Archive for the ‘Hormone Clinic’ Category

Your thyroid gland plays a key role in making sure that yourbody operates at peak performance. It releases just the right amount of thyroidhormone to help regulate the bodys functions.

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But if something is out of whack with your thyroid, you mayexperience:

Thyroid diseases generally arent preventable. (If youve been avoiding soy or cauliflower to decrease your risk thats just a myth.) But according to endocrinologist Christian Nasr, MD, many thyroid diseases do run in families.

Knowing your family history can help you stay one stepahead of complications from a thyroid disorder and related conditions, he says.

More than 75% of the time, patients with thyroid disease tell me that someone on one side of their family has thyroid disease, says Dr. Nasr.

The more family members that have thyroid disease, the greater the likelihood that there is a hereditary root. And the higher the chances the patient will experience a thyroid problem.

Autoimmune disorders seem to be a genetic link for some of the familial thyroid disorders, he notes. Autoimmune disorders occur when white blood cells go haywire and attack the cells that regulate body functions. The immune systems foul play could cause the thyroid gland to produce too much or too little hormone. So having an autoimmune disease may increase your risk for thyroid disease, Dr. Nasr says.

But this same action the white blood cells attacking bodycells could result in other autoimmune disorders like diabetes, lupus orrheumatoid arthritis, too.

In a family, the same person could have an autoimmunedisorder that causes hypothyroidism and another that causes diabetes, says Dr.Nasr. And you may have a different family member who has diabetes, but notthyroid disease.

The takeaway: Inform your healthcare provider if any autoimmune diseases run in your family, even if there isnt an obvious thyroid connection.

Dr. Nasr has found that even thyroid cancers that arentconsidered hereditary can have a family link. Ive had situations wheremultiple family members have had the type of thyroid cancer thats usually nothereditary, he says.

Clustering of cancers in families isnt unique to thyroidcancer. Some families carry a mutation that suppresses good genes in thebody, which can put them at risk for a variety of cancers.

Different syndromes can increase someones risk for certain types of cancer, Dr. Nasr explains. Cowdens syndrome, for example, increases your risk of thyroid, breast and uterine cancers. Your family history may not include thyroid cancer, but if we see a lot of breast and uterine cancers, we may want to investigate whether there is a syndrome that puts you at risk for thyroid nodules or cancer.

The takeaway: As with the autoimmune disorders, knowyour family history. This information helps your healthcare team find patterns thatmight indicate thyroid disease-causing gene mutations lurking in the background.

What if you dont know about your familys history withthyroid disease? These symptoms may indicate its time to seek medical care:

Once youve addressed your symptoms with your provider, theywill likely perform a neck exam and a simple blood screening test. If allsystems appear to be operating well, your doctor may recommend monitoring overtime. If any of the results are concerning, your doctor may refer you to anendocrinologist or order an imaging test. And if you have a strong family history, genetictesting may help you make important healthcare decisions.

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Thyroid Disease May Run in Your Family and You Might Not Know It - Health Essentials from Cleveland Clinic

Human Growth Hormone (HGH) therapy has been around for decades but has been reserved for specific patients. Those with HIV or children with a hormone deficiency were some of the patients who benefitted. However, in recent years, a new focus has targeted therapy to help adults with hormone deficiencies.

HGH is aproteinproduced by the pituitary gland. The hypothalamus and hormones in the intestinal tract and pancreas help to balance it. It thrusts into production during sleep, exercise or trauma with more produced at night than in the daytime, given rising to the term beauty rest as the hormone is also linked to anti-aging.

Production of the hormone decreases as we age and that can lead to problems typically associated with getting older like:

The purpose of the growth hormone in children is to help bones and muscles grow. It also helps with organ function. Hormone therapy in adults is linked to:

Manycelebritiesare reportedly using hormones, but many are doing it illegally. They do it for anti-aging or for muscle mass. This is something all doctors warn against because the growth hormone has some possible side effects including water retention, high blood sugar, and joint and muscle pain. Plus, for those who have normal hormone levels, illegal use of it and then stopping will cause your body to produce less. That leaves you worse off than before.

Most celebrities who take legal hormone therapy dont like to talk about it for a variety of reasons. Its a controversial subject and many deem it private. However, a handful of aging stars have come out to talk about their decision to go on legal hormone therapy.

Benefits of therapy were noted in a New EnglandJournal of Medicine study. Men on six months of therapy increased their muscle mass 8.8 percent and reduced body fat by more than 14 percent. While it is linked to anti-aging, there are no conclusive studies to prove that.

Those considering hormone therapy must get a prescription in order to go to Hormone Clinic. That includes going to a doctor, getting a blood test and probably some specialized testing on the pituitary gland and hypothalamus. Or, you can just call for free consultation toHGH Therapy Clinicand get all the instructions. This clinic, as long as other top-rated clinics, does not provide therapy for bodybuilders and only provides it to those with a hormone deficiency.

This therapy is administered by injection and should be part of a routine health management plan under a doctors care to avoid side effects. For more information about hormone therapy, fill in the contact form and the knowledgeable advisor will call you back.

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Celebrities that take HGH: Why do they need it? - - VENTS Magazine

MD Medical Group now has drive-thru COVID-19 testing facilities at seven Dallas-Fort Worth locations. (Courtesy MD Medical Group)

The drive-thrus are open to adults and children age 2 and older from 8 a.m.-5 p.m. Monday-Friday. According to MD Medical Group, select locations have the ability to administer 1,200 tests per day.

Those looking to get tested must schedule an appointment by calling or texting 888-776-5252. Same-day appointments are available.

The drive-thru sites are intended to allow people to get tested for COVID-19 while reducing demand at local hospitals, according to the medical group.

Julia Robles, lead medical assistant at Clinicas Mi Doctor, said the health professionals at the clinic start by assessing whether a patient is showing symptoms of COVID-19 and whether they have been exposed to the disease.

We do a quick questionnaire, and then, we will test them for flu and strep first, Robles said. And then, if they meet the criteria, well go ahead and do COVID-19 testing on them as well.

MD Medical Group has drive-thru testing facilities at the following Dallas-Fort Worth locations.

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MD Medical Group opens COVID-19 drive-thru testing sites at 7 locations in Dallas-Fort Worth - Community Impact Newspaper

Young and Clement [3] reported the first case of mllerianosis in the urinary bladder in 1996 and defined this disease as a lesion seen at any site containing admixtures of endosalpingiosis, endometriosis, and endocervicosis. Twenty-one cases occurring in the urinary bladder have been documented in 19 articles (Table1) in the English literature, accounting for the majority of cases of mllerianosis [18]. Some sporadic cases have been reported in the ureter, spinal cord, inguinal lymph nodes and mesosalpinx [2]. To the best of our knowledge, this is the first report to describe mllerianosis of the umbilicus. Due to its rarity, the prevalence of mllerianosis is unknown.

Several hypotheses of the pathogenesis of mllerianosis of the urinary bladder have been proposed; however, the mechanism is not clearly understood. Implantation, one of the most discussed theories, suggests that mllerian tissue implants into the urinary bladder wall during pelvic surgery [3]. However, this cannot explain why mllerianosis is found in surgery-nave patients or in organs other than the urinary bladder. Ten of the 19 cases (52.6%) with detailed surgical records, the present case included, had not experienced any pelvic surgery such as hysterectomy or cesarean delivery. Another theory, metaplasia, advanced by Donne et al., [4] is based on the presence of two or more mllerian-derived tissues, which implies the potential of mllerian epithelium to differentiate rather than the implantation of a single type of the tissue. Moreover, of the 20 cases with marked tumor locations, a total of 16 tumors (80%) were situated on the posterior wall or the dome of the urinary bladder, a place adjacent to the peritoneum and more sensitive to female hormones. Koren et al. [9] in 2006 reported a case supporting the metaplasia theory with the metaplastic epithelium in continuity with the urothelium. The present case is also supportive of metaplasia because of concurrent occurrence of the bladder and the umbilical masses.

Mllerianosis of the urinary bladder mainly affects women of the reproductive age, with a mean age at diagnosis of 44.6years (range 27 to 70years). Of the total 22 patients with mllerianosis of the urinary bladder, five were postmenopausal females. The most common symptoms have been reported to be irritative voiding symptoms (54.5%) including frequency, urgency, urge incontinence and dysuria, abdominal/pelvic pain (45.5%) and gross hematuria (36.4%). These symptoms occurred cyclically in six cases (27.3%), mostly during the menstrual period. One patient with a tumor on the ureterovesical junction presented with renal colic [13]. Our case had none of the symptoms associated with bladder lesions, and only had umbilical bleeding.

Grossly, mllerianosis of the urinary bladder has been described as sessile polypoid, [17] submucosal, [6] or smooth with normal appearing overlying mucosa [14] on cystoscopic examinations. The gross appearance of the bladder tumor in our case revealed the similar findings as a mass with hemorrhage underneath the intact epithelium. Histologically, it revealed multiple foci of glands with variable size lined by tubal, endocervical, or endometrial epithelium situated in the lamina propria and muscularis propria [2, 15]. These glandular cells were immunohistochemically positive for ER and progesterone receptor (PR) [9]. In addition, the stroma surrounding the endometrial glands diffusely expressed CD10, and the epithelia showed positive staining for Ca-125 [15].

Both medical and surgical treatments can be used for mllerianosis of the urinary bladder. Regardless of the lack of consensus on the choice of therapy, most physicians and patients chose the surgical intervention in the reported cases, and most of the patients had a favorable prognosis. Sixteen patients underwent TURBT, only five of whom required subsequent medical treatment, [12, 13] or partial cystectomy [16, 18, 19] due to persistent symptoms or tumor recurrence. None of the four patients who underwent partial cystectomy had recurrence; by contrast, in two cases using gonadotropin-releasing hormone (GnRH) analogues to inhibit pituitary and gonadal function to reduce the tumor volume as medical treatment, cystoscopy showed smaller but persistent tumors at 3months and 2years of follow up. There was no documented distant metastasis or mortality in the cases with short-term follow-up (124months).

Mllerianosis of the urinary bladder mimics several bladder neoplasms such as cystitis glandularis and nephrogenic adenoma [9]. It is most important to differentiate between mllerianosis and invasive adenocarcinoma, both of which exist in the lamina propria and muscularis propria. A case of bladder endometrioid adenocarcinoma complicating mllerianosis has been reported [8].

In conclusion, mllerianosis is a rare neoplasm which mainly affects women of reproductive age. The common presentations of mllerianosis of the urinary bladder include irritative voiding symptoms, abdominal/pelvic pain and gross hematuria. In our case, multifocal mllerianosis were separately located on the urinary bladder and the umbilicus, which implies that the possibility of concurrent bladder mllerianosis should be considered when mllerianosis is found at other location. Despite a favorable prognosis in the majority of patients, in view of the importance of establishing the correct pathological diagnosis, we suggest treatment with a surgical intervention consisting of TURBT and partial nephrectomy if recurrence occurs with persistent symptoms.

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Concurrent mllerianosis of the urinary bladder and the umbilicus presenting with umbilical bleeding: a rare case report and review of the literature -...

Even as Lorena Borjas was feeling ill and waiting on Covid-19 test results, she was worried about how transgender immigrants would cope with the pandemic.

That, according to her friends and chosen family, was typical of Borjas, a transgender Latinx activist from Queens who spent decades advocating for people from marginalized communities. Despite numerous challenges and traumas she faced in her personal life, she never took a rest from fighting for transgender women, undocumented immigrants, sex workers and those living with HIV/AIDS.

On Monday around 5:22 a.m., Borjas, 59, died from complications due to Covid-19 at Coney Island Hospital, according to her close friend Cecilia Gentili.

"Lorena spent her life tirelessly fighting and supporting our trans sisters, making sure they were treated with dignity and respect they deserve," Make the Road New York, an organization that fights for immigrant and working class communities, said in a statement. "We will truly miss her. May she rest in power and love."

She was a fighter and a leader

Borjas was like a mother to Gentili, she said -- one of many people in Queens' transgender Latinx community who shared that sentiment.

"You could aspire to be like her but you clearly know you won't be like her because you are not as selfless as she is," Gentili told CNN.

For more than 25 years, Borjas spent her days serving people in marginalized communities in whatever ways she could.

"Lorena brought light to us when we were living through a very dark time here in New York," said Cristina Herrera, founder and CEO of Translatina Network and a friend of Borjas' since 1987. "She brought us light when we were dealing with the crack epidemic, when we were dealing with the AIDS crisis, dealing with changes in immigration policies."

Borjas walked up and down the streets in her neighborhood of Jackson Heights, handing out free condoms to sex workers. She set up syringe exchanges to protect transgender people who were undergoing hormone therapy. She set up an HIV testing clinic in her own home.

Gentili recalled a time when she was tasked with connecting transgender patients to mental health services at a clinic she worked at. Borjas offered to introduce her to people in the community who could benefit from those services, asking Gentili to accompany her late one night while she was distributing condoms to sex workers.

"She wasn't expecting people to come to her," Gentili said. "She was going to them."

Chase Strangio, deputy director for transgender justice at the LGBT & HIV Project of the American Civil Liberties Union, said he first met Borjas in 2009 and started working closely with her in 2010 through his role at the Sylvia Rivera Law Project, where he was working on immigration and criminal justice issues.

At first, Borjas was a client, but "quickly she became a colleague and co-conspirator," he said.

"She brought people into the office every week who needed legal support and made sure that I was paying attention to the crisis of policing and deportation facing her community," Strangio wrote in an email to CNN.

