Archive for the ‘Hormone Clinic’ Category

The Mens Health Clinic, founded by Dr Robert Stevens MBChB MRCGP Dip.FIPT, is the first clinic of its kind in the UK. From very humble beginnings they now have their very own private medical clinic that attracts people from all over the world. The clinic specialises in the diagnosis and treatment of Testosterone Deficiency. Their clinic offers a uniquely progressive approach to patient care, understanding the need for a personalised approach, not a one-size-fits all model.

Testosterone Deficiency is a medical condition characterised by the negative symptoms associated with low testosterone, along with confirmatory blood test results. The British Society for Sexual Medicine has set out national guidance to support doctors in making the diagnosis. Prominent symptoms of Testosterone Deficiency include an element of low mood, anxiety, and-or depersonalisation. Men often describe a brain fog, fatigue and low libido. Other symptoms can include erectile dysfunction, weight gain, loss of lean muscle mass and a decrease in bone mineral density. As there can be several possible diagnoses for each symptom, it is important to have a comprehensive assessment by a clinician who specialises in the area, before commencing any treatment. There can also be potential reversible causes for low testosterone and so these should always be addressed before committing to, what should be considered, a lifelong therapy.

From the outside, TRT can appear straightforward; if you have a deficiency you restore the testosterone level using exogenous testosterone. Unfortunately, this is a simplistic perspective. Exogenous testosterone suppresses the release of Lutenising Hormone (LH) and Follicle Stimulating Hormone (FSH) from the pituitary gland. As there are LH receptors in numerous organs, most notably the testes and the brain, traditional testosterone monotherapy often causes azoospermia and male infertility due to the suppression of LH. TRT should therefore be addressed as hormone replacement therapy. The aim of TRT and hormone replacement therapy should be to maintain function, in addition to restoring male androgen levels using exogenous testosterone.

Human Chorionic Gonadotropin (HCG) has been used by the NHS to treat male infertility for many years. HCG mimics LH and so The Mens Health Clinic utilises HCG alongside testosterone in testosterone therapy to help preserve fertility and testicular size. Dr Stevens reported nineteen pregnancies in his patients so far with the use of concurrent TRT and HCG. In addition to the fertility aspect, men often report a qualitative improvement in their sense of well-being and libido with the use of HCG alongside their testosterone treatment.

In 2019, The Mens Health Clinic was delighted to be the first clinic in the UK to be granted a licence by the MHRA for the import of Testosterone Cypionate, their gold standard TRT option. Dr Stevens is a proponent of daily injections of Testosterone Cypionate to help mimic the diurnal variation of endogenous testosterone that occurs naturally within the body. He also reports more stable male androgen levels using this methodology. Dr Stevens is also a proponent of subcutaneous injections, over shallow intramuscular ones, as they are less painful and result in less aromatisation of testosterone to oestrogen. Less side effects mean happier, more content patients.

Hormonal balance is fundamental to overall health and well-being. You need a clinician who understands that all hormones are dependent, whether that be direct or indirect. The ratio of testosterone : oestradiol : dihydrotestosterone, is as important as the absolute numbers. The purpose of TRT is normalisation of your male androgen levels to within normal physiological parameters. We aim to reverse the negative symptoms of low testosterone and help you maintain a sustainable improvement in your long-term physical and psychological well-being.

CONTACT:

The Mens Health Clinic9-10 Longham Business Park168 Ringwood RoadFERNDOWNDorsetBH22 9BUTel: 01202 091593Email: info@themenshealthclinic.co.uk

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The First 'Bespoke' TRT Clinic in the UK - News Anyway

Supplementary material for this article is available at http://advances.sciencemag.org/cgi/content/full/5/12/eaax5208/DC1

Fig. S1. Clinical trial SLN mapping case in a patient with head and neck melanoma using cRGDY-Cy5.5-PEG-C dots (NCT02106598).

Fig. S2. Development of 700- and 800-nm emitting NIR fluorescent C dots.

Fig. S3. Morphology and purity characterization of MSH-PEG-Cy5.5-C dots and cRGDY-PEG-CW800-C dots.

Fig. S4. The relationship between probe concentration and signal intensity of different probes.

Fig. S5. The bleed-through of MSH-PEG-Cy5.5-C dot probes to the 800-nm channel under the excitation of a 700-nm laser (particle concentration range, 0 to 125 nM).

Fig. S6. The bleed-through of cRGDY-PEG-CW800-C dot probes to the 700-nm channel under the excitation of a 800-nm laser (concentration range, 0 to 250 nM).

Fig. S7. The bleed-through of cocktail C dots (MSH-PEG-Cy5.5-C dot probes and cRGDY-PEG-CW800-C dot) probes to the 700- or 800-nm channels under the combined excitation of 700- and 800-nm lasers (concentration range, 0 to 250 nM).

Fig. S8. Summary of MIP PET images of all seven spontaneous melanoma miniswines (the related MIP short videos are also provided as movies S1 to S7).

Fig. S9. The marking of the expected SLN locations.

Fig. S10. A representative example of multiplexing optical data analysis using the software (Architector Image Viewer, version 1.9.0) from Quest Spectrum.

Fig. S11. Whole-body PET/CT imaging of pig #1.

Fig. S12. Whole-body PET/CT imaging and histological analysis of pig #2.

Fig. S13. Whole-body PET/CT imaging and histological analysis of pig #3.

Fig. S14. Whole-body PET/CT imaging and histological analysis of pig #4.

Fig. S15. Whole-body PET/CT imaging and histological analysis of pig #6.

Fig. S16. Whole-body PET/CT imaging and histological analysis of pig #7.

Fig. S17. IVIS imaging to identify nanoparticles at the tumor site.

Fig. S18. Average body weight of all male mice from the microdose toxicology study.

Fig. S19. Average body weight of all female mice from the microdose toxicology study.

Table S1. Optimization of 800-nm emitted NIR fluorescent C dots.

Table S2. In vivo signal intensity and bleed-through percentage of cocktail C dots excited with a 700-nm laser.

Table S3. Summary of the injection information of all seven spontaneous melanoma miniswines.

Table S4. Summary of PET SUV numbers of all nodes from seven spontaneous melanoma miniswines (~0.5-mm tumor burden was highlighted in green; NA means tumor burden diameter was not available).

Table S5. Microdose toxicology study animal group.

Table S6. Mortality and morbidity summary table of the microdose toxicology study.

Table S7. Hematology parameters in the microdose toxicology study.

Table S8. Clinical chemistry parameters in the microdose toxicology study.

Table S9. Tissues examined microscopically in the microdose toxicology study.

Table S10. Hematology parameters, group 5, male, tumor, vehicle control (saline), day 2.

Table S11. Hematology parameters, group 6, female, tumor, vehicle control (saline), day 2.

Table S12. Hematology parameters, group 7, male, tumor, test article MSH-PEG-Cy5.5-C dots at 1.2 nmol, day 2.

Table S13. Hematology parameters, group 8, female, tumor, test article MSH-PEG-Cy5.5-C dots at 1.2 nmol, day 2.

Table S14. Hematology parameters, group 9, male, tumor, test article cRGDY-PEG-cw800-C dots at 1.2 nmol, day 2.

Table S15. Hematology parameters, group 10, female, tumor, test article cRGDY-PEG-cw800-C dots at 1.2 nmol, day 2.

Table S16. Hematology parameters, group 11, male, no tumor, test article MSH-PEG-Cy5.5-C dots at 1.2 nmol, day 2.

Table S17. Hematology parameters, group 12, female, no tumor, test article MSH-PEG-Cy5.5-C dots at 1.2 nmol, day 2.

Table S18. Hematology parameters, group 13, male, no tumor, test article cRGDY-PEG-cw800-C dots at 1.2 nmol, day 2.

Table S19. Hematology parameters, group 14, female, no tumor, test article cRGDY-PEG-cw800-C dots at 1.2 nmol, day 2.

Table S20. Hematology parameters, group 15, male, tumor, vehicle control (saline), day 14.

Table S21. Hematology parameters, group 16, female, tumor, vehicle control (saline), day 14.

Table S22. Hematology parameters, group 17, male, tumor, test article MSH-PEG-Cy5.5-C dots at 1.2 nmol, day 14.

Table S23. Hematology parameters, group 18, female, tumor, test article MSH-PEG-Cy5.5-C dots at 1.2 nmol, day 14.

Table S24. Hematology parameters, group 19, male, tumor, test article cRGDY-PEG-cw800-C dots at 1.2 nmol, day 14.

Table S25. Hematology parameters, group 20, female, tumor, test article cRGDY-PEG-cw800-C dots at 1.2 nmol, day 14.

Table S26. Hematology parameters, group 21, male, no tumor, test article MSH-PEG-Cy5.5-C dots at 1.2 nmol, day 14.

Table S27. Hematology parameters, group 22, female, no tumor, test article MSH-PEG-Cy5.5-C dots at 1.2 nmol, day 14.

Table S28. Hematology parameters, group 23, male, no tumor, test article MSH-PEG-Cy5.5-C dots at 1.2 nmol, day 14.

Table S29. Hematology parameters, group 24, female, no tumor, test article MSH-PEG-Cy5.5-C dots at 1.2 nmol, day 14.

Table S30. Hematology parameters, group 5, male, tumor, vehicle control (saline), day 2.

Table S31. Hematology parameters, group 6, female, tumor, vehicle control (saline), day 2.

Table S32. Hematology parameters, group 7, male, tumor, test article MSH-PEG-Cy5.5-C dots at 1.2 nmol, day 2.

Table S33. Hematology parameters, group 8, female, tumor, test article MSH-PEG-Cy5.5-C dots at 1.2 nmol, day 2.

Table S34. Hematology parameters, group 9, male, tumor, test article cRGDY-PEG-cw800-C dots at 1.2 nmol, day 2.

Table S35. Hematology parameters, group 10, female, tumor, test article cRGDY-PEG-cw800-C dots at 1.2 nmol, day 2.

Table S36. Hematology parameters, group 11, male, no tumor, test article MSH-PEG-Cy5.5-C dots at 1.2 nmol, day 2.

Table S37. Hematology parameters, group 12, female, no tumor, test article MSH-PEG-Cy5.5-C dots at 1.2 nmol, day 2.

Table S38. Hematology parameters, group 13, male, no tumor, test article cRGDY-PEG-cw800-C dots at 1.2 nmol, day 2.

Table S39. Hematology parameters, group 14, female, no tumor, test article cRGDY-PEG-cw800-C dots at 1.2 nmol, day 2.

Table S40. Hematology parameters, group 15, male, tumor, vehicle control (saline), day 14.

Table S41. Hematology parameters, group 16, female, tumor, vehicle control (saline), day 14.

Table S42. Hematology parameters, group 17, male, tumor, test article MSH-PEG-Cy5.5-C dots at 1.2 nmol, day 14.

Table S43. Hematology parameters, group 18, female, tumor, test article MSH-PEG-Cy5.5-C dots at 1.2 nmol, day 14.

Table S44. Hematology parameters, group 19, male, tumor, test article cRGDY-PEG-cw800-C dots at 1.2 nmol, day 14.

Table S45. Hematology parameters, group 20, female, tumor, test article cRGDY-PEG-cw800-C dots at 1.2 nmol, day 14.

Table S46. Hematology parameters, group 21, male, no tumor, test article MSH-PEG-Cy5.5-C dots at 1.2 nmol, day 14.

Table S47. Hematology parameters, group 22, female, no tumor, test article MSH-PEG-Cy5.5-C dots at 1.2 nmol, day 14.

Table S48. Hematology parameters, group 23, male, no tumor, test article MSH-PEG-Cy5.5-C dots at 1.2 nmol, day 14.

Table S49. Hematology parameters, group 24, female, no tumor, test article MSH-PEG-Cy5.5-C dots at 1.2 nmol, day 14.

Movie S1. MIP video of pig #1.

Movie S2. MIP video of pig #2.

Movie S3. MIP video of pig #3.

Movie S4. MIP video of pig #4.

Movie S5. MIP video of pig #5.

Movie S6. MIP video of pig #6.

Movie S7. MIP video of pig #7.

Movie S8. Image-guided multiplexing, pig #5.

Movie S9. Image-guided multiplexing, pig #3.

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Molecular phenotyping and image-guided surgical treatment of melanoma using spectrally distinct ultrasmall core-shell silica nanoparticles - Science...

Headline after headline has been writtenabout legislators efforts to help Minnesotans suffering because they cannotafford their insulin medication. Yet no tangible compromise has been reached ona medical issue that affects so many Minnesotans.

Many suffering from diabetes simply cannotwait for a more affordable option. Some people have literally died whilewaiting for economic relief that would allow them to purchase a drug that costsas much as $300 for a 10-day supply.

The 30-day deadline has gone and passed,an exasperated Nicole Smith-Holt said. At this point, it feels like itis all PR just making it look like they care. They need to do this to savelives, she stressed.

State Representative Micheal Howardagreed. He has been working to get a law passed that would make insulinavailable to those who either have an emergency or just cannot afford theinsulin they need to survive. We need to show more urgency; there really is noreason why we shouldnt be able to come together and get something done, hesaid.

This is a bill I have been working on formore than a year. Its been like working at the kitchen table trying to figureout how do we create a safety net so that nobody loses their life because theycannot afford their drugs? explained Howard. I understand the frustration foradvocates who have been pushing for this for more than a year. The crisis isright in front of us; the solution is right in front of us. We need all sidesto show that sense of urgency, the legislator said, alluding to what some havecalled foot-dragging and grandstanding on the part of Republicans.

Everybody knows a family member that isaffected, he added.

Medical experts have described diabetes asa disease that occurs when a persons blood glucose, also referred to as bloodsugar, is too high. And having too much glucose in ones blood can cause healthproblems.

Blood glucose is our main source of energyand comes from the food we eat. Insulin, a hormone made by the pancreas, helpsglucose from food get into your cells to be used for energy. Sometimes our bodydoesnt make enoughor anyinsulin or doesnt use insulin well. Glucose then staysin our blood and doesnt reach our cells.

Diabetes leads to heart disease, visionloss, kidney disease, a stroke or even amputation.

According to the American DiabetesAssociation, diabetes is a major health problem in the U.S. The fallout fromthe disease puts a tremendous strain on the health care industry. Studies haveshown that nearly one-third of the total U.S. population is affected by someform of diabetes, either Type 1, Type 2 or prediabetic.

And the risk of diabetes is higher inAfrican American adults. Latest studies showed that about 4.9 million or 18.7%of all African Americans 20 years of age and older have diagnosed orundiagnosed diabetes, compared to 7.1% of non-Hispanic White Americans. Therisk of diabetes is 77% higher among African Americans than non-Hispanic WhiteAmericans.

Holt has expressed disappointment thatafter all of the talk, no compromise has been reached. She said with theexception of a few, there has been little communication with those affected,especially with the families that have been pushing for something to be done.They cant write the bill without us, she said.

Holt has credited Governor Tim Walz withbeing a great ally but said that something needs to be done soon. There havebeen two deaths this year involving young people who simply could not affordtheir insulin.

Holts son Alec Holt died in 2017 when heattempted to ration his insulin because it was no longer affordable on hissalary. He had been on his mothers health insurance plan until he turned 26.His mother said that he searched for an insurance plan that was affordable onhis restaurant salary. But the best option was one that required a $7,000deductible, so he eventually chose to pay for his medical expensesout-of-pocket while he continued to search for a plan that was affordable.

Alec only survived another month. He wentfrom paying two to three hundred for his insulin to a thousand dollars, whichwas out of reach on his salary. His effort to stretch his meds cost him hislife.

According to Health Care Cost Institute, patients with Type 1 diabetes spent an average of $5,705 in 2016, nearly double what they paid in 2015.

Dr. Victor Montori, an endocrinologist atthe Mayo Clinic in Rochester, accused the health care system of corrupting itsmission for the sake of profits. The consequences are human lives,he said. Its a cruelty we can no longer accept.

