay hydrated but some sports drinks can also assist in replacing not just fluids but electrolytes such as sodium and potassium. But try to avoid alcohol and caffeinated beverages, such as coffee and sodas, as these fluids tend to pull water from the body and promote dehydration.

Increased urination and excessive thirst are two telltale signs of the onset of type 2 diabetes. It can also be an indicator of hyperglycemia, a condition where there is too much sugar in the blood, most often experienced by those with diabetes.

According to the CDC, Eating too much food, being less active than usual, or taking too little diabetes medicine are some common reasons for high blood glucose (aka hyperglycemia). Your blood glucose can also go up when youre sick or under stress.

Normally, the amount of sugar leaving the body through the urine is not detectable, explains Dr. Goldman. However, if someones blood sugar level is elevated enough, sugar begins to leave the bloodstream through the kidneys and enters the urine.

The glucose (sugar) molecules are small enough to leak out through the filtration system of the kidneys. As the excessive glucose molecules enter the urine, the glucose draws water with it like a sponge. As a result, the amount of urine formed and frequency of urination increases. As we lose those excess fluids, we eventually become dehydrated.

This is why patients who have elevated blood sugar levels for too long often become dried up and may end up in the emergency department or intensive care unit. Once they arrive, they often require a lot of fluids (through IV) as well as vitamins and medications to get their sugar levels under control in a safe manner.

Dehydration could also be a sign of a condition known as diabetes insipidus. According to Dr. Goldman, Antidiuretic hormone (ADH) is a hormone that allows the body to reabsorb water from urine that is forming in the kidneys. This reabsorption tends to occur most when we are becoming dehydrated, such as while we sweat.

If the body isnt producing enough ADH or the kidneys arent responding appropriately to ADH, then the body doesnt retain as much water as it may need; this may result in more frequent urination and possibly dehydration.

Patients should speak to their provider about sugar levels and what is considered a normal blood sugar level for themselves as well as what to do if these levels become abnormal, suggests Dr. Goldman.

In general, patients should avoid drinking fluids to have excessive amounts of sugar in them because this may eventually lead to uncontrolled blood sugar levels and cause the amount of urination to worsen, Dr. Goldman says.

One reason patients should take in some extra sugar is if their blood sugar level is too low. Patients should speak to their provider further about what is considered a normal as well as low sugar for themselves, he adds.

Certain medications your doctor prescribes may cause certain side-effects, including thirst.

Lithium is a medication that is widely known to possibly result in excessive urine output and therefore increased thirst, according to Dr. Goldman. Over time, it may eventually block the activity of antidiuretic hormone (ADH) in the kidneys, which leads to excess urination and thirst, he says. A number of other medications antipsychotics, antidepressants, anticonvulsants, anticholinergics and alpha agonists can cause dry mouth and, therefore, trigger thirst.

Dr. Goldman also notes that SGLT2 inhibitors (a kind of diabetes medication) as well as steroids can also cause thirst since SGLT2 inhibitors increase the release of glucose from the blood into the urine to lower blood sugar levels and steroids often raise sugar levels as a side effect.

This is why, when someone is placed on steroids (whether short or long term), they may be encouraged by their provider to monitor their blood sugar or accommodate the higher sugar levels by taking more diabetic medications.

Dr. Goldman says you should talk to your provider about these side-effects and see if there are alternative medications available.

Until you and your provider can discuss alternatives, continue taking your medication as directed.

See the original post here:
3 Reasons Why You May Be Feeling Really Thirsty - Health Essentials from Cleveland Clinic

For continuing coverage of how COVID-19 is affecting reproductive health,check out our Special Report.

Four years ago, I needed an abortion in Texas while HB2, Republicans sweeping anti-abortion law, was still in effect. I wondered if Id have to continue a pregnancy for which I wasnt ready.

It took me two weeks to access care that I needed immediately. Im struggling today knowing that as a result of the COVID-pandemic, countless others are facing similar barriers I had faced. Millions have lost their job and are without childcare, and some anti-choice government officials have used the crisis to outright ban abortiondirectly violating our rights under Roe v. Wade.

Weve known that our right to an abortion means nothing if we cant access it. Even though it feels hard right now, you should know advocates have worked for decades to ensure people always have access to abortion care, especially in times like these.