The two worked together to support transgender Latina immigrants and others who were dealing with arrests, convictions and court appearances, he said. Eventually, they co-founded the Lorena Borjas Community Fund, which helps transgender people and others pay for legal costs and bail.

Bianey Garcia, an activist at Make the Road New York, said she first met Borjas when she was 17 -- during a time when she lived "a crazy life." One of her earliest memories of Borjas was when she invited her to a support group.

Later, Garcia, who was previously a sex worker, said she was arrested and incarcerated at Rikers Island. Borjas visited her at the jail complex, listened to her fears about deportation over the phone and eventually found an immigration lawyer to fight for her release.

"I really appreciated her for everything that she did when I most needed," Garcia said.

She faced her own challenges

Borjas came to the United States from Mexico in 1981 when she was 20, according to a short film called "The Story of Lorena Borjas." She considered herself a gay man at the time and didn't see a future for herself in Mexico, Borjas says in the film. So she emigrated in order to transition -- and to find professionals who could help her do so under medical supervision.

Though she successfully transitioned, she remained undocumented until 1986, when she was granted amnesty under a law enacted by President Ronald Reagan. She became a legal permanent resident in 1990. That same year, however, she was arrested on charges of prostitution and trafficking -- though she was a human trafficking victim herself.

Borjas' subsequent convictions meant she could not renew her status as a permanent resident or become a US citizen. Despite her circumstances, she began her life as an activist in 1995, organizing a transgender march to protest "police policies and systems" and helping transgender women with HIV/AIDS.

In 2017, Borjas was granted a pardon by New York Gov. Andrew Cuomo, finally easing her long-held fears of deportation.

"Lorena has done more than anyone else I know to shine a light on the epidemic of trafficking in transgender communities and to help other trans women escape exploitation," Lynly Egyes, who represented Borjas on behalf of the Transgender Law Center, said at the time.

She wanted to people to share joy

Borjas took care of people in ways big and small, friends said.

Aside from helping transgender immigrants navigate the legal system, she also made sure they had food to eat, a roof over their heads and a cell phone, according to Strangio.

Herrera added that Borjas would provide new immigrants with Metrocards so they could use the subway. She stayed up late talking to people and helping them deal with their problems. She'd call people to remind them about medical appointments -- and follow up to see whether they had made it and how things went.

"She just wanted people to be OK," Herrera said.

It was important to Borjas that people not only survived, Strangio said, but thrived and shared joy with each other.

In May 2012, a few months before Strangio was expecting a child, Borjas threw his family a surprise baby shower and bought them a car seat and a stroller.

"We had so much more access and privilege and yet she found a way to demonstrate that she was going to provide love and support to our growing family," he said. "This is what she did for everyone."

Monday night, about 250 people gathered for a virtual vigil to honor Borjas' life and legacy.

CNN's Maria Santana contributed to this report.

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Lorena Borjas, a transgender Latina activist who fought for immigrants and sex workers, has died of Covid-19 - The Albany Herald

captionMr. Tatyana Bellamy Walker worries his gender confirmation surgery will be canceled.sourceCourtesy Tati Bellamy Walker

I took the subway two weeks ago to one of the few transgender healthcare centers in New York City to retrieve my last psychological letter for gender-affirming surgery.

Yet, when I arrived at the center in Manhattan, the psychiatrist wasnt there. I was told she was adhering to the states mandates and began social distancing.

Outside the office, it was a ghost town.

The streets that are normally filled with halal trucks and people selling knockoff purses were nearly empty. And then there was me: a guy who left his house and essentially risked coming in contact with coronavirus for no reason.

This was one of the last letters I need for Medicaid to begin approving my gender-affirming procedure more simply known as bottom surgery. Without these letters, my health insurance will not deem the surgery medically necessary. And as a result, I will not be able to afford it.

This comes just a week after the US Surgeon General requested that health systems consider pausing elective surgeries. Last week, New York Governor Andrew Cuomo ordered that medical centers pause elective surgeries. Whats more, a staff member at the health center warned me that because of the outbreak my surgery could be postponed.

I am not alone: Transgender and nonbinary people face many barriers when it comes to finding access to gender-affirming healthcare. In 2015, the US Transgender Survey found that one-third of trans and nonbinary people face discrimination at the doctors office. Their findings also show that 33% of trans people postponed medical care because of the cost.

On the other hand, research shows gender confirmation surgeries improve the overall mental health and wellbeing of trans and nonbinary people.

For many people, when they hear elective surgery they assume cosmetic surgeries. Ive waited nearly a year for SRS and now the growing coronavirus pandemic is threatening to take it away.

I am scheduled to have bottom surgery or metoidioplasty in July 2020, but because of the delay in elective procedures, its likely that my pre-op appointment and surgery will be rescheduled. Before then Ive had to go through a number of psychological evaluations to be deemed sane for the procedure.

According to national trans health guidelines from WPATH (The World Professional Association of Transgender Health), trans and nonbinary patients who want bottom surgery must have gender dysphoria, have their mental illnesses under control, receive hormone replacement therapy for a year, and live consistently as their gender (whether male, female, or nonbinary). Also, you need letters from a doctor, psychiatrist, and counselor that prove this procedure is medically necessary.

Not only do we face strict requirements for treatment, but this system is backlogged with patients. Last September, I called Mount Sinais Transgender Health Clinic, was put on a waitlist, and then scheduled for my first appointment in November.

At the appointment, I didnt make the weight requirement. All transgender and nonbinary patients are required to have a BMI of 33. At the time, my BMI was closer to 34. Business Insider has previously reported that BMI is an outdated system that doesnt measure body fat. According to health experts, physicians can yield a more accurate result of your health by measuring your waist circumference.

Yet, the facility did not allow me to schedule surgery until I lost the weight. I lost 10 pounds through a crash diet. Hours before I graduated from the Craig Newmark School of Journalism, I weighed in at Mount Sinais Transgender Health Clinic. Then, I had my first consultation with the doctor in January.

I also faced bias from mental health counselors who could write a letter. The first therapist I went to for a letter for bottom surgery told me she didnt feel comfortable advocating for me to get surgery. So, I had to look elsewhere. And my former psychiatrist who is covered under Medicaid calls me Mrs. at every appointment, despite knowing I am male. Therefore, receiving a letter from him was not an option. Now, social distancing has delayed me even further. To this day, I have not received a letter.

In August of 2018, a doctor officially diagnosed me with gender dysphoria, the debilitating distress I feel because of a disconnect between my brain and how the world perceives my body. Since then, Ive received treatment through hormone replacement therapy or injecting my stomach every week with testosterone. This has relieved a lot of my symptoms, such as depression and anxiety.

Much of my dysphoria comes from not feeling socially included in male spaces. On a day-to-day basis, this means finding another bathroom at work because there are no open stalls. At a former internship and graduate school, this meant people intentionally calling me by my dead pronouns and grouping me in with women or ladies.

Its only recently that Ive started to be read as male in public (for example, grocery store cashiers calling me sir, people on the street calling me brother and guy). While this is a relief, its also scary. I avoid public gyms because I fear the potential violence and stigma Ill face in the mens locker. Receiving this surgery as soon as possible will allow me to avoid potential violence and live my life safely.

Now, I am waiting for a call from my surgeons office on whether or not my surgery and pre-op appointment will be rescheduled or canceled. Bottom surgery is one of the final steps Im taking in my gender transition. Most of my legal documents are male. My mail is addressed to Mr. Tatyana Bellamy-Walker and I have an M on my drivers license, social security records, and birth certificate.

And although transgender people are banned from the US military, I managed to be registered into the US Selective Service System, a military draft system for all males under the age of 26.

Yet, somehow, the pandemic is becoming my latest obstacle to participating in public life.

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Elective surgeries are being postponed during the coronavirus outbreak. But my gender-affirming surgery isnt optional its life-saving. - Business...

A healthy sex life is beneficial for the body and mind. In fact, it can reduce stress, lower blood pressure, and improve sleep.

While research is extensive on the benefits of a healthy sex life, there aren't as many studies to determine whether the benefits of masturbation match those of sex with a partner.

However, masturbation is the safest way to achieve sexual pleasure, and some research has suggested that solo sex can be just as healthy. Here's what you need to know.

Older research has connected orgasms with increased immune function. In 2004, a study of 11 men published in the journal Neuroimmunomodulation found that sexual arousal and orgasms activated components of the immune system.

Though the study was very small, the researchers found that masturbation increased the number of inflammatory mediators called leukocytes (white blood cells) and natural killer cells. Both of these fight infection as a part of the body's immune response.

Jennifer Berman, MD, a sexual health expert, also notes that the research was focused on the male experience, and sexual arousal may affect women's bodies differently. But overall, orgasm whether with a partner or without has other known health benefits.

"Sex reduces stress," says Britney Blair, PsyD, a clinical psychologist and founder of The Clinic, a sex therapy clinic in Northern California. Blair clarifies that when she talks about sex, she includes both sex with a partner and solo sex, or masturbation.

"Sex can be like exercise, which is great for your heart, your lungs, and your immune system," Blair says. "Sex is also great for improving sleep and allowing you to fall into deeper sleep more quickly, so overall, masturbation is great for health."

There isn't research that compares the immune benefits of masturbation versus having sex with a partner, but Blair does note that sex may have the additional benefit of boosting oxytocin also known as the cuddle hormone and improving bonding with a partner.

But masturbation has also been found to stimulate the production of endocannabinoids, according to The Journal of Sexual Medicine. These neurotransmitters are a part of the endocannabinoid system, which plays a critical role in regulating the body. Stimulating the endocannabinoid system like through an orgasm may have positive effects on the immune system, inflammation, and the stress response.

Frequent orgasm can also have long-term health benefits, whether through masturbation or partner sex. Men who ejaculated between 4 and 7 times a week between the ages of 20 and 29 were at a reduced risk of developing prostate cancer, according to Harvard Health Publishing. This research included ejaculation through masturbation, intercourse, and nocturnal emissions.

While there isn't equivalent research for women, Blair recommends that women should masturbate or orgasm daily.

A healthy sex life, either with a partner or with yourself, is certainly good for you but there doesn't appear to be an exact number for staying well. Instead, Berman suggests choosing a frequency that is most comfortable for you personally.

"It's individually defined for the person and the couple," says Berman. "There isn't a number of times that you should be having sex. It's what's right for you."

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Does masturbation help your immune system? An orgasm may have benefits - Insider - INSIDER

Coronaviruscure is still not found by health experts around the globe. Thankfully, there were already a lot of hospitals testing their versions of COVID-19 cure for a faster way of solving the viral disease. On Sunday, Mar 29, a U.S-Israeli pharmaceutical company found a medicine that may lead us to flatten the curve to this disease. The US Food and Drug Administration also wants this medicine to have its test trials starting next week. Will it be the long-awaited solution we're looking for?

(Photo : BRENDAN MCDERMID on Reuters )FDA Says Yes to Coronavirus Cure From Israel; US Gov't Ready to Test Trial Medicine Starting Next Week

As of today, Mar 30, more than 700,000 people were already infected with COVID-19, while over 35,000died. With this, everyone is now more determined to find a way to solve this pandemic. Interestingly, the US FDAfinallyapproved medicine that may be one of a potential cure against the virus.

On alocal reportin Israel, NeuroRx, a US-Israeli pharmaceutical company, and Relief Therapeutics, a Swiss drug development company, had finally got approval from the FDA. The companies explained that they are not yet approved to market the medicine. They are only allowed for test trials. The companies are currently approved to create phase-two testing trials starting next week of a possible cure from COVID-19 called Aviptadil.

The drug called Aviptadil is a synthetic form of a neuropeptide hormone that works to enable communications between neurons in the human nervous system. Since COVID-19 patients mostly experience difficulty in respiratory function-- which kills diagnosed patients, the substance is expected to be the solution for this problem.

Specifically, Aviptadil is said to cure Acute Respiratory Distress in most coronavirus patients.

(Photo : JEENAH MOON on Reuters )FDA Says Yes to Coronavirus Cure From Israel; US Gov't Ready to Test Trial Medicine Starting Next Week

However, to clarify, both companies reiterated that they still have no assurance that Aviptadil cures Coronavirus. On the other hand, with the help of the go-signal from the FDA, they are now legally capable of testing the substance to COVID-19 patients.

Just like Aviptadil, US FDA also approved other possible Coronavirus cure from the past. The Trump administration, according to theWashington Post, had also given directives from the agency to legally distribute anti-malarial drugs across the country. Drugs, including hydroxychloroquine and chloroquine, were part of the distribution.

"It is reasonable to believe that chloroquine phosphate and hydroxychloroquine sulfate may be effective in treating covid-19,'' the FDA's chief scientist, Denise Hinton, wrotein the lettergranting emergency approval.

However, other health expertsexpressedtheir dismay with the FDA. Most of them say that the FDA might be rushing things out by allowing the distribution of 'off-label' drugs for rapid testing without proper studies.

"The concern really is if we're talking millions of patients, then this issue of drug-induced sudden cardiac death is absolutely going to rear its ugly head,'' said Michael Ackerman, a pediatric cardiologist, and professor at the Mayo Clinic College of Medicine and Science, who last week co-authored akey paperabout the risks in response to the surge in the drugs' use.

For now, let's see what will happen.

2018 TECHTIMES.com All rights reserved. Do not reproduce without permission.

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FDA Says Yes to Coronavirus Cure From Israel; US Gov't Ready to Test Trial Medicine Starting Next Week - Tech Times

Some cancer patients are angry that athletes, including Red Sox pitcher Chris Sale, are having elective surgery while theirs have been postponed because of the COVID-19 pandemic.