The Alec Smith Emergency Insulin Actpassed by the Minnesota House of Representatives last spring was designed tocreate a statewide insulin assistance program to help Minnesotans who struggleto afford the insulin they desperately need. The bill would be funded throughan Insulin Manufacturer Fee, that would be collected from the threelargest insulin manufacturers, Eli Lilly, French company Sanofi and the Danishfirm Novo Nordisk, that control more than 90% of the market.

Since the House passed its version of anemergency bill, two young Minnesota men have died. A 28-year-old whose familyrequested that he remain anonymous died as a result of rationing his insulinsupply. Jesimya Scherer-Radcliff, 21, who had Type 1 diabetes, died in July.His parents said he was on their health insurance, but he still could notafford the insulin he needed to survive. He reportedly had been rationing his insulinsupply. One of his relatives testified at a legislative hearing on the cost ofinsulin that, Jesy didnt die from insulin rationing, he died from theprohibitive cost of insulin.

The pharmaceutical companies absolutelyneed to be a big participant in this because they caused this problem,explainedHoward. They should have a role in solving it. There are onlythree insulin producers that control the entire market and they have ratchetedthe price up.

According to Rep. Howard, both billsrequire contributions from the insulin manufacturers. The House bill includes amanufacturers fee, while the Senate bill requires companies to provide freeinsulin. The other difference between the bills is the Senate bill allows forlong-term assistance, but leaves out the emergency option plan the Houseprefers as a safety net.

What we do produce is going to be a newbill that will take elements of the House proposal and the Senate proposal,which will create a safety net and provide longer-term situations.

The global insulin market is dominated bythree companies: Eli Lilly, the French company Sanofi and the Danish firm NovoNordisk. All three have raised list prices to similar levels. According to IBMWatson Health data, documented that Sanofis popular insulin brand Lantus was$35 a vial when it was introduced in 2001; its now $270. Novo NordisksNovolog was priced at $40 in 2001, and as of July 2018, it was priced at $289.

Rep. Howard said he holds out hope thatsomething that can be done before the next session in February. It does nothave to be either or it should be yes and. We should try to address theemergency issue first to prevent more loss of life but also look at solutionsfor long term affordability. There is a way to marry the two and accomplishboth goals, a compromise that leaves the door open for public funding as well,he said.

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A matter of life and death: insulin emergency/affordability bill... - MSR News Online

In a contemporary marketplace learn about revealed via Truth.MR, the present and long term possibilities of the Hormone Substitute Treatment Marketplace are totally analyzed. Additional, the document contains an in-depth research of the quite a lot of components which are prone to keep an eye on the expansion trajectory of the Hormone Substitute Treatment Marketplace within the upcoming years.

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In February 2018, Novo Nordisk A/S concluded major section of REAL 1 the pivotal section three trial along side somapacitan, a long-acting expansion hormone to regard adults with expansion hormone deficiency.

Teva Prescription drugs Industries Ltd. presented Vagifem in 2017 for the remedy of atrophic vaginitis. In January 2018, the corporate introduced Estrace cream to regard reasonable and serious signs of vaginal and vulgar atrophy going on because of menopause. Likewise, Mylan N.V expanded its US portfolio within the ladiess healthcare vary with U.S. FDA popularity of Estradiol Vaginal Cream to regard vaginal atrophy.

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Definition

Hormone alternative treatment, additionally known as menopausal hormone treatment, is used to regard quite a lot of signs associated with menopause amongst ladies. Hormone alternative treatment replaces hormones which are low in stage as ladies close to menopause. There are quite a lot of kinds of hormone alternative treatment akin to estrogen hormone alternative treatment, thyroid hormone alternative treatment and expansion hormone alternative treatment.

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More than a few hormone alternative treatment merchandise akin to estrogen hormone alternative treatment, thyroid hormone alternative treatment and expansion hormone alternative treatment is roofed. Via dosage shape, hormone alternative treatment marketplace is segmented into pills, patches, injections, implants and lotions. Via indications, hormone alternative treatment marketplace is categorised into menopause, osteoporosis, thyroid and expansion hormone deficiency. Via distribution channel, its segmented via clinic pharmacies, clinics, retail pharmacies and on-line pharmacies.

The hormone alternative treatment marketplace is classified throughout key areas akin to North The united states, Latin The united states, Europe, Asia Pacific with the exception of Japan (APEJ), Center East and Africa (MEA) and Japan.

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Hormone Substitute Treatment Marketplace International Research and Forecast File 2018 to 2028 - Markets Gazette

This is a guest contribution for The Economists Open Future initiative, which aims to foster a global conversation on the challenges of the 21st century. More Open Future articles are at Economist.com/openfuture

* * *

The day I knew I should quit my job answering phones at the transgender health-care clinic in California was the day a caller (lets use the name Betty) threatened her in-home caretaker with a knife during the call. As the caretaker begged our clinics nurse to track down Bettys doctor and tell him that Betty was having a psychotic episode, Betty stood between her and the apartments front door with a kitchen knife. Betty had poorly controlled paranoid schizophrenia, and often called the clinic agitated, alternately whispering and screaming about government agents stalking her. Betty was also a trans woman whom most people regarded as male, the sex of her birth.

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The clinic followed the informed-consent protocol: its mission was to provide transgender patients who otherwise lacked access to health care with injections, skin patches and pills of feminising or masculinising hormones without having to pass through a series of requirements and assessmentsknown as gatekeepingthat restricted access in the past.

In medicine broadly, informed-consent refers to the ethical requirement that a clinician administering a treatment communicate to the patient the anticipated risks and benefits, as well as reasonable alternatives to the treatment. Yet for transition medicine in America, informed-consent programmes do not require clinical documentation, beyond patient reports, of the patients gender dysphoria over time (ie, a feeling of mismatch between ones biological sex and gender identity) and readiness for medical interventions.

Gatekeeping horror stories are notorious in the transgender community. In the past it was not unusual for a trans person to be told by doctors and psychologists they would not be referred for hormones because they were not visually appealing as their preferred gender, werent interested in dating the opposite gender, or had unresolved mental-health problems (some of which are predictable responses to experiencing transphobia, such as anxiety and depression).

It was not unusual for a trans person to be told they would not be referred for hormones because they were not visually appealing

Pioneering LGBT health centres across America developed informed-consent protocols for hormone treatment in a well-intentioned effort to imbue the experience of pursuing hormone treatment with dignity for patients. But as informed-consent protocols have become the norm rather than the exception, we may be shunting transgender people in America into a parallel medical systemone in which patients bargain away careful assessment and education for greater autonomy and shortened timelines to access medical treatments.

At my clinic, we were informed-consent true-believers. We didnt badger you with questions; as long as you were 18, even if you had no way to pay the clinics fees, you would get your hormones. You had to sign forms stating that you understood that although hormone-replacement therapy (HRT) benefits many trans people suffering from gender dysphoria, the health risks are largely unknown. Starting hormones could have negative consequences for your mental well-being, social functioning and even the intensity of your gender dysphoria (many people find that their distress about a body part like their breasts will only increase when the effects of testosterone appear, such as facial hair).

Also, people were informed that they were waiving the mental-health screening recommended by the World Professional Association for Transgender Health. Its standard of care recommends that patients seeking HRT be screened for schizotypal disorders, autism-spectrum disorders, personality disorders, dissociative disorders, post-traumatic stress disorders and more.

In the case of Betty, I felt that the clinic where I worked wasnt sufficiently concerned whether her mental disorder created delusions that often controlled her life, or meant she was so cognitively disabled that transition predictably left her more isolated and chronically stressed than before she started HRT. The medical staffs attitude towards Betty and many of the other patients who were receiving hormones while managing (or failing to manage) severe mental illness was a profound lack of interest about whether one affected the other.

We were informed-consent true-believers. We didnt badger you with questions; as long as you were 18, you would get your hormones.

In fact, most of us worked there because we rejected the idea that a strongly felt internal sense of gender could be a symptom of mental illness. That shared, ideological foundation meant it was verboten for the staff to consider whether the HRT might be exacerbating Bettys schizophrenic symptoms or making it harder for her to build the basic social relationships that provide the support and positive feedback that is so necessary for mental health. If the HRT did not actually assist Betty in presenting as a woman or improve her functioningand it seemed to be doing neitherwe considered affirming her identity more important than those conventional measures of the treatments effectiveness.

The most radical and liberatory action we could take was to affirm Bettys identity. If we were the one and only place she visited in her day where she was referred to using her chosen pronouns, we considered it paramount we gave her that experience. This commitment to affirming identity through correct pronouns and easy HRT was our reason for being. But strangely, by fulfilling our commitment to affirming felt identity, we seemed to be off the hook for questioning whether we were doing all we could to avoid harming her.

I quit the clinic in 2014, and in 2016 I spoke to the lawyer of a patient suing that same clinic. This patient also pursued HRT while experiencing intense delusional symptomsit was 2012 and he thought the world was ending. The clinic, affirming as ever, recommended and provided the referral letters for him to have an orchiectomy, a removal of his testicles, which he underwent. When his delusional symptoms eventually abated he detransitioned, coming to an uneasy peace being, and presenting as, male.

I know him because we are both detransitioned people. I was also convinced that I was a trans personas a result of misunderstanding a persistent sense that my body felt unreal, a common dissociative symptom following traumaand received HRT at this same clinic, taking testosterone for nine months. For the past five years Ive been a part of a growing community of detransitioned people who are speaking out about questionable norms and practices in transgender medicine.

The clinic, affirming as ever, provided the referral letters for him to have an orchiectomy, a removal of his testicles

When I first detransitioned, my community consisted of online groups of fewer than 100 women. Five years later the detransition discussion-forum on the popular site Reddit has just hit 7,000 people of both sexes. I know detransitioned people who later discovered they had autism-spectrum disorders, detransitioned people who came to recognise that they were experiencing traumatic dissociation, even detransitioned people who had such severe dissociation that they had multiple alters (ie, multiple identities) while being treated with hormones and surgeries.

Our stories, if taken seriously, could help improve the state of transgender health careparticularly at informed-consent clinics, which are becoming the norm at American colleges, LGBT health centres and recently many Planned Parenthoods. Instead we are ignored, compared to ex-gay Christians or treated as political footballs. (I was particularly disheartened when Ryan Anderson, a fellow at the Heritage Foundation, a conservative think-tank, used my and other detransitioners stories in his book that was critical of LGBT and feminist issues, When Harry Became Sally.)

That is because the burgeoning orthodoxy on the left is that detransition is so rare that only transphobes care about it. If you draw attention to the stories of transition gone wrong, the thinking goes, there will be less public support for transition and for transgender people themselves. For academic researchers and journalists, telling our stories is a fast track to being labelled a transphobe. This has profound consequences for what we know about the medical paths that leads to detransition.

In fact, we have no idea how prevalent detransition is in America. The most widely used estimate, that 2.2% of people who transition later detransition, comes from a study in a completely different place (Sweden) and time (1960-2010), when gatekeeping was much stricter. Moreover, that study defined a detransitioner as someone who had changed their name and gender legally (an arduous process in Sweden at the time) and then had the motivation and money to go through the name change process in reverse, a standard so strict that I wouldnt be counted, and nor would 90% of the detransitioners I know.

If you draw attention to the stories of transition gone wrong, the thinking goes, there will be less public support for transgender people

This passionate but misguided argumentthat detransition is extremely rare, thus any research into it is harmful and motivated by transphobiahas led to outright censorship. In 2017 Bath Spa University in Britain shot down a research proposal that sought simply to collect stories from detransitioners. The same year the Philadelphia Trans Health Conference, a major annual gathering of the transgender health community, abruptly cancelled two previously approved panels that I had helped organise on detransition and alternative methods of managing gender dysphoria, because of the level of heated conversation and controversy. These were just two out of nearly 200 sessions.

As a result, the subject of detransitioners health-care experiences remains virtually untouched by academic researchers. This shows in the clumsy approaches of those few researchers willing to engage the subject. For example, a poster presented this summer at the European Professional Association of Transgender Health conference purported to show a very low rate of detransition and regret (0.47%) at an NHS clinic in London. The poster bounced all over social media, cited as proof that detransition is indeed exceptionally rare.

But that estimate was generated by combing through case files for patients who returned to the clinic to inform staff of their detransition or regret. The thing is, though, detransitioners almost never do this. This is widely known within the communitywhy would you go back to a clinic or to a doctor who, in your view, helped you hurt yourself?

Apart from the few who sue their doctors and therapists, detransitioners tend simply to disappear from a clinics view, despite often having urgent needs for continued medical treatment and therapy. I have heard of only three detransitioners who went back to talk to the clinicians who had assisted them in transitioning. (The experience of one who did just that convinced me that I probably never will.) Nor do they tend to go to other clinics for follow-on care: they simply become invisible.

The majority of the studies supporting the conclusion that medical transition yields positive outcomesand there are manyfollowed patients in highly structured clinical programmes that provided comprehensive assessments. But when I searched last February for programmes that met that careful standard in America, I wasnt able to find one. No one knows whether informed-consent protocols will yield the same success rate, but the stories Ive heard during the past five years make me profoundly sceptical.

In a comprehensive examination of peer-reviewed articles on medical-transition between 1991 and 2017 by researchers art Cornell University, called What We Know, there have been no studies tracking a cohort of patients at an informed-consent clinic over time to investigate the outcomes that their protocol produces. Moreover, there have been no studies on what percentage of clinics in America follow the standard of care recommended by the World Professional Association for Transgender Health versus their own informed-consent protocols.

From the point of view of clinics, they would respond to the criticisms by noting that informed-consent clinics often serve a poor and transient population, which presents challenges to following up with patients. Another difficulty is that transgender medicine is a relatively new field serving a small minority of the population, necessarily limiting funding and opportunities for research. As to whether informed-consent policies have the effect of leading people to medical interventions too soon, they would argue that the people who end up feeling ill-served by the high level of patient autonomy will always be a small minority.

Yet this does not obviate the need for better practices. I dont want informed-consent clinics shuttered. I want them to do the tasks normally associated with medical care. This includes giving patients access to differential diagnosis (distinguishing between conditions that share similar symptoms) and follow-up research so that providers can improve the care they offer.

There is a responsible path between making transgender people jump through hoops and allowing people experiencing psychosis to have their testicles removed

For example, ensuring that low-cost psychology referrals are offered to all patients seeking informed-consent care could increase voluntary participation in comprehensive evaluations. Ensuring that staff are trained to identify patients showing signs of certain severe disorders, and to provide psychological evaluations when appropriate, could help prevent outcomes like Bettys.

Even ensuring that all clinics have counselling referrals on hand would be a step in the right direction. Although I received a prescription for hormones by my second visit, many patients sat on the waiting list for counselling from the same clinics social workers for more than five months and when I requested an outside referral, I was told to google the phone number of a local counselling internship site.

There is a responsible middle path between making transgender people jump through hoops to access needed medical care and allowing people experiencing psychosis and delusions to have their testicles removed. Until gender care providers accept their ethical responsibility to find that path, the American medical system continues to serve this community of people poorlybut this time, this neglect is designed and perpetrated by allies under the banner of transgender rights.

_________________

Carey Callahan is a family therapist and board member of the Gender Care Consumer Advocacy Network, a non-profit group that advocates for the rights and welfare of consumers of gender care services.

Go here to read the rest:
Gender identity is hard but jumping to medical solutions is worse - The Economist

with Ali Aminian, MD, and Caroline Apovian, MD

For those of you who have type 2 diabetes with obesity or have a family member that does, one of the best ways to reduce common health risks such as heart disease and stroke is by having gastric bypass surgery.1

The reason for this seems to be that metabolic surgeryany procedure that changes the function and structure of the stomach or small intestinesupports weight loss, leading to improvements in glucose control and insulin sensitivity; and, ultimately diminishes the complications associated with diabetes. Still, how can you be sure that surgery is the right way to go?