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If youre seeking abortion care during the pandemic, I want to help you learn about the same network that helped me access an abortion whenit felt impossible. Here are some tips that might help you navigate the state of abortion access during COVID-19.

How to get an abortion in a state that has deemed abortion nonessential

If youre seeking an abortion in a state thats attempting to or have already restricted access during the pandemic, youve probably experienced a delay in your appointment at least once. But if you have the capacity, you should call clinicsincluding thosein surrounding areasfrequently for updates because circumstances can change day to day.

Some clinics may be scheduling appointments for the future, and if legal action changes abortion access, scheduling an appointment allows the clinic to contact you to tell you about appointment availability. Providers are working closely with advocates to ensure access to abortion care continues, and theyre one of the first to know when services can resume.

Clinics can also connect people with resources for out-of-state abortion care. Providers are already prepared with this information for people over the legal limit to have an abortion in certain states, and who are forced to travel to one of the statesthat provide later abortions.

If youre considering traveling, youre not alone. Fund Texas Choice, a practical support organization providing Texans with travel assistance, told Rewire.News last month that pregnant people with varying gestational ages have reached out for assistance to go out of state since Texas Gov. Greg Abbott (R) banned abortion under COVID-19. The Brigid Alliance, a practical support organization that helps people traveling to clinics providing second- and third-trimester abortions, told Rewire.Newsthat the organization has recently helped people with pregnancies of earlier gestations, as well as families who are forced to travel together as a result of a lack of childcare.

Because of shelter-in-place orders, some state officials are preventing drivers from crossing state lines and subjecting non-residents to 14-day quarantines, which could increase the logistical costs pregnant people face. Some methods of transportation have been affected too. But the Brigid Alliance says it hasnt encountered drivers being turned away when crossing state lines, and the organization is letting folks flying to New Mexico know that in order to be exempt from the state quarantine, they can only travel between the clinic and hotel where theyre staying.

Brigid Allianceis also seeing the impacts that are surging for those providing and needing practical support.

Bus lines have closed down, airlines have spontaneously canceled flights, hotels have closed down entirely or reduced capacitywe had to move people from hotel to hotel in the middle of a three- to four-day process [to get an abortion], and were hearing from partners that there are some Greyhound lines that are doing temperature checks, Odile Schalit, executive director of the Brigid Alliance, said.

Schalit wants people to know support is available for those seeking care amid the ever-changing landscape of abortion access.

While the obstacles to your health care may appear numerous today, please know that there is a network of good people, volunteers, and resources that exist to support you. Tap into our network and, as much as possible, your own, Schalit said. Take your time, break down your plan and needs, and take stock of your unique physical and emotional safety and comfort. For many, accessing abortion care now means having to travel out of your home town, city, and state. While this may seem impossible, we and many others are here to help you construct safe plans for getting to your care.

If youre thinking about traveling out of state for abortion access, consider going to one of the 23 states that dont have a mandatory waiting period to limit the number of times you have to visita clinic before the procedure.

How to get an abortion if you need help paying for an abortion, traveling to a clinic, or other logistical support

Abortion funds and practical support organizations help alleviate the high costs associated with paying for an abortion and traveling in or out of state. Funds generally help with the cost of an abortion, while practical support organizations cover travel-related costs; some do both. Below are some organizations that may be able to help you access the care you need:

To find other local abortion funds and practical support organizations in your area, visit the National Network of Abortion Funds to search for groups by state.

You can also ask abortion clinics to screen you for financial assistance. Unlike assistance from abortion funds and practical support organizations, in-clinic funding can be income-based, but you arent required to show proof of how much money you earn.

How to get an abortion in a state that allows telemedicine

Eighteen states prohibit the use of telemedicine for abortion care. If you live in one of the states that allow it, medical abortions can be obtained up to ten weeks into pregnancy through video conference with an abortion provider.

While U.S. Food and Drug Administration (FDA) restrictions prevent the medication from being mailed to your home, patients can avoid traveling long distances to an abortion clinic while protecting their health during the pandemic by visiting a nearby health center to receive the medication under guidance of a doctor.

TelAbortion, however, can send the medication to your home if youre eligible. TelAbortion is a study run by reproductive and maternal health research group Gynuity, and the evaluation is offered over the internetso you can access it on your own phone or computer. But the FDA requires people participating in the study to visit a health clinic in order to have an ultrasound or pelvic exam, according to Dr. Elizabeth Raymond, senior medical associate for Gynuity Health Projects.