On Monday, Red Sox pitcher Chris Sale went under the knife in Los Angeles to repair the ligaments in his throwing arm.

A few days earlier, on March 24, Shelly Stevens had been scheduled to be on the operating table in Boston for the removal of a mass from her left lung.

But on March 15, Gov. Charlie Baker had ordered hospitals to postpone or cancel all "nonessential elective procedures" to free up resources, such as protective gear, for treating COVID-19 patients. Three days later, Stevens got a call from her surgeon at Mass General, saying they had to postpone the surgery for four weeks, if not more.

After some anger and tears, Stevens accepted her delay, calling it the "right decision." She didn't want to infect anyone, nor did she want to get infected with the highly contagious disease.

But the Brewster woman said she was angered by Sale's surgery as discussions began about the ethics of his "Tommy John" procedure during the global pandemic, when protective equipment for health care workers and testing kits are in short supply.

Now, as the country tries to fight the spread of the virus, Sale is recovering from his surgery while Stevens is fighting the potential spread of cancer inside her lungs.

"(My doctor) said, 'Its not that your (procedure) isnt urgent, or that its not important, but with everything going on, for your own health and safety, the best thing we can do would be to wait,'" said Stevens, 51. "He said they don't have the equipment or staff that they need and that exposing me to the virus would be very detrimental."

Nonessential, elective procedures, as defined by the state Department of Public Health, include, but are not limited to, incision of the skin, orthopedic surgery, endoscopy, oral procedures and podiatric procedures.

The department defines "elective" and "nonessential" as procedures scheduled in advance, since they do not involve a medical emergency. The state recommends providers use their clinical judgment on a case-by-case basis, and the order does not apply to life-sustaining care.

While this is what Baker ordered and what the American College of Surgeons has recommended governors elsewhere, including in California, have issued different orders or none at all regarding canceling elective surgeries during the pandemic.

Sale isn't the only athlete having elective surgery during the pandemic. San Francisco Giants pitcher Tyler Beede had arm surgery last week, and Mets pitcher Noah Syndergaard is scheduled to have it Thursday, according to USA Today.

Although Sale was treated in a private clinic, people took to social media to argue that his surgery used protective equipment that could have been routed toward hospitals treating COVID-19 patients.

"People in Los Angeles were begging for people to bring in masks, gloves, gowns, face masks, and here (Sale) is having surgery that could have waited," said Stevens. "My sister-in-law is a nurse in New York ... and they were given one face mask to wear for an entire week, so it just really made me angry."

Stevens was first diagnosed with cancer in 2010 when doctors found it in her hand. Her type is called leiomyosarcoma, a rare cancer that affects smooth muscle tissue.

Surgeons removed it, but after years of frequent CT scans, doctors found masses in her lungs in November 2018. She underwent more surgery and radiation. About a year later, doctors found a small spot in her lungs. When she returned in February for a follow-up scan, her doctors determined the mass had grown.

Surgery was scheduled. But then COVID-19 reached new levels.

"Every day I wake up and I'm scared. I don't know what's going on inside of my body," Stevens said. "You kind of feel like someone is holding a gun to your head and (you wonder) when are they gonna pull the trigger. Every little ache, every pain, every bump, you think, 'Is this more cancer?' "

Stevens has four daughters from 15 to 20 years old who have been helping her, along with her husband, Ryan. She has started a gratitude journal, in which she writes every night before bed. Tuesday night's topic was the Red Sox.

"Last night I had to try to get over being angry at these baseball players. It's not anything personal. ... but it's something I had to let go of."

The pandemic has had similar implications for another Brewster woman, Raquel Ellis, who was diagnosed with breast cancer in February after visiting the Dana-Farber cancer center in Weymouth. Her double mastectomy was scheduled for April 30, but it has been postponed.

Overall, Ellis said she's been coping. "I live with two teenage boys, so we kind of deal with everything with a lot of humor and silliness," she said.

More than her health, she's worried about how her delayed surgery will affect her ability to take her eldest son to college and teach her students at Ezra Baker Elementary School in Dennis in the fall. "In some ways, those are bigger losses for me," she said.

Her doctors concluded the cancer is related to her hormones, so they started her on hormone blockers to prevent further cancer growth as she awaits surgery. They also told her the mass won't kill her, but she's still eager to get it out.

"It's that feeling of knowing it's there and just wanting to get rid of it because it doesn't belong," she said.

Ellis didn't know much about Sale and the other athletes until her friend, Stevens, shared articles on Facebook, but she now agrees it might not have been a responsible decision.

"I was told (my doctors) don't want to do surgery right now because they don't want to bring a healthy person into a hospital and get them infected," Ellis said. "So it really doesn't make sense whether you're a professional athlete or a teacher or an electrician, that the standards would be any different for a human being."

Sale's surgeon, Dr. Neal ElAttrache, told the San Fransisco Chronicle, "I know that I'm going to get criticized for taking care of these kinds of guys, but it's essential to their livelihoods."

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Nonessential surgery? It depends on who needs it - Wicked Local

With approximately 1 in every 18 people in the world using drugs, theres a growing global prevalence for substance use, according to the latest World Drug Report by the United Nations. While many people are able to use certain substances recreationally, some abuse substances, and others fall into the addiction category.

Addiction, however, doesnt come down to a lack of willpower or a series of bad choices. Whether you become an addict or not depends on a combination of factors, including genetic loading, early childhood trauma, an adverse home environment, and specific personality traits such as impulsivity, poor emotional regulation and distress tolerance. These all increase your risk dramatically, says Jean Coetzee, the Clinical Manager at the Harmony Addiction and Psychiatric Clinic in Hout Bay.

At the basis of every addiction, regardless the type, lie similar drivers, as just mentioned. The drug of choice is just the symptom, but the addiction is the actual disease, says Siobhan Alford, Hospital Manager at the Harmony Addiction and Psychiatric Clinic.

Neuroplasticity: The hope in the fight against addiction

Addictive behaviour is a result of the brains ability to adapt and form patterns, according to a study published in the journal Dialogues in Clinical Neuroscience. Most drugs that are abused activate dopamine (the happy hormone) in the brains reward system. This novel experience produces patterns in the brain that link external cues; to the use of drugs; to the reward system. Over time, the reward system is automatically triggered by these cues alone, leading to an urge to take drugs.

Luckily, every problem has in it the seeds of its own solution. Coetzee explains that when you start adopting healthy coping mechanisms, rather than unhealthy ones like substance abuse, positive neural pathways can also become entrenched in the brain. The two ways in which you can rewire the brain and entrench positive coping mechanisms is through repetition and novel experiences, Coetzee says. There is hope in recovering from addiction because it is possible to change the real estate (physical structure) of your brain and consequently your behaviour and thinking too.

How to identify addictive behaviour

Addictive behaviour usually develops in vulnerable individuals, but how do you know if you or a loved one is at risk of addiction? Although using substances that activate the reward system can contribute to the development of addiction, vulnerability to addiction is influenced by a complex set of variables such as genetic predisposition, environmental circumstances, psychological factors, social pressures or trauma. A strong connection between trauma, post-traumatic stress disorder (PTSD) and addiction has been found in studies by renowned expert Prof. Alexander McFarlane.

A simple way of identifying addictive behaviour in a loved one or yourself is through the presence of the 4 Cs:

In South Africa, alcohol is still the number one abused substance followed by cannabis, methamphetamine and then opioids (which includes codeine, heroine, nyaope and wonga), according to the SACENDU Project. Besides substances, process addictions like gambling, gaming and sex are also very prevalent and treated with the same gravitas as any other drug.

The road to recovery

The first step to recovering from addiction is taking responsibility to become clean. You dont choose to be an addict, but you can choose to become sober, Alford says. Making an appointment at a registered rehabilitation centre is one of the first steps that you can take to come clean. Some centres, like Harmony Clinic, work with medical aids to cover drug and alcohol rehabilitation treatment.

Harmony Clinic takes an evidence-based scientific and medical approach to treating addiction through a biopsychosocialspiritual model. As a dual diagnosis hospital, patients who are admitted to the clinic see a psychiatrist within 48 hours and a general practitioner within 24 hours of their admission, Alford says.

Alongside the medical approach, DBT (Dialectal Behavioural Therapy) skills such as mindfulness are a strong foundation of evidence-based addiction treatment. After eight weeks of daily mindfulness practice, the real estate of the brain can already start to change, Coetzee says. Although the brain rewires quite rapidly, individuals can still be vulnerable years after theyve started their recovery process which is why abstinence (or harm reduction where abstinence is not possible) is strongly recommended.

The road to recovery is equally as important for family members as for addicts themselves. Patients usually show significant progress in therapy and then they go home to where circumstances havent changed, Alford says, which is why experts advise family members of recovering addicts to get their own therapy and to join support groups. Popular networks for family support groups in South Africa include Al-Anon and Nar-Anon.

This post is sponsored by Harmony Clinic produced by Brandstudio24 for Health24.

Anina Visser - PARTNER CONTENT

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You are not your addiction - Health24

This article was medically reviewed by Carolyn Swenson, M.D., an assistant professor of obstetrics and gynecology and member of the Prevention Medical Review Board, on March 27, 2020.

Menstrual cycles have a long list of nicknames that are charmingly dark: the curse, shark week, the blob, crimson tide, and so on. But when it comes to periods getting heavier than usual, the term that should be used most is potential problem.

Heavy menstrual bleedingmedically known as menorrhagiaisnt always cause for alarm, but in some cases, the situation can be a red flag (pun totally intended) for underlying issues that may need attention. Here, OB/GYNs explain the most common causes for a heavy period, along with some thoughts on when to see your doctor about it.

Heavy periods fall on a spectrum. For some women, it can simply be defined as having a heavier flow than usual, causing you to soak through pads or tampons at a more rapid pace. Menorrhagia, on the other hand, is a serious diagnosis and can result in significant blood loss. Per the Mayo Clinic, some signs to watch out for include:

An overactive or underactive thyroid are two of the most common culprits for menstrual difficulties, according to Sherry Ross, M.D., an OB/GYN at Providence Saint Johns Health Center in Santa Monica, CA. Thats because your thyroid actually helps control your menstrual cycle, she says.

Although thyroid disease can cause your periods to stop for several months, it can also lead to heavy and irregular periods, Dr. Ross says. Its an underactive thyroid that tends to be the heavy period producer, because your ovaries are not making enough progesteronethe hormone that helps lower your flow.

Known as PCOS, this condition affects how the ovaries work, Dr. Ross says. Although it can cause loss of periods or irregular cycles, it can also lead to heavy flow due to hormonal shifts, and can be exacerbated by weight gain.

Excess estrogen leads to a thickened uterine lining that isnt shed by the production of progesterone. (Those with PCOS usually dont ovulate, which kicks off progesterone production.) That can lead to heavier flow as well as more clotting.

Almost always benign, fibroids are muscular tumors that grow in the wall of the uterus, and Dr. Ross says theyre common, especially as women age. Having a family history increases your risk, and so does being African American.

In addition to heavy bleeding, youre likely to experience pain along with some bloating and lower back pain, which is why the issue is often mistaken as a heavier-than-usual period. Fibroids are often detected in a regular pelvic exam, but your doc may suggest imaging like an ultrasound or MRI to get a better idea of where theyre located.

Hormone changes leading up to menopause creates a situation where periods become non-predictable, says G. Thomas Ruiz, M.D., OB/GYN lead at MemorialCare Orange Coast Medical Center in Fountain Valley, CA.

Instead of the standard 28-day length of time for a cyclewhich can vary between 21 to 35 days and still be considered normal, Dr. Ruiz notesa change in estrogen as the body prepares for menopause may mean the body is still creating a thicker uterine lining but not shedding it yet. A missed period or two during this time means that lining continues to increase until gravity does its part.

The lining starts to fall off from getting too thick and thats when youll see a heavy menstrual flow, often with significant clots, he says. Some of these patients can bleed for weeks like this, which is not good, because then theres an anemia risk.

In the first trimester, signs of a miscarriage can mimic a menstrual period, because there will be bleeding and clotting, says Dr. Ross. For some women, they may not have even known they were pregnant. According to Penn States Milton S. Hershey Medical Center, as many as 30% of women will experience this at least once, and causes can include chromosomal abnormalities, autoimmune disease, infections, and structural issues with the uterus, among other factors.

If you suddenly try to go from couch potato to triathlete, it can cause a hormonal imbalance as your body attempts to adjust, Dr. Ross says. Although amenorrhea can happen, which means you lose your period, your body could decide to swing in the other direction and go heavy instead.

This causes physical stress, which influences your periods, and that can happen over weeks and months, she notes. As you keep intensifying your training, your periods may become increasingly heavier, she says.

Again with the estrogen: Extreme weight gain can increase body fat, particularly in the abdominal region, which is where the majority of your estrogen is produced. Dr. Ross says that as estrogen increases, that can lead to thicker uterine lining and generally heavier periods. Women who have obesity also tend to experience periods that are longer than seven days and come with blood clots.

Significant weight loss can reverse this effect, she says. That causes a decrease in body fat and estrogen production, making your periods lighter.

Certain coagulopathies, known as bleeding disorders, like von Willebrands disease, platelet function defects, thrombocytopenia, and clotting factor deficiencies can also lead to a heavy flow. Among women with heavy menstrual bleeding, coagulopathies may be the cause in up to 24% of themespecially young women, says Carolyn Swenson, M.D., an assistant professor of obstetrics and gynecology at the University of Michigan.