Cleveland Clinic researchers have developed a risk assessment tool to give you a sense of your health risks for diabetes complications in the decade ahead if you do or don't have bariatric surgery. Photo: fstop123 @ iStock

Recognizing that surgery is a daunting step for some and represents too much uncertainty for others, a web-based risk assessment calculator was created by a team of investigators at the Cleveland Clinic in Ohio to help you to determine if bariatric surgery will favorably improve your long-term health.2,3 The results can be shared with your health provider as a starting off point in discussing a disease management plan now and going forward.

This predictive tool is intended to guide you and your doctor to understand the long-term medical risks associated with type 2 diabetes (T2D) and obesity, and to consider the benefits you might gain from having this surgery,2 says Ali Aminian, MD, a bariatric surgeon at the Cleveland Clinic who presented the research supporting development of this tool at a session during ObesityWeek 2019, in Las Vegas, Nevada.

Dr. Aminian outlined the development of the risk calculator. He and his team evaluated the experiences of 13,722 patients with both diabetes and obesitycomparing patients who underwent bariatric surgery as compared to closely matched individuals who were eligible for surgery but chose to continue with their standard medical treatment.2

After following these patients, the individuals who elected to have surgery proved to have a lower risk for every one of the five common complications associated with diabetes. These included: heart disease, stroke, heart failure, kidney disease, and death from all causes.2

Across the board, following these gastric procedures, individuals had a lower risk of every diabetes-related risk. Unfortunately, fewer than 1% of the patients who were eligible for bariatric surgery have it,3 he says.

The researchers than gathered relevant data from the medical records of nearly 290,000 patients with obesity who were being treated for type 2 diabetes in the Cleveland Clinic Health System from 2004 to 2007.Health measures including age, sex, body mass index (BMI), diabetes-related complications, and medications taken were combined to determine patient-specific risks. The researchers also incorporated levels of hemoglobin A1c, blood pressure, and blood cholesterol levels.3

The data supporting the impact of weight-loss surgery on complications of type 2 diabetes, such as stroke and heart disease as well as kidney disease, was published in the Journal of the American Medical Association.2 The results support use of the risk calculator since the data indicated that patients who had metabolic surgery were 39% less likely to experience conditions such as heart disease, stroke, or diabetic kidney disease and 41% were less likely to die from any cause.2,3

When used by an individual, the risk assessment tool can help give both patients and providers a 10-year disease probability of developing the life-threatening complications related to diabetes if the current path is continued, as well as a comparison should you choose to undergo bariatric surgery.

How Effective Is the Gastric Bypass Risk Assessment Tool? As the Individualized Diabetes Complications (IDC) risk calculator was only just released, there hadnt been enough time to gather feedback yet, Dr. Aminian tells EndocrineWeb. However, he has already heard from several enodcrinologists, cardiologists, and primary care providers that they intend to use the calculator in their practices.

According to Caroline Apovian, MD, of Boston University School of Medicine, the reason for greater disease complications stems from a failure of primary care physicians and endocrinologists to recommend more eligible patients discuss their status with a bariatric surgeon. This risk calculator will help not just patients but also providers to realize the benefits of gastric surgery beyond weight loss, and to recognize the risks of not choosing to have surgery, she says.

While there isnt currently a way to determine which bariatric procedure would be best for each individual, Dr. Apovian tells EndocrineWeb, there are studies that indicate that the Roux-en-Y Gastric Bypass offers the best effect on hormone levels.4-6Dr. Aminian acknowledges that despite the limitations of the risk assessment tool as it doesnt include information on family history of heart disease or length of time with type 2 diabeteswhich would be helpful in addressing patient risk, the results derived by the IDC assessment are still valid.2,3

These gastric procedures are very powerful and safe methods for treating individuals with both obesity and type 2 diabetes, says Dr. Aminian. Having surgery can provide significant weight loss, improve diabetes, cholesterol levels, delivering a survival benefit as well as improved quality of life. Even though treating these patients with bariatric surgery is known to be beneficial, a lack of access to trained surgeons and the stigma associated with any method of weight loss besides diet and exercise, has made this option less desirable, he says.

Dr. Apovian has already made use of the ICD assessment tool in her practice It adds a spotlight that can help patients to better grasp the benefits to surgery.

In another presentation delivered at ObesityWeek 2019 in Las Vegas, Nevada, Oliver Varban, MD, associate professor of surgery including bariatric procedures in the University of Michigan Health System in Ann Arbor, presented data supporting the value of sleeve gastrectomy for individuals who have mild obesity (ie, body mass index [BMI] < 35 kg/m2).7 In this study of more than 45,000 patients, achieving a normal BMI occurring more often in patients with a starting BMI below 35 than above who also voiced greater satisfaction with the procedure.

In a press statement, Dr. Varban said: We hope the study encourages more patients to consider weight loss surgery earlier in their disease and for more health insurers to recognize the benefits of lowering the current BMI-threshold.

Indeed, it is most constructive for providers to introduce patients to this surgical assessment tool to help illuminate the risks individuals likely face in avoiding bariatric surgery, says Dr. Apovian. She anticipates that providers and patients might use the ICD tool together in an office setting when considering the need for treatment to improve outcomes and better manage type 2 diabetes with obesity.

Both physicians and patients still fail to treat obesity as a disease, says Dr. Apovian, raising a long-held observation. Too many doctors still view obesity as a matter of willpower and self-control, expecting patients alone to carry full responsiblity for losing weight. There is need for the medical community to acknowledge that obesity is a malfunction of metabolic pathways driving hunger and satiety talk between the gut and the brain.

Any educational tool that offers to dispel this old way of thinking is very welcome, says Dr. Apovian, as we need to help change attitudes so obesity can be approached as disease in need of medical intervention.

In the future, having more information included in the tool on who will develop heart disease on a genetic level could help patients and providers better target particular treatments to specific people.

The assessment algorithm doesnt allow for influences that may change the results based on demographic information such as race and ethnicity.2 Dr. Apovian has studied the impacts of surgery on different populations, and recently published data that showed that African American and Latino populations dont respond as well as Caucasians to metabolic surgery and are more likely to relapse into diabetes.4

Knowing the reasons for variability in outcomes based on racial differences could assure a more accurate and wider use of the ICD assessment tool but such developments still need more time in the academic incubator.2

More data on the type of surgery and outcomes across subpopulations would be good, says Dr. Apovian, particularly as sleeve gastrectomy produces a different impact on hormones related to satiety then the Roux-en-Y gastric procedure. We are starting to see conversions to Roux-en-Y after failed sleeve surgeries, she says.

As for the ICD tool, Id love to see all practitioners using this in their practices, says Dr. Apovian. It introduces sound numbers to the conversation with patients, and if that helps doctors convert more patients to opt in to surgery, then that will be great.

The Cleveland Clinic research received a research grant from Medtronic.

Last updated on 12/03/2019

Big Breakfast Beats Traditional 6-Meal Diabetes Diet

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Web-based Tool to Help Assess Diabetes Outcomes With and Without Surgery - EndocrineWeb

Mitchell Levine is the new director of the Dental Sleep Medicine Clinic at the University of Tennessee Health Science Center's College of Dentistry.(Photo: Natalie Brewer / UTHSC)

Mitchell Levine wants the clinic he leads to help Shelby County Schools "educate and inform" faculty on identifyingchildren with sleep apnea, which can hinder brain development.

I think faculty in particular may just not be aware, said Levine, director of the Dental Sleep Medicine Clinic at the University of Tennessee Health Science Centers College of Dentistry. They think the child is just not performing well or acting out. They dont always associate it with sleep problems.

Sleep apnea isa condition in which the airway is blocked during sleep, obstructing oxygen intake. It can increase the risk of heart disease and other disorders, according to the National Heart, Lung,and Blood Institute.

For adults, using continuous positive air pressure (CPAP) machines manages the problem. Getting children desensitized and willing to use a CPAP is "no doubt" more difficult, Levine said, and untreated sleep apnea can hinder their neurological, psychosocial and decision-making development, according to UTHSC.

Dental assistant Abby Ridings (left) and fourth-year dental student Carlton Leding clean 11-year-old Tierra Moore's teeth during a visit to the University of Tennessee Health Science Center College of Dentistry on National Give Kids A Smile Day on Thursday, Feb. 2, 2017.(Photo: Yalonda M. James/USA TODAY NETWORK - Tennessee)

That manifests itself in shortcomings at school, which could spiral into challenges beyond the classroom, said Levine, who became director Aug. 1.

Kids who are not being managed well (with sleep breathing) puts them at a disadvantage as they continue to age, he said.

Tackling adult sleep apnea is about managing the problem, unless there is a willingness to undergo major surgery, Levine said. CPAP or oral devices that fit like retainers and keep the airway openare typical treatment options, per UTHSC.

For pediatric sleep apnea, Levine said treating it isabout redirecting the growth processes of the jaw to improve the effectiveness of the airway during sleep.Jaw positioning and enlarged tonsils and adenoids are connected to sleep apnea in children, Levine said.

When snoring becomes a regular occurrence it could be a more serious condition called obstructive sleep apnea. Many use a CPAP mask to help get past this condition.(Photo: nicolesy, Getty Images/iStockphoto)

I think what were realizing is in childrens sleep problems and adults' sleep problems is the manifestations of them seem to be a bit different, he said.

Repositioning the jaw is effective when the child is 8 or 9 years old and growing fast. Before that age range, oral devices come in handy, because structural changes to growth aren't as effective at 5 or 6 years old, Levine said.

An oral device may be all that's needed for a young child with sleep apnea. Over time, natural growth may rid the child of the structural cause, Levine said.

We had parents that would talk about kids not having nightmares anymore or sleepwalking, doing better at school and moving into their own bedrooms again, Levine said of helping children with sleep apnea. There is a unique opportunity on the pediatric side.

Levine hopes UTHSC and the clinic he heads willfind a role in the community beyond custom-fitted oral devices and orthodontic treatments.

Addressing children with sleep-breathing problemsis a key example of that, being a new focus for the clinic. Levine said he has a different perspective than previous leadership due to his experience treating children and addressing orthodontic development.

A dental implant designed by Dr. Ryan Robinson, a dentist at Pike Creek Dental, to treat patients diagnosed with sleep apnea.(Photo: Jennifer Corbett, The News Journal)

If Shelby County Schools faculty can identify children with pediatric sleep apnea, they can direct them to resources that will address the disease, Levine said. SCS and UTHSC have a general partnership already, but a more direct, sleep apnea-focused effort would boost awareness regarding the issue.

Other factors can negatively affect sleep for young people outside of trouble breathing, like using electronics before bed, Levine pointed out. Blue light emitted from smartphones, tablets and other devices competes with melatonin, a natural hormone connected to the onset of sleep.

Early school start times are also a big issue, particularly among high school students with delayed sleep patterns, homework and after-school activities to manage, Levine said. Those students can be at risk for drowsy driving.

A whole education process needs to be introduced, he said.

Max Garland covers FedEx, logistics and health care for The Commercial Appeal. Reach him at max.garland@commercialappeal.com or 901-529-2651 and on Twitter @MaxGarlandTypes.

Read or Share this story: https://www.commercialappeal.com/story/news/2019/12/03/child-sleep-apnea-uthsc-dental-sleep-medicine-clinic-mitchell-levine/4299784002/

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Child sleep apnea: Here's why UTHSC clinic director wants to team up with Shelby County Schools - Commercial Appeal

Yeast isn't just found in bread it can also be found in everybodys genitals. Everyone has it, but it only causes an issue when it becomes out of balance with your bodys natural pH.

Vaginal candidiasis, or yeast infection, is a fungal infection that causes irritation, discharge and intense itchiness of the vagina and the vulva. This is NOT considered an STI. Theyre super common, and affect three-fourths of vagina owners at least once in their lifetime. Many people experience at least two episodes. There are over-the-counter medications that can treat them; however, you should always go to your doctor first, and if you experience recurrent ones, then you should talk to your doctor about different treatments and treatment plans.

For those with a penis, the yeast infection is referred to as candidal (or candida) balanitis. It affects the head of the penis mostly, but can also affect foreskin and the shaft depending on the intensity. For symptoms, you should usually look for burning or itching around the head (especially after having penetrative sex), redness, swelling, small bumps that may contain pus and pain during urination or sex. If you have a foreskin, you may also have difficulty cleaning or moving the foreskin. Unlike with vaginal yeast infections, penile yeast infections are usually acquired through sexual intercourse, but are generally easily treated. Additionally, you may acquire a yeast infection through skin problems or taking certain kinds of antibiotics (which can cause imbalance for the bodys natural genital pH).

You might have a yeast infection in your vagina if you notice these symptoms: Itching and irritation, burning during sex or urination, redness and swelling of the vulva, pain and soreness, a vaginal rash, thick, white, cottage cheese-like discharge or very watery discharge. All peoples discharge is different however. Always ask your doctor about sudden changes in discharge.

Yeast infections are caused by an imbalance in the natural bacteria and strains of yeast inside the vagina. It becomes an infection when the yeast becomes more present than the bacteria that normally keeps it in check. This imbalance can be caused by a number of things, including antibiotic use, which causes an imbalance in the natural vaginal flora, pregnancy, uncontrolled diabetes, an impaired immune system or taking oral contraceptives or hormone therapy that increase estrogen levels.

Remember as well that yeast and bacteria flourish in a damp, warm environment. So, if you fit into any of the above criteria, you can take steps to prevent yeast infections from occurring. Mayo Clinic and Healthline both recommend wearing slightly looser fitting underwear that has a cotton panel in the crotch, as well as avoiding super tight-fitting tights or leggings and being sure to change out of wet or damp workout clothing or swimsuits as soon as youre done. Additionally, refrain from taking extremely hot showers or baths, because the hot, wet environment can exacerbate the issue. You should also refrain from douching. The vagina is self-cleaning, and does not require help in its job. Douching the vagina can only cause worse issues.

You should definitely avoid having sex if you believe you may have a yeast infection of any kind. Bacteria thrives in moist environments, and genitals are the perfect breeding spot. Having sex with a partner may unbalance your partners pH, and you will be exposing them to the risk of infection as well. Its best to just wait it out. Mild infections can have symptoms disappear after only a few days of treatment, while more moderate to severe infections may last anywhere from one to three weeks.

If you think you may have a yeast infection, the best first step is to see a professional. The kind of doctor associated with genital health is a gynecologist for vaginas, and urologists specialize in penile care. Many options are available as well for those who wish to treat at home, such as antifungal treatments (here is a link for over-the-counter treatment of the penis). However, it should be acknowledged that you should check with your general practitioner to address any risks and seek medical attention if symptoms persist for more than the amount of time recommended on the package.

Do you have a question about sex, sexuality, or relationships? You can ask us to find you accurate and reliable information from experts by tweeting @SEATUTK, direct messaging @Sexweekut on Facebook or submitting a question to our anonymous Google form.

Columns and letters of The Daily Beacon are the views of the individual and do not necessarily reflect the views of the Beacon or the Beacon's editorial staff.

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Let's Talk About It: Yeast Infections - UT Daily Beacon

NewsReal LifeEva Echo came out as transgender to wife Pippa two years ago despite fearing it could mean their relationship was over

Tuesday, 3rd December 2019, 5:40 pm

Eva Echo, 39, and her wife Pippa Ng, 29, talk about how Eva's coming out as trans made their relationship stronger, as well as the mental health struggles she faced on her journey to self acceptance.

It was obvious what the customer in Eva's tattoo shop was doing. The smirk on his face after he took a sly snap of her on his phone said it all. "He was clearly sending snaps to his friends, probably telling them, Have a look at this freak," she said.

She knew she stood out. "At that time, adopting an androgynous look and wearing make-up was a sort of comfortable middle ground for me. But I couldnt even say the word transgender, let alone admit it to myself."

The truth was that being called by the male name she was given at birth, and the male body she was born into, had been the root of years of torment. The multiple suicide attempts five major ones that led to hospitalisations. An eating disorder. The self-loathing. The denial.