You will need video conference access in one of the 13 states participating in the study, and have a mailing address in the state where the medication can be sent.

If a person encounters barriers in accessing an ultrasound or pelvic examespecially barriers compounded by the COVID-19 pandemicthey can call a TelAbortion site, as the provider may be able to accommodate their situation.

If youre eligible for a TelAbortion, youll be sent a package containing the necessary medications and an instruction sheet by mail. Afterward, the TelAbortion provider follows up with study participants to ensure the abortion was successful, and to address any side effects and complications. According to their data, the TelAbortion model is just as effective as an in-person abortion.

In the past two months, Gynuity expanded its TelAbortion study to include Maryland and Illinois, and the hope is to continue to expand during the pandemic,as telemedicine abortion care will be critical. In the past few weeks, Gynuity has had a significant increase in traffic to the TelAbortion site.

Weve been doing this study since 2016, [and] now its right there [and] ready, Raymond said. Its gratifying to be able to help in this crisis.

What you need to know about self-managed abortion

Self-managed has proven to be extremely safea 0.3 percent risk of major complications, according to an analysis byAdvancing New Standards in Reproductive Health. Interest in it is also rising.

Self-managed abortion canincludeusing mifepristone and misoprostol, or misoprostol alone, to end a pregnancy. Mifepristone blocks the hormone essential to advancing pregnancy, whereas misoprostol empties the uterus.

Plan C provides a report card on online retailers that offer the medications, resources about how the process works, and the legal risks surrounding it.Some states have laws that could be used against people ending their own pregnanciesat least 21 people have been arrested since 2005, Jill E. Adams, executive director of If/When/How: Lawyering for Reproductive Justice, told Rewire.News.

In states without such laws, Adams said some have faced charges as a result of prosecutors misapplying parts of the criminal codes that were never intended for people ending their own pregnancies. In most cases, the judge determines the law doesnt apply, but at that point, people have already been arrested, lost their job, and face public scrutiny as a result of private records being released.

The risk is highest for populations and communities under surveillance and on the receiving end of disproportionate state violencecommunities of color, especially Black and African American people, immigrants, and trans and gender nonconforming people, are all more at risk of criminalization, and [theyre] also more likely to need self-managed abortion due to barriers to clinic-based care and bans on coverage, Adams said.

Mandatory reporters, like health-care professionals, can also feel obligated to report people should they seek follow-up care from a doctor, even though Adams said the American Congress of Obstetrics and Gynecology and the American Medical Association recommends against it.

No state requires mandatory reporting for suspected or confirmed self-managed abortion, including when the person is a minor, Adams said. If people do report, they are likely violating patient privacy laws.

When seeking follow-up care, people arent legally required to disclose their situation to a doctor. If/When/How: Lawyering for Reproductive Justices legal helpline offers information on a persons rights when talking to law enforcement officialsor doctors involving self-managed abortion. According to the website, no one has been arrested for buying abortion pills online.

The right to abortionself-managed or provider-directedstill exists throughout the United States, Adams said. But laws have been misused and power abused in unjustly criminalizing people for ending their own pregnancies.

The helpline offers free, confidential legal information topeople concerned with being investigated or arrested for self-managing an abortion, as well as legal advice from an attorney when necessary.

But Adams said if there were ever a time to eliminate the sources of criminalization, that time is now. Their legal helpline has received double the number of inquiries they usually get.Local, state, and federal officials should make it clear that no one will be arrested, charged, or detained for ending their pregnancy, or for helping someone else end their pregnancyand not just during the pandemic, but always, Adams said.

If you need an abortion without parental consent

In the 37 states that have forced parental involvement laws for young people seeking abortion care, teenagers are forced to go through the overwhelming process of obtaining a judicial bypass, or permission from a judge to have an abortion. As a result of the pandemic, shelter-in-place orders and school closures prevent teens from discreetly leaving home to go to court, or even obtaining resources that may be able to support them.

Other things to know when seeking abortion care during COVID-19

Be aware that crisis pregnancy centers (CPCs), or anti-choice clinics, are still operating, but they dont provide abortion care. Even if they offer to talk to you about your options, they wont refer you to an abortion clinic or provide the necessary resources to obtain one. Reach out to any of the aforementioned organizations for information about the next steps.