The average woman with a bleeding disorder could first experience prolonged bleeding as young as six years old, but may not receive a diagnosis until 23, per the National Hemophilia Foundation. Other symptoms to look out for include excessive bleeding after an injury, prolonged nosebleeds, blood in urine or stool, and bruising easily.

Certainly, this is not the potential cause that should be your first thought during a heavy period, but it's a small possibility. Heavy bleeding is one of the biggest early signs of uterine, cervical, and endometrial cancer, especially if a woman has already been through menopause and no longer has periods.

But even for those who regularly have menstrual cycles on the heavier side, getting annual screenings is important to make sure cancers like these are caught early if they do develop.

Again, whats considered heavy varies by person, according to Lucille Russo, M.D., an OB/GYN at Northwestern Medicine Central DuPage Hospital in Illinois. For example, if youve had heavy periods all your life and been checked about it, that would be far less of a concern than if your periods suddenly became much heavier than usual.

1 out of 5 women deals with heavy periods, per the CDC.

Typically, I tell patients if they are soaking through a maxi pad or super tampon every hour for a few hours, they should call, says Dr. Russo. Also, if their periods are heavy and long, like lasting more than 10 days, or they are persistently bleeding between periods, they should contact their doctor.

Two other signs to make the call include seeing multiple clots that are bigger than 1-inch wide, and needing to us both pads and tampons at the same time, she adds.

Even if you dont have any of the underlying issues mentioned here, its worth speaking with your doctor about potential treatments, Dr. Russo says, because persistently heavy periods can often cause anemia, a condition where there arent enough healthy red blood cells to carry needed oxygen to your bodys tissues. That can lead to fatigue, weakness, dizziness, and rapid heartbeat with exercise.

Bottom line: In general, its likely you know when something seems wrong down thereget it checked to be safe.

Like what you just read? Youll love our magazine! Go here to subscribe. Dont miss a thing by downloading Apple News here and following Prevention. Oh, and were on Instagram too.

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Why Is My Period So Heavy? - 9 Causes of Heavy Menstrual Flow - Prevention.com

We live in a world of verbs. We eat and drink. We work. We play. We scroll. We run, read and riff about the latest news coming out of D.C. We love, listen and learn. Every moment of every day is about doing. These verbs no matter which you engage in form and define our lives.

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

Yet, wellness expertMichael Roizen, MD, says we treat one of the most vital verbs of every 24-hour cycle sleep as a footnote, rather than the main text.

Sleep has become a cultural sacrificial lamb, Dr. Roizen says. Wed rather work late than get enough ZZZs. Wed rather binge on Bravo. Wed rather stalk social media. Or maybe our bodies just cannot shut down, or health problems make it hard to fall or stay asleep.

In any case, the reality is a harsh one, he says. Our lack of sleep isnt just a boon for the coffee shop industry. Its slowly killing us, Dr. Roizen says.

Dr. Roizen doesnt take a lack of sleep lightly. In fact, he says people dont put lack of sleep in the same category as cigarettes or obesity because fatigue is more of a behind-the-scenes health threat one that has a steady, creeping effect on our bodies. But the risks associated with lack of sleep are big.

Heres how it works: While youre sleeping, your body and brain cycle through various stages ranging from light sleep to deep sleep. You go through that cycle several times a night. It sure feels like nothing is going on after all, youre not aware of anything, except maybe that wacky dream about a tornado, a marching band and your seventh-grade math teacher. Thats maybe one of the reasons people dont give sleep as much attention as they should: They dont feel anything the way they feel exercise or a change in eating habits. So its easy to think that sleep is, well, just a whole lot of nothing.

But thats not the case. When youre closed for business, your bodys cells start their work. Think of the inside of your body as a big factory of shift workers, Dr. Roizen says. Cells clock in when you shut down. All day long, your body at work, during exercise, while youre going about your day has been put through a series of cellular stresses. For example, when you use your muscles, they can experience little microscopic tears. That same kind of stress happens all over your body in all kinds of organs, tissues and systems throughout the day.

To maintain itself and recover from these cellular insults, your body needs a repair crew. Enter your shift workers. While youre sleeping, theyre repairing your muscles, growing and strengthening neurons in your brain, fortifying your bodys damaged cells, he explains. These cells cannot do their jobs optimally unless your body is shut down and in deep sleep.

So you can imagine what happens if you dont give these cellular fixers enough time to work. Your body never gets fully repaired, making you weaker, more susceptible to further insults, and a lot less healthy. In practical terms, Dr. Roizen says, that means lack of sleep can contribute to immune problems, memory issues, higher stress levels and even obesity. Because your brain never fully rids of its waste products (the poop from your brain cells is removed at night, and is done more efficiently the longer you sleep), you can develop inflammation in your memory centers as well.

Yes, perhaps one of the greatest effects of lack is sleep is a high inflammatory response, which is your bodys way of fighting problems. When this response is at high levels all the time because it never shuts down, Dr. Roizen says that leads to a sort of friendly fire within the body: Your attacking immune cells begin to damage the healthy ones (and not just in your brain) putting you at an increased risk for heart disease, diabetes and arthritis. (Heck, research has even shown that lack of sleep even increases hostility in relationships; the fallout can trigger higher stress, which has damaging effects on overall health).

These bodily damages work in various ways, Dr. Roizen says. But if you think about your bodys function as a massive game of dominoes, you can see how it plays out. When you dont get enough sleep, you feel fatigued. When you feel fatigued, your body wants to raise energy levels, so it reaches for the fastest solution: sugar. When you reach for sugar, you gobble up stacks of cookies. And when you do that day after day after day, you gain a lot of weight.

Yeah, yeah, yeah, you say. Youve heard it all before. Get more sleep. Sleep eight hours. Easier said than done, especially if you have a complex cocktail of problems that make is difficult to sleep (pain, hormonal issues, obesity, urge to urinate, and so many other things can disrupt sleep cycles). Like many other health issues, Dr. Roizen emphasizes that sleep is one in which you may need to consider lifestyle and medical tactics to determine what will work best for you.

But you can also use food and nutrients to ease into some possible solutions to help change your verbs from tossing and turning to sweet dreaming. (As long as that sweet dreaming doesnt actually include sweets!)

MVPs: No magic sleep-inducing piece of fruit or secret ingredient will induce drowsiness (though, as youll see in the following, some are better than others). But Dr. Roizen says setting yourself up with a good last meal of the day can help prepare your body for sleep. Research shows that having meals high in fiber and low in foods with saturated fat and simple carbs (sugar) should help. So thats why a dish like beans, grilled fish or chicken, and a large side of vegetables is the best meal choice to help your body prepare to shut down (and as weve learned, the earlier you eat it, the better).

One recent study in The Journal of Clinical Sleep Medicine found that this kind of meal was associated with people falling asleep faster in less than 20 minutes, in fact. When subjects consumed more saturated fats and sugar, the process took closer to 30 minutes. If you have the choice (and you do!), make your protein fish, which, when eaten regularly, has been linked to helping prevent poor sleep.

Key Players: The two nutrients most associated with better sleep are magnesium and tryptophan. Youve heard of tryptophan; its all over the headlines in late November as the reason why you want to zonk out after eating a big plate of Thanksgiving turkey. Although tryptophan may not actually make you tired after a big holiday meal, the food that contain it, or magnesium, are certain good options if youre trying to improve your sleep quality. Tryptophan is an amino acid that converts to the body clock regulating hormone and melatonin. Foods that contain it include egg whites, soybeans, chicken and pumpkin seeds. And when you choose your vegetables for dinner, consider a leafy green like spinach that contain magnesium.

Cut From the Team: Feeling cravings at night? Dont be tempted by a midnight snack. Research on circadian rhythm and eating cycles reveals that midnight is actually the worst time to eat even if you think you just need a little something to make yourself more comfortable. Instead, have a fiber-rich dessert before the sun sets for example, a big bowl of berries or a pear. The fiber will slow things down so you feel full longer and thus less likely to crave something later at night.

The Sub Shop: Snooze Foods

This article was adapted from the best-selling book What to Eat When by Michael F. Roizen, MD, and Micheal Crupain, MD, MPH with Ted Spiker (2018 National Geographic Books)

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What to Eat When You Can't Sleep - Health Essentials from Cleveland Clinic

Advanced Age Management offers Testosterone Replacement Therapy. This mens clinic is located near Cleveland, OH, and it gives men the perfect solution if they are feeling sluggish, low energy, gaining weight, or they have a decreased sex drive. Advanced Age Management says if youre over the age of 35, you could have low testosterone, and this is normal as you get older, but you will start to notice issues more and more as you age.

This mens clinic in Cleveland, OH, says it is due to a condition called Hypergonadism, yet, they want to reassure individuals who may be concerned and worried that their testosterone production level is low, that is why they are now offering testosterone replacement therapy in their clinic. If you are suffering from one of the issues mentioned above, definitely consider scheduling an appointment with your doctor and get your testosterone levels checked. Contact Advanced Age Management, and they will advise you on your next step and get you in for a free testosterone assessment.

At Advanced Age Management, their goal is to help men build up their testosterone levels by testing testosterone levels and creating a treatment plan to get the testosterone levels back to an appropriate level so that each individual does not have to suffer anymore and can carry on with their life. This is all done through the testosterone replacement therapy at their mens clinic.

It would be best if you got in touch with Dr. John Kocka at Advanced Age Management, a low testosterone expert who carries out a series of assessments and testosterone replacement therapy for men and women in and around Cleveland Ohio. According to Advanced Age Management, the cost of the testosterone replacement therapy varies from each patient to the next, as each person will require a different treatment plan. You can, however, schedule a free consultation and also review your financial information with Dr. John Kocka once you get in touch.

Advanced Age Management emphasizes that the therapy offered to men is only for those with testosterone deficiencies, which is why this mens clinic is the best to consult with if you have found out that you have low testosterone. If needed, Dr.Kocka can offer you a same-day consultation.

If you have been given the go-ahead for testosterone replacement therapy, Advanced Age Management assures you that there are many benefits of testosterone treatment. There is evidence to suggest the therapy can improve your cardiovascular health by removing cholesterol from your arteries, a common issue that many men suffer with as they get older.

The mens clinic in Cleveland, OH, assists men for other hormone treatments as well, such as DHEA, cortisol, thyroid, natural growth hormone, insulin, and more.

Contact Advanced Age Management today at (330) 439-6591 and schedule your free consultation with one of their low testosterone doctors. This mens clinic is offering you the chance to increase your testosterone levels and, in turn, improve your health and overall well-being. At Advanced Age Management, the doctors use injection therapy for men who need more testosterone production. You can read more about low testosterone and the testosterone replacement therapy on their website at https://www.lowtohio.com.

Source:https://thenewsfront.com/advanced-age-management-offer-testosterone-replacement-therapy/

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Advanced Age Management Offer Testosterone Replacement Therapy - The News Front

Your brain has nerve cells called neurons that can multiply within certain areas of your brain. A big factor behind this is a growth hormone called brain-derived neurotrophic factor (BDNF). "BDNF is a protein produced by brain cells that is very important to the function and survival of brain cells," Lin explains. "We used to believe that we are born with a specific number of nerve cells in the brain, and once they die, they don't grow back. We now know that is not true."

Instead, your brain has the ability to regenerate and repair itself, and BDNF is "critical" in the process, Lin says. "Studies show curcumin can increase BDNF levels, and thus support brain healing and regeneration from injury and trauma," she says.* Cognitive decline is a form of inflammation of the brain tissues, and, given that curcumin manages inflammation, it may help protect people from developing cognitive decline, Lin says.*

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What Is Curcumin? Why This Anti-Inflammatory Active Is A Game-Changer - mindbodygreen.com

(PRESS RELEASE) CHICAGO Because women have higher rates of eye diseases and eye conditions than men, Prevent Blindness, the nations oldest non-profit eye health organization, has designated April as Womens Eye Health and Safety Month. The group provides free information to the public on various eye health topics, including vision issues, possible changes in vision during pregnancy, cosmetic safety and more.

Women have a higher prevalence of many of the major vision problems, including:

The National Eye Institute states that 26 percent more women aged 12 and older have uncorrected visual impairment due to refractive error compared with men aged 12 and older. And, 14 percent more women aged 40 and older have refractive errors compared with men aged 40 and older. Additionally, women are also more likely to have autoimmune conditions, which often come with visual side effects.

According to the American Academy of Ophthalmology, for women, fluctuating hormone levels of estrogen and progesterone can affect the eyes oil glands, which can lead to dryness. Estrogen can also make the cornea less stiff with more elasticity, which can affect how light travels into the eye. The dryness and the change in refraction can cause blurry vision and can also make wearing contact lenses difficult.

Pregnancy brings an increase in hormones that may cause changes in vision. Women with pre-existing eye conditions, like glaucoma, high blood pressure or diabetes, need to alert their eye doctor that they are pregnant (or planning to become pregnant).

Lastly, women often make the majority of their familys health care decisions and are often responsible as caregivers for the health care choices of their children, partners, spouse, and aging parents. It is important to remind women to make their own vision and eye health a priority to prevent unnecessary vision loss in the future.

Prevent Blindness recommends steps that should be taken to protect vision and eye health, including:

OCuSOFT Inc., a privately-held eye and skin care company dedicated to innovation in eyelid hygiene and ocular health, is partnering once again with Prevent Blindness in support of Aprils Womens Eye Health and Safety Month.

Today, obviously there are significant challenges in maintaining overall health, said Jeff Todd, president and CEO of Prevent Blindness. We want to remind women of all ages that there are many ways to protect the gift of sight today so that it can be enjoyed for many years to come.