"I'd always tried to imitate my friends and be 'one of the lads'," she said. "But I wasn't and my mental health problems were because I had no solid sense of identity, of who I really was as a person."

Then at the age of 37, there in the shop was a reminder of everything she'd been afraid of social rejection, ridicule, discrimination and abuse. Transphobia. But the way forward suddenly became clearer.

This guy really made me wake up and question who I was. I thought, how do people see me, when I dont even know how I see me? If people are already laughing at me, then fuck it, why not go the whole hog?"

Coming out

Eva opened up to her best friend Christine, who was "super supportive", which gave her the courage to tell Pippa, who she'd met at a gig six years ago, and married eight months later.

But Pippa had dated only men. I knew I needed to tell Pippa, but I was a nervous wreck. She already accepted me for who I was and the way I looked. So that made it easier to come out to her. But I know people who come out to their partners and they say it's okay, then some time later it all falls apart. I thought, what if it's really not okay for her?"

Eva swigged back a few glugs of vodka and took a deep breath. There was no going back once the words were said. "I told her everything. She wasn't even surprised. She just sort of shrugged and said, I know'.

It was huge for me. Shes the most important thing in my life. She wasnt angry. Id built things up to be so horrific that it was the ultimate turning point for me. To be accepted for exactly who you are makes you feel really truly loved. Pippa is very protective over me and gets upset if anyone stares at me."

Pippa says she always had a strong feeling Eva was struggling with her gender. "It's not like Eva was this big, burly man who dropped a bombshell about wearing my clothes behind closed doors. I'd never gone for butch men."

And while Pippa never labelled herself, she said she identifies with being pansexual, that is knowing she is attracted to people regardless of their sex or gender identity. "I always dated men and have never dated a woman. But I was aware that was because I'd never met a woman who I felt really attracted to.

"For me love is love, as they say. I really like the phrase 'Love is hearts not parts'. I was just relieved that Eva could now put a name to what was making her so unhappy. And I look and dress a bit 'different' myself. So I can identify with that. Both of us feel sure that we don't want children, so thankfully that's not an issue for us."

Journey to acceptance

And so almost immediately, Eva, from near Birmingham, took steps to begin her transition. But after going to her GP and being referred to a gender identity clinic (GIC) , she was devastated to be told the waiting list had jumped to two-and-a-half years. Like many trans people struggling to access timely help, she considered buying potentially-dangerous hormones online.

"The wait was just for an initial appointment, it would have been longer for me to have anything done. I feel like I knew from the age of four, but it can take trans people like myself years and years to get to a place of realising you're in the wrong body. Then you take this big leap and you expect the help to be there. But every year that passed was another year of not being me."

Fearful of suffering further mental health problems, she sought a diagnosis and hormone therapy from private firm Gender Care, where the waiting list was just three months. She also recently underwent facial feminisation surgery with surgeon Christopher Inglefield, who featured in ITV documentary Transformation Street.

Eva said she isn't on speaking terms with her parents, who have struggled to accept the changes. "I'm Chinese, and while I think culture has played a role, I know of more open minded Chinese families. I understand that they came over from Hong Kong back in the day when there was more open racism and they have struggled themselves with feeling like they fit in."

Pippa's family meanwhile have accepted Eva with open arms. "My dad was brilliant straight away, my mum was too, it just took her a bit longer to remember to refer to Eva as she, or her 'daughter-in-law'.

"At a family do I my granddad was great. He called Eva by her original male name and I explained she was called Eva now. He just hugged and kissed her like he would any woman. If someone of that generation can embrace it, that gives us hope."

You can read Eva's blog where she shares about her transition here.

Do you have a story about relationships to share? Email claudia.tanner@inews.co.uk

There are just seven GICs in England London being the main one, as well as Sheffield, Leeds, Newcastle, Daventry, Nottingham and Exeter to serve a UK trans population estimated to be as large as 660,000.

Record demand for help from NHS gender identity clinics has seen waiting times reach more than two years, research has shown.

Providers of such services say they are not adequately funded by NHS England, according to an investigation by Health Service Journal.

There are no official waiting time statistics, but four of the six providers in England shared their data with the publication which discovered providers are reporting average waiting times of more than two years.

Tavistock and Portman Foundation Trust, the countrys largest provider of transgender services, said back in August when the report came out that its waiting list for a first appointment, at 5,717, is at an all-time high.

One expert clinician says his service is four times over subscribed in terms of what its funded to deliver.

NHS England said its budget for gender identity services increased to 38m in 2019-20, compared to 34m the previous year. However, it acknowledged the problems and said it will be piloting new delivery models.

Campaigners say transgender people are being put at greater risk of suicide and self-harm because of long waits.

A spokesperson for the Tavistock said that in addition to an "an unprecedented increase" in the number of referrals to its service, they are also having to deal with a high staff turnover and patients cancelling appointments. A statement read: "We are aware that the waiting time for a first appointment at GICS is currently growing and are doing all we can to address this."

Original post:
Relationship diaries: 'Love is about hearts not parts' says wife on accepting her partner as trans - inews

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Browse Complete Report @ https://www.marketresearchhub.com/report/global-bone-marrow-transplant-rejection-treatment-market-professional-survey-report-2019-report.html

Table of Contents

Executive Summary1 Industry Overview of Bone Marrow Transplant Rejection Treatment1.1 Definition of Bone Marrow Transplant Rejection Treatment1.2 Bone Marrow Transplant Rejection Treatment Segment by Type1.2.1 Global Bone Marrow Transplant Rejection Treatment Production Growth Rate Comparison by Types (2014-2025)1.2.2 Azathioprine1.2.3 Adrenocorticotropic Hormone1.2.4 Cyclophosphamide1.2.5 Cyclosporine A1.2.6 Others1.3 Bone Marrow Transplant Rejection Treatment Segment by Applications1.3.1 Global Bone Marrow Transplant Rejection Treatment Consumption Comparison by Applications (2014-2025)1.3.2 Hospital1.3.3 Clinic1.3.4 Others1.4 Global Bone Marrow Transplant Rejection Treatment Overall Market1.4.1 Global Bone Marrow Transplant Rejection Treatment Revenue (2014-2025)1.4.2 Global Bone Marrow Transplant Rejection Treatment Production (2014-2025)1.4.3 North America Bone Marrow Transplant Rejection Treatment Status and Prospect (2014-2025)1.4.4 Europe Bone Marrow Transplant Rejection Treatment Status and Prospect (2014-2025)1.4.5 China Bone Marrow Transplant Rejection Treatment Status and Prospect (2014-2025)1.4.6 Japan Bone Marrow Transplant Rejection Treatment Status and Prospect (2014-2025)1.4.7 Southeast Asia Bone Marrow Transplant Rejection Treatment Status and Prospect (2014-2025)1.4.8 India Bone Marrow Transplant Rejection Treatment Status and Prospect (2014-2025)

2 Manufacturing Cost Structure Analysis2.1 Raw Material and Suppliers2.2 Manufacturing Cost Structure Analysis of Bone Marrow Transplant Rejection Treatment2.3 Manufacturing Process Analysis of Bone Marrow Transplant Rejection Treatment2.4 Industry Chain Structure of Bone Marrow Transplant Rejection Treatment

3 Development and Manufacturing Plants Analysis of Bone Marrow Transplant Rejection Treatment3.1 Capacity and Commercial Production Date3.2 Global Bone Marrow Transplant Rejection Treatment Manufacturing Plants Distribution3.3 Major Manufacturers Technology Source and Market Position of Bone Marrow Transplant Rejection Treatment3.4 Recent Development and Expansion Plans4 Key Figures of Major Manufacturers4.1 Bone Marrow Transplant Rejection Treatment Production and Capacity Analysis4.2 Bone Marrow Transplant Rejection Treatment Revenue Analysis4.3 Bone Marrow Transplant Rejection Treatment Price Analysis4.4 Market Concentration Degree

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Bone Marrow Transplant Rejection Treatment Market Status, Types and Applications and Forecast to 2025 - News Description

Knowing your status takes only a minute now. Literally.

A rapid HIV test, new to Florida, is helping local advocates reach more people in a state where the virus has hit epidemic levels.

More than 100,000 people in Florida are living with HIV right now, and about 15 percent of them dont know they have it. Despite advances in medicine that both prevent and treat the virus, along with more outreach and education, rates of infection continue to climb in America.

In 2016, 611 people out of every 100,000 living in Florida had HIV, according to data collected by AIDSVu, an online mapping tool that shows where the virus is spreading in the U.S. Pinellas and Hillsborough counties are among the most active in the state.

Dozens of advocacy groups, local and national, are trying to thwart the spread of HIV. In his State of the Union address in February, President Donald Trump announced an initiative to end the epidemic in the U.S. by 2030. In Pinellas, the Zero Pinellas partnership aims to reduce the number of new HIV infections in the county by 50 percent by 2021.

RELATED: HIV is on the rise in Florida and young people dont seem to care

Metro Inclusive Health, an LGBTQ health care nonprofit and a member of Zero Pinellas, is seeing more people come in for the new test, known as INSTI, which gives a result in 60 seconds.

The new rapid test allows us to give people results sooner, and lets us go out into the field to test people who may be at higher risk for HIV, said Rebecca Nessen, vice president of strategic initiatives for Metro, which offers primary care and HIV services to patients in Pasco, Pinellas and Hillsborough counties, regardless of ability to pay.

Usually the people who are at higher risk arent the type who are going to walk in our door for an appointment, Nessen said.

The test isnt brand new its been on the market for a couple of years. But the Florida Department of Health recently approved it for use, so Metro and other nonprofits that receive grants from the state can use it at their clinics. Metro began offering the service to patients on Sept. 30, Nessen said.

There are a variety of ways to screen for HIV, all involving a blood test. Previously, Metro could test for HIV and receive a result in 20 minutes. Another test the organization offers sends a blood sample to a lab, where results return in 10-to-14 days.

The Centers for Disease Control and Prevention recommend that everyone 13 and older be tested at least once in their lives for HIV. High-risk populations should test at least once a year.

The INSTI test checks for HIV antibodies in the blood. HIV antibodies are disease-fighting proteins that the body produces in response to the infection. It can take three to 12 weeks from the time of infection for the body to develop antibodies, which is why organizations like Metro still offer a range of HIV tests.

Most people who come in to be tested are the ones who suspect they have been exposed," said Shirlene Manuel, a prevention specialist with Metro. And that 20-minute wait time for the other test can be stressful, she said.

Manuel recalled talking on the phone with one patient for two weeks before convincing him to come in for an HIV test. Once he was in the Metro clinic waiting room, he tried to leave.

Shaving off those extra minutes makes a big difference, she said. When someone has made the decision to get tested, generally, they want to know the result right away.

RELATED: A transgender man in search of hormone therapy, he turned to Planned Parenthood

The INSTI test requires a quick prick from a finger and a small amount of blood, which is then mixed with three solutions. Similar to a pregnancy test, one dot or two will appear on the test device to show the result. One dot means the result is negative. Two is positive.

For patients who test positive, Metro is able to connect them with clinical, behavioral and support services. For those who test negative, Metro can help them get a prescription for PrEP, short for pre-exposure prophylaxis, the daily drug that can prevent HIV.

Metro clinical members also use the rapid test at events in the community. From Pride events in downtown St. Petersburg to health fairs, recreation centers and other community gatherings, they offer tests from mobile clinic vans.

But stigma is still a major barrier in convincing people to get tested, Manuel said. It comes across the board, she said, from young and old and people of all races.

Manuel has heard the excuses.

People say, I dont do those kinds of things so they dont think they need to be tested. Or they use condoms, or theyve only had one partner, she said. Even in 2019 going into 2020, stigma in this community is still high.

__________

No-cost HIV tests available

In observance of World AIDS Day on Sunday, health departments are offing free HIV tests at these locations on Monday:

Read the original here:
The one-minute HIV test has come to Florida, and people are taking it - Tampa Bay Times

Telling your family and friends that you are transgender can be difficult - but what happens when you're in a serious relationship?

This was the situation facing married tattoo artist Eva Echo.

The 39-year-old, from Cradley Heath, had been married to her wife for around four years before realising why she had felt so different her whole life.

Reading stories about relationships ending when someone came out as a different gender highlighted her biggest fear.

But she knew that she couldn't hide it anymore.

Eva said: "Towards the end of 2016, I was dealing with a customer at work and this man decided to take pictures of me which I was quite shocked at because I wasn't presenting as female. I've always been quite androgynous.

"I still wore eye makeup and he obviously thought it was hilarious. He needed to take photos, send it around to a circle of friends.

"He denied it when I confronted to about it. I mean, he didn't realise there was a mirror behind him so I could actually see what was on his phone.

"At which point he then said his phone was playing up and that it took a photo and sent it to his friends. I just wasn't buying it. But it also kind of made me think what is it about me that people stare at?

"What is it that I'm seeing differently when I look in the mirror.

"I thought, okay, you know, this is the time I need to take time out, or just figure this out once and for all because leading up to this moment I'd been suffering with an eating disorder, depression, self-harm and even attempted suicide.

"I just knew I couldn't go on having these complete ups and downs, and the idea of being transgender surfaced a bit more around about that time. I started to kind of open myself up to the possibility that I could be transgender.

"I started blogging anonymously at first because I needed somewhere to externalise all the things going on in my head. I had no one to talk to about it really.

"I wanted to stop feeling like my head was going to explode.

"There's still elements of shame, embarrassment and letting people down and telling my partner was scarier because we are so close."

Eva tried hard to gain the confidence to tell her partner, Pippa Echo, about being transgender and even wrote an anonymous open letter to her on her blog in 2017.

It said: "When we first met, I knew you were the one for me. I trusted you entirely.

"The more I was around you, the more I could feel some kind of peace. That I didnt have to constantly battle the world on my own. At the same time, it made me realise I could let my guard down and be more of myself.

"I felt complete for the first time in my life. I cannot thank you enough for letting me feel like that. I guess thats what ultimately led me down this path of self-discovery.

"Just to clarify, Im not saying this is your fault. Not at all. If anything, youve just been you: the caring and genuine person that you are; the person I fell in love with and wanted to marry within a few weeks of knowing you.

"Remember the conversation we had at the flat one day, where you asked why I chose to wear or look the way I do? And I said I felt comfortable enough to do so around anyone for the first time in my life?

"Well, thats the light you provide in my life. Its my fault for then not being able to control this properly, allowing things that I thought I could ignore or lock away to gradually emerge."

When the night finally came to confront the personal crisis head on, she was filled with fear that her partner would leave her for going through this change.

Eva eventually found confidence after a few shots of vodka to calm the nerves.

"Looking on the internet, there's so many stories of partners that call it a day," she said.

"They all go into it in good faith but ultimately most of them just fell out.

"That really scared me because I didn't want to lose so much just because of me. When I went to tell her about it, I was a complete mess. I came home from work and I just kept psyching myself up about it.

"I knew I needed to say something. I just remember walking in and out of the kitchen, giving myself a shot of vodka to try and give me some confidence.

"It must have been about 9 or 10 o'clock by the time I got round to it because I was just stalling so much.

"I was a bit tipsy by the time I came out with it. I literally just said that I thought there was something wrong with me.

"Even when I was trying to explain it, I was still so scared to use the word transgender because it makes it so definite but when I finally came out she said she pretty much knew already.

"It was a huge weight off my shoulders. This great cloud over me for years, and all of a sudden, everything was a bit sunnier."

The couple recently celebrated their six year wedding anniversary and they say their relationship is as strong if not stronger than it was before.

Pippa told BirminghamLive that the day Eva came out to her she initially thought she was going to leave her.

When she finally revealed her identity, Pippa said it was like she 'was giving her her real self' proving to Eva that true love looks beyond gender.

Eva has since revealed her identity on her blog and continues posting to raise awareness of issues in the LGBT community.