The Online Abortion Resource Squad, a group of volunteers who respond to abortion-related questions on Reddit with compassionate, accurate answers, developed a resource site in response to the confusion and uncertainty around abortion during this health crisis.The site offers up-to-date information on clinic operations in states that have deemed abortion as nonessential health care, as well as connecting with local resources for financial and logistical assistance, and locating clinics in your state and nearby states.

Go here to read the rest:
How to Get an Abortion During the COVID-19 Pandemic - Rewire.News

People with hypothyroidism who choose desiccated thyroid extract (DTE) over levothyroxine alone perceive that it works better but patients may not be aware of the risks, new research suggests.

Those were among the findings from qualitative analyses of nearly 700 online posts from three popular online hypothyroidism forums, which found that 75% of patients felt they fared better on DTE than the standard therapy of levothyroxine (LT4).

The results were to be presented at the Endocrine Society's annual meeting in late March, but the meeting was canceled because of the COVID-19 pandemic. They were subsequently published online April 3 in Medicina by Freddy J.K. Toloza, MD, a postdoctoral research fellow at the University of Arkansas for Medical Sciences, Little Rock, and a research collaborator at the Mayo Clinic, Rochester, Minnesota, and colleagues.

Made from desiccated pig thyroid glands, DTE is not approved by the US Food and Drug Administration because it pre-dates the agency, but it was grandfathered in and is sold legally by prescription under the names Nature Thyroid, Thyroid USP, and Armour Thyroid.

DTE is currently used by an estimated 10% to 29% of patients with hypothyroidism, despite concerns about the risk for hyperthyroidism-associated side effects.

"Current [American Thyroid Association] guidelines strongly suggest the use of levothyroxine over DTE as thyroid replacement therapy. We agree with this recommendation given concerns about DTE's side effects," Toloza told Medscape Medical News.

"Nevertheless, additional research should be conducted to understand if this recommendation applies to all hypothyroid patients," he added, and for those patients who are taking DTE, more research is required to determine who is at risk of side effects and methods to prevent these.

Toloza said that patients with hypothyroidism who take DTE frequently described a lack of individualized treatments and a feeling of not been listened to as issues influencing their choice.

"These findings reinforce the need for patient-centered approaches in current clinical practices. Clinicians need to carefully listen to their patients and consider their individual needs and the context of every patient," he noted.

Asked to comment, endocrinologist Rachel Pessah-Pollack, MD, of New York University Langone Health, told Medscape Medical News, "Animal-derived desiccated thyroid hormone contains both T4 and T3. We typically do not recommend using this because it can vary in concentration, meaning that the actual preparation is not physiologic."

Pessah-Pollack,a coauthor of the 2012 joint clinical practice guidelines on hypothyroidism by the American Thyroid Association and American Association of Clinical Endocrinologists, added that one of the major concerns about using DTE is the risk for iatrogenic hyperthyroidism, potentially leading to atrial fibrillation and fractures.

"That is one of the main factors that drive many professional societies to really use caution regarding DTE. That's also why major societies recommend against using DTE...based on the evidence to date," she said.

The whole issue of "combination therapy" in hypothyroidism is contentious, however. Physicians can also prescribe a "combination" of synthetic levothyroxine (LT4) and triiodothyronine (LT3) treatment; this, along with use of DTE products, has been a subject of debate for many years.

The current (2014) American Thyroid Association guidelines do not specifically rule out use of synthetic LT4/LT3 therapy, rather they "recommend only against theroutineuse of combination therapy." And although they don't expressly endorse use of DTE, they removed a statement saying it "should not be used."

"There is definitely a select group of patients who do better on combined T4/T3 treatment, and we're still trying to delineate who that population is," Pessah-Pollack told Medscape Medical News.

"As long as these patients are closely monitored and aware of the risk of hyperthyroidism and have their levels followed to ensure that they're not hyperthyroid, in select cases this is appropriate."

"But, first-line is ensuring that a good evaluation occurs...Clearly this helps us understand that we do need more studies in this area well-designed, blinded studies to really help us get to the bottom of this controversy."

Toloza and colleagues analyzed 673 posts from three online forums, WebMD (Medscape's parent company), PatientsLikeMe, and Drugs.com, selected from an initial 1235 posts because they included more complete information.