For more information on womens eye health, including fact sheets on eye diseases and eye protection, please visithere or call (800) 331-2020. Prevent Blindness offers a free listing of financial assistance services in English and Spanish here.

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ClearVision Optical Remains Committed to Caring for Customers During COVID-19 - InvisionMag

Dr. Ilana Sherer, 38, has a general pediatrics practice in Dublin at the Palo Alto Medical Foundation/Sutter Health with a specialty in caring for gender-nonconforming and transgender youth. Shes also a violinist with Saul Goodmans Klezmer Band. She lives with her wife and two children in Oakland.

J.: You like to say youre the best klezmer violin-playing pediatrician in the Bay Area. How did that come to happen?

Ilana Sherer: Classical violin was a huge part of my life from age 5 through high school. At a Hillel event in college, I sat next to someone in a klezmer band. There was a deep learning curve, but I played through college and then in medical school. Ive played quite a bit here but its more limited now because of my kids. I grew up in a pretty mainstream Jewish community and klezmer helped me see there were other ways to connect to Judaism. Once I entered the klezmer/Yiddish world, I thought about how this is what my grandparents spoke, and how Yiddish culture has these really strong leftist roots.

Did you always know you would be a doctor?

When I was growing up, I was often told by my parents and others Youre going to be a doctor, but I wouldnt go along with what people thought I should do. For a time I thought I might be a research scientist, but then I realized I didnt like working in a lab. There was one person there who was a medical student studying to become a pediatrician. I went along with them to a clinic and thought This is what I want to do. Everyone was right all along, but I had to figure it out myself.

When did you choose to specialize in gender-variant children?

I worked at an LGBT health center during medical school. We treated a lot of transgender people, many of whom experienced homelessness and different kinds of abuse. I saw a 20/20 episode with a transgender college student, teenager and child. The kid was doing really well, and it was an aha moment. I thought, What can we do to protect these kids, to keep them from struggling the way the adults are? When I got to UCSF for residency, I was directed to Stephen Rosenthal, who was creating the [Child and Adolescent Gender Center at UCSF Medical Center].

There are a lot of Jews working in this field, true?

Once, at the center, we were trying to schedule our next meeting and realized that everyone in the room but one person was Jewish. I see it as part of the social justice terrain and my personal responsibility as a queer person and a Jew. These are the kids who need us to support and advocate for them in the way the generation before advocated for me.

How do you explain the rise in trans or nonbinary children, and at younger ages?

Kids are now taught they can be whoever they want to be. Were breaking down this imaginary social binary that tells you what each gender should do, but were also telling kids that you are in charge of how you live your best life and your best self. Not all kids who experiment will continue identifying as transgender, but they feel comfortable exploring it. In the past, a boy wearing a dress would get teased. Now, kids have the freedom to explore how they present and dress.

With a relatively small body of research, how do you know which treatment protocols to follow?

We dont start any medical intervention until puberty. Most children who present as transgender now do so early, sometimes as early as 2 or 3, but we dont need to do anything but support and love them until puberty. Then, they can take hormone blockers, which are fully reversible.

South Dakotas state representatives introduced a law that would make it illegal for doctors to give such hormone blockers to children, but ultimately, it was defeated.

Its so heartbreaking. Doctors providing this care in climates like that are my heroes. I admire those who are sticking their necks out. I feel very protected and lucky to be in the Bay Area.

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This pediatrician helps trans kids and moonlights playing klezmer - The Jewish News of Northern California

"; images = images + ""; images = images + ""; images = images + ""; images = images + ""; images = images + ""; images = images + ""; images = images + ""; images = images + ""; images = images + ""; images = images + ""; images = images + ""; jQuery('.imgGallery').prepend(images); jQuery('.each_image:first').show()}function navigateSliderNext(){coutner_img = parseInt(jQuery('#thecnt0').html());counter_img++;if(counter_img>total_img){counter_img=1}jQuery('#thecnt0').html(counter_img);jQuery('.each_image').hide()jQuery('.each_image[id="is'+counter_img+'"]').show()}function navigateSliderPrev(){coutner_img = parseInt(jQuery('#thecnt0').html());counter_img--;if(counter_imgAbout Dr. HE Obesity Clinic

Dr. HE Obesity Clinic in Istanbul, Turkey offers expert assessment and surgical treatment for obesity from leading bariatric surgeon, Assoc Prof Dr Hasan Erdem, and his team. With extensive pre- and post-operative counselling and a one-to-one patient-orientated approach, the clinic is committed to finding the best treatment solution for each individual case. All surgery is carried out at partner hospitals in Istanbul. Treatment options available include sleeve gastrectomy, gastric bypass and non-surgical weight loss (gastric balloon).

Assoc Prof Dr Hasan Erdem is one of Turkey's leading bariatric surgeons and has performed more than 5000 weight loss surgeries to date.

Dr Erdem qualified from the Istanbul Medical School of Istanbul University in 2002 and completed his specialist training in general surgery at Bezmialem Vakif Gureba Teaching Hospital in Istanbul. Following his national service at a government hospital, he worked as Chief Assistant in General Surgery at the Training and Research Hospital of Istanbul, where he carried out research into advanced laparoscopic and robotic surgery.

Dr Erdem established his private clinic in Istanbul in 2016. The author of a number of scientific publications in the fields of obesity, metabolic and robotic bariatric surgery, he was granted the title Associate Professor of Obesity and Metabolic Conditions in 2018.

Read what patients have to say about Dr. HE Obesity Clinic on Trustpilot

Sleeve gastrectomy or gastric sleeve, is a keyhole procedure to remove approximately 80% of the stomach, including the area where the hunger hormone, ghrelin, is produced. The resulting smaller gastric volume and loss of appetite thus leads to rapid weight loss.

Sleeve gastrectomy is suitable for people aged between 18 and 65 who have failed to lose weight by means of diet or exercise and who have a BMI of 40 or higher. It may also be considered in patients with a BMI of 35-40 who have co-morbidities such as diabetes, hypertension or sleep apnoea.

With the lowest complication risk and highest lifelong comfort compared to other methods, sleeve gastrectomy has become the favoured procedure with bariatric surgeons worldwide.

Gastric bypass offers a permanent solution to the diseases associated with obesity, particularly type 2 diabetes. It is suitable for patients who have a history of multiple unsuccessful attempts at losing weight with diet, those with excess weight that may jeopardise health, people with a BMI of 40 or higher, or people with a BMI of 35-40 with any obesity-associated co-morbidity.

Performed laparoscopically (keyhole surgery), the procedure shrinks the stomach to a small pouch and causes the food to bypass the upper portion of the small intestine. This has a dual effect: both the amount of food that can be ingested and the amount of nutrients that can be absorbed is reduced.

Most patients who undergo gastric bypass surgery successfully lose weight and maintain their excess weight loss in the long term. The role of a dietician is important in the postoperative period to ensure that patients adapt to the dietary changes required, however the rates of postoperative patient satisfaction are high in terms of the psychological and physical effects.

An intragastric balloon is a soft, expandable balloon that is inserted endoscopically into the stomach. Once placed, the balloon is filled with liquid, generating a feeling of fullness when smaller food portions are ingested. A gastric balloon may be in place for 6 or 12 months.

The gastric balloon is designed to work in conjunction with dietary and lifestyle changes. It is suitable for overweight people with a BMI over 25 who have failed to lose weight with diet or exercise, who have lost motivation or who do not want to undergo a surgical procedure.

Dr. HE Obesity Clinic welcomes patients from around the world and has dedicated patient coordination and consultation services in English, German, Bulgarian, French, Spanish, Armenian, Italian and Arabic.

For more information, call the clinics 24/7 Obesity Help Desk on 90 543 346 10 37 or fill out the online form to get a free consultation.

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Dr. HE Obesity Clinic: Weight loss clinic in Turkey - Treatment Abroad

Since 1851, normal human body temperature has been considered 98.6F (37C), established by Carl Reinhold August Wunderlich, 'the father of clinical thermometry'.

However, the German physician also observed variances in temperature depending on age and gender, and noted that normal body temperature is better described as a range.

Here's what you need to know about your body temperature, when it's considered a fever, and how to take it properly.

The human body isn't consistently one temperature, and depending on your age, the time of day, and even the activities you've been doing, it's more accurate to describe a normal body temperature range: between 97F (36.1C) and 99F (37.2C), according to Mayo Clinic.

"Temperature can vary between individuals, where some well members of a family are consistently warmer than others," says Charles Brantly, MD at Central Health. "This is not necessarily a bad thing. The normal range for the vast majority of people is between 36C and 37C."

A 2017 study of 35,488 people published in the British Medical Journal found the average body temperature to be 36.6C, slightly lower than what Wunderlich found in 1851. Moreover, a 2020 study from Stanford University School of Medicine, which assessed temperatures taken from three different databases over a 157-year period, found that the average body temperature has decreased over time a drop of 0.03C per birth decade.

The study authors indicate that the change in body temperature could be linked to improvements in human health and lifespan, as body temperature is an indication of metabolic rate. In this study, a slower metabolic rate was correlated with a longer life.

While core body temperature for men and women is roughly the same, in one study, women were found to generally have a lower skin temperature in some areas, because of their higher percentage of body fat. Brantly says that women can also have varying temperatures during their monthly menstrual cycle, and points out many other factors that can affect temperature on a day-to-day basis.

"On average children tend to be slightly warmer than adults, and those over 65 are cooler," says Brantly. "Exercise, hydration status, and clothing will all affect your day time temperature as well."

Chawapon Kidhirunkul, MD at BDMS Wellness Clinic, also says that time of day can impact your temperature. "Our temperature drops at night during sleep and increases over the day," Kidhirunkul says. "The lowest temperature is at around 4 a.m., and the highest peak at 5 p.m."

This rise in temperature is due to increased cortisol the stress hormone in the body as we go through the day. Kidhirunkul adds that another factor can be food, which usually increases temperature slightly after a meal.

High body temperature is one of the first symptoms of illness. According to Cleveland Clinic, 100.4F is considered a fever for adults, and children may feel feverish at slightly lower temperatures, depending on how you take the temperature.

A fever is an indication that your body is fighting off an infection, and is a common response to many kinds of viruses and illnesses. It's often associated with other symptoms like chills, headaches, tiredness, body aches, and sweating.

If you're feeling feverish, Brantly advises measuring your temperature and recording it several times a day, as thermometers aren't always accurate and your temperature may rise and fall throughout the day.

Fever is also a common symptom of the coronavirus. If you think you may have a fever associated with other symptoms of coronavirus, follow the CDC guidelines for taking care of yourself and preventing the spread of the virus.

There are several options when taking your temperature, such as armpit, forehead, mouth, ear, and rectal methods, according to Kidhirunkul.

The most common and easiest method of taking your temperature is in the mouth, however, Kidhirunkul says rectal temperatures are the most accurate. When it comes to a professional setting, Brantly notes that most hospitals and clinics rely on ear thermometers, though these are more expensive.

The UK's National Health Service recommends digital thermometers, which are inexpensive and easy to use. To take an oral temperature reading at home, follow these steps:

1. Put the thermometer under the tongue.

2. Close your lips around the thermometer to hold it in place.

3. The time the thermometer takes depends on the manufacturer's instructions: set a timer, or if it's digital, it may already have a timer function.

4. Once the time is up, remove the thermometer and then read it.

5. Make sure to clean the thermometer before putting it away.

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What is normal body temperature? How to know if you have a fever - Insider - INSIDER

Head to a motor racing circuit and you might be surprised to find one of the drivers sharing his experience of a bumpy fertility journey, as well as talking tyres and podium positions.

It might seem out of place, but for Toby Trice its a chance to share the tough emotional stress of in vitro fertilisation, or IVF, with a wider audience.

I had all this anger, frustration and stress, which I released through go-karting, says the 29 year old, who has been through IVF and the pain of unexplained infertility with partner Katie.

That led to me embarking on a motorsport career and I realised I could use it to start conversations about fertility and IVF. I want to send out a strong message that you can talk about what you are going through.

Uncertainty, guilt, sadness, anxiety: the emotional stress of IVF has been documented by Fertility Network UK, which found fertility problems and treatment cause high levels of distress.

IVF is not just about the four weeks of treatment, but potentially years of disappointments and hopes, explains Tim Child, medical director at Oxford Fertility and associate professor at Oxford Universitys Nuffield Department of Womens and Reproductive Health. Patients have very often been through the ringer by the time they get to IVF.

The process can be gruelling, both physically and emotionally, with no guarantees of success. While everyone is different, particular points where IVF emotional stress can spike are during internal pelvic scans to check for follicles in the ovaries, during egg collection carried out under a light general anaesthetic or intravenous sedation and on embryo transfer day.

For a heterosexual couple, the man could face anxiety about producing a sperm sample, while the woman might be apprehensive about the daily self-injecting of drugs during the IVF cycle.

Adjunctive therapies such as reflexology, acupuncture, yoga and psychotherapy can be useful around these times to help manage the stresses, says Child.

Clinic-led support groups can be a source of help and, for Kelly Da Silva, her own eight-year journey through multiple rounds of artificial insemination and IVF prompted a desire to help others.

As well as setting up her own childless support organisation and online community The Dovecote, she began working with the Care Fertility clinic where she had her treatment. The 37-year-old pioneered monthly walk-and-talk events in green spaces across the country, as well as Skype events.

Peer-to-peer support can be really cathartic, she explains. The exercise aspect also helps low mood and can be something that gets neglected.