Since coming out almost three years ago, Eva has been on the NHS waiting list for the gender identity clinic (GIC) at Exeter but has gone private in order to speed up the transition process and is currently on hormone therapy.

The male to female transition process is made more complicated by the irreversible effects of testosterone during male puberty that effects bone structure and deepens the voice.

Eva went privately to have her face reconstructed to be more feminine, as the procedure is not covered on the NHS.

She said: "I started hormone therapy last summer and since then I've also had facial surgery.

"That was to Botox injections to my jawline to contour the jawline - an alternative to physical surgery. I also had fat transferred from my stomach to my cheeks and also had the brow bone shaved and contoured as well. At the same time, they lowered my hairline slightly.

"It was very strange going to sleep with one face and waking up with an altered one, because of the swelling as well, it's so surreal. I took time off work to heal.

"It took some getting used to, having this is new person looking back at you in the mirror. But at the same time, it's a relief because you're another step closer to marrying the outside with the inside as well."

Eva plans to continue the final stages of her transition on the NHS but could have up to a year left on the waiting list, due to the NHS being at breaking point trying to cope with the huge surge in patients seeking gender identity services and as there are only 7 clinics in the UK.

Originally posted here:
'My wife's heartwarming reaction when I told her I was transgender' - Birmingham Live

The Fulton County Health Department has scheduled the following health clinics and services.

CANTON The Fulton County Health Department has scheduled the following health clinics and services. Please call the number listed with each service for an appointment or more information.

Maternal child health: Health screenings, WIC nutrition education and supplemental food coupons for women, infants and children. To make an appointment or for more information call 647-1134 (ext. 254). For Astoria clinic appointments call 329-2922.

Canton - Clinic - Monday, Dec. 2 - 8-4 - Appt needed

Canton - WIC Nutrition Education - Tuesday, Dec. 3 - 8-4 - Appt needed

Canton - Clinic/Immunizations - Wednesday, Dec. 4 - 8-4 - Appt needed

Astoria - Clinic, WIC Nutrition Educ. - Wednesday, Dec. 4 - 9-3 - Appt needed

Canton - Clinic - Thursday, Dec. 5 - 8-4 - Appt needed

Adult Health Immunizations: Various vaccines are available. There is a fee for immunization administration. Medicaid cards are accepted. To make an appointment or for more information call 647-1134 (ext. 254).

Canton - Immunizations - Wednesday, Dec. 4 - 8-4 Appt needed

Other times available by special arrangement at Canton, Cuba and Astoria.

Blood Lead Screening: Blood lead screenings are available for children ages one to six years. A fee is based on income. To make an appointment or for more information call 647-1134 (ext. 254). For Astoria appointments call 329-2922.

Canton - Clinic - Wednesday, Dec. 4 - 8-4 - Appt needed

Family Planning: Confidential family planning services are available by appointment at the Canton office for families and males of child-bearing age. Services provided include physical exams, pap smears, sexually transmitted disease testing, contraceptive methods, pregnancy testing, education and counseling. Services are available to individuals of all income levels. Fees are based on a sliding fee scale with services provided at no charge to many clients. Medicaid and many insurances are accepted. After hours appointments are available. To make an appointment or for more information call the 647-1134 (ext. 244). *Program funding includes a grant from the US DHHS Title X.

Pregnancy testing: Confidential urine pregnancy testing is available at the Canton and Astoria offices. This service is available to females of all income levels. A nominal fee is charged. No appointment is needed. A first morning urine specimen should be collected for optimal testing and brought to the health department. Services are provided on a walk-in basis on the following days each week:

Canton: Every Wednesday & Thursday, 8-3:30 (for more information call 647-1134 ext. 244)

Astoria: Every Wednesday, 9-2:30 (for more information call 329-2922)

Womens Health: A womens clinic for pap tests, clinical breast examinations and vaginal examinations is available by appointment. There is a nominal fee for this service. Medicaid cards are accepted. Financial assistance is available for a mammogram. Cardiovascular screenings may be available to age and income eligible women. To make an appointment or for more information call 647-1134 (ext. 244).

Mammograms: Age and income eligible women may receive mammograms at no charge. Speakers are available to provide information to clubs and organizations. For more information or to apply for financial assistance, call 647-1134 (ext. 254).

Mens Health: Prostate specific antigen (PSA) blood tests are available for men for a fee. To make an appointment or for more information call 647-1134 (ext. 224).

Sexually Transmitted Disease (STD) Clinic: Confidential STD and HIV testing services are available by appointment to males and females at the Canton office. Services include physical exams to identify STDs, a variety of STD testing, HIV testing, education, counseling, medications and condoms. There is a nominal fee for services. Services are available to individuals of all income levels. Medicaid cards are accepted. To make an appointment or for more information call 746-1134 (ext. 224).

HIV Testing and Counseling: Confidential HIV testing and counseling services are available by appointment through the sexually transmitted disease (STD) clinic at the Canton office. To make an appointment or for more information call 647-1134 (ext. 224).

Tuberculosis (TB) Testing: TB skin tests are available at no charge by appointment. To make an appointment or for more information call 647-1134 (ext. 254).

Blood Pressure Screenings: The Fulton County Health Department provides blood pressure screenings at no charge on a walk-in basis during the following times:

Cuba - Screening - Monday, Dec. 2 - 8-12 - Walk in

Astoria - Screening - Wednesday, Dec. 4 - 9-12 - Walk in

Health Watch Wellness Program: The Health Watch Program provides low cost lab services. Through this program adults can obtain venous blood draws for a variety of blood tests. Blood tests offered without a doctors order Comprehensive Metabolic Panel (CMP), Complete Blood Count (CBC), Lipid Panel, Prostate Specific Antigen (PSA) test, Hepatitis C test, and Thyroid Stimulating Hormone (TSH). A wide variety of blood tests are also available with a doctors order. There is a charge at the time of service. To make an appointment or for more information call 647-1134 (ext. 254).

Dental Services: The Dental Center offers a variety of basic dental services to children and adults. An appointment is needed. Medicaid and Kid Care cards are accepted. To make an appointment or for more information call 647-1134 (ext. 292).

Continued here:
Health Department announces services for the week of Dec 2 - Canton Daily Ledger

The worlds second most populous country has an unlikely problem. India, which the United Nations projects will surpass Chinas population as early as 2022, has interestingly witnessed a decline in fertility rate. As per the World Population Prospects 2017, the fertility rate of Indians reduced by over 50% from 4.97 during 1975-80 to 2.3 for 2015-20. A further reduction of the fertility rate to 2.1 is expected during 2015-30 and 1.78 by the end of the century. The major reason behind this is not a defect in our bodies, but simply the changing lifestyle of the current generation.

Increasing urbanisation has led to people living a lethargic lifestyle and indulging in unhealthy food habits, which causes ailments such as obesity and diabetes. According to a report, more than 40% of women attending infertility clinics are found to be obese and in men, obesity brings down the semen quality. Moreover, theres a sense of social stigma attached to infertility. Theres a need of regular health monitoring without the burden of spending hefty amounts on clinics, scans and lab results repeatedly. Bengaluru-based Inito was formed precisely to cater to these needs.

Inito, the brainchild of IIT alumni Varun AV (35) and Aayush Rai (30), has built a device which makes it easier for people to monitor their health at home such as tracking a woman's ovulation cycle and diagnosing fertility conditions through a smartphone. The device has been recognized to increase their chances of getting pregnant naturally by 89% by giving the fertile days specific to their body, Rai told ET.

The AI that understood womenUpon realising the change in disease patterns in India due to changes in food and lifestyle habits, the co-founding duo, former employees of Siemens Research, came up with the idea of a home health monitoring device which would analyze the trends of body parameters, diagnose conditions and predict best treatments.

Initos flagship product- Inito Fertility Monitor is a smartphone-connected device which performs real-time lab-grade fertility diagnostics test at home. It comprises of a monitor, a smartphone app- Inito and test stripe.

To gather input, the test strip has to be first dipped in urine, and is then attached to the monitor, which in turn is attached to the smartphone.

Thereafter, the monitor uses its flat-lens technology, which measures two hormones (Luteinizing Hormone and Estrogen) in urine. This helps the AI-based app track womens ovulation cycle, understand cycle variations and identify the high and peak fertility days. The app then suggests up to six fertile days for women to conceive.

The app also works when the cycles are not regular and in fact, records, changing hormone patterns and is, therefore, able to predict almost accurate cycle variations, diagnose fertility issues and provide personalised medical guidance to women. All the data recorded is stored on the app and the cloud.

The device has been medically tested and the results were found to be comparable to those acquired with clinic-grade instrumentation which cost 100 times more and are 10 times bigger, Rai said.

(Pic: Aayush Rai)When asked about what makes Inito unique from other home ovulation tests available in the market, Rai said, Other home ovulation tests measure only 1 hormone, and are confusing to read and interpret. They are also not specific to Indian women and their hormones. The standard protocol is women going to the lab to do a sequence of ultrasound scans called follicular scans to track ovulation. However, with women leading busy lifestyles, it becomes all the more difficult to take out time to go to the lab.

He added that some women also feel a lack of privacy visiting hospitals and clinics for the tests. These insecurities are removed by Inito, whose fertility monitor reminds women when to take the test based on their hormone level variations and can easily be done with comfort at their homes.

Citing an Ernst and Young report, Rai said that South Asian women have a poor ovarian reserve compared to Caucasian women. This means that South Asian women are likely to suffer from earliest onset of infertility and poorer outcomes of infertility treatment. Therefore, even western medicine has failed to provide accurate results for Indian women and Inito has been specifically designed for Indian women and their hormonal patterns.

However, despite having over 95% of accurate results, Rai finds gaining customers trust as Initos biggest challenge. To build customer trust, we take a lot of effort in conducting third party studies, work with doctors etc. to prove the effectiveness of our technology. The biggest challenge for us is that we deal with people's bodies and health. The cost of missing out on even one variable is very high in our industry. In this case, we can't rely on guesswork, everything needs to be clinically validated, he said.

Brisk businessFrom launching the product commercially in 2017-end to have it shipped to more than 350 cities, the four-year-old startup has witnessed a soaring business. According to Rai, the firm grew 10x in the last financial year with 50% of its sales coming from non-Tier 1 towns and cities.

After doing over 1.5 lakh tests on our device, we've managed to collect the largest cloud-based dataset of fertility hormones in the world, he quipped.

Sumon Sadhu, an angel investor who was also an early investor in Inito, believes the startups innovation is a much-needed product for India. Inito has built a device which makes it easy for women to track their fertile days easily sitting at home. Similar ideas have been proposed and researched many times in India, but could never be implemented. With a mix of hardware and software, Initos innovation is supporting women by giving them an easy way to monitor their health and is addressing the declining fertility rate in the country. The firm has the caliber to reach international markets, especially, other parts of Asia as it is more demographically suited for the product.

Inito recently got backed by the American seed accelerator Y Combinator in its Winter 18 cohort. It has so far raised $2 million in funding. The firm is now planning to add 8 more hormone tests to the device, enabling them to not just track ovulation but diagnose conditions like anovulatory cycles, PCOS etc. right on the phone.

Go here to see the original:
Indias fertility rate is crumbling. Y-Combinator-backed Inito might have a solution - Economic Times

Most areas in Europe and North America observe daylight saving time. Daylight saving time is often welcomed in spring, as it helps to extend daylight hours well into the evening. But few may welcome turning the clocks back in fall. Coupled with the natural shortening of daylight hours as winter approaches, the end of DST facilitates a sudden shift in the ratio of sunlight to darkness. As autumn transforms into winter, the number of available hours of daylight slowly dwindles. Some areas of Alaska and Canada see only about three or four hours of daylight per day in the winter months. Conversely, those who live in Key West, Florida, the southernmost point of the contiguous United States, may enjoy around 10 hours of daylight. Fewer daylight hours can adversely affect mood and productivity. Seasonal affective disorder, often referred to as SAD or the winter blues, has been recognized and included in the Diagnostic and Statistical Manual for Mental Disorders. Clinicians say that, as days become short and dark, a predictable set of symptoms of SAD may emerge. Individuals with SAD may experience a host of symptoms, including difficulty waking in the morning; diminished energy levels; a tendency to eat more; an inability to concentrate; and depression. The Cleveland Clinic advises that approximately half a million people in the United States suffer from winter SAD, while 10 to 20 percent may suffer from more mild forms of winter blues. The Canadian Mental Health Association states that between 2 and 3 percent of Canadians will experience SAD in their lifetime. Another 15 percent will experience a mild form of SAD that leaves them only slightly depressed. Similar symptoms can occur for those people who live in cloudy regions or high latitudes. Evidence strongly suggests SAD is linked to sunlight. This lack of sunlight may trigger production of melatonin in some individuals. Melatonin is a hormone made in the pineal gland that regulates sleep onset and sleeping patterns. A combination of self-care strategies as well as professional medical treatment may help those with winter blues or more severe SAD. The U.S. Department of Health and Human Services says that these strategies can help people coping with SAD. Get out of the house into sunlight or brightly lit spaces early in the day when the sun is out. Increase time spent outdoors. Take a break midday and enjoy lunch outside or take a walk, even if its chilly. Try to spend time with other people and chat with friends and relatives. Avoid overloading on carbohydrates like cookies and candies. Talk to a doctor about using light therapy, which is the first line of SAD treatment, according to the University of Maryland School of Medicine. Consider cognitive behavioral therapy or talk therapy with a licensed mental health provider. He or she also can make recommendations about the use of medication to alleviate symptoms if other treatments do not provide results. There are many ways to mitigate the symptoms of winter blues.

View original post here:
Beating the winter blues - thewestsidejournal.com

Communities have always played a huge part in the response to HIV. People coming together, organising themselves and demanding their right to health. For people most vulnerable to HIV, it is no exaggeration to say that communities often make the difference between life and death.

For young women and girls and for marginalised and vulnerable groups of people such as gay men, straight men who have sex with men, transgender people, sex workers, people who use drugs, prisoners and migrants, the pathway to health is not always as clear-cut as it should be. Stigma and discrimination, repressive laws, ignorance and even hate, can all prevent vulnerable people from accessing life-saving prevention, treatment and care.

This is where communities often step in. Communities of people living with HIV, of marginalised and vulnerable groups, of women and of young people lead and sustain the delivery of peer-to-peer HIV services, defend human rights and advocate for access to essential services. They fight every day to keep people at the centre of decision-making and implementation and help to make sure that no one is left behind.

Women and girls are the backbone of care support in their families and communities, providing unpaid and often undervalued work in caring for children, the sick, the elderly and the disabled and underpinning fragile social support systems. The involvement and leadership of communities of women is vital in the response to HIV and we must support them and utilise their potential.

Community-based services often support fragile public health systems by filling critical gaps; they are led by or connect strongly with women and other marginalised populations; they provide services that complement clinic-based care and they extend the reach of health care to groups that would otherwise fall through the gaps.

For example, Rainbow Sky Association of Thailand (RSAT) is one of the five community-based organisations in Thailand that provide free PrEP services through lay providers under the successful Princess PrEP Project. With four clinics and 10 drop-in centres across the country, RSAT is a one-stop service with flexible service hours. In addition to PrEP, RSAT provides needs-based and client-centred services such as hormone level check-ups for transgender people, STI screening, legal consultation and harm reduction. The Thai Red Cross Aids Research Centre with PEPFAR support through the USAID LINKAGES Thailand project implements continuous capacity building to ensure that community-health workers can provide HIV services in accordance with national standards.

Sisters is another community-based organisation whose reputation is spreading across borders as a model for programmes that provide HIV services where they are most needed. The organisation that carries out outreach work among Pattaya's transgender community. Sisters runs a drop-in centre in Pattaya where they provide medical services, counselling and skills development for transgenders. Working in partnership with transgenders to identify their needs, Sisters also advocate for policies and programmes that improve their health, safety and engagement in the Aids response.