About half (51%, n = 257) of patients had primary hypothyroidism/Hashimoto's thyroiditis, 25% (n = 126) had postsurgical hypothyroidism, and 16% (n = 81) had postablation hypothyroidism. Among the 172 posts in which DTE dose information was available, the mean dose was 84.1 mg/day. Treatment duration ranged widely, from 2 weeks to 45 years.

Among the posts describing the source of the DTE prescription, the initial interest was driven mainly by the patient in 54% (n = 88), while 46% (n = 74) said that a clinician drove their interest in trying DTE. (The type of clinician was not reported.)

Among posts mentioning thesource of DTE, local pharmacies were the most common (63%, n = 75), followed by pharmacies outside the United States (31%, n = 37), and online (6%, n = 7).

Previous thyroid treatments were mentioned in 300 posts, of which 93% mentioned LT4 monotherapy.

Among the reasons for changing to DTE were no improvement in clinical symptoms (47%, n = 75), development of side effects (24%, n = 38), no change in overall well-being (22%, n = 36), and no changes in laboratory workup (7%, n = 12).

Perceived benefits of DTE included improvement in clinical symptoms (56%, n = 155), change in overall well-being (34%, n = 94), possibility of reaching previous health status (7%, n = 19), and low cost compared with previous treatment (3%, n = 8).

Specific symptoms reported to have improved included fatigue (28%, n = 43), weight gain (17%, n = 26), and neurocognitive symptoms (5%, n = 8). The average time to notice benefits with DTE was about 30 daysbut ranged widely from 2 days to 4 months.

The majority of posts (77%, n = 99) stated that DTE was more effective than their previous therapy, while 13% (n = 17) described it as equally effective and 10% (n = 13) said it was less effective.

Side effects of DTE were described by 20% (n = 136), including weight loss (15%), fatigue (11%), palpitations (11%), heat intolerance (11%), sleep disturbances (10%), high blood pressure (7%), and hair loss (5%).

A qualitative analysis of the posts yielded five major themes: experience with previous therapies before starting DTE, perceived effectiveness and benefits of DTE, DTE side effects, need for individualized therapy for hypothyroidism, and barriers to obtaining DTE.

One patient posted: "Synthroid [levothyroxine] did not help...and gives me bad side effects...my endocrinologist blamed all side effects on everything except the Synthroid."

Another wrote, "It [Armour] changed my life...I'm glad I found a medication that makes me feel normal again...all have improved; moods, skin (no itching), no headaches, goiter is down."

Others cited the lower cost of Armour compared with Synthroid.

However, some expressed negative experiences with DTE, such as, "My doctor expected that this medication would help me with brain fog, energy, and tiredness. I experienced the opposite."

And some couldn't obtain it. One wrote, "Doctors think they know how u feel and do not even tell you about Armour. I asked my doctor and was told there was not enough studies on it to show its effectiveness."

Pessah-Pollack pointed out that the study data don't address whether patients' initially prescribed levothyroxine doses were optimal, and noted that sometimes changes are needed, such as during pregnancy, following weight gain, or if the patient is taking other certain medications.

"It's unclear from patient-reported symptoms whether or not they actually had an evaluation of their thyroid levels to ensure that their dose of thyroid hormone was correct before switching over to T4/T3 replacement...There are many factors that need to be taken into account before we decide that the medication itself isn't working."

What's sorely needed, she said, are "well-designed, blinded studies that look at this controversy."

"Here, we don't know why patients are feeling better...We need to do additional work including validated symptom questionnaires and comparing thyroid levels of patients who are on Armour thyroid with those on levothyroxine monotherapy."

Toloza agrees:"It is not possible to say that DTE is working better for the user due to the limitations and the nature of the data used in our study."

"However, our findings are in-line with previously published research, which has shown that a subset of patients may prefer DTE to levothyroxine and have higher satisfaction with this treatment. Nevertheless, the reason behind this is still not well understood," and it should be further investigated.

Pessah-Pollack has reported being an advisor for Boehringer Ingelheim-Eli Lilly and Radius Health, and a moderator for Sanofi.

Medicina. Published online April 3, 2020. Abstract

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Patients Say Desiccated Thyroid Better Than Standard Therapy - Medscape