I realised I could start conversations about fertility and IVF. I want to send out a strong message that you can talk about what you are going through

Da Silva has also set up a buddy scheme, matching those going through the same stage and type of treatment. Plus, I am buddying up men, same-sex couples and women having donor sperm or eggs, she says. Not everyone is on the same journey.

The focus on matching those on similar journeys is important, as the Human Fertilisation and Embryology Authoritys latest statistics show significant increases in same-sex partnerships and single patients among the 75,000 IVF cycles in the UK each year.

Female same-sex partnerships now make up 5.9 per cent of IVF cycles, while single patients make up 3 per cent.

Helen George, a psychotherapist specialising in fertility issues and founder of BME Voices Talk Mental Health, says counselling in an emotionally safe space can help prepare for IVF.

It also provides the opportunity to explore the lasting implications of having IVF treatment using donor eggs, sperm or surrogacy, she adds.

Its something that Gloucestershire couple Heidi and Gary Stephens advocate. While Heidi, 34, had counselling through the IVF process, Gary, 50, believes he would have benefited from the emotional help, especially as he went through surgical sperm recovery to retrieve blocked sperm.

I dont like talking about my worries, but inside it was eating me away, he says. You have to remain positive, but its such a lottery. With hindsight, I would have seen a counsellor.

While IVF treatment is filled with uncertainty, theres an area that can be controlled: nutrition. Nutritionist Dr Marilyn Glenville, a specialist in womens health, says regulating blood sugar has the biggest impact on helping women going through the rollercoaster of hormones.

The same hormone, cortisol, that manages stress also manages blood sugar, so we can end up feeling more stressed, she says.

Reducing refined sugars, such as the comforting chocolate muffin after that internal pelvic scan, and replacing it with high-quality, fresh foods, can minimise additional emotional stress. Supplements containing magnesium and B vitamins act as natural tranquillisers, says Glenville, while chromium can help tackle sugar cravings.

Meanwhile, work can prove a further painpoint, with Fertility Network UKs research finding 58 per cent of people said work affected their treatment.

Although theres currently no statutory right to time off for IVF treatment, more employers are now taking the issue seriously and creating their own policies.

Nurse Natalie Herring, 32, and her husband Ian, 36, struggled with fertility before undergoing IVF and she says being open with her employer helped.

Im very lucky as my employer has an IVF policy, which is best practice, so I was very open with my manager, she says. They were so supportive, there to listen and help me as much as they could if I needed it.

With more than 1.1 million IVF cycles now having taken place in the UK, and more than 300,000 babies born through IVF, the chances are patients are not the first in their workplace dealing with IVF.

Professor Geeta Nargund, medical director at CREATE Fertility and lead consultant for reproductive medicine services at Londons St Georges Hospital, concludes: If we want people to be more open and honest about fertility issues, we need to raise awareness, educate and get the conversation started. Its time to lift the stigma and help people with emotional support.

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IVF journey: tips to manage the emotional stress - Raconteur

Does the coronavirus pandemic have you feeling anxious? Unfortunately, that might compound the problem. Stress can weaken the immune system. How about something thats been proven to reduce stress and help people fight off the cold virus: a big hug. On second thought, maybe not. Exercise can reduce stress. Of course, no gyms or yoga studio are still open. But there are a bunch of other ways to ease your worries that are cheap, relatively easy and still allow you to maintain your social distance. Here are seven of our favorites:

Chew gum

A surprising number of studies (only a few of which were funded by the Wrigley Science Institute) have shown that chewing gum reduces anxiety. For example, researchers in Japan found that test subjects asked to chew mint-flavored gum twice a day for 14 days reported lower levels of anxiety and mental fatigue compared with a control group that got just a mint.

In the words of the American Institute of Stress: There is little doubt that chewing gum can be a powerful stress buster. One has only to look at a tightly contested baseball game on TV to see how many players, coaches and managers are vigorously chewing bubble gum or something else to relieve their pent-up tension.

Say amen

Feeling lonely because youre forced to work at home or need to practice social distancing? Try talking to God.

Shane Sharp, a Northern Illinois University sociologist who has studied prayer, said many people are able to manage negative emotions through prayer.

Sharp said prayer basically is communicating with an other who can make the situation less threatening.

People, when they pray, it makes salient in their minds that God loves and cares for them, Sharp said.

If you go down on your knees, you wont be alone. Sharp said about 70% of Americans pray at least once a week.

Give thanks

Being thankful or expressing gratitude can help with relationships, stress and depression.

One method might be to keep a gratitude journal, where you regularly write down things youre grateful for.

Sarah Moe, CEO of Sleep Health Specialists in Minneapolis, suggests something even simpler.

She asks clients who have trouble getting to sleep to say aloud three things they are grateful for before they close their eyes or if they wake up in the middle of the night and have trouble falling back to sleep.

Hearing your own voice remind you all that you have to be grateful for seems to improve relaxation and reduce stress, Moe said.

Ground yourself

Its starting to get warm enough to go barefoot outside, and thats a healthy thing, according to advocates of a practice called grounding or earthing.

Biohackers and health gurus like Deepak Chopra say that giving our bodies a chance to connect to the subtle electrical charge of the Earth can help with stress, mood, pain and inflammation.

They recommend going barefoot on the concrete, soil or grass outdoors for a half-hour at a time, or using grounding devices that will give you that connection while indoors.

Yuk it up

It might not hurt to try to find the humor in the situation.

According to the Mayo Clinic, laughter can be a great form of stress relief, stimulating circulation, aiding muscle relaxation, enhancing the intake of oxygen-rich air, increasing endorphins released by your brain, even improving your immune system.

When youre short on laughs, Mayo recommends everything from comic strips to funny movies. Even laughing at not anything in particular can help.

Even if it feels forced at first, practice laughing. It does your body good, according to the Mayo Clinic.

If you want to find something funny about the pandemic, check out the YouTube videos on the creative, hands-free Wuhan shake.

Or, if youre working from home, take a break with the viral BBC dad video, described as every work-from-home parents nightmare.

Yarn bomb it

Knittings meditative, repetitive rhythm has been shown to reduce blood pressure, lower depression and anxiety and increase a sense of well-being. Manipulating soft, soothing yarn has been compared to yoga in its ability to create a relaxed state.

If you start now, youll have a head start on the Craft Yarn Councils Stitch Away Stress campaign in April.

Heavy petting

Just 10 minutes spent petting a dog or a cat has been shown to reduce levels of a major stress hormone, according to a study conducted at Washington State University.

Oh, by the way, the American Kennel Club, the World Health Organization and the Centers for Disease Control say that pets arent affected and are not a source of infection for COVID-19.

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Stressed out by coronavirus? Here are 7 simple things you can do right now to relax - Minneapolis Star Tribune

HASTINGS Innovative Womens HealthCare is the newest clinic in Hastings, focusing on womens (and sometimes mens) health care to help people live the best life.

Owned and operated by Elizabeth and Jim Hardy, the clinic is located at 223 E 14th St, Suite 50.

Elizabeth Hardy earned a Bachelor of Science in Nursing degree in 1989 and a Master of Science degree as an Advanced Practice Registered Nurse in womens health in 1998. Both degrees are from University of Nebraska Medical Center.

She has additional training with the International Society for the Study of Womens Sexual Health, is certified in bio-identical hormone pellet therapy, and is a certified sexual assault nurse examiner.

While Hardy has had many years of experience in hospitals, professional education, public heath and administration, she said her main passion has always been the care of women in obstetrics, gynecology and reproductive health clinics.

She is a member of Nebraska Nurse Practitioners and Nurse Practitioners in Womens Health.

Im excited to work with adults at Innovative Womens HealthCare, Hardy said.

The Hardys have five children and she says she enjoys family time, boating and Tri-City Storm hockey.

Hardy said Innovative Womens HealthCare provides wellness and preventive care including annual exams, education, testing, and identification of treatment options.

Services offered include menopause symptom support, hormone therapy and care for women with bladder leakage and/or symptoms associated with sexual activity. Additional services are available for men including hormone level evaluation and testing for sexually transmitted infections.

Hardy said coming to a clinic can be uncomfortable for many people.

Its hard to disclose to clinic staff your specific needs and to ask for services that might feel personal or delicate, she said.

Hardy said Innovative Womens Health is unique as its environment is designed to be inviting and to minimize discomforts.

Our staff will put you at ease and offer professional health care, Hardy said. Ultimately, individuals can expect expert guidance in achieving optimum health with traditional and unique therapies.

She said the vision of Innovative Womens HealthCare is to provide a variety of health-oriented therapies addressing mind-body-spirit needs of the individuals we serve.

Our goal is to provide individualized quality health care to women and men regardless of race, ethnicity, religion, disability, family structure, sexual orientation or income while maintaining confidentiality and dignity of those served, Hardy said.

The clinics mission, she said, is to support women in every stage of life and level of wellness. Using patient goals, internal and external resources, and individualized health strategies harmonious with individual values, adults will be assisted in reaching maximum wellness.

Our services include womens wellness evaluation, preventive measures, symptom management, and treatment of selected conditions, she said.

Annual exams. Wellness physical exams include assessment and screening tests for early identification of health problems that can be treated and prevented.

Testing. Tests include vaginal pap exams, mammograms, blood chemistry, metabolic tests, bone density, exams related to weight gain, fatigue, insomnia, incontinence, problems of a sexual nature, and tests for sexually transmitted infections.

Education. Based on individual needs, education is designed to empower adults to actively participate in their health care. The clinic provides verbal, written, blogs, and websites for nutrition, physical activity, healthy lifestyle and weight loss.

Identification of treatment options. When a problem or diagnosis is identified, the clinic will discuss options available for treatment, including pros and cons and possible referrals so patients can make the most informed decision to move forward with a plan.

Menopause and perimenopause. The years leading up to the end of reproductive cycles often include symptoms that are undesirable and uncomfortable. The clinic offers options available that can help prevent, minimize or eliminate these symptoms.

Hormone therapy. Hormones direct how body systems function. For many people, hormones are not at optimal levels which leads to low energy, sleep issues, over eating, mood changes, weight changes, low bone density, hair loss, and low sex drive. Hormones are evaluated and options are explored in order to reach optimal levels for reproductive and thyroid hormones.

Sexual issues. There are many reasons adults experience low libido or pain with sexual experiences. It may be a new symptom or a long-term issue. The clinic can identify treatable causes and discuss options to improve or eliminate symptoms.

Incontinence. Many women experience urgency or leaking of urine with coughing, sneezing or laughing. Clinic staff can help identify what is causing incontinence and offer solutions to help.

The clinic also offers bio-identical hormone replacement therapy; Votiva skin treatment with microneedling radio frequency technology for wrinkles, scarring, stretch marks and sweating; Votiva FormaV radio frequency technology for female intimacy problems and incontinence; and Arterosil.

Hardy said people should visit her clinic because it provides personalized setting different from all-to-common rushed, stressful hubbub of many health care settings.

We also offer new alternatives from the traditional treatments often not requiring prescription or surgery, she said.

They accept many insurance companies, Every Woman Matters and cash pay. Some services are cash only.

We take the preventative approach to healing problems by identifying risks and symptoms in peoples lives to plan a course of action to decrease complications, often using natural solutions to avoid medication, Hardy said. Prescription are provided only when needed. Our philosophy is to support and promote total health prevention of diseases.

She said male and female hormone testing with blood work drawn in the clinic is very popular.

We offer many options like pellet insertion to optimize hormone levels and extend treatment intervals to improve quality of life and overall health, Hardy said. The clinic setup is designed to be cozy and comfortable with chandeliers in every room. People relax and are able to share difficult stories.

The clinic sees patients from a wide area including Custer, Valley, Nuckolls, Furnas and York counties.

When it comes to their future plans, Hardy said their desire is to maintain a personal, intimate setting, yet to expand to offer services in other communities.

We have had the most outstanding patients since our opening a year ago and want to thank them for their confidence, Hardy said. We have a portal on our website (www.womenshealthnebraska.com) for sharing, messaging and making appointments.

The clinics phone number is (402) 834-3973 and it has a Facebook page.

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Innovative Womens HealthCare serves clients in several counties - Grand Island Independent

"But I wasn't sure how rooted in research it was or if it was going to be safe to do," Kemptar said. "I didn't want to start down the path that would lead me to ruin."

So Kemptar, who lives and teaches in Esko, started looking up places that offered voice coaching in the area and the first call she made was to the University of Minnesota Duluth's Robert F. Pierce Speech-Language-Hearing Clinic.

"Just total dumb luck," Kemptar said. "It turns out it was the best program I could have possibly found."

For about 10 years, the UMD Speech Clinic has offered free and individualized transgender voice therapy. This past fall the clinic started offering group sessions as well for anyone who wants to work on developing their desired voice alongside others experiencing something similar.

Kemptar attended those group sessions every week.

"The really great thing about it was that it was a way for trans people to get together. Which is really rare," Kemptar said. "For people that are first starting to transition, especially male to female, it's really hard to go out in public. It's a lot more noticeable."

Ashley Weber, the clinical instructor speech language pathologist, said she hasn't heard of anywhere else in the state offering a group-based version of transgender voice therapy.

"The fact that we're offering a group network was a really big deal," Weber said. "We've found big success within the group of having peers that can support each other and give each other feedback."

Speech-language pathologist Ashley Weber demonstrates how a computerized speech lab is used to help people re-training their voices to match their gender identity at UMDs speech clinic. (Steve Kuchera / skuchera@duluthnews.com)

The UMD clinic has received calls from people in the Twin Cities wanting to drive up for the group session. Weber said the University of Minnesota Twin Cities, which offers individualized services, is in the process of figuring out how to formulate group-based services too.