At a time, when reduced funding is putting the sustainability of HIV services in jeopardy, community activism remains critical. Indeed, a greater mobilisation of communities is urgently required and barriers that prevent them delivering services and seeking funds must be dismantled. Communities must have the space and power to voice their demands and write their own solutions. In 2016 world leaders signed the United Nations Political Declaration on Ending Aids, which recognised the essential role that communities play in advocacy, participation in the coordination of Aids responses and service delivery. Moreover, they recognised that community responses to HIV must be scaled up and committed to at least 30% of services being community-led by 2030.

Most countries are nowhere near reaching that commitment and where investment in communities is most lacking, there is often weaker progress against HIV and other health challenges.

Communities stand ready to play their part in building healthier and more resilient societies, but they need our support. On World Aids Day tomorrow, let's celebrate communities, recognise the essential role they play in the response to HIV and commit to meeting the promises made to them.

See the rest here:
Communities are the difference in HIV response - Bangkok Post

A study published in the Nutrition Journal examined the relationship between vitamin D and atrial fibrillation. Their report includes thirteen studies from 2011 to 2018 with 6,519 cases of atrial fibrillation and 74,885 participants.

One study showed that vitamin D deficiency promotes atrial fibrillation by activating the renin-angiotensin-aldosterone (RAAS) system. It is responsible for the structural and electrical wiring of the atrium. Mainly it is a hormone system responsible for controlling blood pressure and electrolyte balance. If its too active then you will have high blood pressure. Vitamin D negatively affects the RAAS. Also, vitamin D has antioxidant properties that reduce oxygen free radicals in the atria. These oxygen free radicals are responsible for inflammation and arrhythmia in the heart. Serum vitamin D levels were lower in those where atrial fibrillation occurred than in those where it did not occur. Serum vitamin D per 10ng/ml increase was associated with decreased postoperative atrial fibrillation. Vitamin D deficiency led to an increased risk of atrial fibrillation by 23%. Inadequate levels of vitamin D increased the risk of atrial fibrillation by 14%. This shows a correlation between vitamin D and atrial fibrillation.

Sunlight exposure is the primary way humans produce vitamin D. However in the north from November to March, there is not enough UV-B rays for vitamin D production. Also called the sunshine vitamin, vitamin D can be found in fatty fish like salmon and mackerel. Almond milk, other meat such as pork, egg yolk, and fortified orange juice also contains vitamin D. The amount of vitamin D required on a daily basis is a recommendation of 600 IU. Vitamin D is a fat-soluble steroid that increases the absorption of calcium, magnesium, and phosphorus. In these studies, lower vitamin D levels have been found in people with acute myocardial infarction, stroke, heart failure, and cardiovascular disease.

Vitamin D is essential for preventing cardiovascular disease. It also helps the immune system stay healthy and protects against infections. According to this study, there seems to be a correlation between vitamin D and atrial fibrillation. While more research is required, vitamin D intake should be taken seriously. Vitamin D deficiency is becoming a problem in some communities and could lead to a burden on the healthcare system.

Written by Katrina F. Zafer, BSc

References

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Is there a correlation between a deficiency in vitamin D and atrial fibrillation? - Medical News Bulletin

Although one in nine men will receive a prostate cancer diagnosis in his lifetime, cutting-edge research has allowed more men to live longer or even be cured.

One such program that sheds light on this cause is City of Hopes NoShaver November. The month-long fundraising and awareness campaign urges participants to forego shaving to start a conversation, encourage testing and raise critical funds to continue leading-edge prostate cancer research and promising new therapies conducted at City of Hope.

CURE recently spoke with Dr.Tanya Dorff, a medical oncologist at City of Hope who specializes in prostate cancer, about the campaign, her current work and where she sees the future of prostate cancer treatment shifting in the coming years.

CURE: What led you to City of Hope? What do you do there?Dorff: City of Hope was attractive to me because I am a clinical and translational researcher. The reason I came here was to work with scientists who share what we are seeing in the clinic and who incorporate the latest insights from the scientific discoveries in our laboratories into patient care. There is a real sense of mission and urgency that binds scientists to clinicians at City of Hope in a way that is unique and gratifyingly productive.First and foremost, I take care of patients who remain my central inspiration and raison detre, but I spend part of my time writing and running clinical trials that have real potential to impact how we treat patients in the future how we can do even better in the future than we do today. I lead the genitourinary cancer program, which includes fostering collaborations between the incredible physicians from urology, radiation oncology, radiology and pathology to work together both clinically and in research projects.You are Grammy-winning songwriter and vocal producer Kuk Harrells physician. Can you tell me what it was like to treat him?Kuk is such an incredible gentleman; it has been a pleasure to be part of his care team. His attitude toward treatment was one of diligence, and he has approached his illness as an opportunity for personal growth and for giving back by promoting prostate cancer awareness through his story. It has been inspiring to see him come through what was a lengthy and involved treatment with so much positive energy.How has the field of prostate cancer treatment evolved in recent years?More and more men with prostate cancer can be cured, and the men who cannot be cured with todays treatments are clearly living longer and better. This is thanks to new drug approvals in advanced, resistant prostate cancer but even more so to the application of more intensive therapy earlier in the course of the disease. This has been the biggest paradigm shift in prostate cancer over the last five years: up-front intensification in metastatic hormone sensitive prostate cancer.The next big shift in prostate cancer treatment is just now upon us molecular selection of therapies to individualize prostate cancer treatment. The most imminent example is olaparib (Lynparza), a PARP inhibitor, which worked better than standard treatment in patients with castration-resistant prostate cancer whose tumors harbor mutations in DNA repair genes. But the ingenious theranostic approach will be close behind where imaging (scans) show us whether a cancer is expressing a certain target (i.e. PSMA) and if so, a radioactive particle linked to that target is applied (i.e. Lu-177 PMSA).

What are you most hopeful for in cancer treatment in the future?I believe immunotherapy will be the way to durable remission or a cure. Here at City of Hope, we are working hard to improve the effectiveness of immunotherapy for patients with metastatic prostate cancer, studying intensive treatments such as CAR-T and bispecific T-cell engaging antibodies, among other approaches. Our scientists are looking at our patients in real time to learn why treatments work or dont work, and how to better engage the immune system. I am very hopeful that these biologic insights will eventually translate into therapeutic success such as we have seen in leukemia with CAR-T and melanoma with immune checkpoint inhibitors.What advice would you offer someone who has just received a cancer diagnosis of their own?One: Play an active role. Ask questions, and if something doesnt sound right or make sense, ask again. It is so important that patients buy into their treatment, understand and feel confident about the treatment plan. No one is perfect, not even the best doctor, and working together as a team will lead to the best success.

Two: Be a squeaky wheel. Patients who communicate symptoms in real time fare better because problems are addressed before they become more serious.

Three: Stay active. Exercise is one of the things that has been shown over and over again to help cancer survivors and cancer patients in various stages. Obviously, a conversation should occur with the treatment physicians to ensure that there are no restrictions but patients who are more active will come through treatment in better shape.

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Exploring the Future of Prostate Cancer with City of Hope - Curetoday.com

The Food and Drug Administrations approval of Calquence (acalabrutinib) for adult patients with chronic lymphocytic leukemia or small lymphocytic lymphoma offers an exciting treatment option, according to Dr. John C. Byrd.

BY Kristie L. Kahl

(The FDAs approval) places another active drug in the combinations of therapy in the in the repertoire in development for physicians, Byrd D. Warren Brown Chair of Leukemia Research; Distinguished University Professor of Medicine Medicinal Chemistry, and Veterinary Biosciences; and senior advisor for cancer experimental therapeutics at The Ohio State University Comprehensive Cancer Center said in an interview with CURE.

The approval, which was granted under the FDAs Real-Time Oncology Review and newly established Project Orbis programs, was based on positive results from the interim analyses of two phase 3 clinical trials: the ELEVATE-TN trial in patients with previously untreated CLL and the ASCEND trial in patients with relapsed or refractory CLL.

In the randomized, multicenter, open-label, phase 3 ELEVATE-TN trial, the researchers evaluated the safety and efficacy of Calquence alone or in combination with Gazyva (obinutuzumab) compared with chlorambucil plus Gazyva in 535 treatment-nave patients with CLL.

Median progression-free survival (time from treatment to disease progression) was 22.6 months in the control arm, but was not yet reached in both of the Calquence treatment arms. The objective response rate (complete and partial responses to treatment) was 79% in the control arm, compared with 94% in the Calquence combination arm and 86% in the monotherapy arm. Median overall survival was not yet reached in any of the three arms at a median follow-up of 28.3 months.

In the international, multicenter, open-label, phase 3 ASCEND trial, 310 previously treated patients with CLL were randomized to receive either single-agent Calquence or rituximab (Rituxan) plus idelalisib (Zydelig) or bendamustine.

At a median follow-up of 16.1 months, the median progression-free survival with Calquene was not reached, compared with 16.5 months in the control arms. At 12 months, 88% of patients on Calquence showed no disease progression compared with 68% in the control arm.

Common side effects included anemia, neutropenia, upper respiratory tract infection, thrombocytopenia, headache, diarrhea and musculoskeletal pain.

Of note, tolerability of treatments for CLL/SLL have been an issue with the current treatment landscape. Therefore, the favorable tolerability and safety profile associated with Calquence is important.

Having less side effects for a chronic therapy is very important when you get into adverse events such as hypertension where you know there are not only effects that are irritating but also affect our cardiovascular system and the risk of other bad things happening, said Byrd.

With this, it is an exciting time with such advancements for the treatment of this disease. Were in a great place in CLL now that we have several targeted therapies that are approved. All of these options are good options for our patients. This just puts another nail in the coffin for treatment with chemotherapy, Byrd said, noting that he does not recommend patients consider chemotherapy as a treatment option.

The era of getting chemotherapy for this disease is virtually done, Byrd said. Essentially, I would say for almost all patients, chemotherapy should not be a consideration. There's only one very small subset, the IGBH-mutated patientsbut for the majority of patients, those who have high-risk disease, doing chemotherapy plus immunotherapy is not a good option. Targeted therapies offer an alternative approach that is better than chemotherapy.

To conclude, he added that new studies are even evaluating the approach of time-limited therapy, where patients would receive therapy for a set period of time, and if they experience remission, stop treatment, versus receiving continuous BTK inhibitor therapy.

Read CUREs original coverage of the FDAs approval of Calquence for patients with CLL/SLL.

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What Patients With CLL/SLL Should Know About the FDA - Curetoday.com

Totalprestige spoke to Dr. Amit Kumar, President and CEO of Anixa Biosciences and Dr Vincent Tuohy of the Cleveland Clinic about their partnership in developing a breast cancer vaccine that could potentially eliminate breast cancer as a disease. That is a bold statement, but animal studies have demonstrated spectacular results and the United States government has agreed to fund the beginning of human studies. The technology was developed at the Cleveland Clinic by Dr. Tuohy and his research team, based on the discoveries they made regarding how breast cancer forms. Dr. Tuohy and the Cleveland Clinic have partnered with Dr. Amit Kumar and his Silicon Valley biotech company, Anixa Biosciences (NASDAQ:ANIX), to begin testing in humans and should the data mirror the data in animals, take the technology to commercialization.

Dr. Kumar, can you give us a little background about Anixa and how you came to the company? What excited you about Anixa?

Anixa is a relatively new biotechnology company. The predecessor company was a failed company in the electronics and IP licensing industry. When I got involved at the board level, the company had been delisted and was on the verge of going out of business. Over a period of time, we financed the company, and brought it back onto NASDAQ. In July 2017, I was Chairman of the Board, and at that time, I took on the additional roles of President and CEO, and we re-positioned the company as a biotech working on many exciting projects, of which the breast cancer vaccine is one. Our stock is traded on NASDAQ, the stock symbol is ANIX, and the website is http://www.anixa.com

Anixa is also very different from other biotech companies. We are executing a business model that has us working with the best cancer centers in the world to help develop and validate our products. This strategy enables us work to on multiple, diverse projects that each have potential multi-billion dollars of value as well as tremendous value for cancer patients. In that light, we are working on a liquid biopsy technology for early cancer detection, a therapy for ovarian cancer as well as the vaccine for breast cancer.

Your partnership with the Cleveland Clinic envisions a new approach to addressing breast cancer thanks to Dr Vince Tuohys research. Can you tell us how you and the Cleveland Clinic began working together?

I met Tony Giordano, who is a business development executive at the Cleveland Clinic, in early 2019. He introduced me to the breast cancer vaccine technology that Vince Tuohy had developed, and I was very intrigued. After meeting Vince as well as his R&D and clinical team at the Cleveland Clinic, and reviewing the animal data that they had completed, I was sold. I felt that Vinces approach was a pathway to possibly eliminating some of the most aggressive forms of breast cancer and possibly all breast cancers. Vaccination against infectious diseases like smallpox, polio, and many others have had a profound effect on human health. In fact, vaccines have enabled mankind to completely eliminate some of these diseases. Before vaccines, some of these diseases were scourges on humanity. A few years ago, the first cancer vaccine was approved. This vaccine targets the cause of cervical cancer, as well as some other cancers. With this vaccine, we feel that within a generation, we can eliminate cervical cancer in the US, and if we can get this vaccine to the developing world, we can eliminate cervical cancer in the same way we have infectious diseases like small pox.

When I saw what Vince had done at the Cleveland Clinic, I realized his technology could potentially do the same with breast cancer. Breast cancer is the most common cancer in women, and a few men contract breast cancer as well. In the US alone, we spend close to $50 billion annually diagnosing, treating and performing research on breast cancer. If you count the supportive care, missed work, and other non-direct costs, the economic cost is exponentially higher. Worldwide, the number is even bigger. I am just talking about the economic value. We should not forget about the deaths, the debilitating surgeries, and the impact on the family enduring a battle with cancer. In addition, many women are getting prophylactic (preventative) mastectomies even though they are healthy, just because they do not want to get cancer. One high-profile case was that of movie star Angelina Jolie who had her breasts and ovaries removed so she would not contract cancer in those organs, because her heredity put her at high-risk.

Vinces technology has the potential to eliminate breast cancer. Imagine if this works in humans as well as it works in the animal studies. In that case, women would simply get an injection and perhaps a booster shot, and may never have to worry about disfiguring and painful preventative surgery or contracting breast cancer at all. That would change the paradigm of cancer care and have an immeasurable impact on patients as well as our healthcare system.

Anixa Biosciences has been working on the fight against cancer for some time. The companys partnership with the Cleveland Clinic is a logical step in building a better future that is able to combat cancers. The two groups will now lead the fight together and could be the ones to eliminate breast cancer completely.

Anixa Biosciences has been in a fight against cancer for some time now. How will partnering with the Cleveland Clinic improve your work at Anixa?

Our company partners with key scientists in academia to work on projects that we think will have great impact on cancer. We have two other programs in our portfolio. One project is a liquid biopsy to try to identify cancer at the earliest stages. We know that treating early stage cancers are much more successful than later stage cancers. A third project is a specialized technique to treat ovarian cancer, a cancer that has not had any real improved therapies for decades. But I feel the vaccine technology that we are developing with the Cleveland Clinic could have the greatest impact. Cleveland Clinic is regularly ranked as the best hospital in the US and the entire world. It is an honor for a young, small company like ours to be working with an institution of such high repute.

Obviously, it is too early to tell just what the partnership will be able to accomplish. That said, how do you see this working relationship changing medicine and the treatment of cancer?

The Cleveland Clinic team has been working on this vaccine for nearly a decade. So, there is a lot of research data. One of the most compelling pieces of data was the animal study testing the vaccination approach. Vince took a mouse that is genetically engineered to contract breast cancer. He immunized a group of these mice with his vaccine and had an equal number of the same type of mice injected with everything but the vaccine. Of the mice that got the vaccine, 100% of them did not get cancer. Of the control mice, 80% of them presented with breast cancer and died. It is rare to have such night and day experimental result. If this vaccine works in humans in the same way, we would expect all women who got vaccinated to never get breast cancer. Our plan is to work with Vince and the Cleveland Clinic to help take this vaccine into human testing. The animal data is very compelling, but we have to prove it works as well in humans and that requires human trials under the guidance of the US Food and Drug Administration. We hope to begin those trials in the coming year.