The clinic has seen up to five individuals in the group setting which currently meets every Wednesday evening and welcomes more participants.

"Everybody's at a different stage," Weber said. "The ages range within the group so everybody brings a different experience into it, and a lot of humor, which I love."

Most of the clients at the clinic are people transitioning from male to female. Weber said that's because once people transitioning from female to male start taking testosterone, the hormone is able to lower the pitch of their voice for them. Estrogen, however, doesn't have much of an effect on vocal quality.

During the 6-12 month process in which clients meet twice a week for individualized training, Weber and student clinicians work with individuals on gradually increasing vocal pitch, both for authenticity and safety reasons. If done too fast, people can experience vocal abuse and loss of voice, which only deepens vocal pitch.

Some clients even work on language and how they use description.

"Since expression is a huge part of our culture ... being mis-gendered through your expressions can be really damaging," Weber said. "We just want to offer individuals that voice and make sure we're affirming their gender identity."

Because insurance can be finicky when it comes to covering outpatient services, Weber said voice therapy can be a barrier for individuals already dealing with hefty medical expenses. At UMD, the clinic is able to provide the services for free largely through grants and donations.

Clients use a voice journal to track different aspects of their voice as well as their goals and progress. The journal also outlines exercises to do at home.

A voice journal used by people training their voices to match their gender identity includes exercises to perform at home. (Steve Kuchera / skuchera@duluthnews.com)

"These clients have been some of the hardest working clients I've ever had," Weber said. "They really have to fight for what they're doing."

While going through the training last year, Kemptar said she warmed her voice up every morning like she was taught.

"Because it's all muscles," Kemptar said. "You're just exercising your muscles. They're going to get tired, but you have to build them up to be able to get where you want."

Before starting voice therapy, Kemptar said she often found herself not using her voice because she feared it was her "giveaway."

"I felt like it was kind of a tell that I was trans," Kemptar said. "It was interfering with my enjoyment of life. So that was my motivating factor, even if it was going to be dangerous I was willing to take that risk. I am lucky that I found a healthier alternative."

One of the most rewarding parts of undergoing the voice therapy, Kemptar said, was when she listened to her final voice recording and compared it to the first one.

"It was like night and day," Kemptar said. "There were times I was in tears because she'd play back my voice, and I'm like, 'That's me?'"

Although she's done with the training, Kemptar still checks in with herself to make sure her voice is where she wants it to be.

Since the clinic started offering transgender voice therapy about a decade ago, approximately 10-15 people have gone through the training, according to a clinic secretary. Most of those clients are from more recent years.

According to Essentia spokesperson Louie St. George III, Essentia Health also has a voice therapist who offers transgender voice therapy services.

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UMD speech clinic now offers group-based trans voice therapy - Duluth News Tribune

Fatal blood clots, suicidal behavior, lowered IQs, brittle bones andsterility are just a few of the potential side effects of puberty blockersthat the transgender industry doesnt want talked about.

By Celeste McGovern, September 18, 2019

Thousands of children attending affirmative gender health clinicsglobally, including in the United States and the United Kingdom, are beinggiven powerful puberty-blocking drugs with a litany of serious side effects including death according to Food and Drug Administration data.

And the National Health Service (NHS) in England is currentlyinvestigating issues surrounding use of the drugs since it registered a 4,500%increase last fall in the number of youths seeking treatments to alter theirbiological sex in the previous nine years.

The drugs, sometimes referred to as chemical castrators because theyare used to treat sex offenders, are increasingly used as a first-linetreatment for gender-confused children as young as 10 years old when they arereferred to counseling.

Frequently on their first consultation, children and teens areimplanted with hormone-blocker-releasing rods or taught to self-inject thedrugs to pause their adolescence and prevent developmental changes, likegrowth of breasts and facial hair while they decide on which sex they wouldlike to identify.

The practice recently gained the endorsement of the Endocrine Societyand the American Academy of Pediatrics, but the Food and Drug Administrationhas not licensed the drugs for transgender medicine due to lack of supportiveevidence. They are approved for treating prostate cancer and uterine pain inadults. The agency has recorded more than 41,000 adverse events reported withtheir use between 2013 and June 30, 2019.

More than 26,000 of the events associated with the two hormoneblockers, Leuprolide acetate and triptorelin (which includes Lupron and similardrugs used by clinics), were classified by the federal agency as serious,including 6,370 deaths. The drugs, which dramatically lower testosterone andestrogen levels in the body, are linked to life-threatening blood clots andother complaints, include brittle bones and joint pain.

Inducing Disease

The recent increase in the number of gender dysphoric youths seekingdrug treatments is particularly alarming to experts who see the drugs effectsas too risky to prescribe in their current form if at all.

Michael Laidlaw, an endocrinologist from Rocklin, California, testifiedbefore the British House of Lords on the issue of transgender health care inMay. Laidlaw told the Register, These drugs actually induce a known disease inpreviously hormonally healthy children.

Puberty blockers, he explained, interfere with normal signals betweenthe brain and the sex organs, thereby creating a disease state calledhypogonadotropic hypogonadism in youths. Its a serious condition thatendocrinologists would normally diagnose and treat because it interferes withdevelopment, but in [gender dysphoria] cases theyre inducing this diseasestate, Laidlaw said.

Because the drugs are relatively new, their long-term effects have yetto be fully determined, but one 2018 study of long-term risks of pubertyblockers from researchers at Boston Childrens Hospital found that while sideeffects of the drugs are advertised to resolve three-six months after stoppingtreatment, in actuality, the majority of subjects reported long-term sideeffects while almost one-third reported irreversible side effects thatpersisted for years after discontinuing treatment.

In addition to experts, those who have experienced the drugs effectsare also raising the alarm.

On social-media platforms, women describe crippling long-term sideeffects after taking the drugs as children. One woman on a Facebook page calledBAN Lupron said she was given Lupron for years as a young child to stoppremature puberty, and now, as a 24-year-old mother of two, I have [a]herniated disc in my lower lumbar, S-I Joint dysfunction, [a] shredded meniscusin my right knee shoulder pain tendonitis in my left foot, extreme toothdecay and minimal teeth left, TMJ [jaw pain].

A 25-year-old said on the page that she suffers from osteoporosis and acracked spine, while a 26-year-old indicated the need for a total hipreplacement.

Youths who take puberty blockers complain of similar side effects andof menopausal symptoms, including hot flashes, insomnia, fatigue, rapid weightgain and depleted bone density.

I stubbed my toe; it broke. I fell over; my wrist broke. Same with myelbow, an anonymous teen, who was prescribed the drugs by the Tavistock NHSgender center, told the Times newspaper of London.

They promise you that your breasts will disappear, that your voicewill be deeper, that I would look and sound more like a boy. For me, that wasthe best thing that could have happened, the teen said about her attitude atthe time, but she came to call taking the drugs the worst decision Ive evermade.

Evolving Guidelines

These and similar complaints have come to the attention of some membersof the medical community, who urge some kind of government oversight.

Yes, there can be poor or improper treatments by some; thus,governments as well as medical organizations should investigate reports ofpatient/family complaints in this regard, Michigan State Universitypediatrician Donald Greydanus told the Register. Greydanus is one of eightauthors of a paper, published in the August issue of the journal Disease-a-Month,overviewing care of teens who identify as transgender.

Greydanus is not necessarily opposed to the use of castration drugs,but he acknowledges that prudence must still play a role in how they areadministered especially since the drugs have a sketchy safety record.

Adolescents with gender dysphoria should not be started on pubertyblockers until at least early adolescence, he said. Sex-affirming hormonetherapy using high levels of hormones of the opposite sex may start soonafter, and surgery by age 18, generally, but he said, These guidelinescontinue to evolve and to be debated!

Greydanus added that proper informed consent should let all partiesknow the drugs risks before they are given.

All drugs have side effects, he told the Register, and some can beworse in some patients versus others.

However, Laidlaw called the hormone-blocking drugs untested andunsafe for adolescent children. He referred to them as development blockersbecause their results are systemic and block normal brain development and ahost of other body functions as well as sexual maturation.

Development is so stunted, he said. If you take these long-term, youwind up with an adult with child-like sex organs. If they are taken at a veryearly stage, they wont develop sperm. Permanent infertility is a possibleoutcome for those who use the drugs, he said.

Puberty is a time of tremendous growth and not just in the gonads, hesaid, noting that bone formation is also taking place at this time. They arelengthening as well as strengthening.

The effects of the drugs on bone density are well-documented, Laidlawsaid. By the end of two years the bone density of the girls [taking pubertyblockers] is down in the lowest 3%.

Mental-Health Concerns

According to guidelines from the World Professional Association forTransgender Health, children must be screened for underlying mental issues. Yeta Freedom of Information request filed by Oxford sociologist Michael Biggsrevealed that nearly one-third of the children treated at one clinic in Britainhad been diagnosed with autism spectrum disorder.

Besides putting patients with pre-existing mental conditions at risk,the drugs also seem to be having a deleterious effect on young patientsdeveloping mental capacities, studies have shown.

Puberty is also a time of tremendous brain changes, when gray matterbecomes denser which may explain why puberty blockers have been found tolower IQ.

One 2016 study found that girls treated with puberty blockers had aneight-point lower IQ score than controls who did not receive the treatment.This was similar to the seven-point IQ drop from 100 to 93 reported among 25girls who took puberty blockers for two years for early puberty and a nine-pointIQ drop in a study of a 12-year-old boy 28 months after taking the blockers.

Proponents of the drugs claim the effects are reversible, but we dontknow what will happen in all the cases, Laidlaw said.

But the mental damage may be even more serious than a drop in IQ forpatients.

Concerns about the impact of puberty-blocking drugs on the mentalhealth of youths were raised in England when Biggs uncovered the unpublishedresults of a study by the Tavistock and Portman NHS Trusts Gender Identity DevelopmentService (GIDS).

Although the results for using puberty blockers had been reported tothe public as positive, Biggs found that for all but one yardstick (that ofparents perspective) the outcomes were negative and that a significantincrease was found in the number of drug-treated youths who agreed with thestatement: I deliberately try to hurt or kill self.

Transgender Censorship

But even scientific evidence pointing to the risks of castration drugsdoesnt seem to matter to the cultural gatekeepers who wish to seetransgenderism normalized in society.

Demand for the drugs as puberty blockers has skyrocketed withgovernment-sponsored and cultural transgender programming, including televisionshows like I Am Jazz, an American reality TV following Florida teen JazzJennings, who was born male but took hormones and was surgically castrated toappear female. And the market for the drug has a potential to expand further,as gender science is extending to transgender preschool children.

With such positive reinforcement of transgenderism in culture,criticism of treatment for gender dysphoria is increasingly banned as harmfuland transphobic. The same tendency toward censorship also surfaced recentlyin state legislation. Last month, North Carolina became the 18th state to banthe use of taxpayer dollars for any conversion therapy practices that seek tohelp transgender children overcome their confusion without drugs and surgery.

Experts in the field are also not immune to such censorship. Laidlawtold the Register that as an endocrinologist, he tweeted on July 21 about thedangers of puberty blockers but his tweet was deleted by Twitter last month,and he has been unable to post on the platform since.

Likewise, when Biggs revealed the unpublished GIDS report to theBritish press, the Oxford professors Twitter account was reportedly suspendedfor transphobic statements.

Catholic Teaching

Aside from the medical risks involved with castration drugs, theprinciple driving their promotion flies in the face of Catholic teaching onhuman sexuality.

Pope Francis addressed the issue of transgenderism in his 2015encyclical Laudato Si (Care for Our Common Home), citing the words of hispredecessor, Benedict XVI, that man too has a nature that he must respect andthat he cannot manipulate at will.

Man, Benedict said in his September 2011 address to the GermanParliament, does not create himself. He is intellect and will, but he is alsonature, and his will is rightly ordered if he respects his nature, listens toit and accepts himself for who he is, as one who did not create himself.

[V]aluing ones own body in its femininity or masculinity is necessary if I am going to be able to recognize myself in an encounter with someone who is different, Pope Francis added. In this way we can joyfully accept the specific gifts of another man or woman, the work of God the Creator, and find mutual enrichment.

__________________________________________

Celeste McGovern writes from Nova Scotia, Canada.

https://www.ncregister.com/daily-news/fda-thousands-of-deaths-associated-with-drugs-given-to-trans-children

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FDA: Thousands of Deaths Associated With Drugs Given to 'Trans' Children - Catholic Citizens of Illinois

16 March 2020

The spread of a novel coronavirus (SARS-CoV-2), which causes the disease COVID-19, presents UK fertility clinics and patients with a unique set of challenges. Some of this is because we simply don't know enough about the effects of the infection on fertility, fertility treatment and early pregnancy. Early data, summarised in the Royal College of Obstetricians and Gynaecologists guidance, are reassuring, but the number of reported cases is still small.

Clinics could face logistical challenges if large numbers of staff are unable to work due to quarantine requirements, or if elective work in hospitals is shut down to make space for emergencies. Should this prospect impact the advice we give patients? The UK Government, at the time of writing, has held back from the more radical social distancing measures implemented in other countries. This leaves clinics with a dilemma of whether to continue to offer fertility treatment to unaffected patients, or to go beyond current Government advice and suspend services.

Patients' anxieties are understandable and those who wish to delay their treatment should be accommodated. It makes sense for anyone who meets the criteria for self-isolation (which are also evolving as we write) to be advised not to start treatment and indeed to stop active treatment if already commenced.