What can Anixa Biosciences offer Dr Tuohy in his work and development of the vaccine to fight breast cancer?

We will work with the team to begin and progress the clinical trial work. There are a number of steps, some of which are relatively quick and some of which will be long and expensive. We hope to work hand in hand with the Cleveland Clinic to progress the technology and to bring additional corporate partners to the table as well, when the trials get larger and once we near commercialization.

Over a quarter of a million women in the US will be diagnosed with invasive breast cancer in 2019. The number is staggering, but if the Breast Cancer Vaccine created by Anixa Biosciences and the Cleveland Clinic is successful, then that number could drop to an incredibly low figure. That figure could be zero.

In 2019, it was estimated over 268,000 women in the US would be diagnosed with invasive breast cancer. What will these numbers look like in the future if the revolutionary approach created by Dr Vince Tuohy is successful?

If in humans the performance is similar to what it was in animals, none of these 268,000 women will get breast cancer and no woman should die of breast cancer. Can you imagine a world where women dont have to worry about the most common form of cancer in women? What an amazing world that would be.

If successful in treating breast cancer, is there a chance the vaccination created by Dr Tuohy can be used to treat other forms of cancer?

That is a very good question. The approach that Vince is using to develop the breast cancer vaccine, can be used for other cancer vaccines as well. In fact, Vince has also developed an approach to vaccinate against ovarian cancer, but that program is a year or two away from human testing. As we go forward, we hope to work with Vince on other cancer vaccines.

In 2018, it was claimed over 608,000 people in the US died of cancer. With new research being completed, do you see these numbers dropping in the next 10 years, staying the same, or increasing due to lifestyle choice?

I believe those numbers will get smaller. There are a number of factors that will drive those numbers lower. I am a member of the Board of Directors of the American Cancer Society, which is the larger cancer fighting charity in the world. We monitor carefully the cancer rates, mortality and other factors. Statistics show that one in two men will get cancer in their lifetime and one in three women will as well. We feel that the number of deaths will decline due to lifestyle changes (reduction in smoking, healthier lifestyles, etc.), early detection, and most importantly prevention. In addition, our understanding of how the immune system battles cancer is advancing quickly. Those scientific advancements will enable better ways to treat and prevent cancer, like Vince Tuohys vaccine technology.

We previously spoke in 2018 about Anixa Biosciences (formerly ITUS Corporation) and the early cancer detection technology it was working on. Can you tell us about any new developments Anixa Biosciences has made since then?

Yes, we will be launching later this year, our first product for detection of prostate cancer. We are rapidly completing the steps necessary to launch this test and we hope to have an impact on the way prostate cancer is diagnosed in this country.

You believe in being more proactive in the fight against cancer. How can modern medicine be more proactive in the search and treatment of cancer in patients?

If one studies the advances we have made in cancer care over the last century, there are some key points that emerged. The biggest impact on mortality has come from early detection and elimination of high-risk behavior like smoking. While we have made great advances in therapies, the impact there has been modest. That is why I am a firm believer in early detection and prevention. Prevention can be achieved in a number of ways, including lifestyle changes but also vaccination once proper vaccines can be developed.

Dr Tuohys and the Cleveland Clinics breakthrough vaccine has been years in the making. The group has been hard at work for nearly two decades from the initial plan to this stage. There has been a lot of work, funding, and trials that have gone into the vaccine. Now, he is ready to take it to the next level alongside Anixa Biosciences in hopes that someday soon women around the world will be given the vaccine to prevent breast cancer.

Dr. Tuohy, first off, can you tell us about the Breast Cancer Vaccine and how it targets cancer cells in women?

We modeled the breast cancer vaccine on the childhood vaccine program that protects against infectious diseases by providing pre-emptive immunity against attenuated pathogens before children engage the disease-causing variant. This prophylactic model is largely responsible for the dramatic increase in human life expectancy that occurred during the 20th century. Our challenge was to develop an adult vaccine program that would provide pre-emptive immunity against adult onset diseases like breast cancer. However, the immunity we needed to prevent breast cancer is very different from the more conventional antibody-mediated immunity that protects against infectious diseases. We had to create a cell-mediated immunity that recognizes the emerging breast tumors and prevents them from growing into mature destructive cancers. Also, we had to do this without inducing collateral damage against any normal tissues and without being able to target a pathogen because breast cancer and most other cancers are not associated with any definitive disease-causing pathogen. This was quite a challenge.

We identified a protein called -lactalbumin that is produced exclusively in the normal breast tissues only during lactation and is not expressed at any other time in any other normal tissues. However, when breast cancer develops, this protein is once again produced. When we induced a powerful cell-mediated immunity to this protein in mice, it protected them from developing breast tumors and also inhibited the growth of established tumors and did so without inducing any detectable damage to any normal tissues. We subsequently found that -lactalbumin is particularly expressed in triple negative breast cancers (TNBC), the most aggressive and lethal form of breast cancer and the most common form of this disease occurring in women at high genetic risk. Therefore, we believe the breast cancer immunity that we created can be effective as a treatment for established growing TNBC, but its greatest effectiveness occurs when it is used prophylactically to prevent tumors from growing in the first place.

How long has it taken from creating the vaccine to reach this point in your research?

Actually, I conceived this plan in 2002, and immediately started assembling the reagents and mice needed to test our retired protein hypothesis whereby normal self-proteins that are expressed in adult-onset cancers but are retired from expression in normal cells due to the natural aging process can serve as viable vaccine targets for inducing safe and effective cancer prophylaxis. This took several years to test and we published the results in Nature Medicine in 2010. It took a very long time to get the grant funding to move this discovery into clinical trials but we managed to do so in 2017 and are preparing to test our vaccine in phase I clinical trials very soon.

How significant is your partnership with Anixa Biosciences in the development of the Breast Cancer Vaccine?

I cannot say enough about the importance of our partnership with Anixa Biosciences. I have been spearheading the movement of our breast cancer vaccine from discovery and development, through the FDA regulatory process, and into clinical testing. This effort has been very difficult and often very frustrating. I am lucky to have a very talented and dedicated team at the Cleveland Clinic to facilitate this effort, but now I have a very supportive CEO in Dr. Amit Kumar who recognizes the feasibility of our vaccine in creating a paradigm change in controlling breast cancer and ovarian cancer. I think the support from Anixa and Dr Kumar guarantees the completion of our clinical trials and has already been productive with submission of a joint application for funding. I am delighted to continue working with Anixa and Dr. Kumar and look forward for some time to come to a successful and productive relationship.

Although things are moving forward quickly for the Breast Cancer Vaccine, Dr Tuohy stresses that things take time and it could be a while until the vaccine is made available to women. Due to the research, testing, trials, and reviews that go into the vaccine, commercialization may be years away.

When will the Breast Cancer Vaccine go into clinical trials with real patients?

We are currently assembling our application to the FDA and plan to submit our application by the end of 2019. We hope to have permission from the FDA to vaccinate human subjects soon thereafter. We anticipate starting our recruitment of test subjects for determining the safety and dosage of our vaccine in a phase I clinical trial by mid 2020.

If the vaccine is found to be effective in the fight against breast cancer, how long until it can go into production and be used in everyday medicine?

This question is always very difficult to answer because it requires substantial speculation on my part in anticipating whether the FDA will allow us to assess early efficacy of our vaccine using molecular indicators rather than waiting for complete overall survival data. The latter data could take ten years or more to collect and the FDA will rightfully be very cautious about safety before allowing our vaccine to have widespread use. In any event, no matter how long it may take, we must not hesitate to keep moving forward with our vision of a world without breast cancer.

Dr. Kumar has previously alluded to the Breast Cancer Vaccine being used in a similar way to children being vaccinated against smallpox and other preventable diseases. How significant would this medicine be to the worlds population?

We are always mindful of the fact that smallpox was once seen as an incurable disease that ravaged young people. However, the smallpox vaccine eradicated the disease. Now, it is hoped that the breast cancer vaccine will offer a pre-emptive strike against the most lethal form of breast cancer and prevent women from ever having to face it.

Current estimates indicate that by 2020, Medicare reimbursement costs for breast cancer will likely exceed $20bn annually. Considering that the median age of diagnosis of breast cancer is 62 years,these costs represent less than half of the total annual costs. Thus, in 2020 and every year thereafter, the costs to Americans for breast cancer will exceed $40bn annually. These built-in costs of breast cancer certainly dwarf whatever expenses may be needed to finance clinical trials for primary immunoprevention of this disease.

Successful induction of pre-emptive immunity against breast cancer would clearly have a dramatic impact on reducing the overall tumor burden in the USA and thereby reduce our annual healthcare costs. In the USA, there are over 268,000 new cases of breast cancer diagnosed each year, and worldwide there are close to 2 million new cases anticipated to be diagnosed yearly. I would think that the cost of screening, diagnosis, and treatment of breast cancer worldwide may conservatively cost at least $100bn a year. Thus, I think a preventive vaccine would have an enormous impact on global healthcare costs. I never really thought about the global impact of my work and am quite staggered by this potential. I cannot think of anything more impactful that I could do other than creating and testing vaccines to prevent adult-onset cancers and finally addressing these great unmet needs in our healthcare. I couldnt be more excited about the possibilities of such a paradigm-changing strategy for controlling so many lethal diseases that impact so many lives worldwide.

The Breast Cancer Vaccine would be used to vaccinate women over 40-years old at risk of cancer. Is there a chance it could be used on younger women as a preventative measure?

We have certainly made arguments in the past about how our vaccine that targets a lactation protein can be administered to women over 40 years of age because 95% of all breast cancers occur in women over 40 and only 3% of children are born to women over 40. It seemed to us in the beginning that most 40-year-old women have ended their childbearing years and have entered their breast cancer susceptibility years and could get vaccinated against -lactalbumin without adversely affecting lactation.

However, we now realize that women with the greatest need for a preventive vaccine are those at high-risk due to carrying mutations in their BRCA1 or BRCA2 genes. About 70% of women with these mutations develop breast cancer in their lifetime, and the most common form of breast cancer that they get is TNBC. Thus, ultimately, we would like to make our vaccine available to women that have completed their childbearing years. However, for our initial clinical trials, we will focus on women at high genetic risk who have the greatest need for a preventive vaccine since their only alternative to lower their breast cancer risk is bilateral mastectomy and subsequent reconstructive plastic surgery. Personally, I think a preventive vaccine is a much less traumatic and a much more civilized alternative to such traumatic surgical intervention.

If successful in the next stage of trials, would you move onto developing a vaccine for other types of cancers such as testicular or ovarian cancer?

We did develop a vaccine for testicular stromal cell cancer a few years ago. It was very effective in our preclinical studies in mice. However, the incidence of this disease in humans is very low making it extremely difficult to recruit sufficient patients for clinical testing and extremely difficult to secure the funding for such a rare though very lethal form of testicular cancer. We are much more focused now on our ovarian cancer vaccine which is designed to prevent ovarian cancer, the most lethal of all female-specific cancers. To me, ovarian cancer is a disease that screams PREVENT ME!! because it is typically diagnosed late at advanced stages, resistance to treatment is common, and 52% of all women die from this disease within five years of their diagnosis. We have already applied for funding to complete the preclinical studies for our ovarian cancer vaccine and hope to start clinical trials within the next year or two. What strikes me today is that we have no adult vaccination program to prevent the cancers we confront with age. Such a program is long overdue because it is simply unacceptable that in the United States, one in eight women will develop breast cancer, one in six men will develop prostate cancer, and ovarian cancer kills most of the women soon after their diagnosis. The 21st century must bring us safe and effective pre-emptive immunity against these common and lethal adult onset cancers and extend human life expectancy in the same way that childhood vaccinations did in the 20th century. This to me is the real moonshot program. It is my dream that when when my grandchildren reach middle age, they get their breast, ovarian, and prostate cancer vaccines and are thereby protected from these diseases in the same way they were protected from so many infectious diseases by the childhood vaccination program. Indeed, the job of our immune system is to keep us healthy, but to do this, it needs instructions, and vaccines are simply instructions for our immune system, so it knows exactly what to do to protect us from disease. I think we have only just begun to realize how much disease protection our immune system can provide. It is an exciting time for testing the limits of what our immune system can do to control so many cancers.

Dr. Tuohy, the Cleveland clinic previously received $6.2 million in grant money from the US Department of Defense. What was the DoDs role in the development of the vaccine and motivation behind granting the funds?

At first, it may seem surprising that the Department of Defense would be interested in supporting efforts to prevent breast cancer. However, it is a little-known fact that military families have a higher incidence of breast cancer than the rest of the American population. We dont know why this is the case, but it is nevertheless a good reason for the DoD to finance our proposal and provide the funding needed to test our breast cancer vaccine in clinical trials.

How will treating patients before they develop breast cancer rather than after they develop it change medicine?

I think it is important to change the language here. We are not treating patients before they develop disease because treatment implies that there is a disease in place to begin with. Administration of a preventive vaccine for breast cancer is the opposite of a treatment because prevention implies that the disease never occurs and precludes any need for treatment.

Our breast cancer vaccine is designed to prevent the need for treatment. Our approach represents a paradigm change in the way to control breast cancer, ovarian cancer, and hopefully other adult-onset cancers. Instead of waiting for these cancers to occur and going on offense to beat the daylights out of the cancer (and the patient) with surgery, chemotherapy, radiation therapy, hormone therapy, and immunotherapy, we are going on defense before the cancer appears so we can reduce the overall tumor burden and the need for treatment.

Such a paradigm change brings with it a wonderful opportunity to dramatically alter the natural history of these adult onset cancers. I am delighted to have this opportunity and eagerly look forward to determine whether we can eliminate several adult-onset cancers in our lifetimes. I cannot begin to tell you how excited I am about this opportunity and how excited our entire team is in being involved in this magnificent journey with Dr. Kumar and Anixa Biosciences.

So, what would the world be like without breast cancer? It is a world that many believed would never occur. However, with Anixa Biosciences and the Cleveland Clinic working together, they are attempting to eliminate one of the worst diseases in the world today. Vaccines to eliminate childhood diseases changed the world in the 20th century. Now, vaccines to prevent cancer in adults could be the major medical breakthrough of the 21st century.

For more information, please visit https://my.clevelandclinic.org/ and https://www.anixa.com/

Images credit: Larry Spencer and Brian Byllesby

Journalist and author. Contributor

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EXCLUSIVE: The Team That Wants To Eliminate Breast Cancer - Totalprestige Magazine

The moral of this article is not simply that your doctor is doing it wrong. Many conventional doctors and medical institutions are basing their screenings on science-backed recommendations outlined by the U.S. Preventive Services Task Force (USPSTF). Heres an example of the Cleveland Clinics screening guidelines. A cholesterol screening, for example, is recommended every 5 years (or more based on risk) after age 20.

This often catches big stuff, which is good, but not always in time for you to prevent it altogether. Case in point: After my five-year stretch with no blood work, a lipid panel actually revealed I had high cholesterol and borderline high blood sugarsomething I was able to address, but that I could have addressed much earlier had I noticed my numbers slowly creeping up.

The message isnt test for everything! either. Testing has been given this halo effect of, You should test to be healthier, but some of these specialty tests are super unnecessary, says integrative physician Amy Shah, M.D.. I get people in my practice all the time who want to know their food sensitivities, but I have to be the bearer of bad news and tell them food sensitivity tests are really poor at this point. I try to stay on the side of less is more.

The truth is: You dont need to have big fancy tests done to get a lot of information about how you are shifting metabolically, says Kristann Heinz, M.D., R.D., a doctor board-certified with the American Board of Integrative-Holistic Medicine. You can glean a lot of information from pretty basic teststhe key is doing them regularly (preferably annually), so you can track your results over time and spot trends. You want to catch smoke before theres fire.

More:
What Blood Tests You Should Ask For Based On Your Family History - mindbodygreen.com

Menopause, when a woman no longer has menstrual periods, is a natural part of life, but it can be a major upheaval, especially when symptoms are severe. Are you approaching menopause and worried about what to expect? Here is everything you need to know.

Most women hit this milestone in their early 50s. According toWomen's Health, the average age for onset of menopause is 52. Some women, however, reach menopause in their 40s or earlier.Early menopauseoccurs between the ages of 40 and 45. A small percentage of women may even experience what is called premature menopause before the age of 40. A woman is not considered to be in menopause until she hasn't experienced any menstrual bleeding, even spotting, for 12 months consecutively, and can no longer become pregnant.

A woman's hormone levels are going to change gradually as her body reaches menopause. This transition to menopause is referred to as perimenopause. During this phase, you will start to experience irregular periods which may be lighter or heavier than usual or of varying duration. You may even have months where there is no menstrual bleeding at all.

Why is this happening? The ovaries are no longer consistently producing the same levels of the hormones estrogen and progesterone. Some women will even start to have hot flashes and other symptoms.

Perimenopause for most women typically begins in the mid- to late-40s, and it can take about 4 years for menstrual periods to completely stop. For some women though the transition can be as short as two years and for others as long as 8 years.

The most important thing to remember, if you don't want a surprise pregnancy, is to continue practicing birth control for at least a year after your last period.

Menopause symptomsoften begin during perimenopause. The most common are irregular periods, vaginal dryness, hot flashes, trouble sleeping, night sweats, mood changes, weight gain, dry skin and thinning hair.

Your risk for certain health conditions such as cardiovascular disease, osteoporosis and urinary incontinence may also increase. Once a woman reaches menopause, some symptoms like hot flashes may abate a little, occurring less frequently or at least less severely.

While there is no way to prevent menopause, there are certain lifestyle changes you can make to reduce the severity of the symptoms. Here are some suggestions fromWomen's Health,The Mayo ClinicandHarvard Health)

Certain medications also can help. There has been conflicting evidence about hormone replacement therapy however.Harvard Healthcautions that some studies have shown that estrogen therapy has been linked to an increased risk for heart disease, stroke, breast cancer and blood clots. On the positive side though, it reduces the risk of fracture and colon cancer. If you are considering hormone replacement therapy, talk to your gynecologist about all the possible benefits and risks.

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Everything women need to know about menopause - PhillyVoice.com

You have two options when it comes time to see if you have a baby on board.

The most common is an at-home urine pregnancy test, available over the counter, though you can take a urine pregnancy test at a medical clinic. Another option is a blood test performed at a medical clinic.

"Both tests check for a hormone called human chorionic gonadotropin, or hCG," says Crystal Newby, MD, of Kansas City Ob-Gyn. "This hormone is produced after a fertilized egg attaches to the wall of your uterus."

The egg typically attaches 6 days after fertilization, at which point, hCG levels in your blood and urine will increase for the next 6 to 10 weeks. Once hCG levels are high enough, you can expect an accurate reading, but not before then.

Blood tests for pregnancy are more sensitive to hCG than home pregnancy tests. They can detect this hormone in low quantities and tell you if you're pregnant sooner than a home test.

Depending on a woman's cycle, a blood test can detect pregnancy between 6 and 14 days after conception and is considered by doctors to be 99% accurate.

While blood tests can provide results sooner than home pregnancy tests, they are usually more expensive and take longer to provide results because the blood must be sent to a lab for analysis.

If the lab is in-house then it will take a few hours. But if the lab is at a different location, it could take several days to learn the results.

Home pregnancy tests can provide results faster and be more convenient than a blood test. But you'll probably have to wait longer to receive accurate results.

Most home pregnancy tests advise you to take the test after you miss your next period. If you have a standard 28-day cycle, you'll be most fertile two to three weeks before your period. So if you get pregnant during that fertility window, you'll need to wait at least 14 to 18 days after conception to take a home pregnancy test.

If you follow directions, home pregnancy tests are an estimated 97% to 99% accurate. Yet if you get a negative result and suspect you're pregnant, check the instructions on the box. Home pregnancy tests typically recommend retaking the test 5 to 7 days later, when the hCG levels in your body will be higher.

This type of result is called a "false negative." Sometimes you can receive a false negative result if you take a pregnancy test too soon when your hCG levels are too low for the test to detect them accurately.

Moreover, recent miscarriages, fertility drugs, and rare hCG secreting tumors can interfere with the results of at-home urine tests. If you receive conflicting results after taking a home pregnancy test multiple times, doctors recommend a blood test.

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When to take a pregnancy test for the most accurate result - INSIDER

Exercising and eating well but not seeing results? It could be your monthly cycle

Independent.ie

Exercising regularly, eating well but not seeing any results? Experts believe that harnessing the power of your menstrual cycle to achieve your fitness goals could reap massive long-lasting rewards.

https://www.independent.ie/life/health-wellbeing/exercising-and-eating-well-but-not-seeing-results-it-could-be-your-monthly-cycle-38717231.html

https://www.independent.ie/incoming/article38721606.ece/d71db/AUTOCROP/h342/Kirby-of-Chelsea-FC.jpg

Exercising regularly, eating well but not seeing any results? Experts believe that harnessing the power of your menstrual cycle to achieve your fitness goals could reap massive long-lasting rewards.

News that the Chelsea FC Women's Football team sync their menstrual cycles to their training regime has highlighted the benefits of tailoring your exercise regime and diet to the various stages of your monthly cycle.

Lioness and Chelsea FC football player Fran Kirby (26) spoke about how the team's training now focuses on the players' menstrual cycles and how they affect their training methods. She and her team-mates use a period tracking app to log their symptoms, which is then shared with coaches to maximise the women's training schedules.

"It can affect you so much, whether it's your co-ordination or your reaction time - which is so vital in so many sports," said Kirby.

Earlier this year, a global study showed that exercising can reduce some of the symptoms associated with the menstrual cycle. In a survey of 14,000 women, 78pc found exercise eased some of the most common symptoms like stomach cramps, breast pain and mood changes.

The study - led by Dr Georgie Bruinvels, co-creator of the fitness app FitrWoman, and based on data provided by users of the social network Strava - found that moderate intensity exercise was the most effective way of combating symptoms.

However the survey also found that teenage girls in the UK and Ireland were likely to exercise less during adolescence than their counterparts in other parts of the world, with 40pc of women in the UK and Ireland reducing their levels of exercise during puberty, compared to less than 20pc in the US, France and Germany.

"We wanted to start an important conversation about exercise, the menstrual cycle and other lifestyle factors that will empower all women to work with their body, not against it. We want women to feel comfortable discussing something that is very normal and natural," said Dr Brunivels.

Dr Rebecca Robinson - a consultant in sports and exercise medicine at the Centre for Health & Human Performance Health Optimisation on Harley Street (CHHP) - has also pointed out that by using the cycle to adapt training, women can attain significant physiological benefits.

"The menstrual cycle in sport has historically been under-researched. Hormones that cycle in flux are tricky for researchers, so women have often been excluded from trials for that reason," she said.

Making positive lifestyle changes in harmony with the monthly cycle is making a big impact in the lives of sportswomen who have teams of trainers and nutritionists on hand to help plot and plan their regime.

But what about the ordinary woman negotiating the demands of a busy life who may not have the foggiest clue about where to start charting her cycle to maximise the potential of whatever exercise she can fit in?

Galway-based Jonathan Gibson, who runs The Athlete Clinic, providing coaching, athlete testing and athlete services to both domestic and international athletes, believes that women often overlook their cycles and don't integrate it into their training regime.

But he says it's important to start taking it into consideration, whether you're a busy mum trying to make time for exercise again after having a baby or a seasoned triathlete going for your first Ironman.

Gibson, a certified coach with Cycling Ireland, Swim Ireland, Gymnastics Ireland, an Ironman University Coach and soft tissue and injury management consultant, says he was an early convert to the power of the period in a woman's fitness journey.

And he says it's often the case that women are not seeing results because they're not doing the best kinds of exercises or eating correctly for the place they're at in their cycle.

Gibson maintains that our hormones control much of what's going on in our bodies so it makes sense to exercise in a way that's in sync with them.

"When you start to understand your cycle and what's going on, you'll start to see big differences," he says.

And he recommends that if you're starting out on any training regime it's important to eat regularly and aim for consistency as well as starting to get in touch with your own cycle by tracking where you're at.

During the first eight days of the cycle, Gibson says the focus should be on strength training and doing things like gym work. If you can't get to a gym, incorporating things like squats and hand weights into your workout at home will help you start to see results in your muscle tone.

In fact, two international studies carried out in 2014 and 2017 suggest that strength training during this period may result in higher increases in muscle strength, compared with other times of the month.

Days eight to 12 should include some rest days, building up to increased cardio work on days 12-14, according to Gibson. This could be something like skipping in the garden, or salsa dancing, or even going for a run but basically doing anything that gets your heart rate up.

With energy levels at their highest, Gibson says mid-cycle is a good time of the month to push yourself physically and enjoy the additional endurance and strength that often characterises this time.

He explains that the hormone progesterone remains low, meaning that the body's overall pain tolerance increases and this is a good opportunity to strive for your own personal best.

However, he urges women to be cautious about overdoing it in this phase of the cycle because research shows that day 14 is typically the time women can get injured because often they feel so good, they overdo it in the exercise stakes.

Heading into the luteal phase (days 14-28), after the egg has been released at ovulation, Gibson recommends easing up on the strength training and focusing on things like walking and cycling but generally doing what he calls 'lower heart rate exercises' as you approach day 28.

The days leading up to day 28 offer a good opportunity to schedule a rest week. This doesn't mean skipping exercising entirely but doing 40 to 50pc less during this time, he says.

Gibson explains that during this time, it's important to listen to your body, reduce the intensity of your workouts and incorporate things like yoga into your routine.

He also says that it's also really important for women to understand the importance of eating regularly to keep hormones balanced.

"The effects of the stress hormone cortisol are well documented and going for long periods without eating or even going for a hard workout session without fuelling up properly beforehand will all stress the female body," says Gibson.

Health & Living

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Exercising and eating well but not seeing results? It could be your monthly cycle - Independent.ie

The British government is robust in condemning the violence inflicted on women and girls across Africa, the Middle East and Asia, where female genital mutilation (FGM) is practised. But the claim that it takes a zero-tolerance approach to all types of FGM is open to challenge. The NHS puts some children who identify as transgender on a medical pathway that can ultimately lead to sex-reassignment surgery, which of course necessitates the mutilation of their genitalia.

FGM was made illegal in Britain in 1985. Since then, successive governments have tightened the law to give ever more protection to women and girls, most recently in the 2015 Serious Crime Act. This included a new offence of failing to protect a girl under 16 from FGM, and the introduction of FGM Protection Orders. By March last year, 220 such orders had been issued, according to a House of Commons Briefing Paper.

Every branch of government is in accord about FGM. The Home Office says it is a form of child abuse and violence against women. The NHS echoes this: FGM is illegal in the UK and is child abuse. According to the Department for International Development (DfID), It is a form of violence against women and girls, a human-rights violation, and it can result in a lifetime of physical, psychological and emotional suffering. In April, DfID committed 35million over the next five years to support an Africa-led initiative to end FGM.

But closer to home, the government appears to be entirely complicit in a different form of genital mutilation, in the form of gender-reassignment treatments, pathways and surgery. Though these may pose a far less immediate physical threat to someones physical wellbeing than FGM, they still have the potential to destroy young peoples lives.

There are eight NHS Gender Identity Clinics offering transgender health services in relation to gender dysphoria or gender reassignment (ie, surgery). The Gender Identity Development Service (GIDS), run by the Tavistock and Portman NHS Foundation Trust, is a specialist clinic for children who have difficulties with their gender identity. GIDS and its regional satellites do not offer patients reassignment surgery, which is illegal for those under 18. But it will discuss a referral to adult services well in advance of [patients] turning 18. GIDS stresses that all its patients are treated individually with no preference or expectation for the pathway or outcome they may follow. But exactly how many former GIDS patients have opted for reassignment surgery is hard to measure: neither the public nor private sector are particularly transparent on this point.

The mixed messages we give out concerning genital mutilation and teenagers sex reassignment surgery, good; FGM, bad are echoed by our conflicted stance over prescribing drugs to young people who identify as trans.

The ethics of drug trials in less developed parts of the world have long been a concern in the West, perhaps best captured by the John le Carr novel, The Constant Gardener. Many in the West are uneasy about the global poor being human guinea pigs for Big Pharma. Participants in clinical trials for new drugs are easy to find in, say, Sub-Saharan Africa, but question marks remain about whether poverty-stricken and often illiterate people can provide a level of informed consent with which we are comfortable.

But while we wring our hands over the exploitation of patients overseas, closer to home we seem happy that children are being prescribed puberty-blockers and cross-sex hormones. The NHS states that patients under the age of 16 can give their consent to treatment provided theyre believed to have enough intelligence, competence and understanding to fully appreciate whats involved in their treatment.

How far anyone fully appreciates what is involved in the treatment of minors prescribed puberty-blockers and cross-sex hormones is open to question. Both GIDS and the NHS acknowledge that the research evidence about these drugs long-term impact is limited. And what we do know is deeply concerning. As GIDS says on its website, it does not know whether or not a puberty-blocker alters the course of adolescent brain development, while admitting that cross-sex hormones will cause some irreversible changes to the body. The NHS flags up possible risks to fertility. Hormone treatment is neither without risk nor an exact science, as those women taking hormone-replacement therapy or drugs to boost their fertility will attest. Would we endorse Big Pharma playing hormone roulette with children in Africa?

The United Nations has sought to outlaw breast ironing, which affects an estimated 3.8million girls in West Africa, mainly in Cameroon. Like the breast binding favoured by some gender-dysphoric teenage girls in Britain, breast ironing seeks to suppress or reverse breast development. While binding is hardly as drastic as ironing, its effects include constricted breathing, pain and possible tissue damage. Breast ironing is perceived as a means of protecting girls from sexual predation. Here, breast binding is often perceived by trans teens as a short-term alternative to a mastectomy.

In the past few years, awareness of trans issues has grown in Britain, not least thanks to vigorous advocacy by LGBT pressure groups. Simultaneously, the number of referrals to GIDS has soared, up from 678 in the financial year 2014/15 to 2,590 in 2018/19. Of those 2018/19 referrals, around 10 per cent were aged three to 10. More than 1,000 were aged 14 and 15. And whereas transgenderism in adults is often thought of as male-to-female, two-thirds of the children and young people referred to GIDS that year were assigned female at birth.

As much as it is unpalatable to some members of the trans community, who are swift to cry transphobia in a bid to block debate, it is legitimate to raise questions about transgenderism and minors. Why do a disproportionate number of girls suffer gender dysphoria? Does social contagion and peer pressure have a role to play? Could the girls actually be body dysmorphic rather than gender dysphoric? Is identifying as trans the new anorexia?

Offering a caring, supportive environment for troubled children, GIDS appears a victim of its own success. Have minors been fast-tracked on to an irreversible medical pathway in part in response to the services overwhelming caseload, as former staff members have claimed?

The UN is committed to intensifying global efforts to combat FGM, which secretary-general Antonio Guterres described earlier this year as an abhorrent human-rights violation. It is time we in Britain recognised that, in trying to satisfy an unhappy combination of troubled minors, the trans lobby, and diversity and equality advocates, we are tolerating practices we would find unacceptable should they be happening to women and girls elsewhere in the world.

Dr Sarah Ingham is currently writing a history of women and the military. Follow her on Twitter: @inghamsarahj

Picture by: Getty.

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Gender reassignment: the West's answer to FGM? - Spiked