Some would go further and say that all elective fertility treatment should be delayed. The European Society forHuman Reproduction and Embryology advises that all fertility patients should 'avoid becoming pregnant at this time'. A Twitter poll targeting reproductive medicine clinicians found 45.5 percent support for delaying frozen embryo replacement in patients in areas with a high COVID-19 burden.

The question then arises, for how long should treatment be delayed? It is reported that the UK will see the peak of infections three months from now, with a tail persisting into the autumn and a potential second peak after this. If we were to delay all fertility treatment, UK clinics may struggle with the capacity to cope with demand when treatments re-start. One could easily envisage a delay of six months, which may well harm the chances of conception for some patients. Hence the need for advice to be tailored to each individual patient's situation. Delaying treatment, in effect closing clinics, would have other impacts including financial strain (particularly for smaller stand-alone clinics) and loss of morale among the more vulnerable fertility patients.

Furthermore, Chinese researchers have identified that testicular Leydig cells and seminiferous tubules express the angiotensin-converting enzyme 2 (ACE2) receptor, which is used by the virus to gain entry into cells. This short discussion paper has not been peer-reviewed and there is no evidence to suggest that the virus is found in the testes, as reported in BioNews 1039. However, this paper does alert to the need for further research into whether male fertility may be affected by COVID-19, so that patients can be adequately counselled.

The fact is that this is a fast-moving situation, with facts and knowledge changing daily. This makes it hard for professional bodies to issue meaningful guidance to practitioners and patients. The American Society for Reproductive Medicine even calls its guidance 'suggestions', showing the tentative nature of such advice. As far as UK clinics are concerned, unless restriction of movement is introduced, it is reasonable to continue treatment for those who are well and wish to continue. However, centres must be prepared to terminate or complete treatment (including through cycle cancellation, oocyte or embryo freezing) and cease initiating new treatments as and when 'lock-down' commences.

Clinicians have in their toolbox measures, which can be taken proactively, to reduce the risk to patients who find themselves in a situation where treatment has to stop. A patient may develop symptoms, or fall into a risk group, for COVID-19 after having started ovarian stimulation. Patients on a g onadotropin-releasing hormone (GnRH) antagonist regime could be managed by stopping follicle-stimulating hormone (FSH) administration and continuing antagonist administration until the patient's ovarian response has settled. Data from small case studies indicate that GnRH antagonist continuation after the trigger of final oocyte maturation is effective in reducing the risk of ovarian hyperstimulation syndrome (OHSS). Where concern exists about a high ovarian reserve, consideration should be given to co-treatment with letrozole, keeping oestradiol levels low and reducing concern about the risk of OHSS.

The key is anticipation of problems, both clinical and organisational. All centres should have a contingency plan in place that describes a stepwise reduction in their activities. This allows prioritisation down to a minimal activity if needed. It is unlikely that any licensed fertility clinic can shut down completely; work goes on behind the scenes, in particular around the maintenance of storage banks. There are practical considerations for this maintaining tanks for example but also the regulatory issues around consent expiry and data management. Urgent medical issues will still arise, and it may be appropriate to maintain a fertility preservation service for cancer patients. This prioritisation must take into account national and local pandemic policies, as well as recognition of likely reduced levels of staffing due to illness and isolation. Mitigation policies may include replacing consultations with phone- or video-calls and making sure there is a good communication policy for patients who have treatment-related problems.

We must also bear in mind the anxiety that is generated by how this pandemic is playing out. In our connected world, news, including fake news, travels faster than the virus. It is hard to escape the sense of a storm looming or a tidal wave about to break. In some countries, of course, the storm is now raging and the tide has overwhelmed even well-resourced health systems.

Fittingly for the first pandemic of the social media age, there have been extensive informal discussions on these issues among clinicians across many social media platforms. US colleagues have collated a number of measures, gleaned from social media, that clinics should consider in their response to this challenge.

Things are moving apace, and we must respond in a safe and effective way, but without panic. The British Fertility Society and the Association of Reproductive Clinical Scientists are committed to providing guidance to UK clinics as the situation evolves.

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Keep calm and... stop? Fertility treatment in a pandemic - BioNews

20 March 2020

The British Fertility Society (BFS) and the Association of Reproductive Clinical Scientists (ARCS) have announced new guidelines for fertility patients during the coronavirus pandemic.

Summary

UK COVID-19 epidemic continues to escalate.

Whilst pregnant women can be generally reassured they are asked to consider themselves a vulnerable group.

It is expected that UK licenced fertility centres will now be working to suspend treatments.

UK fertility centres must establish the requirements to maintain a minimum service, which may include non-elective fertility preservation.

Centres are expected to keep communication open with patients for advice and reassurance.

Centres are expected to minimise their impact on National Health Service (NHS) resources.

Background

A novel coronavirus infection that can cause serious disease (COVID-19) in a minority of affected people has taken on pandemic proportions, leading to extraordinary measures being introduced across the world.

The situation with respect to the number of affected persons and UK government advice on measures to increase social distancing is evolving. As of 18 March 2020: 56,221 people have been tested in the UK of whom 2662 tested positive for coronavirus, and 104 have died as a result of the illness. The government has advised against non-essential social contact and non-essential travel. Self-isolation has been advised for anyone with symptoms of coronavirus along with their household. The NHS has imposed restrictions on elective surgical and outpatient work, other than in situations where this is needed for the treatment of cancer or the purpose of saving life. The NHS has put in place plans for using medical and nursing staff from different areas in the most efficient way to deal with anticipated patients. This includes block-buying capacity in private hospitals. The aims of these measures are to free-up the maximum possible inpatient and critical care capacity, to prepare for anticipated large numbers of COVID-19 patients who will need respiratory support and to support staff and maximise their availability.

This guidance builds on the initial response from BFS and ARCS to this unprecedented challenge to the UK health system and the health of the population. It is designed to help all UK fertility clinics, regardless of their setting, to prioritise and organise their activities during the outbreak, whilst complying with their clinical, ethical, regulatory and social duties. Few UK licenced clinics will be able to close down completely, since virtually all will have embryos and gametes in storage banks which must be properly maintained in accordance with the law. Centres are advised to plan a flexible local policy which allows for prioritisation and a number of eventualities. Policies must take into account local conditions, breadth of work undertaken and clinic resources (including financial resilience). The overriding priority is for centres to act in a socially responsible manner.

Policies to take into account include the national strategy led by the chief scientific advisor and chief medical officer. Hospital-based clinics will be influenced by their own trust pandemic strategy which is likely to mirror national plans. Clinic groups may develop an overarching strategy, whilst individual centres will need to consider local prevailing conditions.

In developing their local policies, clinics must take into account their duty to abide by regulations arising from the Human Fertilisation and Embryology Act 2008, and laid out by the Human Fertilisation and Embryology Authority (HFEA) in its Code of Practice. HFEA guidance to clinics is available and updated as required. In all this, clinicians retain an ethical responsibility of beneficence and non-maleficence to their patients. A wider social responsibility of promoting public health and preventing harm from infection exists for all citizens, but especially health care providers. All clinics, whether in the state or private sector, should be mindful of their wider responsibilities, including the need to promote social distancing and to consider the potential effects of their work on local NHS services, which are likely to be stretched to an unprecedented extent.

At the time of writing, it is not thought that the infection causes miscarriage or fetal abnormality, and pregnant women do not appear to be at increased susceptibility to the infection or to developing complications. However, in the Prime Minister's bulletin on 16 March 2020, it was made clear that pregnant women were considered a vulnerable group, because this is a new infection and data on effects in pregnancy is limited. Further, there is concern for the potential care commitment required for any pregnant women with symptoms. The question arises whether the benefit of continuing to treat our infertile population may be outweighed by the additional concerns. It is reasonable that women who have risk factors for severe illness if infected, for instance those with diabetes or underlying respiratory disease or immunosuppression, should be advised against conceiving during the outbreak.

Fertility patients with symptoms of COVID 19

Pregnancy should be avoided in women who display symptoms of COVID-19. Patients who are in the stimulation phase of their treatment, but have not yet received the trigger, should be advised treatment cancellation. In such a situation, stopping follicle stimulating hormone (FSH) while continuing with gonadotropin-releasing hormone (GnRH) antagonist (or agonist as the case may be) is likely to protect against ovarian hyperstimulation syndrome (OHSS). Patients should be counselled against unprotected intercourse to avoid the risk of multiple pregnancy.

Patients who have received human chorionic gonadotropin (hCG) or GnRH agonist trigger may proceed to egg collection and freeze-all, if appropriate facilities are available and after a multi-disciplinary assessment of risk.

Patients who develop symptoms after oocyte collection should not have an embryo transfer.

Embryo transfer, or intra-uterine insemination should not be carried out in women with suspected or diagnosed COVID-19.

Stopping treatment programmes

For the reasons above, it is expected that, as the UK epidemic is now proceeding, all centres will stop initiating new fertility treatments, including in vitro fertilisation (IVF), frozen embryo transfer, surgical sperm retrieval, insemination and ovulation induction. This is also in keeping with recommendations from other professional bodies in the field of fertility treatment (Ref 4 and 5). When such a decision is made, it is reasonable for clinics to complete treatment that has already commenced in patients who remain well and where the centre's resources allow this to be done safely. However, clinics should be mindful both of their duty to minimise spread and of the impact of any complications on the NHS. Moderate or severe OHSS, which is often managed in an NHS emergency care setting, has been reported in 3.1 to 8 percent of stimulated treatment cycles. The risk of OHSS is reduced by the use of GnRH agonist trigger and freeze-all. It is mandatory therefore to consider these measures in women currently in the process of treatment.

Fertility preservation

Where resources allow, it is appropriate to continue non-elective fertility preservation, for example sperm and oocyte or embryo storage for cancer patients, provided they show no symptoms of infection. It should be borne in mind that these patients may be immunocompromised, and shared decision-making involving the patient, oncologist and fertility specialist is key. Fertility preservation should only be carried out in patients who remain well during treatment, and provided sufficient resources are available to do this safely. Local arrangements will be needed to allow these procedures to take place.

Outpatient clinics and diagnostic work

As part of social distancing, it is reasonable to advise that all face-to-face work should pause, other than in emergency situations, and where delay would be detrimental to the prospects of patients. Where possible, clinics should facilitate telephone or video consultations. If patients are attending for face-to-face encounters, care should be taken to stagger appointment times to prevent large groups of people congregating in waiting areas. Group sessions and support group meetings should not go ahead while social distancing is in place. Staff who can work from home should be facilitated to do so where appropriate, by provision of remote access to electronic case records as confidentiality restrictions allow.

Patient support and communication

Clinics should be aware of the potential emotional impact of the disruption of treatment services on their patients, occurring on a backdrop of anxiety about the effects of the virus itself. Measures should be put in place to keep patients informed of changes to the service and the reasons for these. Patients are likely to have concerns about the effect of delay on their chances of success and eligibility for NHS funding. It is likely that the ongoing uncertainty about the length of delay will compound these worries. All members of the clinical team have a role to play in supporting patients, with a special emphasis on the role of trained counsellors. It is recommended that usual facilities for answering phone call queries be enhanced to account for increased demand around short notice changes in service provision. Clinic websites and apps have a role in keeping patients informed and allaying anxieties in a difficult time.

Issues concerning funding and eligibility

Clinics should establish liaison with commissioners of NHS services to clarify their position on funding of treatment cycles that are cancelled, and the eligibility of patients who reach age thresholds without receiving treatment, due to the coronavirus outbreak. Significant numbers are likely to be affected, and it is likely that individual Exceptional Funding requests will not be appropriate for the circumstances we recommend that commissioners make timely decisions to guarantee treatment in the future for all currently eligible fertility patients negatively affected by the COVID-19 pandemic, to minimise distress and facilitate pathways once treatment resumes.

Staffing

Centres should work to identify the minimum number of staff that are necessary to maintain urgent services such as fertility preservation for oncology patients. It is likely in NHS settings that a large proportion of medical and nursing staff will need to be redeployed to other areas, however measures should be taken to try to ensure that staff with the requisite skills and training to deliver urgent treatments are available at all times. If sufficient staff are not available due to illness, then centres should seek support through their reciprocal support agreements with other centres or networks.

Sufficient scientific staff should be in place to maintain and ensure the ongoing safety of gamete and embryo storage banks. To guard against the risk posed by significant numbers of scientific staff becoming ill and forced to self-isolate, centres should ensure that sufficient scientific staff are available and are cross-trained to deliver all key tasks including ongoing quality control and maintenance.

Appropriate levels of staffing should be determined by the person responsible, taking advice from nursing, medical and scientific professional leads within the centre. It is incumbent upon public relations (PR) to ensure that services are reduced in keeping with available levels.

Diagnostic services

Where assisted conception centres undertake diagnostic activities, such as semen analysis or post-vasectomy testing and these involve attendance at the clinic, these should be suspended in order to minimise social contact.

Where diagnostic services are part of NHS pathology (or other) departments, the above also applies and staff may be asked to redeploy during the epidemic.

Resuming services

Whilst every effort must be made to reduce services over coming weeks and months, it is necessary to think forwards towards a resumption of services. Maintaining contact with patients whose treatment has been disrupted or deferred is important, and consideration should be given to prioritisation when services are able to recommence. The timing of this will be dependent on ongoing Government advice, resumption of NHS normal working practices as well as centres' own staffing and other resources.

The BFS and ARCS continue to monitor the ongoing pandemic and advice from national authorities. Further guidance will follow as appropriate, with the ultimate aim of resuming normal services as soon as possible.

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Guidance for the care of fertility patients during the coronavirus COVID-19 pandemic - BioNews